Grant: Bringing Geisinger Reforms to Lahey Clinic

One of a series of reports on the October 21 MMS forum, “Toward a Shared Vision of Payment Reform.”

Several audience members at the October 21 payment reform conference asked Howard Grant, M.D., chief medical officer at Pennsylvania’s Geisingner Health System, “Could we do what you do here in Massachusetts?” After revealing that he was about to become CEO at Burlington-based Lahey Clinic, Dr. Grant said, “Call me in about six months, and I’ll let you know.”

Geisinger’s often-praised integrated and coordinated system in central Pennsylvania is facilitated by relatively homogeneous patient populations, a large percentage of Geisinger-employed physicians, and most importantly by Geisinger owning a local health plan, what Dr. Grant referred to as the “sweet spot.” All parties – physicians, hospitals, and insurer – are at the table for every systemwide clinical and business decision that Geisinger makes.

Even if a framework like that can’t be replicated in Massachusetts, Dr. Grant observed that several aspects of Geisinger’s success could be. For example, advanced medical homes flourish in the Geisinger system. Geisinger hired 250 additional nurses who are “embedded” in the medical homes to provide what Dr. Grant called “concierge care for the sick, a 24/7 continuum of care.” The results include a 25 percent reduction in hospital admissions and a 53 percent reduction in readmission after discharge. Just as important, Dr. Grant said, “Providers are happier, and patients are thrilled.”

Geisinger’s so-called value reimbursement program is another potentially replicable innovation. The program begins with fee-for-service payments (“We didn’t want to perturb the system too much,” said Dr. Grant) and stipends to help practices invest in care-delivery innovations. Incentive payments based on quality and efficiency are added, and they are significant. One five-physician primary care practice realized $300,000 in incentives in one year, Dr. Grant reported.

The forum was co-sponsored by the Massachusetts Medical Society and the Commonwealth Fund.

This video clip provides more details about the clinical improvements that Geisinger achieved.

Download his slide  presentation. (.pdf, 26 pages)

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