ACKNOWLEDGMENTS
Many people did the work we are summarizing in this book, but some deserve special mention. Most important were those who created the innovation infrastructure and those in the various clinical and health plan units that created the individual care reengineering examples detailed in these pages.
The initial rebuilding of Geisinger’s physician leadership, the organization’s evolution from discipline-based to interdisciplinary service line-based caregiving, and the transformation from “piecework” payment for each unit of work (RVU-based compensation) to physician compensation based on strategic goal achievement began under the leadership of Dr. Bruce Hamory and Dr. Joseph Bisordi, and subsequently was supervised by successor chief medical officers Dr. Howard Grant, Dr. Albert Bothe, and Dr. Steven Strongwater. Interestingly, Dr. Bisordi became chief medical officer of Ochsner Health System, Dr. Grant became chief executive officer of Lahey Clinic, and Dr. Strongwater became CEO of Arius following their times at Geisinger.
The establishment of our “Skunk Works” innovation group was initiated by Geisinger’s first chief of innovation, Dr. Ronald Paulus, who is now CEO of Mission Health in Asheville, North Carolina. His key recruits, Meg Horgan and Seth Frazier, helped expand the enabling capabilities of this nonclinical unit and helped create a separate transformation group committed to scaling innovation throughout all of the Geisinger clinical operations. Seth Frazier became a key principle of Evolent, an organization like our own xG Health Solutions committed to scaling the volume- to value-based healthcare transformation throughout the country.
The innovation and transformation groups both reported to Joanne Wade, Geisinger’s first executive vice president for strategy. Joanne and Dr. Steele justified the resource commitments and the patient quality and value returns on those commitments to the management and compensation committee of the Geisinger Health System Foundation (now Geisinger Health Foundation) board of directors. Without this innovation and transformation infrastructure, none of the specific payer or provider side innovations would have occurred. Taking a chance on this investment before there was any substantive evidence of return, both in terms of benefit for patients and a viable business model, was a function of three key Geisinger board members: Frank Henry, our chairman at that time; William Alexander, then our finance committee chair; and Allen Deaver, management and compensation committee chair.
As explained in the text, the key structural advantage for innovation to occur at Geisinger was the interaction between Geisinger insurance and Geisinger clinical care. The most important proof of this possible payer/provider synergy was led by Dr. Norman Payson. Although we only “rented” his expertise and credibility, the time he spent with us, as well as the ramifications of the new Medicare Advantage reimbursement rules in the 2003 Medicare Modernization Act (MMA) budget process, and the initiation of the Hierarchical Condition Categories (HCCs) all solidified the fundamentally positive interaction that began to occur between our payers and providers for the 50 percent of patients we both cared for and insured. An equally important contribution from Dr. Payson’s interim GHP leadership was our recruitment of his immediate successor, Dr. Richard Gilfillan, as the Geisinger Health Plan CEO. Dr. Gilfillan and Dr. Duane Davis, our insurance company chief medical officer, became the critical translators of what was known as the Geisinger payer/provider “sweet spot,” making the concept of payer and provider entities working together for the benefit of their mutual constituents real. Dr. Gilfillan subsequently became head of the innovation center (CMMI) at CMS and later CEO of Trinity Health. Dr. Davis became chief executive officer of the Geisinger insurance entities.
Additional critical enablers of our acute and chronic care reengineering included Geisinger’s two IT leaders at the inception of ProvenCare, Dr. James Walker, chief medical information officer, and Frank Richards, chief information officer. Without these two visionaries, the embedding of our reengineering content into the Epic electronic health record system would not have happened, and routine care would not have changed without the embedding of the new care pathways. Jean Adams, Joan Topper, and Tammy Anderer were key translators of both the internal IT content embedding and our new outreach to many non-Geisinger, nonemployed provider partners in the innovation experiments. As senior leaders strategized, conceptualized, and articulated the need for fundamental change in employed and nonemployed provider behavior, they translated the necessary infrastructure modifications so caregivers could provide added value to their patients and our insurance company members. Karen McKinley, Scott Berry, Janet Tomcavage, and Dr. Thomas Graf were critical leaders in redesigning community practice and the interaction among our 55 community-based sites and the hospital-based specialists and subspecialists. Without these valuable, committed, and aspirational leaders and doers, none of the specific innovations would have happened.
Based largely on the good clinical leadership of Dr. Al Casale, chief of cardiothoracic surgery and co-chair of the heart care service line, Dr. James Blankenship, chief of cardiology at Geisinger Medical Center, and Michael Doll, cardiothoracic surgery chief physician assistant, our first acute care episode reengineering—elective interventional heart care—assured the success of our original heart surgery “warranty” and significant internal and external affirmation. Extension of ProvenCare acute reengineering to other hospital-based interventions including hip and knee replacement and spine surgery has been led most recently by Dr. Michael Suk, chairman of the department of orthopaedic surgery, and Dr. Jonathan Slotkin, director of spinal surgery.
The predicates for success of our commitment to bundled best practice in reengineering care for patients with prevalent chronic diseases should be credited to Dr. Steve Pierdon and Lee Myers, the “founders” of Community Practice Service Line (CPSL), Geisinger’s first and most innovative service line. This initial interdisciplinary approach to caregiving was subsequently expanded to 27 other service lines. Dr. Thomas Graf and Dr. Suzy Kobylinski followed Dr. Pierdon as CPSL leaders, ensuring the Geisinger patients first and continuous innovation commitments. Dr. Fred Bloom, now the chief medical officer at Guthrie Healthcare System headquartered in Sayre, Pennsylvania, was the key leader of much of our ProvenHealth Navigator medical home reengineering efforts, along with Janet Tomcavage and Dr. Duane Davis from Geisinger Health Plan. These leaders created a fundamentally different interaction among our caregivers largely located in the community sites, the hospital-based specialists and subspecialists, and our Geisinger insurance plan. Major leaders on the specialty side of these new relationships included Dr. Eric Newman, head of rheumatology and vice chairman of medicine; Dr. John Kennedy, head of endocrinology; Dr. Paul Kettlewell in child psychology; Dr. Edward Hartle, chairman of medicine; Dr. Jonathan Hosey and Dr. Steven Toms in the neurosciences; and Dr. David Franklin in surgery. Dr. Hosey, Dr. Toms, and Dr. Franklin have all assumed leadership positions at other academic or integrated delivery systems.
Most recently, the extension of Geisinger reengineering to specialty drug purchasing and management has been led by Michael Evans, Deb Templeton, and Dr. Robert Weil. In addition, Dr. Ray Roth, who was the GHP chief medical officer at that time, was critical in partnering with Mike Evans and Janet Tomcavage in coordinating both the Geisinger insurance platform and the clinical enterprise in all of the organization’s drug purchasing and caregiving reengineering. Dr. Weil is now chief medical officer of Catholic Health Initiatives.
Two individuals who were major contributors during Dr. Steele’s tenure as CEO and continue to be the key translators of Dr. Feinberg’s ProvenCare patient experience are Dr. Greg Burke, chief patient experience officer, and Susan Robel, executive vice president and system chief nursing officer.
Most of the ongoing innovation at Geisinger and most of the bets on future innovation are under the direct supervision of Dr. David Ledbetter, Geisinger’s chief scientific officer; Dr. Alistair Erskine, chief informatics officer; and Dr. Greg Moore, who initiated the Institute for Advanced Application and is a senior leader at Google.
The strategic goal of innovation was broadened during the last five years of Dr. Steele’s tenure at Geisinger to include scaling and generalizing both within Geisinger and outward into non-Geisinger systems and markets. It soon became clear that scaling was significantly more complicated than innovating, particularly when extrapolating from the ideal Geisinger culture, fiduciary structure, and market demography and penetration into more complex milieus. Dr. Earl Steinberg is Dr. Steele’s partner in founding and running our primary scaling engine, xG Health Solutions. xG would not exist without Dr. Steinberg’s vision and resilience, the confidence of the Geisinger board of directors, and the literal buy-in of our private equity partner, Annie Lamont of Oak Investments. Colleagues pirated from Geisinger to lead the xG efforts include Meg Horgan, Dr. Steven Pierdon, Dr. Ray Roth, Joanne Wade, and many individual Geisinger subject matter experts whose commitment to spreading the Geisinger model has led to significant successes in California, Delaware, rural Illinois, Maine, New Jersey, northern Virginia, Washington state, West Virginia, Wisconsin, and even Singapore, to name a few client locations.
Finally, a huge debt of gratitude to David Jolley, who co-wrote much of this work, mitigating almost all of Dr. Steele’s idiosyncratic and self-adulating writing. And most important, a debt of gratitude to Nicole Lucas, who singlehandedly managed the manuscript process at the same time she managed Dr. Steele through this latest project.
And, of course, our thanks and admiration to the more than 30,000 members of the Geisinger family—our employees—who work night and day, seven days a week and on holidays, to provide professional and compassionate care to our patients and members. They are front and center in everything we do and all of our success.