Why Geisinger’s “Fresh Food Farmacy” Initiative Could Turn Out To Be a Nationally Replicable Model | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Why Geisinger’s “Fresh Food Farmacy” Initiative Could Turn Out To Be a Nationally Replicable Model

February 13, 2018
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It was very encouraging to read about the Geisinger “Fresh Food Farmacy” program, which is giving away healthy foods to diabetic patients, and moving forward strategically to improve their health status

It was so encouraging to read Associate Editor Heather Landi’s report on an exciting initiative at the Danville, Pennsylvania-based Geisinger Health System. As she noted in her report, under the headline, “Can a Prescription for Fresh Food Treat Diabetes? At Geisinger, an Informatics-Driven Project Is Showing Promising Results,” she noted that, “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 give away fresh, healthy food to diabetes 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.”

As Andrea Feinberg, M.D., medical director of Health and Wellness at Geisinger Health, and the clinical champion of the Fresh Food Farmacy, put it to Landi, “Geisinger is very focused on approaching medical conditions from a population health perspective—we not only want to take care of each person that’s in front of us and provide them with the best state-of-the art care that we can, but we also look at our patients in their communities and see how we can improve the overall health of those that we serve.”

As Landi further noted, “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.”

Meanwhile, Jonathan Slotkin, M.D., director of spinal surgery in the Geisinger Health System Neurosciences Institute, also serves as medical director of Geisinger in Motion, a department focusing on digital engagement and patient- and provider-facing mobile device technologies, within the division of informatics at the health system. Slotkin helps lead the informatics work that underlies the Fresh Food Farmacy project. “For me,” he told Landi, “it’s fascinating from an informatics standpoint because it brings together traditional clinical care, which we’ve all gotten pretty good at, but it also brings in the harder issues around data and the transactional level of social determinants of health, costing, supply chain and distribution, things that most medical systems are not yet optimized for. I think as we all endeavor to manage and help our populations with social determinants of health, we are going to be faced with these challenges more and more.”

So here’s what’s fantastic about all of this: first, the leaders at Geisinger are approaching this issue broadly and strategically. Focusing on food and nutrition in aiming to improve the health status of their diabetic patients, is exactly the right kind of thing to do. The reality, as Geisinger’s leaders know, is that most of what makes the difference for diabetics, in controlling their blood sugar levels in their day-to-day lives, is not connected with the purely medical, but rather, is connected with nutrition and exercise—the so-called “lifestyle” factors (though really, to be honest, nutrition is so much more fundamental than being about “lifestyle”—but there, the English language fails us to some extent, I would say).

What’s more, this is absolutely an area in which leveraging information technology not only makes sense, but really is a critical success factor. As Landi noted in her report, “The project team also leveraged the MyGeisinger patient portal tool, which links to the health system’s Epic EHR, to screen patients for food insecurity. Care managers also called patients to screen them for food insecurity.” As Dr. Feinberg told her, “Our hypothesis was, and still is, that if you have unmet social needs and if you are faced with food insecurity and you cannot afford to pay for healthy, nutritious food, then your diabetes cannot be well controlled.”

The third major element here has to do with leadership, management, and process. In the past, what used to be called “disease management” programs tended not only to be very limited in size and scope—they also tended to lack c-suite support, and tended to be run as “one-off” efforts disconnected from overall operations in patient care organizations. I remember interviewing the clinician leaders of a CHF (congestive heart failure) disease management program at a Southern California hospital way back in 1997. A time-pressed cardiologist and two very harried cardiac nurses were attempting to run the entire program, and, in visiting them in their facility, it was clear that they were overwhelmed on a practical level. Their initiative was great, at least in theory; but making it work was just so difficult, given their limited resources.

This Geisinger program clearly has support from the top of the organization, and, importantly, the resources—human and financial—to make it work—as well as the commitment to pursue it across time.

What’s more, Geisinger’s leaders have been willing and able to dig into the web of IT and data challenges that inevitably emerge in these initiatives. As Landi noted in her report, “Early on in the project, program leaders recognized specific data governance issues that needed to be addressed to make the program more effective,” as she quoted Dr. Slotkin as noting that, “In a lot of health systems, medical problems being added to the EHR problem list is something that usually only happens under physician direction. We felt that food insecurity was both pervasive enough and devastating enough that we needed to liberate it, so non-physician providers, like dieticians or others, could have the authority to add food insecurity to the problem list,” he told her. “Food insecurity does have a recognized diagnostic code. We took that through our senior leadership governance committee, and Andrea was successful in getting approval for non-physicians to add that to the EHR problem list.”

As Landi noted, “The program has now been expanded to 115 patients, with the goal of reaching 250 patients for the Fresh Food Farmacy in the next six months”; and she quoted Dr. Feinberg as noting that the food provided to patients is enough to feed the patients as well as the family members in their households. “Once we get up to 250 patients, we’ll be feeding somewhere between 750 and 1,000 people per week,” she told Landi. Geisinger has several community partners, including the Central Pennsylvania Food Bank, that provide food, mostly fresh fruits, vegetables, lean proteins and whole grains, for the program, at a reduced cost.

And, the Geisinger leaders confirmed for Landi that they are committed to making this initiative work over the long haul.

So, all of those elements—focusing on a set of big-picture issues; meeting patients where they live; strategically planning and implementing the data and IT elements needed for success; achieving executive leadership buy-in and commitment to the initiative; obtaining the commitment for ensuring the financial and human resources needed; scaling up the initiative intelligently over time; and ensuring a constellation of community-based participation and allyship—all of those elements are vital to the success of any program like this one. As a result, Geisinger’s clinicians and care managers are obtaining the patient buy-in and engagement that they need. What’s more, Geisinger leaders have the advantage of being able to partner with the leaders of their own health plan, in order to attract patients/plan members into this program, and to be able to marry clinical and claims data in order to make the program work optimally.

All of those elements have been key to achieving real patient engagement—not the superficial, check-the-boxes kinds of patient engagement markers so common in this kind of endeavor. As Dr. Feinberg told Landi, “We found historically that these are often very disengaged patients; they have been disappointed, they don’t know how to take care of themselves and they don’t have resources to buy healthy food. We’re giving them the education and the tools they need, we’re removing the obstacles, and with that, we follow the improved health and improved fiscal outcomes as well,” she said.

My prediction? This Geisinger program could prove to be a model for this kind of work that really could be replicated in patient care organizations across the U.S. I can’t wait to hear what this initiative looks like a year from now—the path ahead looks genuinely exciting for pioneering program.

 

 

 

 

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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”

 

 

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Thursday, December 13, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more substantial role in improving outcomes and reducing cost of cancer care.

In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.

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Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.

 

 


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