Alignment Service Suite

 

Improving health care efficiency and strategy impact through clinical and financial alignment

 
 
Health plans are seeking to better engage their provider network and improve plan efficiency, impact, and overall operations. But new strategies often have unseen results in non-related areas. Product design impacts clinical utilization, clinical policies impact our provider network’s efficiency and satisfaction, provider reimbursement impacts care pathways and utilization. We need to build a smarter engine that tracks product, provider, and clinical initiatives. Plans today often have data platforms and modeling systems take on this challenge, making it difficult to design a mutually beneficial provider and clinical strategy.  Plus, insufficient oversight can’t detect and monitor trends that can further hinder clinical and provider innovations.
 
GHG’s Alignment Solution Suite offering improves health care pathway efficiency through product, clinical and financial alignment. This internal benchmark system monitors performance across departments, detects internal or external deviations, and observes both short and long term trends. The Alignment Service Suite can dually operate with internal reporting functionality, empowering your interdisciplinary team to jointly review challenges, successes and past strategy impacts, all with the support of GHG consultant expertise.
 
Product design, clinical metrics, and financial drivers are combined to create a monitor and alert system. Fully integrated data compilation provides comprehensive reporting and highlights areas of concern. GHG experts can then support you in developing targeted strategies to remedy the outliers.
 
These health care analytics implement action plans that transcend departmental silos:
 
• Clinical
– Medical Management Redesign
– Inpatient Reduction Program
– Readmission Reduction Strategies/Transition of Care Redesign
– Population Management Foundation Development
 
•Provider/Network
– Post-acute care model analysis
– Smart Network development by health system
– Episode of Care Development
– Increase in global capitation exploration
 
• Risk Adjustment
– Strategy Assessment
– Data Analysis for RAF and STARS impact
– Best Practices Operational Manual
 
• Operations Performance Assessment

 

• Product & Benefit Design
 
GHG reviews multiple operating areas and reports on trend drivers represented in summary reports and deep dive medical expense reports.
 
It offers your team deep-data dives into:
• Medical cost
• Medical condition outcomes
• Clinical performance and utilization
• Cost of care by setting
• Benefit design impact
• Network engagement success & opportunities
 
GHG’s Alignment Service Suite delivers a cross-departmental drill down into the following elements:
• Benefits
• Member Dimension
• Date Dimension
• Provider Dimension
• Claims
• Pharmacy
 
GHG’s Alignment Solution Suite assessment is backed by industry leading health care expertise and is managed by a team of veteran consultants who will help lead your organization to better financial alignment, product design and health care efficiency.

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