Healthcare access is increasingly treated as an engineering problem. Health systems across the country are building centralized referral hubs, deploying navigator workflows and redesigning the path from primary to specialty care. The bottleneck isn’t a shortage of desire to treat patients but a mismatch between where patients go for care and where they actually need to be.
“We’ve got to fundamentally redesign how care is delivered,” said Terry Gilliland, MD, president and CEO of Danville, Pa.-based Geisinger, during an interview with “Becker’s Healthcare Podcast.” “We identified in a couple specialties, as an example, where we have a very limited number of providers. We counted them up. There’s one that had 21,000 patients that we felt had clinical conditions that would warrant, we call repatriating back to primary care.”
The math is straightforward, even if the execution is not. If a specialist’s panel contains tens of thousands of patients whose conditions could be managed in primary care, freeing them creates capacity for the patients who genuinely need specialist-level intervention. Dr. Gilliland said the effect is significant enough to represent a structural shift in how the system approaches access.
“If you think about how much supply that frees up for our specialists and those various ones that are constrained, that’s a game changer for making it so that people can actually come in and see the right provider at the right place, the right time,” he said.
The patient repatriation strategy sits within a broader access push that includes traditional capital investments — Geisinger is building new towers and transitioning from double- to single-occupancy rooms — as well as service line expansions in oncology and behavioral health in certain communities. But Dr. Gilliland is explicit that physical plant and headcount growth, on their own, aren’t sufficient answers to the access challenge his communities face.
“We’re never going to achieve the access we need by physical plant or by services or by simply increasing the number of providers,” he said.
The constraint is real. Geisinger serves a Central Pennsylvania population that is both aging and modestly shrinking, a demographic combination that increases care demand even as the pool of working-age residents who might enter the healthcare workforce contracts. Access challenges compound in that environment. The system, which operates 10 hospitals and more than 125 care sites, can’t hire its way to sufficient specialist capacity across its geographic footprint.
The redesign Dr. Gilliland is describing mirrors what other systems are pursuing — a structural rethinking of care delivery rather than a capacity-addition strategy. But Geisinger’s version is anchored in identifying the patients currently held in specialist panels who, by clinical criteria, belong elsewhere, and moving them.
Technology is enabling the analysis that makes that intervention possible. Dr. Gilliland described a framework he has been building toward for years with a data layer that now extends well beyond the EHR to include a broad range of individual health information, an insight layer increasingly powered by artificial intelligence, and an engagement layer designed to reach patients and members outside of traditional care encounters.
“The universe in healthcare has expanded because of what’s available with technology,” he said. “But it has to still be tethered to a system of care so that when you do need that care, you can come in and see it.”
The access redesign also connects to Geisinger’s integrated health plan, which covers approximately 600,000 members. The combination of a clinical enterprise and a payer arm means the system can track outcomes and costs across the full continuum of a patient’s care — and has a financial incentive to get patients into the right setting from the start. Repatriating 21,000 patients from specialists to primary care isn’t just an access optimization; it’s a cost-of-care intervention.
Dr. Gilliland said the work is unfinished. Primary care shortage areas have worsened nationally in recent years, and Geisinger’s rural communities face the same workforce dynamics driving those gaps. Redirecting patients to primary care assumes those primary care practices have the capacity to absorb them — a condition that can’t be assumed in every geography the system serves.
“We are nowhere near where we need to be,” Dr. Gilliland said, “but we’re at least on that trajectory to achieving that.”
