Case Studies

ProvenHealth Navigation at Geisinger Health System

Geisinger Health System
Danville, PA
545 Beds

Geisinger Health System is an integrated health services organization that serves more than 2.6 million residents in 44 counties in both central and northeastern Pennsylvania.

The Problem

With the care delivery system changing, Geisinger Health System began looking for ways to improve patient outcomes, quality of service and value of care. The organization’s community practice ser¬vice line—doctor’s offices within the health care system—met and examined its structure and discussed ways to provide higher value care to members and patients. In 2006, Geisinger Health System and Geisinger Health Plan developed and established a medical home model, creating ProvenHealth Navigator.

ProvenHealth Navigator was designed to reduce downstream costs from the highest acuity by moving resources upstream. In particular, more services are rendered in primary care as the starting point in the chain of care delivery. Successful upstream efforts are expected to reduce inpatient care costs and unnecessary duplication of service.

The Solution
The medical home model is built upon a five-point framework: patient-centered primary care, integrated population management, medical neighborhood, quality outcomes and value-based reimbursement. With this framework, ProvenHealth Navigator “wraps a bundle of services around the patient and family and addresses healthy behaviors, disease prevention and disease management.” These services include 24/7 phone access to a nurse care manager, same-day appointments and a primary-care office staff that facilitates access to community resources and helps patients understand medications and prescription coverage—all of which help decrease unnecessary hospitalizations.

The Result
Geisinger’s medical home model improved care coordination, enhanced patient access to primary care providers and provided more effective and efficient disease and case management. Additionally, studies show that ProvenHealth Navigator reduced costs over time. From November 2007 to December 2010, Geisinger’s estimated total cumulative savings was 7.1 percent (based on the model that accounts for the prescription drug coverage interaction effects) and 4.3 percent (based on the model that does not account for the interaction effects).

Lessons Learned
Although it takes time to reap benefits from the redesign of care, cost savings are achievable.

Contact Information

Janet Tomcavage (Geisinger Health Insurance Operations and Health Plan)
(570) 271-6784
Thomas Graf, MD (Population Health and Longitudinal Care Service Lines)
(570) 214-4996

This case study was originally featured in the HPOE guide: "Engaging Health Care Users: A Framework for Healthy Individuals and Communities," published January, 2013.

Additional Resources

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