Geisinger Health Plan

GEISINGER HEALTH PLAN BENEFITS THE COMMUNITIES IT SERVES BY PROVIDING HIGHER QUALITY FOR EACH PERSONS HEALTH CARE DOLLAR THROUGH INNOVATIVE MODELS OF CARE AND COVERAGE THAT SUPPORT GEISINGER HEALTHS CHARITABLE MISSION.

PROVENHEALTH NAVIGATOR (PHN) GHP'S PROVENHEALTH NAVIGATOR IS A PARTNERSHIP BETWEEN PATIENTS, PRIMARY CARE PROVIDERS AND GHP TO IMPROVE MEMBERS' HEALTH. ALSO KNOWN AS A "MEDICAL HOME," PHN PROVIDES A CASE MANAGER WHO WORKS WITH THE MEMBER'S HEALTHCARE PROVIDERS, THE MEMBER AND THE MEMBER'S FAMILY COORDINATING CARE WITH HOSPITALS, SPECIALISTS, PHARMACISTS AND SKILLED NURSING FACILITIES. THE MODEL BLENDS ASPECTS OF CHRONIC CARE, MEDICAL HOME AND PATIENT CENTERED PRIMARY CARE MODELS. ADDITIONAL FUNCTIONAL COMPONENTS ARE INCLUDED, CREATING A NEW HEALTHCARE DELIVERY VEHICLE: HEALTH NAVIGATOR ("HN"). ACTING AS THE FIRST LINE CAREGIVER AND GUIDE, GHP NURSE CASE MANAGERS HELP MEMBERS NAVIGATE THE HEALTH CARE SYSTEM. HN'S KEY STRATEGY OFFERS MEMBERS ACCESS TO AN HN CASE MANAGER 24 HOURS A DAY, 7 DAYS A WEEK. THE PRIMARY CARE PRACTICE TEAM AND GHP, WORKING WITH THE MEMBER AT THE CORE OF THE SYSTEM, ACCEPT RESPONSIBILITY TO OPTIMIZE HEALTH STATUS FOR EACH INDIVIDUAL MEETING WITH PREESTABLISHED QUALITY, EFFICIENCY, AND MEMBER SATISFACTION OUTCOME TARGETS FOR THE PRACTICE POPULATION. THE COST OF PROVIDING PHN TO NONMEMBERS WAS 2.9M DURING 2021. PROVENCARE CHRONIC DISEASE GEISINGER IDENTIFIED COMMON CHRONIC DISEASES (DIABETES, CORONARY ARTERY DISEASE, CONGESTIVE HEART FAILURE) AND ADULT PREVENTION MEASURES (IMMUNIZATIONS, COLONOSCOPIES, ETC.). USING EVIDENCE BASED BEST PRACTICES, CARE WAS "BUNDLED" TO INCLUDE THE MOST EFFECTIVE TREATMENT. SUCCESS IS MEASURED BY MEETING 100% OF THE BUNDLE REQUIREMENTS, TRACKED OVER TIME. GEISINGER'S MADE SIGNIFICANT IMPROVEMENT MEETING THE BUNDLE REQUIREMENTS FOR DIABETES AND PREVENTIVE CARE FOR ADULTS. PROVENCARE ACUTE EPISODIC CARE (THE "WARRANTY") BEGINNING WITH CORONARY ARTERY BYPASS GRAFTS (CABG), THE PROCESS INCLUDES IDENTIFYING HIGH VOLUME DIAGNOSIS RELATED GROUPS (DRGS), DETERMINING BEST PRACTICE TECHNIQUES AND DELIVERING EVIDENCE BASED CARE. THE GEISINGER CLINICAL ENTERPRISE WORKED WITH GHP TO ESTABLISH A GLOBAL FEE THAT INCLUDES PREOPERATIVE CARE, HOSPITALIZATION, PHYSICIAN FEES, REHABILITATION, AND CARE (ADMISSIONS DUE TO COMPLICATIONS) RELATED TO THE SURGERY WITHIN 90 DAYS. THIS ADDITIONAL CARE IS NOT CHARGED (IF SEEN AT A GEISINGER FACILITY). THIS "WARRANTED" CARE HAS BEEN SUCCESSFUL AND FEATURED IN THE NEW YORK TIMES AND IN THE ANNALS OF SURGERY. GEISINGER HAS PROGRAMS FOR ANGIOPLASTY WITH ACUTE MYOCARDIAL INFARCTION (HEART ATTACK), HIP REPLACEMENT, CATARACTS, ERYTHROPOIETIN (A DRUG USED FOR KIDNEY PATIENTS), PERINATAL CARE, LOW BACK PAIN AND BARIATRIC SURGERY. TRANSITIONS OF CARE HELPING PATIENTS TRANSITION THROUGH LEVELS OF CARE, FROM HOSPITAL TO HOME, IS AN IMPORTANT COMPONENT OF ENSURING COMPREHENSIVE AND HIGH QUALITY HEALTHCARE SERVICES. GEISINGER HAS IMPLEMENTED NEW STRATEGIES WITHIN THE HOSPITAL AND PRIMARY AND SPECIALTY SETTINGS TO ANTICIPATE PATIENT NEEDS AND COORDINATE SERVICES TO ASSURE TIMELY AND SAFE TRANSITIONS. THESE STRATEGIES INCORPORATED TIMELY COMMUNICATION FROM THE HOSPITAL TO PRIMARY CARE PROVIDERS, LEVERAGED DATA FROM ELECTRONIC HEALTH RECORDS & CLAIMS TO IDENTIFY RISK AND USED CASE MANAGERS TO PROVIDE EARLY FOLLOW UP SERVICES. GEISINGER'S EFFORTS AROUND TRANSITIONS HAVE DEMONSTRATED MORE COORDINATED FOLLOW THROUGH AFTER DISCHARGE AND REDUCTIONS IN READMISSIONS. ELECTRONIC HEALTH RECORD (EHR) GEISINGER IS ON THE FOREFRONT IN THE DEVELOPMENT AND USE OF THE EHR. GHP HELPED SUPPORT THE 100 MILLION INVESTED IN EHR OVER THE LAST SEVERAL YEARS. ENDLESS POSSIBILITIES EXIST FOR IMPROVING THE QUALITY OF CARE WITH THE EHR. GHP USES THE EHR TO COMMUNICATE WITH MEMBERS WHO ARE INVOLVED IN MEDICAL OR DISEASE MANAGEMENT PROGRAMS AND THEIR PHYSICIANS. GEISINGER ALLOWS COMMUNITY HOSPITALS AND PHYSICIANS TO ACCESS PATIENT INFORMATION TO CARE FOR THEIR PATIENTS. DISEASE AND CASE MANAGEMENT SERVICES TO IMPROVE THE HEALTH OF MEMBERS, GHP PROVIDES DISEASE AND CASE MANAGEMENT PROGRAMS AND SERVICES TO COORDINATE CARE FOR THOSE WITH CHRONIC CONDITIONS. THE PROGRAMS ARE FOCUSED ON CONGESTIVE HEART FAILURE, HYPERTENSION, DIABETES, CORONARY ARTERY DISEASE, OSTEOPOROSIS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CHRONIC KIDNEY DISEASE, ASTHMA, TOBACCO CESSATION AND WEIGHT MANAGEMENT. THESE PROGRAMS WERE THE RESULT OF A COLLABORATION OF EXPERTISE BETWEEN GHP AND GEISINGER PROVIDERS AND HAVE ATTAINED NATIONAL RECOGNITION BY HEALTH MANAGEMENT ORGANIZATIONS & INDUSTRY GROUPS. THIS SUCCESSFUL COLLABORATION IS AN EXAMPLE OF HOW THIS UNIQUE RELATIONSHIP BENEFITS THE COMMUNITY. COMMUNITY HEALTH, EDUCATION AND OUTREACH GHP EMPLOYEES PROVIDE THE PUBLIC WITH INFORMATION ON TOPICS SUCH AS INSURANCE EDUCATION, ADVANCE DIRECTIVES, DENTAL AND HAND HYGIENE, ASTHMA CARE, THE IMPORTANCE OF SCREENINGS & IMMUNIZATIONS AND WELLNESS. GHP PROVIDED INFORMATION TO 55,511 INDIVIDUALS AT 1,288 EVENTS INCLUDING HEALTH FAIRS, SCHOOL BASED PRESENTATIONS, SEMINARS AND ORGANIZATIONAL MEETINGS. THIS EDUCATION INCLUDED: 1. 64 HEALTH EDUCATION EVENTS FOR CHILDREN WERE HELD COVERING DENTAL, NUTRITION & PHYSICAL ACTIVITY, HAND HYGIENE AND SUN SAFETY TOPICS. MORE THAN 740 CHILDREN ATTENDED THE EVENTS. 2. NEARLY 330 EVENTS SUPPORTED EVIDENCE BASED CHRONIC DISEASE PROGRAMMING, REACHING A TOTAL PARTICIPATION OF OVER 220 INDIVIDUALS. 3. ALMOST 740 WELLNESS ACTIVITIES WERE HELD AT EMPLOYER GROUPS AND COMMUNITY EVENTS. ALL OF OUR PROGRAMS ARE AVAILABLE TO OUR COMMERCIAL MEMBERS WHICH REPRESENT APPROXIMATELY 144,527 INDIVIDUALS. 4. MORE THAN 154 EMPLOYER GROUP AND COMMUNITY FLU EVENTS WERE HELD, PROVIDING 6,238 FLU SHOTS. GHP EDUCATES THE GENERAL PUBLIC, MEMBERS, EMPLOYER GROUPS, BROKERS, PARTICIPATING PROVIDERS AND OFFICE PERSONNEL ON HEALTH AND WELLNESS TOPICS RANGING FROM WOMEN'S HEALTH TO COLD AND FLU PREVENTION. THE INFORMATION IS AVAILABLE IN A VARIETY OF FORMATS INCLUDING NEWSPAPER ARTICLES, NEWSLETTERS, EMAILS, BROCHURES AND POSTERS. GHP SUPPORTS MANY LOCAL ORGANIZATIONS THROUGH COMMUNITY SPONSORSHIPS. THE ORGANIZATIONS INCLUDED LOCAL CHAMBERS OF COMMERCE AND THE BOY SCOUTS OF AMERICA. THE COST OF COMMUNITY HEALTH, EDUCATION AND OUTREACH ACTIVITIES WAS 4.3M DURING 2021. SOCIAL DETERMINANTS OF HEALTH GEISINGER IS PROACTIVELY ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES IN A VARIETY OF WAYS. WE HAVE MOVED BEYOND TRADITIONAL MEDICAL CARE TO PROVIDE COORDINATED SOCIAL SERVICES AND OPPORTUNITIES TO OUR PATIENTS AND HEALTH PLAN MEMBERS WHILE CONNECTING THEM WITH COMMUNITY- BASED ORGANIZATIONS. WE ARE WORKING ACROSS SECTORS TO FIND CREATIVE, INNOVATIVE WAYS TO HELP INDIVIDUALS ADDRESS THE SOCIAL AND ENVIRONMENTAL FACTORS THAT IMPACT THEIR HEALTH. OUR SDOH STRATEGY ALIGNS DATA, COMMUNITY ENGAGEMENT, CONNECTION TO RESOURCES, AND SUSTAINED OUTCOMES TO HELP THE NEEDS OF OUR PATIENTS, MEMBERS, AND GEISINGER COMMUNITIES. WE HAVE BUILDING OUT ANALYTICS DASHBOARDS THAT WILL IDENTIFY SOCIAL NEEDS AND OVERLAY WITH HIGH RATES OF MEMBERS WITH CHRONIC DISEASES. THIS DASHBOARD WILL ALLOW US TO IDENTIFY THE SOCIAL NEEDS OF OUR POPULATIONS SO THAT THE APPROPRIATE RESOURCES OR NEW PROGRAMS CAN BE IMPLEMENTED. THE DASHBOARD COMBINED WITH A UNIVERSAL SOCIAL NEEDS SCREENING FOR PATIENTS AND MEMBERS THAT WILL HELP TO IDENTIFY DISPARITIES CAN BE ADDRESSED DURING CLINICAL VISITS OR THROUGH OUTREACH BY CARE TEAM MEMBERS BY USING THE NEIGHBORLY PLATFORM. GEISINGER HAS LONG RECOGNIZED THE VALUE OF AND EMBRACED EQUITY. LAST YEAR, GEISINGER HIRED ITS FIRST CHIEF DIVERSITY, EQUITY AND INCLUSION OFFICER AND DEVELOPED A SYSTEM-WIDE DE&I COUNCIL THAT WILL SUPPORT BOTH THE CLINICAL ENTERPRISE AND GEISINGER HEALTH PLAN. OUR APPROACH TO HEALTH EQUITY WILL FOCUS ON THE CARE AND SOCIAL DRIVERS OF OUR MEMBERS, PATIENTS, AND THE COMMUNITIES FOR WHICH WE LIVE AND SERVE. THROUGH OUR UNDERSTANDING AND CULTURAL AND STRUCTURAL COMPETENCIES, WE CAN AFFECT HEALTH EQUITY IN MULTIPLE POPULATIONS IN MEANINGFUL WAYS. IN OUR ELECTRONIC HEALTH RECORD, WE HAVE DEFINED DATA ELEMENTS, CLINICAL WORKFLOWS AND ORGANIZATIONAL PRACTICE ASK PATIENTS AND MEMBERS ON RACE, ETHNICITY, LANGUAGE PREFERENCE, SEX, GENDER IDENTITY, SEX ASSIGNED AT BIRTH, ORGAN INVENTORY, AND AFFIRMATION HISTORY, AND SOGI SMARTFORM TO COLLECT ADDITIONAL INFORMATION OF PRONOUNS AND SEXUAL ORIENTATION, AS WELL AS VETERAN STATUS. THE QUESTIONS ARE EITHER ANSWERED BY THE PATIENTS IN ADVANCE OF A VISIT OR ASKED IN CLINICAL SETTINGS. THE RESPONSES ARE USED TO HELP CLINICIANS AND STAFF HAVE APPROPRIATE CONVERSATIONS WITH PATIENTS ABOUT SEXUAL ORIENTATION AND GENDER IDENTITY. TO ENSURE GEISINGER STAFF ARE TRAINED, INTERNAL TEAMS DEVELOPED A TRAINING PROGRAM THAT INCLUDED UNCONSCIOUS BIAS TRAINING, SAFE ZONE TRAINING, AND LGBTQ+ PATIENT-CENTERED CARE TRAINING. THE CURRENT DATA COLLECTION WILL PROVIDE INSIGHTS INTO DISPARITIES ACROSS OUR MEMBERS AND PATIENTS. FROM THE IDENTIFIED DISPARITIES, TARGETED INTERVENTIONS WILL BE DEVELOPED FOR CURRENT AND FUTURE PROGRAMMING. AS THE DE&I EFFORTS AT THE ORGANIZATION CONTINUE TO GROW, ADDITIONAL INITIATIVES WILL BE CONSIDERED; AT THIS TIME INDEPENDENT EFFORTS ARE NOT BEING CONDUCTED. ADV