News & Commentary

Geisinger's PCMH Garners Attention


Geisinger Health Plan is touting its patient-centered medical home (PCMH) effort, and with good reason. A recent study in Health Affairs (http://tinyurl.com/PCMH-Geisinger) notes that the insurer’s ProvenHealth Navigator shaved off 7.9% of total costs for more than 6,400 Medicare enrollees from January 2006 through June 2013.

The largest source of savings was acute inpatient care ($34, or 19% savings per member per month), which accounted for 64% of total estimated savings. Acute admission rates fell by 18% during the study period.

That’s impressive, but many experts say that the PCMH model works well only under certain circumstances, and cannot be widely replicated (/archives/2015/2/pcmh-finds-success-within-narrow-limits).

For instance, Geisinger is an integrated system, with both insurance and provider arms. The researchers, most of whom are affiliated with Geisinger, note that the insurance arm has the advantage of being led by a systemwide programmatic leadership that focuses on the entire care process instead of a single episode.

They also say that the main goal of PCMHs is not to save money but to emphasize providing the right care earlier in the process through routine doctor visits, better care coordination, and preventive services. That said, savings continued to grow into the eighth year of the Navigator program, and it doesn’t seem to be a matter of the savings in acute care coming from shifts to costs in other areas of care.

The explanation from the Geisinger researchers is familiar: Cents spent on timely prevention can eliminate the need to spend dollars on treatment. How long can that last? They conceded that the law of diminishing marginal returns eventually will kick in.

Still, eight years is a long time, and the researchers say their findings suggest that the PCMHs can achieve cost savings in larger contexts.