It’s ‘stu­pid­ity’ to in­stall health IT with­out re-en­gi­neer­ing the en­tire work­flow

Modern Healthcare - - Q & A -

“You’ve got to look at your pa­tient-care pro­cesses and say, ‘How are we go­ing to do it dif­fer­ently?’ ”

Since 2001, Dr. Glenn Steele Jr. has served as pres­i­dent and CEO of Geisinger Health Sys­tem, an in­te­grated de­liv­ery sys­tem based in Danville, Pa., with eight hos­pi­tal cam­puses, a 1,100mem­ber mul­tispe­cialty group prac­tice and a 467,000-mem­ber health plan.

Steele, named to Mod­ern Health­care’s list of the 100 Most In­flu­en­tial Peo­ple in Health­care for the past six years, is step­ping down as CEO in June but will con­tinue as chair­man of xG Health So­lu­tions, an in­de­pen­dent ven­ture Geisinger launched to dis­sem­i­nate its ex­per­tise in care man­age­ment and health IT. Last month, he re­ceived the Na­tional Cen­ter for Health­care Lead­er­ship’s 2014 Gail L. War­den Lead­er­ship Ex­cel­lence Award. Steele pre­vi­ously served as vice pres­i­dent for med­i­cal af­fairs at the Univer­sity of Chicago, surgery pro­fes­sor at Har­vard Med­i­cal School, and CEO of Dea­coness Pro­fes­sional Prac­tice Group in Bos­ton. Mod­ern Health­care re­porter An­dis Robeznieks spoke with Steele about how his or­ga­ni­za­tion is deal­ing with Med­i­caid and ex­change-plan growth, his con­cerns about im­ple­men­ta­tion of pay-for-per­for­mance and health IT, and his legacy at Geisinger. This is an edited tran­script.

Mod­ern Health­care: How is Geisinger pre­par­ing for the pos­si­bil­ity of the Supreme Court strik­ing down the Oba­macare pre­mium sub­si­dies in Penn­syl­va­nia and other states?

Dr. Glenn Steele: I’m not wor­ried about the Supreme Court right now. I’m wor­ried about all those prod­ucts where we’ve made bets. Ob­vi­ously, I’m in fa­vor of ex­pand­ing ac­cess. Any­thing that in­sures more peo­ple is the eth­i­cal way to go. But I be­lieve you can make a good business case for it. Still, the tur­bu­lence is pretty chal­leng­ing right now.

MH: What bets are you speak­ing of?

Steele: Our big bet is go­ing into the Med­i­caid man­aged­care mar­ket. We’re almost two years into that with about 130,000 Med­i­caid mem­bers. That’s a learn­ing process for us be­cause a sig­nif­i­cant amount of ben­e­fi­cia­ries’ cost uti­liza­tion has to do with things other than health­care. We’re still learn­ing about a lot of the life is­sues that have to be dealt with.

There are a huge num­ber of folks who have to have 24/7 care or mon­i­tor­ing be­cause of a com­bi­na­tion of dis­ease, eco­nomic de­pri­va­tion or dis­abil­i­ties. That’s not what health sys­tems gen­er­ally are good at deal­ing with. But we think that if we’re in it on both the in­surance and provider sides, it’s bet­ter than if we’re just in it on one side.

The sec­ond big bet is get­ting into the ex­change. We’re now into our sec­ond year of prod­uct de­sign. We’re com­mit­ted to the ex­change be­cause we think in the fu­ture more peo­ple will be buy­ing their in­surance on the In­ter­net. So we need to learn how to do our var­i­ous health-plan metal tiers, how to price and how to in­crease med­i­cal lit­er­acy. We’ve prob­a­bly got around 60,000 ex­change en­rollees now, and 85% are new to our or­ga­ni­za­tion, so we don’t know how sick they are or how much they uti­lize.

The third big bet is Healthy PA, Gov. Tom Cor­bett’s waiver model for ex­pand­ing Med­i­caid. The rules are very com­plex and they’re still volatile. They’re even more volatile now be­cause Demo­crat Tom Wolf will be our new gov­er­nor. But I sus­pect that we’ll have the Cor­bett model for at least a cou­ple of years. We sus­pect we’ll pick up 40,000 to 45,000 ad­di­tional mem­bers.

MH: Have in­sur­ers started to take up Geisinger’s bun­dled-ser­vice, guar­an­teed-price war­ranty of­fer? If not, why not?

Steele: Ab­so­lutely not. It’s one of the great sar­donic as­pects of my life. I have a num­ber of sup­po­si­tions. The vast majority of in­sur­ers were trans­act­ing fee-for-ser­vice and it just wasn’t worth it for the big­gies to change their back-of­fice trans­ac­tion just for Geisinger. As we move to­ward ac­count­able care or­ga­ni­za­tions and more shared risk, there is a need for even the big­gies to trans­act some­thing dif­fer­ent.

MH: Do you have con­cerns about how pay-for-per­for­mance mod­els are be­ing im­ple­mented?

Steele: One of my great fears is that we’re go­ing to do for qual­ity ex­actly what we ex­pe­ri­enced for in­ter­ven­tional work. My great night­mare is we’ll de­velop an ICD-10 for qual­ity, with lots of pars­ing of each com­po­nent of qual­ity. I think that’s crazy. A lot of the pay-for-per­for­mance stuff built into fee-for-ser­vice is a move in that di­rec­tion. We haven’t been able to get to some­thing that looks more like tak­ing re­spon­si­bil­ity

fi­nan­cially for health­care over time for a pop­u­la­tion. There’s still a resid­ual fear of cap­i­ta­tion, which is le­git­i­mate, be­cause peo­ple were wor­ried that health­care sys­tems would with­hold ser­vice. But I be­lieve we can pro­tect against that now.

MH: How do you know the pa­tient-cen­tered med­i­cal home model Geisinger pi­o­neered re­ally works?

Steele: We’ve shown over the last eight years or so that our Proven Health Nav­i­ga­tor model has sig­nif­i­cantly de­creased hos­pi­tal­iza­tion per thou­sand across our en­tire sys­tem. Our sys­tem is pretty large, and so the prob­a­bil­ity of some sort of bias be­cause it’s not a ran­dom­ized clin­i­cal trial goes down.

We’ve now ex­panded this to the East­ern Maine Health Sys­tem and the West Vir­ginia Univer­sity Health Sys­tem, and we’re ex­pand­ing it into New Jersey and into Delaware. We’re build­ing up a port­fo­lio of ex­pe­ri­ence with non-Geisinger providers and we’re get­ting the same ef­fects on hos­pi­tal­iza­tion.

It’s my re­li­gion. Any­thing I can do that ex­tracts un­nec­es­sary vari­a­tion or re­dun­dancy in ser­vices or un­nec­es­sary vis­its to the emer­gency room will keep pa­tients in bet­ter shape and de­crease cost. And be­cause our in­surance company is in the same fidu­ciary as our provider, any­thing that de­creases to­tal cost of care is good for our business model.

MH: Do you un­der­stand why physi­cians com­plain about health IT hurt­ing their work­flow and ef­fi­ciency?

Steele: Here’s my Jonathan Gru­ber state­ment: This is an is­sue of stu­pid­ity. If peo­ple be­lieve that you can put IT in, con­tinue work­ing the same way you did be­fore IT, and not get in­ef­fi­ciency, we are talk­ing dou­ble-digit IQs here. What every­body’s learned over the last 15 to 20 years is if you put IT in, whether it’s hos­pi­tal-based or am­bu­la­tory, you have to look at the en­tire work­flow and use the IT im­ple­men­ta­tion as an ex­cuse for reengi­neer­ing your work­flow from be­gin­ning to end. If you don’t do that, it’s go­ing to cre­ate havoc. You’ve got to look at your pa­tient-care pro­cesses from be­gin­ning to end and say, “How are we go­ing to do it dif­fer­ently? How is this go­ing to make it bet­ter?”

On the ben­e­fits of health IT, we couldn’t do point-of-ser­vice care in­no­va­tion with­out hav­ing near re­al­time data fed back to us. You’ve got to have data both from the in­surer side and the provider side to pre­dict which pa­tients or co­horts of pa­tients are most likely to need the high­est-in­ten­sity vig­i­lance. If you don’t have feed­back in a timely fash­ion, it’s not go­ing to work.

MH: How would you de­scribe your legacy at Geisinger?

Steele: Well, I’m not dead yet. I don’t worry about legacy. I’ll be there through June of 2015. I’m cer­tain that we’ll have ter­rific suc­ces­sor can­di­dates. I sus­pect that with my in­volve­ment in this spinoff, xG Health So­lu­tions, as well as a num­ber of other op­por­tu­ni­ties not re­lated to Geisinger, I’ll be able to con­trib­ute.

I’m most proud of the fact that over my almost 15 years at Geisinger, we’ve spawned eight CEOs and three chief med­i­cal of­fi­cers of other health­care com­pa­nies. Some­times I won­der if it isn’t too much of a good thing be­cause when th­ese great peo­ple leave, we’ve got to re­dis­tribute work or get new peo­ple in. But that’s prob­a­bly the most im­por­tant as­pect of legacy. I’m re­ally quite pleased.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.