GEISINGER HEALTH PLANPub 78
Pub 78
Programs
Program 1 [2021]
I. GENERAL INFORMATION THREE COMPANIES COMPRISE WHAT IS KNOWN AS GEISINGER HEALTH PLAN: GEISINGER HEALTH PLAN ("GHP"), A TRADITIONAL HEALTH MAINTENANCE ORGANIZATION (HMO); GEISINGER QUALITY OPTIONS, INC., PREFERRED PROVIDER ORGANIZATION (PPO) PLANS; AND GEISINGER INDEMNITY INSURANCE COMPANY (GIIC), OFFERING AS A THIRD PARTY ADMINISTRATOR (TPA) PROVIDING ADMINISTRATIVE ONLY SERVICES. THE THREE COMPANIES BASED IN DANVILLE, PENNSYLVANIA TOGETHER, HAD MORE THAN 542,900 MEMBERS AS OF DECEMBER 31, 2020. GHP, A NOT FOR PROFIT ORGANIZATION, PROVIDES PRE PAID MANAGED HEALTHCARE TO ITS MEMBERS. AT DECEMBER 31, 2020, GHP PREDOMINATELY PROVIDED MANAGED HEALTHCARE TO GOVERNMENT PROGRAMS INCLUDING 204,900 MEDICAID MEMBERS, 69,400 MEDICARE ADVANTAGE MEMBERS AND 13,400 CHIP MEMBERS. GHP ALSO PROVIDED MANAGED HEALTHCARE TO 50,300 COMMERCIAL MEMBERS. FOUNDED IN 1972, INCORPORATED IN 1984, AND INITIALLY LICENSED BY THE DEPARTMENT OF INSURANCE IN 1985, GHP OPERATES IN 48 CONTIGUOUS COUNTIES IN MOSTLY RURAL CENTRAL AND NORTHEASTERN PA. GHP CONTRACTS WITH MORE THAN 62,200 PROVIDERS AND 135 HOSPITALS. GHP IS CONSISTENTLY RECOGNIZED FOR QUALITY. GHP HAS BEEN ACCREDITED FOR QUALITY BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) SINCE 1993. THE COMMERCIAL AND MEDICARE HMOS ARE RATED ONE OF THE TOP HEALTH PLANS IN THE NATION IN THE 2020 2021 NCQA HEALTH INSURANCE PLAN RATINGS. NEW FACILITIES AND MORE SERVICES GHP, A 501(C)(4) NONPROFIT ORGANIZATION, INVESTS ITS REVENUES IN EXCESS OF COSTS TO PROVIDE HEALTHCARE TO MEMBERS TO IMPROVE FACILITIES AND SERVICES, INCREASE BENEFITS AND PROVIDE AFFORDABLE RATES. GHP TYPICALLY MAKES ANNUAL CONTRIBUTIONS TO GEISINGER HEALTH, IT'S 501(C)(3) PARENT, TO ENHANCE TEACHING, EDUCATION AND RESEARCH PROJECTS TO BENEFIT ALL PENNSYLVANIANS. THESE CONTRIBUTIONS ARE USED TO FUND NEW FACILITIES AND TO ADD SERVICES TO OUR EXISTING HOSPITALS AND PHYSICIAN CLINICS IN DIRECT SUPPORT OF GEISINGER HEALTH'S CHARITABLE MISSION AND OF ITS CHARITABLE AFFILIATES BY ENHANCING HEALTHCARE PROGRAMS AND SERVICES THROUGHOUT THE REGION WHILE IMPROVING THE AVAILABILITY OF PATIENT CARE IN OUR SERVICE AREA. PROVIDING AFFORDABLE, HIGH QUALITY, COMPREHENSIVE HEALTHCARE AND BENEFITS INCREASES THE ACCESS OF CARE TO THOSE WHO MIGHT NOT OTHERWISE BE ABLE TO AFFORD HEALTHCARE AND CONTRIBUTES TO THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. GHP PROVIDES COMPLETE HEALTHCARE SERVICES ON A PREPAID BASIS THROUGH AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PROVIDING HEALTHCARE TO THE ENTIRE COMMUNITY. GHP CHANNELS EXPERIENCE, KNOWLEDGE AND FUNDS TO PURSUE GEISINGER'S PROJECTS. NO OTHER ORGANIZATION IN THIS REGION HAS BOTH PROVIDER AND PAYER JOINED TOGETHER TO CREATE SYNERGIES TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED. PROVENHEALTH NAVIGATOR (PHN) GHP'S PROVENHEALTH NAVIGATOR IS A PARTNERSHIP BETWEEN PATIENTS, PRIMARY CARE PROVIDERS AND GHP TO IMPROVE MEMBERS' HEALTH. ALSO KNOWN AS A "MEDICAL HOME," PHN PROVIDES A CASE MANAGER WHO WORKS WITH THE MEMBER'S HEALTHCARE PROVIDERS, THE MEMBER AND THE MEMBER'S FAMILY COORDINATING CARE WITH HOSPITALS, SPECIALISTS, PHARMACISTS AND SKILLED NURSING FACILITIES. THE MODEL BLENDS ASPECTS OF A CHRONIC CARE MODEL, A MEDICAL HOME MODEL AND A PATIENT CENTERED PRIMARY CARE MODEL. ADDITIONAL FUNCTIONAL COMPONENTS ARE INCLUDED, CREATING A NEW HEALTHCARE DELIVERY VEHICLE: HEALTH NAVIGATOR ("HN"). ACTING AS THE FIRST LINE CAREGIVER AND GUIDE, GHP NURSE CASE MANAGERS HELP MEMBERS NAVIGATE THE HEALTH CARE SYSTEM. HN'S KEY STRATEGY OFFERS MEMBERS ACCESS TO AN HN CASE MANAGER 24 HOURS A DAY, 7 DAYS A WEEK. THE PRIMARY CARE PRACTICE TEAM AND GHP, WORKING WITH THE MEMBER AT THE CORE OF THE SYSTEM, ACCEPT RESPONSIBILITY TO OPTIMIZE HEALTH STATUS FOR EACH INDIVIDUAL MEETING WITH PRE ESTABLISHED QUALITY, EFFICIENCY, AND MEMBER SATISFACTION OUTCOME TARGETS FOR THE PRACTICE POPULATION. THE COST OF PROVIDING PHN TO NON MEMBERS WAS 1.6M IN THE SIX MONTHS ENDED DECEMBER 31, 2020. PROVENCARE CHRONIC DISEASE GEISINGER IDENTIFIED COMMON CHRONIC DISEASES (DIABETES, CORONARY ARTERY DISEASE, CONGESTIVE HEART FAILURE) AND ADULT PREVENTION MEASURES (IMMUNIZATIONS, COLONOSCOPIES, ETC.). USING EVIDENCE BASED BEST PRACTICES, CARE WAS "BUNDLED" TO INCLUDE THE MOST EFFECTIVE TREATMENT. SUCCESS IS MEASURED BY MEETING 100% OF THE BUNDLE REQUIREMENTS, TRACKED OVER TIME. GEISINGER'S MADE SIGNIFICANT IMPROVEMENT MEETING THE BUNDLE REQUIREMENTS FOR DIABETES AND PREVENTIVE CARE FOR ADULTS. PROVENCARE ACUTE EPISODIC CARE (THE "WARRANTY") BEGINNING WITH CORONARY ARTERY BYPASS GRAFTS (CABG), THE PROCESS INCLUDES IDENTIFYING HIGH VOLUME DIAGNOSIS RELATED GROUPS (DRGS), DETERMINING BEST PRACTICE TECHNIQUES AND DELIVERING EVIDENCE BASED CARE. THE GEISINGER CLINICAL ENTERPRISE WORKED WITH GHP TO ESTABLISH A GLOBAL FEE THAT INCLUDES PRE OPERATIVE CARE, HOSPITALIZATION, PHYSICIAN FEES, REHABILITATION, AND CARE (ADMISSIONS DUE TO COMPLICATIONS) RELATED TO THE SURGERY WITHIN 90 DAYS. THIS ADDITIONAL CARE IS NOT CHARGED (IF SEEN AT A GEISINGER FACILITY). THIS "WARRANTED" CARE HAS BEEN SUCCESSFUL AND FEATURED IN THE NEW YORK TIMES AND IN THE ANNALS OF SURGERY. GEISINGER ALSO HAS PROGRAMS FOR ANGIOPLASTY WITH ACUTE MYOCARDIAL INFARCTION (HEART ATTACK), HIP REPLACEMENT, CATARACTS, ERYTHROPOIETIN (A DRUG USED FOR KIDNEY PATIENTS), PERINATAL CARE, LOW BACK PAIN AND BARIATRIC SURGERY. TRANSITIONS OF CARE HELPING PATIENTS TRANSITION THROUGH LEVELS OF CARE, FROM HOSPITAL TO HOME, IS AN IMPORTANT COMPONENT OF ENSURING COMPREHENSIVE AND HIGH QUALITY HEALTHCARE SERVICES. GEISINGER HAS IMPLEMENTED NEW STRATEGIES WITHIN THE HOSPITAL AND PRIMARY AND SPECIALTY SETTINGS TO ANTICIPATE PATIENT NEEDS AND COORDINATE SERVICES TO ASSURE TIMELY AND SAFE TRANSITIONS. THESE STRATEGIES HAVE INCORPORATED TIMELY COMMUNICATION FROM THE HOSPITAL TO PRIMARY CARE PROVIDERS, LEVERAGED DATA FROM ELECTRONIC HEALTH RECORDS & CLAIMS TO IDENTIFY RISK AND USED CASE MANAGERS TO PROVIDE EARLY FOLLOW UP SERVICES. GEISINGER'S EFFORTS AROUND TRANSITIONS HAVE DEMONSTRATED MORE COORDINATED FOLLOW THROUGH AFTER DISCHARGE AND REDUCTIONS IN READMISSIONS. ELECTRONIC HEALTH RECORD (EHR) GEISINGER IS ON THE FOREFRONT IN THE DEVELOPMENT AND USE OF THE EHR. GHP HELPED SUPPORT THE 100 MILLION INVESTED IN EHR OVER THE LAST SEVERAL YEARS. ENDLESS POSSIBILITIES EXIST FOR IMPROVING THE QUALITY OF CARE WITH THE EHR. GHP USES THE EHR TO COMMUNICATE WITH MEMBERS WHO ARE INVOLVED IN MEDICAL OR DISEASE MANAGEMENT PROGRAMS AND THEIR PHYSICIANS. GEISINGER ALSO ALLOWS COMMUNITY HOSPITALS AND PHYSICIANS TO ACCESS PATIENT INFORMATION TO CARE FOR THEIR PATIENTS. DISEASE AND CASE MANAGEMENT SERVICES TO IMPROVE THE HEALTH OF MEMBERS, GHP PROVIDES DISEASE AND CASE MANAGEMENT PROGRAMS AND SERVICES TO COORDINATE CARE FOR THOSE WITH CHRONIC CONDITIONS. THE PROGRAMS ARE FOCUSED ON CONGESTIVE HEART FAILURE, HYPERTENSION, DIABETES, CORONARY ARTERY DISEASE, OSTEOPOROSIS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CHRONIC KIDNEY DISEASE, ASTHMA, TOBACCO CESSATION AND WEIGHT MANAGEMENT. THESE PROGRAMS WERE THE RESULT OF A COLLABORATION OF EXPERTISE BETWEEN GHP AND GEISINGER PROVIDERS AND HAVE ATTAINED NATIONAL RECOGNITION BY HEALTH MANAGEMENT ORGANIZATIONS & INDUSTRY GROUPS. THIS SUCCESSFUL COLLABORATION IS AN EXAMPLE OF HOW THIS UNIQUE RELATIONSHIP BENEFITS THE COMMUNITY. COMMUNITY HEALTH, EDUCATION AND OUTREACH GHP EMPLOYEES PROVIDE THE PUBLIC WITH INFORMATION ON TOPICS SUCH AS INSURANCE EDUCATION, ADVANCE DIRECTIVES, DENTAL AND HAND HYGIENE, ASTHMA CARE, THE IMPORTANCE OF SCREENINGS & IMMUNIZATIONS AND WELLNESS. GHP PROVIDED INFORMATION TO 345,970 INDIVIDUALS AT 703 EVENTS INCLUDING HEALTH FAIRS, SCHOOL BASED PRESENTATIONS, SEMINARS AND ORGANIZATIONAL MEETINGS. THIS EDUCATION INCLUDES: 1.NEARLY 40 HEALTH EDUCATION EVENTS FOR CHILDREN WERE HELD COVERING DENTAL, NUTRITION & PHYSICAL ACTIVITY, HAND HYGIENE AND SUN SAFETY TOPICS. MORE THAN 165 CHILDREN ATTENDED THE EVENTS. 2.NEARLY 120 EVENTS SUPPORTED EVIDENCE BASED CHRONIC DISEASE PROGRAMMING, REACHING A TOTAL PARTICIPATION OF OVER 475 INDIVIDUALS.3.ALMOST 745 WELLNESS ACTIVITIES WERE HELD AT EMPLOYER GROUPS AND COMMUNITY EVENTS. ALL OF OUR PROGRAMS ARE AVAILABLE TO OUR COMMERCIAL MEMBERS WHICH REPRESENT APPROXIMATELY 195,974 INDIVIDUALS. 4.MORE THAN 230 EMPLOYER GROUP AND COMMUNITY FLU EVENTS WERE HELD, PROVIDING 9,920 FLU SHOTS. DUE TO COVID 19, ALL WELLNESS IN PERSON COMMUNITY OUTREACH EVENTS AND PROGRAMS WERE CANCELLED FROM MID MARCH TO JULY REDUCING OUR TOTALS. GHP EDUCATES THE GENERAL PUBLIC, MEMBERS, EMPLOYER GROUPS, BROKERS, PARTICIPATING PROVIDERS AND OFFICE PERSONNEL ON HEALTH AND WELLNESS TOPICS RANGING FROM WOMEN'S HEALTH TO COLD AND FLU PREVENTION. THE INFORMATION IS AVAILABLE IN A VARIETY OF FORMATS INCLUDING NEWSPAPER ARTICLES, NEWSLETTERS, EMAILS, BROCHURES AND POSTERS. GHP SUPPORTS MANY LOCAL ORGANIZATIONS THROUGH COMMUNITY SPONSORSHIPS. THE ORGANIZATIONS INCLUDED LOCAL CHAMBERS OF COMMERCE AND THE BOY SCOUTS OF AMERICA. THE COST OF COMMUNITY HEALTH, EDUCATION AND OUTREACH ACTIVITIESGeographiesNot indicatedDatesJul 1, 2020 – Dec 31, 2020Source990No causes providedNo populations provided–$1.3BGeneral Mission-Related Initiatives
HEALTHCARE - SEE SCHEDULE OGeographiesNot indicatedDatesJan 1, 2024 – Dec 31, 2024Source990No causes providedNo populations provided–$3.2B
Copyright 2026. All rights reserved to Chario Inc. (d.b.a. Impala)