This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs
According to Thomas Graf, M.D., chair of the Geisinger Community Practice Service Line, during the past three years, Geisinger practices testing the ProvenHealth Navigator model saw a 40 percent reduction in hospital 30-day readmissions and a 20 percent reduction in overall hospital admissions when compared to a control group that did not use the system. In addition, the cost of care for patients in the test group was 7 percent less than the cost of care for the patients in the control group, Graf said.
At the same time, said Graf, physician, staff member and patient satisfaction rates among the medical home sites were far greater than the satisfaction rates among the control sites, based on surveys conducted by Geisinger.
"The patient-centered medical home allows you to do primary care the way you would want to do it," said Graf. "From our perspective, it is really the way we do business now. It is about knowing who all of the patients in your entire populations are, where they are, what is going on with them and then being proactive about managing them."
Geisinger has data on 85,000 patients covered by the ProvenHealth Navigator model and, thus, is able to compare cost and quality data for these patients with 150,000 patients who are enrolled in nonmedical home practices that contract with the Geisinger Health Plan. The health care system is now in the process of expanding ProvenHealth Navigator to other practices it contracts with, as well as to the remaining six Geisinger practices.
ProvenHealth Navigator "is our way of delivering care going forward," said Graf.
"Each person on the team has a specific function independent of the others, with the physician directing and referring the care," said Graf.
These core concepts, in turn, are coupled with 10 quality metrics that serve as guides for Geisinger's primary care system and that slowly evolve, according to Graf. Last year, for example, one of the metrics called for all ProvenHealth Navigator sites to achieve level-three PCMH recognition from the National Committee for Quality Assurance -- a goal that was met.
Other quality metrics address the entire spectrum of care, from office visits to electronic communications to case management.
The Future of Medicine
Geisinger has addressed that problem by changing the payment structure to support the medical home. The health care system continues to pay physicians on a fee-for-service basis, but it also provides advanced practitioner stipends and staff bonuses and has directly increased the compensation of physicians by 10 to 15 percent.
Geisinger also furnishes practices with additional funds to help them carry out PCMH functions. The goal is to move from a volume-based to a value-based system, according to Graf. The company employs a gain-sharing program that gives the medical home sites the opportunity to earn bonuses if they meet certain cost goals and achieve quality standards. "If the practices hit 100 percent of their quality measures, and they save money, then they receive 50 percent of their savings," said Paulus. "If they hit 70 percent of their quality metrics and save money, they receive 70 percent of the 50 percent."
Paulus stressed that the medical home practices must save money and meet the quality goals to qualify for the bonus payments.
Medical Home Success Depends on Primary Care Attributes
Health IT Over-Emphasized, Say Researchers
Patient-Centered Medical Home Special Report
More From AAFP
Patient-centered Medical Home
How the AAFP and Chapters Are Supporting the PCMH Movement
Patient-Centered Medical Home Checklist
(2-page PDF; About PDFs)