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

Geisinger Inpatient Facilities

Geisinger Medical Groups

Geisinger Health System Hub and Spoke Market Area

Geisinger Health Plan Service Area

Careworks Convenient Healthcare

Non-Geisinger Physicians With EHR

Gray’s Woods

Geisinger Health System

• 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

Maintain and

Optimize

Close Gaps in

Care

Care Plans

Populations

Leveraging Care Gaps

Action Arms

Lab and Imaging “Gap”

Management

Referral “Gap” Management

Care Gaps

Goals –Endpoints

Mammo every year

Prevention

Chronic Diseases

A1c 7- 8

Unclosed Loops

Abnormal Pap Follow up

Medication Safety

Methotrexate monitoring

Regular care “failures”

HF exacerbation

Office-Based Decision Support

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

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

“Geisinger knows and cares about me and my family”

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

• 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

Contact Strategies

Method

Option 1: Single Contact Method

Option 2: Multiple Contact Methods

• Letters/Auto Letters

• Pt Portal Broadcast

• Personal Phone Calls

• Telephony Recorded Msg

• Telephony Warm Transfer

• Office Visit

Data Warehouse

Validate Data

Care Gaps Identified

Appoint Patient

Obtain Order/Referral (Auto Orders)

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

$662,689

$2,262,264

$4,001,340

$2,481,788

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

$4,500,000

Jul-10 Aug-10 Sep-10 Oct-10

0

5000

10000

15000

20000

25000

Net Revenue

Care Gaps Closed

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

Electronic Health Record+ Health Information Exchange+ Care Coordination – Case Management

Process + Healthcare Providers + Patients + Care Coordinators – Case Managers ______________________________

Care Coordination Components

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– s

– s

1. Problems2. Procedures3. Family History4. Social History5. Payers6. Immunizations7. Medications8. Medical Equipment9. Vital Signs10.Functional Status11.Results12.Allergies13.Encounters14.Plan of Care15.Purpose16.Advance Directives

Sample Electronic Health Record

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)

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Health Information Exchange

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!

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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.

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What a shared EHR means to someonewho 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.

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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.

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Keystone Beacon Community Security

• 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”

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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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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.

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Thank You!

John M. KravitzGeisinger Health System

jmkravitz@geisinger.edu

570.214.8833