Dr Hilary Thomas has over 20 years of experience in the National Health Services (NHS), UK, where she also served as a professor of oncology and a medical director. Currently, in her role as KPMG’s Chief Medical Adviser and a member of the global Centre of Excellence in Healthcare and Life Sciences, Dr Thomas is working at the interface of healthcare and life sciences. She is involved in redesigning care models and pathways and helping organisations realign their organisational strategy and business models with the changing ways in which the public interacts.

For the Abbott Hospital Leadership Summit 2015, Dr. Thomas designed her talk as a ‘tapas’ lecture, made of snippets from healthcare organisations from around the world. In the first half of her lecture, she focused on enhancing the quality and reducing costs of hospitals. One of the notable examples she cited was the Geisinger Health System, USA - widely considered to be a pioneer in providing cost efficient and quality healthcare.

Geisinger Health System made use of financial incentives in a bid to change clinician behaviour. In the beginning, it sought to simply encourage innovation by marking a small percentage of its physician’s remuneration (~5%) with incentives for steps such as opening a virtual clinic, bringing in interventions etc. The incentive compensation model enabled the linking of salary with individual goals as well as reform initiatives of the hospital. For example, at GHS, physicians were granted a $1000 per-month stipend to encourage skill development.

The model also motivated GHS’ the physicians to move their patient records to the MyGeisinger patient portal, a rich source of information for its healthcare practitioners today.

Geisinger Health System also used incentives to encourage its physicians to implement the infrastructure on which its medical home program - the ProvenHealth Navigator - is built. This program addresses the oft-neglected needs of patients with chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease, diabetes etc. Under the model, first, high-risk patients are identified at the hospital. Then, a team comprising a nurse case manager and a community health assistant (a trained, non-licensed health worker) oversees their transition to home, visits them at their home and forms a care plan that can be easily understood and implemented by the patient. The team imparts additional services such as follow-up care, appointment management and arrangement of support services. Due to its highly interactive nature, the program also involves training nurse case managers in communication skills.

In its nine-month pilot, ProvenHealth Navigator brought to light 433 gaps in care optimisation, 201 gaps in care related to safety, 21 gaps in end-of-life planning and 416 gaps related to medication management. Over time, the program has helped reduce 30-day hospital readmission rates for patients with congestive heart failure by more than 44%. Moreover, a 90-month research showed that GHS saved about $34 (19% savings) per member per month in acute inpatient care, which alone accounts for about 64% of the total estimated savings.

Geisinger Health System’s experiments over the past two decades show that the incentive compensation model and the “medical home” care delivery model are viable ways in which hospitals can improve clinical outcomes while reducing their costs.

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