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.
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.
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.