Is there strong supporting infrastructure in place?

Is there strong supporting infrastructure in place?

These new ways of working require a supporting infrastructure so clinicians feel confident they are able to perform the new tasks and roles required of them. This means ensuring the organization can support them.


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The organization should support clinicians through:

  • Population management – healthcare professionals must have the ability to identify the target population for a given service and stratify it for the different risks that individuals and groups have from those conditions. This requires the ability to link patient data including prescribing, primary care and hospital encounters.
  • Bringing all the data together – either virtually or in a single repository, is an important step. As well as health information, data about the patient’s social context greatly improves the predictive power of the models.
  • Reaching out to patients – designing services that help patients manage their own health more efficiently. This could include expert patient programs, condition specific technology such as apps, proactive visits by staff and better care planning. See the case studies in this report or KPMG International’s previous report Creating new value with patients, carers and communities for how this works in practice.1
  • Utilization management – in the context of coordinated care, ensuring that the location and type of care is appropriate for the needs of the patient. Often this forms the foundations of strategies to shift care into patients’ homes.
  • Clinical decision support – coordination is difficult if clinicians in one part of the coordinated system are uncertain about how other parts of the system manage care. Standardized, evidence-based tools and processes as well as transparency between organizations, will give professionals the confidence to transfer care to other providers. Geisinger’s ProvenCare system, see case study below - US – ProvenCare: The Geisinger Health System as an example of this in practice.
  • Reporting and performance management – the move away from isolated episodes of care is a particular challenge for many performance management systems, but ways must be found to assess an individual’s contribution in the context of the wider pathway and in terms of patient outcomes.

A key challenge will be that the skills to develop and run some of this new infrastructure are scarce. However, not all of these functions need to be provided in-house. Outsourcing, joint ventures with other providers and partnerships with technology companies will play an important role in releasing economies of scale and moving to more sophisticated forms of outcome based finance, HR and data management.

Case study: US – ProvenCare: The Geisinger Health System

The Geisinger Health System in Pennsylvania, US is an example of many aspects of coordinated care, including designing internal financial flows to incentivize low-cost, early interventions that prevent emergency admissions over time. They have achieved this by providing incentives to organize all of the interventions from prevention to the quaternary interventions of their own hospitals.

Established 100 years ago, Geisinger has become:

  • A nonprofit, physician-led, integrated health system serving a population of 2.6 million people in rural northeastern and central Pennsylvania, through three acute/ tertiary/ quaternary hospitals and an alcohol/chemical dependency center.
  • A multispecialty group practice employing more than 740 physicians on 50 sites, including 40 community clinics.
  • A 220,000-member health plan, which contracts with more than 18,000 independent providers including 90 hospitals.
  • An organization known for innovation through its Geisinger Center for Health Research.
  • A provider organization with medical education programs serving medical students, residents, fellows, and other medical professionals and annual patient volumes of over 40,000 inpatient discharges and 1.5 million outpatient visits.

Geisinger Health System has dramatically increased the use of evidence-based, high quality, efficient healthcare for acute and chronic conditions through its ProvenCare model. This sets out clear care processes to reliably deliver a coordinated bundle of evidence-based (or consensus-based) best practice, reinforced with packaged pricing based on outcome measures.

For example, Geisinger charges a flat fee for its Plan members who need certain surgical procedures. This flat fee covers preoperative care, surgery, and 90 days of follow-up treatment (at a Geisinger facility) including that of any related complications. Pricing the bundle at a discount creates an incentive for efficiency and, in effect, offers a warranty against complications.

ProvenCare has had dramatic results on the community:

  • 100 percent lower in-hospital mortality (which decreased from 1.5 percent to zero);
  • 21 percent decrease in patients with any complications (from 38 percent of patients to 30 percent) and 45 percent decrease in readmissions within 30 days (from 6.9 percent to 3.8 percent)
  • 10 percent increase in patients discharged to their homes
  • financial outcomes also improved, including a 16 percent drop in average length of stay (from 6.3 days to 5.3 days) and 5 percent lower hospital charges.

The ProvenCare product portfolio has been expanded to include angioplasty, hip replacement, cataract surgery, erythropoietin use, bariatric surgery, angioplasty with acute myocardial infarction, and prenatal care.

Geisinger has achieved physician buy-in to this more standardized approach because of three factors:

  1. There is significant market stability.
  2. Physicians are well equipped to do their jobs.
  3. They work in a collaborative environment where they have tangible impact on the health of their community. 


1. KPMG International, 2014.

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