During the first full day of a new three-and-a-half day conference being held this week at the Aria Resort in Las Vegas, David T. Feinberg, M.D., the president and CEO of the 13-hospital, Danville, Pa.-based Geisinger health system, articulated a vision of care for the communities the system serves that extends far beyond traditional care delivery, and encompasses literally feeding and housing those in need. Dr. Feinberg’s speech stood out as visionary even among numerous vision-focused statements made at the “HLTH: The Future of Healthcare” conference, sponsored by a team led by HLTH founder, chairman and CEO Jonathan Weiner, who founded and has led Money 20/20, a well-known financial services industry conference, and Shoptalk, a retail and e-commerce conference.
At the outset of his keynote speech, Dr. Feinberg, who became Geisinger’s CEO in 2016, detailed the recent announcement of the MyCode Community Health Initiative, which was first publicly revealed on March 14. As an article co-authored by Dr. Feinberg, Huntington F. Willard, and David H. Ledbetter and published online on March 14 in the Harvard Business Review explained it, “Standard screening tests such as colonoscopy, mammography, and cholesterol measurement are fine for individuals at average risk for cancer and heart disease but are inadequate for people whose genetic profiles put them at much higher risk. Current clinical guidelines, based primarily on families large enough to show a positive family history for that condition, fail to identify about half of the high-risk individuals in the population. For those individuals, we need a different approach that accurately forecasts their risk and anticipates their health needs,” the article’s authors stated. “To this end, Geisinger has launched a DNA sequencing project with the potential to identify virtually everyone in our patient population who is at increased risk for early onset, inherited cancer and cardiac events. Already we have identified more than 500 patients who are at increased risk for disease and have uncovered previously undetected cases of cancer and heart disease, allowing our doctors to treat these much earlier than they could have otherwise.”
David T. Feinberg, M.D.
The March 14 article went on to say that, “In our precision health programs, sequencing the known functional parts of the genome for our patients is becoming a clinical reality, not just as a diagnostic test for patients who present with particular symptoms, but for all patients in our community. Understanding their genome’s warning signals is now an essential part of their health forecasting, wellness planning, and health management. As full partners in their own care, they can now work with their physicians to modify lifestyle or behaviors to mitigate the risks that have been revealed, and to anticipate future health needs. This type of forecasting allows us to provide truly anticipatory “health care,” instead of the responsive “sick care” that has long been the health care system’s default.”
In his speech on Sunday afternoon at the HLTH Conference, Dr. Feininger announced a new care delivery protocol at Geisinger, in which patients undergoing routine testing in a number of areas will be offered genetic testing free of charge. He noted that “We have about 200,000 patients, through a research study with Regeneron, who have consented” to participate in the MyCode Community Health Initiative. “And they’ve come up with incredible research insights,” he said, referring to Geisinger’s genetic researchers. “But we felt the research was going too slowly in crossing the chasm,” which is why, he said, “We’re announcing here today, that when patients come in for routine tests such as colonoscopy and mammography, we will be offering them genetic screening, free of charge.” Sunday’s announcement had been hinted at broadly in an April 30 press release, in which Feinberg had stated that “We think it’s time to transition our successful genomics program beyond the realm of research and into routine clinical care for all of our patients.”
The potential for identifying genetic risk factors early enough to appropriately intervene is very exciting, Feinberg said, citing the recent case of a teenaged patient whose genetic testing had a powerful impact on her and her family’s life. “For example,” he said, “I recently met a 16-year-old girl who came into one of our hospitals dehydrated from soccer practice. We did her whole exome sequencing and found two genes associated with fatal arrhythmias in young athletes. And we looked at the 30 members of her extended family whom we had cared for in the past, and were able to discover that 15 of them had that same genetic sequence. In fact, her Uncle Bill had died from ‘choking,’ but further investigation was able to determine that he had actually died of that arrhythmia. And this young woman now has a defibrillator and is on beta blockers. So every patient coming in for tests will be offered free of charge whole exome sequencing. In fact, he said, “We’ve finding that 15 percent of patients need such interventions”—and, those patients are offered genetic counseling via a mobile app that explains the genetic mutation that has been revealed through a patient’s whole exome genetic testing. All of this activity, he noted, is taking place in the context of an overall community in central and northeastern Pennsylvania that is largely rooted to the area, with the health system having cared for multiple generations of many families. As a result, he said, the potential for this initiative to contribute to overall health status across Geisinger’s overall service area is quite significant.
Feeding and housing those in need—a holistic vision of health
Dr. Feinberg went on to articulate an exceptionally expansive vision of the role of the Geisinger Health system in caring for the health, in extremely broad terms, of the communities it serves. First, he shared some information and insights around Geisinger’s Fresh Food Farmacy initiative, which Healthcare Informatics Associate Editor Heather Landi reported on in a Feb. 8 article. As Landi noted in that article, “With the aim of addressing food insecurity, as a significant social factor impacting health, and to improve patients’ diabetes management, Geisinger launched an IT- and data analytics-driven Fresh Food Farmacy initiative to provide fresh, healthy food to diabetes patients, at no cost to the patients. The health system initially launched the program in July 2016 as a pilot project at Geisinger Shamokin Area Community Hospital in Coal Township, in Northumberland County, which has the second-highest rate of long-term diabetes complications in central Pennsylvania.”
Further, Landi noted in her February report, “While Geisinger healthcare leaders are using an old approach, essentially “food as medicine,” to tackle medical conditions, the Fresh Food Farmacy initiative is an informatics-driven project that relies heavily on data integration, analytics and mobile technology to do everything from tracking clinical outcomes to managing the food supply chain.”
Speaking of the Fresh Food Farmacy initiative on Sunday, and contexting the MyCode Community Health Initiative and the Fresh Food Farmacy initiative in the framework of a broader whole, Feinberg said, “We think that that genetic piece is just a sliver of what matters. We spend too much time talking about our great doctors and hospitals and treatments. Access to healthcare probably has a 20-percent effect on your overall health,” he said. “The other 80 percent includes your genetic code, and we’re all in on that. And we’re moving into clinical care for genetics. But as important as your genetic code is, so is your zip code. And we say, as important as your genetic code is, so is your zip code. We say we have to sequence your zenetics. And food insecurity huge. And when you’re food-insecure, you buy high-calorie food that increases the chance of type 2 diabetes. And diabetes affects everything else, bidirectionally. I’m 56 years old, and when I was born, fewer than 1 percent of Americans had diabetes,” he noted. “Now, 10 percent do. And in 30 years, 30 percent will. We call diabetes a foodborne illness.”
As a result of the Fresh Food Farmacy initiative, Feinberg said, Geisinger care managers and dieticians have been able to significantly reduce the documented hemoglobin a1c levels of diagnosed diabetics being treated by Geisinger clinicians. “We have care managers, dieticians, etc., helping these patients, and we have patients who previously should have had hemoglobin a1c levels of 6 or 7, but whose levels were 8, 9, or 10 instead. So we brought patients in and said, OK, let’s give you fresh, healthy food for you and your family. We started with a little market. Next year, we will have served one and a half million meals. And we’ve found that hemoglobin a1cs went from 13 to 7; average 2.5-percent decrease. Metformin will decrease your a1c by 1 point, while eating healthy foods will decrease it by 2.5 percentage points, he said, noting the improved well-being and enjoyment of life that numerous patients have already been able to show, as a result of the initiative.
“And so whether it’s genetic testing for all patients or giving out food, are those practices sustainable?” Feinberg asked. In fact, he said, “Typically, those diabetics were costing us $200,000 a year. Within 3 months in the program, their healthcare costs plummeted to $40,000 a year, and it was costing us about $1,000. So for us, it makes sense, and now we’re scaling it to folks who have pediatric obesity and heart failure. We’re literally opening up Fresh Food Farmacies at every care location, and turning them into places that look like Whole Foods.
Further, Dr. Feinberg noted, concerns over Lyme disease and MRSA (methicillin-resistant staphylococcus aureus) are such that “We’ll be giving docs a Lyme score, from 1 to 9, for each patient, based on where patients live. They’ll also get a score indicating their risk of MRSA,” because of the high risk in central Pennsylvania and other farming areas related to the acquisition of MRSA in connection with the slaughter of livestock; as well as a score noting how close patients live to Marcellus Shale drilling activities in Pennsylvania.
What’s more, Geisinger now offers free transportation to those community members in need of it, for individuals within 50 miles of the health system’s cachement area in central Pennsylvania or within 25 miles of the cachement area in the Allentown-Scranton area—not only for trips involving healthcare visits and treatment, but more generally. “We’ll give you rides to see the doctor, or see your friend or for other reasons. We’re going to eliminate some of the loneliness and isolation that lead to obesity and heart disease,” Feinberg explained.
And then Feinberg went on to share with his audience at HLTH why he’s been leading another initiative, this one to provide housing for pregnant mothers who are opiate-addicted and homeless or at risk of homelessness. “I was rounding with one of our care managers,” he recounted, “and asked her what she’d like. She said, ‘I have this pregnant, opiate-addicted mom, who can’t get housing.’ And so we looked into that and asked, how many opiate-addicted homeless moms do we have? We found we had 17. And we said, this is ridiculous. If you’re an opiate-addicted, homeless mom, the chances of your baby having health problems is huge. So we’ve identified all the opiate-addicted, homeless or housing-fragile pregnant moms, and have been working to provide housing for them. We’re using this vulnerable moment to capture them and help them. We don’t know what the results will be, but 14 people a day are dying in Pennsylvania from opiate overdoses. The death rate from those overdoses in central Pennsylvania is four times higher than in New York City. So for us, a health system engaged in our community, believe that it’s important for us to care for our community.”
Feinberg went on to cast an even wider conceptual net around his vision for healthcare. “For us, what really matters is so much about what’s happening outside the clinics or the hospitals,” he said. “We have 13 hospitals in our system. And I think my job is to close all of them. I know that out of 2,000 beds we have, if people ate right, used alcohol in moderation, didn’t use illegal drugs, wore seatbelts, ate healthily, had access to broccoli and blueberries, and didn’t shoot people with guns, 1,000 of those beds could be gone. Seven out of 10 Americans are on a prescription medication.,” he noted. “So we can have a lot of breakout discussions about what we can do about pharma pricing, or we can get a lot of people off medication. And this is about proven techniques to get us healthy again. This has happened in my lifetime; and I think what we need to do is to reverse course. For the first time in my lifetime, life expectancy has gone down, and to me that’s criminal,” and an issue that healthcare providers must address. Much remains to be done, he concluded, but the future will be about patient care organizations truly looking after the health, and not only the illness of their patients and communities. “This is exciting work.”