Recently, I had a cardiac ablation at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., for my paroxysmal atrial fibrillation – the kind of specialty care that many assume requires a trip to a major urban medical center. The new technology, pulse field ablation, is cutting-edge and is so effective that it’s become first-line therapy for a condition typically treated with drugs. So, when I had a run of atrial flutter this year, I decided it was time to do something – that continuing with drug therapy wasn’t going to cut it. Even though I could go anywhere to get treated, when I searched for the very best physician and team regardless of location, it turned out that I did not have to leave the region or travel hours from home because I could receive excellent care from a highly skilled team close to where I live and work.
That experience stayed with me because I have also lived in places, like a Colorado mountain town, where specialized care is pulled toward urban centers connected to larger systems. That is not a knock on that town or the organizations serving it. Regional affiliations can stabilize hospitals and preserve access. In many parts of the country, that is the prevailing model for rural health care.
But my own experience raises a larger question: What does it take to build a different model?
At Geisinger, we are taking a different path from several common healthcare trends. We are not assuming advanced care must be concentrated in large cities. We are not giving up local control through a traditional merger. And we are not exiting the health insurance business when the market becomes difficult.
These choices are connected by one philosophy: health systems that are accountable to the communities they serve have to make decisions for the long term. Not just for this year or the next budget cycle, but for what people will need in 2031, 2036 and beyond.
The continued concentration of advanced care in large urban hubs is one of the most significant challenges for rural communities. The hub-and-spoke model can make sense when certain services need to be centralized and strong centers of excellence are important. But when too much care moves too far away, patients and families face real burdens: long drives, time off work, transportation and lodging costs, separation from support systems, and in some cases, delayed or avoided care.
Geisinger was founded on a different idea. More than 100 years ago, Abigail Geisinger created a hospital so central Pennsylvanians would not have to travel far from home for good care. That commitment still guides us.
The goal is not to provide every service in every location. That would not be clinically or financially responsible. The goal is to build the right capabilities across our region so patients can receive as much of the care they need as close to home as possible. That means strong community or critical access hospitals, coordinated primary and advanced specialty care, virtual and mobile access, transportation and emergency infrastructure, and consistent quality standards across the system.
Another common response to financial and operational pressure is for hospitals to give up local control and become part of a larger system through a traditional merger. Sometimes, that may be necessary. But it can also move decision-making farther from the communities being served. Over time, services may shift to urban centers and local capabilities are reduced.
Geisinger saw the value of scale, but we also knew we needed to preserve our identity and local decision-making. Through Risant Health, we can accelerate action that was already central to our strategy, while preserving our mission and community commitment. We can move faster on value-based care, strengthen areas like pharmacy, supply chain and technology, and build new capabilities without being absorbed into a model that pulls care – and decision-making – away from our communities.
The third trend is health systems withdrawing from insurance business. The pressure is real. Utilization, medical costs, administrative burden and policy uncertainty have made health insurance more difficult for many provider-sponsored plans.
At Geisinger, we chose to transform our health plan rather than abandon it. That required stronger operating discipline, closer alignment between the health plan and the clinical enterprise, and a clear focus on improving outcomes while managing total cost of care. Our health plan allows us to invest in prevention, reduce administrative friction for patients and clinicians, design care around community needs, improve affordability, and keep healthcare resources connected to the region.
None of this means preserving every facility, service or structure exactly as it exists today. Long-term stewardship still requires difficult decisions. The question is what will those decisions accomplish: short-term financial performance, or a sustainable strategy to strengthen access, quality, affordability and community health?
Health systems cannot do this alone. Policymakers and payers also have an important role to play. Rural and community-based care needs sustainable reimbursement, timely and thoughtful distribution of rural health transformation funds for programs poised to make the most impact, flexibility to build care models for local populations, support for workforce and digital infrastructure, and policies that reward prevention, coordination and lower total cost of care.
Admittedly, Geisinger’s model is not a formula for every organization. But the broader challenge is the same for us all: resist making only short-term decisions in response to short-term pressure.
My own care experience in Wilkes-Barre was possible because of decades of decisions to build clinical capability locally, preserve Geisinger’s mission and maintain an integrated model of coverage and care. Those choices are often harder than following the trend. They require investment, discipline and patience.
But they also show what is possible when a healthcare organization thinks in decades, remains accountable to its communities and is willing to take a different path.
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