About Jonathan Slotkin, MD, FAANS
Jonathan R. Slotkin, MD, FAANS is Associate Chief Medical Informatics Officer at Geisinger. He is also the Director of Spinal Surgery for Geisinger Health’s Neuroscience Institute. Dr. Slotkin has developed key strategies and solutions to drive digital provider and patient engagement, including the use of mobile device and bring your own device (BYOD) technology. He has a particular interest in consumerism in healthcare and digital methods for both the measurement of clinical patient outcomes and the improvement of patient experience. He has been a leader in the design and implementation of several of Geisinger’s care delivery reengineering initiatives, including ProvenCare(R) Lumbar Spine and ProvenExperience(TM). He was physician lead of Geisinger’s ProvenExperience(TM) patient refund app program. Dr. Slotkin has active translational research in the areas of tissue engineering and regenerative medicine and is co-founder and serves on the scientific advisory board of LaunchPad Medical. He has expertise in employer-purchased health care and the design and delivery of bundled care paradigms. Dr. Slotkin completed residency training and was chief resident of neurological surgery at The Brigham and Women’s Hospital, Harvard Medical School. Care delivery reengineering, digital transformation, consumerism, and helping employers reimagine the care of their associates are the things that drive him.
About Geisinger
One of the nation’s most innovative health services organizations, Geisinger serves more than 1.5 million patients in Pennsylvania and New Jersey. The system includes 13 hospital campuses, a nearly 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. Geisinger is known for its focus on caring and innovative programs including the ProvenCare® best-practice approach to maximize quality, safety and value; ProvenHealth Navigator® advanced medical home; Springboard Health® population health program to improve the health of an entire community; ProvenExperience™ to provide refunds to patients unhappy with their care experience; and Geisinger’s MyCode® Community Health Initiative, the largest healthcare system-based precision health project in the world. With more than 215,000 volunteer participants enrolled, MyCode is conducting extensive research and returning medically actionable results to participants. A physician-led organization, with approximately 32,000 employees and more than 1,800 employed physicians, Geisinger leverages an estimated $12.7 billion positive annual impact on the Pennsylvania and New Jersey economies. Repeatedly recognized nationally for integration, quality and service, Geisinger has a long-standing commitment to patient care, medical education, research and community service. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
To read Part 1 of Jonathan Slotkin’s interview, please click here.
Medical Travel Today (MTT): In this follow-up interview, I would first like to focus on employers selecting a Center of Excellence. Then I’d like to address the role of international hospitals and their relationship to employers.
Jonathan Slotkin (JS): When it works well, what we’ve seen and what we’ve often recommended is that these become iterative processes and growing programs. When you start, you want to start with enough skills to make it worthwhile with respect to the amount of work that goes into building programs like this and what your system will gain and learn about itself– and I don’t mean financially. I do mean making it worthwhile for the patients and creating redesigning the way that you deliver care.
You don’t want to start tiny. But, on the other hand, I don’t know that I’d go live with 20 programs at the same time. Begin with a modest number of concurrent programs with a pathway to continue to grow and build.
We have seen the growth and cross over that can happen when the system starts with one or a couple of employers in acute episodic care, with follow on destination type care that expands when local ACO type care is offered to the same or other employers.
In our case, we view this as an ongoing and continuous relationship. For example, recently Nancy Jester who is the senior manager for the centers of excellence program for Walmart, visited with us for an entire day. She met with all the stakeholders and toured the facility and met with our President and CEO Dr. Jaewon Ryu. We are already thinking about and planning, “what are the next steps.”. What is the next set of innovations we can help bring together to Walmart’s associates and to the nation?
MTT: I did some interviewing with the City of Hope and others about oncology bundles and there seems to be a lot of interest in it — but not a lot of uptake yet. Are you positioned to talk about that?
JS: I can talk about it to a certain extent.
Absolutely, oncology is a growing area. Walmart has had an oncology evaluation program in place for several years that is provided by the Mayo Clinic and involves confirmation of diagnosis, treatment plan and evaluation. It has been successful for Walmart and its family.
There are also at least two employers that I’m aware of that have quietly started an oncology Center of Excellence program. I think one of them is going to announce publicly soon but it is still kind of operating in stealth mode. I would characterize it that extremely well-known players are now going to be entering this space and it is a growing area.
MTT: Is it for any specific type of cancer? Bundles for breast cancer vs. colon cancer or any other specific oncological state?
JS: That level and detail I would need to defer to somebody at Health Design Plus for more detail. But these programs seem to work well over a wide range of malignancies.
MTT: And they would be bundled options?
JS: They are bundled options and, in some cases, like Walmart, it’s more about treatment recommendation evaluation rather than the provision of actual treatment.
MTT: And then does that follow suit for other specific disease states? Neurological procedures? IVF? Any of those?
JS: We are seeing more of that, but I think we are also going to start seeing more and this won’t be travel for treatment options. It would be more regional.
Again, this is likely to be ACO-like, with centers taking over all aspects of care for employers’ patients but in a capitated / patient-year type way. Walmart is doing this type of work regionally now in 10 or 11 markets.
With respect to the acute episodic type work, that is also starting to grow. For example, as you know, in recent years bariatric surgery has become more and more common in Center of Excellence care, and that topic was previously not common.
MTT: How important is it for the Center of Excellence to take the temperature – so to speak — of the employees that do travel? Is that something where the data is collected at the COE level through surveys or any ongoing interaction with the employee?
JS: This is in terms of patient satisfaction and not quality outcome measurements — which is a different, important conversation.
But for most of the centers I know, including ours, this type of work includes Press Gainey and HCAPS which we do with our local patients as well as with the traveling patients. We conduct Press Gainey for outreach to our destination care patients and in fact, the results with those patients are fantastic — which is really truly great.
I would recommend to others that they utilize Press Gainey, HCAPS or other benchmarking and measurement tools.
In terms of satisfaction with a specific program offering, assessment of that is generally conducted by the TPA. For example, Health Design Plus administers Walmart, and over 95 percent of the patients report that they are very satisfied or higher with their experience with the Centers of Excellence program.
MTT: Does a LeapFrog Group rating matter?
JS: Every organization makes decisions on what rating bodies they participate with, and in Geisinger’s case, we have strong positive feelings about Leapfrog, and think that Leapfrog well represents our experience.
Others that exist separately from Leapfrog often just pull from the same federal and Medicare-based data sources and simply repackage them. I think that some of those smaller rating organizations might bring a little less value than Leapfrog.
I think Leapfrog brings real value, so I would separate those types of bodies into those that have primary data – meaning data acquired versus those that have secondary, resold or repackaged data which I think might be the less interesting group.
MTT: Some of them are a popularity contest.
JS: Yes.
MTT: Let’s move to the challenges facing smaller employers. How do they manage to implement a COE program and is it possible for them to have the same kind of relationship with the Centers of Excellence that for example, a Walmart would have?
JS: We are interacting with medium-sized employers that are in late discussions with us about replicating this type of work. So, it is very achievable on a medium scale and I even think on a small scale.
The system is in place that we built for Walmart and others, and it is relatively easy for us to apply those same systems to smaller entities.
MTT: And that goes for the pricing too?
JS: This would get entertained on a case-by-case basis. But Geisinger’s position — and it is Walmart’s position too — that our business will always grow and will always be well regarded if we deal with our vendors and customers fairly.
MTT: That’s a good way of stating it – fair pricing.
JS: Look at Walmart. They are very public about this.
I don’t speak for Walmart, but they are very public about the fact that their own suppliers like Proctor and Gamble and their relationships with customers will always be the longest and best when all the pricing and direction is fair for all parties involved, especially the customer.
MTT: Do you ever encounter employers that just don’t want to do this? The pressure from the local hospitals is so strong that they don’t want to go ahead with a program like this.
JS: I know that is out there, and there’s no question in our case that the general excitement and press around this opportunity has been loud. When folks reach out to us, it’s because they are interested.
We haven’t had to do a lot of cold calling at all where we just show up with a bag and try to demonstrate capabilities. That’s why I can’t personally relate to a lot of this sales experience.
But I’m certainly familiar through other parties and associates that there are folks at some employers who appear to fear the process. There is this chasm in front of them that feels deep and wide, even though it might simply be the perception of a chasm that scares us.
MTT: On that theme, have you had any response to the publication of the Harvard Business Review Publication review of the article and if so, what was it? How would you characterize it?
JS: We have had a tremendous amount and I know Walmart and HDP have had a wide response. This has included reach-outs from other employers, other payers, other delivery systems and then many that included questions, inquiries, desires for partnerships and requests for further information.
I think that the suite of articles has received into the six figures in the number of views and it is doing very nicely in that sense. We are achieving what we all hoped for which was to further the conversation about the need for positive disruption in the nations health care system with this type of work.
As I mentioned, we recognize that there are other ways to do this that can work well. But we just wanted this to be a call to arms for other employers and for providers that we need to move on to the next wave.
MTT: Have you had any inquiries or responses from outside of the US?
JS: Yes.
MTT: Can you discuss that a little bit?
JS: Yes, I think I can discuss it in detail without mentioning the country or I could mention the country and not discuss it in detail. Which would you prefer?
MTT: I prefer both! Where are the inquiries coming from — South America, Europe or Asia?
JS: Asia.
MTT: Asia. Interesting – China, I bet. Do you feel comfortable discussing it at all? What types of people are inquiring and what kinds of services do they want?
JS: Yes, there was a visitor – a major university in a country with representatives of a large trade association also in that country. The academic and theoretic aspects of that country are of importance to this related work.
But there is also the practical application and the loose representation that they had of this specific, very large company that was interested in getting involved with the direct purchase of care in the home country where it existed.
It’s also interesting that historically in this specific country, employers have not played a massive role in healthcare. Now, they are increasingly wanting to play a role and step up to take a more active role — particularly in maintaining the health of their workforce.
MTT: Interesting. Would that be a similar type of relationship that an employer in the US would have with Geisinger?
JS: That is to be determined. But right now, it is just us advising them.
There wasn’t extensive discussion or contemplation of their associates flying from that country to the US, but it was going to be a two-fold arrangement.
One was us helping them understand how it can be applied in their home country. This is a company that also has a significant US presence that perhaps we could be involved here in the US assisting that company.
MTT: The message to the US Center of Excellence is “Think Globally?”
JS: There’s no question.
We’ve had outreach from international purchasers, and I would tell people that those conversations are worth contemplating. I think this goes beyond what existed for decades.
The one-off couple of patients that come over to the US, probably very high net worth patients, has existed forever.
I think what we are thinking about here is a systematized approach and, by the way, hopefully, a democratized approach that would be available to all the associates at a company like this and not just the highly paid executives.
MTT: What about the Europeans who consider themselves so sophisticated in the delivery of care? Are employers interested in traveling patients?
JS: I think it is up to employers to realize that this is a conversation that they can largely help control and dictate.
What I think it is eventually going to happen is a move to value-based, quality-based competition here in the US.
It’s not just by the reputation of a place, but by measurable quality measures that become the source that these providers need to compete.
On all sides of the equation, everyone needs to be comfortable that payers are going to draw the line on a piece of paper and say to us there are provider groups that are above this line and there are groups that are below.
We could spend all day blaming the test and howling at the moon about why someone is below the line. But I think we all realize that we must get over blaming the past and start realizing how to engage in this arena.