This session will be led by Dr. Tomas Davis, a 2008 graduate from Drexel University College of Medicine in Philadelphia, PA. He completed his combined residency in med-peds at Geisinger in 2012. He served as med-peds co-chief during his fourth year. He is currently director of the comprehensive care clinic, designed to care for adolescents and young adults with complex medical illness that start in childhood and will follow them into adulthood. The clinic operates as a combination of both the medical home and complex care delivery models. He has received a grant from the Picker Institute, “Employing a Patient-Centered Approach to Develop a Medical Passport to Improve Transition and Educate Health Care Providers.” The information obtained from this grant has been presented at both national and international conferences and has been incorporated into the comprehensive care clinic. Dr. Davis is also active in the Health Care Transition Research Consortium leadership group looking at improving transitions of care nationally and internationally. He has worked on multiple projects on transitions and continues to look for new and exciting projects for residents to participate in. Most recently, he has received funding through GHP Quality Fund to be clinical lead for the Medically Complex Pediatric Patient Care Model redesign looking to combine both clinical enterprise and health information technology to improve care for the most medically complex pediatric patients. When not in the hospital he enjoys spending time with his daughter and wife, watching Philadelphia sport teams, cooking, and exploring the area.
Adolescents and young adults with special care and health needs in the United States–many of whom have Medicaid coverage–at the transition phase between pediatric and adult care often experience critical care gaps. To address this challenge, a new model referred to as Comprehensive Care Clinic (CCC) has been developed and implemented by Geisinger Health System since 2012. CCC comprises a care team, consisting of a generalist physician, pharmacist, and a nurse case manager, that develops and closely follows a coordinated care plan. This presentation examines the CCC impact on total cost of care and utilization by analyzing Geisinger Health Plan claims data obtained from 83 Medicaid patients enrolled in CCC. The results indicate that CCC enrollment was associated with a 28% reduction in per-member-per-month total cost, driven by reductions in hospitalization and emergency department visits. This finding suggests a clinical redesign focused on adolescent and young adults with complex care needs can potentially reduce total cost and acute care utilization among such patients. Also, he will discuss how this can be translated to other home institutes.