Our History
In 1996, Founder John Gorman left his post as Assistant to the Director of HCFA’s Office of Managed Care and founded Managed Care Compliance Solutions (MCCS) to provide Medicare regulatory compliance advisory services to healthcare payers.
Following the enactment of the federal Balanced Budget Act (BBA) of 1997, demand for MCCS’ services grew among managed care plans in tandem with the rapid growth of the Medicare+Choice program.
During this period, MCCS developed the Medicare+Choice Toolkit -- a guide to help health plans implement regulations resulting from the BBA – and helped a large national managed care organization rebuild its Medicare operations in the Mid-Atlantic region.
In 2001, following a period in which interest among payers in the Medicare+Choice program had waned, MCCS reorganized in anticipation of the pendulum’s return, and hired key managed care executives to head up the company’s product development and marketing and sales capabilities. In 2002, MCCS was reintroduced to the industry as Gorman Health Group (GHG). That same year, a majority of the managed care organizations that chose to participate in HCFA's Medicare PPO Demonstration program turned to Gorman Health Group for professional assistance.
By late 2003, when the Medicare Modernization Act (MMA) became law, GHG was positioned as the go-to firm for mastery of the regulatory and business implications of the MMA and the creation of the Medicare Part D prescription program. As a result of numerous high-profile client engagements during this time, GHG is largely regarded as having spearheaded the creation and design of the Medicare Advantage PPO product.
Since 2004, GHG has brought many dozens of Medicare plans to market, including Prescription Drug Plans (PDPs), Medicare Advantage (MA) plans, and Special Needs Plans (SNPs). GHG has led enterprise-wide implementations of its programs at some of America’s most-respected managed care companies, and led engagements resulting in dramatic increases in operational efficiencies, member satisfaction and clinical outcomes. As a response to the increased financial pressure on plans, GHG also pioneered the development and introduction of the industry’s leading HCC management solution.
Today, having served more than 200 health plan clients since the MMA’s passage, GHG is increasingly focused on providing our Medicare managed care clients with business tools and solutions to help them better manage beneficiary relationships, improve internal operations, foster CMS compliance, and optimize revenues.
