Hood, Henry, 5–6
Hospital admissions, 148, 156
Hospital for Special Surgery, 53
Hospital readmissions, 148
Hospital-centric integrated delivery networks, xiii
Hub-and-spoke delivery system, 8
Humira, 169
Hypertension management, 131–132
Incentives:
in improving healthcare value, 22
linking fundamental change with, 32–35, 57–58
linking strategic goals with, 89, 101, 134
seeing patients do better as, 57–58
(See also Compensation)
Information overload, 158
Infrastructure, 63 (See also Enabling change)
Initiating change, 49–61
choosing engineering targets, 51–54
success factors in operationalizing and scaling, 54–60
Innovation:
beta test for, 51–53
choosing targets for, 65
critical factors in, 20–24
culture of, 5–6, 27–29
Delta Team for, 162
demand for, 106–107
evolution of structure for, 70
in future vision for healthcare, 213–229
Geisinger’s definition of, 32
generalizing, 54, 60
linking incentives to, 32–35
models of, 66–67
monitoring negative effect on patients, 189–190
operationalizing, 68–70
scaling, xvii, 54–60
sustaining, 36
Institute for Advanced Application, 70
Institute for Advanced Study, 66
Institute for Healthcare Improvement Triple Aim, 163
Insurance companies:
doctor groups and hospitals purchased by, xiii
Geisinger, 9–10, 19 (See also Geisinger Health Plan [GHP])
from hospital-centric integrated delivery networks, xiii
returns in fee-for-service system for, 16–17
(See also Vertically integrated payer/provider model)
Insurance coverage, 17, 221
access to, xvii
on patient statements, 204–209
Insurance operations, scaling and generalizing, 37
Integrated delivery networks:
as financial contrivances, xiii
hospital-centric, xiii
visit requests from, 74
Integrated health system:
definition of, xii–xiii
physicians’ rationales for moving to, 159–160
Intellectual property, 76, 216
Internal transfer pricing, 10, 30, 57
Intravenous iron dextran, 170
Investment committee, 42
Iron sucrose, 170
IT:
enabling reengineering, 161–117
in support of EHRs, 160, 161
IT experts, 67
Janet Weis Children’s Hospital and Level One Pediatric Trauma Center, 1–2, 187
Joint replacement surgeries:
hip surgery, 94, 96–102
patient information about, 201–202
JP Morgan, 76
Klein, Joe, 11
Leadership:
concept of, xiv–xv
effect of change in, 72
of foundation board, 41
in physicians’ practices, 162–163
in ProvenHealth Navigator, 148–149
recruiting, 23
role of, 64
rounding by, 196–197
triad leadership partnerships, 23, 65
Legacy, securing, 36
Lewisburg community practice, 136–137
Lewistown community practice, 136–137
License agreements, 76
Life Flight, 2
Lockheed Martin Corporation Skunk Works, 67
Lung cancer, 102–104
Maffei, Frank, 1–2
Management and compensation committee, 42
Market growth, 36–37, 71
Marks, Victor J., 190
Mayo Clinic, 5
McCole, Anita, 128–129
Medicaid, ix, xi
increased availability of, 217
in patient, provider, and payer triad, xvi
Medicaid managed care, 56, 134–135
Medical affairs committee, 42–43
Medical neighborhood, in ProvenHealth Navigator, 143–145
Medical practices (see Physicians’ practice(s))
Medicare, ix, xi
expansion of, 217
non-fee-for-service payment under, 217
Medicare Advantage, 27, 28, 134–135
Medicare managed care, 56
Medicare Modernization Act (MMA), 28
Medication therapeutic management (MTM) program, 157
Medications:
biologics, 166–167 (See also ProvenCare Biologics)
in development for cancer, 183–184
management of, 165–166
oncology drug spending, 183
specialty, use of and spending on, 166–167
Mergers and acquisitions, 37, 218 (See also Penn State Hershey Medical Center)
Metrics:
for chronic disease care, 154
in compensation setting, 89
literature search for, 91
modification of proposals for, 69
from PHC4, 52
preventive care, 114
for ProvenHealth Navigator, 145–148
of quality, transparency in reporting, 194–195
(See also Performance measures and metrics)
Milstein, Arnold, 20, 21
Mission, xiii
applied to new endeavors, 34–35
of improving healthcare value, 22
joint, of payers and providers, xiv
MMA (Medicare Modernization Act), 28
Mount Sinai, 18
Mowery, Alison, 210
MS (multiple sclerosis), 169–178
MTM (medication therapeutic management) program, 157
Multidisciplinary teams, 84–85, 91, 168
Multiple sclerosis (MS), 169–178
MyCode, 213
Name tags, 197
National recognition, 36, 59–60
National representation on board, 45
Neonatal intensive care, 3
New York Times, 11
New York University, 18
Newman, William (Bill), 159–160
Noll, Tiffany, 187
Nonclinical management staff (PHN), 163
Non-fee-for-service payment, 217
Nonfiduciary partnering, xiii
Nurse care managers (PHN), 127–130, 139–142, 155–156, 161, 201
Nurse leaders, 67
Nurse practitioners, white lab coats for, 197
Nurses:
nursing best practices, 198–200
uniforms for, 197
Oak Investment Partners, 76
Obama, Barack, 11, 60
Obamacare (see Patient Protection and Affordable Care Act (ACA))
Objections to change, 85–86
Operational return, 9
Operationalization:
of innovation function, 68–70
success factors in, 54–60
Operations:
in care reengineering, 35–36
continuing pull of, 70
dominance of day-to-day operational crisis, 65–66
mitigating focus on, 66
scaling and generalizing engines, 37
Oral iron, 169–170
Orthopaedics Institute, 200
Orthopedics:
best practices in, 53
hip surgery, 94, 96–102
OurNotes system, 203, 226
Outcomes of care, ix, x
and cost of care, x, 20, 21 (See also ProvenCare)
performance metrics, 145–148
populations with worst outcomes,
21
professional pride in, x–xi
(See also Quality of care)
Pacific Business Group on Health, xii, 219
Partners HealthCare, 18
Partnership model, 23
Partnerships, linking mission to, 35
Patient compact, 87
Patient compliance monitoring, 87
Patient experience:
best practices for, 192–193
personalized care models, 221–222
pre-ProvenCare initiatives for, 190–191
(See also ProvenExperience)
Patient Experience Steering Committee, 191
Patient outreach, in ProvenCare Chronic, 121–122
Patient population, of Geisinger, 7–8
Patient Protection and Affordable Care Act (ACA), xi, xii, 17, 56, 59–60, 217
Patient risk status, 139
Patient satisfaction, xv, 145, 147
refunds for dissatisfaction with services, 192, 211–212
reporting ratings of, 195
(See also ProvenExperience)
Patient-centered care, 8, 225
Patients:
in care delivery reengineering processes, 112–113
communications with, 158
doctor-patient relationship, 218
as essential partners, 86–87
interactions with care managers, 140–142
OurNotes to, 203
research participation by, 223, 224
Payer-provider structure, xiii–xiv, 148–149, 217–219 (See also Vertically integrated payer/provider model)
Pay-for-volume model, 220
PCPs (see Primary care physicians; Primary care providers)
Penn State Hershey Medical Center, 8, 18–19, 40, 41
Pennsylvania Health Care Cost Containment Council (PHC4), 52
Performance measures and metrics:
for ProvenCare Acute, 84
for ProvenCare Chronic, 110–117
for ProvenHealth Navigator, 145–148
Personalized care models, 221–222
Pharmacists, embedded, 157
PHC4 (Pennsylvania Health Care Cost Containment Council), 52
PHN (see ProvenHealth Navigator)
Phones answered by humans, 202
Physician assistants:
leadership by, 67
white lab coats for, 197
Physician groups:
rationales for moving to integrated system model from, 159–160
stability of, 8
Physician leaders, xiv
in leadership triad, 23
in PHN, 163
Physicians:
doctor-patient relationship, 218
fundamental personality traits of, 51
patient rounding on demand by, 201
pre-surgery calls by, 200
white lab coats for, 197
(See also Providers)
Physicians’ practice(s), 151–164
after ProvenHealth Navigator, 155–159
complexities in transformation of, 160–162
leadership issues with, 162–163
of William Newman, 159–160
before ProvenHealth Navigator, 151–155
regulatory and cost pressures on, 218
Population health management, in ProvenHealth Navigator, 138–143
Practice transformation (see Physicians’ practice(s))
Precision medicine, 222–224
Predictive analytics, 31–32
Press Ganey Patient Satisfaction Survey, 195, 199
Preventable complications, warranty for risk of financial effects of, 83
Prevention:
focus on, 17
preventative caring, 129, 219–221
Prices for care, xi
bundled, 84, 88–89
internal transfer pricing, 10, 30, 57
(See also Cost of care)
PRIDE (Proven Innovation Drive for Excellence), 69
Primary care leaders, 107
Primary care physicians (PCPs):
optimizing connection between specialists and, 144–145
redefining role of, 131
shortage of, 129–131
Primary care providers (PCPs), 107–110, 136
Primary care redesign, in ProvenHealth Navigator, 130–138
Problem resolution, standardized continuous service recovery for, 209–211
Problems in developing Geisinger approach, 15–24
chaos in U.S. healthcare environment, 16–18
critical factors in innovation, 20–24
turmoil within Geisinger, 18–19
Productivity, 89
Professional appearance policy, 197–198
Proven Innovation Drive for Excellence (PRIDE), 69
ProvenCare, 2–4, 83
acclaim for, 10–13
achievements of, 3–4
care pathways in, 101, 102
components of best outcome in, 81
five-year strategies in developing, 25–38
problems underlying development of, 15–24
return on investment in, 81
(See also specific topics, e.g.: Initiating change)
ProvenCare Acute, 79–104
attributes of high-performance system, 83
bundled payment package in, 88–89
for CABG, 90–95
core components of, 83–84
determining unjustified variation in caregiving, 81–82
early success of, 90–94
for hip surgery, 94, 96–102
implementation stages for, 84–87
initial heart care targets for, 51–54
for lung cancer, 102–104
modification of proposals for, 69
typical acute care today, 82
ProvenCare Biologics, 165–186
anemia alternatives, 169–170
cancer treatments, 183–184
CareSite specialty pharmacies, 184–185
hepatitis C alternatives, 178, 180, 181
multiple sclerosis alternatives, 170–178
psoriasis alternatives, 178–179, 181–183
ProvenCare Chronic, 105–126
clinical orders in, 119, 121
collaborating on change for, 107–110
expanding value reengineering portfolio to, 106–107
impact of, 122–123
initial type 2 diabetes targets for, 54–55
patient case studies, 124–125
patient outreach in, 121–122
performance measure set for, 110–117
provider process in, 117–120
ProvenCare Heart, 54
ProvenCare Knee, 3
ProvenCare Perinatal, 3
ProvenExperience, 187–212
bedside shift report, 198
best practices in, 190–209
calls to patients before surgery, 200
C.I.CARE communication framework, 193–194
hourly rounding, 198–199
leadership rounding, 196–197
OurNotes to patients, 203
patient rounding on demand, 201
phones answered by humans, 202
professional appearance policy, 197–198
redesigned bills, 204–209
same-day appointments, 202–203
smartphone app for, 211–212
standardized continuous service recovery, 209–211
transition to home care, 201–202
transparency in quality metrics reporting, 194–195
whiteboards, 199–200
ProvenHealth Navigator (PHN), 127–164
embedded nurse care managers in, 127–130, 139–142, 155–156, 161
focus of, 32
leadership issues in, 148–149, 162–163
medical neighborhood in, 143–145
performance metrics for, 145–148
physicians’ practices after, 155–159
physicians’ practices before, 151–155
popu
lation health management in, 138–143
practice transformation complexities with, 160–162
primary care redesign in, 130–138
primary goal in, 151
Provider process, in ProvenCare Chronic, 117–120
Providers:
consolidation of, prior to ACA, 18
high-performing provider networks, xii
in patient, provider, and payer triad, xvi
patient relationships with, 218
payment incentives for, 218
(See also Nurses; Physicians; Vertically integrated payer/provider model)
Psoriasis, 178–179, 181–183
Public payer, ix–x, xvi
Purchaser of care, in patient, provider, and payer triad, xvi
Quality metrics, transparency in reporting, 194–195
Quality of care:
access, quality, and cost triangle, xi
and cost of care, x, 20, 21 (See also Care reengineering)
as fundamental, xvii
at Geisinger, 2
Geisinger’s definition of, 32–33
linking mission to, 35
as outcome of care reengineering, 216
striving for perfection in, 36
RAND study, 20–21
Recruiting, 23, 60, 66, 106
Reengineering (see Care reengineering; Value reengineering)
Refunds, for dissatisfaction with services, 211–212
Regeneron Pharmaceuticals, 222, 223
Research initiatives, 22
Research participation, 223, 224
Review team, 92
Revlimid, 169
Robel, Susan M., 191
Rounding:
on demand, 201
hourly, 198–199
by leadership, 196–197
Same-day appointments, 202–203
Scaling, 216
for community practices, 137–138
engines of, 37–38
innovation in, xvii
outside of Geisinger, 71–73
success factors in, 54–50
team members devoted specifically to, 75
Self-insured employers, xii, xvi
Service recovery, 209–211
Shared mission, xiii
Shift reports, 198
Sickness care system, 220
Siebecker, Joi, 196
Single parent fiduciary structure, xiii–xiv, 39–40 (See also Governance; Vertically integrated payer/provider model)
Smartphone app, for ProvenExperience, 211–212
“SNFists” (skilled nursing facilities providers), 151–162
Society of Thoracic Surgery National Database, 103
Specialists:
collaboration with primary care providers, 107–110, 136
and community practitioner team, 144
optimizing PCP connection with, 144–145
in ProvenHealth Navigator, 131
Specialty pharmacies, 184–185
Staff morale, xiii
Standardized continuous service recovery, 209–211
Stanford Medicine, 193
Stanford University, 18
Statements, billing, 204–209