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February 14, 2015 12:00 AM

Geisinger's second century of innovation: Health system spreading best practices through new company

Andis Robeznieks
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    One hundred years ago, when Abigail Geisinger, the widow of an iron mining magnate, founded the 63-bed George F. Geisinger Memorial Hospital in Danville, Pa., she told the chief surgeon: “Make my hospital right; make it the best.”

    Today, Geisinger Health System is extending its respected brand far beyond central and northeast Pennsylvania with xG Health Learning, which condenses years of care-delivery learning into a 40-hour online course.

    Geisinger has joined the Mayo Clinic and the Cleveland Clinic in the increasingly competitive field of disseminating best practices. Geisinger's online course is part of xG Health Solutions, an independent, for-profit company Geisinger launched in 2013 and supported with $40 million from Oak Investment Partners, a venture capital firm. Geisinger is the largest shareholder and Dr. Glenn Steele Jr., Geisinger's CEO, is its chairman of the board.

    Columbia, Md.-based xG Health Solutions aims to help other systems replicate Geisinger's success in delivering high-quality care at lower cost. Customers include Bassett Healthcare Network, Group Health Cooperative and Marshfield Clinic Health System. The company says it helped West Virginia United Health System reduce hospital admission rates by 16% and readmission rates by 17% for the system's employees and their dependents.

    Not-for-profit Geisinger, an integrated delivery system with eight hospital campuses, a 1,100-member multispecialty group practice and a 467,000-member health plan, will celebrate its centennial Sept. 12.

    Geisinger has long been considered an innovator in healthcare delivery and research. In the early stages of his efforts to pass the Affordable Care Act, President Barack Obama cited Geisinger as a model for healthcare reform.

    On the scientific side, Geisinger formed a genomic research partnership last year with Tarrytown, N.Y.-based Regeneron Pharmaceuticals called MyCode Community Health Initiative to identify gene variants associated with disease. Dr. David Ledbetter, Geisinger's chief scientific officer, was at the White House on Jan 30 when Obama announced the launch of his administration's precision- medicine initiative.

    Geisinger is noted for its early implementation of ProvenHealth Navigator in 2006, its patient-centered medical-home model for primary care, and its early adoption of electronic health records in 1995. It launched Geisinger Health Plan in 1972. And its ProvenCare program started offering an all-inclusive price, including a warranty, on coronary-artery bypass and other procedures in 2006. But Geisinger's CEO laments that insurers and employers have not yet taken Geisinger up on that deal. “It's one of the great sardonic aspects of my life,” said Steele, who's retiring as CEO in June but staying on as xG chairman.

    Dr. Richard Gilfillan, who formerly headed the Geisinger Health Plan and now serves as CEO of Trinity Health, emphasized Geisinger's national influence. “Building on their long history of integrated health system innovation, they have done important work developing electronic medical records, as well as new care and payment models focused on delivering the Triple Aim,” Gilfillan said. “Each of these initiatives has helped inform the widespread efforts underway to transform our delivery system nationally. It is a great legacy of risk-taking entrepreneurial leadership by Glenn Steele and his team.”

    But Geisinger is hardly resting on its laurels. Dr. Earl Steinberg, CEO of xG, said he spent more than six months identifying “the ingredients in the Geisinger secret sauce” and differentiating between “what was real, what was myth and what was tribal knowledge.” Steinberg said Geisinger's model for sharing best practices differs sharply from those of the Mayo Clinic and the Cleveland Clinic.

    “We weren't going to be in the franchising business,” Steinberg said. Instead, xG offers a “rifle-shot” approach to developing the tools organizations need to operate in a performance- or risk-based payment system. These include population-health data analytics, case-manager training and EHR optimization. The goal is to show other health systems how to “make the right thing to do the easy thing to do,” he said.

    Some observers say many of the care innovations fostered by the Affordable Care Act were influenced by Geisinger, particularly because Gilfillan served as founding director of the Center for Medicare and Medicaid Innovation. “You see the Geisinger footprint all over CMMI because of Rick,” said Dr. Terry McGeeney, former CEO of the American Academy of Family Physicians' patient-centered medical-home consulting service TransforMED.

    Experts say Geisinger's work helped lay the foundation of the patient-centered medical-home model, which focuses on team-based coordinated care, increased patient access and communication, and use of data to improve population health. “The concept of the medical home is not necessarily new, but it hadn't really been put into practice in an effective way until Geisinger did it,” said Dr. Douglas Wood, medical director of Mayo's Center for Innovation.

    McGeeney said that aligning Geisinger Health Plan's payments with the medical-home model helped make the medical home work. “Aligned incentives were something we all said, but it was hard to do,” he said. “They were visionaries.”

    Keys to the Geisinger program include automating administrative tasks, delegating more clinical responsibilities to nurses, pharmacists and medical assistants, and ensuring clerical work is performed by clerks, not clinicians. Geisinger also has customized its EHR system to offer doctors screens that provide them with all the data they need at a glance. “It has everything I need to know, so I'm not playing hunt and peck through the record,” said Dr. Thomas Graf, Geisinger's chief medical officer for population health.

    Abigail Geisinger, center, leads a groundbreaking ceremony in 1913 where the George F. Geisinger Memorial Hospital would open two years later.

    Steele stressed the importance of redesigning care processes to accompany the use of health IT. “You have to look at the entire workflow and use the IT implementation as an excuse for re-engineering your workflow from beginning to end,” he said. “If you don't do that, it's going to create havoc.”

    Geisinger has extended the medical-home model into nursing homes. In that setting, nurse practitioners or physician assistants are embedded full time, acting as “the eyes and ears” of supervising physicians, Graf said. As a result, hospital admissions among nursing home residents have fallen by more than 30%, he said.

    There are skeptics. While the xG business plan focuses heavily on helping other health systems implement the medical-home model, researchers have not found definitive proof that the model works. A February 2014 study in the Journal of the American Medical Association found that among 32 practices operating as medical homes for three years, there were limited improvements in quality and no significant changes in cost and utilization of services. “These findings suggest that medical-home interventions may need further refinement,” researchers concluded.

    On the other hand, a study published in November in the Annals of Internal Medicine found that Geisinger's use of medical-home case managers led to high patient satisfaction and a lower rate of emergency department visits among 1,415 patients surveyed between 2009 and 2011.

    Geisinger's wide-ranging innovations are coming together in its MyCode Community Health Initiative. That genomic research effort is leveraging the system's decades of insurance claims data and electronically warehoused clinical data. Participants in Geisinger's genetic sequencing effort will receive information on their risks for disease while allowing their de-identified data to be made available for research. The original plan aimed to sequence 100,000 patients, but Ledbetter said Geisinger is ahead of schedule and is considering increasing the target to 250,000 patients.

    The key to the initiative's strong participation, he said, is that Geisinger has built a multigenerational level of trust in the communities it serves, leading to a consent rate of at least 90%. “Patients feel a sense of altruism and trust,” Ledbetter said. “They feel good about how they are contributing to new knowledge that may keep individuals and families in central Pennsylvania and beyond healthier.”

    Follow Andis Robeznieks on Twitter: @MHARobeznieks

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