ProvenCare how to deliver value based healthcare the geisinger way

PRAISE FOR ProvenCare and Glenn Steele and David Feinberg “In rural Pennsylvania, an extraordinarily innovative model for the future of the U.S healthcare system has emerged In ProvenCare, leaders Glenn Steele and David Feinberg give us the compelling inside story of how they built it and what it will take for the rest of us to so, too.” —Atul Gawande, MD, MPH Samuel O Thier Professor of Surgery, Harvard Medical School; and New York Times bestselling author of Being Mortal “Using vivid stories, its visionary leaders Glenn Steele and David Feinberg show us how Geisinger became a national leader in delivering high value care—care so consistently good it is called ‘ProvenCare,’ which comes with a warranty and even refunds if patients are dissatisfied More important, other healthcare systems can implement the Geisinger formula and achieve the same successful transformation.” —Ezekiel J Emanuel, MD, PhD Vice Provost of Global Initiatives; Chair, Department of Medical Ethics and Health Policy; and Levy University Professor, University of Pennsylvania “For more than a decade, Geisinger has been showing U.S healthcare what ‘social capital’ can mean—the improvements that are possible when clinicians work together in real teams, when ‘performance’ is clearly defined, and when insurance and provider functions are integrated Geisinger’s innovations and effectiveness were led first by Glenn Steele, and more recently by David Feinberg—two of the best CEOs in modern healthcare ProvenCare represents their playbook, and a road map for other organizations to follow their lead.” —Thomas H Lee, MD Chief Medical Officer, Press Ganey; and author of An Epidemic of Empathy in Healthcare 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM “Our health system must achieve better care, better health, lower costs, and the best possible patient experience through innovation and spreading proven results Drs Steele and Feinberg eloquently describe the Geisinger journey, and the story serves as a guiding light for everyone in our health system who wants to achieve better results The book should be read by everyone who is focused on health system transformation, improvement, caring for patients, and innovation.” —Patrick Conway, MD, MSc Deputy Administrator for Innovation and Quality and Director, Center for Medicare and Medicaid Innovation, CMS* “A must-read for anyone interested in understanding how changing the way care is provided can unlock value in healthcare Written by the former and current CEOs of Geisinger, it is a readable explanation of the importance of clinical leadership and integrated health systems in creating value The discussion and experience with ProvenCare will be especially helpful to clinicians, while the financial outcomes of ProvenCare will capture the attention of system CFOs.” —Gail Wilensky, PhD Economist and Senior Fellow, Project HOPE “A n aging population with multiple chronic conditions, coupled with increased consumerism as patients become more involved in their healthcare decision making, means hospitals and health systems are examining their care processes as they grapple with these new challenges David and Glenn provide a how-to manual on improving access to care and the quality of care, while lowering costs, in their extraordinary new book Their fresh approach is based on their leadership of one of the country’s leading health systems A must-read for everyone interested in advancing health in America.” —Rick Pollack President and CEO, American Hospital Association “Great leaders, to paraphrase Napoleon, must define reality and then give hope ProvenCare accomplishes both of these objectives, and provides a road map for improving healthcare outcomes that is fact-based, and battle-tested This is fundamentally a story about leading change in the very complex field of healthcare The results achieved within the Geisinger system are inspirational, compelling, and relevant.” —L Kevin Cox Chairman, Health Transformation Alliance; and CHRO, American Express Company * The quote represents Dr Conway’s personal views and not necessarily the views or policies of the Centers for Medicare and Medicaid Services 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM “P rovenCare explores common myths about healthcare in America, and exposes the fallacy that more care is better, along with the tragedy of how many in our country are underserved by our medical system Glenn Steele and David Feinberg argue that the patient must always come first, and demonstrate that it is through coordination and collaboration, as well as a singular focus on outcomes, that we can improve care while lowering costs This excellent book is both an exposé and personal guide that provides powerful support for the collaborative and evidenced-based approach to practicing medicine championed by Geisinger, an approach that is leading the way in the transformation in American healthcare.” —Ann Lamont Managing Partner, Oak Investment Partners “ProvenCare beautifully illustrates how, together, Dr Steele, Dr Feinberg, and Geisinger have created proven strategies that balance innovative, integrated technologies with high-touch personal care ProvenCare, where care and caring go hand in hand, is a model for the future that can be implemented today PeaceHealth looks forward to adopting Geisinger’s approach to care delivery to further our own patient-centric focus on transforming the health and well-being of our patients and communities.” —Liz Dunne President and CEO, PeaceHealth “D rs Steele and Feinberg provide a rare blend of visionary thinking and practical and tactical acumen Our cooperative of America’s leading self-insured health plans benefits immensely from Dr Steele’s leadership This book is focused on our transformational mission, but also zooms in on the healthcare problems of today and offers solutions to them.” —Rob Andrews CEO, Health Transformation Alliance “Grounded within the context of our rapidly changing healthcare landscape, Drs Feinberg and Steele offer a thought-provoking look at Geisinger’s pioneering approach to reengineer care management and improve health outcomes for patients The lessons learned from Geisinger’s innovations to truly integrate care offer new insights to help tackle the fundamental challenges of access, quality, and cost in healthcare that have remained with us for decades.” —Sheila Burke, RN, MPA, FAAN Senior Public Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; and Adjunct Lecturer in Public Policy, Harvard University 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM “R egardless of what happens in Congress or state legislatures, the healthcare industry is in the throes of massive transformation For leaders of health systems, as well as clinicians trying to lead successful transformation, ProvenCare is a terrific playbook that shares the insights and passion of Drs Steele and Feinberg, who have positioned Geisinger as a role model for what is needed in American healthcare The book is full of insights into the who, what, when, why, and how of this transformation It is not a coincidence that many Geisinger leaders have moved on to have significant impact at many prominent healthcare organizations, and now xG Health Solutions, the Geisinger spin-off, is assisting others Follow the journey and use the insights gained to help accelerate the transformation taking place across this industry.” —Lee B Sacks, MD EVP and Chief Medical Officer, Advocate Health Care “Dr Glenn Steele and Dr David Feinberg, well known for their creativity and leadership in helping to solve the complexities of providing value and quality in healthcare, have provided valuable insights into the success of Geisinger as a delivery model for today and tomorrow Beyond telling the story of the success and creation of the care model with thought and creativity, the lessons learned can be adapted not only to larger systems but also to our struggling rural hospitals Refreshingly straightforward and practical.” —Lou Hochheiser, MD Professor Emeritus, University of Vermont; and former CEO, St John’s Medical Center “Steele and Feinberg have given us a timely and inspiring procedural on how to improve clinical outcomes and patient satisfaction and reduce the cost of healthcare ProvenCare is a must-read for anyone who desires to fix our broken health system.” —George F Lynn President Emeritus, AtlantiCare; and former Chairman, American Hospital Association 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM ProvenCare How to Deliver Value-​B ased Healthcare the Geisinger Way Glenn D Steele Jr., MD, PhD David Feinberg, MD, MBA 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM Copyright © 2018 by Geisinger Health Foundation All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-1-25-964229-6 MHID: 1-25-964229-1 The material in this eBook also appears in the print version of this title: ISBN: 978-1-25-964228-9, MHID: 1-25-964228-3 eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs To contact a representative, please visit the Contact Us page at www.mhprofessional.com TERMS OF USE This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill Education and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill Education has no responsibility for the content of any information accessed through the work Under no circumstances shall McGrawHill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise To all our Geisinger patients and insurance members, it is our privilege to care for you And to everyone in the Geisinger family who works daily to care for the people we serve 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM This page intentionally left blank CONTENTS PREFACE vii ACKNOWLEDGMENTS Why Geisinger? xvii The Problem 15 The Fix 25 Effective Governance 39 Getting Started 49 Enabling Change 63 ProvenCare Acute: Taking It to the Next Step 79 ProvenCare Chronic 105 ProvenHealth Navigator: Geisinger’s Advanced Medical Home 10 Leading and Managing a Successful Practice Transformation 127 151 11 ProvenCare Biologics 165 12 ProvenExperience 187 13 Future Vision 213 NOTES 231 INDEX 237 v 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM ... contract, tort or otherwise To all our Geisinger patients and insurance members, it is our privilege to care for you And to everyone in the Geisinger family who works daily to care for the people... benefit is distributed to the patient, to the provider, and back to the purchaser All of these stakeholders have to experience direct benefit from the value created If there is no sustainable... AM ProvenCare How to Deliver Value-​B ased Healthcare the Geisinger Way Glenn D Steele Jr., MD, PhD David Feinberg, MD, MBA 9781259642289_STEELE_P4.indd 9/21/17 8:36 AM Copyright © 2018 by Geisinger