Gorman Health Group | Medicare Home
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one-stop access to expert advice

Guidance and support in every strategic and operational area in Government-sponsored health programs

Medicare Advantage (MA) plans face extreme regulatory requirements and operational pressure with the prospect of new business models. To succeed, Health Plans must achieve higher quality and Star Ratings, surmount the Centers for Medicare & Medicaid Services (CMS) and medical loss ratio (MLR) requirements, and develop member onboarding and retention capabilities, all while operating in a highly competitive market.

 

GHG brings nearly 20 years of industry leading solutions, and unparalleled experience, to optimize your plan’s business models and best practices, while increasing the overall quality of operations, ensuring your MA plan is positioned to make the most of the program’s opportunity, and capitalize in the area’s that matter to you most: cost, quality and revenue.

Compliance

GHG offers guidance and support in every strategic and operational area to ensure alignment with CMS. Learn how we can help you create early warning systems to ensure that operational inefficiencies and threats to member satisfaction are immediately identified.

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Clinical

Our clinical team of experts can assess your current quality program, and develop integrated strategies to build a new foundation focused on critical areas. We are changing how you approach medical management, quality and Star Ratings.

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Risk Adjustment

From start to finish, we support our clients in evaluating the efficiency, strategic value, and overall compliance of plan’s risk adjustment programs. We ensure that the procedures for capturing, processing and submitting risk adjustment data to CMS are accurate, timely, and complete.

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Strategy & growth

The leading experts in Marketing, Sales and Strategy development for nearly 20 years, we design and implement both short and long-term strategies to promote profitable growth to ensure future success.

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Network/aco

Supporting network design and medical cost control implementation, our multidisciplinary teams of experts evaluate the design and delivery of high quality collaborative care, while achieving compliance and improving revenue cycle management.

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pharmacy

As leading experts in Part D, Pharmacy Benefit manager (PBM), Formulary and Pharmacy programs, we can help your MA Prescription Drug (MAPD) or Prescription Drug Program (PDP) develop and implement efficient and compliant internal operations, and effectively prepare for CMS audits with professional services and unmatched compliance tools.

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operational performance

Our team of operations consultants can translate your business strategies into practical, efficient work processes, and introduce excellence through every aspect of your implementation; from enrollment to claims payment.

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