At ProspHire, we work across all segments of the healthcare delivery system: hospitals, health plans and other providers across the country to help improve the quality and cost of healthcare services. Working together with providers, plans and health systems, we can create innovative solutions that address quality care across the entire continuum. We focus on quality strategies, clinical care operations and pharmacy benefit management.
Today, our clients are challenged with streamlining care coordination with enhanced data analytics, improved workflows, and ensuring compliance standards to provide member (patient)-centric care to all. This often includes system implementation efforts of new or existing care management platforms. We typically get called when our clients need system implementation support, clinical expertise that can be translated to the technology requirements for care management platforms.
Care management is a vital part of health plan success. Building the infrastructure for the most efficient and effective method to reach members and coordinate care is a fundamental requirement. Access to data has greatly impacted our ability to target members most in need; but unfortunately, the data can be difficult to turn into usable, real-time information. We help our clients by implementing the appropriate systems for data analysis and getting the information into the right hands to impact care. We develop programs based on the issues and challenges their members face. We help our clients achieve their goals - from rapid identification to implementing best-in-class methods for contact, education, care coordination and care transitions.
Regulatory performance reporting, such as Medicaid pay-for-performance models, is another area of improvement focus for health plans. We help plans understand their gaps, help define new and better solutions for performance improvement and build roadmaps to success. We assist with project management and implementation. With our experience in provider operations, we bring methods for improving provider workflows to prevent data extraction issues.
Hospitals are refocusing on quality performance metrics now that the surge of the pandemic is winding down. We help hospitals identify their performance based on the available information, define a clear path for improvement and build and implement performance improvement plans that will impact hospital reimbursement, quality of care and patient satisfaction. We help hospitals focus and improve key metrics like hospital-acquired conditions, readmission reduction and improved performance in cost-of-care initiatives.
Health plans are struggling with the rising cost of drugs and ensuring their pharmacy benefit management companies (PBMs) are helping them drive the best solutions. Medication management, patient adherence, and specialty pharmacy drug costs are all critical to improving patient care. Still, many plans and providers don’t have the information or infrastructure to make significant improvements. Our goal is to help plans identify, contract with and manage the right partners to proactively ensure patients get the right medications at the right price.
There are three crucial principles we want to help our clients achieve: operational transformation, enhanced experiences and amplified results. Our work is centered around helping our clients take proactive and innovative approaches that will help drive organizational change and achieve these principles.
We recently had the opportunity to work with a health plan on developing a more in-depth approach to caring for patients with chronic diseases with a concentration on care transitions, patient education and patient empowerment. As the program grows, the added measures of remote monitoring, video contact and greater connections with providers and care planning will help the plan move from a reactive position to a proactive approach.
On the hospital side, we recently worked with a client to complete a current state assessment of the opportunities to improve CMS quality metrics and develop a roadmap for improvements. We defined opportunities in care transitions, discharge planning, and patient satisfaction. We developed tools for discharge planning, updating patient education materials, community resource guides, and staff training and recognition programs to support communication and patient satisfaction.
I believe plans and providers will continue to focus on the challenges of access to care, value-based payment models and building innovative methods to provide services in difficult staffing and economic situations. With our experience with plans and providers around the country, we can bring solutions that are unique and tailored to the needs and strategy of the organization.
Working in a hospital setting and later focusing on pediatric clinical research and now across the healthcare continuum as a consultant have helped me see the bigger picture of healthcare and how, as a clinician, I can help others see multiple perspectives in developing valuable, member (patient)-centered improvements. At the heart of our projects is the context of the patient, the provider and the payer working together.
We know that well-functioning Utilization and Care Management programs can enhance patient/member and provider satisfaction, improve health outcomes and reduce unnecessary health care costs. With our experience in clinical strategies that include care management implementation, clinical workflow assessments, policies and procedures review and Pharmacy solutions, ProspHire can provide the necessary leverage needed to improve efficiency, effectiveness and compliance within your clinical space.