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Elevating Healthcare Operations

About Gorman Health Group

We hold ourselves to a higher standard

More than 200 health plan clients and an additional broad range of other industry participants each year trust Gorman Health Group’s team of professionals to deliver expert counsel and tools to help them meet their goals. We pride ourselves on having both day-to-day alignment with the latest CMS guidance and the long-term strategic vision to keep it all in perspective. Our mission as the industry’s most active professional services consultancy and provider of technology-based solutions is to empower health plans and providers to deliver higher quality care to beneficiaries at lower costs, while serving as valued, trusted partners to government health agencies.

Gorman Health Group is the leading solutions and consulting firm for government-sponsored health programs. Our experts consist of seasoned veterans who have served at every decision making level of leading health plans, PBMs and state and federal agencies. Collectively our staff members have thousands of years of experience in every functional area of a health plan and their business partners. No other firm can boast of such a complete view of the industry from policy and politics to resolution to efficient and compliant private sector operations.

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Everybody’s got a story

Here’s ours

In 1996, GHG Founder & Executive Chairman 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 health care 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. 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.  One of these was Tom Anderson, the former Chief Government Programs Officer for United Healthcare’s corporate office, who encouraged John to think more globally about the industry and its prospects.  The two mapped out a design for a Medicare PPO product, and an early blueprint for what would later become the Special Needs Plan with an emphasis on dual eligibles.   With its broader focus on government programs, in 2002, MCCS was reintroduced to the industry as Gorman Health Group. That same year, a majority of the managed care organizations that chose to participate in HCFA’s Medicare PPO Demonstration program turned to GHG for 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 drug program.

Since 2004, GHG has brought dozens of Medicare plans to market, including Prescription Drug Plans, PPOs, and Special Needs Plans. GHG has led enterprise-wide implementations of its programs at some of the country’s most-respected managed care companies, and led engagements resulting in dramatic increases in operational efficiencies, member satisfaction, clinical outcomes, and profitability.   About this time John came to think of GHG’s consulting practice as a laboratory for technology and outsourced services: where GHG identified a consistent need among its clients, we would consider whether software or outsourcing was a better solution than providing advice.  In 2005, as a response to the increased financial pressure on plans, GHG pioneered the development and introduction of the industry’s first turnkey HCC management solution (and in 2009, its successor, CenseoHealth), began development of cutting-edge revenue management software for Medicare plans (known today as Valencia™), and started to build a capability to conduct certification and training of sales agents (known today as Sentinel Elite™).   In 2006 with the launch of the Medicare Part D drug benefit, GHG gave greater emphasis to Medicaid, and began its work on dual eligibles and managed long-term care in earnest.   Today, having served more than 250 health plan clients since the MMA’s passage, GHG is increasingly focused on providing our government clients with business tools and solutions to help them navigate the opportunities presented by health reform. Today, hundreds of clients serving millions of beneficiaries leverage the strategic counsel and technology solutions of GHG to maintain compliant operations, improve market position, and advance growth objectives.