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ProvenCare

Page 21

by Glenn D Steele


  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 managers (PHN), 127–130, 139–142, 155–156, 161

  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

 

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