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Davis Presentation

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Davis Presentation

  1. 1. 1 11 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. 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. 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. 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. 5. 5 Value is defined as hitting target metrics in the domains of: • Patient experience • Quality outcomes • Efficiency outcomes
  6. 6. 6 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
  7. 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. 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. 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. 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 – SNF’s – ER coverage
  11. 11. 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. 12. 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. 13 13 Initial Results are promising • Quality – improved outcomes • Efficiency – improved medical trend
  14. 14. 14 Proven Health Navigator Quality Metrics Quality Metric Site #1 Baseline CY2006 Site #1 PY1 CY2007 % Improvement Risk assessment 0 100% 100% Plan of Care 0 99% 99% Follow-up Encounters N/A 84% 84% Ability to get desired appts 84% 84% 0% Care received during visit 91% 92% 1% Pneumococcal Vaccine 82% 86% 5% Influenza Vaccine 68% 63% -7% Diabetes 9% 11% 22% CAD 11% 16% 45%
  15. 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/1000 - 12% + 6% Readmission Rate - 11.7% - 2% * Risk Adjusted
  16. 16. 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. 17 1717 Q & A Discussion

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