Capstone Speaker: Dr. Ronald A. Paulus, Executive Vice President, Chief Technology and Innovation Officer, Geisinger Health System

Presentation Title: “A Prescription for Real Change: What ‘Real’ Health Reform Would Require”

Dr. Paulus opened with a clear statement: To fundamentally change health care, you have to do things with the information collected in health IT. Geisinger, a physician-led health care system dedicated to health care, education, research and service spanning 40 Pennsylvania counties and serving 2.5 million people, is looking to do precisely this. For instance, Geisinger is using their MyGeisinger website to offer personal health record, account balance and payment options, and physician communication (e.g. prescription renewals, online appointment requests, and medical advice for non-urgent questions or concerns).
Dr. Paulus indicated that the reason he feels that fundamental change of healthcare is needed is because the current care model is not working for anyone. For one thing, we are producing marginal quality inefficiently. Additionally, today’s healthcare lacks a core integrator of all siloed perspectives (e.g. providers, payers, services, pharmaceutical, etc.)
Geisinger is approaching care change with 5 key initiatives:

• First, make an investment in primary care to optimize population health
• With the ProvenHealth Navigator ℠, Geisinger is looking to make the medical home happen.  
• This service blends aspects of chronic care, medical home and patient-centered primary care to improve the health of members to keep patients healthy and out of the hospital.
• Second, create a value-based reimbursement program that is a partnership between payer and provider – each doing what they do best – to motivate change.
• The ProvenCare Chronic® program creates bonus payment opportunity through efficiency. The key step is that while efficiency creates a potential bonus pool, any bonus payment has to be triggered by quality care outcomes (to ensure that corners are not simply cut).
• Third, put integrated population management in place to motivate efficient, quality acute care.
• Geisinger has committed to a 90-day global fee – ProvenCare Acute® - that aligns incentives for quality, efficient care rather than for complications and continued fee for service.
• Fourth, foster a value-driven  microdelivery/referral program  based on quality results.
• The development of the ProvenTransitions progam was meant to provide resources for end of life wishes.
• In addition, through collecting quality and efficacy data about caregivers and their patients’ outcomes, it becomes easier to refer patients to the “best” primary care and specialists.
• Fifth, achieve patient engagement, because people are their own primary caregivers.
• The ProvenEngagement offering at Geisinger is meant to tackle the issues of non-compliance that can sabotage solid health management.
• Geisinger has created tools for specific conditions (e.g. diabetes, CHF) that can outline the impact certain health decisions can have on a patient’s health situation. By helping patients see the impact of “doing nothing” or taking other steps to control specific health conditions (e.g. CHF or diabetes), they can make informed health decisions to actively manage their own health.
• Patients ultimately sign a compact with their caregivers – they promise to commit to certain health improving actions, and their physicians commit to being there and taking questions when needed

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