Reforming the
HealthCare
Delivery System
Learning Objectives
1. Recognize the drivers that lead Geisinger to
initiate reform of their healthcare delivery
system
2. Identify best practices from Geisinger's program
success to replicate in other organizations
3. Outline the Health Information Technology
Geisinger utilizes to manage their population
health
4. Summarize initial results achieved such as up to
25% reduction in admissions for patients with
multiple chronic disease conditions such as
Congestive Heart
Geisinger Health System
Gray’s Woods
Geisinger Inpatient Facilities
Geisinger Health System Hub and Spoke Market Area
Careworks Convenient Healthcare
Geisinger Medical Groups
Geisinger Health Plan Service Area
Non-Geisinger Physicians With EHR
Geisinger Health System
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2.6 million in service area
~ 1000 physicians
42 community practice sites
2 hospitals
300,000 health plan members
Healthcare IT and Informatics
– EPIC Ambulatory since 1998
– Inpatient since 2007
– OpTime, ED and other modules
• Data warehouse since 2009
– Care Gap identification and closure
Digital Translation of
Quality
Establish
the Digital
Gold
Standard
Adopt the
Digital
Gold
Standard
Close
Gaps in
Care
Maintain
and
Optimize
Leveraging Care Gaps
Populations
Goals –
Endpoints
Action Arms
Prevention
Mammo
every year
Office-Based
Decision Support
Chronic
Diseases
A1c 7- 8
Care Gaps
Unclosed
Loops
Abnormal Pap
Follow up
Medication
Safety
Methotrexate
monitoring
Regular care
“failures”
HF
exacerbation
Care Plans
Lab and Imaging
“Gap”
Management
Referral “Gap”
Management
Improving Care for 23,555 Diabetics
Improving CAD Care for 14,804 Patients
Improving Preventive Care for 210,681 Pats
Care Gaps Program
Population Health—Closing Care Gaps:
– Close preventive, chronic and restorative care gaps for targeted patient
populations by age/gender, disease, or condition
Engaging Patients:
– Patient & family-centric care coordination
– Proactive
– Technically elegant
– Patient experience is personalized and warm
“Geisinger
knows and
cares about
me and my
family”
Transform Geisinger Culture by Leveraging Technology:
– Data mining using evidence-based protocols & registries
– Decision support (patient, clerical, nursing, provider-level)
– Seamless connections (patient, PCP, specialty, ancillary, payor)
– Strong relationships
Care Gaps Mission
Achieve ‘Best Outcomes in
the Nation’
Patient Level
Population Level
Professional Level
– Lift clinician load by
facilitating work outside of
exam room
– Clinicians cheering for Care
Gaps closed
Financial Level
Flawless Coordination,
Execution, Partnerships
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Patients
Clinical Service Lines
Scheduling Services
Geisinger Health Plan
Marketing
IT
Research
Finance
Population Health: Auto Orders
Where we were: routine orders are placed by staff
and providers in office visit [MANUAL PROCESS]
Where we’re now: auto-generate routine orders
outside of the office visit [AUTOMATED PROCESS]
– Standardized lab/imaging testing
– Take work off of providers and nurses
– Display open orders to clinic/scheduling staff to increase
opportunities to close care gaps
Option 1: Single
Contact Method
Contact Strategies
• Letters/Auto Letters
• Pt Portal Broadcast
Care Gaps
Identified
Data
Warehouse
Validate
Data
Method
• Personal Phone Calls
• Telephony Recorded Msg
• Telephony Warm Transfer
• Office Visit
Option 2: Multiple
Contact Methods
Obtain Order/Referral (Auto
Orders)
Appoint Patient
Benefits of Auto Orders
• Pts receive labs and imaging studies when due
(monthly mining process)
• Ordering “work” is lifted from the office visit
• Provides an opportunity to stage pt visits to the
lab or radiology through Care Gaps Outreach
Care Gaps Closed 19,257
Care Gaps YTD
$4,500,000
25000
$4,001,340
$4,000,000
20000
$3,500,000
$3,000,000
$2,481,788
$2,500,000
15000
$2,262,264
Net Revenue
Care Gaps Closed
$2,000,000
10000
$1,500,000
$1,000,000
5000
$662,689
$500,000
$0
0
Jul-10
Aug-10
Sep-10
Oct-10
Geisinger’s Medical Home
Model enabled thru the
Keystone Health
Information Exchange
OUR BEACON COMMUNITY:
IMPROVING HEALTHCARE
COORDINATION
Profile of the Keystone Beacon Community
• Serving 256,000 citizens in 5 counties of Pennsylvania’s
mostly rural Susquehanna Valley
• 4 hospitals
• More than 100 primary care physicians
• More than 10 specialists
• More than 100 physician offices
• 2 long term care facilities
• Long term acute care hospital
• Home health care
Keystone Beacon Community Objectives
• To reduce hospital readmissions in patients with CHF
and COPD
• Provide immediate, secure access to patient information
• Reduce admissions and E.D. visits for patients with
conditions that could have been treated in an outpatient
setting
• Link participants to the Keystone Health Information
Exchange
Keystone Beacon Community Objectives
• To provide E. D. physicians and hospitals rapid access to
patients who are new to your hospital
• To develop a robust database with critical information
(including medication lists) on thousands of participating
residents in Columbia, Montour, Northumberland, Snyder
and Union counties
Care Coordination Components
Electronic Health Record
+ Health Information Exchange
+ Care Coordination – Case Management Process
+ Healthcare Providers
+ Patients
+ Care Coordinators – Case Managers
______________________________
Electronic Health Record (EHR)
• Computerized version of patient’s clinical, demographic
and administrative information
– Laboratory results
– Immunizations
– Diagnoses
– Medications
– Images
– Allergies
• Stored in a secure electronic format
• Requires healthcare providers to have a reason to view it
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Sample Electronic Health Record
1. Problems
2. Procedures
3. Family History
4. Social History
5. Payers
6. Immunizations
7. Medications
8. Medical Equipment
9. Vital Signs
10. Functional Status
11. Results
12. Allergies
13. Encounters
14. Plan of Care
15. Purpose
16. Advance Directives
– s
Health Information Exchange
Electronic channel between healthcare provider and
patients that allows sharing of the electronic health
record:
• Requires patient permission
• Access limited to participating healthcare providers and patient and
patient designees (such as spouse, daughter, son)
– S
What a shared EHR means to a patient
in the emergency room…
It means that a patient who had surgery at Geisinger,
post-surgical care at Riverwoods (L.T.C.) and is treated
for chest pain at Evangelical Community Hospital has all
his information in one place … in real time!
– S
What a shared EHR means to a patient
taking multiple medications…
It means a healthcare provider can quickly see all the
medications prescribed for a patient and reduces the
likelihood of an additional medication being added that
could cause an interaction.
–S
What a shared EHR means to someone
who is out of town…
It means a healthcare provider at a healthcare facility
outside of the area can access a patient’s health
information and avoid duplicative testing and
unnecessary procedures.
–S
What a shared EHR means to a mother who needs
to quickly access her child’s immunization
records…
It means that the mother can access and print the
information from the electronic health record whenever
or wherever the information is needed.
–S
Keystone Beacon Community
Security
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Provides critical patient information when and where
it is needed
Only accessible by participating provider
Able to track who accesses patient information
Able to track when it is accessed
Backed up to redundant off-site servers via “Cloud”
–S
Coordinated Care = Best Treatment
Possible
Results of a recent study of the Greater
Susquehanna Valley shows that coordinated
care is capable of simultaneously improving
quality and reducing costs, while enhancing
physician and patient satisfaction.
American Journal of Managed Care, August 2010
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S
Care coordination results*
• 40% reduction in unnecessary hospital
readmissions
• 20% reduction in unnecessary hospital
admissions
• 7% reduction in cost of care
*Statistics reflect three year observational study of 15,000 Geisinger Health Plan
Medicare Advantage members at 11 of Geisinger’s community practice sites.
–S
Thank You!
John M. Kravitz
Geisinger Health System
jmkravitz@geisinger.edu
570.214.8833