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111 ProvenHealth Navigator: A Patient Centered Primary Care Model Duane Davis, MD, VP, Chief Medical Officer Janet Tomcavage, RN, MSN, VP, Health Services.

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Presentation on theme: "111 ProvenHealth Navigator: A Patient Centered Primary Care Model Duane Davis, MD, VP, Chief Medical Officer Janet Tomcavage, RN, MSN, VP, Health Services."— Presentation transcript:

1 111 ProvenHealth Navigator: A Patient Centered Primary Care Model Duane Davis, MD, VP, Chief Medical Officer Janet Tomcavage, RN, MSN, VP, Health Services Geisinger Health Plan

2 2 Geisinger Health System: Danville, Pa Geisinger Clinic: 700 Physicians 41 Community Practice Sites Geisinger Medical Centers - 3 Acute Care Hospitals Geisinger Health Plan: 80 Hospitals 16,000 Providers 215,000 Members

3 3 Better Value for health care spend is the goal 1.Someone needs to be charged with delivering value 2.Medical Home/Chronic care models will cost more 3.Any delivery system changes must deliver savings today 4.Proven Health Navigator is GHS value agent

4 4 Proven Health Navigator Strategy Deliver optimal health status for individuals and population based value outcomes via a partnership between PCPs and GHP that provides 360 degree, 24/7 care and guidance to the practice population.

5 5 Value is defined as hitting target metrics in the domains of: Patient experience Quality outcomes Efficiency outcomes

6 66 ProvenHealth Navigator Pilot Goals Improve patient experience and health status Improve quality and efficiency across the entire spectrum of care Transform primary care from transaction to value focus Provide meaningful coordination across all of Health Care

7 7 The System has five functional components 1.Patient Centered Primary Care 2.Integrated Population Management 3.Care Systems 4.Quality Outcomes Program 5.Value Reimbursement Program

8 8 1. Patient Centered Primary Care : expanding primary care capabilities Acute and chronic illness care Expanded scope of services Team based care Patient and family engagement & education Rx management program Chronic disease and preventive care optimization via EMR embedded triggers

9 9 2. Population Management: giving PCPs ability to see and impact a population Predictive Modeling Population profiling and segmentation Health promotion Case Management on site Disease Management education Patient specific intervention plans Remote monitoring Pharmaceutical management

10 10 3. Value Care Systems: keeping patients in line of sight across the care continuum Micro-delivery referral systems –High volume specialties –Ancillary services – Radiology, Lab 360 degree care systems –Hospital care –Home Health –SNFs –ER coverage

11 11 4. Quality Outcomes Program : t racking outcomes and continually improving Patient Satisfaction Metrics Chronic Disease Metrics –Diabetes, CHF, Coronary Disease, Hypertension Preventive Services Metrics –HEDIS Influenza, Pneumoccal

12 12 5. Value Reimbursement Program: Aligning payment with value outcomes Fee For Service Practice transformation stipends - Physician - Infrastructure Value Based incentive payments –Opportunity based on efficiency results –Payments based on quality metrics

13 13 Initial Results are promising Quality – improved outcomes Efficiency – improved medical trend

14 14 Proven Health Navigator Quality Metrics Quality Metric Site #1 Baseline CY2006 Site #1 PY1 CY2007 % Improvement Risk assessment0100% Plan of Care099% Follow-up EncountersN/A84% Ability to get desired appts84% 0% Care received during visit91%92%1% Pneumococcal Vaccine82%86%5% Influenza Vaccine68%63%-7% Diabetes9%11%22% CAD11%16%45%

15 15 Efficiency Results at initial ProvenHealth Navigator sites are positive Phase 1 Sites 2006/2007 Trend* Non-HN Sites 2006/2007 Trend* Inpt Allowed PMPM- 15%+ 10% Pre-Rx Allowed PMPM- 4%+ 7% Total Allowed PMPM+ 3%+ 12% Total Admits/ %+ 6% Readmission Rate- 11.7%- 2% * Risk Adjusted

16 16 Experience to date has led to 5 implementation priorities Predictive Modeling to stratify Population Make Case Manager key member of care team Manage transitions of care – post acute hospital Manage SNF admissions Use EPIC reporting and decision support to drive QI

17 17 Q & A Discussion


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