Abstract

Gateway HealthSM, a nationally ranked managed care organization, needed to quickly build out a strategy to improve a Star rating which would lead to $40 million in additional revenue. The health plan called upon SDLC Partners for strategy and execution support to help them achieve this goal.

The Challenge

Gateway was challenged by a lagging Star rating. The organization, which offers a variety of health plans for Medicaid and Medicare eligible individuals, needed to quickly assemble a strategy to improve the rating which would ultimately lead to additional revenue in excess of $40 million. The health plan, however, lacked insight into the areas of focus and called upon its execution partner of choice, SDLC Partners, to help develop a sound strategy.

The Solution

SDLC Partners’ high-performing team collaborated with Gateway to develop an integrated strategy focused on improving Star ratings associated with member perception of the health plan. The team conducted detailed workshops involving stakeholders across the organization for member touch point analysis, member journey mapping, and identification of various interventions to improve member experience. Leveraging its deep industry knowledge and experience SDLC developed ‘Star Power’ – a unique assessment framework that prioritizes the interventions (projects) based on the inputs and efficiency of the interventions. Working alongside the business owners, SDLC helped refine the vision and priority of interventions with an actionable roadmap and a clear focus on short term interventions and high ROI interventions.

The Results

SDLC assisted Gateway in successfully driving a holistic portfolio of short term interventions. By establishing a new, cross-functional team, interventions were executed by teams from member services, provider services, retention, marketing, and compliance. The interventions implemented had an impact on member experience of more than 50% of the eligible plan population. Interventions related to providers and data analytics are currently underway and will help improve specific Star measures.

About Gateway HealthSM

Gateway Health is a nationally ranked managed care organization, offering a variety of health plans for Medical Assistance (Medicaid) and Medicare eligible individuals. With more than 20 years of experience, Gateway Health is committed to its innovative care models, quality clinical outcomes and responsive and consultative customer service.

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