ProvenCare delivers lower health costs with improved quality

About ProvenCare

ProvenCare is changing patients’ lives for the better. Together, the Geisinger team is focusing on specific procedures, closely tracking the thousands of these procedures they perform…so as to continuously adjust and advance patient care.

That’s why our patients spend fewer days in intensive care and recover faster. It’s also why our success rates exceed the national average. Now that’s peace of mind.

ProvenCare: Redefining the way we deliver care
At Geisinger, we’ve always been dedicated to providing the highest quality care. And, with ProvenCare, we’ve taken that commitment one giant step further. The result is an intensive treatment program which assures that the best care is delivered to patients in our ProvenCare programs.

Developing ProvenCare programs is no easy task. Our patient care teams spend countless hours reassessing how they perform specific procedures. They examine patient care records. They also research “best treatment” recommendations from national experts, professional associations and databanks.

Through their research, they identify critical steps that greatly improve the chances of a successful procedure and recovery.

A letter from Glenn D. Steele Jr., MD, PhD

President and CEO Geisinger Health System
Thank you for your interest in ProvenCare™ .. At Geisinger, we’re very proud of this innovative program. It ensures that every patient who receives procedures included in our ProvenCare portfolio —at any Geisinger or participating non-Geisinger hospital—receives the most consistent, comprehensive and effective care possible. By that, we don’t mean just “good care,” but care that exceeds national standards.

The media has labeled our program “surgery with a warranty.” While no surgical procedure comes with a guarantee, the ProvenCare program is about more than continually providing the highest level of service. It’s also about standing firmly behind the care we offer with not just words, but a strong commitment. It’s about being accountable to our patients and their families.

In fact, I am such a firm believer in ProvenCare that I have pledged Geisinger’s name and financial well-being to each patient. Geisinger is one of the first in the country to offer such a program. And, I can tell you that ProvenCare is changing the way healthcare is delivered.

ProvenCare has exceeded our expectations and I am confident it will exceed yours.

ProvenCare Process

Proven Care Process
1.Identify eligible patients
2.Document appropriateness
3.Enroll and active the patient and family
4.Deliver evidence-based care
5.Geisinger is paid a global fee
•One fee for the entire identified period of time
•Global fee includes 50% share of historical readmission rate (guaranteed payer savings, Geisinger upside based on complication and readmission reduction and efficient care
All or None Measures

They are involving the family of the patient in the overall program of care and guaranteeing through their global fee to cover all redmission costs. They are putting their commitment to the patients recovery into financial incentives for the patient, the patient’s family and into their financial well-being.

•Measure percentage of patient who receive all related services (not indicidual measure alone)
•Most all or none measures will not reach 100%
•Some goals not appropriate for all patients,some goals not achieveable for all patients

ProvenCare CABG Financial Results
•Average total LOS fell 0.5 days (6.2 vs. 5.7)
•30-day readmission rate fell 44%

They have clear measures and processes to ensure the quality of care is right the first time.

Health Policy Considerations

•Access to health insurance is key
◦Should include regional plans (provide flexibility and innovation)
•Formation of Integrated Sytsems should be facilitated
◦Bundled payments
◦Episode of care payments
◦Treatment based – not insurance risk
◦Accountable care organizations
◦“Cost saving” shared with providers
•Healthcare Information Technology
◦Computers and Electronic Health Records are necessary, not sufficient
◦Redesign of care required
◦Ongoing upgrades needed
•Comparative effectiveness research
•Training of next generation

They are providing better quality of care prior to the enactment of any national policy, all based upon reducing screening patients, ensuring the quality care is given right the first time and creating a “quality culture’ within their entire organization.

Benchmarks

ProvenCare relies on evidence-based standards — what’s been shown in medicine to work best for patients — to guide surgery and post surgical care. Here are the 40 steps involved in ProvenCare for coronary artery bypass graft surgery:

Preadmission documentation
•ACC/AHA indication
•Screening for and consultation re: IMI (inferior myocardial infarction)/RV (right ventricular) involvement
•Treatment options and patient preference
•Need for warfarin – Ant.MI (myocardial infarction) or WMA (wall motion abnormality)
•Current user of clopidogrel or warfarin?
•Screening for stroke risk
•Carotid doppler (if the test is indicated)
•Vascular surgery consultation (if indicated)
•Ejection fraction
•Screening for need to use intra-aortic balloon pump (IABP)
•Screening using epiaortic echo (as indicated)
•Patient withheld clopidogrel/warfarin for 5 days pre-op
Operative documentation
•Patient received correct dosing of beta-blocker (pre-op)
•Correct use of intra-aortic balloon pump (pre-op –>post-op)
•Pre-op Abx (within 60 minutes of incision; Vancomycin within 120 minutes)
•Blood cardioplegia (on-pump patients)
•Epiaortic echo of the ascending aorta and the peer consult
•Intra-operative hyperglycemia screening
•Correct insulin management (as indicated; per protocol)
•Use of LIMA (left internal mammary artery) for LAD (left anterior descending) grafting

Their processes work to ensure their commmitment to their patients, reduce overall costs and protect their financial health as an institution.

ProvenCare by the Numbers

Elective Coronary Artery Bypass Graft
Program went live: February 2006
Number of procedures in first year: 181
Percentage of patients eligible to participate: 34% (under Geisinger Health Plan)

Proven Care by the Numbers

(18 months) Before
Proven Care With
Proven Care % Improvement/
Reduction

Average total length of stay Before 6.2 After 5.7 – Minimal change

30-day readmission rate Before 6.9% After3.8% Reduction 44%

Patients w/ any complication Before 38% After 30% Reduction 21%

Patients w/less than 1 complication Before 7.6% After 5.5% Reduction 28%

Incidence of atrial fibrillation Before 23% After 19% Reduction 17%

Neurological complication Before 1.5% After 0.6% Reduction 60%

Any pulmonary complication Before 7% After 4% Reduction43%

Blood products used Before 23% After 18% Reduction 22%

Re-operation for bleeding Before 3.8% After 1.7% Reduction 55%

Deep sternal wound infection Before 0.8% After 0.6% Reduction 25%

The numbers speak for themselves.

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One thought on “ProvenCare delivers lower health costs with improved quality

  1. I don’t know If I said it already but …Hey good stuff…keep up the good work! 🙂 I read a lot of blogs on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks,)

    A definite great read..Jim Bean

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