Skip to main content

Geisinger CEO Shares How 65 Forward Program Improves Primary Care for Senior Patients

Analysis  |  By Melanie Blackman  
   August 20, 2020

Dr. Jaewon Ryu details how the health system's program for older adults includes at-home models.

In an article published earlier this month titled: "What Seniors Can Expect as Their New Normal in a Post-Vaccine World," scenarios of how life will potentially be different for people over age 60 in the post-COVID vaccine world are explained. It suggests a higher utilization of telemedicine, a team of doctors to treat a single patient, and technology at home that may help older patients avoid going to the doctor's office.

Pennsylvania-based Geisinger has already made steps to change the way in which senior patients interact with its health system.

According to Geisinger, patients aged 65 or older make up approximately one-third of the total patient population at the health system. Through a program called 65 Forward, Geisinger aims to improve primary care for senior patients. The program has a 98% patient satisfaction rating.

"If you look at the demographic trends, we're going to have to figure out a way to take better care of those as they age," Geisinger CEO Dr. Jaewon Ryu says. "How do you keep them healthy? … How do you keep them closer to home and in the communities?"

Ryu spoke with HealthLeaders about how the health system has innovated and created new programs to care for their senior patients and the strategy behind them.

This transcript has been edited for clarity and brevity.

HealthLeaders: Can you explain how the 65 Forward program works?

Jaewon Ryu: If you look at primary care across this country, it's always been a little bit of one-size-fits- all. If you look at the care model and the care needs of different segments of the population, the reality is that one size does not always fit all. Trying to juggle all these different scenarios within a single practice becomes difficult.

It's also a good illustration of what can be done when you partner between a health insurance function, and a clinical enterprise function. If you're solely on the clinical enterprise side, you have to worry about what is or is not reimbursable. When you have a health insurance company—and, in our case, it happens to be our own—married up with a clinical enterprise, then you can develop these differentiated services.

If you had to worry about, "Can I bill for yoga?" well, you can't really bill for yoga; that's not what is traditionally allowed in healthcare. Within a health insurance company, if yoga is going to keep people healthier and make them feel better about their health, it's absolutely worth it. And that's been the beauty of the model, is what can happen when you do those things. That's why we've been able to bring the senior focus model [to] primary care.

A big feature of [the program] is we limit the patient panels. The typical primary care panel in this country has about 2,000–3,000 people in it. At Geisinger, we try to keep it on the low end around 2,000 [people per doctor]. But, in this model, we cap it at 450. That means more frequent visits, longer visits, and we can connect with you over the phone or virtually with however you want to stay engaged and healthy.

We have a lot of services that prevent the need for people to go to urgent care, the ER, and the hospital. That's been tremendously well received. The patient satisfaction score is in the 98th percentile and that has held steady. It just goes to show what can happen when you bring something that meets the needs of the populations that you're serving.

We thought there's a better way to do primary care, especially for those 65 and older. Our primary care model was good, but we saw an opportunity to go from good to great. We saw an opportunity to take it to the next level with multidisciplinary teams. It wasn't just the physician or the advanced practitioner, but also having consistent social workers, consistent community health assistance care coordinators, and clinical pharmacists to help navigate all the different medications and having that be more consistent across the entire primary care enterprise. We did that starting in 2017.

We also doubled the appointment time for everybody above the age of 65. We were seeing about one- to-two fewer patients per provider per day in primary care across our system. In other words, we slowed our providers down so that they had a little more time to spend with patients and had a team supporting them to help offload some of the administrative work. As a result of that, we saw access numbers improve. We saw patient satisfaction in the primary care centers improve.

And that's how we rolled out 65 Forward. It marries up the clinical component of the clinic with activities and wellness; sort of like a community center in the front, where they can come and hang out and participate in these activities. Then on the back half of the clinic, it's more their primary care provider, the team, and so forth.

It's really a combination of all of those factors, and that's what led to the strategy. If patient satisfaction goes up, if access goes up in availability, and we see that the rate at which patients need hospitalization goes down, and the rate at which they're going to the ED goes down, then that's a tremendous service for our patients. And it pairs nicely with our health insurance members, which is why it's been launched as a collaborative effort between our health plan and our clinical enterprise.

HL: What are the social needs that this program addresses for patients aged 65 and over?

Ryu: There's a need out there to provide regular social outlets. It's a testament to the fact that there may not be a whole lot of those options out there in the community, where folks who are 65 and older can come and interact with each other. A lot of the activities are focused around wellness, whether it's physical activity wellness, or even just having them work with their hands.

There's some art [programs], whether it's pottery or drawing. There's book club. Yoga is one of the more popular ones. There's a handful, but it addresses those social needs. We have other programs throughout the system like our Fresh Food Farmacy program that addresses social determinants of health. Those programs are around our system as well. One of those sites just happens to be co-located in the same building as one of our 65 Forward sites. Those are the kinds of programs that we're trying to pull together, to tackle people's health in the community and make health easier.

HL: What were the steps in rolling this program out, such as ensuring proper training and positive patient experience? What investments were made?

Ryu: All the investments were related to the buildings, much like any clinic that we would build from scratch. But you hit a key point. It was a lot of training and education, even of our own staff to understand what are the needs of that 65 and older population.

[It was] making sure that we had people who were passionate about [serving this population], because we're firm believers that when you do what you love, it shows. It's going to relate to a better experience for our patients. It was a lot of educating and making sure we're getting people who are similarly and like-minded along those lines.

A lot of that prep work was in areas like identifying the right staff, educating, and training them to make sure they were equipped, and then getting the word out in the community. We needed to make sure that people understood that it was a different model, so as part of that go-live last year, we had open houses where we wanted people to walk through the clinic. They walk into this clinic and they see yoga, exercise balls, dumbbells, a rowing machine, and a treadmill, and they're like, "Wait, did I land at the right place?"

That open house was important to introduce people to the model. We had tremendous uptake, and we continue to see uptake. Initially, we started with a single provider physician at the first site, then a single provider physician at the second site, and now we're up to five total providers across the two sites, and that's been in less than a year.

HL: How has the pandemic affected the 65 Forward program?

Ryu: Believe it or not, in these models, it's been less of an impact. It's because these clinics aren't as crowded.

The biggest place where there's been an impact is related to wellness classes and activities. The team was able to adapt quickly on that by moving certain classes outside, creating distancing, masking where appropriate and wherever possible. And then at the same time, [patients] were still able to get their care with their physician and provider with the right distancing and with the right precautions. It was a huge benefit. Those patients in those models missed less of a beat than in other environments.

HL: What's your long-term strategy for post-acute care and hospital-at-home?

Ryu: Moving things into the home is a big part of our strategy. The Geisinger at Home model is a big component that focuses on the sickest 3%–4% of our patient population. Many of those do tend to be 65 and older, although not all. That model was another one that even through COVID we were able to maintain more because these folks were getting care into the home.

Moving those care programs out into the home has been huge. We've seen tremendous impact from that, even dating prior to COVID.

Within the next coming months, we want to launch something called the "hospital-in-the-home model." It's been done at a couple other places across the country. We think we can integrate it even better. But essentially, the idea being Geisinger at Home may identify a population and follow them in the home. But what happens if someone comes to our emergency room? You can't send them home as you might, currently. But if you could bring some services into their home, there may not be a need to admit them to the hospital. An ER physician would admit them to the home, as opposed to admitting them [to the ER].

Related: Geisinger Health 'Disappointed' in DOJ's Move to Block PA Hospital Acquisition

Related: Social Determinants of Health: Lead or Partner

“If you look at the demographic trends, we're going to have to figure out a way to take better care of those as they age. How do you keep them healthy? … How do you keep them closer to home and in the communities?”

Melanie Blackman is a contributing editor for strategy, marketing, and human resources at HealthLeaders, an HCPro brand.

Photo credit: Geisinger 65 Forward Health Center in Kingston, Pennsylvania. Photo courtesy of Geisinger.


KEY TAKEAWAYS

Geisinger's targeted primary care model has a 98% satisfaction rating.

The COVID-19 pandemic had less of an impact on senior patients enrolled in the 65 Forward program, says Geisinger's CEO.

Geisinger is looking to launch and perfect a "hospital-in-the-home model" within the next couple of months.


Get the latest on healthcare leadership in your inbox.