Full text is available at:
http://content.healthaffairs.org/cgi/content/abstract
/27/5/1235?ijkey=xGyM8BnoFl/q2&keytype=ref&siteid=healthaff
In the Literature
Synopsis
Through innovations like patient-centered medical homes, chronic disease management, and bundled payment of acute-care episodes, Geisinger Health System in Pennsylvania is improving its quality of care and achieving better outcomes for patients, while at the same time lowering costs and increasing value.
Background
Serving central and northeastern Pennsylvania, Geisinger Health System comprises nearly 700 physicians across 55 clinical practice sites, three acute-care hospitals, a variety of specialty hospitals and ambulatory surgery campuses, a 215,000-member health plan, and other services and programs. Geisinger's 2.5 million patients are, on average, poorer, older, and sicker than patients nationally.
Innovative Practices
Medical homes. At Geisinger, the implementation of patient-centered medical homes has meant round-the-clock access to primary and specialty care services, which are enhanced through the use of nurse care coordinators, care management support, and home-based monitoring. Physicians and patients alike have access to electronic health records (EHRs); for patients, this means they can view lab results, schedule appointments, receive reminders, and e-mail their providers. To encourage physician participation in the medical home innovation, Geisinger provides practice-based monthly payments of $1,800 per physician, and stipends of $5,000 per 1,000 Medicare patients to help finance additional staff. Preliminary data show a 20 percent reduction in hospital admissions and 7 percent savings in total medical costs. Based on this success, Geisinger is expanding the initiative to additional practice sites.
Chronic disease care optimization. Geisinger provides coordinated, evidence-based care for patients with chronic diseases, including diabetes, congestive heart failure, and hypertension. Through its use of EHRs, Geisinger is able to standardize clinical practices, provide doctors with a "snapshot report" of patients' relevant clinical information, and generate automated reminders for patients as well as the clinical team. Patients can also self-schedule appointments and receive an after-visit summary to see how they are doing compared with their goal. In addition, practices receive performance reports that compare their results with historical trends and peer sites. Physicians may receive financial incentives linked to patient satisfaction, quality, and value goals. Initial results from more than 20,000 diabetic patients have shown statistically significant improvements in measures like glucose control, blood pressure, and vaccination rates.
