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Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System
Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System
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The fact sheet on the Comprehensive Primary Care (CPC) initiative announced in fall 2011 by the Centers for Medicare and Medicaid Services (CMS) points to results from several organizations that "have taken the lead in investing in primary care:"

  • Group Health Cooperative of Puget Sound reduced emergent and urgent care visits by 29 percent and hospital admissions by 6 percent.
  • Geisinger Health Plan reduced admission rates by 18 percent and hospital readmissions by 36 percent per year.

Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System takes a look at the successful patient-centered approaches by these two innovators, sharing key strategies and lessons learned from program implementation.

CMS says its CPC program is modeled after the innovative practices developed by large employers and others in the private sector. Under CPC, Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in CPC will be given resources to better coordinate primary care for their Medicare patients.

This 50-page report gives healthcare organizations a leg up on CPC, starting with an examination of the staffing model from Group Health Cooperative that, in addition to impressive clinical outcomes, has earned the health system a reputation as a "model for healthcare reform."

Michael Erikson, Group Health's vice president of primary care services, walks through the Washington State-based cooperative's primary care practice redesign, retooled staffing models and program rollout tips. Group Health Cooperative was among the top 10 commercial health plans for 2009-2010 as ranked by the NCQA and U.S. News Media Group.

Another model frequently imitated in the industry is Geisinger Health Plan's ProvenHealth Navigator (SM), the plan's home-grown medical home constructed around an embedded case manager.

In ProvenHealth Navigator(SM), Geisinger's home-grown medical home model, case managers are carefully matched with primary care practices, where they help to identify highest-risk patients and develop customized care plans that foster self-management of chronic conditions and more judicious use of healthcare resources.

How does the presence of a case manager in a physician practice affect practice workflows, efficiency, patient health status, health utilization and patient and provider satisfaction? Geisinger Health Plan's Diane Littlewood, RN, BSN, CDE, regional manager of case management for health services, and Joann Sciandra, BSN, CCM, director, case management strategic planning for health services, address these aspects of the approach and more, including:

  • Engaging and incenting physician practices to embed case managers to assist with care transitions and patient compliance;
  • The case manager selection and training process;
  • Identifying populations for case management;
  • Skill sets, roles, tools and responsibilities of the embedded case manager;
  • Case load management;
  • Real-life examples of patient self-management patient action plans;
  • Results from Geisinger's embedded case manager program, including its impact on patient compliance, care transition management, medication adherence, hospital readmissions;
and much more.

Table of Contents

  • Group Health Cooperative Medical Home Staffing Model
    • Six Principles of the Group Health Medical Home Pilot
    • Call Management and Virtual Medicine Practices
    • Pre-Visit Preparations
    • Care Team Roles
    • Results from the One-Year Study
    • Impact on ER, Hospital and Urgent Care Utilization
  • Geisinger ProvenHealth Navigator and the Embedded Case Manager
    • The Embedded Case Manager
    • Principles and Priorities of Case Management
    • Selecting a Case Manager
    • Case Manager Skill Sets
    • Case Manager Training and Support
    • Identifying High-Risk Cases
    • Post-Discharge Processes
    • Results from the Case Manager Effort
  • Q&A: Ask the Experts
    • Distinguishing Referral Types
    • Moving Group Health Model to FFS Environment
    • Educating Group Health Patients about New Care Delivery Models
    • Setting Goals with Group Health Patients
    • Resources to Support Practice Transformation
    • The Co-Op as Model in Healthcare Reform
    • Integrating the Medical Home with the Health Plan
    • Technology Supporting the Medical Home Model
    • Staffing the Case Manager Call Center
    • Home Health and Home Visits
    • Stratifying Complex Patients
    • Case Manager Competencies
    • Investment in Medical Home Infrastructure
    • Targeted Case Management Populations
    • The Case Managers Role in the Practice
    • Engaging the Practice in the Program
    • Making the Most of the Case Manager Resource
    • Case-Managing the Most at Risk
    • Building Physician Buy-In for the Embedded Case Manager
    • Case Management Tools
    • Predictive Modeling for Risk Identification
    • Funding and Reimbursement for the Embedded Case Manager
    • Timeline for Program Implementation
    • Importance of Technology in Program Model
  • Glossary
  • For More Information
  • About the Presenters
Publication Date: January 2012
Number of Pages: 50
ISBN 10: 1-937229-41-6 (Print version); 1-937229-42-4 (PDF version)
ISBN 13: 978-1-937229-41-2 (Print version); 978-1-937229-42-9 (PDF version)
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