make change where it matters most
Translate your business strategies into practical, efficient and rigorous work processes
At Gorman Health Group, we maintain the country’s largest staff of senior operations consultants. Our team can translate your business strategies into practical, efficient and rigorous work processes with the highest degree of compliance and accountability. Our exposure to many dozens of health care organizations every year means that we have worked with virtually every software or service vendor in the space.
Alignment Service Suite
GHG’s Alignment Service Suite offering improves health care pathway efficiency through product, clinical and financial alignment. This internal benchmark system monitors performance across departments, detects internal or external deviations, and observes both short and long term trends. The Alignment Service Suite can dually operate with internal reporting functionality, empowering your interdisciplinary team to jointly review challenges, successes and past strategy impacts, all with the support of GHG consultant expertise.
Root Cause Analysis
Gorman Health Group has decades of experience stress-testing hundreds of operational business units and can assist with implementing CAPs post-audit or in proactively addressing operational problems before regulators come knocking. Our comprehensive root cause analysis service focuses on every segment of your organization’s value chain – we can help you address the immediate operational problem and also uncover the root cause behind it.
GHG anticipates that CMS will continue adjusting thresholds, curving the Star Ratings year after year in an effort to separate the remarkable from the ordinary. Now is a critical time – MA Plans must examine not just this year’s score and what contributed to it, but their Plan’s score history in the Stars program and what it says about the enterprise’s overall approach to key issues.
We understand Medicare ACOs: We have helped launch eight over the past two years. But we also understand that this is just a first step toward taking greater control over the Medicare revenue stream by “moving up the food chain.” Our team of veteran executives can help your ACO evaluate the options, manage the workflow to achieve either a Medicare Advantage contract with CMS or a risk contract with an existing MA plan, and continue to achieve improved outcomes. Our comprehensive management solutions provide ACOs in transition with the tools, processes, and expert guidance to drive overall performance through new models of finance, leadership, and clinical value.
Network Development and Operations
In addition to our continuing work launching new entrants into the MA market, we are helping many experienced plans by developing smart networks: accountable care, shadow capitation, and payment bundling within their current service areas and networks. We’re developing some of the most innovative bonus and incentive arrangements in the industry by adhering to the dictum that trends may be national, but all health care is local. GHG will assess the alignment of your products, your current network, your market, and your network requirements. We’ll help you track results – both positive and negative – back to related network components.
Health Insurance Exchange Training
The most critical component to success in the new exchange marketplaces: Thoroughly trained staff. From your internal staff to your network physicians, your customer service representatives to your sales brokers, the issuers with the best-trained team members will be ready to handle the unpredictable challenges presented by your prospective new members. And right now is the time to get started. Gorman Health Group provides training sessions on the critical topics your team needs to be ready for the October launch of the health insurance exchanges.
GHG works with the sales teams of dozens of health plans of all sizes and geographies. And we’ve noticed something: the industry has been missing a system of control for that crucial time between when a lead is generated, through the “kitchen table” sale, to the submission of the enrollment application itself. The industry is blind to the very place where most sales violations take place. Until now. Let us introduce you to our partners at Bloom Marketing Group, an insurance services company and its extraordinary, first-in-class mobile application Ascend.
General and department-specific training is a mandatory part of a Compliance Program, but creating and keeping training materials up to date is time consuming and requires wide-ranging expertise. To help your organization increase the value of your number one asset — its people — we offer training on the wide range of topics that impact your business every day. Whether you are looking for one course or the full library, to train one user or an entire organization, we have the training you need.
Every health care organization is looking for improved outcomes, better compliance and enhanced process efficiency when it comes to managing membership and premium payments. But if you’re in multiple markets, like Medicare Advantage and the Health Insurance Marketplace, then it’s a must-have for survival. The biggest risk health plans face in government programs is managing membership and financial data.