Geisinger shows how data drives change

Glenn Steele Jr., MDGlenn Steele Jr., MD

'Attack cost or increase quality? If you reengineer, you may get a twofer.'

Geisinger Health System, the pioneering integrated care network, is "perfectly designed to do a huge number of experiments in both the provider and payer sides," said its Chief Executive Officer Glenn Steele Jr., MD, on Thursday.

In his keynote at the Healthcare IT News/HIMSS Media Healthcare Business Intelligence Forum in Washington, Steele made the case that behavior change is critical to better outcomes. And it’s not just patients' behavior either -- providers' and payers', too.

Thanks to the huge amount of patient data stored in two decades' worth of Epic electronic health records -- and a leading-edge data warehousing initiative -- Geisinger has been able to arrive at some critical insights about the cost and quality of care, and the relationship between them.

[See also: Geisinger CEO gives tips for smarter BI.]

"The innovation sweet spot is the 50 percent of patients we care for that we also insure," said Steele. At the same time, however, even in that cohort, half of the care they receive is from non-Geisinger providers.

For all the enlightenment Geisinger has arrived at by deploying smart analytics tools on its reams of clinical and claims data -- read about some of them in this Healthcare IT News Q&A -- Steele recognizes that, to some extent, their situation is unique, he said: "If we do something cool to reengineer care, is it applicable to the real world?" Still, it's clear that in this era of risk and accountability, other healthcare organizations are looking to Geisinger for inspiration.

Many other versions of payer/providers integration have sprung up in recent years, although Steele suspects that many of them will "struggle" as entrenched ways of doing things come into friction with new modes of thinking. "Cultural antipathy is the rate limiter, not the data flow," said Steele.

Case in point: Geisinger's analytics teams have made big strides in establishing that more expensive care does not equal better care. In fact, the opposite tends to be true.

"We think there's a definite inverse correlation between cost and quality," he said. In most cases, "high cost really does correlate with low quality."

Despite this, insurance companies -- who, one would think, would delight those findings -- have been all but unresponsive. Geisinger deals with plenty of payers beside themselves, of course.

"You may ask: How many of the non-Geisinger payers have asked to get in on this?" said Steele. "The short answer is none. Zero. Most of our payers are dealing in the old-fashioned, fee-for-service way."

Still, the health system has soldiered on, growing and evolving, charting new discoveries derived from the data flowing through the "fixed pipe" of EHRs (as Steele refers to them).

The more complex our organization get, the simpler our message has to be, he said, pointing to a honed, three-part mission: a patient-centered focus on activation and empowerment, fostering a culture of quality and safety and also embracing a spirit of value reengineering.

Oftentimes, the care delivered in this country is "too much, too little or wrong," said Steele. At the same time, he chafed against the false distinction that improving quality and reducing cost is an either/or question.

"Attack cost or increase quality? If you reengineer, you may get a twofer," he said. While the data-mining capability on the insurance side "is totally different" from the information on provider side," said Steele, the "integration of those two has been the success" in Geisinger's better outcomes in the treatment of diabetes, congestive heart failure and more.

For instance, he said, "in three years" Geisinger was able to effect "a huge, huge change in heart attack, stroke and diabetic retinopathy" by targeting care to the cohorts most in need.

Since those ailments are so debilitating -- and so costly -- the financial benefit surely follows.

"We haven't done the economics of this, but there's got to be a huge impact," said Steele. "The economics and the quality aspects will be very interesting and will link together."

As Geisinger has changed the way its clinicians have delivered care, so to has it focused on behavior change from its patients. Returns have been encouraging, said Steele.

"When you focused on the sickest and got information from the insurance company and it was modified so it was usable, it changed behavior," he said. That's development that's "really exciting," said Steele, pointing to other patient engagement initiatives such as Geisinger's early participation in the OpenNotes pilot, through which "we've opened up all of our progress notes to all of our patients except psychiatry and the ER."

[See also: Kaiser, others open notes to patients.]

"When I mention this to docs they think I'm a communist," Steele joked. But amazingly "the world did not end" with open access to patient data, he said. Instead, patient "looked at (the notes) a lot. They're very, very interested."

In fact, "there's lots of errors they find that they correct," said Steele. "Like any other data, if you use it, it gets better."

Now Geisinger is forging ahead on a slew of new care improvement and patient engagement efforts.

There are huge big data initiatives, such as "whole genome sequencing for 100,000 of our patients. There are "healthcare in the cloud" projects, building upon data derived from devices distributed to patients' homes. There are innovations aimed at EHR redesign, to better enable engaged and personalized care.

"We're not looking for a quick win," said Steele. "But I think this is really going to be a fascinating exercise over the next few years."