C-B2-02: Measuring the Effect of a Patient-Centered Health Initiative on Clinic-Level Outcomes

Background: Geisinger Health Plan’s ProvenHealth Navigator (PHN) Program, a “Patient Centered Medical Home” initiative is designed to improve patient experience, optimize patient’s health status, and improve efficiency. Components include 24-hour primary and specialty care access, a GHP funded nurse case manager embedded in each practice site to coordinate services for patients with complex medical conditions, home based monitoring, interactive voice- response surveillance, and support for end-of-life care decisions. We analyzed hospitalization rates as well as financial outcomes to measure the effect of the PHN intervention in 11 clinics. Methods: Monthly data from 44 Geisinger clinic sites from 2005 to 2008 were retrospectively analyzed to test for a significant effect of the PHN intervention on admissions, readmissions, and expense outcomes. Eleven sites began the ProvenHealth Navigator at different times during the study period between 2006 and 2008. Statistical analysis was performed (SAS 9.1.3, Cary, NC) using Poisson regression to model admissions per member and readmissions per admission, or using linear regression to model inpatient expenses and total pre-prescription (PreRx) expenses per member. Each of these clinic level outcomes was modeled as a function of year, month, mean risk score, percent males, mean age and PHN status. PHN status was modeled using a within clinic and betweenclinic variable (Berlin et al., Biometrics 1999) to minimize confounding due to center-exposure association. The significance of the within clinic variable was tested at the p