WASHINGTON — Geisinger Health System has used a medical home model to slash inpatient costs in a demonstration program that it is now expanding to more of its practice sites, Dr. Glenn Steele Jr., CEO, said at a press briefing.
The pilot was conducted at Geisinger's practice sites in Lewistown and Lewisburg, Pa. Dr. Steele said that the multicomponent medical home program reduced all-cause inpatient admissions by 20% at Lewistown and 14% at Lewisburg during the pilot period of January-October 2007.
Readmissions during the same period were reduced from 19% in the 9-month period before the program started to 16% after the medical home was implemented, Dr. Steele said. At Lewisburg, readmissions dropped from 15% to 8% (Health Affairs 2008;27:1235-45).
Dr. Steele acknowledged that the Geisinger program might be hard to replicate. Geisinger is an integrated delivery system serving 2.6 million people across 43 counties in central and northeastern Pennsylvania. It has 700 employed physicians in 55 practice sites, three acute-care hospitals, specialty hospitals, ambulatory surgery centers, home care, and a 215,000-member health plan.
The medical home program offers 24-hour access to primary care and, through the primary care physician, consultation with a specialist; a nurse-coordinator at each practice site; a personal care navigator to respond to patient inquiries about health and where to get care; home-based monitoring; and support ranging from virtual care management to electronic health records for all participants.
Physicians were paid $1,800 per month to participate. Each practice site received $5,000 for every 1,000 Medicare members enrolled, as support for infrastructure changes, additional staff, and extra practice hours. Bonus payments were provided if physicians met targets for 10 quality indicators. Each practice received monthly performance reports.
Geisinger also has a coordinated program to manage patients with chronic disease such as diabetes, heart failure, chronic kidney disease, coronary artery disease, and hypertension. This has become somewhat of an extension of the medical home program, with a new focus on prevention.
And the health system continues to build on its ProvenCare program, which addresses hospitalizations as episodes of care guided by best practices and risk-based pricing.
Although it may not be possible to exactly replicate the Geisinger experience, there are implications to be considered by policy makers, physicians, and others interested in the medical home, Dr. Steele said. Geisinger can more easily align incentives for physicians and for all patients; it's not clear that Medicare or commercial payers could do that across their physician and patient populations. The use of an electronic health record system has enabled Geisinger to start leveraging its benefits, but that was after a long transformation period, according to Dr. Steele.
Geisinger, however, is not looking back. It has expanded the medical home to 32 of its 55 sites and expects to be publishing those results soon, Dr. Steele said.