Medical Home Model Interview – Interview with Joann Sciandra of Geisinger Health Plan

Interviewer: Can you please introduce yourself,
your position and tell us a little bit about Geisinger Health Plan? Joann Sciandra: Hello. My name is Joann Sciandra and Iím the director
of case management and strategic planning for Geisinger Health Plan. Geisinger Health Plan is a not-for-profit
health plan thatís located in Danville, Pennsylvania. We cover 42 counties that are located in central
and north east PA. Our membership is 275,000. Of that 275,000 we have 63,000 Medicare Advantage
patients. Interviewer: A few years back Geisinger Health
Plan instituted a Medical Home model. Can you please tell us a little bit about
that? Joann: In 2006 Geisinger Health Plan, in our
community practice service line, which are our doctorís offices, sat down and looked
at the way we were providing care to our members and our patients. We were doing a good job and patients were
having good outcomes. But we knew as healthcare changes occurred
over the next couple years, we had to change things for the better. So this partnership and this collaboration
was the result of what we call our Proven Health Navigator, or what is commonly known
as Medical Home. Currently, we have a total of 42 Medical Home
sites, that are located throughout the Geisinger system. Of this 42 Medical Home sites, a majority
of them are Geisinger owned sites. But we do have several sites that are doctorís
offices that we do not own. So we have patients or health plan members
that go to these doctorís offices and we have a Medical Home there. The purpose of Medical Home was to really
look at the quality of care that we were providing our patients. And can we improve quality and in turn decrease
cost? And this cost savings would not only be evident
for the health plan, but this cost savings would also be evident to our members and would
affect our members who were now experiencing some cost sharing through their insurance
plan. So how it worked was we actually went out
into the doctorís offices, met with them, and looked at the whole structure. So the whole doctorís office becomes a Medical
Home. But what is every player on that team doing
and are they doing the right role to impact care? And what we found were that we could make
some changes for the better, and to improve the care that we were providing our patients. One of the things that we did was that we
built in a template. So within our electronic medical record, we
built in a schedule that every day there would be appointments available to patients post-discharge. So when a patient would go to the hospital,
on discharge we want them seen by their primary care doc within three to five days. The reason for this is that we noted at the
health plan about one in five patients were going back to the hospital within 30 days
of discharge. So we got them in to see their primary care
doc early on, and the impact of that was a reduction of what we would call the readmission
rate, the patients going back to the hospital. So we built that in. We also built in what we would call acute
visits. So when a patient calls the office and has
a problem, we want to take care of that problem the same day. Patients donít want to go to the emergency
room and we want to do our best to meet those needs within the clinic. We also looked at the Medical Home sites to
see if there were procedures that we currently were not doing, that we could safely do within
the clinic, and there were. And our patients, really from patient satisfaction
surveys, have been very satisfied with the level of care that weíve been able to provide
at the clinic setting. So really looking at what you would call maybe
even like a one-stop shopping. So every patient within a Medical Home site
is touched. Meaning that we have a group of patients that
are well, so we manage them. We get their flu shots, their pneumonia shots,
their mammograms, their preventative screening, their PSAs. Then we also have a population that has complex
health problems. This is the population that might have heart
failure, diabetes, COPD, patients that have cancer diagnoses. How are we going to manage their care and
what do we need to put in place to help these patients navigate a very complex healthcare
system? We introduced the concept of a case manager. We embedded or we placed a nurse, a registered
nurse case manager within the doctorís office at the Medical Home site. These nurses are highly skilled, highly trained,
with a lot of clinical background. These nurses work side by side with the primary
care physician in managing the healthcare needs of a complex population. We also had a population of patients that
might have one or two conditions, be it diabetes, heart disease, hypertension. How are we going to provide services and care
to these patients? How are we going to provide education and
management and making sure they were getting what they were needing? We introduced a health manager or disease
manager that meets with the patients within the primary care site. What our patients like about this is they
donít have to be going to the hospital. They donít have to be going to other areas. They can get everything right at their Medical
Home. So their Medical Home really becomes their
main contact for their healthcare needs. Interviewer: Now, Joann, youíve probably
touched on a lot of these, but are there any specific benefits? Whether it be for the patient, the health
plan, or the hospitals and the clinics? And if so, does any one partner benefit more
than the other? Joann: What we hear from our members and what
we hear from our patients is the improvement in their quality of life. So the goal is to really improve quality care
that theyíre getting and to have better outcomes and so patients can really return to their
normal daily lifestyle. So thatís the benefit to the patient. But thereís also a cost benefit to our members
and to our patients. What weíre seeing in healthcare today is
a lot more cost sharing. So if we can impact the number of times someone
needs to go to the emergency room or to be hospitalized, itís going to have a direct
impact on the members and the patients. At the health plan side, we do see an impact
on total cost for the managing with our members. But what weíre able to do is to take that
cost that we have and put it back into more programs and to hire more case managers and
to develop more programs to meet the needs of our members. Interviewer: You touched on the growth of
the program. Just roughly how successful do you think the
program has been on a social standpoint and on a healthcare standpoint? Joann: Well, from talking to our members,
and we actually do patient satisfaction surveys, itís been very successful. Members have seen a change in the care that
theyíre receiving for the better. The members with chronic conditions really
liked the idea of having that nurse as a resource and as that contact within their Medical Home
site to help meet their healthcare needs. Itís been very effective in early identification
of problems. Take a patient with heart failure. The health plan has partnered with what we
would call a tele-monitoring vendor. We actually put Bluetooth scales, so this
is a scale that uses Bluetooth technology in our heart failure membersí homes. They get on the scale every day, their weight
is transmitted to a web portal, so our nurse case managers can actually see their patientsí
daily weights and it impacts the care of those patients if thereís any changes in their
condition. Interviewer: Thatís awesome. What would you say then if — obviously this
program is continuing to change as healthcare changes. What do you think the future of this program
is? And is there anything on the horizon as far
as changes or growth? Joann: We as a health plan and as a system
are always looking for new innovations. And currently within our Proven Health Navigator,
weíre looking at a process or actually a new — and I donít want to call it a program,
because itís not a program, and Medical Home is not a program. Itís a way that weíve really changed our
care delivery system. But one aspect that weíre looking at now
is the patients that what we would call have complex or morbid conditions. These are patients that have multiple healthcare
needs, multiple conditions, and really having the ability to have a case manager work a
little bit closer with them and to follow them through each part of healthcare. So if that patientís in the hospital, the
case manager makes a visit. If theyíre in a nursing home, they would
do home visits. Having a case manager even more readily available
to what we would call the patients with more complex needs. Weíre continuously looking at ways to improve
what weíre doing. Interviewer: Do you believe that this is a
system that other health systems and insurance companies should be looking to initiate? Joann: I do and I think we as an organization
do. Weíre seeing this. Weíve been working with several organizations
in the United States. And actually weíre working with the health
ministry in Singapore. They came to us, the health ministry in Singapore,
and asked them to work with them on setting up Proven Health Navigator within Singapore. Within the United States weíre recently working
with Hudson Valley, which is located in New York City. This is a healthcare system that came to us
and said, you know, we really like what youíre doing. We like Proven Health Navigator and we want
to do something like this for our doctorís offices and for our patients. So weíve done a lot of education with them
on site. We actually go out to Hudson Valley, go within
their future Medical Home sites or Proven Health Navigator sites, and work with their
doctors, look at the workflow. Weíve done training for their case managers. And weíre actually seeing more and more requests
on a daily basis to help people to achieve this. Interviewer: How do you believe a structure
like the Medical Home model, Geisinger Health Plan and Geisinger have will impact healthcare
in America? Joann: I think itís going to impact healthcare
in several ways. I mean, one way itís going to impact for
quality of life. A patient who has a chronic condition like
heart failure, does not have a quality life if theyíre in and out of the hospital. Thatís not living their life. So itís going to impact the care that we
provide, and itís going to impact what a patient or what a person is able to do in
their day to day life. But itís also going to impact cost. Itís going to impact the cost for patients
and for health plan members, what they have to really pay out of their pocket. And itís going to, you know, give somebody
like Geisinger the ability to have a cost savings and be able to build new programs. Interviewer: You provided us with a lot of
great information on the Medical Home. Is there anything else that you would like
to add? Joann: First of all Iíd like to thank you
for giving us this opportunity to talk about Medical Home and to talk about Proven Health
Navigator and the success that weíve had. It takes an organization to really take what
I would call a leap of faith. So when I look at Geisinger Health Plan and
what our leadership did back in 2006, it was a leap of faith. Was this going to be successful? And, you know, to be honest, there was money
that had to be put up upfront to really look at the care structure and to hire what we
currently have, 100 case managers and disease managers working with our patients and our
members. So again, thank you for having me here and
the opportunity to share our success. Interviewer: Thank you. Joann: Thank you.

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