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
managing, 202
phones answered by humans, 202
same-day appointments, 202–203
Access to health insurance, xvii, 221
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
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
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
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
Cardiology care:
congestive heart failure, 109–110
Care gaps program, 157
Care in place, 225–226
Care managers (PHN), 127–130, 139–142, 155–156, 161
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
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 reengineering 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:
linking incentives to fundamental change, 32–35, 57–58
linking incentives to strategic goals, 89, 101, 134
Compliance monitoring, 87
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
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
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
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
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))
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:
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
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 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
outside of Geisinger, 71
Genetic abnormalities, 223–224
Genotyping, 223
George F. Geisinger Hospital, 4, 5
GHP (see Geisinger Health Plan)
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
(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
Holy Spirit Health System, 40
Home care:
care in place, 225–226
families as caregivers, 226–227
transition to, 201–202
Hood, Henry, 5–6
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
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
linking incentives to, 32–35
models of, 66–67
monitoring negative effect on patients, 189–190
operationalizing, 68–70
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)
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
IT experts, 67
Janet Weis Children’s Hospital and Level One Pediatric Trauma Center, 1–2, 187
Joint replacement surgeries:
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
Marks, Victor J., 190
Mayo Clinic, 5
McCole, Anita, 128–129
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))
expansion of, 217
non-fee-for-service payment under, 217
in patient, provider, and payer triad, xvi
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)
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
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
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)
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
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
acclaim for, 10–13
achievements of, 3–4
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
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
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
population 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)
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
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
Steele, Glenn D., xiii, xv, 20, 34, 42, 47, 70, 79–80, 113, 191
Steele, Glenn D., Jr., 4, 49–50, 79-80, 92-94
Steele, Glenn D., Sr., 49–50
Strategic prioritization process, 31–32
Strategic vision, for care reengineering, 34–36
Structural design elements, 55–68
Success:
in operationalizing and scaling, 54–60
from tailoring expectations to strengths and structural/cultural aspects, 34
Surgery:
at-home equipment boxes for patients following, 201
calls to patients before, 200
Tecfidera, 169
Technology:
communication, 65–66
IT enabling reengineering, 161–117
IT in support of EHRs, 160, 161
in ProvenHealth Navigator, 128–129
(See also Electronic health records [EHR])
Thomas, Cassandra, 228
TIME magazine, 11
Transition to home care, 201–202
Transitions of care, 156
Transparency, in reporting quality metrics, 194–195
Type 2 diabetes care, 57–58
best practice goals for, 10–11
outcome measures, 147
performance measures for, 112–117
ProvenCare reengineering for, 108–109
UCLA Health, 193
Ulcerative colitis, 169
Ultraviolet light (UV) treatment, 181–183
Uniforms, 197–198
University of California San Francisco, 18
U.S. Department of Health and Human Services, 209
U.S. News & World Report, 12
Utilization measures, 162
UV (ultraviolet light) treatment, 181–183
Value:
linking mission to, 35
payment for, 220–221
unlocking, 53
Value creation:
direct benefit from, xvi
redistribution of profits from, 30
Value reengineering, 4–10
culture of innovation for, 5–6
with electronic health records, 6–7
enabling (see Enabling change)
expanding to ProvenCare Chronic, 106–107
high-probability early wins in, 22
initiating (see Initiating change)
and patient population, 7–8
permitting and recovering from failure in, 8–9
in ProvenCare Biologics, 167
sweet spot in, 9–10
Variation in care/performance:
with biological medications, 166
inventorying breadths and depths of, 86
justified, 87
in physicians’ practices, 155
unjustified, 81–82
Venditti, Angelo, 196
Vertical integration, xiii, xiv
Vertically integrated payer/provider model, 26–27
criticisms of, 26
legal challenge to, 43
moving culture toward, 27–29
(See also ProvenCare)
Virginia Mason Health System, 27
Web portal, 203
Wellness, focus on, 17
Whiteboards, 199–200
Wilensky, Gail, 45
xG Health Solutions, xvii, 74–76, 216
rationale for creating, 75
scaling and generalizing, 37–38
in scaling outside of Geisinger, 71–72