Aim­ing to pro­vide concierge care ‘for the masses’

Modern Healthcare - - Q & A -

In May, Dr. David Fein­berg suc­ceeded Dr. Glenn Steele as pres­i­dent and CEO of Danville, Pa.based Geisinger Health Sys­tem, which in­cludes nine hos­pi­tal cam­puses, a 1,200-physi­cian mul­ti­spe­cialty group prac­tice and a 467,000-mem­ber health plan.

Fein­berg, a psy­chi­a­trist, pre­vi­ously served as the CEO of the UCLA Hos­pi­tal Sys­tem in Los An­ge­les. This year he earned spots on two Mod­ern Healthcare lists, plac­ing 86th on the 100 Most In­flu­en­tial Peo­ple in Healthcare rank­ing and 12th on the 50 Most In­flu­en­tial Physi­cian Ex­ec­u­tives and Lead­ers list. Mod­ern Healthcare re­porter An­dis Robeznieks re­cently spoke with Fein­berg about how he plans to make Geisinger more pa­tient-cen­tered, his sys­tem’s ge­netic re­search pro­gram, and the chal­lenges of man­ag­ing the health of Med­i­caid pa­tients. This is an edited tran­script.

Mod­ern Healthcare: What are your pri­or­i­ties as the new CEO?

Dr. David Fein­berg: We want to take pa­tient-cen­tered­ness to the next level. We want to en­gage with our pa­tients and fam­i­lies in a way that’s com­pas­sion­ate and kind, and de­liver care that is of the high­est qual­ity in a safe and cul­tur­ally sen­si­tive man­ner. We want to make our tran­si­tions in care re­mark­ably smooth. We want pa­tients to un­der­stand their bill.

MH: How would you com­pare Geisinger to the UCLA sys­tem you came from?

Fein­berg: At UCLA, it’s a bal­anc­ing act be­tween the teach­ing, re­search and clin­i­cal oper­a­tions. At Geisinger, our true north, which is sup­ported by our amaz­ing teach­ing pro­gram and our ge­netic re­search, is our de­liv­ery sys­tem. With that fo­cus, Geisinger has been able to out­shine a lot of places.

In acute care, prob­a­bly the best num­ber that shows you’re do­ing a good job is the ob­served-to-ex­pected mor­tal­ity rate. At Geisinger in May, for all our fa­cil­i­ties it was 0.5. I never heard of a num­ber that low. We found that for our Wilkes-Barre hos­pi­tal, it was 0.2. We’re sav­ing five times as many peo­ple as we’re sup­posed to be sav­ing.

In Los An­ge­les, there are physi­cians, in­clud­ing my wife, who pro­vide concierge care to af­flu­ent pa­tients with great needs. At Geisinger, what I’ve seen is concierge care with the same level of at­ten­tion to de­tail, for the masses. For ex­am­ple, we just learned we over­took Switzer­land and we’re best in the world in an­ti­co­ag­u­la­tion ther­apy for stroke pa­tients. So we have world-class out­comes de­liv­ered in a cost­ef­fec­tive man­ner.

MH: Could you de­scribe Geisinger’s ge­netic re­search pro­gram and its eth­i­cal is­sues?

Fein­berg: Re­gen­eron Phar­ma­ceu­ti­cals picked us as a part­ner be­cause fam­i­lies have stayed here for gen­er­a­tions, of­ten in the same house or on the same block. We have 20 years of elec­tronic health-record in­for­ma­tion, 15 years of ra­di­o­log­i­cal data and 30 years of health plan claims data. We ask our fam­i­lies, “Would you al­low us to look at your DNA?” We’ve had a 90% pos­i­tive re­sponse rate. Next cal­en­dar year, we’ll have 250,000 pa­tients with ge­nomic, clin­i­cal and ad­min­is­tra­tive in­for­ma­tion recorded, with most of their fam­ily mem­bers in the same study.

How does that im­pact our pa­tients? We had a teenage fe­male who came in from soc­cer prac­tice com­plain­ing about de­hy­dra­tion. We treated her and asked her to be a part of the study. We then saw in her ge­nomic pro­file a fam­ily pro­cliv­ity to­ward car­diac ar­rhyth­mia and looked at the rest of the fam­ily. We dis­cov­ered that an un­cle died in a res­tau­rant from chok­ing. Most likely, it wasn’t chok­ing, but rather a car­diac event. We brought in the whole fam­ily and told them the risks.

We’ve hired a lot of bioethi­cists and ge­netic coun­selors, and brought in pa­tients to give us ad­vice on who should give them the news and how. We found that some peo­ple are brother and sis­ter and don’t know they’re brother and sis­ter. Our de­fault po­si­tion is that the re­la­tion­ship be­tween pa­tients and their pri­ma­rycare doc­tor is the most im­por­tant. That’s how you will get this in­for­ma­tion back to pa­tients.

So what we have now is not just pre­ci­sion medicine, but an­tic­i­pa­tory medicine. We can say, “Here’s what might hap­pen to you and here’s what you can do to pre­vent it.” Geisinger is turn­ing 100 years old this month. I think in the next 100 years, the bet Geisinger made on big data is go­ing to be im­pact­ful through­out the coun­try and the world.

‘We want to take pa­tient-cen­tered­ness to the next level.’

MH: How is it to head up a health plan?

Fein­berg: I hadn’t had much ex­pe­ri­ence on the in­sur­ance side. So I did a lot of home­work be­fore I came to make sure I didn’t ask too many stupid ques­tions. But I’ve caught up on the lingo and I hope I can start adding value to that part of our equa­tion.

MH: Has Geisinger ben­e­fited from Penn­syl­va­nia’s de­ci­sion to ex­pand Med­i­caid to low­er­in­come adults?

Fein­berg: I don’t know yet if we’ve ben­e­fit­ted, but we now have 165,000 Med­i­caid man­aged-care mem­bers in our Geisinger health plan. The out­come has yet to be seen be­cause it’s too early.

Geisinger ex­cels at man­ag­ing peo­ple with chronic con­di­tions. But these pa­tients typ­i­cally can af­ford the co­pay and med­i­ca­tions. They don’t have to worry about whether they can pay their elec­tric­ity bill. I’ve made some home vis­its to the man­aged Med­i­caid pa­tients. For them, it’s a whole dif­fer­ent sit­u­a­tion.

I met one gen­tle­man who uses a scooter to move around his sin­gle-room apart­ment. He’s a chain smoker. He or­ders Domino’s pizza and leaves it on the cof­fee ta­ble to eat over the next few days. He has no fam­ily or so­cial in­ter­ac­tion. Tak­ing care of pa­tients like him, it’s much more than just keep­ing track of his he­mo­glo­bin A1c level. You have to make sure they make it to their ap­point­ments, that their homes are safe, and that they have work­ing heat­ing and air con­di­tion­ing.

This pop­u­la­tion has a very dif­fer­ent set of pri­or­i­ties. The jury is still out on whether we’ll be suc­cess­ful. But I’m pleased that we’re do­ing it, and we’re do­ing more than our fair share.

MH: As a psy­chi­a­trist, what are your thoughts on the nu­mer­ous men­tal health re­form bills be­fore Congress?

Fein­berg: For pa­tients suf­fer­ing from men­tal ill­ness and sub­stance-abuse dis­or­ders, it’s a night­mare. Not only are they deal­ing with prob­lems which can be dev­as­tat­ing in them­selves, they in­ter­act with a heath sys­tem that is not de­signed to in­te­grate their care. That Congress is will­ing to have these dis­cus­sions is long over­due.

I met a young man who was in one of our hos­pi­tals for a heroin over­dose. He said he was do­ing fine. Then he started cry­ing. It was be­cause his mom found him un­con­scious, fainted, was in­jured and needed to be air­lifted to a hos­pi­tal. His big­gest con­cern was how his mom was do­ing. We don’t have a sys­tem in place to tell this fam­ily we’ll take care of them. We di­vide the med­i­cal and psy­chi­atric treat­ment up in­stead of do­ing it in an in­te­grated fash­ion.

At Geisinger, they’re em­bed­ded to­gether. Be­hav­ioral health can be ad­dressed at the same clinic where you bring your kids in for their school phys­i­cal. We have phar­ma­cists coun­sel­ing on opi­oid pre­scrip­tions. That’s the best ap­proach. I’m very sup­port­ive of Congress mak­ing sure fam­i­lies are en­gaged in treat­ment, and that there is par­ity be­tween med­i­cal and men­tal health pay­ment.

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