to his board as the fifth item on a strategic plan for the health
center, and it was approved in December 1995.
In May 1996, Mr. Palmer held a community
meeting for 120 local providers, advocates, elected officials, clergy
and citizens and presented his vision for a network that would:
- Coordinate care for high-risk populations across disciplines.
- Improve health and reduce system costs (inpatient,
emergency room visits).
- Receive a percentage of the cost savings.
- Use the cost savings to pay for health care for the
uninsured and reduce dependence on grants and government funding.
To accomplish this, three distinct programs would be developed
- Case management and outreach services.
- Basic coverage to the uninsured using a network
- Discount prescriptions using physician dispensing
and the federal 340B
A strategic planning committee, made up providers,
advocates and other volunteers, was then created and began meeting
two to three times per month, (at 7am) for two consecutive years,
to develop the business plan, by-laws and basic corporate structure
for the network. Mr. Palmer subsequently presented the business
plan to the leaders of Pittsburgh-based foundations that funded
health care and requested start-up funds to build the network.
The network’s initial funders became the
Forbes Fund, Jewish Healthcare Foundation, McCune and Richard King
Mellon Foundation, who provided not only financial resources but
also human capital to create a new model of care.
Operations began on March 15, 1998 with Mr. Palmer
and an assistant in a one-room office in Monroeville, Pennsylvania.
By the fall of 1998, twelve interested agencies
representing a combination of medical, social and behavioral health
safety-net providers joined the Network, bringing high-risk patient
experience and the grassroots relationships needed to reach the
Network’s target population.
In May 1999, the region’s largest
Medicaid HMO, Gateway Health Plan, contracted with Coordinated Care
Network to provide Preventive Case Management
services to over 5,000 members. This program ran for almost five
years through January 31, 2004, and was subsequently replaced with
the 340B Poly-Pharmacy Member Case
In June 2000, (the former) UPMC/Best Health
Plan became the second Medicaid HMO to contract with Coordinated
Care Network for its Preventive Case Management services. Serving
approximately 10,000 patients, this program ran through December
Overall, the Network’s Preventive Case
Management services reduced inpatient and emergency room utilization
by 18% & 24% respectively (per 1,000 population), and became
a national model. Both the University of Pittsburgh Medical Center
Health Plan and Gateway Health Plan adopted Preventive Case Management
models of care internally and operate them today as a standard of
In March 2001, Coordinated Care Network
received a prestigious national Community Access Program (CAP) grant
from the Health Resource and Service Administration, a branch of
the federal government, for implementation of the 340B Physician
Dispensing and Mail Order Program. Metro Family Practice, who joined
the Network in August 2001, became the first Federally Qualified
Health Center to implement the program.
Zoar NewDay, a treatment program for women,
was approved for membership and joined the Network in February 2002.
Coordinated Care Network also expanded and moved its offices to
a 5,500 square foot space in Monroeville, Pennsylvania in order
to house the central pharmacy and mail order facility.
Metro Family Practice launched the 340B Physician
Dispensing and Mail Order Program in September 2002. Since then,
45 others have contracted (including the University of Pittsburgh
Medical Center) and nine sites
are currently operational.
Mr. Palmer presented the concept for the
340B Poly-Pharmacy Member Case Management program, initially referred
to “HiRx Case Management,” to Gateway Health Plan in
May 2003 as a way to reduce pharmacy and inpatient costs through
a combination of case management and 340B mail order services. Gateway
agreed in principle to identify their high pharmacy utilizers and
refer them for case management under a special model involving Metro
Family Practice and CCN’s case management department and mail
In November 2003, the Pennsylvania Department
of Public Welfare formally approved the 340B Poly-Pharmacy Member
Case Management contract at which point operational and implementation
planning were accelerated.
The 340B Poly-Pharmacy Member Case Management
Program officially launched on May 1st, 2004.
As a result, health care facilities in
other states have requested CCN to replicate this model for their
Medicaid populations, and the state of Pennsylvania is currently
working on a pilot to apply the model to Medicaid fee for service