Geisinger’s Proven Patient

Experience

Making it the Best…

For Every Patient…

Every Time!HFMA Tennessee Chapter

Dixie Conference 2016March 22, 2016

Nashville, TN

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Presenters

Kevin F. Brennan, CPA, FHFMA

Executive Vice President, Finance & CFO

Geisinger Health System, Danville, PA

Phone: 570-271-6626

E-mail: kbrennan@geisinger.edu

Barbara M. Tapscott, CHFP

Vice President, Revenue Management

Geisinger Health System, Danville, PA

Phone: 570-214-8429

E-mail: bmtapscott@geisinger.edu

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Agenda

• Overview Geisinger Health System

• Transforming Healthcare with Technology

• Patient Centric Innovations

• Engaging and Communicating with Patients

• Geisinger’s Proven ExperienceTM Model

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Geisinger Health System An Integrated Health Service Organization

Provider

Facilities

$3,147M

Physician

Practice Group

$1,130M

Managed

Care Companies

$2,395M

Geisinger Medical Center and its Shamokin

Hospital Campus

AtlantiCare Regional Medical Center-

Mainland and City campuses

Geisinger Wyoming Valley Medical

and its South Wilkes-Barre Campus

Geisinger Community Medical Center,

Scranton, PA

Geisinger-Bloomsburg Hospital

Geisinger-Lewistown Hospital

Holy Spirit Hospital

Marworth Alcohol & Chemical Dependency

Treatment Center

8 outpatient surgery centers

2 Nursing Homes

Home health and hospice services covering 25

counties in PA and 3 counties in NJ

>138K admissions/OBS & SORUs

2,663 licensed inpatient beds

Multispecialty group

~1,300 physician FTEs

~790 advanced practitioners

~215 primary & specialty clinic sites

(81 community practice)

1 outpatient surgery center

~3.4 million outpatient visits

~520 resident & fellow FTEs

~365 medical students

~500,000 members (including

~84,000 Medicare Advantage

members and ~153,000

Medicaid members)

Diversified products

~56,000 contracted

providers/facilities

45 PA counties

Offered on public & private

exchanges

Members in 5 states

Moody’s Aa2/Stable

Standard & Poor’s AA/Stable

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Population Health

A Patient-Centered Continuum of Care

Retail Clinic

Community

Practice Site

Retail

Pharmacy

Multi-

Specialty Clinic

Ambulatory Care

& Surgery Center

Specialty Center,

e.g. Cancer or Sleep

Urgent Care

Center

Tertiary/Quaternary

Medical Center

eICU

Inpatient Rehab

Outpatient Rehab

Home Care

Hospice

Specialty Outreach

(“Face-to-face” &

Telemedicine)

After-Hours

Care Center

ProvenHealth

Navigator

Destination

Medicine

Acute CareCommunity-Based Care

Post-Acute &

Transitional

Care

Imaging Center

E-Visit

MyGeisinger

Adult Health Program

& Day Center

Lab Outreach Site Work Site Clinic

Wellness Nursing Homes/SNF

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Population Health Delivered One Person At A Time

“If you strip down what we do in health care, we’re simply

people caring for other people…I want

to deliver care that’s not only the highest quality, it also

has to have heaping levels of compassion . I have met

people who have told me how phenomenal the care is at

Geisinger…it’s much easier to understand the experienceright from a patient…

We have to get it right

every time with

every patient.”

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Transforming Healthcare with Technology

Running costs: ~4.0% of annual revenue

Fully-integrated EHR

Networked Patient Portal - ~270,000 active users (37% of ongoing

patients)

Patient self-service (self-scheduling, patient-entered data)

Home monitoring integrated with Medical Home

“Outreach Health IT” – 10,221 users in 865 non-Geisinger practices

Remote support for regional ICUs (eICU®)

Telestroke services to regional Eds (eHealth)

Active Regional Health-Information Exchange (KeyHIE)

22 hospitals, 175 practices, 1.1M patients consented,

publish 700,000 clinical documents monthly, participants access

89,000 monthly

GHS awarded “Most Wired” health care system by Hospitals &

Health Network Magazine for 13 consecutive years

Transforming Healthcare with Technology

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MyChart Patient Portal (MyGeisinger)

A secure, confidential and efficient way to view electronic health information

• Schedule appointments

• Review lab results/diagnostic exams

• Track health/review previous visits

• Refill/renew prescriptions

• Converse with physician’s office

• Pay bill or calculate out-of-pocket expenses*

John Doe

*Using MyGeisinger/MyEstimate®

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MifflinMifflin

Adams

Allegheny

Armstrong

Beaver

Bedford

Berks

Bradford

Bucks

Butler

Cambria

Cameron

CarbonCentre

Chester

Clarion

Clearfield

Clinton

Columbia

Crawford

Cumberland

Delaware

Elk

Erie

Fayette

Forest

FranklinFulton

Greene

Huntingdon

Indiana

Jefferson

Juniata

Lackawanna

Lancaster

Lawrence

Lebanon

Lehigh

Luzerne

Lycoming

McKean

Mercer

Monroe

Montgomery

Montour

NorthamptonNorthumberland

Perry

Philadelphia

Pike

Potter

SchuylkillSnyder

Somerset

Sullivan

SusquehannaTioga

Union

Venango

Warren

Washington

Wayne

Westmoreland

Wyoming

York

Blair Dauphin

52 Unique Healthcare Organizations

251 Physician Practices 30 Home Health Locations 95 Long Term Care Facilities18 HospitalsH

H

HH

H

H

H

HH

H

H

H

HH

H

H H

H

H

Total Unique Patients, 4.4M Discharges, >12K/month ED visits, >43K/month

Keystone Health Information Exchange®

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Experience with Partnerships

TelemedicineSpecialty consults both

IP and OP– Rheumatology

– Pulmonology

– Psychiatry

– Infectious Disease

– Others

Ancillary departmental services

– Echo

– EEG

– Infectious Disease

– MFM

Geisinger

Population Health

Care Management

Data Analytics

Administrative Services

Total:

8400 Beneficiaries

50,000 eff. 1/1/2016

e-ICU

Reductions in LOS, Mortality & Morbidity

Improves AICU LOS

ACO

Across 40 sites/14 Hospitals 8 Hospitals/127 beds8 Hospitals; ~1,400 Physicians

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Geisinger in Motion Key ProjectsInteractive Patient System for Inpatients

• “Infotainment” content to distract patients from pain and discomfort

• MyChart Bedside portal to connect with clinical content

Lumbar Spine iTunes University

• Patient engagement materials to prepare for and recover from surgery

• iBook, spine & patient portal mobile apps, health questionnaires

MyGeisinger Pre-Visit Center

•Patient outreach 2 weeks prior to the visit to “prep” for the visit

•Health questionnaires, OpenNotes, preventive & maintenance care

Clinician Mobile Device Program

•Access to secure messaging between clinicians

•EMR mobile app access including PACS images viewing and photos uploaded directly into the EMR

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Patient Centric Innovations

ProvenCare® Acute Episodic Bundles

CAB

and PCI

Bariatric

Surgery

PerinatalSurgical

Mgmt. of

Lung Cancer

Hip: Fragility

Fracture or

Arthroplasty

Heart Failure

Lumbar

Spine

• Clinical Best

Practices

• Workflow Process

Redesign

• Convener for CMMI

Bundling Initiative

(7 organizations)

• Corporate Destination

Medicine Option

COPDTotal Knee

Arthroplasty

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Population Health

ProvenCare® Chronic Care

Diabetes

Congestive Heart Failure

Coronary Artery Disease

Hypertension

Prevention Bundle

Referenced in Group Practice Journal, April 2012

ProvenCare® Type 2 Diabetes Value Driven Care Outcome Improvements

Retinopathy

–Less than 3 years

–166 cases prevented!

–Quality of life maintained

–Savings…priceless!

Heart Attack

–Less than 3 years

–305 prevented with estimated savings of $27,111/case = $8.3M!

Stroke

–Less than 3 years

–140 prevented with estimatedsavings of $2,921/case = $412K!

Primary Care Diabetes Bundle Management: 3-Year Outcomes for Microvascular

and Macrovascular Events; American Journal of Managed Care,

6/26/14;20(6):e175-e182

Population Health

ProvenHealth Navigator®

Health Affairs: 4/26/2015.

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ProvenHealth Navigator® Results

*Outcomes represent the period 2007—2012 and more than 80,000 Geisinger Health Plan

members in Geisinger Health System practices.

All cause 30-day

readmissions

Acute care admissions 27.5%

34%Patients say quality

of care improved when they worked with a case manager

72%

ED visits remain flat for ProvenHealth

Navigator® patients

Demonstrated improvement in the risk of heart attack, stroke, and retinopathy in individuals with diabetes

3-year results in

25,000 patients305 MIs prevented

140 strokes prevented

166 cases of retinopathy prevented

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ProvenHealth Navigator®

Innovations in Management of Elderly

• “SNFist” model in targeted 20 nursing homes

• Redesigned care model

• Focused on transitions of care and length of stay

2013-2014 Results

SNF readmission rate reduced from 13.4% to 12.1%*

SNF ALOS reduced from 25.1 to 19.3

* Baseline readmission rate when program (2008) started - 30%

Time Magazine: June 11, 2012

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Activating Patients with Transparency: “Open Notes”

12-month research project started in 2010

>100 PCPs and more than 21,000 patients

Geisinger’s participation: 27 PCPs & 10,000 patients

99% of patients want it to continue

– 92% looked at some or all of their notes

– 90% felt they understood their medical conditions better

– 91% felt more in control of their health care

– None shared their notes with a lawyer

Providers found process to be seamless

– Minimal impact on clinic operations, out of office

work effort or practice style

2013-2014 expanded to specialty care departments

~1,700 Providers

> 315,000 Patients

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Special Care CentersSM

Chronic Care Management in an Urban Setting

Operates as a primary care medical home

• Improves the experience of care

• Improves the health of populations

• Reduces per capita costs of health care

Results

• Reductions in heart failure cases, Systolic BP and LDL-Cholesterol levels

• Average savings of $170-$200 PMPMfor large groups and self-insuredemployers

• 20% reduction in pharmacy spend

Atlantic City

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Innovations in Paramedic Care:Home visits for lab tests, IV medications and hospital follow up

Wall Street Journal: August 18, 2015

Responders trained in chronic diseasemanagement, medication compliance andhome safety

Augments visiting nurse services and home care programs

Early results (March 2014-June 2015):– Prevented 42 hospitalizations,

33 ER visits and 168 inpatient days

– In case of heart failure patients, hospitaladmissions and ER visits reduced by 50%, hospital readmissions <30 days fell by 15%

– Patient satisfaction scores 100%

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Innovations in Personalized Medicine

• Regeneron partnership to advance genomic medicine– 86,000 consented patients with goal of 250,000

• Clinical data warehouse grows

• Data analytics deployed to identify care gaps, permitting clinical intervention

• Focused population health research initiatives: Obesity, Autism, etc.

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Engaging and Communicating with Patients

Price Transparency Is Just One Element of a Patient-Centered Approach

hfma.org/dollars

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MyEstimate®

Pricing tool providing self-serve options for out-of-

pocket expenses on the top 300 most frequent

ambulatory and inpatient procedures. Pricing varies

based on payer negotiated rates– Insurance verification

• Real-time estimate for top

contracted payers and

Medicare Fee-for-Service

• Customized estimate based on

procedure, an individual’s benefit

plan, and location of service

Transparency with Financial CommunicationsMyEstimate® Portal

Financial CounselorsAvailable

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• Provides guidance on when/how communication should take place regarding patient insurance coverage, financial counseling, patient liability for the service and any prior balances

• Emphasizes open, clear and early communication, including defining a path for financial resolution

• Defines financial interactions when medical services are scheduled, as well as when emergency or non-emergency care is delivered

HFMA Best Practice Project

Patient Financial Interactions

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PFI – Emergency Department Interaction

• Compliance with EMTALA in determining when to initiate financial interactions

• Financial counseling & insurance verification

• Prior balance and patient cost-share

• Payment options, including payment plans

• Provider’s financial assistance programs

• Proactively attempt to resolve prior balances through insurance and financial assistance

• Summary of care documentation

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PFI – Time of Service Interaction (non ED)

• Patient engagement, including a patient advocate

• Patient care is not interfered with

• Patient consents in order to expedite discharge

• Insurance verification and financial counseling, including payment arrangements

• Clear credit policies

• Summary of care

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PFI – Advance of Service Interactions

• Setting for discussion– Outbound contact in advance of scheduled service– Inbound contact from patient inquiring about upcoming service– Scheduling/Contact Center when appointment is made

• Insurance verification and financial counseling

• Prior balance discussions

• Patient share-of-cost and payment arrangements

• Focus on patient education

• Care estimate

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PFI – Best Practices for All Financial Interactions

• Compassion and patient advocacy

• Standard language for staff

• Facilitate one-time resolution

• Staff education

• Patient engagement

• Cost estimates for care

• Sensitivity and respect for patient privacy

• Clarity in policies

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PFI – Measurement Criteria & Reporting

• Training program evaluation

• Process compliance evaluation for each best practice (PFI) scenario

• Technology evaluation

• Feedback on process and response

• Annual PFI compliance report

New Resource for Consumers

Understand pricing terminology

Get a price estimate—step by step

Navigate in-network and out-of-network pricing

Tap into price information available through providers, payers, and employers

Available as a PDF to other organizations as a public service.

Contact Scott Kenemore, skenemore@hfma.org, for permission to post.

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Helping Individuals Make Informed Choices

• With Health Insurance– How to Get an Estimate– Insurance Codes– Questions to Ask Your Doctor Before Elective Surgery – Ask Your Health Plan about Pre-Approval

• What to Know About– Emergency Care– In-Network vs. Out-of-Network

• Medicare Beneficiaries– Websites and Phone Numbers– Counseling Services– Hospital/Physician Resources

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Helping Individuals Make Informed Choices

• Without Health Insurance– Financial Counseling– Insurance Marketplace– Financial Assistance– Price Estimate

• Definitions and other resources

A Call To Action

In a system where. . .

– Charges are primarily used as a factor in a payment calculation

– Actual prices are essentially invisible to the consumer, and…

– Charges have little relationship to the service being acquired

. . . change is inevitable!

We all contributed to this situation—hospitals, physicians,

payers, the business community, and even patients.

We all need to work together to fix it!

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Revenue Cycle Excellence

Customer Engagement

• Adoption of Patient Friendly Billing® Practices

• Patient Engagement Pre-Service to Billing (MyVisit Model)

• Pricing Transparency (MyEstimate®)

Value-Based Model

• Employee Engagement

• End-to-End Revenue Cycle

• Performance Outcomes Incentive Program

Innovative Technology

• Commitment to continuous improvement

• Innovative Business Practices

• Leading Edge Technology

MAP: Measure . Apply . Perform

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Geisinger’s ProvenExperienceTM Model

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What is & Why ProvenExperience™?

What: A promise that every patient and member gets the best experience every time with Geisinger, and would recommend Geisinger to a family member or friend.

Why: Patient care is critical to our well-being. It must be measured in many ways in addition to quality and safety, including compassion, kindness, respect and alleviating unnecessary suffering.

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Optimal Patient

Experience

White Boards

Bedside Shift

Report

Nurse Leader

Rounding

Purposeful Hourly

Rounding

Consistent Communi-

cations

ABIGAIL

Nursing Patient Experience Best Practice Bundle

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Rounding

• Unit/department managers expected to round their areas regularly

• Platform leaders expected to round their platforms weekly

• Launched manager/leader rounding at each platform on rotating basis in August

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Ratings & Comments on “Find a Provider” Tool

• 25,000+ comments displayed• 4% rejected due to

• PHI

• Libelous comments

• References to other providers or matters not related to care

• 500+ new comments weekly

• Ratings updated monthly

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Patient Satisfaction Transparency

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Initial Results

• Providers’ ratings increasingly displayed at or near top of Google searches

• Too early to conclude, but observing initial uptick in ratings and web traffic

Phase 1

Pilot LivePhase 2

Pilot

CP

SL

Ou

tpa

tie

nt S

pe

cia

lty

Press Ganey Care Provider Ratings

Geisinger.org Find-a-Provider Web Traffic

Result:

35% increase in unique

traffic in first month over

prior month

Google Search Results

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Professional Appearance

• Dress Policy• Consolidated multiple dress policies into one

• Uniforms• Nursing uniforms being implemented and in effect Jan 1, 2016

• Uniforms and/or professional attire to be implemented in other areas

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Consistent CommunicationConsistent Communication will utilize the C. I. CARE model to prescribe the expectations, per example below for a generic

outpatient clinic:

Connect with patients by addressing them as Mr./Ms. or by the name that they prefer

o Smile, make eye contact

o “Good Morning/Afternoon/Evening. Welcome to Knapper Clinic. How may I help you?”

o “Thanks, Mr./Ms. <Last Name> - we’ve been expecting you!”

Introduce yourself and your role

o “ My name is Lisa, I’m a nurse and I’m working with Dr. Smith today”

Communicate what you are going to do; how long it is going to take; how it will impact patient

o “I’m going to <explain each step in order>, and it will take a few minutes, and then I will let Dr. Smith know any important information

before he comes in to see you.”

Ask permission before examining the patient & anticipate patient needs, questions or concerns

o “Do you mind if I go ahead and examine you?”

o “You seem concerned. What are your biggest concerns/worries?”

Respond to patient questions or requests with immediacy

o If do not have answer: “Let me get back to you on that. I will follow up within <specific timeframe>”

Exit courteously and/or with an explanation of what will come next

o “As for next steps, <list steps>”

o “Thank you for trusting us to care for you here at Geisinger.”

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Happy Experience

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Summary

A world-class patient experience is important to the financial health of an organization

Electronic health records are a powerful tool

Clinical/financial information is becoming increasingly transparent

Engage and communicate with your customers

Always make it the best, for every patient, every time!

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Questions?