Care Management and 340B
Progressive Healthcare's participation on clients' care management teams is synonymous with optimizing both health outcomes and cost. Our many care management projects show how simple changes in infrastructure, business models, and workflows can profitably achieve these goals. Recent projects include:
Developing a heart failure program from protocol development through clinic implementation and pharmacy integration. The program improved both clinic outcomes and margins.
Converting a loose association of 175 PCPs and a hospital into a clinically integrated network. After executing a direct contract with an employer, the CIN earned a $3 million gain-sharing bonus in the first year.
Leading the analysis for the turnaround of a provider-owned Medicare Advantage Plan. Within 18 months, the plan was profitable.
Care management covers many disparate needs (or type of care management):
Acute care within a hospital:
Emergent care, from ED through Observation or Inpatient (from ICU to floor)
Elective care (e.g., surgery)
Post-acute care
Chronic care
Episodic care (e.g., cancer care across the continuum)
On-going treatment via medication
These types of care management often interact/overlap. For example, inpatient performance (e.g., length of stay; readmission rate) is driven largely by post-acute care. An inability to manage patients with chronic conditions (e.g., Heart Failure) will drive inpatient admission usage.
Perhaps the most-overlooked application of care management (or “Population Health”) is in the management of 340B. For 340B-eligible providers, the ability to manage the care (i.e., medications) directly affects the performance of the 340B program. For example, low medication adherence not only affects patient care (and their clinical outcomes) but it also reduces the margin earned by the 340B program.
Our Care Management and 340B service offerings include:
