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Informing National Health Policy with Lessons from Geisinger

Presentation to Alliance for Health ReformMarch 20, 2009

Bruce H. Hamory, MD, FACP

Executive Vice President, Chief Medical Officer, Emeritus

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“Make my hospital right,

make it the best.”

Abigail Geisinger

1827-1921

“Geisinger Quality – Striving for Perfection”…2006 - 2011

The Legacy

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Geisinger Health System

ProviderFacilities$1,025M Physician

Practice Group$481M

Managed CareCompanies

$954M

An Integrated Health Service Organization

• Multispecialty group• ~ 750 physicians• 40 comm. practice sites• > 1.5 million outpatient visits• 264 residents and fellows

• Geisinger Med. Ctr. (+ Janet Weis Children’s Hospital)• Geisinger Wyoming Valley Med. Ctr. w/ Heart Hosp. & Henry Cancer Ctr.• Geisinger South Wilkes-Barre Hosp. • Marworth Drug & Alcohol Treatment Center• 2 ambulatory surgery centers• > 40K admissions, >800 in-pt beds

• ~228,500 members• Diversified products• >18,000 contracted physicians

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Business Strategy & Development4/08*All MRNs are defined as inpatient and outpatient for GMC, GWV and GC

Geisinger Population-Based CareCY 2007

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• 228,500 members

– HMO, PPO, diversified products

– 35,600 Medicare Advantage

• 18,000 empanelled physicians

• 90 non-Geisinger hospitals

• 43 PA counties (of 67)

Geisinger Health Plan

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What is needed?

• Physician leadership

• Health Information Technology (HIT) as an enabler

• Governance that allows money to be received and moved between entities

• Elimination of widget payments (move to bundled, episode-based payment)

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Electronic Health Record

• Necessary, not sufficient

• Redesign of care is needed

• The basis for chronic disease care

• Provides real-time feedback to doctors and patients on performance

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Evidence-Based Medicine for Acute Care(ProvenCareTM)

• Does not require HIT to do

• Facilitated by HIT

• Bundled payment (MD’s and Hospitals)– Reduces complications and readmissions– Increases value to patient and purchaser

• Value needs to be shared with providers and purchasers

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Lessons Learned from Patient Navigator(Advanced Medical Home)

It is possible to improve patients’ health and dramatically reduce cost

• Requires change in primary care delivery model; the change is not easy– Needs active, engaged providers– Needs active, empowered team

• Transitions of care create specific gaps and opportunities • Patients with very complex conditions need very close follow-up through

every system of care– Home– Hospital– Skilled nursing home

• Critical to have case manager embedded in primary care site

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Someone Needs to be Charged with Designing and Operating Systems to Produce Value!

• Value in healthcare will not fall from the sky or simply emerge from following correct processes.

• Value comes from actively managing the flow of patient experience and care in particular ways to optimize outcomes.

• It can be delivered only by doctors, nurses and staff who are actively focused on efficiently optimizing each patient’s health status every day.

• The way to get that focus is to speak to it very directly, develop metrics that can demonstrate success, and reward people as it is achieved.

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National Health Policy Implications

• Access to health insurance is key– Should include regional plans (provide flexibility

and innovation)

• Formation of Integrated Systems should be facilitated– Bundled payments– Episode of care payments– Treatment based – not insurance risk– ? Accountable care organizations– “Cost saving” shared with providers

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National Health Policy Implications – continued

• Definition of “Medical Home” needs to be advanced

• Health Information Technology– Computers and Electronic Health Records are

necessary, not sufficient– Redesign of care required– Ongoing upgrades needed

• Comparative effectiveness research• Training of next generation

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Questions/Comments