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Improved patient outcomes, reduced cost of care

Apr 07, 2015 10:34AM ● Published by Erica Shames

A new study reports that Geisinger Health System’s patient-centered medical home, ProvenHealth Navigator (PHN), is producing sustainable, long-term improvements in health outcomes for elderly Medicare patients at a reduced cost. The study, which was posted online today in the April edition of the journal Health Affairs, found that total costs associated with PHN exposure declined by approximately 7.9 percent over the 90-month period of the study, while acute inpatient admission rates fell by 18 percent.

Geisinger’s ProvenHealth Navigator is a model that encourages a transition away from episodic illness and toward a comprehensive coordinated primary care approach. The program is structured to empower patients to be more informed about their health, better able to navigate the health care system and more equipped to make educated decisions about their health care options.

 “This study illustrates the potential dual benefits of patient-centered medical homes in terms of lowering costs while achieving improved quality of care,” said Thomas Graf, M.D., chief medical officer for population health and the longitudinal care service lines, Geisinger Health System, a study author who directs PHN. “Geisinger’s ProvenHealth Navigator experience has shown that achieving higher quality of care can lead to significant and sustainable reductions in the cost of care over a long period.”

In addition to Dr. Graf, Geisinger authors included Daniel D. Maeng, Ph.D., a research investigator for Geisinger’s Center for Health Research; Janet Tomcavage, RN, MSN, senior vice president and chief, value-based strategic initiatives; Duane E. Davis, a consultant at xG Health Solutions who was chief medical officer at Geisinger Health Plan at the time of the study, and Glenn D. Steele, M.D., Ph.D., president and CEO. Nazmul Khan, national advisory manager at PricewaterhouseCoopers, also was an author.

The researchers estimated cost savings associated with PHN by examining Geisinger Health Plan clinic-level claims data from more than 6,400 elderly Medicare patients attending clinics over a 90-month  period (Jan. 1, 2006 through June 30, 2013). They used the data to identify savings in four areas – inpatient, outpatient, professional and prescription drugs.

Their analysis found that the largest source of costs savings was in acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. They also found that longer exposure to PHN yielded greater reduction in acute inpatient admission rates.

The authors cite three reasons for the reported success of ProvenHealth Navigator:

It is a data-driven, payer-provider partnership that goes beyond simply enhancing information technology infrastructure at practice sites. Instead, it seeks to translate practice-specific data into meaningful care plans by clinical experts.

It is led by system-wide programmatic leadership that focuses on the entire care process instead of a single point in the process.

It seeks to extend value for patients and medical professionals beyond traditional primary care settings.

“These findings provide some useful insights into the potential impact of a patient-centered medical home (PCMH) transformation for primary care providers and payers that may be considering PCMH adoption, particularly for their elderly Medicare patient populations,” Dr. Graf said. “This group typically has greater prevalence of multiple chronic diseases and uses more health care than the general population. Elderly Medicare patients are more likely than others to be prone to avoidable hospitalization and duplicative care that may be reduced via better care coordination, like this.”

About Geisinger Health System

Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development of innovative care models such as ProvenHealth Navigator® and ProvenCare®. As one of the nation’s largest rural health services organizations, Geisinger serves more than 3 million residents throughout 48 counties in central, south-central and northeast Pennsylvania. The physician-led system is comprised of approximately 23,500 employees, including a 1,200-member multi-specialty group practice, nine hospital campuses, two research centers and a 467,000-member health plan, all of which leverage an estimated $7.7 billion positive impact on the Pennsylvania economy. The health system and the health plan have repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit, or follow the latest Geisinger news and more on Twitter and Facebook.

ProvenHealth Navigator®: Sharing Geisinger’s Operational Experience in Building a Successful Medical Home

PHN – ProvenHealth Navigator

PTMPY: Per Thousand Members Per Year

Source: Gilfillan, RJ, et al. Value and the Medical Home: Effects of Transformed Primary Care. The American Journal of Managed Care. 2010;16(8):607-614.

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