Recognize the drivers that lead Geisinger to initiate reform of their healthcare delivery system


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Recognize the drivers that lead Geisinger to initiate reform of their healthcare delivery system

  • Recognize the drivers that lead Geisinger to initiate reform of their healthcare delivery system

  • Identify best practices from Geisinger's program success to replicate in other organizations

  • Outline the Health Information Technology Geisinger utilizes to manage their population health

  • Summarize initial results achieved such as up to 25% reduction in admissions for patients with multiple chronic disease conditions such as Congestive Heart





2.6 million in service area

  • 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














Population Health—Closing Care Gaps:

  • 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


Achieve ‘Best Outcomes in the Nation’

  • 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



Where we were: routine orders are placed by staff and providers in office visit [MANUAL PROCESS]

  • 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




Pts receive labs and imaging studies when due (monthly mining process)

  • 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









Serving 256,000 citizens in 5 counties of Pennsylvania’s mostly rural Susquehanna Valley

  • 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



To reduce hospital readmissions in patients with CHF and COPD

  • 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



To provide E. D. physicians and hospitals rapid access to patients who are new to your hospital

  • 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

  • Electronic Health Record

  • + Health Information Exchange

  • + Care Coordination – Case Management Process

  • + Healthcare Providers

  • + Patients

  • + Care Coordinators – Case Managers



Computerized version of patient’s clinical, demographic and administrative information

  • 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


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Electronic channel between healthcare provider and patients that allows sharing of the 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)
        • S


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!

  • 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


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.

  • 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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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.

  • 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


It means that the mother can access and print the information from the electronic health record whenever or wherever the information is needed.

  • 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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Provides critical patient information when and where

  • 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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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.

  • 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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40% reduction in unnecessary hospital readmissions

  • 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. Kravitz

  • Geisinger Health System

  • jmkravitz@geisinger.edu

  • 570.214.8833



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