Quality Initiatives - American Medical Group Association质量计划-美国医学协会
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• 190,000 Commercial lives • 38,000 Medicare Advantage
lives • Three companies:
– GHP – not for profit HMO – GQO, GIIC – for profit
Insurance Companies
6
Why Transform Care? Current model is not working
Value Transformation of Health Care:
Geisinger’s ProvenHealth Navigator SM Bending the Cost Curve
April 2010 Maria Kobylinski MD, Department Director
Community Practice Service Line
Geisi9ng/1e5r M/2e0d2ic0al Groups
Geisinger Health System Hub and Spoke Market Area Geisinger Health Plan Service Area
Careworks Convenient Healthcare
Non-Geisinger Physicians4with EHR
• Diversified products – commercial, medicare, TPA & CHIP • 80 contracted hospitals • 1000 contracted physicians
Geisinger Health System
Gray’s Woods
Geisinger Inpatient Facilities
Our Founder
“Make my hospital right, make it the best.” Abigail Geisinger 1827-1921
“Geisinger Quality – Striving for Perfection”… 2006 - 2011
Geisinger Health System
– Driving more uninsured – Unaffordable to government
• Primary care crisis • Patient care growing increasingly uncoordinated
– Consumer-directed health care has no link to PCP’s – Increased Specialty Care
– Pt base facilitates clinical research capability
• Succeeds by executing organizational change
5
GHP Insurance Operations
• Commercial, Individual, Medicare and SCHIP product lines
Access
Community Practice Service Line
Building Market Prominence
• Represent 30% of Geisinger physician group • Providing ¾ million outpatient visits annually • Geisinger’s face to the community
Physician Practice Group
Managed Care Companies
• Over 227,000 members
Leabharlann Baidu
• 700 physicians • 40 Comm. Practice sites • 1.5 Million Visits • 220 Interns & Residents
An Integrated Health Service Organization
Provider Facilities
• 2 Acute Care Hospitals • Children’s Hospital • Heart and Cancer Centers • Women’s Center • Drug & Alcohol Tx Center • 4 ambulatory surgery centers • 30K Admissions & 800 in-pt beds
McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A.
– 40 sites – primary care, outreach, & ancillaries – Admitting to 15 local hospitals – Community based identity, local market intelligence
• Largest Geisinger referral source >$300M
• Burden of chronic disease is growing
– Increasing incidence of disease – Increasing number of older patients
• U.S. health care still producing marginal quality • Escalating costs
System lacks an integrator of care
Patients receive just 55% of recommended care
Volume 348(26) 26 June 2003 pp 2635-2645
The Quality of Health Care Delivered To Adults In the United States
lives • Three companies:
– GHP – not for profit HMO – GQO, GIIC – for profit
Insurance Companies
6
Why Transform Care? Current model is not working
Value Transformation of Health Care:
Geisinger’s ProvenHealth Navigator SM Bending the Cost Curve
April 2010 Maria Kobylinski MD, Department Director
Community Practice Service Line
Geisi9ng/1e5r M/2e0d2ic0al Groups
Geisinger Health System Hub and Spoke Market Area Geisinger Health Plan Service Area
Careworks Convenient Healthcare
Non-Geisinger Physicians4with EHR
• Diversified products – commercial, medicare, TPA & CHIP • 80 contracted hospitals • 1000 contracted physicians
Geisinger Health System
Gray’s Woods
Geisinger Inpatient Facilities
Our Founder
“Make my hospital right, make it the best.” Abigail Geisinger 1827-1921
“Geisinger Quality – Striving for Perfection”… 2006 - 2011
Geisinger Health System
– Driving more uninsured – Unaffordable to government
• Primary care crisis • Patient care growing increasingly uncoordinated
– Consumer-directed health care has no link to PCP’s – Increased Specialty Care
– Pt base facilitates clinical research capability
• Succeeds by executing organizational change
5
GHP Insurance Operations
• Commercial, Individual, Medicare and SCHIP product lines
Access
Community Practice Service Line
Building Market Prominence
• Represent 30% of Geisinger physician group • Providing ¾ million outpatient visits annually • Geisinger’s face to the community
Physician Practice Group
Managed Care Companies
• Over 227,000 members
Leabharlann Baidu
• 700 physicians • 40 Comm. Practice sites • 1.5 Million Visits • 220 Interns & Residents
An Integrated Health Service Organization
Provider Facilities
• 2 Acute Care Hospitals • Children’s Hospital • Heart and Cancer Centers • Women’s Center • Drug & Alcohol Tx Center • 4 ambulatory surgery centers • 30K Admissions & 800 in-pt beds
McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A.
– 40 sites – primary care, outreach, & ancillaries – Admitting to 15 local hospitals – Community based identity, local market intelligence
• Largest Geisinger referral source >$300M
• Burden of chronic disease is growing
– Increasing incidence of disease – Increasing number of older patients
• U.S. health care still producing marginal quality • Escalating costs
System lacks an integrator of care
Patients receive just 55% of recommended care
Volume 348(26) 26 June 2003 pp 2635-2645
The Quality of Health Care Delivered To Adults In the United States