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Payment Transformation

Featured care delivery and payment innovation:

Clinician Digital Assistant

In its planning phases, this project strives to create an environment that allows physicians to spend more face-to-face time with their patients and helps achieve best outcomes through improving patient interactions. A digital physician assistant captures and synthesizes patient-care provider conversations through artificial intelligence (AI), thereby helping to improve the care team’s efficiency and effectiveness, as well as reduce administrative burdens for physicians and clinical staff.

Through a system that records conversational interactions, the virtual assistant’s AI can assist with decision-making at each point in the patient journey, including patient and colleague interactions and patient case review. Its capabilities also include recommendations based on symptoms and pre-existing conditions, location and insurance-based options — all to improve patients’ outcomes, quality of care, affordability and experience.

Chronic Disease Management Command Center

Our teams are developing an innovative approach for people struggling with chronic disease to make better health a reality. The Chronic Disease Management Command Center is a care model designed to improve outcomes and lower healthcare costs for those living with chronic disease or diseases. The Command Center will harness groundbreaking technology, including remote patient monitoring, patient reported outcomes, virtual visits and artificial intelligence to transform the way our care management infrastructure interacts with those we care for in our hospitals and clinics. By focusing on personalized holistic experiences and interventions, we can empower those with chronic disease to take a more active role in their care and ultimately live healthier lives.

Our initial focus will be on five chronic conditions:

  • Diabetes
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure
  • Stroke
  • Hypertension

We plan to add additional conditions as the platform grows and scale our efforts across the entire Geisinger system by 2021.

Keystone Accountable Care Organization

Geisinger is a member of the Keystone Accountable Care Organization (ACO), which is a group of nearly 5,000 physicians and advanced practitioners and 9 hospitals who deliver over $800 million annually in coordinated healthcare services to more than 80,000 Medicare patients in Pennsylvania.

Established in 2013, the Keystone ACO focuses on delivering coordinated, high-quality care for a lower cost. In fact, its participating organizations have saved Medicare an estimated $50 million before shared savings payments, all while improving rates of preventive care and providing enhanced services, like chronic disease management. To achieve these outcomes, the Keystone ACO partners with administrators, providers and office staff to embed best practice protocols in how they engage, treat and educate their patients. It also develops and deploys new care models across its network that harness technology, like telemedicine video visits and Radar vests to reduce heart failure complications.

Following a value-based payment model, Medicare payments to Keystone ACO providers incentivize lowering cost and improving care quality and patient outcomes. The Keystone ACO participated in Track 1 of the Medicare Shared Savings Program (MSSP) from 2013 to2017, transitioned to the Track 1+ Model in 2018 and is currently a Basic Track E Model ACO. Under the shared savings model, Medicare pays Keystone ACO providers fee-for-service rates for the healthcare services they deliver to patients, and they have the potential to earn additional payment if the total care expenditures for the Keystone ACO’s attributed population are below an established expenditure benchmark. If the attributed population’s total care expenditures are above the expenditure benchmark, the ACO may owe money to Medicare.

Bundled payments

Geisinger has been engaged in Medicare’s Bundled Payment for Care Improvement program since 2014, and in 2020, more than $140 million in healthcare services delivered by Geisinger will be part of Medicare’s Bundled Payment for Care Improvement Advanced (BPCIA) program. The goal of the BPCIA program is to improve care quality, while reducing costs for 90-day episodes of care that begin with a hospital stay by closely coordinating hospital and post-hospital services. Since 2014, Geisinger has saved Medicare an estimated $10 million before shared savings payments through reduced length of stay, readmissions and use of high-cost post-acute services, such as inpatient rehab and skilled nursing. Geisinger’s work for the BPCIA program focuses on care redesign and the adoption of evidence-based clinical protocols, maintaining a high-performing post-acute provider network and providing care coordination services for discharged patients.

Four of Geisinger’s hospitals participate, including:

  • Geisinger Medical Center
  • Geisinger Wyoming Valley Medical Center
  • Geisinger Community Medical Center
  • Geisinger Lewistown Hospital

As with all value-based payment models, the BPCIA payment structure incentivizes Geisinger to standardize the quality of its hospital care and to improve post-hospital patient outcomes for the immediate 90-day period following a hospitalization. Under a retrospective bundled payment model, Medicare pays Geisinger fee-for-service rates for the healthcare services delivered to qualifying hospitalized patients, and Geisinger has the potential to earn additional payment if the care expenditures during the 90 days are below an assigned target cost. If the total cost of care for each of these patients is lower than the target price, the Centers for Medicare & Medicaid Services (CMS) distributes the difference to Geisinger. If the costs are higher, Geisinger distributes the difference to Medicare.

Our leadership team:

  • Meg Horgan, MSN, RN, Senior Clinical Advisor
  • Melody Danko-Holsomback, CRNP, MSN, Chief Administrative Officer, Keystone ACO
  • Janet Comrey, RN, BSN, MHSA, Director, Value-Based Care