Clinical Innovation
MEMBERCENTRICITY in Medical Management
Perhaps it is only after your plan is done squeezing every penny out of its SG&A budgets that it will remember that roughly 85% of all plan expenditures are clinical, not administrative...
The best plans function as health care providers, not insurers. And while every MA plan has a medical management function, few do it well. In the $2T health economy, there is no shortage on money spent on complex patient modeling, claims analysis, and other forms of IT driven patient management.
But substantial progress can be made in managing care using your best in-house resource: people. A flexible, multidisciplinary team following a simple utilization management playbook is the quickest path towards lasting change. In many cases, your existing resources, channeled and managed differently, are sufficient to drive great change in utilization patterns, the efficacy of discharge planning, and the role of concurrent review. Once this patient centric mentality is in place at your plan, then you are ready to invest in technology that drives exponential value from care coordination and provider outreach.
For more information, please contact us at 202-364-8283 or via e-mail at ghg@gormanhealthgroup.com.
