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.