Managed Care - January 2008 - (Page 16) LEADING WITH ITS HEART PROGRAM Geisinger’s “warranty” for CABG surgery has gotten a lot of attention, but is it transplantable? By Frank Diamond Managing Editor S omewhere along the line the word “warranty” was used to describe ProvenCare, Geisinger Health System’s experimental program for coronary artery bypass graft (CABG) surgery. It stuck. Geisinger is a health care company in central and northeastern Pennsylvania with about 2.6 million members. It includes Geisinger Health Plan, which has about 210,000 beneficiaries, and a 650member physician group practice, Geisinger Clinic. Although Geisinger itself doesn’t call ProvenCare a warranty program, it is not above mentioning that publications as diverse as the New York Times and the British Medical Journal describe it that way. When a group of Geisinger clinicians published an article about ProvenCare in the October issue of the Annals of Surgery, “warranty” appeared several times within quotation marks. Newspapers and medical journals duly expressed some caveats. For instance, since Geisinger Clinic offers the warranty to Geisinger Health Plan, the money stays in-house. There is also more cooperation between insurer and provider than you might expect to find under normal circumstances. Pure form Questions have also been raised about whether the sample size of the initial experiment, 137 CABG patients treated between Feb. 2, 2006 and Feb. 2, 2007, was statistically meaningful, though it’s meaningful enough to Geisinger officials for them to have maintained ProvenCare. This “pure form of P4P,” as it was described in the Annals of Surgery, will probably not work for emergency room surgery, for instance. Then there’s the whole issue of transferability. Could it even work as planned for CABG outside of a group model health insurer? Nonetheless, there’s a lot to like about it, and if it never gets replicated completely, still, aspects of it are bound to have their effect. “We’re quite confident that essential components of this are generalizable to other payers,” says Alfred S. Casale, MD, a cardiac surgeon at Geisinger Wyoming Valley Heart Hospital in Pennsylvania. He credits part of ProvenCare’s success to Geisinger’s electronic health records. ProvenCare works like this. One of the three hospitals involved charges a flat fee for CABG “plus 50 percent of the historically expected cost of management of complications” for the next 90 days, according to Alfred S. Casale, MD, a cardiac surgeon at Geisinger Wyoming Valley Heart Hospital in Pennsylvania. “What we’ve essentially said to the Geisinger Health Plan and will say to other payers [emphasis added, and more on this later] is that by doing this program and you giving us a package price that includes a 50-percent share of what you could have 16 MANAGED CARE / JANUARY 2008
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