In order to positively impact outcomes and performance, it’s imperative that health plans evaluate and prioritize clinical capabilities. GHG’s expertise in clinical and population health gives us the unique ability to help your organization grow, maximize quality, decrease costs, and strengthen revenue.

GHG’s team of experts will work with your clinical team to deliver high-quality strategic, operational, financial, and clinical services by providing innovative value-based care solutions and technology products.

Clinical Program Development

GHG’s clinical team leverages population-specific data to design evidence-based strategies, interventions, and innovative care delivery models. Our approach to clinical program development incorporates detailed program descriptions, operational policies and procedures, accreditation readiness, audit processes, and audit remediation that is patient-centered and tailored to payor-specific member populations.

Model of Care Evaluation

CMS expects plans to be able to demonstrate that the Model of Care has been executed. CMS utilizes a step-by-step review of plan processes as it relates to the goals, processes, and performance outlined in the MOC. GHG can help you evaluate the structure of your current MOC to ensure that you have a successful submission and approval process.

Social Determinants of Health Strategy

Developing an SDOH strategy requires expertise in program design, implementation, operations, and rigorous program evaluation with underserved, vulnerable, and hard-to-reach populations. It also requires knowledge of how health plans and the healthcare delivery system work. GHG’s clinical experts can help you harness SDOH data, develop a strategy to address SDOH, or measure the success of current SDOH initiatives.

Medical Management

GHG will work with your medical management team to conduct efficiency assessments and evaluate your current processes to ensure that effective strategies are in place across all departments. Together, we can improve your MLR and reduce administrative costs while identifying areas of improvement in care management and utilization management effectiveness.

HEDIS Reporting & Evaluation

GHG can help support your organization’s overall quality improvement goals, metrics, and performance by conducting a HEDIS evaluation. We will work with you to analyze your NCQA HEDIS data to mine for improvement opportunities and identify interventions for your health plan, targeting operations, providers and/or members.

Mock Audits & Remediation

Achieving operational excellence begins with identifying your organization’s strengths and weaknesses. GHG conducts mock audits and provides expert guidance related to regulatory and operational issues to help alleviate risk. Using our broad array of services and compliance tools, we will help you develop and implement efficient and compliant internal operations that will prepare you for CMS audits.

Prospective Risk Documentation

GHG’s clinical and risk adjustment experts work closely together to bring you a well-rounded approach to clinical strategy. A prospective risk documentation program can have a tremendous impact on your broader clinical and quality strategy. Prospective risk capture programs demand that plans continually evaluate performance of the providers in the network to inform a strategic and operational path forward.

Interim Management

If you are looking for a seasoned veteran, GHG can enrich your team with our own, providing the leadership and knowledge your organization needs. GHG’s clinical and population health experts can supplement your existing team with able professionals who have years of experience providing strategic services to the industry.