Our nationally-recognized network of care is making headlines across the country. Driven by our employees, the research we do is part of what puts us on the leading edge of being prepared for the future of healthcare - and the changes with reform.
At the same time, our efforts make a significant impact here at home. With programs like you see below, people are literally becoming healthier individuals, and, as a result, our entire population is strengthened.
All of these innovations are made possible through $12.5 million spent on our research, investment in our people, more than $130 million in technology like Electronic Health Records (EHR) and collaborations among our organizations and with community partners.
Geisinger's sophisticated health information technology (HIT) enables caregivers to provide consistent care at a reduced cost across the system's footprint through a number of innovative initiatives. A sampling of these programs follows.
ProvenCare is a multipronged approach to providing quality care at a reduced cost. ProvenCare, a collaborative effort between Geisinger Clinic and Geisinger Health Plan (GHP), relies on the redesign of care processes and Geisinger's advanced electronic health record (EHR) to create and standardize evidence-based best-practice "bundles" of care. Findings show that the program has significantly increased adherence with guidelines and improved clinical outcomes. Strategic Priorities:
- Identify high-volume diagnostic-related groupings
- Determine best-practice techniques
- Deliver evidence-based care
- GHP pays global fee
- No additional payment for complications
ProvenCare® Acute Episodic
Recognized by The New York Times, The Washington Post, The Financial Times, and others, the model features a global price that covers all aspects of preadmission, inpatient, and follow-up care at a Geisinger facility, as well as any care including readmission, due to postoperative complications within a 90-day period. Originally designed for coronary artery bypass graft (CABG) surgery, the model has been expanded to cover other surgical and interventional procedures related to bariatric surgery, hip replacement, and cataract surgery. Results consistently show decreased mortality, rates of infection and other complications, length of stay, and readmission rates. The ProvenCare Acute Episodic Care Portfolio includes:
- Total hip replacement
- Cataract removal
- Percutaneous coronary intervention
- Bariatric surgery
- Perinatal care and delivery
- Low back pain management
- Chronic kidney disease and erythropoietin
- Lung cancer resection (National Collaborative)
ProvenCare® Chronic Disease
Following many of the principles of the ProvenCare Acute Episodic model, this initiative expands bundling to the chronic care continuum-providing care in the hospital, in physicians' offices, at home, or in other settings. It also covers adult disease prevention. Payment arrangements include a quality-based incentive program for primary care providers (PCPs). As with the acute episodic model, evidence-based, standardized best practices are hardwired into the EHR to ensure that every patient receives every element of care, every time. The ProvenCare Chronic Disease portfolio includes:
- Congestive heart failure
- Coronary artery disease
- Prevention bundle
Geisinger's staff leverages the system's EHR to deliver targeted, optimum care. By systematically identifying patients who are due for regular screenings, vaccinations, and testing as part of an overall wellness standard-e.g., colonoscopy, mammograms, flu and pneumonia vaccines, tetanus boosters, bone density screening- Geisinger closes preventive, chronic, and restorative care gaps for targeted patient populations by age/gender, disease, or condition. As of July 2010, 50,872 care gaps were closed, with a net contribution margin of $5 million.
Keystone Beacon Community Award
Geisinger was awarded a $16 million grant to create the Keystone Beacon Community as part of the U.S. Department of Health and Human Services' Beacon Community cooperative program.
The Keystone Beacon Community, which builds on the KeyHIE secure electronic infrastructure, will focus on improving continuity, quality, and efficiency of patient care. At the same time, it will leverage electronic connectivity to smooth patient transitions throughout the care continuum-primary care, free clinics, inpatient, outpatient, and home health and skilled nursing facilities.
The funding will allow Geisinger to extend the benefits of its patient-focused HIT initiatives, including PHN, to other healthcare providers throughout Columbia, Montour, Northumberland, Snyder, and Union counties. Ultimately, the plan is to roll out the service regionally to illustrate that improved patient outcomes resulting from HIT and care coordination can be achieved beyond the walls of institutions such as Geisinger.
ProvenHealth Navigator (Advanced Medical Home)
ProvenHealth Navigator (PHN), a collaboration between GHP and Geisinger Clinic, is the system's patient-centered advanced medical home initiative.
Rolled out in 2007, PHN is designed to drive sustained changes in healthcare quality and value by providing physician-directed, team-based care. The model is designed to improve the quality of care provided in physician offices through the implementation of a series of patient-centered, integrated, physician-guided, cost-effective, and evidenced-based longitudinal protocols.
Results of a Geisinger study published in the August 2010 edition of the American Journal of Managed Care show that PHN is capable of simultaneously improving quality and reducing costs, while enhancing physician and patient satisfaction.
The observational study looked at four years of claims data for approximately 15,000 of GHP's Medicare Advantage members at 11 of Geisinger's community practice sites. When compared with a control group, over the past three years PHN reduced hospital 30-day readmissions by 40% and overall hospital admissions by 20%. Additionally, the cost of care for PHN patients was 7% less than the cost of care for patients in the control group.
Today, PHN has been adopted at 31 Geisinger community practice sites, one internal medicine practice, and five non-Geisinger practice sites. It employs 61 case managers (paid for by GHP) who work in physician offices. By early 2011, PHN will be rolled out to the remaining Geisinger community practice sites as well as to other contracted practices.
One of the key focuses of research in the next 10 years will be personalized health, the use of environmental and genomic information to help predict how well a patient will react to a therapy. By adding genetic information into a treatment protocol, physicians are able to work with patients to make better treatment decisions. As shown in the figure below, Geisinger has developed a variety of programs in support of personalized health initiatives. Applying Personalized Health to the Study of Obesity One of the distinguishing characteristics of research at Geisinger is the ability to work with clinical partners and other research entities within and outside the system. Geisinger's Obesity Institute is a perfect example.
Working with the Translational Genomics Research Institute (TGen) in Phoenix, researchers at Geisinger's Obesity Institute are looking at possible genetic reasons why so many Americans are overweight, and why diet, exercise, and specifically, bariatric surgery, may fail to significantly reduce excess weight in some patients.
Geisinger and TGen also are leveraging each other's expertise to uncover genetic mutations that predispose patients to diseases such as congestive heart failure, abdominal aortic aneurysms, and the potential side effects of prescription drugs.