Is ‘Model Health System’ Geisinger Replicable Elsewhere?
Geisinger Health System, in central Pennsylvania, has been widely hailed as a model for health reform by leading Democrats including President Obama, the Philadelphia Inquirer reports. But, its success may hinge on "a rare combination of factors" including "a relative lack of competition, its stable patient base, and the fact that its 800 doctors are on salary," as well as an in-house pharmacy and insurance plan that covers one-third of its patients. If that's the case, Geisinger's particular achievements may not be replicable elsewhere, experts say, calling into question its status as a prized model for more costly areas of the country.
One reason the region may have attracted so much attention, the Inquirer suggests, is that the Dartmouth Atlas Project, which compares Medicare spending by region in search of big variation, has identified it as a low cost area. It averaged $6,790 per patient in 2006, compared with $9,665 in Philadelphia. "Elliott Fisher, director of the Center for Health Policy Research at Dartmouth College, said the nation could cut health spending by 20 percent to 30 percent by making everyone behave like low-cost regions," the Inquirer reports. Fisher said Geisinger has "made a very firm commitment to both improving care and reducing costs."
However, "Even people who like Geisinger's style say it would be hard to transplant to Philadelphia. Hospitals here also use checklists of evidence-based care. Some, like the Hospital of the University of Pennsylvania, have most doctors on salary. But the fact that many are paid by outside insurance companies and get referrals from distant primary-care doctors makes package pricing and extensive-care coordination difficult" (Burling, 10/18).