When Glenn Steele, Jr., M.D., Ph.D., spoke on Thursday morning, people listened. That’s because what Dr. Steele, the president and CEO of the Danville, Pennsylvania-based Geisinger Health System, has almost a unique message to offer the leaders of hospitals, medical groups, and integrated health systems across the U.S. The transformation that he has been leading for the past nearly 14 years is an example of leadership-led change on a level almost unrivaled in the U.S. healthcare system.
The fact is that when Dr. Steele arrived at Geisinger as CEO in 2001, as he told me in an interview for my 2007 book Paradox and Imperatives in Health Care (co-authored with Jeffrey C. Bauer, Ph.D.), he was faced with an internal crisis around both clinical outcomes quality and financial stability in the system. Dr. Steele had marching orders from the organization’s board of directors, and he had a vision—a really big vision.
Glenn Steele, Jr., M.D., Ph.D.
But, as I recounted in Paradox and Imperatives, Dr. Steele had to proceed step by step. He found a physician champion in Dr. Alfred Casale, a fellow surgeon, who shared his passion for positive change, and who set about corralling all 17 cardiothoracic systems practicing at Geisinger at the time, and building with them a 41-step clinical pathway for non-urgent, routine CABG (coronary artery bypass graft). After spending numerous weeks building the pathway, Dr. Casale helped to lead his colleagues forward to implement it as mandatory with allowed exceptions, meaning that any cardiothoracic surgeon leading a CABG procedure could deviate from the pathway, as long as that surgeon also documented every deviation in the organization’s electronic health record. Well, guess what? Having built the pathway themselves, virtually none of the surgeons chose to deviate from their own pathway.
What’s more, once the outcomes started rolling in, it became clear that the elimination of unjustified variation in routine CABG had been a huge success. And then, in a stroke of genius, the cardiothoracic surgeons agreed to be the guinea pigs in an experiment in which Geisinger offered patients a cost guarantee—an estimate based on the predicted cost to them (or, really, in most cases, charges to their insurers), based on an analysis of past data and individual cases.
Once that first ProvenCare® bundle was put together, the Geisinger folks never looked back. And, as they went from success to success with standardized approaches to managing a variety of procedures and care conditions (including bariatric surgery, hip fracture surgery, lumbar spine surgery, and care management for a variety of conditions), they also continued to build the culture of achievement and striving that Dr. Steele had already begun to instill in the organization.
Fast-forward to 2014, and the kinds of population health management, continuous clinical transformation, and innovative partnering with purchasers (including Wal-Mart) and payers (including virtually all the major health plans in Pennsylvania) are now so renowned that Geisinger has created its own institute and conferences in order to spread the knowledge that Geisinger leaders have gained in the process of striving forward on quality and cost.
What’s more, Dr. Steele has a vision of a future healthcare system, one that will require years, almost certainly decades, to build. “What do we want to be?” Steele asked his audience rhetorically. He answered his own question by stating that the U.S. healthcare system needs to move forward along the following dimensions: “affordable coverage for all; payment for value; coordinated care; continuous improvement and innovation; and national health goals and leadership.”
And, importantly, healthcare IT leaders will be central facilitators of all the transformation that is needed. Indeed, the kinds of transformation that have been achieved at Geisinger have only been possible through a constant cycle of data collection, analysis, and feedback for continuous performance improvement.
And yet such achievement is possible. And that was the true gift of Dr. Steele’s message—not that Geisinger is unique or nearly unique in American healthcare, but rather that it is not unique—that other patient care organizations absolutely can achieve what Dr. Steele and his colleagues have, if only they have the personal leadership, the vision, the commitment, and the perseverance, to get there. I truly hope the members of Thursday’s audience were listening to that keynote address, because the future of American healthcare will rely on the embracing of the Geisinger vision, or some version of it, among leaders in patient care organizations nationwide.