Daniel D. Maeng

Can a Patient-Centered Medical Home Lead to Better Patient Outcomes? The Quality Implications of Geisinger’s ProvenHealth Navigator

One of the primary goals of the patient-centered medical home (PCMH) is to provide higher quality care that leads to better patient outcomes. Currently, there is only limited evidence regarding the ability of PCMHs to achieve this goal. This article demonstrates the effect of PCMHs in improving certain clinical outcomes, as shown by the ProvenHealth Navigator (PHN), an advanced PCMH model developed and implemented by Geisinger Health System. In this study, the authors examined the claims data from Geisinger Health Plan between 2005 and 2009 and estimated the effect of PHN on reducing amputation rates among patients with diabetes, end-stage renal disease, myocardial infarction, and stroke. The results show that, despite its relatively short period of existence, PHN has led to significant improvements in certain outcomes, further illustrating its potential as a care delivery model to be adopted on a wider scale.

Reduced Acute Inpatient Care Was Largest Savings Component Of Geisinger Health System’s Patient-Centered Medical Home

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health Systems patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care (

Cost-Effectiveness of IL28Β Genotype-Guided Protease Inhibitor Triple Therapy versus Standard of Care Treatment in Patients with Hepatitis C Genotypes 2 or 3 Infection

34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

Can Health Insurance Improve Employee Health Outcome and Reduce Cost? An Evaluation of Geisingerʼs Employee Health and Wellness Program

Background/Aims: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients. Methods: Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling. Results: For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2 IL28Β variants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed. Conclusions: Markov modeling revealed that modest increases in SVR rates from IL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.

Impact of a Medically Complex Patient Care Model on Cost and Utilization Among Adolescents and Young Adults With Special Health Care Needs

Objective: To evaluate the impact of a health plan–driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care. Methods: A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees. Result: The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.73 and 0.56; P < 0.01). There was also a 10% to 13% cost reduction (P < 0.05) during the second and third years of the program. The cumulative return on investment was approximately 1.6. Conclusion: Health plan–driven employee health and wellness programs similarly designed as MyHealth Rewards can potentially have a desirable impact on employee health and cost.

Contents Vol. 17, 2014

Adolescents and young adults with special care and health needs in the United States–many of whom have Medicaid coverage–at the transition phase between pediatric and adult care often experience critical care gaps. To address this challenge, a new model referred to as Comprehensive Care Clinic (CCC) has been developed and implemented by Geisinger Health System since 2012. CCC comprises a care team, consisting of a generalist physician, pharmacist, and a nurse case manager, that develops and closely follows a coordinated care plan. This presentation examines the CCC impact on total cost of care and utilization by analyzing Geisinger Health Plan claims data obtained from 83 Medicaid patients enrolled in CCC. The results indicate that CCC enrollment was associated with a 28% reduction in permember-per-month total cost, driven by reductions in hospitalization and emergency department visits. This finding suggests a clinical redesign focused on adolescent and young adults with complex care needs can potentially reduce total cost and acute care utilization among such patients. Also, he will discuss how this can be translated to other home institutes. Questions?

Reducing Long-Term Cost by Transforming Primary Care: Evidence From Geisinger's Medical Home Model

R. Adany, Debrecen, Hungary A. Aaro, Odense, Denmark D. Avard, Montréal, Qué., Canada I. Blancquaert, Montréal, Qué., Canada J.-J. Cassiman, Leuven, Belgium E.E. Castilla, Rio de Janeiro, Brazil S. Grosse, Atlanta, Ga., USA J. Harris, Oslo, Norway A. Haslberger, Vienna, Austria D. Ibarreta, Sevilla, Spain M. Karmali, Toronto, Ont., Canada H. Lehrach, Berlin, Germany J. Little, Ottawa, Ont., Canada N. Malats, Madrid, Spain C. McBride, Bethesda, Md., USA S.A. Morré, Amsterdam, Th e Netherlands P. O’Leary, Perth, W.A., Australia F. Paccaud, Epalinges, Switzerland B. Peterlin, Ljubljana, Slovenia Editor-in-Chief