Clinical and Population Health

Our experts analyze clinical, utilization, and cost data to apply strategies and interventions that improve clinical and financial outcomes

Population health management (PHM) improves clinical health outcomes by using analytics as well as financial and care delivery models that support care coordination and patient engagement. Unlike traditional wellness or disease management programs, PHM focuses on a total population across the care continuum, ranging from minimal health risk to complex chronic disease management. PHM strives to reduce disease burden by implementating preventive wellness and chronic care interventions and focusing on payment systems and delivery of services.

At GHG, we take a holistic approach to population management that is person-centered and incorporates the mental, social, physical, and cultural aspects in the plan of care. GHG partners with you to identify the unique needs of your member populations and provide evidence-based interventions that support collaboration with community resources, providers, and professionals to improve the health of members and communities.

Services include:

Clinical

The complexity of healthcare management is continuously evolving as the incidence and prevalence of chronic disease grows. An effective response not only requires access to clinical, cost, and use datasets, but also robust analytics. Our experienced clinical team leverages population-specific data to design evidence-based strategies, interventions, and innovative care delivery models for preventive screening and chronic disease management. 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.

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Stars & Quality

Once a product strategy is established, the conversation must turn to benefits. Smart benefit design is a dynamic process that begins with an examination of intended markets with consideration given to strengths in member retention and medical management, and is executed with specific enrollment and financial targets in mind. Whether your organization is just entering the government programs space or is already well-established, our team is standing by to assist.

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Stars & Quality

To effectively achieve and maintain the highest Star Ratings, plans must implement an intentional strategy that is simultaneously focused on the individual and the broader population, and is informed by data-driven gap identification. This includes educating providers and beneficiaries on the myriad of services and resources available, on the importance of timing seasonal outreach and participation in preventive screenings, and on collecting responses from patient experience surveys. GHG’s experts advise on data analysis, uncovering process opportunities, intervention strategies, and workflows that improve overall quality improvement and member satisfaction to support the success of your plan, year after year.

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Pharmacy

Medication adherence is an important part of chronic disease management. An effective medication adherence program can not only have a profound influence on a patient’s well-being, quality of life, and health outcomes, but it can also positively impact medication and the associated utilization costs from a plan perspective. Our team of experts advise on the identification and removal of adherence barriers while isolating patient-specific factors that cause or influence lack of adherence. Learn more about how we support startup Part D operations through operational assessments, pharmacy benefit management (PBM) selection, management of Prescription Drug Event (PDEs) and claim checks, and surveillance through delegation and mock audit processes.

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Medical Loss Ratio

Once a product strategy is established, the conversation must turn to benefits. Smart benefit design is a dynamic process that begins with an examination of intended markets with consideration given to strengths in member retention and medical management, and is executed with specific enrollment and financial targets in mind. Whether your organization is just entering the government programs space or is already well-established, our team is standing by to assist.

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Medical Loss Ratio

Once a product strategy is established, the conversation must turn to benefits. Smart benefit design is a dynamic process that begins with an examination of intended markets with consideration given to strengths in member retention and medical management, and is executed with specific enrollment and financial targets in mind. Whether your organization is just entering the government programs space or is already well-established, our team is standing by to assist.

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Product

The Medicare market demands that organizations carefully select and strategically diversify their product portfolios. GHG’s experts in clinical and population health partner with our product team to help you develop a product strategy that takes into consideration member experience, care coordination, and patient engagement to enhance cultural competence and ensure that the unique needs of your beneficiaries are being met.

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Network

Our clinical team partners with our colleagues in network development to bring a singular perspective with regard to engaging providers in population health management and building member confidence in plans and network providers – particularly as it relates to HEDIS measures, Star Ratings, and patient participation. GHG works with clients to develop provider network governance structures; establish provider ownership in achievement of plan goals, measures, and member retention; organize network providers; and create transparent reporting processes. Through population management analytics and clinical operations, our team can identify both individual and population use cases for member retention and network success.

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Compliance

Clinical workflows and compliance have become intimately intertwined. Our clinical team develops population health management strategies and designs healthcare interventions, processes, and workflows to manage specific member populations. In collaboration with the compliance team, who has oversight into adherence to compliance and regulatory requirements, the clinical team implements process improvement strategies when opportunities are identified. Learn how our integrated teams work side by side to hardwire workflows and interventions, create early warning systems, and address operational inefficiencies to ensure client and member satisfaction.

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Compliance

Once a product strategy is established, the conversation must turn to benefits. Smart benefit design is a dynamic process that begins with an examination of intended markets with consideration given to strengths in member retention and medical management, and is executed with specific enrollment and financial targets in mind. Whether your organization is just entering the government programs space or is already well-established, our team is standing by to assist.

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