Geisinger Study Finds Diabetes Care “Bundle” Produces Better Health Outcomes

Plainsboro, N.J.—June 27, 2014—A study published today in The American Journal of Managed Care found that an all-or-none, or “bundled,” approach to primary care deployed by Geisinger Health System for patients with diabetes produced better health outcomes and that the benefits happened quickly.

More so than most chronic conditions, diabetes offers a window into the nation’s general health because people who develop type 2 diabetes typically have multiple health issues at once, and many are tied to lifestyle. Treating this disease, then, requires healthcare providers look at the big picture, not just tackle individual symptoms, which means tracking what happens to patients, and not just recording their weight or glycated hemoglobin (A1C). That’s what Geisinger did when it created an all-or-none bundled measure to provide care to these patients.

“By doing this bundled management and improving this reliable diabetes system of care, we improved patients’ outcomes — not just their numbers, but their health outcomes — in three years,” said Thomas Graf, MD, chief medical officer for Population Health at Geisinger Health System, an author of the study.

The study, which measured hazard ratios (HRs) for 4,095 patients enrolled in the Diabetes System of Care, compared with 4,095 patients not enrolled in the program. Adjusted HRs for myocardial infarction (0.77), stroke (0.79) and retinopathy (0.81) were all significantly lower among patients in the diabetes care group. The study found that most risk reduction occurred during the first year, which suggests that efforts to change healthcare delivery to improve quality can work quickly.

How Geisinger achieved these results is as important as what was achieved. “We did not add extra staff. We just redesigned the roles and responsibilities within the primary care office to have the staff work more together as a team to help the patients accomplish their goals,” Dr. Graf said. “In this team-based model, the physician is still in charge as the quarterback of the team, but this system uses other team members to perform other tasks so the physician can focus on making complex medical decisions and motivate the patients to meet their goals.”

Change, however, is not easy, as the authors note. They report that creating system-wide change requires constant evaluation, and improvements must be scalable across a variety of practice settings. Accountability is a key, according to their findings. Payment must be prompt to ensure ongoing progress and buy-in.

“This study is important because if a health system or health plan is going to invest in this system, they want to know the benefits of those investments,” Dr. Graf said.

The Geisinger results are important in light of soaring incidence rates of type 2 diabetes, which the study notes skyrocketed 40 percent between 2007 and 2010. According to the American Diabetes Association, 26 million Americans have the disease, with most suffering from type 2.

To read the full study, click here.

About the American Journal of Managed Care
The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system because of the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology, diabetes management, respiratory care, and immunology and infectious disease.

About Geisinger Health System
Geisinger Health System is an integrated health services organization widely recognized for innovatively using the electronic health record and developing innovative care models such as ProvenHealth Navigator® and ProvenCare®. As one of the nation’s largest rural health services organizations, Geisinger serves more than 2.6 million residents throughout 44 counties in central and northeast Pennsylvania. The physician-led system is composed of more than 21,000 employees, including a 1,100-member multispecialty group practice, eight hospital campuses, two research centers, and a 467,000-member health plan, all which leverage an estimated $7.4 billion positive impact on the Pennsylvania economy. The health system and the health plan have repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a longstanding commitment to medical education, research and community service. For more information, visit www.geisinger.org, or follow the latest Geisinger news and more on Twitter and Facebook.



Rocky Edmondson RN, BSN, MBA, CCRN
Senior Director, Bundled Payments, Care Redesign and Management Advisors, xG Health Solutions

Rocky Edmondson is the Senior Director of Bundled Payments for Care Redesign and Management Advisors at xG Health Solutions. Rocky has been involved in workflow redesign, program implementation, and analytic evaluation of Bundled Payment Programs across the country, and he coaches Hospitals, Health Systems, Post-Acute Providers, and Physician Groups on how to successfully implement care redesign in the Bundled Payment for Care Improvement (BPCI) and CJR Programs.

Rocky’s passion is helping people to understand the intricacies of Bundled Payment Programs. He has a talent for teaching people how to cut through all the noise and just do the things that matter to be successful in these programs.

Rocky holds an Associate’s Degree in Nursing from the University of Hawaii Maui, and a Bachelor’s Degree in Nursing and a Master’s Degree in Business Administration (MBA) from Boise State University.

Prior to joining xG Health Solutions, Rocky was the Southeast Region Director of Clinical Operations for Remedy Partners, overseeing program design, implementation and analytic evaluations for Bundled Payment Programs. Prior to embarking on a career in Bundled Payments, Rocky was a Registered Nurse for 18 years, working in a number of positions within Critical Care. Before becoming a Nurse, Rocky was an Institutional Broker at Merrill Lynch and advised a number of healthcare systems and large corporations on cash management strategies. In addition, Rocky has started several businesses and provided consulting for small business startups. Rocky served in the U.S. Marine Corps as a Recon Marine.

Janet Comrey RN, BSN, MHSA
Director, Population Health Solutions, Geisinger Health System

Janet Comrey, RN, BSN, MHSA has over 30 years of diversified nursing and leadership experience at Geisinger Health system and currently serves as Director of a small department embedded within Population Health. One of her key roles is managing the Bundle Payment for Care Improvement (BPCI) program since January 2014 earning an overall positive net payment reconciliation to date. Janet also serves as the coordinator for Project Achieve at Geisinger which is a national PCORI funded study related to patient’s perceptions of transitions of care.

Janet received her nursing education through Geisinger’s diploma program, her BSN through Bloomsburg University, and later earned her graduate degree from Marywood University. During her tenure at Geisinger she taught quality improvement methodology and facilitated improvement teams the Geisinger Quality Institute. She is currently enrolled in the Institute for Healthcare Improvement Advisory program.

Professional memberships include Sigma Theta Tau, Phi Kappa Phi, American Society for Quality.

Andrew Blackmon, MBA, MHS
Chief Sales and Business Development Officer

Chief Sales and Business Development Officer Andrew Blackmon, MBA, MHS, has more than 18 years of experience in healthcare product sales, marketing, and strategy.

Before joining xG Health, Andrew was vice president of sales for population health and risk management solutions at McKesson. He came to McKesson through acquisition of MedVentive, an early population health vendor. Before MedVentive, he served as vice president of enterprise solutions development at MedAssets. He is a past president of the Georgia chapter of HIMSS, and he has held strategy and planning positions at PricewaterhouseCoopers and Orlando Health.

Andrew has an MBA and a Master’s of Health Science from the University of Florida Warrington, College of Business, and a Bachelor of Arts degree in Psychology from Rollins College.

Holly Barbella, RN, MBA

Risk Coordinator, Geisinger Health System

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Earl P. Steinberg, MD, MPP
Chief Executive Officer

Earl P. Steinberg, MD, MPP, is a nationally recognized expert in healthcare quality improvement and serves as xG Health’s chief executive officer. Earl also is an adjunct professor of Medicine and of Health Policy and Management at Johns Hopkins University and a member of Blue Cross/Blue Shield Association’s National Medical Advisory Panel.

Before joining xG Health, Earl was executive vice president of Innovation & Dissemination, and chief, Healthcare Solutions Enterprise at Geisinger Health System.

Before joining Geisinger, he was senior vice president for Clinical Strategy, Quality & Outcomes at WellPoint, Inc., the largest commercial health insurer by membership in the US, and president and CEO of Resolution Health Inc. (RHI), a leading healthcare data analysis company that provides innovative quality improvement and cost reduction services to health plans, employers, pharmacy benefit managers, and disease management companies.

Before joining RHI, Earl spent six years as vice president of Covance Health Economics and Outcomes Services Inc., director of its Quality Assessment and Improvement Systems Division, and co-director of its Outcomes Studies Group. He also spent 12 years on the full-time faculty at Johns Hopkins University, where he was professor of Medicine and of Health Policy and Management and director of the Johns Hopkins Program for Medical Technology and Practice Assessment, and four years on the Federal Physician Payment Review Commission. He co-chaired the Institute of Medicine’s panel on Standards for Development of Trustworthy Practice Guidelines.

Earl has received many awards, including the Henry J. Kaiser Family Foundation Faculty Scholar Award in General Internal Medicine (1984), the “Outstanding Young Investigator” Award from the Association for Health Services Research (1988), and a Special Presidential Visionary Award from the National Kidney Foundation (NFK) (2004) for his work as the scientific director of the NKF’s landmark Kidney Disease Outcomes and Quality Initiative, which produced more than 250 clinical practice guidelines for management of patients with end-stage renal disease. He also is a fellow of both the American College of Physicians and AcademyHealth, and he has published more than 125 articles in peer-reviewed journals.

Earl received his AB from Harvard College (summa cum laude), his medical degree from Harvard Medical School, and a Master of Public Policy from the Kennedy School of Government. He performed his residency training in internal medicine at Massachusetts General Hospital.