Patient Identification & Engagement
To reach plan members who are best suited for our program, we work with payors and providers to identify patients who are at the highest risk for hospital readmissions or have challenges adhering to complex drug regimens.
Because PPA has been managing complex patients for more than a decade, we’ve developed specific methods and tools to engage with hard-to-reach Medicaid, Medicare and other high-need populations.
Home Visits & Medication Inventory
Our first step toward containing costs is to assess the patient’s existing regimen.
We begin by conducting a complete medication inventory at the patient’s home, which includes collecting information on unfilled prescriptions, supplements and vitamins. We also interview the patient and caregiver to capture information about the patient’s existing medication regimen, and conduct assessments/surveys to learn how we can best equip them with tools and resources to assist in regimen adherence.
Reconciliation & Regimen Assessment
Our clinical pharmacy team conducts a comprehensive medication reconciliation based on the data captured from the initial in-home visit and, if available, the original primary provider medication list. All medications, including unfilled prescriptions, are reconciled for a holistic review by the provider.
During this process, we identify duplicate therapies, omissions in care, medications on the health plan’s preferred medication list and any medications that require prior authorization or have coverage/quantity limitations. To monitor polydoc and polypharmacy activities, we identify all providers who have prescribed the patient medication and the pharmacies that filled the prescriptions.
Upon final reconciliation, the provider develops a preferred medication regimen. All of the patient’s providers—including specialists—receive access to the full medication regimen to reduce the likelihood of duplicate prescriptions.
Synchronization & Alignment
To simplify regimen activity for the patient and improve adherence, PPA synchronizes the provider’s medication regimen so the patient receives just one at-home delivery each month. We also provide patients with educational tools, such as easy-to-read bottle tops and descriptive wallet cards—updated monthly—with the current medication regimen, to help them understand their therapy and the purpose of each medication.
Should the regimen change or patient need an acute medication during the month, we make the changes necessary, deliver the medication and educate the patient on the new regimen. If a patient is hospitalized, we work with the provider to ensure the patient’s medications are reconciled with the hospital medications, reducing duplications in therapy and readmissions due to non-compliance.
As needed, PPA will conduct additional in-home patient visits if non-adherence or stockpiling of medications is suspected, or if the provider requests additional check-ins and assessments.
Ongoing Adherence & Compliance Support
To consistently monitor adherence and uncover changes in a patient’s medication regimen, a certified therapy coordinator speaks with the patient and/or caregiver at least once a month to capture medication challenges, changes in health, and information from ER visits, hospital stays and physician appointments. We communicate with each patient and/or caregivers roughly five times per month.
Your patients and their caregivers can also connect with one of our patient care representatives 24 hours a day, 7 days a week with any questions.
To continuously identify gaps in therapy and provide one-on-one adherence coaching to improve outcomes, caseworkers and providers have access to real-time adherence reporting through our collaborative portal, AlliancePoint.
Continuous Collaboration & Validated Outcomes
We understand the importance of tracking medication regimen activity and therapy outcomes to ensure patients receive the most appropriate care, and to ensure we’re doing everything possible to reduce costs.
To foster ongoing communication and to provide unhindered care team visibility of real-time regimen activity, we provide a web-based, data-driven collaboration portal, AlliancePoint.
AlliancePoint allows you to see all your members’ prescribed medications, who prescribed them and when they were delivered. Our system analyzes and reports patient regimen activity, adherence data and therapy outcomes, giving you instant access to the information you need for HEDIS, NCQA, PCMH, ACO and other reporting requirements.
Using AlliancePoint, you can communicate directly with providers and clinical pharmacists, and receive alerts (along with the prescribing providers) of any changes in patient regimen activity or treatment issues that arise.