Provider Problem: How to deliver cost effective care to patients in the prison system, as well as other vulnerable populations.
Advis Innovation: Optimize 340B by leveraging a telemedicine model.
How do you ensure that your hospital delivers cost-efficient, quality care to vulnerable populations? With over 2.3 million inmates, whose healthcare costs nearly $8 billion a year, a particularly vulnerable and costly population of patients resides in our nations prison system.
Advis has become one of the nation’s leaders in instituting 340B relationships between covered entities and state prison systems to help drive down costs and improve service. This model can service other vulnerable populations as well. Have you evaluated your 340B program to optimize performance? The telemedicine model may benefit you.
Ideally, with prison system patients, a physician-patient relationship is first established through a telemedicine encounter. The hospital’s credentialed provider is located either within the hospital’s four walls or within a provider-based practice location. This location has 340B child site status, recognized as the distant site of the telemedicine encounter. The state provides a dedicated treatment room within the corrections facility where the patient is located. This room is known as the originating site for the telemedicine encounter. The state reimburses the hospital for its services through Medicaid, where inmates are covered under the state’s program. In other instances, where the DOC directly provides healthcare to inmates, the hospital and DOC engage in a direct, payor-type relationship with negotiated terms of coverage and reimbursement. Once responsibility for the patient and reimbursement for services are established, the hospital may choose to utilize its 340B eligibility to purchase 340B drugs to better manage drug costs.
More often than not, the focus of the discussion is on high-cost HIV/AIDs drugs. The resulting structure may take many forms. Contract pharmacy relationships are common if the DOC maintains on-site pharmacies at its corrections facilities; more creative solutions such as utilizing the hospital pharmacy and a courier service are likewise employed. In 2015, a spokesman for HRSA stated that 29 covered entities operated service arrangements with state prison systems. Although some of these relationships are likely exclusive, your state DOC may be open to exploring a relationship with your hospital. Advis will help you identify and define the opportunity where one exists or can be created. We will quantify that opportunity and its impact upon you and the state. Advis then works with legal to design contracting strategies to meet the needs of your hospital and the state. This service model can be adapted to service any vulnerable patient population.
If you are interested in this opportunity or other innovative 340B strategies, please contact The Advis Group at (708) 478-7030, or visit us on the web at www.advis.com