Pro Pharma Announces a Scientific Approach for ACO and HealthCare Exchange Program Oversight

Pro Pharma is announcing Financial and Clinical Outcomes Management and Quality Management Program™ Interventions to assist Physician Provider Groups and ACOs in demonstrating that they can effectively manage utilization and decrease cost.
NORTHRIDGE, Calif. - July 31, 2013 - PRLog -- Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consulting organization which focuses on data analytical expertise, announced today that their decades of experience in oversight and management of systems similar to ACOs and Exchanges can benefit both ACOs and Physician Provider Groups.  The Patient Protection and Affordable Care Act (aka: Health Care Reform) Legislative Alerts note that there are numerous changes forthcoming in the HealthCare marketplace.  The new world of ACOs and Exchanges is ultimately not that new at all.

Pro Pharma’s experience in managing Health Care Benefits for Coalitions of Self-Insured Employers interested in the comparative financial and quality performance of Multiple Plans managed by a collection of Health Plans and Pharmacy Benefit Managers (PBMs) is unmatched in today’s marketplace.

Dr. Stern, President of Pro Pharma, notes that “there is at least one thing that ACO’s and Exchanges have in common; they are both group efforts. And, as groups, they require information to manage their processes and outcomes for success”.  

MD groups and ACOs need to demonstrate that they can manage utilization and decrease cost.  They need data to identify utilization, cost, and quality gaps.  Dr. Stern continues to explain that “actually, the identification and cure of quality gaps will have as a consequence decreased cost trends and control over utilization. Exchanges will need to demonstrate comparable or above average performance in cost, utilization and quality as well.  The survival and long-term viability of Plans in each Exchange will be dependent on their ability to demonstrate excellent value for the money that beneficiaries spend.”

Process Management can make a group more productive.  Dr. Stern states that “Outcomes Management attempts to improve the financial, utilization and clinical outcomes of the individuals touched by the ACO, and the businesses and individuals touched by the Exchanges is imperative.”  Since the bottom-line is that both ACOs and Exchanges will be judged by their outcomes, it is good business practice to implement programs now.

The surgical use of data to identify specific actions that can be taken by individual physicians and groups ultimately leads to outstanding performance of target groups when compared to control groups. This experience has been duplicated time and again for provider groups who drove to improve their quality performance in order to improve their internal financial positions and their sales positions to Health Plans.

Carol Stern, CEO of Pro Pharma, states that “Pro Pharma provides Financial and Clinical Plan Comparisons ( for purchasers and payers across the US that lead to actionable results on a monthly basis.  Implementation utilizing the Quality Management Program™” (  provides comparisons that are benchmarked and trended to ensure that results are sustainable and continually improve. The implementation of comparative findings to apply cures can start with a small group of 100 Primary Care Physicians (PCPs) and demonstrate impact compared to a control group of their peers.  “The cost is less than $1 PMPM with guaranteed minimum ROIs of 1.5:1 in 12 months, or faster if Physicians are given incentives”, notes Ms. Stern.

Please contact Pro Pharma if you are interested in exploring how the results of Pro Pharma's scientific approach to oversight and management can work for your organization utilizing our verifiable and validated programs.

About Pro Pharma Pharmaceutical Consultants, Inc.

PRO PHARMA is a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.

As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.

Pro Pharma’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators.   PRO PHARMA markets Biotech Modeling™, Invoice Screening ™, JCode Calculator™, Quality Management Program™, Rx MAC List™, Treatment Calendar™, and Pro Pharma Suite of Tools™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.

About Quality Management Program™ (QMP)

 Pro Pharma’s Quality Management Program™ (QMP) is a multi-faceted approach that targets the pharmacy benefit cost and quality from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, HR rep education, and messaging to actives/retirees.  The program is focused on providing patients and physicians specific tools designed to make more informed purchasing decisions that expand member co-pay dollars.  The bottom line is:  payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.

About Pro Pharma Suite of Tools™

Pro Pharma’s Suite of Tools identifies the cost and clinical issues for both Pharmacy and Medical, and formulates management plans and objectives to develop action plans to address “prescriptions for change”.

About Invoice Screening™

About 10% of drusg spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against:  formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function.  This ensures that clients only pay for valid claims, which saves time and dollars in the long run.

About JCode Calculator™

Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payments.  The advantage to this product is that it bases all Injectable reimbursement on AWP, WAC and ASP cost, and can be customized.
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