Job: President and CEO of Geisinger Health System, which integrates hospitals and medical practices with insurance plans in central and northeastern Pennsylvania.
Why he matters: Since Steele joined Geisinger in 2001, the company has been recognized as a national model for using electronic records to manage patient healthcare efficiently, improving patients’ health outcomes while still eliminating unnecessary costs.
Geisinger Health Plan, the system’s insurance arm, formed a partnership with the five-hospital Meridian Health System. It also is in talks with the two-hospital Atlantic County-based system AtlantiCare to form an affiliation.
Squeezing out unjustified costs: Steele said his goal for Geisinger is to eliminate the “30- to 40- to 45-percent of what we do in medicine” that doesn’t help patients “and in some cases, might hurt them,” including unjustified variation and unnecessary duplication in treatments and services.
Geisinger has been in a unique position to roll out new approaches to providing healthcare because it has an insurance arm, has a large share of both local patients and employers, and has contracts with or employs a large percentage of local providers.
Why he looked to New Jersey: Steele said both Meridian CEO John K. Lloyd and AtlantiCare CEO David Tilton understand that the entire country is moving away from paying providers for “units of work,” such as each service they provide, and moving toward paying to keep people healthy – an approach that Geisinger has already taken successfully.
The Geisinger approach: Geisinger analyzes its patient data, with an eye toward the 20 to 25 percent of patients that it sees as having the greatest potential for improved health. Frequently, these are patients with chronic conditions like diabetes or congestive heart failure.
Geisinger then works with the patients’ providers to improve care so that the patients are less likely to be hospitalized. Payments based on such measurements as reducing the rate of re-hospitalizations changes the incentives for providers.
“The data feedback has to be as close to real time as possible for the providers,” Steele told a conference at Princeton University in April.
For example, Meridian’s Medicare patients are offered Geisinger Gold, a private Medicare Advantage plan. Patients enrolled in the plan who have chronic conditions may be assigned a nurse who helps provide customized care and monitors the patient’s health. The company also tracks which providers provide care that differs from accepted best practices and checks to see if the providers can justify the variation.
“Just getting rid of unjustified variation in how treatment is given is a huge increase in value,” both in reduced costs and improved outcomes, Steele said. Geisinger has a great deal of leverage with the many providers that it employs in Pennsylvania – those who aren’t amenable to reducing unjustified practices are fired.
Steele’s hopes for the future: He would like to provide data to the public that demonstrates improvements that result from Geisinger’s standards. He thinks this could prompt patients to choose a Geisinger plan or system.
While this detailed data isn’t available yet, Steele encourages patients to look at publicly available information on the observed death rates for hospitals, compared with the expected rates.
Illustrating how seriously Steele takes sharing data with patients, Geisinger opens up to patients all of the notes of the healthcare providers it employs, with exceptions for psychiatric and emergency care.
Excited about New Jersey, but looking beyond it: Steele would like to see Geisinger grow nationally – it also has partnerships in Delaware and Maine – and internationally, beginning with a partnership with Singapore’s health ministry.
Different from Pennsylvania: In New Jersey, Geisinger won’t be directly employing the healthcare providers, so it remains an open question whether it will “capture their attention,” Steele said.
Well-educated: A Maryland native, Steele has a bachelor’s degree from Harvard University in history and literature, a medical degree from New York University School of Medicine, and a Ph.D. in microbiology from Lund University in Sweden. After working as a surgeon in Boston, Steele served as dean of the Biological Sciences Division and the Pritzker School of Medicine and vice president for medical affairs at the University of Chicago.
Why Steele came to Geisinger: He said he became convinced in Chicago “that the most important thing in improving healthcare was the application of new knowledge, not creation of new knowledge.”
Personal life: Steele and his wife Lisa have three children and two grandchildren. While he enjoys music, skiing and golf, “I don’t do my hobbies enough,” he said.