Geisinger launches program to change care, incentive systems

Health System Program to Utilize Enhanced Electronic Health Record

Nov. 9, 2006, DANVILLE, PA. – Geisinger Health System announced today that it is piloting an innovative pay-for-performance program that will significantly change the way hospitals and doctors deliver and are reimbursed for care.
 
“In our current system, healthcare providers are paid by health plans for every hospital stay regardless of the quality of care that is provided,” said Geisinger Health System President & CEO Glenn Steele Jr., MD, PhD.

“In fact, if a patient is readmitted because of an infection or avoidable complication, the provider still gets paid,” Steele said.

The ProvenCare SM initiative relies on established clinical evidence and Geisinger’s advanced electronic health record system to guide surgical procedures and post surgery-care.

If a patient is readmitted or requires additional care, neither Geisinger Health Plan nor the patient would pay for that follow-up care. The initiative is geared toward cutting healthcare costs by reducing the need for additional treatment following surgeries.

Steele explained that this initiative is different because it involves a set of evidence-based standards that, if met, should minimize readmissions and reduce complications. As part of the ProvenCare approach, Geisinger Clinic physicians follow patient-centered best practice guidelines.

“ProvenCare should make Geisinger Health System physicians exquisitely conscious of doing it right,” said Dr. Alfred Casale, Geisinger’s director of cardiothoracic services.

ProvenCare has initially been applied to coronary bypass surgery, Casale said.

Relying, in part, on guidelines from the American Heart Association and American College of Cardiology, Geisinger developed a series of steps that its physicians should take during their care of coronary bypass patients, Casale said.

The steps should minimize post-surgery complications and better serve the patient, Casale said. (ProvenCare is for other major surgeries as well, including hip replacement.) 

At its core, ProvenCare actively engages the patients in their own treatment, encourages stronger physician-patient partnerships and offers a new assurance that patients will receive a measurably high level of care.

Geisinger is willing to take a financial risk in order to deliver state-of-the-art care, said Richard J. Gilfillan, MD, president and CEO of Geisinger Health Plan and Geisinger Indemnity Insurance Company.

“The most important thing is that we’re being explicit about what it means to give the best care,” Gilfillan said.

Several recent studies have shown that only a little more than one-half of adult patients receive recommended care in the United States. This initiative seeks to improve on those results and give patients more of the care they need, Steele said.

“It demonstrates Geisinger’s commitment to quality and value,” Steele said. “This helps us as we strive for perfection at all levels of care, from a patient’s first clinic visit to full recovery.”

About Geisinger Health System

Geisinger Health System is one of the nation's leading fully integrated healthcare providers. Founded in 1915, Geisinger serves more than two million residents throughout central and northeastern Pennsylvania. The physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger includes three major regional medical centers, a 650-member group practice, a not-for-profit health insurance company, and the Geisinger Center for Health Research—dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes. For more information, visit www.geisinger.org.

Begun in 1985, Geisinger Health Plan, a not-for-profit health maintenance organization (HMO), serves the health-care needs of more than 200,000 members in 40 counties throughout central and northeastern Pennsylvania.

# # # #