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Patient-centered medical homes (PCMHs) have the potential to improve patient experience of care. Since 2006, Geisinger Health System has implemented its own version of an advanced PCMH model, referred to as ProvenHealth Navigator (PHN). To evaluate the impact of PHN on patient experience of care, the authors conducted a survey of patients whose primary care clinics had been transformed to "PHN sites" and were under case management at the time of the survey. A comparable survey of patients from non-PHN sites also was conducted for comparison. The results suggest that patients in PHN sites were significantly more likely to report positive changes in their care experience and quality; moreover, they were more likely to cite the physician's office as their usual source of care rather than the emergency room (83% vs. 68% for physician's office; 11% vs. 23% for emergency room). However, the results also suggest that there was no significant difference between PHN and non-PHN patients in their perceptions of access to care or primary care physician performance in terms of patient-centered care (eg, listening, explaining, involving patients in decision making). These findings are consistent with the expectation that transformation of primary care into PCMH can lead to improved patient experience of care.

One of the primary goals of the patient-centered medical home (PCMH) is to provide higher quality care that leads to better patient outcomes. Currently, there is only limited evidence regarding the ability of PCMHs to achieve this goal. This article demonstrates the effect of PCMHs in improving certain clinical outcomes, as shown by the ProvenHealth Navigator (PHN), an advanced PCMH model developed and implemented by Geisinger Health System. In this study, the authors examined the claims data from Geisinger Health Plan between 2005 and 2009 and estimated the effect of PHN on reducing amputation rates among patients with diabetes, end-stage renal disease, myocardial infarction, and stroke. The results show that, despite its relatively short period of existence, PHN has led to significant improvements in certain outcomes, further illustrating its potential as a care delivery model to be adopted on a wider scale.

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.

BackgroundElectronic medical records and insurance claims data from the Geisinger Health System were examined to assess the real-world healthcare costs of being overweight or obese at different glycemic stages, including normal glycemia, pre-diabetes (PreD), and type 2 diabetes (T2D).MethodsThe medical history of the sample subjects was segmented into different glycemic stages via diagnosis codes, glycosylated hemoglobin A1c or fasting plasma glucose laboratory results, and use of antidiabetic drugs. Healthcare resource utilization captured by the claims and associated costs (in 2013 values) were examined for each glycemic stage. The association between costs and body mass index (BMI) was estimated by regressions, and adjusted for sociodemographics. We predicted the adjusted incremental annual costs associated with high BMI, relative to normal BMI (18.5–24.9 kg/m2).ResultsWe identified 48,344 adults in normal glycemic stage, 3,085 in the PreD stage, and 9,526 in the T2D stage (mean age 46, 58, and 60 years, respectively; mean BMI 29, 32, and 33 kg/m2, respectively). The adjusted incremental annual costs associated with high BMI relative to normal BMI ranged from $336 for overweight (25–29.9 kg/m2) to $1,850 for class III obesity (≥40 kg/m2) during normal glycemic stage; were only significant for class III ($2,434) during the PreD stage; and ranged from $1,139 for overweight to $4,649 for class III during the T2D stage (all p < 0.05).ConclusionsPositive associations between healthcare costs and BMI levels were observed within each glycemic stage. Management of body weight is important in reducing the overall healthcare costs, especially for subjects with PreD or T2D.

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In Brief Providing diabetes patients all of the care recommended by current guidelines is a clinical challenge. Geisinger Health System has designed a provider-led, team-based system of care to more consistently and reliably meet this challenge. This system of care uses an all-or-none bundle of diabetes measures and electronic health record tools to improve both process measures and intermediate diabetes outcomes.