Geisinger makes cut for vetted network of imaging providers: 'Savvy employers like Walmart know the real thing when they see it'

Geisinger has earned designation as a Radiology Center of Excellence by Covera Health, a New York City-based company that uses advanced clinical analytics to objectively measure quality in radiology.

With its new distinction, Geisinger joins a national program that integrates with self-funded insurers' existing health networks to steer community members toward local radiology providers based on their diagnostic accuracy — not price — to curb misdiagnoses. Danville, Pa.-based Geisinger is also a member of Covera Health's Quality Care Collaborative, in which participants receive practical, actionable feedback to improve their clinical practice.

Walmart is one of the most influential employers that taps Covera Health's Radiology Centers of Excellence for associates' diagnostic needs. Bentonville, Ark.-based Walmart expanded its Centers of Excellence program — established in 2013 — to cover diagnostic imaging through a multiyear partnership with Covera Health this spring. As a result, the 1.1 million people on Walmart's medical plan have access to Covera Health's Radiology Centers of Excellence, which supports better outcomes through a nationwide network of vetted radiologists who receive ongoing quality performance feedback and support.

Jonathan Slotkin, MD, director of spinal surgery for the Neuroscience Institute and associate chief medical informatics officer at Geisinger; Aalpen Patel, MD, chair of Radiology for Geisinger; and Ron Vianu, CEO of Covera Health, recently caught up with Becker's Hospital Review to discuss Geisinger's new distinction as a Radiology Center of Excellence and opportunities for payers, providers and employers to collaborate.

Question: What challenges in healthcare does Geisinger hope to resolve by joining Covera's Quality Care Collaborative?

Dr. Jonathan Slotkin: For us, it's not only about the challenges we face, it's the challenges our nation faces. The healthcare system in the U.S. is broken. Employers are purchasing healthcare for 49 percent of Americans, which is more than Medicare and Medicaid combined. The most innovative employers have realized they actually control the market. Nobody is about to ride in on a white horse to save [the industry] — not the government, not insurers, not even providers. Most employers are taking a leap now and saying, "We want better care quality for our associates and for the country."

Unwarranted variation in care in the modern era almost always begins with imaging. Imaging is the gate where all invasive, expensive care starts. Imaging is not a commodity, but it's been treated as such — as if it's the same everywhere and you just get in the machine and an image turns up. Unneeded imaging, poor quality imaging or misinterpreted imaging all increase the chances that you don't get the care you do need or get invasive treatment that you don't need. Innovative employers like Walmart are now taking a step back from just acute episodic care and looking toward the places where care starts, which in this case is imaging.

Dr. Aalpen Patel: When a diagnosis is not made properly or there's significant variation in the diagnosis, we have a big problem. How do you deal with that within radiology? What patients and payers and, in some cases, employers don't understand is that radiology is not a commodity.

If you were to simplify it, there are two fundamental segments in radiology quality — image production and image interpretation. First, is the quality of the image produced actually showing you abnormalities you need to see? Second, once you see what you need to see, are you making the right diagnosis? When we look at quality programs, those questions are going to be at the forefront — and Covera and Walmart have recognized that. Covera is offering a much more robust tool to objectively manage the quality and diagnostic accuracy within radiology. Once you have that, you can share objective feedback with the radiologists, so the quality improvement process happens in a much more palpable way.

Q: What should other radiology provider groups know about/expect from Covera Health’s Radiology Center of Excellence designation process?

JS: From the health system side, the highest levels of the organization need to make a decision to do things differently. As a system, we've decided that we think about the total episode of care and the total cost of care. We are not beholden to unit costs. When an organization makes that decision, everything else comes naturally.

I wouldn't say it comes easily, because this work can be hard at first. But you make a decision to say, "We're going to build the processes, have them in place and measure the outcomes that matter to patients. We're going to actively seek building arrangements with direct employer purchasers." Those are the steps the organization needs to go through before getting involved in any of this work, including diagnostic radiology. It's not something where you just wake up and say, "We want this business and we're going to do it." Savvy employers like Walmart know the real thing when they see it.

Ron Vianu: With any provider group new to Covera, we like to begin with a conversation about whether a partnership makes sense for their organization. To succeed, it's critical that there's meaningful alignment across the organization based on a belief that participation can drive real value to their patients, physicians and employers. If there's only alignment with a subset of stakeholders — only two of six necessary decision makers, for example — there's a lot of reeducation that needs to happen across teams, which slows the process. But if all the necessary folks understand why they're doing this and why it's important, the process from that point forward is very smooth.

In terms of the process itself, there are multiple steps that may include an onsite visit with the clinical team, as well as bringing on the organization from a legal, compliance and regulatory perspective. All participating institutions — whether health systems or individual provider groups — join the Quality Care Collaborative, which lets us view information within the system and provide feedback. Then there's ongoing back-and-forth exchange of data between the two organizations.

JS: The easiest way to work against this arrangement is to have a posture or language that you're the 800-pound gorilla provider system and an employer has to have you, as if you are the giant roaming the earth. That's the fastest way to have these smart employers run in the other direction. Large employers are savvy to that behavior and what it means.

Q: Can you share any reactions from Geisinger's radiologist community and or the patients involved in this program?

AP: We discussed it at a high-level with our faculty radiologists, and the initial reaction has been very positive. Our physicians look for ways to improve themselves and understand their strengths and weaknesses. The designation as a Radiology Center of Excellence and participation in Quality Care Collaborative gives them a robust tool to improve their diagnostic accuracy and improve care. Along with patient, payer, and employer education about quality in radiology, I think provider education about the Quality Care Collaborative and quality tools is very important — we plan to educate them specifically on how to use the feedback they receive and integrate it into their practice. 

Q: What's next for innovation in healthcare quality? What role will employers, payers and providers have?

RV: With respect to the Radiology Center of Excellence program, there has been an overwhelmingly positive reaction and receptivity from the employer, payer and provider communities, who recognize that this is something that's been sorely missing in the quality dialogue and they're excited to bring this to their organization. Above and beyond that, there are exciting and interesting things in the works, which will further support this mission, which we hope to announce shortly.

JS: If there's one message we want to get out, it's that you don't have to be the size of Walmart to benefit associates with this kind of innovation. We're seeing increased interest in direct-to-employer care from medium-sized employers and even small and conglomerates of small employers. We think we're going to be involved in a lot of work in that space imminently. One other thing we will increasingly see is desire from smart employers and provider systems that are ready to keep moving innovation efforts earlier and earlier in the cycle of care. Imaging represents a huge step in that direction. I think we'll be seeing from a lot of smart players work to democratize and distribute this approach in the cities where people live, and increasingly for chronic disease management and primary care.

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