Geisinger Health Plan serves more than 600,000 members in the state of Pennsylvania, including rural and underserved populations outside larger metropolitan areas.
THE PROBLEM
Many of these members want or need to access health care from their home, whether that looks like a mother who needs a breast pump and support from an in-home lactation consultant or a COPD patient who receives breathing therapy and oxygen daily or weekly.
But the infrastructure that exists today to help patients navigate care at home is fragmented and challenging.
“We at Geisinger have done our best to provide our patients with the best home care possible – with best-in-class clinical providers, telehealth communications and innovative care programs – but without that layer of technology, we faced our own challenges.” said dr. John Bulger, chief medical officer at Geisinger Health Plan.
“Managing our sustainable medical device network and the more than 1,900 DME providers we work with every day created significant administrative burdens and made it challenging to allocate time and resources to managing network visibility on metrics such as quality,” he continued. “This resulted in a highly fragmented network, creating an inconsistent provider referral experience and minimal member loyalty.”
These supplier challenges also created an unpredictable member experience, with the highest volume DME supplier being rated 1 out of 5 stars by members.
“We regularly received complaints and grievances from members regarding poor service, delivery delays, billing errors, unexpected charges or general unresponsiveness,” Bulger explains. “Our mission at Geisinger has long been to improve the quality of life for our patients through health, so it was essential that we improve the home care experience for providers, providers and, most importantly, patients.”
PROPOSAL
Geisinger was ideally looking for a supplier that could streamline the end-to-end member experience, enable timely and seamless care transitions, and deliver both direct and indirect savings to Geisinger.
“Tomorrow Health's technology platform improves visibility, increases quality and reduces costs, while remaining compliant with existing benefits and coverage,” Bulger said. “The solution is a foundational home care infrastructure platform that can help healthcare organizations like us support home care for thousands of patients.”
MEETING THE CHALLENGE
What this looks like in practice is essentially the automation of the DME ordering process. Tomorrow Health's technology integrates into a referring provider's workflow, providing them with a multi-step questionnaire based on the items they prescribe for home care and the complexity of the member's care plan requirements.
The seller then sends the order to a medical device supplier who can process the order more directly, as more than 80% of the supplier's digital orders include full documentation, Bulger noted.
“This saves administrative time, reduces operating costs and reduces the time it takes for members to get medical equipment to their homes,” he said. “From there, patients, referring providers and payers are kept informed of prescription status – and future care is integrated and automated to enable a more seamless experience and greater patient support.
“The launch required no technical integrations and minimal IT resources from our Geisinger team,” he continued. “The Tomorrow Health platform integrates with our existing EHR for increased vendor use and seamless workflow. The vendor also helped build awareness of the solution by training our customer service teams, providing our members with support throughout the service .in process.”
The company also leveraged Geisinger's extensive supplier network, which provided clear guidance and practical instructions in navigating a new system.
RESULTS
“We have seen an incredible, measurable improvement in the way we deliver home care to Geisinger patients across the state,” Bulger reported. “Most notably, we have worked with our actuary team to calculate a fourfold financial return on our investment from our work with Tomorrow Health – largely by optimizing our provider network to increase efficiency, automate manual processes and reduce delays in healthcare, which can often result in costly readmissions and avoidable recurrences in healthcare.
The supplier also helped Geisinger reduce total lead time since they started work by 83%.
“The platform's ease of use not only saves administrative time, but also gives providers the peace of mind that their members are receiving high-quality equipment and services,” he said. “The platform has in turn helped many of our suppliers improve their order times, reducing end-to-end order times across the network by six days.
“Most crucially for me, after implementing the solution, we also saw a 95% member satisfaction rate – which, as our Chief Medical Officer and someone who regularly contacts patients to listen to their concerns, was critical to a successful partnership. They tell me that they are receiving their home care and equipment significantly earlier than before, and that they find the proactive communication and updates reassuring during difficult times.”
The vendor's healthcare advocate program ensures experts are available to communicate with members, answer questions, clarify order status and resolve any issues promptly, so patients are never left in the dark about their care, he added .
ADVICE FOR OTHERS
“I am a strong believer in the importance of home health care,” Bulger said. “More than 70% of American adults prefer home care to a medical facility after a major medical event – and for Medicare populations alone, an estimated $265 billion in healthcare services will shift to the home over the next three years.
“We know that for thousands of our patients, the home is their best option and first choice for care – allowing them to live their lives flexibly while achieving better health outcomes,” he continued. “But as an industry, we have not optimized the way home care is delivered today, and the nuances of this process can pose challenges for healthcare systems and payers looking to provide patient care in the home.”
Geisinger has seen its investment in a home care provider pay off: This technology automates manual processes, keeps communication between all parties seamless and creates a strong foundation to build and grow its home care offering, he added .
“I would encourage other healthcare organizations and health insurers that recognize the challenges of the home care system to look at the impact that care at home can have, not only on their business and overall healthcare costs, but also on patient satisfaction and health outcomes.” , he advised. “Our work in this area has brought greater support, comfort and freedom to patients and their families – and we have only just scratched the surface of what is possible.”
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