Leveraging data to improve healthcare Premium

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Raising the quality of healthcare and optimizing health expenditure — are these two irreconcilable objectives? Not always: the US company Geisinger Health System manages to maintain this tricky balance by leveraging data — with the help of humans.

Biography

Kurt Wrobel

With an MBA in health management from Wharton (2000), Kurt Wrobel has spent his career in various US health maintenance organizations (HMOs), including HealthMarket and PacificCare Health Systems. Wrobel joined Geisinger Health Plan as chief actuary in 2014 before assuming the role of financial manager a year later, a position in which he works closely with the Geisinger Health System parent company.

 

Geisinger Health System is a Pennsylvania-based health organization that was founded over a century ago. Geisinger runs 13 hospitals and two research centers, employing 32,000 people (including 1,800 doctors). It serves a population of three million in Pennsylvania and neighboring states, with many rural and/or poor communities. Its insurance company, Geisinger Health Plan, offers a range of health-coverage options to over 600,000 members. Geisinger Health System is renowned for combining patient care and cost control, and is held up as a model in the United States. Its care innovations are based on the advanced way it harnesses data, which is used to coordinate patient care and administration, from consultations with physicians to covering costs to in-patient care.

Managing patient care

Geisinger pioneered the development of electronic medical records to facilitate patient follow-up, with the organization investing over $100 million since 1995. The system, which can be accessed by various Geisinger teams, makes it possible to share and transmit important patient information. The aim is to have an overview of a patient’s state of health in order to deliver the most effective treatments and protocols. “Our mission is to provide high-quality care at a competitive price,” explains Wrobel. “Our data helps us achieve these goals. It informs and guides our decision-making, meaning we can adjust the care offered to different policyholders and improve the treatment they receive. For example, by consulting the health history in a patient’s medical record we can identify individuals who need additional services, such as home care.” The health of every new patient is assessed. For those at high risk, Geisinger Health Plan employs nurse case managers who are responsible for overseeing patients’ treatment. The nurses explain procedures to patients and their relatives, and teach them how to manage their illness more effectively. Their tasks also include monitoring patients’ conditions on a regular basis and coordinating different specialists to avoid complications that might aggravate the illness or lead to an emergency readmission. It’s an anticipatory strategy that limits relapses, enhances the lives of patients, and reduces costs.

A mission to improve the quality of care

Excerpt from Business Digest N°295, April 2019

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