Supporting network design and medical cost control implementation
The pressure is on for Health Plans to maximize revenue, cut costs, improve member patient outcomes and control medical spend.
Gorman Health Group evaluates the design and delivery of high quality collaborative care while achieving compliance and improving revenue cycle management. Our multidisciplinary team of experts will assess the alignment of your products, your current network and your market to translate your business strategies into practical, efficient and rigorous work processes with the highest degree of compliance and accountability.
Our expert teams can then provide support in the following areas:
Gorman Health Group will evaluate your organization’s role and vision, focusing on ACO optimal strategies around revenue growth (including Risk Adjustment, HEDIS, Stars, etc.) accuracy and compliance. We will ultimately create a strategic revenue plan with tactical recommendations outside your organization’s current initiatives moving forward.
Reviewing and understanding your existing network, as well as network performance is critical when thinking about your network expansion approach to improve member access, quality, and financial performance. GHG’s team of experts will review your current provider operations, and provide recommendations regarding not only your network expansion approach, but best practices pertaining to contracting strategy, performance-based provider reimbursement and staff development.
Network Development and Operations
Gorman Health Group is currently developing some of the most innovative bonus and incentive arrangements in the industry by adhering to the dictum that trends may be national, but all health care is local. GHG will assess the alignment of your products, your current network, your market, and your network requirements. We’ll help you track results – both positive and negative – back to related network components.
We understand Medicare ACOs: We have helped launch eight over the past two years. But we also understand that this is just a first step toward taking greater control over the Medicare revenue stream by “moving up the food chain.” Our team of veteran executives can help your ACO evaluate the options, manage the workflow to achieve either a Medicare Advantage contract with CMS or a risk contract with an existing MA plan, and continue to achieve improved outcomes. Our comprehensive management solutions provide ACOs in transition with the tools, processes, and expert guidance to drive overall performance through new models of finance, leadership, and clinical value.