GSM Implementation

Adjudica has designed the GSM platform to allow a gradual, staged implementation, providing transparency and involvement before eventually moving to full democracy and control. Initially the GSM is used to provide transparency into what the group is spending on care, allowing group members to see where their budget is going. Plan administrators can decide if and when to implement the full democratic aspects of the GSM, shifting control of aspects of annual plan design over to the group members themselves.

Initial Transparency Implementation:  Administrators use the GSM platform to show plan members how much in aggregate is being spent on their health care, and where the money is going. The administrator uses the GSM to highlight trends that will impact group member’s cost and coverage.  Plan members become comfortable with the idea of reviewing their health care at the group level. 

Building to Awareness:  Once plan members are comfortable with the group financial view, the plan administrator can begin using the tool to increase awareness on the part of plan members – how their actions and decisions impact the cost of care for everyone.

Involvement and Feedback:  The plan administrator uses the democratic aspects of the tool to begin soliciting feedback and involvement from the group members – how they would like to see their plan changed, where they think savings might be possible, suggestions for wellness programs, etc.

Democracy for Annual Plan Decisions:  Members get directly involved in suggesting changes, signing support for other suggested changes, and voting on those ideas that reach a threshold of support.  Members help shape their plan to fit within the budget provided by the payer.

Democratically Make the Tough Decisions:  For those plan sponsors who want to stay within a capped budget, an option is available to require the membership to help make tough decisions that might be required to keep costs under control.  Instead of the plan sponsor just absorbing costs overruns, the membership is proactively presented with a list of plan changes that will automatically trigger in the next plan period unless budget comes in on or under target.  Members have the ability to change the order of those changes and they have the ability and motivation to come up with other ideas.  By setting the stage and communicating with the members upfront, the plan sponsor is able to avoid the difficult once-a-year conversation describing the cost increases and coverage reductions that will be in place for the following plan period.