Proven Care Process

1. Identify eligible patients
2. Document appropriateness
3. Enroll and active the patient and family
4. Deliver evidence-based care
5. Geisinger is paid a global fee

• One fee for the entire identified period of time
• Global fee includes 50% share of historical readmission rate (guaranteed payer savings, Geisinger upside based on complication and readmission reduction and efficient care

All or None Measures

• Measure percentage of patient who receive all related services (not indicidual measure alone)
• Most all or none measures will not reach 100%
• Some goals not appropriate for all patients,some goals not achieveable for all patients

ProvenCare CABG Financial Results

• Average total LOS fell 0.5 days (6.2 vs. 5.7)
• 30-day readmission rate fell 44%

Health Policy Considerations

• Access to health insurance is key
  • Should include regional plans (provide flexibility and innovation)

• Formation of Integrated Sytsems should be facilitated
  • Bundled payments
  • Episode of care payments
  • Treatment based – not insurance risk
  • Accountable care organizations
  • “Cost saving” shared with providers

• Healthcare Information Technology
  • Computers and Electronic Health Records are necessary, not sufficient
  • Redesign of care required
  • Ongoing upgrades needed

• Comparative effectiveness research
• Training of next generation