The Annual Full Replacement COB Files Are on Their Way
It's that time of year again when Part D plans will receive full replacement Coordination of Benefits (COB) files from the Centers for Medicare & Medicaid Services (CMS). The Health Plan Management System (HPMS) memo dated 3/6/15 states that the 2015 Full Replacement COB files will be sent to organizations beginning March 19th. Plans will need to distinguish these files from daily COB notification files by the date of receipt and the file size. Easy enough? Not exactly.
Opportunity to Review and Correct Your Records
The full replacement COB files offer organizations a great opportunity to review their current records, make corrections, and re-sync with CMS. When a Medicare Part D enrollee has other prescription drug coverage, coordination of benefits allows the plans that provide coverage for this same beneficiary to determine each of their payment responsibilities. This process is necessary in order to avoid duplication of payment and to prevent Medicare from paying primary when it is the secondary payer. Unfortunately, many times plans will "just load" the data file when received. This is a very risky decision, as doing so will override information you have already validated with outdated information from CMS. File analytics is a necessary step in the process.
GHG can evaluate your file to determine actions needed, including verification letter mailing
- Part D sponsors are required to notify each beneficiary of other prescription drug coverage information as reflected in the COB file from CMS. The beneficiary should review the information and report back any updates. It's important to analyze the file and not send out verification letters to members unnecessarily, especially if a letter was recently sent to a member or if the member is terminated. Plans that use the "send letters to all" approach will realize this just overloads your customer service call center.
GHG can assist with the Primary record validation and correction
- Many times erroneous information is on the data file and gets loaded time and again. This can cause multiple problems such as bad COB flags at the Pharmacy Benefit Manager (PBM) or, worse, point-of-sale (POS) issues at the pharmacy which could lead to Complaint Tracking Module complaints (CTMs). It's important that information submitted to the Electronic Correspondence Referral System (ECRS) is valid, complete, and consistent. Transactions submitted that are incomplete or fail ECRS system edits will be submitted for development, which will place a freeze on the record for up to 100 days.
Unsure where to start? Contact me at ctobin@ghgadvisors.com, and let us help you maneuver through the COB file verification process.
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When it comes to financial reconciliation and overall membership data management, you must protect against leakage. Need help staying ahead of the CMS reconciliation process? GHG will access your member premium revenue, accounts receivable and CMS revenue reconciliation. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is underway! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Room Rate expires on March 23. Register your team for The Gorman Health Group 2015 Forum today!
Go-to-Market — No Department Left Behind
Although the next Annual Election Period (AEP) is a ways off, now is the time to start thinking about product development and overall strategy. In most organizations, the start of the "Go-to-Market" (GTM) strategy discussions begins with the C-Suite, Product Development, and Sales and Marketing. This keen group of professionals works sequestered and siloed for a period of time and then, voilà , they emerge with the lifeline of the health plan's benefits and strategy in their hands.
In order to launch a successful set of products (as well as strategies for selling these products), one of the most important and initial steps must be the creation of a fully integrated GTM governance structure to enable the organization to manage more effectively between strategy implementation, optimization, compliance requirements, and results tracking of an integrated marketing strategy. This will require the involvement of multiple functional areas, even those that aren't traditionally thought of (e.g., Medical Management, Pharmacy, Compliance, Member Services, Provider Relations, etc.), which means no department can be left behind.
"The failure to include Compliance as part of GTM initiatives is a prime reason for some of the regulatory pitfalls that arise and are discovered way too late," says Regan Pennypacker, Vice President, Compliance Solutions. "Whether your organization deals in Medicare, Medicaid, or a combination of these lines of business, the overall guiding principles will be the same. A culture of compliance starts at the top and is effectively integrated when each area of the organization takes ownership of compliance requirements and expectations respective to each functional area."
Execution and management of this initiative is no easy task. A successful GTM strategy brings Compliance and operational stakeholders to the table. Assigning the right accountable parties at the onset is critical to ensuring regulatory requirements are implemented and overall strategy is executed. For suggestions and solutions on how to build your GTM strategy and team, contact me directly, cknight-lilly@ghgadvisors.com.
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Gorman Health Group's marketing experts have developed strategic plans for hundreds of Medicare Advantage Plans, Prescription Drug Plans, Special Needs Plans and Exchange participants. We will work with you to understand your market, mining demographic data for opportunity and finding the gaps in the competitive field into which your plan can fit. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Register your team for The Gorman Health Group 2015 Forum today!
Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal
Friday, February 20th after close of business, the Centers for Medicare and Medicaid Services (CMS), released its 2016 Advance Notice of Medicare Advantage Payment, known affectionately as "the call letter."
This one was the most anticipated in years, and the industry unexpectedly ducks bullets in it, in risk adjustment, Star Ratings, and elsewhere. It's got a few unicorn farts in it, and a couple puffs of Chanel No. 5 as well.
The lack of any shockers is the bigger positive for the industry, a turning point really. CMS is saying it won't settle its scores with payers through policy, but through enforcement, where the facts are often too tough for politicians to stick their necks out.
Last fall's surprise positive announcement that MA benchmarks were tracking to increase 2.02% next year started this year's dance. Now comes the draft call letter, and on April 6, the final, all of which will be different as CMS winds through its process and the full fury of industry lobbying is brought to bear. It's worth noting that this year a first-time majority of 53 Senators signed the annual "don't hurt Medicare Advantage (MA)" letter to CMS, vs. only 40 last year. The increased Congressional pressure and the fact that MA now represents one out of three beneficiaries is driving this call letter.
By our calculations, the 0.95% reduction in MA benchmarks claimed by CMS is really negative 1.76% all-in. This is the unicorn fart. The final number quoted by CMS, 1.1% positive, is in part because CMS is taking credit for a 2.0% improvement in risk scores as plans continue to improve their risk adjustment management skills. Kinda cheeky. Our read on the underlying trend is +1.53%, frankly, better than we anticipated.
On risk adjustment, anticipation was that CMS would take a lethal shot at prospective in-home evaluations, a tough fee-for-service normalization factor, and an increase in the coding intensity adjustment, but NONE of those happened.
On home visits, despite a hailstorm of bad press and advocacy group investigations, CMS isn't even dealing anymore, just laying out "best practices" and saying "we're watching you." The regulators laid out 8 criteria that would make the prospective evaluation more like a risk assessment conducted by a Special Needs Plan, including:
- Evaluation performed by a physician or qualified non-physician practitioner
- Includes all components of the wellness visit including health risk assessment
- Medication review and reconciliation
- Scheduling appointments and referrals with appropriate providers and community resources
- Environmental scan of the home for safety risks and need for adaptive equipment
- Verifies that the information obtained during the assessment is furnished to appropriate plan staff and providers
- Provides enrollees with a summary of the information collected
- Enrolls the beneficiary in disease management or care management programs.
Taking these steps and embedding risk adjustment management inside a health plan's Medical Management department would effectively audit-proof the company from the dreaded data validation audits expected to intensify this year.
Another shocker: CMS did the absolute bare-minimum on the coding intensity adjustment, and then heaved up a dangerous proposal to recalculate it starting in 2017. If implemented, CMS would cut payments to all MA plans by enough so that total payments would be no greater than under the pre-HCC, pre-PIP-DCG, pre-2000 AAPCC demographic model. This would make risk adjustment a zero sum game, in which individual plans could win or lose, but in which CMS would never pay out more than under the old AAPCC model. That would settle the score on home visits once and for all, and indelibly damage risk adjustment as a healthcare financing innovation.
A final surprise: CMS acknowledges it has a problem on Star Ratings for health plans serving dual eligibles and the low-income. The agency is cutting the weight of several Stars measures where vulnerable members score poorly, by a whopping 50% in 2016. This buys time for CMS and several plans overweight with low-income members and highly exposed to Stars underperformance to conduct additional research and take steps against what is driving the correlation.
It was, in the end, a surprisingly favorable call letter for health plans and other stakeholders, particularly capitated provider organizations. But we're still a long way from the Final Notice on April 6. How plans should react:
- First, write comment letters. Deadline is March 6 at 5 pm EST.
- The proposal to cap total MA payments at the same level as would have been paid under the pre-2000 demographic-only risk adjustment system is dangerous. Plans need to point out how the Congress, in the 1997 Balanced Budget Act, mandated a health-based risk adjustment system because the demographic adjustments were inadequate. We are not aware of any authority in that, or any other law, to allow CMS to set a cap on total MA payments.
- Take the guidance on home risk assessments seriously, and implement CMS' suggestions before they become mandates. Plans must hard-wire their risk adjustment program into their care management program, so they are actively managing the risks they identify.
- Don't rely on averages: the impact of CMS rates and other changes will vary from county to county, market by market. Let us help you examine the impact on your service area.
- Continued rate pressure means plans have to continue to get better and better at the key components of their business: risk adjustment, care management, Stars, and enrollment data reconciliation.
- Focus on the Stars metrics with the greatest weights, especially the intermediate outcomes measures and the plan-wide quality improvement measures. Determine if the reweighting of seven metrics will have a positive or negative impact on your plan, and react to offset any negative effects, by emphasizing other metrics where there is room for improvement.
It's going to be an interesting 45 days to the Final Notice, but one thing is sure in this call letter: CMS is conceding that Medicare Advantage has gone mainstream, and that its support in Congress can no longer be tangled with. CMS is showing its preference to impact industry behavior through its boot rather than its pen.
Resources
Join John Gorman, GHG Executive Chairman, and colleague, Bill MacBain, GHG's Senior Vice President of Strategy and former health plan CFO, as they provide a hard-hitting analysis of critical areas addressed in the document, including a look at the various components that make up the trend factor, a proposed change to how risk scores are determined, health risk assessments, and Star Rating measures on March 3, 2015. Register Now >>
Registration for the Gorman Health Group 2015 Forum is now open! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Register your team for The Gorman Health Group 2015 Forum today!
Risk Adjustment Data Validation (RADV) Audits Just Got Real
Last night the second-largest Medicare Advantage plan in the country, Humana, filed an SEC document detailing a US Department of Justice investigation into the company's risk adjustment coding and data collection practices. The investigation is an extension of a 2010 physician-led whistleblower action under the False Claims Act. The company has over 3.2 million Medicare Advantage members.
For years CMS has struggled to define the process and methodology it would use to pursue payment recoveries from Medicare Advantage plans which were overpaid under risk adjustment. In 2012 it finalized its process and launched its first round of RADV audits, on a parallel track with those being conducted by the Office of Inspector General at the Department of Health and Human Services.
The Justice Department's involvement in the Humana audit would appear to indicate the review is in the advanced stages and has been underway for some time. The methodology assures an extrapolated repayment to the Federal government for unsubstantiated codes submitted for risk adjustment. That this action also comes in connection with the False Claims Act and a qui tam whistleblower action could signal serious trouble for the insurance giant.
RADV just got real.
Resources
GHG can support your risk adjustment from start to finish when it comes to preparing for your RADV audit and prepare a readiness plan. We're standing by to support you in comprehensive audit coordination, limited audit oversight and targeted engagement services. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Register your team for The Gorman Health Group 2015 Forum today!
In 2015 a Slap on the Wrist Can Be the Kiss of Death
It is truth that in the second term of Democratic administrations, scores get settled between Washington regulators and business partners of the Federal government. 2015 will be no different for our favorite agency, the Centers for Medicare & Medicaid Services (CMS). It's already on a pace for 2015 to be the toughest year ever in enforcement actions against Medicare Advantage plans. And generally speaking, the regulatory bar is rising faster than anyone imagined. Consider:
- So far in 2015 CMS has issued significant new Medicare Advantage and Part D regulations, and this year's Advance Notice for 2016 rates and rules for Medicare and Part D health plans is the most anticipated I can remember in more than 20 years.
- 2015 is the toughest year in benchmark payment rates thanks to the approximately $200 billion in cuts from the Affordable Care Act.
- 2015's technical corrections for Star Ratings are almost bewildering in their complexity in raising the clinical bar. Indeed, in 2014, an election year, CMS famously told Medicare Advantage plans below 3 Stars for 3 consecutive years that a stay of execution was granted. In the fall, many of those low performers were quietly shown the door and were non-renewed. In 2015, however, the agency is handing out live ammunition to its firing squad. Now an intermediate sanction freezing marketing and enrollment automatically knocks the plan down to 2.5 Stars, often meaning loss of millions in bonus payments and rebate dollars. In competitive markets now, the first plan sanctioned is the first hunk of roadkill.
- The HHS Office of Inspector General, the guys with the badges and guns in Medicare, have made data validation audits for Medicare Advantage risk adjustment one of its top priorities in its 2015 workplan. And the President's budget includes over a half-billion dollars in recoveries from these RADV audits.
- But nowhere is there better evidence that the paper tiger is growing its claws back than in CMS' track record in enforcement actions against MA plans. In January, the agency levied the highest monthly toll of civil monetary penalties ever -- and if it keeps up the pace, 2015 will be nastiest enforcement environment in Medicare history.
*January 2015
Granted, CMPs don't typically amount to much, usually no more than a couple hundred grand, rarely 7 figures plus. But the damage is actually far greater, when considering damage in the local and national press; the chatter factor among beneficiaries; lost membership, and damage to the Star Rating and the relationship with CMS, which for many plans is or is becoming its biggest customer. A slap on the wrist is now the kiss of death in this environment.
Last week, my colleague conducted a webinar on the "Top 10 Things Killing Your MA Plan." CMS' top infractions, in order, are coverage determinations and grievances, and formulary administration, or performance of your pharmacy benefits management vendor. Those findings are driven by these 10 root causes:
Now is the time to ensure your compliance function and Medicare operations have the right tools, processes and people to be successful in the toughest environment we've ever seen in government health programs. In 2015, Gorman Health Group launched its latest product, CaseIQ™ , providing a new way to ensure your Appeals & Grievance cases come to a timely and compliant resolution. The tool not only captures all the data points needed to categorize, work and report coverage disputes and complaints; it also guides users through the appropriate processing of each case, minimizing the risk of non-compliance due to user error. Built and governed by GHG Medicare compliance subject matter experts, CaseIQ™ aims to keep our clients out of CMS' audit crosshairs. Learn more in our recent press release.
In addition, in the Common Conditions, Improvement Strategies, and Best Practices memo based on 2013 program audit results, CMS outlined areas where plans have been consistently non-compliant and described best practices to address failings. Ongoing monitoring is at the heart of non-compliance. Our solution, the Online Monitoring Tool(OMT™), is a highly flexible oversight tool and dash boarding software that brings together key metrics, documents, and tasks for ongoing monitoring and auditing, which results in the Organization being audit ready. This integrated solution also streamlines vital compliance activities, such as the implementation of new requirements and corrective actions. Read our recent White paper to learn more.
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CaseIQ™, GHG's latest solution, offers built-in reports that allow for tracking of past performance, current backlog as well as trends, and is designed to assist the caseworker to a complete and compliant resolution in Part C (MA) appeals, Part D appeals, and Part C and Part D grievances. Learn more >>
Registration for the Gorman Health Group 2015 Forum is now open! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Register your team for The Gorman Health Group 2015 Forum today!
Medicare Secondary Payer (MSP) is all about the money.
Money going out as a result of paying claims as primary payer when it's possible you should be paying as secondary payer. CMS reduces plan payments for members with MSP, shown on the Monthly Membership Report (MMR) as an MSP adjustment (reduction).
Money coming in results when research and outreach attempts validate paying as secondary payer; transactions are submitted to change or delete the occurrence records in Electronic Correspondence Referral System (ECRS). The recovery results are shown as favorable MSP adjustments (increase) in your Monthly Membership Report (MMR) payment. Claims recovery also produces additional revenue.
Medicare Secondary Payer shifts the burden from Medicare to commercial insurance companies. The burden is shifted to both employer plans (Group Health Plans) as well property and casualty insurers (Non-Group Health Plans). For Medicare Advantage plans, MSP is when an employer group sponsored health plan pays primary over the Medicare Advantage plan.
MSP validation is not a one and done process. Information can change, be inaccurate or out of date. Outreach validation requires diligence and persistence. ECRS submissions need to be monitored for non-responses and records under development. Other coverage information and system flags need to be updated for claims reprocessing and recoveries from other insurers for claims that were paid as primary in error.
GHG's MSP Reconciliation Team has delivered exceptional outcomes for our clients by recouping millions of dollars in MSP recoveries — much more than our clients expected! Each time we're able to obtain a positive validation and submit a correction to ECRS it means money for the client. That's a satisfying feeling!
Resources
When it comes to financial reconciliation and overall membership data management, you must protect against leakage. Need help staying ahead of the CMS reconciliation process? GHG will access your member premium revenue, accounts receivable and CMS revenue reconciliation. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open! Attendees can expect timely, actionable advice on the trends shaping health care from notable speakers, including Barclay's analyst, Joshua Raskin, and regulatory guidance directly from Jennifer Smith, a Director in the Medicare Parts C and D Enforcement Group at the Centers for Medicare & Medicaid Services (CMS). Register your team for The Gorman Health Group 2015 Forum today!
How to Maintain the Accuracy & Consistency of Data through an Entire Life Cycle
It doesn't matter whether you call it the Annual Election Period (AEP), Open Enrollment Period or Fall Open Enrollment; it's that busy time of the year when beneficiaries are on the move. Now that the dust has settled, it's time to take a thorough look at your member data. Your members are your revenue. Accurate member data and continuous maintenance will yield the maximum, most accurate level of revenue to your organization.
While Plans strive to have correct data in their systems right from the start, it doesn't always work out that way. The result is inconsistencies in data and the need for an "AEP Reconciliation". That's the process of identifying a discrepancy, correcting it and not only making it right, but keeping it right. Reconciliation is about maintaining and assuring the accuracy and consistency of data from the start and over its entire life cycle.
Member data is the heart of an organization and the driver for many processes. It's critically important that this data is correct in all of your organization's systems. All systems need to be in sync, CMS to Plan, Plan system to Plan system, Plan system to PBM — it's a continuous circle of checks and balances.
Accurate data not only helps create that important first contact experience with your member but keeps you connected to your member. Correct member data reinforces your organizations credibility and promotes a feeling of value to your member.
Data Reconciliation Tips
- Member Demographic Information — Maintain and update any changes to names, DOB, addresses (permanent, billing, personal representatives, POA's), telephone numbers, email addresses.
- Enrollment Spans— Verify that the Plan/PBP/LIS is correct in all spans within the enrollment — not just the current span.
- Payment Method — Validate that the correct payment method is set up (SSA, Direct, RRB, EFT, etc.)
- Special Status — Update special status or status flags in the appropriate systems to ensure proper claims payment and plan payment. (i.e. ESRD, Hospice, MSP, Medicaid, Institutional etc.)
- Optional Supplemental Benefits — If your enrollee elects supplemental benefits, verify the Part C premium change was submitted to CMS.
- CMS Reports — Work monthly CMS reports promptly and completely. (List of CMS reports is available in PCUG v8.3, Table K-1 All Transmissions Overview)
- Plan Discrepancy Reports — Compare data within your own plan systems and with your PBM. Create discrepancy reports and work them daily or weekly.
Don't forget about Medicare Secondary Payer (MSP) Reconciliation!
Now is the best time to tackle all that MSP information you've received. Many plans get overwhelmed with MSP data, especially at this time of the year, and find it difficult to perform the time consuming outreach and research that's necessary to obtain validation results.
This simple process carries a powerful financial punch — efforts here can yield big results! GHG can assist with MSP Reconciliation. We have experienced analysts that can research, perform outreach and reconcile your MSP data.
Start the year off right - with clean, accurate data.
GHG's Consultants and Reconciliation Analysts have the expertise, knowledge and experience for all your reconciliation projects.
Resources
To hear more information on reconciliation, including detailed evaluations of the MMR & MOR reports, come hear GHG's expert, Jennifer Young explain the Fundamental of Membership Accounting & Reconciliation, January 26-27th at the Medicare Advantage Membership Accounting & Reconciliation Conference, Sanibel Harbour Marriott Resort & Spa, Ft. Myers, FL.
Let GHG check the box in each and every operational area of your organization. Our team of veteran experts can assist in AEP preparation, transmitting of timely and accurate membership information, recommending staff levels and utilization, and maintaining and improving all enrollment processes. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor. Register today >>
Operational Assessment — time for a “Check-Up"
It's time for an operational assessment.
Here's why….
An operational assessment is an opportunity to review your day to day operations to ensure processes are accurate, running efficiently and most importantly, compliant. Over time employees tend to reinvent the wheel - they stray from the documented processes and before you know it, the way it's being done is now the accepted "norm". If management isn't close to the work being performed or not working with a "sleeves rolled up" attitude, then you may be unaware of exactly what's going on in your operational areas. You may believe the staff is doing "this" but they're actually doing "that".
Here's another reason .…
You don't know what you don't know.
GHG's Operational Assessment starts with a period of discovery through observation and interviews. We get people talking. Individuals will have a chance to demonstrate and explain their role and tasks within the operational area. It's through this review and discovery phase we uncover the good, the bad, and the ugly. Typically, an operational assessment will consist of reviewing processes, policies & procedures, production reports and performance metrics, training materials, and systems.
The only thing you have to fear….
Organizations shouldn't fear finding gaps or process failures — they should fear not finding them. Assessments are meant to identify problems, make best practices corrections, and implement changes for excellence; there are no blame games.
Don't delay….
There's no time like the present for an operational assessment. The benefits of improved operational performance can be compelling, including better performance, efficiencies, and increased revenue.
Achieving excellence is a process. Begin the journey with a Gorman Health Group Operational Assessment and we will guide you on the road to excellence.
Resources
Let GHG check the box in each and every operational area of your organization. Our team of veteran experts can assist in AEP preparation, transmitting of timely and accurate membership information, recommending staff levels and utilization, and maintaining and improving all enrollment processes. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor. Register today >>
Private label health plans - a tool for increase market capture and improved patient outcomes
Private label health plans or co-branded health plans are joint efforts between like minded health plans and provider organizations interested in enhancing market share, achieving improved patient outcomes, minimizing duplication of services and achieving financial accountability. In its purest form, a private label health plan combines the strengths of the participating providers such as reputation, innovative practice patterns, trusted referral patterns and coordination of care techniques with those of the participating health plan such as benefit design, network design, contract administration and other insurance plan core competencies.
Most often, a private label enterprise has as its core characteristics, a value based limited network in which the participating providers agree to, and adhere to, mutually designed clinical and financial performance targets which are intended to optimize patient outcomes and financial performance targets ultimately leading to increased provider and health plan profitability. Benefit plans are customized to maximize in network access, member engagement and minimize out of network referrals. The insurance partner, in addition to providing the basic insurance administrative and medical management insurance functions, contributes by offering access to data and technology often unavailable to providers otherwise.
Private label health plans are a potentially attractive option for health plans that are already working with Accountable Care Organizations , (ACO's) and large Integrated Health Systems, (IDS) who control all, or a majority of, the resources necessary to achieve continuity of care ranging from primary care to end of life care.
Large self insured Employers that labor under legacy self insured insurance programs for their retiree populations are potential customers for private customized private label benefit plans and value based networks because they offer the Employer greater control over benefit offerings, defined employee or retiree contribution and medical cost.
At the Gorman Health Group we have a history of supporting Medicare and Medicaid Health Plans and Provider organizations on innovative approaches to network development, healthcare pricing and model of care development, as well as working with ACO's on achieving improved financial performance and member engagement.
Resources
Need our help? Interested in starting a dialogue on Private label plan development, value based network formation or optimization of ACO performance? Take the first step and call us at 202-364-8283 and ask for me directly or one of our senior subject matter experts or contact us via the GHG website. We are here to help.
Registration for the Gorman Health Group 2015 Forum is now open and our Early Bird discount has been extended to January 16. Enter promo code EarlyBird30 at checkout to receive your 30% discount. Register today >>
New Year's Resolutions for Your Organization!
Every January 1st we have the opportunity to reflect on our prior year. We make lists of all the things we want to do or maybe do better in the upcoming New Year. The typical resolutions are lose weight, quit smoking, save money, exercise more, eat healthier, create a budget or plan a trip. The practice of evaluating our personal life is a good way to celebrate our accomplishments while thinking about ways we can improve in the New Year.
Our professional, workplace life should be no different. Now is the time to evaluate current practices. Take time to list all your departments' processes and functions. Evaluate each one. Is the process working well? Is it efficient? Is there room for improvement? Should it be replaced?
The future of organizations will rely on operational cost management. Each department within an organization should be continually looking for process efficiencies to reduce costs, and ways to boost productivity.
If you think this sounds overwhelming, use GHG's simple tool to start the operational evaluation process. It can be as simple as Keep, Fix or Replace.
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GHG has experienced consultants that can assess and review the operational areas of your organization. We can review current processes and look for efficiencies to improve outcomes and better compliance. Make a resolution to improve your organization's operational areas — GHG can help make it happen in 2015. Visit our website to learn more >>
Registration for the Gorman Health Group 2015 Forum is now open and our Early Bird discount has been extended to January 16. Enter promo code EarlyBird30 at checkout to receive your 30% discount. Register today >>