Health Insurance Exchanges
Knowledge-Driven preparation is essential
This new industry brings about greater challenges than we’ve ever known in government programs while also providing immeasurable opportunities for health plans that prioritize high quality, clinical care, as well as proper coding and documentation and highly functioning enrollment and reconciliation functions. As we’ve seen in the last two years, administrative and clinical complexities cannot be understated.
GHG has first-hand knowledge of vital plan operations and provides comprehensive strategies across a full spectrum of business needs:
The application process is an arduous one. Completing the application requires the cooperation from your entire organization. The actual submission leaves no room for error, and the review process requires quick thinking and prompt responses to CMS follow up questions. We’ve assisted scores of organizations through every step of the application process, from gathering the right data, completing the application, submitting, and responding to follow-up questions.
A successful implementation requires detailed back end knowledge of CMS requirements, guidance and operational knowledge. These attributes are difficult to have readily available when you are just starting out or have the need to continue to focus on existing business. We’ll serve as your primary knowledge base and launch your start up or expansion with you.
With the implementation of the Affordable Care Act (ACA) health plans, providers, and IT professionals have a new outlook regarding the core concepts behind risk adjustment. Focusing on the evaluation of your organization’s overall risk adjustment strategy as it applies to plan design, interventions, compliance, provider/vendor partnerships, and EDGE Server data submissions is where we come in. GHG will help you understand and transform your organization to meet the demanding changes that the healthcare industry is experiencing today.
We’ve developed strategic plans for organizations of all sizes and types. We begin with analytics of the market and a capacity assessment of your organization as the two must be considered in tandem. From here we drive quickly to a practical action plan. Our deliverable doesn’t sit on a shelf. Our real deliverable is the process itself, led by plan veterans who have put concept into reality.
Quality Ratings System
GHG anticipates that CMS will continue adding measures, adjusting thresholds, and curving the QRS ratings year after year in an effort to separate the remarkable from the ordinary. Now is a critical time – Exchange plans must examine not only this year’s ratings but also their approach to person-centered healthcare across all key business functions.