ProvenHealth Navigator®: Sharing Geisinger’s Operational Experience in Building a Successful Medical Home

ProvenHealth Navigator®: Sharing Geisinger’s Operational Experience in Building a Successful Medical Home

Looking for new population health strategies and tools? If yes, join us at the ProvenHealth Navigator® Conference!


ProvenHealth Navigator® (PHN) Results at Geisinger Health System

ProvenHealth graph
PTMPY: Per Thousand Members Per Year
Source: Gilfillan, RJ, et al. Value and the Medical Home: Effects of Transformed Primary Care. The American Journal of Managed Care. 2010;16(8):607-614.

What: ProvenHealth Navigator®: Sharing Geisinger’s Operational Experience in Building a Successful Advanced Patient-Centered Medical Home

An intensive two-day conference that provides strategies and tools essential for strategic planning for, implementation and operational leadership of an advanced patient-centered medical home for successful management of your population’s health.


Day 1: 7:30am – 5pm – Learning Sessions, 6pm – 7:30pm – Reception & Dinner

Day 2: 7:30am – 3pm – Learning Sessions

See Detailed Agenda>


Attendees: This program is primarily designed for senior level healthcare provider and payer executives or leaders responsible for successful strategic planning for, implementation, and operational leadership of an advanced patient-centered medical home.

Featured Speakers:

    • Tom Graf CMO

      Chief Medical Officer, Population Health & Longitudinal Care Service Lines, Geisinger Health System

      Dr. Thomas Graf is the Chief Medical Officer for Population Health and Longitudinal Care Service Lines for Geisinger Health System. Dr. Graf is responsible for the Value Re-Engineering of the Care Continuum and other Population Health initiatives for Geisinger including the ACO portfolio and with CMS, the Physician Group Practice Transitions Demonstration and Bundled Payments for Care Improvement leading 16 hospitals from across the country in driving performance. He leads the Community Practice, Internal Medicine, Pediatrics, Psychiatry and Care Continuum Service Lines in coordinating and accelerating population health related activities across 22 counties in central and northeast Pennsylvania. In addition, he partners with Geisinger Health Plan leadership on system-wide population health delivery with a primary focus on facilitating improved service and value and increasing the connections between the various elements of the health care continuum.

      He is recognized nationally as a leader in medical home and post-acute care redesign, including the implementation nearly 40 NCQA Level III accredited Medical Home sites in the Geisinger ProvenHealth Navigator® model. He has extended this to include comprehensive nursing home care with dedicated providers tied to ProvenHealth Navigator clinics. Dr. Graf has established innovative care models for optimizing chronic disease with established systems of care enhanced by MyCare modules of care for individual disease parameters lead by mid-levels through the use of the Delta Innovation Incubator program he established. Dr. Graf serves as a content expert for the AHRQ’s Patient Centered Medical Homes Project, AHRQ’s I LIVEPC, international primary care improvement project, AHRQ’s Innovation Spread project, and AMGA’s Caring for Patients with Multiple Chronic Diseases Collaborative. The Value Re-engineering efforts of Geisinger were recently recognized as the AMGA 2011 Acclaim award winner.

      After graduating from University of Michigan Medical School and completing Family Medicine residency training at Henry Ford Health System in Detroit, he served on the faculty of the Henry Ford Family Practice Residency and was Director of the Southwest Georgia Family Practice Residency prior to joining Geisinger.

        • Joann Sciandra RN BSN CCM

          RN BSN CCM

          Joann Sciandra RN BSN CCM currently holds the role of Associate Vice President (AVP), Population Management and is accountable for ProvenHealth Navigator® (PHN), disease/case management, wellness, and population management consulting services departments at Geisinger Insurance Organization (GIO). She is administratively accountable for integrated population management, including the developing the overall strategy and goals for clinical operations related to disease and case management, PHN, and wellness / employee health. Joann provides innovative leadership and direction to the design, implementation, analysis, monitoring and reporting of all population management services. Additionally, she is charged with managing medical trends, designing, implementing and administering best practice disease and case management programs, collaborating with Geisinger’s Community Practice Service Line (CPSL) and other provider groups in the clinical transformation and implementation of ProvenHealth Navigator®, leveraging continuous quality improvement, driving and promoting services that are patient centric.

          Prior to her promotion to AVP, Joann held the role of Director, Case Management Strategic Development. In this role, she was an integral in providing direction to the nurse case managers with the ProvenHealth Navigator ® program at Geisinger Health Plan and the start-up and maintenance of the medical home program at select CPSL sites.

          Joann was also involved in case and care management as a case manager, preceptor, and team leader in care coordination. Additionally, her experience includes nursing practice in the intensive care unit as well as geriatric clinic coordinator.

          Joann’s professional dedication extends beyond Geisinger; she is a member of the CMSA and involved in community education programs. She has been a co-author for several publications and has presented nationally and in Singapore regarding the medical home and case management.

          Joann earned her Bachelor of Science in Nursing Degree from Wilkes University. She is also a Certified Case Manager. Currently enrolled in a Master of Health Care Administration program.

            • Richard Martin MD FAAFP

              Chief, Care Continuum Service Line

              Richard A. Martin, M.D. FAAFP is a Board certified family physician with more than 30 years’ experience in all aspects of Family medicine.

              A graduate of Jefferson Medical College and Geisinger Medical Center Family medicine residency he has spent most of his career with the Geisinger Health System in various leadership roles, including Department Director in the Community Practice Service Line, Chief of the Care Continuum Service Line, and Chief Medical Officer of the Keystone Accountable Care Organization.

              Dr. Martin also serves as a Subject Matter Expert for patient centered medical home development, practice transformation and analytical redesign strategies for xG Health Solutions.


              Henry Hood Center for Health Research
              Geisinger Medical Center
              100 N. Academy Avenue
              Danville, PA 17822

              Cost: $1,800 per person (Contact us re discounts for groups of 3 or more from the same organization.)

              Register: Click on your preferred date below to register.