Value Based Care

PPN has embraced Value Based Care programs as a step toward the future of the practice of medicine through the use of Care Coordination and Cost-To-Quality Analytics. We support physicians in satisfying the principles of Clinical Integration while assisting them with population management and achieving the “triple aim” of improved patient access to healthcare, quality and cost efficiency.

Care Coordination

PPN Patient Care Coordinator Nurses function as an extension of the Physician’s office in the support of their patients through the following activities:

  • Notify physicians when their patients have been admitted to the hospital or visited the Emergency Room
  • Contact patients and physicians during and after hospitalizations in order to assist the transition of care to improve health outcomes and reduce readmissions
  • Monitor the care of complex patients and assist the patients and providers in accessing additional services that may be needed such as disease specific support through the patient’s health plan and the engagement of social services
  • Provide education for at-risk patients and their families
  • Education regarding Preferred In-Network Providers
  • Education regarding appropriate Emergency Room utilization
Cost-To-Quality Analytics
  • Population Health Management with the use of Predictive Risk Stratification
  • Identify and help close “Gaps in Care”
  • Identify Out-of-Network utilization

Our Current Programs

Patient Centered Medical Home

Cigna Collaborative Accountable Care (CAC)

Commercial ACO Programs

Blue Cross Blue Shield of Texas ACO and United Healthcare ACO