Like many health systems, Geisinger, based in Danville, Pennsylvania, cares for a large population of older patients with complex needs. Many of these vulnerable patients are homebound and struggle with food insecurity, social isolation, lack of transportation and other difficulties. This limits their access to essential care and contributes to alarming increases in their overall cost of care.
To tackle these challenges, Geisinger launched a delivery model in 2018 called Geisinger at Home. Working closely with patients’ primary care physicians, a team of doctors, nurses, dietitians, case managers, pharmacists, mobile paramedics and other support staff brings care to frail patients where they live. In addition to providing services such as necessary testing, acute care and wound care, the program offers specialty care as needed. Unlike hospital-at-home models, which typically provide care for three to five days, ours is a longitudinal approach that starts with a comprehensive in-home assessment and care plan, with the goal of providing ongoing clinical services.
The results have been dramatic: For the more than 5,000 patients who have been enrolled in the program, we’ve seen a 35% drop in emergency department visits, a 40% decline in hospital admissions and an average annual reduction in spending per patient of almost $8,000. Most important for patients is their improved quality of life.
Identifying those most in need of intervention was critical. Using medical-claims data, the team evaluated Medicare Advantage members within Geisinger’s own health plan to find high-risk patients. Half of eligible patients had heart failure, 40% had chronic lung disease and a third had diabetes. Their median age was 84, with average annual costs exceeding $30,000; many had annual costs of more than $100,000.
The program has grown to include more than 100 clinicians covering more than 15 counties. One key to scaling has been to deploy the right skill set and “tag team,” with the physicians and advanced practitioners completing a comprehensive physical exam while the nurse or community health worker assesses the patient’s home — the food on hand, medications the patient is using and safety issues. Sometimes simple interventions have a big impact; our community health workers, for example, focus on cost-effective measures such as fitting a shower rail or providing a rolling walker that can head off a debilitating hip fracture.
We’ve leveraged technology to gather clinical data remotely, and we’ve focused on the most efficient and cost-effective ways to allocate staff. Can the pharmacist do a medication review from the office with the community health worker stationed in the home, instead of traveling there himself? Can mobile paramedics provide acute care services to free up nurses for other patients who need a more comprehensive assessment? The answer to both questions is yes.
We’re now looking at technologies that can help us sustain and expand the program. For example, we’re evaluating software to improve scheduling and decisions around field-team availability. We are also establishing chronic care pathways and crisis protocols to optimize our workflow and the frequency of our interventions. Because of these changes, Geisinger at Home clinicians have had to learn to don many hats. And this is ultimately the greatest strength of our initiative: the flexibility that team members continue to show as our model evolves.
Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.