In a Nov. 18 webinar hosted by Becker's Hospital Review, clinicians from Geisinger Health System in Danville, Pa., and experts from xG Health Solutions shared details about ProvenCare®, which helps provider organizations drive outcomes and reduce readmissions through quality and standardization.
The presenters included John Bulger, DO, MBA, the chief quality officer in Geisinger's division of quality and safety, Alfred Casale, MD, the associate CMO and director of Geisinger Heart Institute and the chair of Geisinger's cardiothoracic surgery department, Jeffrey Davis, MD, MPH, senior medical director with xG Health Solutions, and Alex Zimmerman, MSN, RN, the director of advisory services for xG Health Solutions.
The ProvenCare® system was created because Geisinger leaders saw trends in healthcare like overuse of treatments, unreliable compliance with best practices and lack of accountability for outcomes and quality, Dr. Bulger explained.
"We sat down and said, 'How do we fix this? How do we get at changing this paradigm,'" Dr. Bulger said. That conversation, and a lot of work, led to the ProvenCare® approach. The goal of ProvenCare is to facilitate delivery of highly reliable, evidence-based care, or to "get it right every patient…every time we do it," he said.
ProvenCare is based on evidence-based best practice elements that reduce unnecessary variation. These elements are integrated into organization’s EHR to ensure their delivery and compliance. A multi-disciplinary clinical team can use ProvenCare to identify and agree on best practices and integrate them into care delivery. ProvenCare is also a cultural change, as clinicians and the care team need to recognize their practice and change it.
In the process of redesigning the workflow of a practice around a disease entity as part of the ProvenCare program, like heart failure or treatment of diabetes, the following five areas are the real tenets Geisinger goes through, Dr. Bulger explained:
1. Eliminate non-value added work
2. Automate any manual tasks possible
3. Delegate office visit-related work to trained non-physician staff, or "use people at the top of their license," he said.
4. Incorporate new workflows into provider practice, using hardwired reminders and tools to enhance efficiency
5. Activate the patient and family
Geisigner has developed ProvenCare modules for both acute and outpatient setting. It is those modules that xG Health converted to marketable products and services to help other provider organizations outside Geisinger.
The ProvenCare method has six core components, as described by Dr. Casale:
1. Clear documentation of appropriateness of care
2. Establishing evidence or consensus-based best practices. These best practices should be things that would cause physicians to "fail [their] boards" if they fail to do them.
3. Redesign the workflow of the clinical system to reliably deliver the best practices every time. Dr. Casale called this the "most critical aspect" of the model and referred back to the five tenets outlined by Dr. Bulger earlier in the presentation.
4. Turn patients and families from passive entities to active participants in the program
5. Provide a packaged price for the episode of care to move into the bundled payment arena
6. Transfer risk for financial effects of preventable complications to the health system
Dr. Casale shared some outcomes from implementing this model for patients undergoing coronary artery bypass grafts at Geisinger. Once making the ProvenCare improvements, clinical outcomes improved: There were 67 percent fewer in-hospital deaths and 76 percent fewer deep sternal wound infections, for example. Prices were also lowered.
For the outpatient side (ProvenCare Chronic), Dr. Davis from xG Health walked through the diabetes process redesign, which involves the following:
- Automating things like reminder letters to patients or pre-visit planning
- Delegating different roles to clerical workers, clinical nurses or case managers so everyone works at the top of their license
- Incorporating processes like having best practice alerts in the EHR, like if a foot exam is needed
- Activating patients by enrolling them in the patient portal. "When people are more engaged and have interaction in the patient portal, they have a better health status," Dr. Davis said.
How to get started
For hospitals, health systems or provider groups interested in getting started on the ProvenCare system, Mr. Zimmerman shared the following five tips to get started:
- Identify a condition or procedure to improve. Many organizations choose one with a "burning platform for change," he said.
- Gain executive support.
- Find a clinical champion. "You need a clinical leader to carry the flag and lead the team" through the process, Mr. Zimmerman said. This person could be one with a formal position of power, like a service line leader, or could be someone with a lot of passion for the project.
- Commit to change.
- Develop a customized approach and work plan.
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