The era of fee-for-service is far from over, and providers can still thrive while focusing on delivering a high volume of hospital and ambulatory care, rather than on eliminating unwarranted variation improving the health of a population, says Glenn Steele Jr., M.D., Ph.D., president and CEO of Danville, Pa. -based Geisinger Health System and chairman of the board of xG Health Solutions.
However, he also notes that the U.S. health care system is not as efficient as it should be, and we are all paying for it. "We pay financially, and then, God forbid, if one of our family members or one of us has to get care, we'd like to know where to go to get the best possible outcomes. And right now, that's pretty opaque."
Public and private payers alike have recognized the need for health care transformation —changing payment models and provider and patient behavior to drive the delivery of higher-value care. In turn, providers are just beginning to recognize it is time to change their approach.
"There's a huge amount of change that we're going through," Steele says. "The capabilities required to take care of a population of patients, the ability to provide care for episodes of hospital-associated care at lower cost, but better outcomes, the fundamental move toward an attack on total cost of care . . . the need for that is straightforward."
What is not as straightforward is how to smoothly switch to a focus on value. Still, based on years of innovation and experimentation, Steele says, Geisinger has figured out some ways to cut costs while improving quality.
Geisinger's guide to value reengineering
The most significant lesson other health systems can learn from Geisinger's experience concerns the importance of provider-led value reengineering and care redesign, Steele explains. It takes much more than simply revamping the payment structure. Everyone —from physicians to nurse practitioners to pharmacists —needs to be on board.
"Unless providers really believe that, at the end of the transformation process, care for their patients will be better, it doesn't happen," he says.
By making essential cultural changes and using a team-based care approach, Geisinger has seen success through innovations such as its ProvenCare® model of evidence-based protocols and its ProvenHealth Navigator® advanced medical home model.
How and why health systems should 'activate' patients
For a health system to thrive under value-based population health models, its patients must become "co-directors" of their care, Steele explains. He calls it "activating" patients.
For example, Geisinger takes part in the OpenNotes initiative, which lets patients read the notes in their electronic health record.
"If we can use a number of fairly straightforward techniques — like making our notes available to all our patients — they'll become much more actively involved," he says.
Overall, Steele says Geisinger has the knowledge and know-how required to improve quality and cut national health care costs by 30 to 40 percentIt is simply a matter of making the transition on a large scale.
"It's a done deal in my brain," he explains. "That's the challenge: How do we scale this against all of the incentives that are still working very, very well for the hospital-centric organizations out there?"
Download the white paper to find out the key capabilities needed for value-based success and how to target changes in provider behavior and the patient-provider relationship.