Cathy McClain Gordon
Cathy McClain Gordon is a Senior Consultant at Gorman Health Group (GHG). In this role, she leverages her extensive knowledge of health plan operations and medical group operations to deliver exceptional solutions to managing financial risk and moving toward value-based reimbursement. Cathy brings GHG clients more than 20 years of experience with Commercial programs, the Health Insurance Marketplace, and government-sponsored programs including Medicare Advantage, Medicaid, and TRICARE. Cathy possesses a passion for health insurance operations, regulatory compliance, quality management, provider network contracting and maintenance, and business development.
Over the years, Cathy has leveraged her expertise and knowledge to aid clients in managing financial risk arrangements by developing and deploying successful risk adjustment strategies, preparing for delegation oversight and monitoring, developing care coordination models, executing provider network incentive models, and employing quality improvement strategies to meet the Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set (HEDIS®), state, and health plan quality measures.
Prior to joining GHG, Cathy worked for Medicare Advantage Organizations (MAOs), Management Service Organizations (MSOs), and commercial insurers, leading healthcare reform implementation and process improvement initiatives, preparing for delegation oversight and monitoring, implementing internal corrective action plans, developing program compliance tools, provider network contracting and maintenance, vendor management, driving population health management strategies, and executing risk adjustment strategies. She also led various technology assessments and implementations.