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ProvenCare Process

Proven Care Process

  1. Identify eligible patients
  2. Document appropriateness
  3. Enroll and activate 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 individual 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