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MHK

Enterprise Software Platform for Medicare, Medicaid, and Exchanges

MedHOK solutions improve clinical outcomes, care management and quality measures, and links reimbursement to improved quality outcomes for accountable care organizations, patient centered medical homes, health plans, public sector agencies, providers, hospital systems and third party administrators.

09/02/2026

September is National Su***de Prevention Awareness Month, a time to raise perceptions, encourage open conversations about mental health, and remind those who may be struggling that support is available. Sometimes the most important thing we can do is simply reach out. Check in with the people in your life. Listen without judgment.

If you or someone you know needs help, the 988 Su***de & Crisis Lifeline provides free, confidential support 24 hours a day.

Call or text 988, or visit https://hubs.li/Q04wh4jr0.

***dePreventionMonth

09/01/2026

CMS has launched QualTech, a new initiative focused on how technology can help improve healthcare quality. For health plans, it signals a larger shift in the quality conversation: Although measurement still matters. the question that is increasingly being asked is: What happens after a care gap, risk, or quality opportunity is identified?

Can that insight reach the right team? Can it trigger action? Can technology help reduce the administrative work required to get there?

Our latest blog looks at CMS QualTech, the continued evolution of digital quality measurement, and why the next phase of quality management may be less about measuring more, and more about putting quality information to work.

08/28/2026

$13.4 billion is on the table for Medicare Advantage plans in 2026. But fewer plans are qualifying for a share of it.

Federal spending through the is expected to reach at least $13.4 billion this year. At the same time, only 68% of Medicare Advantage enrollees are in plans qualifying for quality bonuses, down from 75% in 2025.

For , the numbers reinforce a bigger reality: quality is an operational and financial imperative, not merely a reporting exercise. Strong performance depends on what happens throughout the year: identifying gaps, turning member data into action, coordinating interventions, and giving teams the context they need to act.

Our latest blog looks at what the growing stakes around Medicare Advantage quality mean for health plan leaders.
Read more: https://hubs.li/Q04vKBcp0

08/17/2026

The conversation around healthcare AI is quickly changing. For years, the focus has been on what AI can do. Now, a more consequential question is emerging: What can AI actually get done?

As AI moves from generating insights to initiating actions and advancing workflows, healthcare organizations must revisit their approach to orchestration, governance, human oversight, and how work moves across the enterprise.

Our latest MHK Strategic Insights blog explores what this shift means, and why healthcare AI may be entering its ex*****on era.

Read the full article:
https://hubs.li/Q04thhSs0

08/11/2026

CMS is asking Medicare Advantage and Part D organizations and their certifying actuaries to weigh in on the CY 2027 actuarial bid process.

The feedback window is open through August 21, 2026, giving plans an opportunity to share their experience with Bid Pricing Tools, bid instructions and guidance, actuarial certification, supporting documentation, and the BPT Bid Desk Review process.
What should plans be doing now? Engage actuarial, finance, and bid teams to identify lessons learned, focus feedback on actionable process improvements, and coordinate organizational comments before the deadline.

Read the latest MHK Compliance Pulse for details and recommended next steps. (Link in comments.)

08/10/2026

CMS’s first plan preview window for 2027 Medicare Part C and Part D Star Ratings data closes August 11.

Medicare Advantage organizations, Prescription Drug Plans, and Section 1876 Cost Plans should use this opportunity to validate posted measure data and methodology and report suspected issues before the preview window closes.

The first preview does not include Star Rating assignments, making the immediate priority data integrity and identifying potential issues ahead of the second preview in September.

Read the latest MHK Compliance Pulse for key dates, HPMS access information, and recommended next steps:
https://hubs.li/Q04stK9d0

08/06/2026

CMS’s CY2025 Part C and Part D Program Audit and Enforcement Report makes one point especially clear: significant compliance failures often begin with operational breakdowns—not simply misunderstandings of CMS policy.

Our latest Compliance Pulse examines:

• Process changes piloted during the 2025 audit cycle
• Six key lessons from program audits and enforcement evaluations
• The operational failures that can lead to beneficiary harm, penalties, and enrollment sanctions
• Priority areas on the CMS oversight horizon, including prior authorization, data integrity, interoperability, and governance

See what health plans should consider as they strengthen operational controls and prepare for evolving audit expectations: https://hubs.ly/Q04s9Nsl0

08/05/2026

Research shows that nearly 5 in 6 clinicians are using AI tools without guidance from their employer, and 29% of those AI-assisted patient interactions happen outside business hours. This means care teams are reaching for AI on their own terms, in their own time, often without their organization's awareness.

But this isn't a story about clinicians doing something wrong. It's about infrastructure that has yet to catch up to behavior.

For health plans, the risk isn't AI adoption itself but the visibility gap it creates. Every ungoverned tool is a blind spot in compliance, data security, and care quality consistency.

Getting ahead of this requires organizations to use systems built to absorb AI use safely, in real time, without slowing care down.

In this week's Strategic Insights, learn what this means for health plans and what a governance framework that actually works looks like. Link in comments. ⤵️

07/21/2026

How much do recent developments change the conversation around Medicare Advantage Star Ratings?

With more than $13 billion in projected quality bonus payments and a high-profile legal challenge to CMS's Star Ratings methodology, quality performance is receiving renewed attention across the industry.

For health plans, these developments reinforce an important reality: operational excellence, regulatory readiness, and quality performance remain closely connected. What do you see as the biggest challenge health plans face in maintaining strong Star Ratings over the next few years?

Read more about recent developments in this week's Strategic Insights: https://hubs.li/Q04q8hvs0

07/14/2026

has opened a 30-day comment period on its proposed CY2027 Part C and Part D Audit Protocols. The proposed revisions extend beyond formatting updates and introduce changes that could affect audit readiness, universe preparation, data validation, D-SNP coordination, and operational reporting.

Our Compliance Team reviewed the draft protocols and highlights the most significant proposed changes, what they could mean for health plans, and recommended next steps before the August 5 comment deadline.

Read the complete analysis: https://hubs.li/Q04prvLb0

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