3. From the Latin per os, or by mouth.
4. Margo A. Halm, “Hourly Rounds: What Does the Evidence Indicate?,” American Journal of Critical Care 18, no. 6 (November 2009): 581–84.
5. Geisinger study, “Access to Doctors’ Notes Increases Med Adherence,” PRNewswire, November 2, 2015, http://www.prnewswire.com/news-releases/geisinger-study-access-to-doctors-notes-increases-med-adherence-300170282.html.
CHAPTER 13
1. Health Care Payment Learning and Action Network, Alternative Payment Model Framework and Progress Tracking Work Group, “Alternative Payment Model Framework Final White Paper,” January 1, 2016, https://hcp-lan.org/workproducts/apm-whitepaper.pdf.
2. American Academy of Pediatrics, “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report,” Pediatrics 128, supplement 5, December 2011, http://pediatrics.aappublications.org/content/128/Supplement_5/S213.
3. Kristin N. Ray, Amalavoyal V. Chari, John Engberg, Marnie Bertolet, and Ateev Mehrotra, “Opportunity Costs of Ambulatory Medical Care in the United States,” American Journal of Managed Care, August 18, 2015, http://www.ajmc.com/journals/issue/2015/2015-vol21-n8/Opportunity-Costs-of-Ambulatory-Medical-Care-in-the-United-States.
4. Chris Krepich, “Geisinger Staff Honors Hero; Nurse Bonds with Lightning-Strike Victim, His Family,” Bloomsburg Press Enterprise, July 29, 2016.
INDEX
Please note that index links point to page beginnings from the print edition. Locations are approximate in e-readers, and you may need to page down one or more times after clicking a link to get to the indexed material.
Abelson, Reed, 59
ABIGAIL standards (patient experience), 191, 192
ACA (see Patient Protection and Affordable Care Act)
Access, quality, and cost triangle, xi
Access to care, 189, 221–222
managing, 202
phones answered by humans, 202
same-day appointments, 202–203
Access to health insurance, xvii, 221
Accountability, 23, 153, 210
Accountable care organizations (ACOs), xiii–xiv, 148
Acute services:
fee for, 2–3
typical American acute care, 82
(See also ProvenCare Acute)
Administrative partners, xiv, 23, 65
Advanced care management, 142–143
Advanced medical home (see ProvenHealth Navigator (PHN))
Advocacy, linking mission to, 35
Alexander, William, 47
Allina Health System, 43
All-or-none bundle of care commitment, 132
Ambulatory care, 54, 57 (See also ProvenHealth Navigator (PHN))
American Academy of Pediatrics, 224
American Association of Hip and Knee Surgeons, 53
American Journal of Managed Care, 122–123
American Surgical Association, 55
Anemia, 117, 169–170
Anticipatory medicine, 222–224
Anticoagulation therapy management service, 3
App, for ProvenExperience, 211–212
Appearance of professionals, policy for, 197–198
Appointments:
nonproductive time related to, 225
same-day, 202–203
AtlantiCare, 40
AT&T, 67
Autism care, 55, 117
Baseline data, 68, 81–82
Bedside shift report, 198
Behavior change, 219
Bell Telephone Laboratories, 66–67
Berwick, Donald M., 132
Best practices:
choosing elements of, 84
default, 100
establishing, 91–92
information on, 52–53
modification of proposals for, 69
monitoring of patient compliance with, 87
for patient experience, 192–193
in ProvenCare, 81 (See also specific areas of care)
Bills, redesigned, 204–209
Biologics (see ProvenCare Biologics)
Blue Cross of Northeastern Pennsylvania, 22
Boards of directors:
agenda for, 45–46
composition of, 45, 46
foundation board, 39–40, 45
insurance board, 43–45
leadership of, 41
in Penn State Hershey Medical Center merger, 40, 41
presentations for perspective in, 42–43
selection of chair for, 6
structure of, 41–42
(See also Governance)
Bravman, John, 47
Budgeting process, 67–68
Bundled care:
all-or-none commitment to, 132
for CABG, 90
for chronic diseases, xxii, 10, 36, 54, 57, 132, 133, 136–138, 144, 148, 154 (See also ProvenCare Chronic)
for nursing practices, 198, 200
Bundled payment package, 84, 88–89
Burke, Greg F., 191
C sections, 3
CABG (see Coronary artery bypass graft surgery)
Cancer:
biologicals for, 183–184
lung cancer treatment, 102–104
oral chemotherapies, 169
risk with biologics, 182–183
Capital BlueCross, 22, 26
Cardiology care:
as beta test, 51, 53, 54
congestive heart failure, 109–110
Care gaps program, 157
Care in place, 225–226
Care reengineering, xv, 29–32
choosing targets for, 51–54
enabling (see Enabling change)
initiating (see Initiating change)
linking incentives and fundamental change, 32–35
and operational trajectory, 35–36
outcomes of, 215
professionals’ motivation for, 21
strategic vision for, 34–36
(See also ProvenCare)
Caregiver–patient relationship, xv
Caregivers:
in clinical pathway, 55
embedded nurse care managers, 127–130
family as, 226–227
transparent reporting of quality ratings for, 194–195
Caregiving, preference for innovations over, 69
CareSite specialty pharmacies, 184–185
Caring:
becoming the best in, 228–229
as central to reengineering and innovation, 218
characteristics of, 216
imperative for, 214–216
preventative, 219–221
Cataract surgery, 56
Centers for Medicare and Medicaid Services Pioneer Accountable Care Organization (ACO) model, 148
Centers of excellence, xii
CEO:
as chair of insurance board, 44
in innovation budgeting, 68
partnering between board chairman and, 41–42, 46–47
visibility of, 38
Cerner, 6
Certified trauma center designation, 6
Chief information officer, 70
Chief medical informatics officer, 70
Chief of innovation, 67
Chief scientific officer, 70
Chronic diseases, 15–16
Chronic pain management, 157
Chronic service:
fee for, 2–3
reengineering (see ProvenCare Chronic)
Cicio, Gina, 210
Clinical leaders, xiv, 23
choosing initial targets to appeal to, 51–52
at head of transformation effort, 64
in operationalizing innovation, 68–69
Clinical orders, in ProvenCare Chronic, 119, 121
Clinical pathway:
including caregivers in, 55
responsibility for developing, 168
Clinical service reengineeri
ng targets, 51–53
Clinician satisfaction, 145, 147
Collaborating on change, 107–110
Commission on Cancer ProvenCare Lung Cancer Collaborative, 103
Commonwealth Fund, 11
Communication, 38
in chronic disease care, 121–122
C.I.CARE communication framework, 193–194
concerning genetic abnormalities, 223–224
information overload, 158
OurNotes to patients, 203
in physician practices prior to PHN, 152
Communication strategy, strategic vision in, 35
Communication technology, 65–66
Community practice reengineering, 134–138
Community Practice Service Line (CPSL), 54
Compensation:
fundamental change in, 42, 57
linking incentives to fundamental change, 32–35, 57–58
linking incentives to strategic goals, 89, 101, 134
Compliance monitoring, 87
Concierge care, 128, 132
Congestive heart failure, 109–110, 144–145
Consolidation of providers, prior to ACA, 18
Continuous service recovery, 209–211
Cookbook medicine, 87
Copays, refunded to dissatisfied patients, 12
Coronary artery bypass graft surgery (CABG), 3, 11
as beta test, 22, 53, 54, 90–91
long-term outcomes of, 107
ProvenCare Acute for, 90–95
Dr. Steele Jr.’s experience with, 79–80, 92–94
Dr. Steele Sr.’s experience with, 49–50
variations in care, 86
Cost of care, 219
access, quality, and cost triangle, xi
for anemia, 169–170
benefit of reducing, 26–27 (See also Care reengineering)
decreased by care reengineering, 216
flat fee services, 2–3
as fundamental, xvii
at Geisinger, 2
oncology drugs, 183, 184
for psoriasis, 181–182
and quality of outcome, x, 20, 21 (See also ProvenCare)
specialty medications, 166–167
Cost shifting, xii
Coventry Health Care, 22
CPSL (Community Practice Service Line), 54
Crohn’s disease, 169
Culture of innovation, 5–6, 27–29
Data:
availability of, 31–32
baseline, 68, 81–82
on MS treatments, 172
Davis, Karen, 45
Delivery of care:
care in place, 225–226
determining unjustified variation in, 81–82
hospital-centric integrated networks, xiii
hub-and-spoke delivery system, 8
hurtful or useless cost in, 21, 59
non-Geisinger systems for, 71
in physician practices after PHN, 155
in physician practices prior to PHN, 153
(See also Care reengineering; Integrated delivery networks; ProvenExperience)
Delta Team, 162
Design of system:
driving principles for enabling change, 64–66
structural design elements, 55–68
Diabetes care, 144–145
diagnoses in, 117–118, 121
medication therapeutic management program in, 157
patient case studies, 124–125
patients’ role in, 121–122
summary report in, 118–119
(See also Type 2 diabetes care)
Dissatisfied patients, refunding copays to, 12
Doctor-patient relationship, 218
Documentation:
of MS patient treatment, 171
in physician practices prior to PHN, 152
(See also Electronic health records [EHR])
Dominance of day-to-day operational crisis, 65–66
Duffy, Kim, 187
Education initiatives, 22
Electronic health records (EHR), 6–7
in diabetes care, 117–119, 121
early use of, 152
IT support for, 160, 161
in MS treatment, 172–173
in population health management, 138
in psoriasis and hepatitis C care, 181
value of near real-time data from, 31
Embedded nurse care managers (PHN), 127–130, 139–142, 155–156, 161
Embedded pharmacists, 157
Employers, self-insured, xii, xvi
Enabling change, 63–77
design principles for, 64–66
operationalizing innovation function, 68–70
scaling outside of Geisinger, 71–73
structural design elements, 55–68
xG Health Solutions, 74–76
Enbrel, 169
EOBs (explanations of benefits), 204–209
Epic, 6, 113, 122 (See also Electronic health records (EHR))
Erythopoietin (EPO), 169, 170
Evidence-based practices:
and care gaps program, 157
hourly rounding, 198–199
information on, 52–53
of physicians prior to PHN, 153
in ProvenCare, 81
(See also specific areas of care)
Executive vice president for strategy and strategic program development, 66, 68
Explanations of benefits (EOBs), 204–209
External affirmation of ProvenCare, 59
Failure:
learning from, 55, 56
permitting and recovering from, 8–9
False polarities, 58
Families:
in care delivery reengineering processes, 112–113
as caregivers, 226–227
as essential partners, 86–87
interactions with care managers, 140–142
and patient rounding on demand, 201
Federal health insurance exchange, 217
Fee-for-service reimbursement, ix
under ACA, xi
returns to insurance companies from, 16–17
revenue generation under, 16
Feinberg, David T., xv, 4, 42, 47, 188, 189, 191, 192, 227
Finance committee, 42
Financial experts/leaders, xiv–xv, 23, 65
Financial responsibility data, 204–209, 222
“Five Ps,” 199
Five-year strategies, 25–38
care reengineering, 29–36
extending previous strategic aims, 36–38
vertically integrated payer/provider model, 26–29
Flywheel effect, 51, 53, 55, 106
Foss, Harold, 5, 46, 47
Four “Ps” in healthcare, 217–219
Future vision for healthcare, 213–229
access to care, 221–222
anticipatory, precision medicine, 222–224
care in place, 225–226
caring imperative, 214–216
family as caregivers, 226–227
four “Ps,” 217–219
preventative caring, 219–221
Geisinger, 1–13
acclaim for ProvenCare model, 10–13
board of directors chair at, 6
evolution of, 4
five-year strategies of, 25–38
healthcare value reengineering at, 4–10
insurance company of, 9–10, 19
leadership concept at, xiv–xv
problems in developing new approach at, 15–24
ProvenCare approach at, 2–4
ProvenCare innovations at, xii
scaling innovation at, xvii
shared mission and staff morale at, xiii
vertical integration at, xiii–xiv
(See also specific topics)
Geisinger, Abigail, 5, 34, 35, 46–47, 191
Geisinger Accelerated Performance Program, 69
Geisinger Commonwealth School of Medicine, 4
Geisinger Community Practice
Service Line (CPSL), 54
Geisinger Gold, 18–19
Geisinger Gold Medicare HMO, 28
Geisinger Health Foundation Board, 39
Geisinger Health Plan (GHP), 5, 9–10
board for, 43–45
decision to retain, 27
evolution of, 27–29
in northeast Pennsylvania, 71
in other states, 72–73
Geisinger Health System Foundation Board, 39
Geisinger Innovations, 67, 68
Geisinger Marworth Alcohol and Chemical Dependency Treatment Center, 210
Geisinger Medical Center, 2, 3, 7–8
Geisinger Transformation, 69–70
Generalizing, 216
engines of, 37–38
innovation, 54, 59–60
outside of Geisinger, 71
Genetic abnormalities, 223–224
Genomic sequencing, 213, 223
Genotyping, 223
George F. Geisinger Hospital, 4, 5
GHP (see Geisinger Health Plan)
Governance, 8, 39–48
agenda for board, 45–46
board leadership, 41
board structure, 41–42
composition of board, 45
of insurance company, 43–45
leadership relationship in, 46–47
during Penn State Hershey Medical Center merger, 40
presentations for perspective in, 42–43
Guidelines for care, establishing, 91–92
Harvoni, 169
HCCs (Hierarchical Condition Categories), 28
Health Care Payment Learning and Action Network, 217
Health economists, interaction with, 67
Health insurance:
and ACA, 17
access to, xvii, 221
(See also Insurance companies)
Health navigators, 3, 201 (See also ProvenHealth Navigator (PHN))
Health Transformation Alliance, xii, 219
Healthcare Effectiveness Data and Information Set, 155
Healthcare environment:
future vision for, 213–229
at Geisinger, prior to ACA, 18–19
national, chaos in, 16–18
needs for transformation of, 17
sickness care system, 220
Healthcare spending, x
on chronic diseases, 16
main components of, xi
(See also Cost of care)
Healthcare value, 17, 22 (See also Value creation; Value reengineering)
Henry, Frank, 47
Hepatitis C, 169, 178, 180, 181
Hierarchical Condition Categories (HCCs), 28
Highmark, 22
High-performance systems, attributes of, 83
High-performing provider networks, xii
Hip surgery, 94, 96–102
HMO plan, 27, 28
Holy Spirit Health System, 40
Home care:
care in place, 225–226
families as caregivers, 226–227
transition to, 201–202