Gorman Health Group | Clinical
17590
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Clinical

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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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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