As Geisinger’s president and chief executive officer, Dr. Jaewon Ryu is working to improve the quality, affordability and experience in all aspects of patient care. Dr. Ryu has cultivated a spirit of innovation and transformation across the organization, driving new approaches to some of health care’s most complex problems. These include initiatives like primary care redesign; Geisinger at Home, which brings health care services to patients in their home; and 65 Forward, Geisinger’s senior-focused, concierge health care centers. All of these are examples of the organization’s commitment to making health easier by improving outcomes, engagement and affordability.
Through the Vision Series, Dr. Ryu shares his vision for a U.S. health care system that can best serve the rapidly growing aging population. He explains Geisinger’s efforts to make health care easier by focusing on things that bring care delivery to the patient’s doorstep. He also discusses the challenges and opportunities associated with in-home, community and virtual care options as we get closer to the realization of this type of health care system.
When we start thinking about this, we think about how to make health easier. I think it’s especially important when you’re dealing with populations that are aging. We see it all around us. For many of our areas in central and northeastern Pennsylvania, the aging demographic — those who are 65 and older — is actually the fastest-growing segment of our demographic. As we think about the care models and the needs of that population as they age, the reality is it’s different from what younger populations may need.
I don’t think the one-size-fits-all care delivery model works as well for folks who are aging and as a result of aging, their clinical needs are also evolving. The analogy that I’ve been using is we used to always think about care delivery through the lens of Field of Dreams, the movie, where you build it — these big fancy hospitals and campuses and state-of-the-art technology — and you expect people to come.
We have all of that, but then when you expect people to come, oftentimes, that’s not the easiest way to address their health care needs. Instead, what we’re focused on for the next chapter for Geisinger is to build clinical programs and take them to where the people are; whether that’s in the home or closer into the communities, in the clinic setting and otherwise, getting upstream of these clinical conditions so that before [someone] needs to be hospitalized or go for an ED visit, we’re able to address them in an easier environment.
Some of our programs do just that, and especially for those who are 65 and older, like Geisinger at Home. By visiting our sickest 3-5% of patients at home to deliver care, we’re addressing needs right in the home and are able to identify potential issues that we may not have otherwise seen. For patients managed in the program, we have seen a 35% reduction in hospital admissions and a 23% reduction in ED visits.
When we’ve done that, we’ve seen reductions in ER use rate by up to 35% to 40%, and reductions in the rate of hospitalization by 20% to 25%. That’s a good illustration of building clinical programs, taking them out to meet people where they are. By virtue of doing so, we’re able to decrease the rate at which they’re having to come into these more complicated environments.
We have another good example, which is our LIFE Geisinger program. Again, it focuses on the frail and elderly. It’s an adult day center program. [We] deliver care in these centers but also have other programming. By doing that, we’ve also seen that we’re able to keep people out of environments like the ED and the hospital.
That’s how we think that we can make health care easier, and I think that’s how the country can make health care easier, by focusing on things that really bring things to the doorstep, into the home, into the virtual, into the clinic, which is a whole heck of a lot easier than when they land in the ED and the hospital.
Yes, I think part of this is built off the notion that one-size-does-not-fit-all. Especially in primary care, when you’re dealing with an aging population, they tend to have larger needs, they tend to have more chronic comorbidities. In the rushed confines of a typical primary care visit, sometimes you just don’t have the time to deal with each and every one of the chronic disease needs.
Out of recognition of that, a couple of years ago we launched 65 Forward, which is our senior-focused primary care centers. As the name would suggest, it’s for folks who are 65 and older. There are a few differentiating features. One is that the average panel size in those clinics is a fifth of what you would see in a traditional primary care center, which means that’s a whole lot more time for those folks with the physicians and other staff on the care team.
At the same time, we’ve married up the clinical aspects with a robust system of wellness programming. You enter these clinics and on the front part, you would see what looks like a yoga studio or an exercise, mini-fitness area. You might see pottery classes, you might see book clubs, you might see a backgammon club or cooking lessons.
For a lot of these seniors, we want them to come in and experience it almost like a community center, because we know that loneliness is a factor. It’s not like there’s a diagnosis code for loneliness, but we know that’s a significant factor as people age. We try to create the sense of community, but then as you progress and move to the back end of the clinic, it resembles more your typical primary care clinic but with a lot more services that are co-located, whether it’s the imaging capabilities or lab capabilities.
Sometimes we’re even able to have specialists rotate through there, certainly virtually, but sometimes in person. The idea is to make things as easy as possible, to have as much as possible in a one-stop-shop, in a manner that spends a whole lot more care with them. We also pair this up with other programs which are more broadly available throughout Geisinger like our mail-order pharmacy.
When your prescription lands on your doorstep as opposed to having to run off to the pharmacy to get it, you’re more likely to maintain adherence. In fact, our data shows that you’re 37% more likely to maintain adherence to your medication.
That, of course, helps you manage diabetes, high blood pressure, congestive heart failure and so forth, if you’re making sure that you take those medications. All of these programs feed off of each other and come together, but 65 Forward is a great example of where so many of them come together all in the same place.
The short answer is we’re not where we need to be, and I think we still have a lot of work to do to get there as a country.
That being said, I think a lot of things are starting to move in that direction, [such as] some of the programs through the Medicare program, with alternative payment mechanisms that really put a focus on things like primary care. I think that really illustrates the focus that the entire industry is shifting toward.
I think a lot of this is just simple recognition clinically that a lot of the issues facing those who are 65 and older are things that need a little bit more of a different management approach than what may be issues for you and me as younger populations. We may have a knee accident [from] skiing, and then have to go to the ER and get an MRI, and [then] we have knee surgery.
For folks who are 65 and older, the chronic disease burden is more significant, so things like diabetes, hypertension, congestive heart failure and chronic obstructive pulmonary disease require management in a longitudinal way, and there’s nothing better than primary care to do that kind of thing. I think we’re going to see a continued resurgence of primary care. I know, for us, it’s front and center of our strategy.
At the same time that we continue to build on our specialty programs, we know that primary care is really going to be influential and impactful for the communities that we serve. We have our own medical school that became a part of Geisinger three or four years ago.
“Through our Abigail Geisinger Scholars program, 45 members of each class will go to medical school tuition-free if they’re going into primary care, or in some cases behavioral health, because we know that those are deep needs within the community.
For every year of support that we provide for them, there’s an expectation of a year of service back to Geisinger at the completion of their training. I think it’s that same notion that if we can invest in primary care for our communities, we know we’ll be better positioned to take care of an aging population.
Yes. I think what you’re getting at is definitely something we face all the time. Unfortunately, one of the byproducts of having so many very neat aspects of the health care system is that they all have to integrate and coordinate with one another, and sometimes that’s difficult. It’s difficult when you have four or five different specialists or four or five different sites of care, and they’re all sitting on separate electronic medical records.
I think those are definitely the challenges. It is exactly what makes it even tougher as you age because even for younger folks, sometimes keeping all of that straight is very difficult. Then you combine that with some of the effects of chronic disease and having to juggle more things, I think that’s really a tall task to expect of anybody.
There’s a big risk for fragmentation in an environment like that, and doing as much as possible to coordinate and having a dedicated team that is on point to coordinate the care across those different silos, I think that’s a huge opportunity for improvement.
A lot of the programs that I talked about today, believe it or not, they’re built off of that concept that if you identify a person or a team that has the ball, so to speak, they’re the hub that coordinates across many spokes. We think that makes it easier for patients and their family so that there’s somebody who’s seeing across as opposed to just within each silo.
I think that’s also the benefit of being part of an integrated delivery system the way that we are here, that at least some of those functions that you named are all housed on the same electronic medical record.
There’s a tremendous value in having our specialists and our primary care docs on the same electronic medical record, or having the inpatient and the outpatient, or also the lab, pharmacy, and radiology, all sit on that same body of electronic medical records. I think that really puts into a different gear what we’re able to do, to coordinate rather than fragment.
I think what’s best for the patient is when things are as coordinated and integrated as possible.
Now, it doesn’t mean it has to all be part of the same organization, but I think that working together on the collaboration and integration is very important. I think like-minded organizations that are rooted in that as their north star — what is the best for the patient? — they’re going to eventually align because they see the world similarly.
Anywhere we can get a more longitudinal view of a patient’s care encounter and figuring out how to get as upstream as possible and prevent [negative outcomes], is when we’re doing our patients the greatest service. Any organizations that are aligned around that as a mission and as a core goal have the opportunity to collaborate.
Yes, we’ve done some of that. We’ve sought out partners, [mainly] in the primary care space for providers outside of our own Geisinger employed providers. Anywhere where we can find collaboration, I think that makes a lot of sense. I think it depends on where you are in the spectrum of care delivery, or in the spectrum of who touches the patient. [In terms of those] at the hub versus the ones who tend to be at the spoke, the hubs have a better shot of being in that coordinated role. I think that’s where you have the greatest opportunity to make a difference in how a patient’s health is managed.
Yes, people talk a lot about telemedicine nowadays, especially with what we’ve seen with COVID, and we were no different. We saw a rapid uptake of telemedicine, which we think is tremendous. I’ll broaden it a little bit and say, really, any use of technology that augments communication [is tremendous], whether it’s between care teams and providers and their patients, or whether it’s between different members of care teams or different providers who are involved in the care.
I think good things tend to happen when you provide a technological means to make communication easier. That’s exactly what we’ve seen where patients are more engaged with their health as a result of having easier access to their providers or to their care teams. When providers are able to have easier access to conversations with one another about a patient’s care, good things tend to happen.
You referenced interoperability with electronic medical records. I think that is a tremendous enabler, but it’s certainly not the silver bullet. I think you can get to that kind of communication if you make other modes also available, whether it’s telemedicine or otherwise. I think all of those things, they’re almost never bad. The more you have that fuels that ability to coordinate and communicate, I think the better off patients are going to be.
We still have a fairly fragmented health care industry. Especially as you age, it’s really tough to keep track of and navigate and coordinate. I think that’s the single largest barrier to seniors getting the kind of care that they need, and oftentimes, even the care that they want.
If there’s one thing I wish I could change, it’s that health care wouldn’t be so fragmented and disjointed and that people would be more focused on the upstream activities to try to prevent the downstream progression of disease and so forth. I think we still have a lot of work to get there. The good news is, I think that’s moving.
I know that if you look back 10 years ago, we didn’t have a lot of these programs. We, the health care industry, didn’t have programs like the ACOs or didn’t have programs like bundles, looking at what comes after and before a patient’s episode. I think those are the kinds of things that will continue to improve the care of seniors.
What’s interesting is COVID has actually underscored the importance of going upstream and preventing. If you think about what we did during COVID and are still doing, it’s all about trying to get upstream and prevent. I think the same principles hold true for a non-COVID scenario, in particular with those who are 65 and older.
A couple of examples: [First] we have gone pretty aggressively into the nursing homes in the community, even those that we don’t necessarily own and operate, to figure out how we help them to mitigate the spread of the virus, because it was only a matter of time until it hit our inpatient units and so forth. I think there was recognition across the industry that we are truly all in this together.
It’s the same reason why we got very active in contact tracing and prevention in the schools and the communities and the local businesses. It meant swimming upstream and getting ahead of disease progression. I think that’s really the theme of the day, whether it’s COVID or not, and it’s apropos of what we’re talking about here with senior care.
All these programs that I’ve been describing hit on the notion of going upstream and building models that take care into the homes, into the virtual sphere, into the clinics, and try to meet people where they’re at before the downstream happens.
I think everybody is just better positioned, and you do an awful lot of good for the community. That’s really been where our focus has been in every single program. Of course, many of them still have to be in the hospital, that makes sense, but the ones that we can really take and transport into more convenient environments and take it to the patients, that’s what we’re trying to do.
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