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.

Gail R. Wilensky, PhD, is an economist and a senior fellow at Project HOPE, an international health foundation. She serves as a trustee of the Combined Benefits Fund of the United Mine Workers of America and the National Opinion Research Center and is on the board of regents of the Uniformed Services University of the Health Sciences. Dr. Wilensky served as president of the Defense Health Board, a federal advisory board to the Secretary of Defense, was a commissioner on the World Health Organization’s Commission on the Social Determinants of Health and co-chaired the Department of Defense Task Force on the Future of Military Health Care.

She was administrator of the Health Care Financing Administration (now called CMS) from 1990 to 1992 and the deputy assistant for policy development to President George H. W. Bush in 1992. Dr. Wilensky chaired the Physician Payment Review Commission from 1995 to 1997 and MedPAC from 1997 to 2001. She is an elected member of the Institute of Medicine and has served two terms on its governing council.

A former chair of the board of directors of Academy Health, a former trustee of the American Heart Association and a current or former director of numerous other non-profit organizations, Dr. Wilensky is also a director of UnitedHealth Group, Quest Diagnostics and BrainScope.

Dr. Wilensky testifies frequently before Congressional committees, serves as an advisor to members of Congress and other elected officials, and speaks nationally and internationally. She earned a Bachelor of Psychology and a PhD in economics at the University of Michigan and has also received several honorary degrees.

Sherry A. Glied, PhD, has been the dean of the Robert F. Wagner Graduate School of Public Service at New York University since 2013 and was professor of Health Policy and Management at Columbia University’s Mailman School of Public Health where she served as chair of the Department of Health Policy and Management from 1998-2009. She served as assistant secretary for Planning and Evaluation at the Department of Health and Human Services and as senior economist for healthcare and labor market policy on the President’s Council of Economic Advisers in 1992–1993, under Presidents George H.W. Bush and Bill Clinton, and participated in the Clinton Health Care Task Force.

Dr. Glied has been elected to the National Academy of Medicine and the National Academy of Social Insurance and served as a member of the Commission on Evidence-Based Policymaking.

Dr. Glied’s principal areas of research are in health policy reform and mental healthcare policy. She is the author of Chronic Condition (Harvard University Press, 1998), coauthor (with Richard Frank) of Better But Not Well: Mental Health Policy in the U.S. Since 1950 (Johns Hopkins University Press, 2006), and coeditor (with Peter C. Smith) of The Oxford Handbook of Health Economics (Oxford University Press, 2011).

Thomas H. Lee Jr., MD, MSc is a Diplomate of the American Board of Internal Medicine, subspecialty cardiology. He is chief medical officer for Press Ganey, the market leader in measurement of patient experience for US hospitals and ambulatory care providers. He was network president for Partners Healthcare System, the integrated delivery system founded by Brigham and Women’s Hospital and Massachusetts General Hospital.

He is senior physician at Brigham and Women’s Hospital and part-time professor at Harvard Medical School and Harvard School of Public Health. He serves on New England Journal of Medicine editorial board, and the boards of the American Society for Clinical Investigation, the American Medical Association, the Special Medical Advisory Group of the Veterans Administration and the Panel of Health Advisers of the Congressional Budget Office.

Dr. Lee has held national leadership roles in defining and measuring quality of care, including serving on the Board of Overseers of the Malcolm Baldrige National Quality Award from 2008 to 2010 and the Committee on Performance Management of the National Committee for Quality Assurance, which develops the widely-used HEDIS measures, where he served as co-chair from 2002 to 2009. He is the author of more than 300 publications and several books, including An Epidemic of Empathy, Chaos and Organization in Healthcare, and Eugene Braunwald and the Rise of Modern Medicine.