Informing National Health Policy with Lessons from Geisinger

1. Informing National Health Policy with Lessons from Geisinger Presentation to Alliance for Health Reform March 20, 2009 Bruce H. Hamory, MD, FACP Executive Vice President, Chief Medical Officer, Emeritus

2. The Legacy “Make my hospital right, make it the best.” Abigail Geisinger 1827-1921 “Geisinger Quality – Striving for Perfection”…2006 - 2011

3. Geisinger Health System An Integrated Health Service Organization Provider Facilities $1,025M Managed Care Companies $954M Physician Practice Group $481M • 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 • Multispecialty group • ~ 750 physicians • 40 comm. practice sites • > 1.5 million outpatient visits • 264 residents and fellows

4. Geisinger Population-Based Care CY 2007 Business Strategy & Development 4/08 *All MRNs are defined as inpatient and outpatient for GMC, GWV and GC

5. Geisinger Health Plan • 228,500 members • HMO, PPO, diversified products • 35,600 Medicare Advantage • 18,000 empanelled physicians • 90 non-Geisinger hospitals • 43 PA counties (of 67)

6. 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)

7. 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

8. 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

9. 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 9

10. 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. 10

11. 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

12. 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

13. Questions/Comments