Transcript Geisinger

NJAMHAA’s Annual Conference
South Iselin, NJ
April 15, 2015
Glenn Steele, Jr., MD, PhD
President & CEO
Geisinger Health System
The Legacy
 A proven record of innovation
 Leading population health initiatives
regionally and nationally
 Driving "sweet spot" performance
 Successfully integrating acquisitions
 Maintaining Geisinger's financial strength
 A legacy of financial accountability
 Making it the best....a century of progress
Abigail Geisinger
1827-1921
“Geisinger Quality – Striving for Perfection”…
2
Geisinger Health System
An Integrated Health Service Organization
Provider
Facilities
$2,237M
Managed
Care Companies
$2,167M
Physician
Practice Group
$998M
 Geisinger Medical Center and its
Shamokin Hospital Campus
 Geisinger Wyoming Valley Medical
and its South Wilkes-Barre Campus
 Geisinger Community Medical Center, Scranton, PA
 Geisinger-Bloomsburg Hospital
 Geisinger-Lewistown Hospital
 Holy Spirit Health System
 Marworth Alcohol & Chemical Dep Treatment Center
 4 outpatient surgery centers
 2 Nursing Homes
 Home health & hospice services covering 22 counties
 >100K admissions/OBS & SORUs
 2,045 licensed inpatient beds
 Pending: AtlantiCare Health System








Multispecialty group
~1,220 physician FTEs
~750 advanced practitioners
113 primary & specialty clinic sites
(60 community practice)
1 outpatient surgery center
~2.8 million outpatient visits
~430 resident & fellow FTEs
~335 medical students
 ~477,000 members (including
~100,000 Medicare Advantage
members and ~132,000 Medicaid
members)
 Diversified products
 ~50,000 contracted
providers/facilities
 43 PA counties
 Offered on public & private
exchanges
 Members in 5 states
Moody’s Aa2/Stable
Standard & Poor’s AA/Stable
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
3
Transforming Healthcare with Technology
•
•
•
•
•
•
•
•
•
•
> $200 M invested (hardware, software, manpower, training)
Running costs: ~4.0% of annual revenue of > $3.9 Billion annual revenue
Fully-integrated EHR: 46 community practice sites; 7 hospitals; 7 EDs; 4 Surgical Centers;
17 (includes CareWorks retail-based and urgent care clinics, walk-in and after hours clinics)
– Acute and chronic care management
– Optimized transitions of care
Networked Patient Portal - ~268,386 active users (41% of ongoing patients)
– Patient self-service (self-scheduling, patient-entered data)
– Home monitoring integrated with Medical Home
“Outreach Health IT” – 10,221 users in 865 non-Geisinger practices
– Remote support for regional ICUs
– Telestroke services to regional EDs
Active Regional Health-Information Exchange (KeyHIE)
– 22 hospitals, 175 practices, ~1M patients consented, publish 700,000+ documents monthly,
participants access ~89K patients monthly
e-health (eICU®) Programs
Keystone Beacon Community
– HIT-enabled, Community-wide care coordination in 5 rural counties
CDIS (Clinical Decision Intelligence System)
• Clinical EDW: Clinical/Financial/Operational/Claims Data available to 3000+ Geisinger users
running over 80M queries per month
• GHP: Data since 2006 and forward of 40M Health Plan Medical Claims for about 1M members.
The Health Plan has ~120 analytical users accessing the EDW.
Functional ‘Apps’ Portfolio
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
4
Geisinger Health System Coverage Area
5
5
Strategic Priorities
• Quality and Innovation
– Patient centered focus
• Patient activation (empowerment)
• Culture of quality, safety and health
– Value re-engineering
• Transformational changes – embedding innovations
• Market Leadership
– Collaboration/partnerships
(local, regional, national)
– The GHS Brand
• Scaling and generalizing
• The Geisinger Family
– Personal and professional well being
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
6
The “Sweet Spot” for
Partnership & Innovation
Aligned objectives between the health plan & clinical enterprise,
with each organization contributing what it does best.
Joint
Health Plan
(~500K members and
~50K providers)
•
•
•
•
•
•
• Population Health
• Population Served
• EHR / Infrastructure
(36% of GHS patients
are GHP members)
Population analysis
Align reimbursement
Finance care
Engage member and employer
Report population outcomes
Take to market
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
•
•
•
•
•
•
Clinical
Enterprise
(585K unique MR#)
Care delivery
Identify best practice
Design systems of care
Interpret clinical reports
Continually improve
Activate patient & family
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
7
Sweet Spot Innovations
2000-2006
• Non-proprietary EHR
• Patient Portal
• Value Reengineering
• ProvenCare® Acute
• ProvenCare® Chronic
• PGP Demo (ACO Precursor)
• Data Warehouse
• Quality Incentives
• PPO
•
1990’s
• EHR
Installation
• Medicare
Advantage
•
•
•
2007-2010
• Value Reengineering
• ProvenHealth
Navigator®
• Practice-based CM
• Clinical decision
support
8
•
•
•
•
•
•
•
•
2011-2012
Robust Care Gap Program
Transition of Care Bundle •
Specialty PCP integration
Natural Language
•
Processing
Proof of generalizability
beyond Central PA
Open Notes
SNFist
2013-2014
Launch of xG
Health
Medicaid MCO
Private/public
exchanges
Urgent care
centers
CPSL
alternative to
ED
Proven®
Biologics
Geisinger in
Motion
Geisinger Patient-Centered Continuum of Care
Community-Based Care
Specialty Outreach
(“Face-to-face” &
Telemedicine)
Ambulatory Care
& Surgery Center
Acute Care
Tertiary/Quaternary
Medical Center
Destination
Medicine
eICU
MultiSpecialty Clinic
Urgent Care
Center
Specialty Center,
e.g. Cancer or Sleep
After-Hours
Care Center
Community
Practice Site
E-Visit
MyGeisinger
Post-Acute &
Transitional
Care
Inpatient Rehab
Adult Health Program
& Day Center
Outpatient Rehab
Retail Clinic
Imaging Center
Lab Outreach Site
Wellness
Work Site Clinic
Nursing Homes/SNF
Retail
Pharmacy
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Home Care
Hospice
ProvenHealth
Navigator
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
9
Disruptive Innovation & Value Reengineering
Population
Identification
Populations
Bundle
Development
100% Care Processes and
Protocols (Digital)
Patients and
Conditions
Low
Regular Care
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Efficiency and Reliability
Workflow
Modification
Delegation
and
Algorithms
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
High
Automation
Patient
Activation
10
THE GEISINGER VALUE
RE-ENGINEERING “TOUCHSTONES”
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
11
State of the Evidence…
Volume 348(26) 26 June 2003
pp 2635-2645
The Quality of Health Care Delivered To Adults In the United States
McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer:
DeCristofaro, Alison: Kerr, Eve A.
BACKGROUND
We have little systematic information about the extent to which standard processes involved in healthcare—a
key element of quality—are delivered in the United States.
METHODS
We telephoned a random sample of adults living in 12 metropolitan areas in the United States and…received
written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care
for 30 acute and chronic conditions as well as preventative care…
RESULTS
Participants received 54.9 percent of recommended care.
CONCLUSIONS
The deficits we have identified in adherence to recommended processes for basic care pose serious threats
to the health of the American public. Strategies to reduce these deficits are warranted.
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
12
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
Cost/Quality “Correlation”
Higher
Low Efficiency
High Quality
High Efficiency
High Quality
(Dream Suppliers)
50th %ile
Lower
MD Quality Index
(outcomes or % adherence to EBM)
50th %ile
Low Efficiency
Low Quality
(Nightmare
Suppliers)
Lower Efficiency/
Higher Cost
High Efficiency
Low Quality
Higher Efficiency/
Lower Cost
MD Longitudinal Cost Efficiency Index
(total cost per case mix-adjusted treatment episode)
Geisinger Health System - Proprietary
Heal • Teach
• Discover • Serve
Adapted
from Regence Blue Shield;NotArnie
Milstein, MD - Mercer
for reuse or distribution without permission
Copyright Geisinger Health System 2015
Cost = Quality
2006-2010
GHS Innovations
Cost/Quality ≠ R
2003
Cost or Quality
1993-1994
Hillary-Care ‘Debate’
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
14
ProvenCare® Portfolio
ProvenCare®:
•
•
•
•
•
•
•
•
•
•
•
•
•
ProvenCare® Autism
ProvenCare® Bariatric Surgery
ProvenCare® Cellulitis
ProvenCare® COPD
ProvenCare® Coronary Artery Bypass
Graft (CABG)
ProvenCare® CNS Mets
ProvenCare® Epilepsy
ProvenCare® Fragility Hip Fracture
ProvenCare® Heart Failure
ProvenCare® Hepatitis C
ProvenCare® Hysterectomy
ProvenCare® Inflammatory Bowel
•
•
•
•
•
•
•
•
•
•
•
•
•
ProvenCare® Lung Cancer (CoC
Collaborative)
ProvenCare® Lumbar Spine
ProvenCare® Migraine
ProvenCare® Multiple Sclerosis
ProvenCare® Percutaneous Coronary
Intervention (PCI)
ProvenCare® Perinatal
ProvenCare® Psoriasis
ProvenCare® Rectal Cancer
ProvenCare® Rheumatoid Arthritis
ProvenCare® Total Hip
ProvenCare® Total Knee
ProvenCare® Evidence-Based Guidelines (EBG) (in conjunction with PRIDE):
–
–
–
–
Chest Pain – R/O MI (ED)
Kidney Stone (ED)
Newborn Protocols
Pediatric Abdominal Pain (R/O Appendicitis (ED))
‒
‒
‒
‒
Pediatric Head Injury (ED)
Pediatric Pulmonary Embolism (ED)
Sepsis (ED) & Sepsis (Med/Surg)
Vent Management
Portfolio as of: 01/23/15
15
Provencare® Biologics
Why
Specialty drugs will
account for nearly
½ of all drug sales
in coming years
Targets
Hepatitis C
Scope
Approach
GHS projected 2014
expense avoidance
of $58M
Process Redesign
Inflammatory Bowl
Disease
Channel Redesign
Multiple Sclerosis
Rheumatoid
Arthritis
GHP expected to
avoid expenses of
$172M
Oncology
Formulary
Management &
Contracting
Total Cost of Care
Psoriasis
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
16
Company’s New “Centers of Excellence” Program is First-of-its Kind
Partnering with Six of the Nation’s Foremost Health Care Systems to
Provide Better Care
We devoted extensive time developing Centers of Excellence in order to
improve the quality of care our associates’ receive. We have identified six
renowned health systems that meet the highest quality standards for
heart, spine and transplant surgery. Through these organizations, our
associates will have no out-of-pocket expenses and a greater peace of mind
knowing they are receiving exceptional care from a facility that
specializes in the procedure they require. This is the first time a retailer
has offered a comprehensive, nationwide program for heart, spine and
transplant surgery.”
~ Sally Welborn, senior vice president of global benefits at Walmart
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
17
ProvenCare® CHRONIC DISEASE
Portfolio of ProvenCare®
Chronic Disease Programs
•
•
•
•
•
•
Diabetes
Congestive Heart Failure
Coronary Artery Disease
Hypertension
COPD
Prevention Bundle
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
18
Improving Diabetes Care for 30,005 Patients
3/06
Number of Patients
20,178
2/14
1/15
2/15
27,788 30,005
29,977
Diabetes Bundle Percentage
2.4%
14.2%
18.5%
18.2%
% Pneumococcal Vaccination
59%
79%
80%
80%
% Microalbumin Result
58%
78%
76%
77%
% HgbA1c at Goal
33%
46%
49%
48%
% LDL at Goal
50%
60%
65%
65%
% BP at Goal
39%
79%
76%
76%
74%
85%
85%
85%
*Change to @ Goal on patient list July
2014
*Change to @ Goal on patient list July
2014
% Documented Non-Smokers
19
© 2015 Geisinger Health System & xG Health Solutions.
Proprietary – Not for reuse or distribution without permission.
ProvenCare® Type 2 Diabetes
Value Driven Care Outcome Improvements
Heart Attack
–Less than 3 years
–306 prevented with estimated
savings of $27,111/case =
$8.3M!
Stroke
–Less than 3 years
–141 prevented with estimated
savings of $2,921/case =
$412K!
Retinopathy
–Less than 3 years
–166 cases prevented!
–Quality of life maintained
–Savings…priceless!
Primary Care Diabetes Bundle Management: Three-Year Outcomes for Microvascular and Macrovascular
Events ( FBloom; TGraf; WStewart; GSteele, et. al. , June 2014 (20(6); 175-182)
20
Improving CAD Care for 18,502 Patients
9/06
2/14
1/15
2/15
13,688
17,078
18,501
18,502
8%
26%
30%
30%
% LDL <100 or <70 if High Risk
38%
61%
70%
70%
% ACE/ARB in LVSD,DM, HTN
65%
79%
79%
78%
% BMI measured
79%
99%
99%
99%
% BP < 140/90
74%
79%
79%
79%
% Antiplatelet Therapy
89%
95%
95%
94%
% Beta Blocker use S/P MI
97%
97%
97%
97%
% Documented Non-Smokers
86%
86%
86%
86%
% Influenza Vaccination
60%
78%
73%
75%
Number of Patients
CAD Bundle Percentage
21
© 2015 Geisinger Health System & xG Health Solutions.
Proprietary – Not for reuse or distribution without permission.
Improving Preventive Care for 263,582 Patients
11/07
2/14
1/15
2/15
203,074
243,727
261,726
263,582
Adult Preventive Bundle
9.2%
19%
20%
20%
Breast Cancer Screening (q 2 yrs 50-74) (discuss q 2 yrs
40-49)
46%
72%
74%
74%
Cervical Cancer Screening (q 3 yr Age 21-29) (q 5 yr Age
30-64)
64%
75%
73%
73%
Colon Cancer Screening (Colonoscopy q 10 yrs Age 5074 or FOBT yearly)
44%
65%
65%
65%
Lipid Screening (Every 5 yr M > 35, F > 45)
75%
87%
87%
87%
Diabetes Screening (Every 3 yr > 45)
85%
91%
91%
91%
Documented Non-Smokers
75%
79%
79%
79%
Tetanus Diphtheria Immunization (every 10 yr)
35%
76%
77%
77%
Pneumococcal Immunization (Once Age >65)
84%
84%
84%
84%
Influenza Immunization (Yearly Age >18)
**Change in age from Age>50 to Age>18 February
2013
47%
46%
44%
45%
Chlamydia Screening (Yearly Age 18-25)
22%
40%
40%
40%
Osteoporosis Screening (every 7 yr Age >65)
52%
78%
77%
77%
37%
43%
43%
Number of Patients
Zoster Vaccine (Age >60) **New Measure February
2013
22
© 2015 Geisinger Health System & xG Health Solutions.
Proprietary – Not for reuse or distribution without permission.
ProvenHealth Navigator® Results
Acute care
admissions
Demonstrated improvement in the risk
of heart attack, stroke, and retinopathy
in individuals with diabetes
27.5%
All cause
30-day
readmissions
3-year results in
25,000 patients
305 MIs prevented
140 strokes prevented
166 cases of retinopathy prevented
72%
Patients say quality
of care improved when
they worked with
a case manager
34%
ED visits remain flat
*Outcomes represent the period 2007—2012 and more than 80,000 Geisinger Health Plan members in Geisinger Health System practices.
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
23
23
ProvenHealth Navigator®
Innovations in Management of Elderly
• “SNFist” model in targeted 20 nursing homes
• Redesigned care model
• Focused on transitions of care and length of stay
2013-2014 Results
SNF readmission rate reduced from 13.4% to
12.1%*
SNF ALOS reduced from 25.1 to 19.3
* Baseline readmission rate when program (2008) started - 30%
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
24
Reengineering Primary & Specialty Care Integration
PCP & specialists coordinated patient management
– CKD/ESRD high risk management
– Psychiatric care management
– Neurology/Dermatology/Endocrine/Cardiology/Autism
Convenient Care redesign of primary
care/emergency medicine
– 14 urgent care/after hours care sites
– Coordinated low cost alternative to ED
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
25
Integration of Behavioral Health & Primary Care
• BH problems are a serious public health concern
• Effective treatments exist
• Most people with BH disorders get no care
• Significant individual & societal consequences
• Education, employment, crime
• Disability benefits, health care costs
• PCPs are the de-facto BH providers
• New models of BH service delivery needed
• Integrating BH and primary care - A promising model
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
26
Clinical Model & Services
• Sites & staff
• Problem focused
eval/treatment
• Family, individual, &
group therapy
• Consults & hand-offs
• Crisis appointments
• Same day evaluations
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
•
•
•
•
•
•
•
Screening tools
Handouts
Communication
Psychiatry telemedicine
PCP education
Liaison to MH/school
Clinic wide
interventions
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
27
Program Evaluation & Outcomes
Collaboration
Access
Quality Care
IPC Key
Components
Reduced
Costs
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Satisfaction
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
28
Summary and Future Directions
• Integration of BH and PC Services – A Promising
Model
• Expand to more primary care sites
• Conduct outcome research as we expand – recent
PCORI grant submitted
• Collaborate with GHP on innovative and sustainable
payment models (value not volume)
• Enhance resident training
• Consult with systems and insurers
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
29
TRANSFORMING HEALTHCARE
WITH TECHNOLOGY
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
30
Activating Patients through Transparency:
“Open Notes”
Background
 12-month research project started in 2010
Results
 99% of patients requested continuation of the pilot
Current Status
 >1400 Geisinger providers are live,
>220,000 patients
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
31
Innovations in Personalized Medicine
 Regeneron partnership to advance genomic medicine
 Clinical data warehouse grows
 Data analytics deployed to identify care gaps, permitting clinical
intervention
 Focused population health research initiatives: Obesity, Autism, etc.
 Institute for Advanced Application
 Geisinger in Motion
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
32
Scaling and Generalizing – Experiments
(Geisinger Health System / Geisinger Insurance Operations / xG Health)
GHS:
GIO:
•
•
•
•
•
•
•
• Medicaid MCO
• Health Insurance
Exchange
• New Jersey
• Delaware
• Maine
• West Virginia
Wilkes-Barre
Scranton
Shamokin
Lewistown
Bloomsburg
Harrisburg
Atlantic City
*Empowered by GHS/xG Health Solutions
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
• 57 Organizations*
(12/30/14)
IP expertise • knowledge • transformation
33
Scaling and Generalizing
PRODUCT DEVELOPMENT
& SERVICE DELIVERY
CORE OPERATIONS
Mission: Execute Core Business / Innovate
Mission: Generalize / Disseminate / $ Return
Geisinger
Health Plan
Quality &
Safety
Leadership &
Governance
Research
IP
Development
& Refinement
IP
IP
Care
Design/
Delivery
xG Health
IP Productization
Analytics
Services
Geisinger
Support
Services
Clinical
Enterprise
Reduced Cost of
Care
Transformation
Roadmap
Improved
Quality and
Coordination
of Care
Improved
Clinical
Outcomes
EHR
Optimization
Multi-Payer Solutions
Innovation &
Transformation
34
Improved Patient &
Provider Satisfaction
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2015
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
35
Where We Are Now (Geisinger)
•
•
•
•
•
•
•
Consolidation of Providers
Payer-Provider “Integration” Model Expansion
Value Re-engineering
Medical Tourism (i.e., Walmart ProvenCare®)
Reference Pricing
Bundling Episodic Care / ACOs
Population Health (aka, Total Cost of Care)
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
36
Where Do We Want to Be? (Geisinger)
• Distributed Data
Personalized Medicine/Genetics
Healthcare in the cloud
• “Activated” Patients/People
• Transparency and availability of standardized data
on cost and quality
• New Provider Surrogates/Locations
• Social Network Enabling
• Behavior Change Analytics
• Generalizing Value Re-engineering
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
37
From Fee-for-Service
to
Total Cost of Care
(
Residual “Piece Rate”)
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
38
Enabling Behavior Change:
 Providers
 Patients
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
39
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Geisinger Health System - Proprietary
Not for reuse or distribution without permission
40
Concluding Comments
 A proven record of innovation
 Leading population health initiatives
regionally and nationally
 Driving "sweet spot" performance
 Successfully integrating acquisitions
 Maintaining Geisinger's financial strength
 A legacy of financial accountability
 Making it the best....a century of progress
Abigail Geisinger
1827-1921
“Geisinger Quality – Striving for Perfection”…
41