The goal of value-based healthcare is better quality, lower cost care for the member. Health plans need to engage and build communities of stakeholders that impact and predicate their success. All stakeholders involved in the member's care must be coordinated, engaged, and provide collaboration.
The MedHOK Unified Payer Platform enables healthcare payers to engage and build communities with members, providers, and business partners. MedHOK facilitates effective interactions with key healthcare stakeholders to ensure improved compliance adherence, revenue realization, and complete member profile data.
MedHOK seamlessly integrates with critical health plan and third-party systems such as Electronic Medical Record Systems (EMRs), Enterprise Data Warehouses (EDWs), Claims Systems, and Industry Data Sources. Additionally, MedHOK helps payers interact and engage with providers and members via secure portals, system interconnections, and mobility solutions to build productive relationships.
MedHOK's Unified Payer Platform creates an ecosystem of actionable data that enables workflows, creates the most complete member profile possible, and lays the foundation for ongoing compliance and improved quality.
Success with value-based healthcare requires the collaboration of stakeholders involved in the care of the member. MedHOK's Unified Payer Platform enables the collaboration and coordination of stakeholders, integration of industry data and sources, and positions the payer for success.
Click each headline below to learn more about each component.
MedHOK’s Provider Portal enables proactive and supportive collaboration with your network of providers. The Provider Portal provides real-time and actionable information to providers for each assigned member, boosting compliance, quality of outcomes and revenue. MedHOK’s Provider Portal goes beyond facilitating just administrative activities by enabling important care, quality and compliance activities. With MedHOK’s Provider Portal, payers can facilitate all care in a timely fashion.
360Provider is part of the enterprise-wide functionalities of the MedHOK Unified Payer Platform. 360Provider aggregates all demographic information on the provider as well as data related to all members assigned to a given provider or treated by one. All associates working in the system have access to the most complete, accurate, and real-time data on a provider to improve care, quality, and member satisfaction.
MedHOK’s Provider Disputes feature is a pre-configured workflow solution for processing and tracking provider disputes from a member and/or provider. The system-defined workflow ensures that cases are processed consistently, and correspondence is triggered automatically and is attached to the case. Along with Root Cause Analysis and Process Improvement functionalities, health plans resolve appeals in a timely manner and drive operational operational improvements. The Dashboard allows for real-time monitoring of activity by management and promotes a proactive approach to caseload and compliance deadlines.
MedHOK is partnered and fully integrated to critical industry data sources across the medical and pharmacy spectrum of care: