Aiming to provide concierge care 'for the masses'

In May, Dr. David Feinberg succeeded Dr. Glenn Steele as president and CEO of Danville, Pa.-based Geisinger Health System, which includes nine hospital campuses, a 1,200-physician multispecialty group practice and a 467,000-member health plan. Feinberg, a psychiatrist, previously served as the CEO of the UCLA Hospital System in Los Angeles. This year he earned spots on two Modern Healthcare lists, placing 86th on the 100 Most Influential People in Healthcare ranking and 12th on the 50 Most Influential Physician Executives and Leaders list. Modern Healthcare reporter Andis Robeznieks recently spoke with Feinberg about how he plans to make Geisinger more patient-centered, his system's genetic research program, and the challenges of managing the health of Medicaid patients.

This is an edited transcript.

Modern Healthcare: What are your priorities as the new CEO?

Dr. David Feinberg: We want to take patient-centeredness to the next level. We want to engage with our patients and families in a way that's compassionate and kind, and deliver care that is of the highest quality in a safe and culturally sensitive manner. We want to make our transitions in care remarkably smooth. We want patients to understand their bill.

MH: How would you compare Geisinger to the UCLA system you came from?

Feinberg: At UCLA, it's a balancing act between the teaching, research and clinical operations. At Geisinger, our true north, which is supported by our amazing teaching program and our genetic research, is our delivery system. With that focus, Geisinger has been able to outshine a lot of places.

In acute care, probably the best number that shows you're doing a good job is the observed-to-expected mortality rate. At Geisinger in May, for all our facilities it was 0.5. I never heard of a number that low. We found that for our Wilkes-Barre hospital, it was 0.2. We're saving five times as many people as we're supposed to be saving.

In Los Angeles, there are physicians, including my wife, who provide concierge care to affluent patients with great means. At Geisinger, what I've seen is concierge care with the same level of attention to detail, for the masses. For example, we just learned we overtook Switzerland and we're best in the world in anticoagulation therapy for stroke patients. So we have world-class outcomes delivered in a cost-effective manner.

MH: Could you describe Geisinger's genetic research program and its ethical issues?

Feinberg: Regeneron Pharmaceuticals picked us as a partner because families have stayed here for generations, often in the same house or on the same block. We have 20 years of electronic health-record information, 15 years of radiological data and 30 years of health plan claims data. We ask our families, “Would you allow us to look at your DNA?” We've had a 90% positive response rate. Next calendar year, we'll have 250,000 patients with genomic, clinical and administrative information recorded, with most of their family members in the same study.

How does that impact our patients? We had a teenage female who came in from soccer practice complaining about dehydration. We treated her and asked her to be a part of the study. We then saw in her genomic profile a family proclivity toward cardiac arrhythmia and looked at the rest of the family. We discovered that an uncle died in a restaurant from choking. Most likely, it wasn't choking, but rather a cardiac event. We brought in the whole family and told them the risks.

We've hired a lot of bioethicists and genetic counselors, and brought in patients to give us advice on who should give them the news and how. We found that some people are brother and sister and don't know they're brother and sister. Our default position is that the relationship between patients and their primary-care doctor is the most important. That's how you will get this information back to patients.

So what we have now is not just precision medicine, but anticipatory medicine. We can say, “Here's what might happen to you and here's what you can do to prevent it.” Geisinger is turning 100 years old this month. I think in the next 100 years, the bet Geisinger made on big data is going to be impactful throughout the country and the world.

MH: How is it to head up a health plan?

Feinberg: I hadn't had much experience on the insurance side. So I did a lot of homework before I came to make sure I didn't ask too many stupid questions. But I've caught up on the lingo and I hope I can start adding value to that part of our equation.

MH: Has Geisinger benefited from Pennsylvania's decision to expand Medicaid to lower-income adults?

Feinberg: I don't know yet if we've benefitted, but we now have 165,000 Medicaid managed-care members in our Geisinger health plan. The outcome has yet to be seen because it's too early.

Geisinger excels at managing people with chronic conditions. But these patients typically can afford the copay and medications. On the other hand, Medicaid patients have to worry about whether they can pay their electricity bill. I've made some home visits to the managed Medicaid patients. For them, it's a whole different situation.

I met one gentleman who uses a scooter to move around his single-room apartment. He's a chain smoker. He orders Domino's pizza and leaves it on the coffee table to eat over the next few days. He has no family or social interaction. Taking care of patients like him, it's much more than just keeping track of his hemoglobin

A1c level. You have to make sure they make it to their appointments, that their homes are safe, and that they have working heating and air conditioning.

This population has a very different set of priorities. The jury is still out on whether we'll be successful. But I'm pleased that we're doing it, and we're doing more than our fair share.

MH: As a psychiatrist, what are your thoughts on the numerous mental health reform bills before Congress?

Feinberg: For patients suffering from mental illness and substance-abuse disorders, it's a nightmare. Not only are they dealing with problems which can be devastating in themselves, they interact with a health system that is not designed to integrate their care. That Congress is willing to have these discussions is long overdue.

I met a young man who was in one of our hospitals for a heroin overdose. He said he was doing fine. Then he started crying. It was because his mom found him unconscious, fainted, was injured and needed to be airlifted to a hospital. His biggest concern was how his mom was doing. We don't have a system in place to tell this family we'll take care of them. We divide the medical and psychiatric treatment up instead of doing it in an integrated fashion.

At Geisinger, they're embedded together. Behavioral health can be addressed at the same clinic where you bring your kids in for their school physical. We have pharmacists counseling on opioid prescriptions. That's the best approach. I'm very supportive of Congress making sure families are engaged in treatment, and that there is parity between medical and mental health payment.