Case Management
GCS understands that case management is a dynamic process which involves assessing, planning, implementing, coordinating, monitoring, and evaluating care to improve outcomes, experiences, and value for our members.
Our case managers do the following:
Routinely oversee hospitalizations and manage member discharges
Work closely with primary care providers to ensure that the best level of care is achieved post-discharge
Update case notes, provide authorization numbers, and facilitate transportation and transfer between hospitals and skilled nursing facilities
24/7 Nurse Triage
GCS understands that 24/7 nurse triage services are a KPI in the patient-first model of care. By providing access to care when it is needed by a licensed nurse, there is cost-savings from avoiding unnecessary emergency department visits or business-hours-only care.
This is why we offer this service in partnership with employers, health plans, physician practices, nursing homes, and health systems.
Our 24/7 nurse triage service includes multilingual services by a licensed nurse in the following areas:
Advice on how best to care for yourself
Evaluate treatment options
Determine if an emergency department visit or business-hours only care is needed
Health Coaching
GCS understands that members or patients benefit from one-to-one health coaching. Day-to-day struggles of self-care, especially for chronic conditions, often need additional on-the-ground support.
Our health coaches are credentialed and trained to guide your members or patients towards improved health outcomes with techniques such as motivational interviewing and clinical interventions.
Use of these techniques are accompanied by health risk assessments and coordination of care across the interdisciplinary care team to evaluate conditions and services that are tailored to their specific needs.
Condition Monitoring
GCS understands that management of chronic conditions can be a financial and emotional burden for healthcare professionals and patients.
GCS offers an evidence-based clinical program for diabetes management that utilizes device readings and encounter data to provide real-time visibility into glycemic control.
Our program provides digital health tools under the guidance of highly trained clinicians to achieve the following:
Eliminate guesswork → real-time glycemic readings → real time glycemic control
Customize member engagement → concierge-level of personalized care
Guide necessary clinical interventions → help members or patients achieve better health and well-being
Reduced costs → improve clinical outcomes → increased provider satisfaction
Health Risk Assessments
Industry-standard in the field of health promotion
Front-line tool in assessing an individual person’s likelihood of positive health outcomes
Statistically significant data from across similar patient groups can be used as baseline KPIs for specific health outcome
When does GCS administer its Health Risk Assessment?
Initially upon enrollment
Annually
After any transition of care
Intake Coordination
GCS understands the laborious process of onboarding members. This is why GCS offers Intake Coordination services.
Our Intake Coordinators do the following so you don’t have to:
Conduct initial screenings of complex case management referrals
Confirm services
Ensure that all documentation is clear, concise, and meets regulatory and client standards
Transitional Care (Post Discharge)
GCS understands that the quality of transitional care services can greatly impact health outcomes.
When are transitional care services advised?
Transitioning from one phase of treatment to another, such as moving from hospital to home care
Experiencing multiple health conditions which require healthcare services in various settings
Ensuring successful transitions from child to adult health services
Medication Therapy Management
GCS understands that medication therapy management is a challenge for many members and patients. To lessen this burden, we offer medication therapy management (MTM) services that are tailored to meet the specific needs of each Plan.
Our Intake Coordinators do the following so you don’t have to:
Our services include:
An in-depth discussion between a pharmacist or healthcare provider and the member to review their medication profile
Members receive a thorough review of their medications and are educated on proper medication adherence to ensure they are taking their medications as prescribed
Population Health Management
GCS understands how data drives outcomes. With the use of this value-based model, we employ industry-standard principles; incentivized contracting for increased compensation, shared decision-making at the clinical level, and tech platforms for accurate data management.
To support our goal of enhancing members’ lives, we align ourselves with these principles on our continuum of Population Health Management and provide the following services:
Health Coach (Care Management)
Care Coordination
Health Risk Assessments
Transition of Care
Nurse Advice Line
Disease Management
Medical Management
GCS understands that medical management can weigh down your workflow. To support you, we offer a team of experienced clinicians who conduct authorization services according to your medical criteria.
Our team works with your providers to ensure an effective cost-control process that is consistent and timely, by providing you with the following:
UM Intake for both Inpatient and Outpatient
UM Outpatient Clinical Reviews/Prior Authorization
Discharge Planning
Inpatient Concurrent Review
Home Health Reviewers
Emergency Department Care Coordination