The Healthcare Hub

Geisinger Health: Reducing Variation With Physician Engagement

posted by: Hani Elias, JD, MBA
Wednesday, April 3, 2019

The vast majority of physicians are not getting the information they need to improve care quality, lower costs and drive value for patients, a point that Lumere’s recent physician survey, published Physician Leadership Journal, makes abundantly clear.

Geisinger Health System is one organization that has worked hard to address this gap. The 13-hospital, Pennsylvania-based system has long been a leader in effectively engaging physicians, including the 2006 launch of ProvenCare, an ongoing effort to operationalize evidence-based medicine and improve value for patients.

During a recent webinar, I was joined by Geisinger’s Chief Physician Officer Dr. Michael Suk (also a practicing orthopedic surgeon) and Vice President of Enterprise Supply Chain Services Jun Amora to talk about how the systems comprehensively reimagined its approach to evaluating new products and existing spend by optimizing physician engagement.

“Geisinger has a long tradition of continuous improvement and innovation,” Dr. Suk said. “It was only natural in 2016 for us to begin to look at areas of variation within our supply chain spend. We essentially started with a whiteboard and decided how we would redesign a process that would ensure physician engagement, transparency in process and price, and ownership of the process by those who are on the front line.” Additionally, the system needed to scale its existing supply chain process, which had become cumbersome and lacking in enterprise-level oversight as the system had grown and expanded.

Dr. Suk and Jun emphasized three key factors that enabled them to successfully develop and implement a groundbreaking process that has been embraced by stakeholders throughout the system.

  • Start with Physician Engagement

In 2015, Dr. Suk—who at the time led Geisinger’s Department of Orthopaedic Surgery—was named the system’s Chief Physician Officer with the goal of better aligning clinicians with the system’s supply chain team. “As physicians, we don’t get trained in hospital operations and the supply chain side as medical students, residents or fellows,” Dr. Suk said. “And even in the practice of medicine, oftentimes we don’t have exposure to price and process.”

For Dr. Suk and team, ensuring that physicians had a role in reshaping and participating in the supply chain process was critical. This involved an in-depth education and training so that clinicians understood how their involvement would help ensure a focus on patient care, not just price. “It was very surprising to see how many physicians actually enjoy understanding price and process and how it affects what’s going on in their world.”

Physicians are truly involved at every stage of the process, including sitting on decision-making committees and always submitting their own requests for new products. In exchange, supply chain took several steps to make it easier for physicians to be engaged. For example, they paired down questions on the request form to only those that were most critical.

  • An Innovative Approach to Governance

Geisinger took the unique approach of creating a single governing body to look holistically at new product requests and existing spend, all under the umbrella of its clinical use evaluation (CUE) process. “As a supply organization, we’re given a savings target we have to hit,” Jun said. “We hit those savings via multiple initiatives— renegotiating contracts, sourcing projects, managing our formulary. But the other half of what we do is evaluate new products.”

Prior to transforming its supply chain process, Geisinger had streamlined nearly 30 existing service lines into nine distinct institutes. By directly aligning the CUE process with the institute model, Geisinger was able to ensure that it embodied the tenets of the systems broader ongoing ProvenCare effort.

Within the CUE program, each institute’s clinical leader is now directly responsible for their area of expertise. Doing so also allows the system to apply a comprehensive and integrated lens to clinical variation by ensuring that new products are not introduced unless they are clinically relevant at the same time they standardize existing products.

  • The Importance of Evidence

The Geisinger team recognized that a critical factor in driving clinical engagement was the introduction of evidence into the CUE process. “We started with the premise that a new product isn’t always bad, it just needs to be proven,” said Dr. Suk. “We welcome innovation if we have a good process by which we can evaluate and measure outcomes to ensure the best patient results. When physicians are directly engaged in the process, they have an opportunity to review the evidence and decide if they truly want to push [a new product request] through the system.”

As a result, Jun said that the supply chain team has seen a reduction in new product requests, enabling them to shift attention to variation reduction efforts. “We’re still reviewing new product requests,” he said, “but since they’re coming in a lot more vetted now, we’re able to use that time for strategic sourcing initiatives.”

Success Story: Shoulder Devices

One such initiative was launched in 2018 when the team uncovered an opportunity to standardize the purchasing of devices for shoulder replacement procedures. “Shoulder arthroplasty is still a relatively new area,” Dr. Suk said. “As a result, there’s still a lot of continuous technical innovation that’s occurring. But with that comes a number of vendors who are trying to distinguish themselves within the marketplace. So what we saw very rapidly over the last several years is tremendous growth in the number of total shoulder offerings and an explosion in the number of companies offering them.”

At Geisinger, this meant that each of the six surgeons performing shoulder procedures was using devices from up to 10 vendors. By reviewing the evidence with the surgeons and other key stakeholders, Geisinger was able to determine benchmark pricing, push back on vendor claims of product differentiation, and ultimately standardize to eight vendors. Finally, to alleviate physician concerns about switching devices, they partnered with the remaining vendors to provide in-depth training.