Gorman Health Group | Clinical
17590
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Clinical, Quality & Stars

Changing how you approach Medical Management, Quality and Stars

In order to positively impact quality and financial outcomes, health plans must prioritize clinical capabilities as part of their goal to provide the best care to members, strengthen provider relationships, and drive overall plan performance. This is where we come in. GHG’s clinical team of experts can assess your current quality program, and develop integrated strategies to build a new foundation focused on the areas that matter to you most: cost, quality and revenue.

HEDIS EVALUATION & STRATEGY

Big changes in payment rates loom for every plan and their at-risk provider networks. Uncertain where your organization stands? GHG will work with you to analyze your Healthcare Effectiveness Data and Information Set (HEDIS) data for gaps, and identify interventions for your health plans, providers and members. From there, we will develop a winning strategy to identify gaps and implement an action plan.

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MODEL OF CARE

Now is the time to reevaluate the structure of your current Model of Care (MOC) for your Special Needs Plans (SNPs), as the requirements call for more than just resubmitting your previously written documents. Does your current MOC coincide with the requirements published? GHG is ready to help you evaluate your current MOC to insure you have a successful submission and approval process.

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STAR RATINGS

GHG can evaluate your Star Ratings approach, and identify tactics you can begin implementing immediately, to integrate initiatives, eliminate redundancies, and build an enterprise-wide Star management structure. We can help you identify clinical, operational, and networking opportunities to increase your rating.

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MEDICAL MANAGEMENT

GHG’s team of multidisciplinary experts will work with your medical management team to evaluate your current processes through efficiency assessments. and ensure effective and efficient strategies are in place across all departments. Further, we will work with your team to improve MLR through best practices, and reducing administrative costs, while identifying areas of improvement in care management, as well as utilization management effectiveness.

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QUALITY IMPROVEMENT

Now is a critical time for quality improvement. GHG will work with your team to improve quality of care with renewed engagement strategies, data management, and advanced planning to further improve health outcomes, and reduce the cost of care for beneficiaries. Through data and reporting measure assessments, we will be able to recommend strategies that will improve clinical quality performance and ensure your processes are aligned with CMS expectations.

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Star Ratings Assessment

GHG performs Star Rating performance assessments for organizations to identify areas of improvement, and implement best practice methods to increase its HEDIS and Star scores. Whether your plan’s Star Rating is on the bubble or solidly above 4 stars, this is an excellent time to re-evaluate your strategies, work plans, and tactics, to best ensure that your Stars remain aligned.

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