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STRATEGIC INITIATIVE SUPPORT

Clinical & Pharmacy Programs

This chapter has discussed various methods for using the ACG System to identify members for proactive, targeted interventions, with the goals of improving coordination of care and avoiding future medical costs.

CLINICAL SCREENING

P3Health provides a robust set of clinical markers that help Care Managers perform the following functions:

  • Proactively identify patients with expectations of high future costs.

  • Stratify a population based on risk for program intensity.

  • Target candidates meeting criteria for Care Management programs.

  • Review a comprehensive risk profile of the patient including likelihood of hospitalization, risk for poorly coordinated care, and possession of chronic medications.

There are many methods for using the ACG System to identify patients for proactive, targeted interventions, with the goals of improving coordination of care and avoiding future medical costs. The ACG System provides flexibility in defining and evaluating populations of interest. A general report overview is provided, as well as examples for identifying populations for the following areas:

  • Disease Management and Wellness Programs

  • Complex Case Management

  • Pharmacy Management

  • Utilization Management

PHARMACY MANAGEMENT PROGRAM IDENTIFICATION

​Pharmacy management programs are a great way for identifying opportunities to improve patient health, streamline costs and drive provider performance improvement. P3 provides strategically important tools to drive value in these important areas for your internal programs:

  • Identify Patients with Hypertension Pharmacy Gaps

  • Identify Patients that are Poly-pharmacy with Medication Gaps and No Ambulatory Visits

  • Identify Patients with Narcotic Use

  • Identify High Pharmacy Users with Discordant Medical and Pharmacy Risk

  • Medication Therapy Management Program (MTMP) Candidate Selection

  • Identify Members for MTMP Programs