We just concluded this morning's grand rounds, the next stage of the Silverman Institute annual symposium. Glen Steele presented, with responding comments from Paul Guzzi, CEO of the Greater Boston Chamber of Commerce; Roberta Herman, COO and CMO of Harvard Pilgrim Health Care; and Gene Lindsey, CEO of Atrius Health.
Glen expanded on last night's themes, one of which was reducing variation in the clinical setting within a health care system. He presented the following chart about Geisinger's experience after reducing variation in cardiac surgery. Results that were already quite good improved dramatically.
The business case improved, too: Net revenue increased 3.8%; Direct costs decreased 5.1%; Contribution margin increased 11.3%; Total inpatient profit per case improved $2560. The insurance companies saw a reduction of 4.8% in cost per case of cardiac bypass surgery, amounting to a cost 28% to 36% less than that of other providers.
Geisinger has also focused on integrating care upstream to people in the primary care practices and beyond, into their homes. Glenn called this "concierge care for the sick, not the rich." Again, the results were impressive, in terms of reduced hospital admissions for people with congestive heart failure and other serious chronic conditions.
The program elements are: Partnership between primary care physicians and GHP that provides 360-degree, 24/7 continuum of care; “Embedded” nurses; Assured easy phone access; Follow-up calls post-discharge and post-ED visit; Telephonic monitoring/case management; Group visits/educational services; and personalized tools (e.g., chronic disease report cards.)
Paul and Roberta and Gene all offered thoughtful observations about the nature of the Massachusetts market and the concerns and hopes of the business community. I can't give them all here because I need to rush off to the poster session, but the universal point that struck home to me was Gene's:
The big opportunity that we have is our waste. We need to unlock the vault and tap into that resource.