May 17, 2023

Accelerating value in health care

An op-ed by Geisinger Health board of directors members Gail R. Wilensky, PhD; Sherry A. Glied, PhD; and Thomas H. Lee Jr., MD, MSc.

Reprinted with permission from Geisinger Health. This piece originally ran in Becker’s Hospital Review on May 16, 2023.

Kaiser Permanente and Geisinger recently announced that they are coming together (pending regulatory review) with a shared mission to increase value in healthcare across the country. We, the three authors of this piece, have throughout our careers in health policy worked to improve access and affordability of care, and we all serve on Geisinger’s board. We have served on the Board because we believe Geisinger has been and will continue to be one of the organizations that move healthcare in the right direction. We write now to share why we believe that this new combination is a significant step toward that goal.

For decades, the US healthcare system has been challenged by unstainable costs and less than stellar clinical outcomes. It’s not working well for patients, for providers, or for the purchasers of care. One of the underlying problems is a delivery and payment model that can misalign incentives to focus on episodic services and “downstream” activity rather than on “upstream” total costs, care coordination, and prevention. Health policy analysts have long preferred value-based care models where payment is based on the value or quality of services and outcomes delivered and the focus is on promoting health, access and affordability.

The adoption of this value-based approach across the county has been challenging because it requires a redesign of both the payment model and the conventional care model. While there has been some progress, there is still a long way to go. Today, as news reports again document the healthcare affordability crunch challenging employers, consumers, and governments, the timing is ripe to accelerate these efforts. The COVID pandemic and its aftermath have also demonstrated the fragility of the legacy healthcare model and its sustainability and effectiveness in improving health across populations and communities.

Despite these and other challenges, we see plenty of reasons for optimism. Capabilities in clinical practices, technology, data/analytics, consumer insights, and provider enablement have evolved and continue to mature quickly. Propelling investments in these “next-gen” capabilities and leveraging them can catalyze exactly the type of transformation needed to effectuate this healthcare model of tomorrow. They can help move us to a care system that achieves better outcomes, increases affordability and significantly improves both the patient and member experience.

Enter this transaction. It is not your typical health system combination. The logic rests on the shared vision of these two organizations to enhance and further develop capabilities that can advance health within a community. Kaiser Permanente and Geisinger bring complementary capabilities and a like-minded approach to care — one that can be more broadly applicable across the healthcare industry writ large. Kaiser Permanente is the gold standard in what has become known as “population health” within an integrated delivery and financing model built on innovation and data. Geisinger is a nationally recognized organization that has innovated in a multi-payer, multi-provider framework to drive better health across its populations, including some of the most vulnerable such as the Medicare, Medicaid, and rural segments. Both organizations share objectives and operating philosophies — focusing on improving health and wellness rather than treating people primarily when they are sick and in need of hospital care. They also share a commitment to education and research, perhaps best embodied through their respective medical schools and training programs.

If this combination is approved, Geisinger will become the inaugural member of Risant Health, Kaiser’s new health systems division, which is designed to spread the very best in population health to diverse markets across the country. The new division will leverage Kaiser’s expertise in value-based, integrated care and coverage and Geisinger’s experience of advancing value-based care in a pluralistic model of providers and payers.

Participating community-oriented health systems, wherever they are located and whatever populations they serve, will be supported by world-class expertise on a scale that otherwise would not be possible. Transformation will be enabled by investments in innovative care models, technology, facilities and “next-gen” capabilities such as digital tools that will offer an enhanced patient, member and provider experience.

Geisinger was founded in 1915 by Abigail Geisinger who opened a hospital to serve a small rural community in Danville, Pennsylvania. Her motto was “to make it the best.” As board members, we have always taken to heart Abigail’s wise and timeless words. We wholeheartedly believe that this partnership will indeed deliver on Abigail’s charge, by continuing to bring the very best in health, not only to the communities we serve, but also to communities large and small across the country.

Drs. Wilensky, Glied, and Lee all serve on the Geisinger Health Board of Directors.