Case Management
GCS understands that case management is a dynamicprocess which involves assessing, planning, implementing, coordinating, monitoring, and evaluating care to improve outcomes, experiences, and value for our members.
Our case managers provide the following services
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 essential in the patient-first model of care. Providing access to a licensed nurse when care is needed helps reduce costs by avoiding unnecessary emergency department visits and limitations of business-hours-only care.
This is why we offer this service in partnership with employers, health plans, physician practices, nursing homes, and health care 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 onself
Evaluate treatment options
Determine if an emergency department visit or business-hours - only care is needed
Health Coaching
GCS understands that members and patients benefit from individualized health coaching. Daily self-care challenges, especially with chronic conditions, often require additional, hands-on support.
Our health coaches are credentialed and trained to guide your members or patients toward improved health outcomes with techniques such as motivational interviewing and clinical interventions.
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.
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
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 diabetes management program that leverages device readings and encounter data to provide real-time insights into glycemic control
Health Risk Assessments
Industry-standard in the field of health promotion
Front-line tool in assessing an individual’s likelihood of positive health outcomes
Data drawn from similar patient populations can be used to establish baseline KPIs for targeted health outcomes.
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 that require care across 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:
An in-depth discussion between a pharmacist or healthcare provider and the member to review their medication profile
Members receive a comprehensive medication review and education on proper adherence to ensure medications are taken 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 with these principles across our Population Health Management continuum 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 partners with your providers to support a consistent and timely cost-control process by delivering 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