WVUHS

Channeling Geisinger’s best-in-class approaches to achieve impressive results

West Virginia United Health System (WVUHS) is the largest health system in West Virginia, with 1,286 beds covering 10 counties. The health system has a total of 866 physicians who are either employed or affiliated with WVUHS.

 

In seeking to position itself as the high performing care delivery system in its market, WVUHS has focused on reengineering primary care and developing patient-centered medical home capabilities. Looking for a catalyst to jump start its system integration efforts, WVUHS considered multiple partners and then chose Geisinger as a provider-led organization that demonstrated strong experience in building patient-centered medical homes. WVUHS began working with Geisinger Health Plan in January 2012 and then with xG Health Solutions after our launch in 2013. The Geisinger Health Plan team provided population health and data analytics to support the design of population health management models and strategies, claims processing, and third-party administration (TPA) services.

 

The initial population for these services included 50% of WVUHS employees and their dependents (approximately 10,000 lives) in Phase I (2012). The relationship was expanded in January 2013 to include the remaining 50% of the employee population with total lives reaching approximately 18,000.

 

The initial analysis performed by Geisinger Health Plan looked at multiple years of historical data to identify trends and build benchmarks. This analysis allowed the team to identify opportunities for improvement, prioritize them based on the impact each could deliver to the system, and build clinical initiatives around these areas. Core clinical initiatives identified and implemented during Phase I and into the beginning of 2013 included:

 

  • The Geisinger Health Plan built a Transition of Care Program with the first nurse starting in March 2012.
  • A disease management program focused on chronic conditions with telephonic support from nurses driving lifestyle changes.
  • The Geisinger Advanced Medical Home approach resulted in the first medical home site beginning operations in January 2012.
  • A second medical home site was established in December 2012 and a third in 2013.
  • A change in the authorization of admissions process began June 6, 2012.
  • A process for authorization of high tech radiology (NIA) was instituted in September 2012 to control costs.

 

Results

 

By the end of 2013, the two-year old partnership with Geisinger Health Plan and xG Health generated strong results for WVUHS, including success in utilization management such as:

 

  • 17% reduction in admission rates
  • 20% reduction in readmission rates
  • 10% reduction in ED visit rates
  • $13 reduction in per member per month total cost of care (holding unit costs constant)

 

For the first medical home that began operations in January 2012, the reductions in utilization were even greater.

 

Additionally, three areas of quality improvement—increased utilization in predefined chronic and preventive care measures, case management for individuals discharged from the hospital, and disease management enrollment—were part of the partnership. For example, by the end of 2013, the first medical home had improved performance on key clinical quality metrics, including LDL Screening, LDL Control, A1c Control, and Breast Cancer Screening.

 

wvhu-chart

 

In case management, outreach efforts for patients discharged from the hospital also improved. In 2012, 85% of patients were contacted by a case manager within three days; 92% were contacted within seven days. In 2013, results improved even further: 90% of patients were contacted within three days and 95% within seven days. In disease management enrollment, 100% of patients with CAD were screened and 66.9% were enrolled in the practice-based disease management program with a case manager. In addition, 100% of patients with diabetes were screened and 62.5% were enrolled in the practice-based disease management program with a case manager.

 

Rocky Edmondson RN, BSN, MBA, CCRN
Senior Director, Bundled Payments, Care Redesign and Management Advisors, xG Health Solutions

Rocky Edmondson is the Senior Director of Bundled Payments for Care Redesign and Management Advisors at xG Health Solutions. Rocky has been involved in workflow redesign, program implementation, and analytic evaluation of Bundled Payment Programs across the country, and he coaches Hospitals, Health Systems, Post-Acute Providers, and Physician Groups on how to successfully implement care redesign in the Bundled Payment for Care Improvement (BPCI) and CJR Programs.

Rocky’s passion is helping people to understand the intricacies of Bundled Payment Programs. He has a talent for teaching people how to cut through all the noise and just do the things that matter to be successful in these programs.

Rocky holds an Associate’s Degree in Nursing from the University of Hawaii Maui, and a Bachelor’s Degree in Nursing and a Master’s Degree in Business Administration (MBA) from Boise State University.

Prior to joining xG Health Solutions, Rocky was the Southeast Region Director of Clinical Operations for Remedy Partners, overseeing program design, implementation and analytic evaluations for Bundled Payment Programs. Prior to embarking on a career in Bundled Payments, Rocky was a Registered Nurse for 18 years, working in a number of positions within Critical Care. Before becoming a Nurse, Rocky was an Institutional Broker at Merrill Lynch and advised a number of healthcare systems and large corporations on cash management strategies. In addition, Rocky has started several businesses and provided consulting for small business startups. Rocky served in the U.S. Marine Corps as a Recon Marine.

Janet Comrey RN, BSN, MHSA
Director, Population Health Solutions, Geisinger Health System

Janet Comrey, RN, BSN, MHSA has over 30 years of diversified nursing and leadership experience at Geisinger Health system and currently serves as Director of a small department embedded within Population Health. One of her key roles is managing the Bundle Payment for Care Improvement (BPCI) program since January 2014 earning an overall positive net payment reconciliation to date. Janet also serves as the coordinator for Project Achieve at Geisinger which is a national PCORI funded study related to patient’s perceptions of transitions of care.

Janet received her nursing education through Geisinger’s diploma program, her BSN through Bloomsburg University, and later earned her graduate degree from Marywood University. During her tenure at Geisinger she taught quality improvement methodology and facilitated improvement teams the Geisinger Quality Institute. She is currently enrolled in the Institute for Healthcare Improvement Advisory program.

Professional memberships include Sigma Theta Tau, Phi Kappa Phi, American Society for Quality.

Andrew Blackmon, MBA, MHS
Chief Sales and Business Development Officer

Chief Sales and Business Development Officer Andrew Blackmon, MBA, MHS, has more than 18 years of experience in healthcare product sales, marketing, and strategy.

Before joining xG Health, Andrew was vice president of sales for population health and risk management solutions at McKesson. He came to McKesson through acquisition of MedVentive, an early population health vendor. Before MedVentive, he served as vice president of enterprise solutions development at MedAssets. He is a past president of the Georgia chapter of HIMSS, and he has held strategy and planning positions at PricewaterhouseCoopers and Orlando Health.

Andrew has an MBA and a Master’s of Health Science from the University of Florida Warrington, College of Business, and a Bachelor of Arts degree in Psychology from Rollins College.

Holly Barbella, RN, MBA

Risk Coordinator, Geisinger Health System

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Earl P. Steinberg, MD, MPP
Chief Executive Officer

Earl P. Steinberg, MD, MPP, is a nationally recognized expert in healthcare quality improvement and serves as xG Health’s chief executive officer. Earl also is an adjunct professor of Medicine and of Health Policy and Management at Johns Hopkins University and a member of Blue Cross/Blue Shield Association’s National Medical Advisory Panel.

Before joining xG Health, Earl was executive vice president of Innovation & Dissemination, and chief, Healthcare Solutions Enterprise at Geisinger Health System.

Before joining Geisinger, he was senior vice president for Clinical Strategy, Quality & Outcomes at WellPoint, Inc., the largest commercial health insurer by membership in the US, and president and CEO of Resolution Health Inc. (RHI), a leading healthcare data analysis company that provides innovative quality improvement and cost reduction services to health plans, employers, pharmacy benefit managers, and disease management companies.

Before joining RHI, Earl spent six years as vice president of Covance Health Economics and Outcomes Services Inc., director of its Quality Assessment and Improvement Systems Division, and co-director of its Outcomes Studies Group. He also spent 12 years on the full-time faculty at Johns Hopkins University, where he was professor of Medicine and of Health Policy and Management and director of the Johns Hopkins Program for Medical Technology and Practice Assessment, and four years on the Federal Physician Payment Review Commission. He co-chaired the Institute of Medicine’s panel on Standards for Development of Trustworthy Practice Guidelines.

Earl has received many awards, including the Henry J. Kaiser Family Foundation Faculty Scholar Award in General Internal Medicine (1984), the “Outstanding Young Investigator” Award from the Association for Health Services Research (1988), and a Special Presidential Visionary Award from the National Kidney Foundation (NFK) (2004) for his work as the scientific director of the NKF’s landmark Kidney Disease Outcomes and Quality Initiative, which produced more than 250 clinical practice guidelines for management of patients with end-stage renal disease. He also is a fellow of both the American College of Physicians and AcademyHealth, and he has published more than 125 articles in peer-reviewed journals.

Earl received his AB from Harvard College (summa cum laude), his medical degree from Harvard Medical School, and a Master of Public Policy from the Kennedy School of Government. He performed his residency training in internal medicine at Massachusetts General Hospital.