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In 2007, more than 470 Medicare Advantage Special Needs Plans (SNPs) --serving dual-eligibles, the institutionalized, or the severely chronically ill -- were operating. Hundreds more SNPs are expected to be up and running for the 2008 benefit year. Whether your organization is offering an SNP product for the first time, or is already offering such products, there are enormous challenges and financial risks inherent that could seriously undermine your long-term success. As the nation’s leading consulting firm on Medicare SNPs, Gorman Health Group can help in a number of critical areas. For existing SNPs and new entrants:Medicare Risk Adjustment (HCC) Management: Many SNPs are leaving as much as $200 PMPM on the table because they don’t have a handle on how to improve their risk adjustment scores under Medicare's Hierarchical Condition Catagory (HCC) system. To survive and thrive, SNPs must raise their risk scores to appropriate levels as supported by clinical documentation – and improve the accuracy of diagnostic coding reported on claims submitted to CMS. Gorman Health Group’s leading experts in Medicare risk adjustment management, in partnership with Leprechaun™, the leading HCC management outsourcing company, can help. And unlike some other consulting firms, we will help you collect, not just identify, the reimbursement you are entitled to. Gorman Health Group is also the leader in helping SNPs reconcile member enrollment data with Prescription Drug Event (PDE) data – also critical for protecting your revenue streams.
Marketing: We’ll advise you on the most effective marketing strategies and tactics to use, depending on SNP type, for recruiting this special population into your plan, and help you avoid common pitfalls that could undermine enrollment growth. Customer Service and Member Retention:Our nationally-leading SNP experts can help you develop and implement a comprehensive, cross-functional, integrated SNP customer service program designed to maximize member satisfaction levels and retention levels – critical in a crowded SNP market. Medical Care Management Programs: GHG's clinical experts will assist plans in adopting and implementing case management and evidence-based medicine programs to ensure that plans can effectively manage the medical and financial risks inherent in caring for sicker populations. Benefit Design and Coordination of Benefits: Our experts will help you tailor a medical and pharmacy benefit design that optimizes value for both your plan and beneficiaries and takes into consideration your SNP competition. In the case of dual-eligibles, we can help integrate appropriate coordination of Medicare and Medicaid benefits into the overall benefit design approach. Data Collection and CMS Reporting: Our experts can assist with data collection and reporting commitments to CMS to demonstrate patient outcomes.
For more information, please email us at |
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