Medical Loss Ratio

Accurately predict and consistently maintain required MLR

For many plans, one of the most significant performance metrics is the Medical Loss Ratio (MLR). MLR provisions can vary by line of business and can have a significant impact on a plan’s ability to deliver high-quality care. Plans must have the ability to accurately project and predict MLR throughout the year and have strategies in place to take action if they are not meeting MLR targets.

GHG can help identify key MLR cost drivers and ensure that your providers and provider network are aligned in order to deliver the highest level of quality care to your beneficiaries.

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Performance Optimization

Clinical and Population Health

Medical Loss Ratio

Performance Optimization

As the increased competition amongst health plans places a heightened emphasis on plan performance, plans must continue to demonstrate improvement across the entire spectrum of plan operations including revenue, medical loss ratio, product performance, compliance, and network.

Clinical and Population Health

GHG can help you conduct efficiency assessments to evaluate your current processes and ensure that effective clinical and population health strategies are in place across your organization. Together, we can improve your Medical Loss Ratio and identify areas of improvement in care coordination and utilization management.

Population Health

Overview of Compliance as it relates to each category: 75 words
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MLR Assessment

It can be challenging for plans to ensure optimal financial performance while waiting for CMS to respond torisk adjustment strategies and quality measures. GHG can conduct an assessment of your cross-operational medical and pharmacy drivers to help you establish long- and short-term strategies to maintain the required MLR and build the operational infrastructure to proactively support bids.

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 robust team of advisory experts can supplement your existing team with able professionals who have years of experience providing strategic services to the industry.

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