1. Reforming the HealthCare Delivery System

2. Learning Objectives 1.Recognize the drivers that lead Geisinger to initiate reform of their healthcare delivery system 2.Identify best practices from Geisinger's program success to replicate in other organizations 3.Outline the Health Information Technology Geisinger utilizes to manage their population health 4.Summarize initial results achieved such as up to 25% reduction in admissions for patients with multiple chronic disease conditions such as Congestive Heart

3. Geisinger Health System Geisinger Inpatient Facilities Geisinger Medical Groups Geisinger Health System Hub and Spoke Market Area Geisinger Health Plan Service Area Careworks Convenient Healthcare Non-Geisinger Physicians With EHR Gray’s Woods

4. Geisinger Health System 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

6. Digital Translation of Quality Establish the Digital Gold Standard Adopt the Digital Gold Standard Maintain and Optimize Close Gaps in Care

7. Care Plans Populations Leveraging Care Gaps Action Arms Lab and Imaging “Gap” Management Referral “Gap” Management Care Gaps Goals – Endpoints Mammo every year Prevention Chronic Diseases A1c 7- 8 Unclosed Loops Abnormal Pap Follow up Medication Safety Methotrexate monitoring Regular care “failures” HF exacerbation Office-Based Decision Support

8. Improving Care for 23,555 Diabetics

9. Improving CAD Care for 14,804 Patients

10. Improving Preventive Care for 210,681 Pats

11. Care Gaps Program 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 “Geisinger knows and cares about me and my family”

12. Care Gaps Mission 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 Flawless Coordination, Execution, Partnerships Patients Clinical Service Lines Scheduling Services Geisinger Health Plan Marketing IT Research Finance

13. Population Health: Auto Orders 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

14. Contact Strategies Method Option 1: Single Contact Method Option 2: Multiple Contact Methods Letters/Auto Letters Pt Portal Broadcast Personal Phone Calls Telephony Recorded Msg Telephony Warm Transfer Office Visit Data Warehouse Validate Data Care Gaps Identified Appoint Patient Obtain Order/Referral (Auto Orders)

15. Benefits of Auto Orders 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

16. Care Gaps Closed 19,257

17. Geisinger’s Medical Home Model enabled thru the Keystone Health Information Exchange

18. OUR BEACON COMMUNITY: IMPROVING HEALTHCARE COORDINATION

19. Profile of the Keystone Beacon Community 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

20. Keystone Beacon Community Objectives 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

21. Keystone Beacon Community Objectives 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

22. Electronic Health Record + Health Information Exchange + Care Coordination – Case Management Process + Healthcare Providers + Patients + Care Coordinators – Case Managers ______________________________ Care Coordination Components

23. Electronic Health Record (EHR) 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

24. –s–s 1.Problems 2.Procedures 3.Family History 4.Social History 5.Payers 6.Immunizations 7.Medications 8.Medical Equipment 9.Vital Signs 10.Functional Status 11.Results 12.Allergies 13.Encounters 14.Plan of Care 15.Purpose 16.Advance Directives Sample Electronic Health Record

25. 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–S Health Information Exchange

26. What a shared EHR means to a patient in the emergency room… 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

27. What a shared EHR means to a patient taking multiple medications… 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. –S

28. What a shared EHR means to someone who is out of town… 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

29. What a shared EHR means to a mother who needs to quickly access her child’s immunization records… It means that the mother can access and print the information from the electronic health record whenever or wherever the information is needed. –S

30. Keystone Beacon Community Security 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” –S

31. Coordinated Care = Best Treatment Possible 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 –S

32. Care coordination results* 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. –S

33. Thank You! John M. Kravitz Geisinger Health System jmkravitz@geisinger.edu 570.214.8833