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ProvenHealth Navigator: A Patient Centered Primary Care Model

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Presentation on theme: "ProvenHealth Navigator: A Patient Centered Primary Care Model"— Presentation transcript:

1 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 1 1

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 2

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

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

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

6 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 6

7 The System has five functional components
Patient Centered Primary Care Integrated Population Management Care Systems Quality Outcomes Program Value Reimbursement Program

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 2. Population Management: giving PCP’s 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 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 SNF’s ER coverage

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

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 12

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

14 Proven Health Navigator Quality Metrics
Site #1 Baseline CY2006 PY1 CY2007 % Improvement Risk assessment 100% Plan of Care 99% Follow-up Encounters N/A 84% Ability to get desired appts 0% Care received during visit 91% 92% 1% Pneumococcal Vaccine 82% 86% 5% Influenza Vaccine 68% 63% -7% Diabetes 9% 11% 22% CAD 16% 45%

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/1000 - 12% + 6% Readmission Rate - 11.7% - 2% * Risk Adjusted

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 16

17 Q & A Discussion 17 17 17

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