Care Management

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.

Progressive Healthcare helps clients meet transformation challenges by offering key services to each of the following stakeholders in our changing reimbursement environment:

Providers

  • Chronic Care Management (CCM)
  • Care plan strategy, including ROI optimization plans
  • Infrastructure plans, including approach to “finance” via fee-for-service
  • Medicare strategy (MSSP; MA; bundled payments; CCM/TCM)
  • Strategy that leverages care management for competitive advantage:
    • Clinical program growth
    • 340B optimization
    • Clinical integration (FTC/DOJ)
  • Network development for:
    • Care management and risk-sharing
    • Payment re-design
    • Incentive alignment
  • Direct employer contracting, including on-site clinic development
  • Payor contracting strategy, including narrow networks, COE, and service-specific tactics

Health Plans (specifically provider-owned), including Own-employee plans:

  • Clinical and Benefit Program evaluation, strategy, implementation, and outcomes
  • Consumer engagement assessments and program development
  • Care Coordination and Case Management outcomes performance analysis
  • Medical Home: strategy, implementation, outcomes
  • Payment system design and transformation
  • Delivery system transformation and improvement initiatives

Employers

  • Benefit Plan outcomes performance
  • Cost and Utilization pattern analysis
  • Network Performance evaluation and Narrow Network development
  • Center-of-Excellence development
  • On-site Clinic strategy and implementation
  • Incentive design for employee engagement in wellness & disease management programs
  • Provider system care integration and optimization
  • Risk-sharing with provider systems