1. ProvenHealth Navigator: A Patient Centered Primary Care Model
Duane Davis, MD, VP, Chief Medical Officer
Janet Tomcavage, RN, MSN, VP, Health Services
Geisinger Health Plan 1 1

2. Geisinger Health System: Danville, Pa
Geisinger Clinic:
700 Physicians
41 Community Practice Sites
Geisinger Medical Centers - 3 Acute Care Hospitals
Geisinger Health Plan:
80 Hospitals
16,000 Providers
215,000 Members 2

3. Better Value for health care spend is the goal
Someone needs to be charged with delivering value
Medical Home/Chronic care models will cost more
Any delivery system changes must deliver savings today
Proven Health Navigator is GHS value agent 3

4. Proven Health Navigator Strategy
Deliver optimal health status for individuals and population based value outcomes via a partnership between PCP’s and GHP that provides 360 degree, 24/7 care and guidance to the practice population.

5. Value is defined as hitting target metrics in the domains of:
Patient experience
Quality outcomes
Efficiency outcomes

6. ProvenHealth Navigator Pilot Goals
Improve patient experience and health status
Improve quality and efficiency across the entire spectrum of care
Transform primary care from transaction to value focus
Provide meaningful coordination across all of Health Care 6

7. The System has five functional components
Patient Centered Primary Care
Integrated Population Management
Care Systems
Quality Outcomes Program
Value Reimbursement Program

8. 1. Patient Centered Primary Care: expanding primary care capabilities
Acute and chronic illness care
Expanded scope of services
Team based care
Patient and family engagement & education
Rx management program
Chronic disease and preventive care optimization via EMR embedded triggers

9. 2. Population Management: giving PCP’s ability to see and impact a population
Predictive Modeling
Population profiling and segmentation
Health promotion
Case Management on site
Disease Management education
Patient specific intervention plans
Remote monitoring
Pharmaceutical management

10. 3. Value Care Systems: keeping patients in line of sight across the care continuum
Micro-delivery referral systems
High volume specialties
Ancillary services – Radiology, Lab
360 degree care systems
Hospital care
Home Health
SNF’s
ER coverage

11. 4. Quality Outcomes Program: tracking outcomes and continually improving
Patient Satisfaction Metrics
Chronic Disease Metrics
Diabetes, CHF, Coronary Disease, Hypertension
Preventive Services Metrics
HEDIS Influenza, Pneumoccal

12. 5. Value Reimbursement Program: Aligning payment with value outcomes
Fee For Service
Practice transformation stipends
- Physician
- Infrastructure
Value Based incentive payments
Opportunity based on efficiency results
Payments based on quality metrics 12

13. Initial Results are promising
Quality – improved outcomes
Efficiency – improved medical trend 13

14. Proven Health Navigator Quality Metrics
Site #1
Baseline
CY2006
PY1
CY2007
% Improvement
Risk assessment
100%
Plan of Care
99%
Follow-up Encounters
N/A
84%
Ability to get desired appts 0%
Care received during visit
91%
92% 1%
Pneumococcal Vaccine
82%
86% 5%
Influenza Vaccine
68%
63%
-7%
Diabetes 9%
11%
22%
CAD
16%
45%

15. Efficiency Results at initial ProvenHealth Navigator sites are positive
Phase 1 Sites 2006/2007 Trend*
Non-HN Sites
2006/2007 Trend*
Inpt Allowed PMPM
- 15%
+ 10%
Pre-Rx Allowed PMPM
- 4%
+ 7%
Total Allowed PMPM
+ 3%
+ 12%
Total Admits/1000
- 12%
+ 6%
Readmission Rate
- 11.7%
- 2%
* Risk Adjusted

16. Experience to date has led to 5 implementation priorities
Predictive Modeling to stratify Population
Make Case Manager key member of care team
Manage transitions of care – post acute hospital
Manage SNF admissions
Use EPIC reporting and decision support to drive QI 16

17. Q & A
Discussion 17 17 17