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Geisinger has found, for example, that by adding case managers--nurses who work by phone and in person from doctors' offices--to chronic elderly-care cases (like my parents before they entered the nursing home), they can give more individual attention and produce better results. The case managers call or visit the patients regularly to make sure they've taken their medication, weighed themselves (on Bluetooth scales that send the results to the Geisinger computers), are eating the right things and are aware of upcoming appointments. They are also there to listen to complaints, which, as those of us who've been through parent care know, are not infrequent. A study published in the American Journal of Medical Quality found that this system produced 18% fewer hospital visits, a staggering 36% fewer return visits and cost savings of 7%. "Geisinger has made steady progress in reducing per capita Medicare costs over the past 20 years," says Dr. Elliott Fisher of the famed Dartmouth Institute for Health Policy and Clinical Practice. "It has gone from the middle of the pack to very near the top."
Over those years, Geisinger has quantified almost every aspect of health care. A bundle of nine routine procedures has been identified to treat diabetics, for example. The bonuses that Geisinger doctors receive depend on how closely they adhere to proven procedures, as monitored by the Geisinger computers. Bonuses also depend, in part, on how the patients rate their care, and doctors--who are not always the most sociable human beings--are asked to go through a bedside-manner orientation program called Patients 101, which schools them in basic procedures like shaking hands with members of the patient's family, looking them in the eye and introducing themselves. This sort of training is especially important in a system in which doctors sometimes must try to deny care requested by patients or their families that is deemed unnecessary. "It takes more time and effort to sit down and have a discussion with the patient rather than just ordering the duplicative X-ray," says Dr. John Bulger, Geisinger's assistant chief quality officer. But the time spent on the discreet application of candor saves money and develops a deeper level of patient trust and satisfaction.
In my parents' case, Geisinger had worked with the nursing staff at the Fairways. I was consulted about every adjustment in medication and told about every time Dad tried to do a walkabout and inevitably fell down. By the third week, the staff and I were co-conspirators, laughing about Dad's stubbornness and trying out new strategies to make him more content. The situation was, of course, horrific--Mom and Dad were both fading away--but I no longer felt so guilty and frustrated. I was part of a team making their passage as comfortable as possible. After the struggles I'd been through with Dad, it's hard for me to describe what a relief this was.