The Medicare Part D prescription drug benefit represents the largest expansion of Medicare since the program's introduction 40 years ago. The impact of the Medicare Modernization Act (MMA) has forced the entire health care industry-including health plans, PBMs, and pharmaceutical manufacturers-to fundamentally change both their short-term and long-term business strategies.

With so much at stake, it’s no wonder that more and more healthcare executives have turned to the Gorman Health Group (GHG) for expert advice and help.

Our reputation in this industry is unmatched. But don’t take our word for it: Lehman Brothers has called us “"The leading consulting firm in Medicare Managed Care.” Our highly-experienced, veteran staff has more than 500 years of combined managed care business and federal regulatory experience. We take pride in being an expert model consultancy; rather than staffing projects with newly-minted MBA’s, we only send senior consultants to the field to meet your needs.

Since the MMA’s passage, GHG has brought dozens of Medicare Advantage (MA) plans, Prescription Drug Plans (PDPs) and Special Needs Plans (SNPs) to market. While our strength comes from having such close relationships with Medicare’s managed care organizations, our full-service consultancy serves all of Medicare and Medicaid’s private-sector partners. We are regarded as having spearheaded the creation and design of the Medicare Advantage PPO product, which many consider to be the future of managed care, as well as being an early advocate for plans having diverse product portfolios.

General professional services for healthcare entities:

  • Strategic and business planning
  • Financial/operational due diligence
  • Marketing and sales strategy and implementation
  • Operational improvement and performance metrics
  • Corrective action plan development and implementation
  • Provider contracting and network management planning and strategy
  • Cultural proficiency assessments and strategy development to address diverse populations
  • Market and consumer preference analysis (qualitative/quantitative)
  • Product development and benefit design
  • Revenue optimization strategies
  • Member retention/satisfaction program development
  • HIPAA implementation
  • Interim management staffing
  • CMS, Administration, Congressional and state representation
  • Staff training

Innovative Business Strategies, Rigorous Operational Support and Regulatory Compliance Solutions for Today’s Federal Health Marketplace

CMS Publishes Final 2009 MA Capitation Rates and Part D Payment Policies; CMS Will Conduct Plan Level Audits and Not Make Coding Intensity Adjustments for 2009, 04.10.08
2009 Advance Notice of Capitation Rates, 3.04.08
CMS Call Letter Establishes New Requirements and Reporting Metrics for Plans 1.24.08
Other SNP Sponsors Could Follow In QMed's Wake, Consultant Says; Medicare Advantage News, 11.15.07
The Medicare Outlook: Keys to Success in the New Senior Market, Munich Re America HealthCare Newsletter, 11.01.07
 
Protecting Beneficiaries: Improving & Monitoring Medicare Marketing Practices - AHIP, 05.07
Hard Sell Cited as Insurers Push Plans to Elderly, New York Times, 05.07.07
Advantage Plan's Risk- Wall Street Journal, 04.22.07
Power Shift in Congress Revives Health Debate - New York Times, 01.02.07
 


For existing Medicare and Medicaid contractors:

  • Strategic and tactical planning
  • Medicare PPO and other product feasibility studies and development
  • Contract conversion
  • Business process evaluation and improvement
  • Patient protection regulation implementation
  • Medicare revenue reconciliations and membership discrepancy reporting
  • Conduct mock site visits and focused reviews
  • Develop and execute corrective action plans
  • Service area expansions and reductions
  • Staff training in Medicare/Medicaid requirements and operations
  • Contract termination/non-renewal

For new entrants to Medicare and Medicaid:

  • "Medicare Advantage/Medicaid Boot Camp": intensive leadership training and planning
  • Feasibility studies and business plans
  • Market and consumer preference analysis (qualitative/quantitative)
  • Marketing strategies
  • Operational gap analyses to support "build or buy" decisions
  • Partnering options and business structure
  • Provider and network integration
  • Federal and state application development
  • Operational development and systems configuration
  • Product launch

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