Creating a Clinical Program
Attached are the instructions to the multi-part assignment and I am focused on resubmitting step 1 (I will open separate orders for steps 2 & 3 later).
I’ve added the professor’s feedback in the comments section of the attached ‘Creating a Clinical Program_prof response.doc’
There is a lot of feedback from the professor, and I think it’s important that you review it all, and we chat about your approach, so please email me with any questions or your thoughts as to the direction. The original plan was to go with the Hypertension program but after the feedback, not sure if we need to change gears and choose something else. She mentioned that if something is already at a 90% adherence rate will the employer really care about that program (maybe but we would need to explain why)? I’ll let you decide based on your review of the feedback.
Below are the links to all the referenced articles around this that the professor wants to ensure are taken into consideration, and I’ve attached those articles without links. It is important that we understand and incorporate the guidance from “The 3 Pillars of value-based decision making” in the attached ‘Clinical programs and value-based decision-making.pdf’ article.
The professor wants this program to be created to be from the perspective of the Magellan PBM, meaning we do not have diagnosis info, we only have drug utilization, adherence, and cost info. As the PBM we need to ensure we are referring to the Magellan formulary for drugs or drug classes that are selected so we know what they already have on the formulary, those preferences, Prior Auth’s etc (more of that info in the “Creating a Clinical Program_prof” document comment sections).
• Magellan Formulary: https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtNTg
When defining the program criteria, goals, and ROIs…Nothing can be vague..we need specific (SMART) criteria or goals and they need to be based on the data provided In the course with GatorCare Data or Adherence documentation (there will be some assumptions but the majority needs to be focused on the data we have). What is the baseline and what is our target metric.
Here are the online articles that should also be considered
• Disease Management: https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/disease-management
• Payor Care Management: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-untapped-potential-of-payer-care-management
Keep in mind what is resubmitted is just a summary draft, but it will be the basis for steps 2 & 3 (separate orders), which will require a lot more detail.
——–Previous Instructions——-(see attached revised assignment document)
I will have multiple parts to this assignment. Each Part will build on the previous, so this theme will be carried over to the next assignment. Whatever you select as the topic will be carried over to the next assignment. I’ll give you the full scope of what we will end up doing, but this assignment will be focused on Step 1, which is just a proposal for future work. We have to progressively create a clinical program (we should not use an existing one out there). The goal of the Clinical Program is to improve any data point in either of the 2 attached files (eg. Improve Trends, Mail order, Adherence, etc). Whatever is selected will be the basis of next week’s assignment. Review the ‘Clinical Program Assignment word doc to complete Step 1 and see what the future assignments will be that I will create orders for. Let me know what metric data point you selected to improve.
