Health plans and payer organizations have built their information systems to support a transaction-oriented, fee-for-service model, with the provider at the crux. Value-based healthcare turns this model on its side, putting the focus on the member, with quality measures driving reimbursements and revenue. Many disparate legacy systems on which payers rely, hinder the ability to have a centralized view of the member and assess compliance adherence in real time.
The best way to succeed in the healthcare payer transformation while adhering to rigorous compliance demands is with a single solution that consolidates continuum of care applications into a single repository, and utilizes all information to automate and enable workflows based on best practices.
Frustrated with single, department-by-department solutions, healthcare payers are turning to a Unified Payer Platform that can manage the entire continuum of care across Medicare, Medicaid, Commercial, and Exchange lines of business to enable and automate workflows, improve productivity, increase organizational transparency, and facilitate compliance.
MedHOK is the industry's first and only Unified Payer Platform that unifies and makes actionable members' medical and pharmacy history, appeals and grievances, enrollment data, interventions, claims, communications, and every interaction with the plan, provider, or business partner into one system that spans the entire enterprise.
MedHOK's Unified Payer Platform aligns the entire organization, simplifies systems and processes, unifies data into actionable ecosystems that enable workflows, and ensures compliance. Built from the ground up to be 100% out-of-the-box compliant with Medicare, Medicaid, Commercial and Exchange, MedHOK’s Unified Payer Platform is also proactively updated with new compliance rules and regulations through seamless pushes to the cloud, ensuring perennial compliance.
In one platform, MedHOK delivers everything you need to succeed with value-based healthcare: