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Home / News & IndustryManaged Care Insight and Analysis
Updated: January 18, 2011
Geisinger Health Plan: Smoother Sailing For Patient Healthcare Navigation

A hands-on guidance in new models of care that helps patients navigate the healthcare system and better manage their own chronic health conditions is now available.

Janet Tomcavage, RN, vice president of health services for Geisinger Health Plan in Danville, Penn., presented such a model care coordination program at Taconic IPA’s Spring Collaborative.

Her discussion focused on the patient-centered medical home.

"Helping patients better manage their own chronic health conditions, and taking a team approach to smooth transitions and work with specialists and hospitals as an extended team, are essential elements of the patient-centered medical home practice," said Dr. A. John Blair III, president of Taconic IPA.

Tomcavage is responsible for development and implementation of innovative medical management strategies for Geisinger, including medical home, disease management and case management approaches.

The event was to be hosted by TransforMED and Masspro. Both companies work with primary care physician practices in the Hudson Valley to adopt more efficient, effective care delivery models. Both have worked with practices in the Hudson Valley Medical Home Project and as a result 11 medical practices at 51 sites received Level 3 medical home recognition from the National Committee for Quality Assurance. (NCQA).

"As the leaders of care teams within their own practices, physicians are in a critical position to decide how care coordination is leveraged to improve health outcomes and lower health care costs," said Dr. Terry McGeeney, president and CEO of TransforMED.

The use of "embedded case managers" in primary care practices is at the heart of the patient-centered medical home model that Geisinger Health Plan launched in 2006.

Geisinger engages 61 nurse case managers who work as part of the healthcare team at 37 physician offices. These case managers identify patients with multiple chronic health conditions, see patients, work with physicians to develop and manage each patient’s care plan and coordinate care each patient receives from specialists or while staying in the hospital. The program has yielded a 15 percent to 20 percent decrease in hospital readmissions at every measurement phase of the program.

Tomcavage cites the case manager as "an important factor" in Geisinger’s success.

"The embedded case manager is a part of the primary care team and can walk down the hallway and talk to each member of the health care team," she said, resulting in a bond between the case manager, the patient and the primary care physician "that becomes the foundation supporting the patient-centered medical home model."

Addresses: The Taconic IPA, 380 Maple Ave. #206, Vienna, VA 22180; (703) 319-0957, www.taconicipa.com. Geisinger, 100 N Academy Ave., Danville, PA 17822; (570) 271-6211, www.Geisinger.org.


  This article was taken from:
The Executive Report on Managed Care

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