To better manage care for older patients with complex needs, Geisinger implemented a home care program called Geisinger at Home, which has helped the health system save money and reduce ED visits and hospital admissions, Janet Tomcavage, Jaewon Ryu, and Sanjay Doddamani write in the Harvard Business Review.

Evaluate 4 successful home-based care models

Tomcavage is Geisinger's chief nursing executive and Ryu is the health system's president and CEO. Doddamani is senior advisor at the Center for Medicare and Medicaid Innovation and formerly served as CMO of Geisinger at Home. 

Geisinger at Home

When Geisinger officials set out to launch the Geisinger at Home program they sought out to create a holistic program that would help home-bound patients who may be struggling with issues like food insecurity, social isolation, and lack of transportation, the authors note.

The Geisinger staff leveraged the health systems health plan to evaluate Medicare Advantage claims data and identify patients who could benefit from a home care program. They discovered that half of the eligible patients had heart failure while 40% had chronic lung disease and a third had diabetes, the authors write. The patients' median age was 84, and average annual costs surpassed $30,000, the authors note. 

As part of the program, Geisinger deploys a provider to visit patients in the home. Each member of the Geisinger at Home team is equipped with technology to gather clinical data. For instance, the team uses Bluetooth scales that transmit patients' daily weights and help the team monitor potential fluid accumulation, the authors write. The team also uses digitally transmitted wound images, which allow decision making to be done alongside hospital-based surgical experts without the patient needing to travel or wait.

Geisinger at Home also utilizes post discharge telehealth visits, whereby a community health worker visits a patient at home and connects them through an iPad that is outfitted with peripherals like a pulse oximeter, stethoscope, and blood pressure cuff, the authors write.

The nature of the program means that many of the providers on the Geisinger at Home team work with a number of dying patients. As a result, the staff frequently engage in conversations with the patient and their family about the patient's prognosis and their end-of-life wishes, the authors write.

Since this occurs so frequently, all team members have become competent and comfortable helping patients and families make end-of-life decisions through specialized training that includes role playing and case studies in which trained actors play patients, the authors write.

Positive results and next steps

Since the program started in the spring of 2018, it has grown significantly, the authors write. It's grown from one physician, one nurse, and a single community health worker in a small rural community to include over 100 clinicians in more than 15 counties, according to the authors.

The program's results have been "dramatic," the authors write. Namely, it's led to a 35% drop in ED visits, a 40% drop in hospital admissions, and an annual reduction in spending per patient of nearly $8,000. Patients also say it has improved their quality of life, the authors write.

Now, Geisinger is looking to sustain and expand the program, according to the authors. This includes working to better integrate claims and authorization data into a patient's EHR and evaluating software to improve scheduling and field-team availability decisions in order to ensure a quick response to patients' needs.

"The most important key to better care for complex, home-bound patients, we've found, is the one that opens the front door," the authors conclude (Tomcavage et al., Harvard Business Review, 11/6).