Geisinger Health System patient-centered medical home (ProvenHealth Navigator)

Program Location:

Harrisburg, PA

Payer Type:

Commercial

Payers:

Medicare

Medicaid

Capitol Blue Cross

Coventry

Highmark

Reported Outcomes

Description:

Launced in 2006, Geisinger Health System’s ProvenHealth Navigator® is an advanced patient-centered medical home that initially served the needs of elderly Medicare patients. Two years later the Navigator was expanded to include the health system’s broader adult commercial population.

According to an April 2015 Health Affairs article, "Geisinger Health System serves roughly three million residents living in central Pennsylvania. Geisinger Health Plan (GHP), a subsidiary of Geisinger Health System that provided health insurance coverage to more than 450,000 members in 2013, has played an integral part in conceptualizing, designing, and implementing the ProvenHealth Navigator (PHN), particularly around hiring and training of case managers embedded (that is, physically located) within every Navigator primary care clinic."

Geisinger is an open and integrated delivery system that actively serves both its own Geisinger Health Plan (GHP) enrollees and non-GHP consumers in its service area.

Program Website

Related News & Resources

Payment Model:

"Financially, while the Navigator sites continue to receive fee-for-service payments from GHP, the total reimbursement is linked to their performance via bonus payments and a shared savings program based on documented metrics of quality and utilization (HEDIS and Cahps)."

- Health Affairs, April 2015

Improved Patient/Clinician Satisfaction:

Population Health Management (June 2013) _{study compared 499 PHN patients with 359 non-PHN patients}

Patients in a PHN were:
- twice as likely to report noticable difference in care, care coordination, and service
- more likely to report that the quality of care at their primary clinic site is different and has improved
- more likely to cite their primary care office as their usual source of care (83% vs. 68%)
- likely to cite the (ER) as their usual source of care (11% vs. 23%)
No significant difference in PHN patient reported access to care or perception of PCP performance

Cost Savings:

Health Affairs (April 2015) _{study of Medicare Advantage patients from 2006-2013}

7.9% total cost savings, on average, across the ninety-month study period
The largest source of savings was acute inpatient cost, which accounts for about 64% of the total estimated savings of $53 (PMPM per practice site)
Other cost components also show some cost savings, but these estimates are not statistically significant
Greater exposure to PCMH (longer implemenation time) is associated with a greater magnitude of cost savings

American Journal of Managed Care (March 2012) _{retrospective claims data analysis of 43 primary care clinics converted into PHN sites between 2006 and 2010}