On Thursday morning, Oct. 30, Glenn Steele, Jr., M.D., Ph.D., president and CEO of the Danville, Pa.-based Geisinger Health System, urged healthcare IT leaders forward to help facilitate transformational change in healthcare, asserting that the kinds of value-based care that he and his colleagues have been creating at Geisinger are the future of U.S. healthcare. Steele was the opening keynote speaker for the day at the CHIME Fall forum, being held this week at the J.W. Marriott San Antonio Hill Country Resort and Spa in San Antonio, Tex., and sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME).
Dr. Steele, one of the best-known change leaders in U.S. healthcare, reviewed some of the accomplishments that have taken place under his leadership at the integrated Geisinger Health System, which serves 2.6 million residents across 44 counties in central and northeastern Pennsylvania. He briefly reviewed the history of the now-famous ProvenCare® program, which he personally helped to create and lead, and which has become a unique model providing both evidence-based care pathways for providers and price guarantees on some procedures for healthcare purchasers, payers, and consumers.
Steele, who announced in July that he plans to retire as CEO in June 2015, said, speaking of the U.S. healthcare system overall, that, “We’re moving away from a fragmented system, from a doctor-centric and hospital-centric system, and towards preventive and primary care. But it’s a schizophrenic time,” he conceded, because of the need for virtually all hospital-based organizations to operate under both fee-for-service and non-fee-for-service payment arrangements right now.
“What do we want to be?” Steele asked rhetorically. He answered his own question by stating that the U.S. healthcare system needs to move forward along the following dimensions: “affordable coverage for all; payment for value; coordinated care; continuous improvement and innovation; and national health goals and leadership.”
Meanwhile, Steele said, speaking of the justly well-known accomplishments of Geisinger Health System, “We’re not necessarily better than anybody else or more committed, or better trained, but we have some huge advantages because of our structure, and the biggest advantage is our payer-provider combination, particularly the ability to increase quality and reduce cost.” What’s more, he said, “How you synergize [efforts] between payer and provider is very important.” An additional advantage, he noted, is that Geisinger controls dominant or significant market share across large swaths of the state of Pennsylvania (and is planning to expand to Atlantic City, New Jersey, this year); and not only enjoys very stable relationships with patients/consumers across those areas of Pennsylvania, but also enjoys multi-generational relationships with multiple generations of members of the same families, in its market areas. The health system also enjoys long-term, solid relationships with numerous health insurers across Pennsylvania, and those insurers have welcomed programs like ProvenCare, which began with a pilot effort to develop a clinical pathway for elective, non-urgent coronary artery bypass graft (CABG) surgery, added a price guarantee, and then expanded into a variety of other procedural and care areas.
Importantly, Steele noted, beginning the ProvenCare program with orthopedic surgeons was interesting from a number of perspectives. “My orthopedic surgeons are highly productive, but also highly aggravating,” he said, to amusement from the audience. “And all my orthopedic surgeons are divas! And what drives them to change has nothing to do with cost reduction,” he noted pointedly. So it is very important, when working with physicians on clinical transformation, to focus on win-win objectives, which support both the doctors’ objectives and those of the patient care organization. “If you can convince the men and women providing the care that you’ll improve quality [through an initiative], the cost will go down,” he said.
Indeed, Steele emphasized that it has become clear in U.S. healthcare over the past decades that “There is a relationship between quality and cost, and it’s inverse.” And that equation, he noted, is also linked to core care management breakthroughs and innovations at Geisinger, among them, “Value-Driven Care” programs for patients with type 2 diabetes and with coronary artery disease (CAD). In a program involving the care management of over 25,000 patients over three years, an identified “diabetes bundle” of care management interventions (pneumococcal vaccination; micro-albumin tests and results; hemoglobin a1c levels brought to individual targets; LDL cholesterol brought to target levels; blood pressure brought to target levels; and documentation of smoking cessation), Steele reported that “The really astonishing thing is that after three years of being involved in this fundamental change of how we took care of a very fundamental disease, the probabilities of our diabetics have a heart attack, stroke, or eye disease, were radically diminished.” Indeed, Steele reported that the health system determined that it had prevented at least 305 heart attacks, 140 strokes, and 166 cases of diabetic retinopathy, among that cohort of 25,000 patients, adding, “I did not think we’d achieve that in three years.”
Similar work is being done with a “CAD bundle” for patients with coronary artery disease, with that bundle including metrics such as specific targets for LDL cholesterol reduction and ACE inhibitor medication maintenance.
Importantly, Steele noted, “The next vista we’re trying to get to is a much more fundamental change in the behavior of our patients and plan members, and that is a fundamental activation in the behavior of the human beings we’re responsible for.”
And as part of that very broad effort, Steele noted the success of Geisinger’s participation in the “Open Notes” movement, which began as a pilot that Geisinger, Beth Israel Deaconess Medical Center in Boston, and Harborview Hospital in Seattle, all participated in. At Geisinger, the project expanded in 2013 to encompass more than 1,100 Geisinger providers and over 170,000 patients (after Geisinger pilot participation involving 24 primary care physicians and 8,700 patients). Significantly, during 2013, Steele noted, over 80 percent of the patients involved in the Geisinger Open Notes initiative opened their notes in their electronic health records; 99 percent of patients, and more than 80 percent of physicians, expressed the desire to continue in the program; and the majority of patients surveyed by the organization reported feeling more in control of managing their own health, better prepared for visits, and more likely to take their medications as prescribed.
Citing the statistic that more than one-third of prescriptions written by physicians are not even filled by patients, Steele said, “This is the start of what I consider to be a fundamental change in the relationship between our patients and providers. One of the metrics we’re looking for is increased medication adherence.”
In the end, Steele said, all stakeholders around healthcare—hospitals, physicians, health plans, employer-purchasers, and patients/consumers—must innovate together to improve clinical and health outcomes and lower costs. And he said, what Geisinger has done is possible nationwide, with the right vision, mission, leadership, and commitment.