Application season is here: How’s your network holding up?
Once again we are in the midst of application season for health plans applying to become a Medicare Advantage Health Plan, expanding their MA geographic footprint or getting into the Health Insurance Exchange space. Regardless of the scope or the specific enterprise, network adequacy and accessibility is a major cornerstone of any MA or Exchange initiative.
In addition, network adequacy and accessibility are no longer the only requirements for constructing and managing provider networks. Today’s healthcare climate and market competition demands that Health Plans offer their membership provider choices which have been vetted for quality of outcomes and fiscal efficiency, ie. value based provider networks. That in turn requires health plans to find ways of evaluating their existing provider networks or newly recruited providers on the basis of past clinical and financial performance, and establish forward looking performance metrics by which to manage provider behavior and reimbursement tied to the delivery of clinical care.
Given that time is short, MA applications are due in March 2015 and Exchange networks must be in place by January 2015, many health plans are hard pressed to evaluate network adequacy, accessibility and develop appropriate reimbursement strategies on their own. That is where the Gorman Health group can help. We have a long history of helping Health Plans offer their members the best network possible. Give us a call, tell us your needs and let’s work together to offer the best network product to your members.
Resources
On Friday, September 26, John Gorman, GHG’s Founder and Executive Chairman together with colleague, John Nimsky, Senior Vice President of Healthcare Innovations, discussed the vehicles for achieving what could be characterized as a reengineering of the health care delivery process and its effectiveness. Join the Point today to access this webinar recording.
Don’t let the application process get in the way of your day-to-day operations. Contact us today to ensure a smooth, compliant process.
From ACO-type incentives to bundled payments and contract capitation, to full professional and global capitation — where the potential is promising, we can help design and implement these arrangements. Find out how GHG can help >>
Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>