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Solutions  


Visually intuitive and 100% web-based, MedHOK’s integrated care management, quality and compliance solutions are HIE ready and ICD-10 compliant. The software is rapidly deployable and can be delivered in a highly secure manner to any device – desktop, handheld and/or PDA. We designed our solutions as separate modules working together using consistent standards, tools, and technologies. This gives our stakeholders the flexibility to implement modules one at a time or all at once.

Each of our solutions is built upon a foundation that facilitates:

  • Connectivity: HIE ready and NHIN compliant, MedHOK’s solutions can create a private HIE and connect all participants in your health care ecosystem to share actionable and relevant information.
  • Data integration by utilizing prebuilt connectors to collect information from multiple existing systems. Targeted data sets include, but are not limited to, medical claims, pharmacy, laboratory, eligibility, practice management, hospital and electronic medical records (EMR).
  • Data cleansing by standardizing and optimizing it for use, including participant-specific mapping.
  • Data aggregation using prebuilt data marts for clinical, quality, operational and financial information.  This provides visibility to all relevant information and historical decisions in the context of the participant.

MedHOK’s integrated care management,quality and compliance platform encompass the following business functions:

  • 360ACO® clinically integrates participant information in real-time between providers and hospitals within the ACO to provide participants with high-quality, cost-effective care.  Disease and case management are central to assisting ACOs with meeting quality metrics and reducing Medicare expenditures in order to recognize shared savings. Learn more
  • 360Quality® creates participant-centric, actionable information by seamlessly integrating quality measures, administrative data, performance metrics and care management to assist plans with  reimbursement linked to improved quality outcomes.  Learn more
  • 360Care® delivers an intelligent, participant-centric and proactive approach to improving care management by leveraging sophisticated analytics, smart interfaces and best-in-class workflow tools.  MedHOK achieves this by integrating utilization, case and disease management functionality with predictive modeling, risk scores, profiles and performance dashboards. Learn more
  • 360Care® RX Specialty offers patient-specific clinical programs that center on medication management to improve patient drug adherence and clinical outcomes. The solution utilizes an intelligent workflow system that optimizes the resources used to manage and perform drug and manufacturer assessments for patients. Learn more
  • 360CDRD® is a CMS-compliant solution that maintains appropriate drug utilization and improves outcomes through close management of pharmaceutical utilization by facilitating drug evaluation reviews, which have been used to significantly reduce pharmacy costs and flatten trends. This includes coverage determination (prior authorization), redetermination, direct member reimbursements and independent review entity (IRE). Learn more
  • 360Measures® is a full NCQA HEDIS Certified Module.  360Measures® provides users with the ability to proactively design, monitor and share quality and performance data via intuitive tracking tools and dashboard reporting, creating cost-effective, state-of-the-art solutions for HEDIS®,  pay for performance (P4P) and pay for quality (P4Q), as well as for patient, provider and population profiling. Learn more
  • 360Risk® is an end-to-end risk adjustment solution aimed at accurate assessment, improvement and reporting of diagnosis-based capitation factors that drive risk score calculation systems. Learn more
  • 360E2F® is a business-configurable workflow solution for processing and tracking TRR enrollment to fulfillment.  Learn more
  • 360A&G® is a business-configurable workflow solution for processing and tracking appeals and grievances. Learn more
  • 360CTM® is a business-configurable workflow solution for processing and tracking CMS Medicare member and Part D complaints. Learn more
  • 360Rx340B® delivers a comprehensive 340B software solution that provides management of patient eligibility, inventory replenishment, compliance and detailed reporting. Learn more
  • 360MTM® offers a workflow foundation for the administration and documentation of medication therapy management programs. Learn more
  • 360PDE® is a business-configurable workflow solution for processing, updating and tracking prescription drug event (PDE) submissions to CMS for Part D payment reconciliation. Learn more