[creativ_pullleft colour=”light-gray” colour_custom=”” text=”Episode 014″]
Geisinger Health System, recognized as one of the better-run health care systems, created xG Health to export the model it used to earn the recognition. CEO Earl P. Steinberg explains how xG Health is successfully deploying Geisinger’s tried-and-true methods to help other health systems.
Earl P. Steinberg
Earl Steinberg, MD is a nationally known expert in evaluation and improvement of the quality and efficiency of health care. Dr. Steinberg was the Executive Vice President of Innovation & Dissemination, and Chief, Healthcare Solutions Enterprise at the Geisinger Health System from June 2011 through September 2015.
Tom Salemi: Hi, everyone. Welcome back to the Breaking Health Podcast. I’m here once again with our host, Steve Krupa. Hey, Steve.
Steve Krupa: Hi, Tom, how are you?
TS: Good. How’s life over there?
SK: Everything’s good.
TS: Excellent. Getting some good snow melt down there in New York?
SK: We are. We are. It’s all gone. It’s all gone.
TS: Good. Through with winter, bring on spring. I know I’m probably premature with that.
SK: You are.
TS: Anyway, let’s talk a bit about today’s Podcast. It’s nice to hear an interview with someone who really loves what they’re doing. You can hear it in their voice.
TS: And that person is Earl Steinberg, Doctor Earl Steinberg, the CEO of xG Health. It’s an interesting company in a tight space. Why don’t you sort of give us some background?
SK: Yeah. No, I really enjoy talking to Earl. I love all the interviews, but this is one of my favorites primarily because a, he has devoted his whole life in research and dissemination of best practices, all from an efficient point of view, an effective point of view in the clinical environment. And he’s been doing that for a good 30 years or so. And he got the opportunity to go to Geisinger, which is one of the great integrated delivery systems in the country, and work with them on that issue to the point which their best practices ultimately became part of a new startup, xG Health Solutions, where he works with other health systems to try to improve the quality and the cost of care across their system, and give them to tools necessary to begin to become ACOs or begin to address bundled payments and some of these different types of payment systems that are coming out from CMS. So very interesting interview. We talk about all of those subjects along with this business in this discussion.
TS: Do they have a tool for measuring success? Or do they actually help you achieve success?
SK: Yeah. So they’ve got the up front analytics to try to figure out what programs you can succeed in. And then they help you build a work flow model for those particular programs, and then they deliver software to help you to manage that workflow for those workups. So if you decided that it looked good for you in your market to begin to take bundled payment risk, they would have an entire process for you, including the software to help you improve your activities in bundled payments, likewise in the ACO market. So it is the beginning of reshaping the way hospitals think about reimbursement and the way hospitals think about their business objectives.
TS: Excellent. All right, well, let’s just get into it. It’s your conversation with Earl Steinberg of xG Health.
SK: Welcome, everybody to the Breaking Health Podcast. I’m talking to Earl Steinberg, the CEO of xG Health. And welcome to the Podcast, Earl.
Earl Steinberg: Thank you very much. Thanks for having me.
SK: I know a little bit about your background, having talked to you, and we had some parallel lives when we were investors in Active Health, and you were involved with Resolution Health. But really, your background goes back firstly to being a researcher on best practices. And it seems to me that you’ve now taken that passion for that research and built up a business career around trying to create systems for those best practices to be brought to use in the healthcare system. Can you give me a sense for your story and your path to your current position?
ES: Sure. Well, my entire career has been focused on trying to improve quality, efficiency, cost effectiveness of healthcare. So everything I’ve done over the past 35 or so years has been focused on that. As you pointed out, I started out doing research figuring out what the best way of managing a particular clinical issue or problem was, and I also did work developing measures that were practical measures that could be employed to determine whether people were doing what we believed to be the right thing to do. And then I decided to shift my focus on developing strategies and products that people could use to increase the likelihood that they would do what we believed to be the best thing to do. But all of that’s just touching the health in different places in an effort to improve quality and cost effectiveness.
SK: Right. And then you ended up really in Geisinger, which is a very well regarded health system. And were you trying to deploy these best practices within that system? Is that what you were doing there prior to xG?
ES: No. Actually I was recruited to Geisinger by Glenn Steele, who was at the time the CEO. And Glenn believed – first of all, was proud of a lot of the innovation and high quality practice that Geisinger was known for. And he believed that there was a lot of what Geisinger was doing that would be of benefit to other healthcare delivery systems, particularly as we moved from a volume to value environment. And he recruited me to try to figure out what Geisinger had that could be exported, how to go about exporting it, and then go do it. So I had the good fortune of being in a position where for 6 to 9 months I just got to study Geisinger.
ES: And I developed an inventory, the first inventory that they had of intellectual property that they had developed, and looked at which things I thought would operate, could operate outside their environment, which things were documented, you know, versus being tribal knowledge, which things were scalable, and then wrote a business plan to take those things to other delivery systems through a new company that Geisinger would spin out. And that’s what xG Health Solutions is.
SK: Let’s just talk a minute about Geisinger, just for some of the listeners that may not know exactly the details there. Why is it that you think Geisinger is a place that has developed innovation in terms of the practice of medicine? What is it about their business that sort of created these processes that they believed they could export to other health systems?
ES: Yeah. That’s a very good question. I think there are several factors. The first is Geisinger had its origin – sort of it evolved out of the Mayo Clinic model. So it was sort of the employed, multi-specialty group practice model and culture. The first CEO of Geisinger came from Mayo. So I think that origin and structure contributed to the culture of the organization. Second, Geisinger is a truly integrated delivery system in the sense that tit has a huge clinical enterprise, meaning a delivery system with, I don’t know, 9 hospitals and multiple, you know, 50 outpatient facilities, etc., etc., employed physicians, nurses, advanced practitioners. And it’s got an insurance company which has about half a million lives. And of those half a million lives, about 40% receive their care from the Geisinger Clinical Enterprise. And as a result, you have the situation where it is in their interest to work together and they have sort of the luxury of being able to test innovation in an environment in which if one side loses, the other side wins. So you know, if they wound up reducing revenue at the hospital, the insurance company is the beneficiary of that.
ES: And vice versa. So they call that 40% of members of the health plan who receive care from the Clinical Enterprise the “sweet spot.” And that’s where much of their innovation goes on. And then they just had as part of their culture innovation, you know, high quality. The woman, Abigail Geisinger, who gave the money to establish Geisinger, had a line of make my hospital the best. And they sort of have tried to adhere to that request.
SK: Yeah. So it’s interesting. I think in order for us to head forward with what you’re doing with your business today, I think it’s important to sort of have this discussion about the difference between being a fee for service provider and a capitated provider, right? I mean I have had conversations with hospital executives, OK, and they were off the record, so I wouldn’t tell you who said it, but sometimes when they look at their line items of revenue and profit, they’ll look and they’ll say, Well, sometimes we’re making money on items in the fee for service world, that is, that don’t necessarily represent the best process of care, right?
SK: Well, readmissions used to be a big part of that. Certainly, readmissions on the commercial side is, right? So when someone gets readmitted, and all of a sudden there you are collecting money on a bed that might have been empty. But in the fee for service market, their objective is basically to sell services. It’s – there’s an incentive to be the best because you certainly don’t want to be known for providing poor care. But at the same time, if there is a link between best practices and reduced revenue for a health system, there’s sort of like OK, where are we in that. And dig into that for a minute with me because I know that’s a big part of why your business is thriving is we’re moving away from that, right?
ES: Yeah. So you know, I couldn’t agree more with what you’re saying. People respond to incentives.
ES: And as you say, the incentive under fee for service is to deliver more services.
SK: That’s right.
ES: And that has driven the behavior. And I can tell you that I call it fee for service crack. You know, that if you are addicted to fee for service crack, and you just can’t get off of that, then you will have no interest in what xG Health Solutions does. So I have presented to several CEOs, CFOs where I’ve explained what we do. I’ve shown results where we have substantially reduced utilization, total cost of care and improved care, and the CFO has gone, Well, why in the world would I want to do that? And –
SK: Well, no, I respond to that in a way – you know, you can see why people get mad at the healthcare system when you’ve got that going on, right?
ES: Sure. And as you say, people don’t do it consciously, although I also have been places where they may know that they’re doing 50% more high end imaging than ought to be done.
ES: But getting them to stop doing it is not easy unless the economic incentive changes, and then miraculously it’s a lot easier to decrease.
SK: And so really, Geisinger had – the bottom line is if you do this well, and you’re taking a full capitation, which is really – and plus the insurance margin, which is what they’re doing on it sounds like around 200,000 lives or so, the money there can be substantial, and probably allow you –
ES: Yeah. So they have half a million lives in the insurance company. And I don’t want to leave you with the misimpression that Geisinger Clinical Enterprise doesn’t do – provide services on a fee for service basis.
SK: Right, right.
ES: So they do. And you know, it’s a little bit of Robin Hood, right? So they achieve a margin like everybody does on their commercial business, and they use it to subsidize some of the innovation that they do overall. But they keep their eye on trying to do the right thing for the patient, and try to come up with new ways of delivering better care at lower cost.
SK: So let me just give the listeners an overview of what you do quickly, because I want to talk about first, before we get into the company, the essence of value based reimbursement. But really, your company is designed to provide a suite of services and software to hospital systems and provider systems that want to begin to organize and engineer their businesses around quote value based reimbursement. Right? Is that a good way to describe what the company does?
ES: That’s exactly right. And you know, we are coming at this from, as we’ve just been talking about, 20 years of experience of having done it.
SK: Sure, yeah.
ES: Right? So we’re not sort of MBAs who are coming in and telling you how to redo care. We’re people who have been front line or are bringing techniques to that have been refined iteratively, and not bringing things that have failed, right? Not everything has worked.
SK: And when I think about you guys, I think you’re one of a few, right? So I can think of Kaiser, of course, at some level, right? In California, certainly InterMountain, maybe Pittsburgh Medical Center, and then there’s you.
SK: And then there isn’t really anybody else that’s really had this experience en masse, unless I’m missing somebody.
ES: Well, maybe I would include Mayo and Cleveland Clinic.
SK: Mayo, yeah. Sorry.
ES: You know, doing some of this. And we probably have each focused on different aspects of it. And the bottom line is that we decided to spin out a company that would focus on it because, well, for multiple reasons, but among them we realize that everybody who was working at Geisinger was already working 150% time. So they weren’t going to do this off the side of their desk at 11 P.M.
SK: Right, exactly. So let’s – give me your perspective on value based reimbursement. What do you think the landscape is? Is it only Medicare at this point? Is it going to evolve into a standard for commercial insurance? What’s your perspective here in the early stages of 2016?
ES: Yeah. So I would say that we cannot afford as a society not to move in the direction of value based payments. And if you think about it, if you step back and you look at it from an employer’s perspective, or you look at it from the government’s perspective, or even an individual’s perspective, who wouldn’t want there to be an incentive to provide high value care? But moving, turning the ship is not easy. And no one knows exactly how long it will take, but Medicare, as you point out, has said OK, here’s the timeline on which we’re going to move to 50 and then 80% value based care. And they’ve implemented bundled payment, probably their best, and ACOs, Medicare shared savings plan. All of these are experiments in value based payments. I think that Medicaid will move increasingly in this direction, and I think state governments will move increasingly in this direction. I think commercial is hard to predict, but there seems to be a lot going on. I don’t see them as the leading edge.
ES: But I think all the big commercial insurers are dabbling, beginning, trying to get a handle on it, and it may be that they’re only offering upside opportunities to the providers, not downside risk. But I would estimated it’ll take, you know, ten, fifteen years till we’re really up where the vast majority of care is being paid for on a value basis. I’ll tell you that the recent legislation that got us out of the sustainable growth rate stuff for paying docs, buried in that is a lot of vague language about shifting away from straight fee for service to value based payment. And one of the things I think is that fee for service, in comparison to fee for service, they’re going to make value based payment look much more attractive.
SK: Awesome. I think that’s great. I think that’s great. And so I’ve done a couple of shows on bundled payments. I had Steve Wiggins on from Remedy Partners.
SK: What – I think an interesting thing to maybe dig into, and if you want to dig into something else, that’s fine also. But I’d like to dig into the ACO. I’d like to understand what the heck that thing is. And I’m imagining that’s a big part of what you’re enabling through your company. Is that right?
ES: Yeah. So let me make a quick comment about bundled payment, and then I’ll turn to ACOs. So we’ve been doing bundled payments since 1984. Right? So DRGs are bundled payments. When people talk about bundles now, –
SK: But they’re little bundles, right?
SK: DRGs are like little, tiny bundles.
ES: Right. They’ve put more into the bundle, right? So they’ve added physicians’ fees and they’ve extended the episode by up to 90 days post discharge. The problem with bundles for episodes is that it creates an incentive for an episode. Or at least there’s no disincentive for an episode.
ES: So it still has that flaw that fee for service has. And I use sort of a saying that bigger bundles are better. Right? So the bigger the bundle, the more likely you are to get real value –
SK: Right. And the ACO is the biggest bundle of them all, right?
ES: Well, so what the ACO is is they’re basically – it’s not the biggest bundle, because they’re not truly capitated. But they’ve got financial incentives to perform and achieve a certain impact on cost of care. And if they do better than a certain amount, they get more. And if they do worse, they get less. Personally, I don’t believe that ACOs in their current structure are sustainable.
SK: OK. You’re going to have to explain that one for me. I mean I might be able to guess why, but tell me why.
ES: Well, I don’t think the payment model is sustainable for providers. It’s like a race to the bottom. And the goal posts keep getting moved, and it becomes harder and harder for the provider to come out in a way that’s financially sustainable.
ES: The other thing is that providers don’t know which patients are attributed to them. And that’s an awkward situation that you’re responsible for somebody, but you don’t know you’re responsible. And the patient has no obligation to receive care from you. So you know, I mean I understand how the design got designed. I just – I don’t think we’re going to wind up there for a large percentage of the population because I just don’t think it works from a financial perspective.
SK: So in its simplest way that you can explain, explain to me what the typical ACO reimbursement looks like so I can back into your points there.
ES: OK. So after the fact, meaning that the –
ES: – the payer looks at the provider – could be defined differently as to who the entity is as the ACO; could be a physician group, could be a hospital-centric – they decide OK, we’re looking at the claims data, and this is the provider from whom you received the most care last year. So we are attributing you to that provider. OK.
ES: Then when you add up all of those people, they look at how much money was spent on healthcare for those people last year. And let’s say that that’s X, and they could then set a price for that population, which obviously then goes down to the person, right, per member per month type thing. But for the population, they could say OK, it was X last year. We’re going to pay you X plus one percent. Well, they also could say we’re going to pay you X minus two percent, or we’re going to pay you X again this year. Geisinger, which was involved in a PGP demo and the PGP transition demo, decided not to become originally an ACO because they didn’t think it was going to be possible for them to reduce, you know, the cost to the extent that they were being expected to, given that they had been reducing costs for years.
ES: So the best way to being successful as an ACO is to come in and having been – come in having been extremely inefficient, high cost previously. Then it’s a lot easier for you to cut out some of that fat.
SK: Got you.
ES: But if you were very efficient, and now you’ve got to take another 2% off, that’s – you’re getting much harder. So you could already be way below others, but if they’re using you as your own benchmark, it gets harder and harder. So over time, you know, entities who are already efficient will find it harder and harder to be successful under an ACO model.
SK: Interesting. I don’t think a lot of people understand that, to be honest with you. I really don’t. And I get it because it reminds me of sort of like the disease management business, 15, 16 years ago, right? You’d go in there and you’d say, well, we’re going to take a bunch of these heart patients and lower their utilization. And then after you did it as a disease management company, they’d say, OK, well, that’s your new baseline.
SK: And now you gotta do it again. And you’d be like, well, wait a second, I just saved you all this money. I mean at some point we’re getting to the point where there’s a sustainable level of cost that you’re not going to be able to crack, I guess. At least –
ES: Right. And just maintaining that. So again, the places that have been most successful have been ones whose baseline was very high.
SK: So big fee for service hospitals that haven’t really had to answer to the constraints placed on them by capitation or insurance premiums and things like that.
ES: Yes. The research says 30% of services are unnecessary.
ES: Thirty percent of costs. Well, so if you started out and you’re given 50% over, right, you’ve got a lot easier job cutting out fat than somebody who had already cut out that 30%.
SK: That’s right, OK. So but now let’s dig into your business, right? So is one of the questions that you answer for your customers what forms of value based payment programs should they be involved with, based on, you know, it sounds like the idiosyncratic nature of each health system?
ES: Yeah. So the answer is yes. And a lot of places that we’ve been to have said they’ve been assessed to death. But the reality is that we can’t give good advice to some place without having a handle on their current state. So we have a very structured assessment that we perform that was honed at Geisinger over a decade of time that looks at the overall structure, governance, leadership, current performance, both from a cost and a quality perspective. How they’re getting paid, the distribution of their patients across payers, who are their – how competitive is their market, who are the big employers in their market. And from that, we can tell them OK, here’s the magnitude of opportunity that you have to take cost out and improve quality. Here’s how hard or easy that could be achieved. And then help guide them so that they enter into arrangements – I don’t remember how you said it, but it was right on – enter into arrangements that they can be successful in.
ES: As opposed to losing their shirts. And so we provide that type of assessment and advice, and then for those that go ahead and enter into those arrangements, we provide assistance in actually achieving the – realize the opportunities that we had identified and get them on the path of being positioned to being successful, as opposed to killed under value based payments.
SK: Now it seems like there’s some things that these health systems aren’t ultimately going to have a choice, right? I mean eventually the bundled – I know bundles are voluntary except for orthopedic, right? Do I have that information right?
ES: Yeah. Right now the only Medicare bundles that are mandatory, and they’re only mandatory in about 75% MSA, so it’s not even throughout the country, it’s just in 75 or so metropolitan areas for total hip and total knee replacements.
SK: So one of the questions – so you would say, all right, we’ve looked at your data and there’s upside to bundles for you. We’ve looked at your data, Geisinger, and we’re not sure there’s upside for ACOs. So this would be advice, but I’m sure Geisinger would probably find upside in bundles, I’m guessing.
ES: Yeah, they’re in bundles.
SK: And so the next step for you – so that’s a consulting arrangement, essentially. It probably uses a lot of analytics, a lot of population health stuff. But ultimately you’re going to bring, and sort of this is the essence of our discussion, forms of software and digital analytics to these systems to help them make the decision where to go from a business point of view, and then I would assume help them succeed if they go in that –
ES: Yeah, help them execute. Exactly. So, you know, to be honest, good population health is not rocket science.
SK: No, but you gotta do it. You gotta just wake up and actually say you’re going to do it, right?
ES: Right, right.
SK: I mean that’s the story.
ES: So it requires, you know, it’s the old adage of doing the right thing to the right people at the right time in the right setting. And if you did that, I mean that’s sort of at a high level what needs to be done. Now the question is how do you execute on that. And that’s where the rubber hits the road, and this experience that we have from Geisinger becomes so valuable. So Geisinger –
SK: And it’s – I’m sorry to interrupt you, Earl, but are we really dealing with efficiencies of the work process? Is that the primary? Or is it also the efficacy of the clinical decision?
ES: I think it’s both.
ES: So let me give you some examples. Number one, Geisinger believes in a team approach to care. And the research shows that for a primary care physician to do everything they’re supposed to do would take them 21 hours a day. It’s not going to happen.
SK: Well, there’s 24, you know.
ES: Yeah. So you’re just not going to work harder and get there. So you need a team, and you need an infrastructure, a system to support what you’re doing so you get more done in less time. And part of that involves off-loading responsibilities from the docs to other capable members of the team.
ES: And we use the adage of, you know, each member of the team operating at the top of their license, so that they’re not doing things that they don’t need to do. So simple things like that. Second is automating things that can be automated. So the first is delegate, right? So you’re delegating tasks that are currently being done by high priced, high cost personnel, and delegate them to lower cost. And then automating –
SK: Which basically is common sense business, right, at the end of the day.
ES: Sure. Yeah.
SK: This is what factories do, right?
ES: Yeah. It’s not rocket science.
ES: So automate things so that things that everybody agrees are supposed to get done, get done. And it’s not subject to potential human vagaries or errors. Geisinger is all about work flow and re-engineering that work flow so it’s efficient and reliable. And that may sound trivial, but Geisinger has since 2006 had something they call ProvenCare. These are evidence based modules for managing particular procedures or conditions. This was the first bundled payment. They were on the front page of the New York Times in 2006, having offered a quote warrantee to patients who underwent bypass surgery, coronary bypass. They basically said if anything had to get, you know, anything had to get done related to that in 30 days afterwards, you come in, it’s free.
ES: SO these ProvenCare modules are based on evidence based guidelines, but there’s nothing proprietary about the guidelines. They’re all out in the public domain from professional societies. What Geisinger has done is integrated them into work flow and monitored, so that complying with them is the easiest thing to do. And monitor compliance so their compliance rate is in the 90s, whereas if you went across the country, it would be in the 50s. We’ve taken care management protocols in the outpatient setting and embedded them in workflow software that our care managers or somebody else’s care managers use. And we use – we call them commando RNs. So these are specially trained and equipped nurses.
SK: Is that what it says, by the way in the manual? Commando RNs? Or is that company – because I mean you’re using some pretty cool words here: warranty, commando. You know, this is not typical clinical language we’re talking here right now.
ES: Yeah, well it’s evolved over time. I didn’t make it up in the last step.
SK: Sorry, I didn’t mean to interrupt you. Go ahead.
ES: Yeah. And then so we provide them with – well first of all, we’ve developed a training program to train case managers. Second, we’ve developed care management software in which we’ve embedded clinical protocols and rules that, based on responses from the patient to various questions, produced an action plan on an automated basis. So produces goals, produces task lists, things of that sort. We do a lot of population health data analytics. And it’s done for two reasons. Well, three reasons. One is to identify where the opportunities are to reduce cost and quantify that. So one place might be in pharmacy. Another place, radiology. Another place, the ER. You know, another place, readmissions. Etc. Or a combination. Second, it’s used to target specific patients for outreach, intervention. And when I was at Hopkins, did a lot of cost effectiveness analysis, and there’s always three options for anything, doing anything. You can do it do something for everybody, do it for nobody, or do it for a high risk subset.
ES: And doing it for a high risk subset is always the most cost effective thing to do. So you don’t have enough care management nurses to work on everybody, so you need to pick out the patients in whom you’re going to have the biggest impact. And then you need to do the data analytics to monitor performance. One of the most exciting things we’re doing, but it’s still early compared to everything I’ve talked about – everything I’ve talked about we do day in and day out. But one of the things that I was most impressed with at Geisinger was they have developed software apps. These are web apps that operate outside the EMR, but talk to the EMR. So in essence, they suck data out of the EMR, reorganize it, present it to the doc in a much more clinically useful way, and provides decision support and assistance in documentation. To we have been working on developing these web apps, and the biggest challenge is getting them to operate with the vast array of EMRs that are out there.
ES: No trivial challenge. But we have succeeded in getting them to operate with Cerner and Epic and Athena. And I think, you know, if you were to fast forward 5 to 10 years, these will transform the way care is delivered.
SK: That’s cool. I mean it’s funny, the EMRs, God bless them, right, I mean they’re out there now. But really, the bang for the buck of the EMR is going to be these applications, right? I mean it’s going to be the ability – we’re capturing the data, which I think a lot of providers would say is maybe causing them to – their ideal work day to be 21 hours, per se. But once we’ve got the data, now we’ve got to start applying some sound applications and analytics so that it becomes clinically useful and some of your ideas can get deployed, right?
ES: Right. And the thing about the data analytics, Steve, is that, you know, the most – data analyses have the most impact if the results are integrated into work flow.
ES: If you’re just posting them on some dashboard or portal or whatever, not the same as integrating it directly into workflow. That’s what –
SK: No, I mean it’s crazy, right? I have to say this is my thing. We’ve got great hospitals here in New York, but they’re not automated for the most part. And every time I see a provider, I get discouraged sometimes because I keep giving them the same answers to the same questions. I feel like, damn, if you would have just known those answers before I came in here, we would be having a much better interaction.
SK: You know? Because you would already be able to say OK, you’re at risk for this, and oh, you lost some weight, or your blood pressure is up. And unfortunately, we’re just not there. But I feel like –
ES: If you took your car in, the car place would needs to be needs to be done to your car.
SK: It’s amazing. When I do take my car in, you know, it’s in my 4th or 5th year of owning the same car. So I go in there and you’re right. They say, well, you were in here for service on this day, and we did this and that. That means we have to do this this time because we haven’t looked at whatever it is. We haven’t looked at the bearings or we have to change the oil or whatever because you’re due for that, right? You’re due for that.
ES: Right. All they did was they computerized the maintenance schedule.
SK: That’s all they did. That seems like a pretty reasonable approach.
SK: You know, it took us a while to get into the quote digital part of the business, but I always think it’s interesting to first understand the problem that digital is going to solve, right? And in your case, you’re solving a lot of problems. Or you’re improving a lot of the business for your customers. So give me – let’s scale this a little bit. How many customers do you have, and really the more important question is what have been your statistical improvements in their business over time?
ES: So we have about 30 customers at the current time. Not all of our customers are sort of recurring customers. A lot of places, after we’ve gotten them up and running, they want to bring various things in house and do it themselves. So while we have 30 customers, we have probably helped 90 customers.
SK: Got you.
ES: In terms of the impact that we’ve had, it depends on what it is that the customer hires us to do for them. So not every customer buys the same menu from the buffet. And when we are involved in doing the data analytics and we are involved in helping set up the medical home and providing the care management, we have consistently reduced utilization – I can look up on the computer – you know, 25, 35% in different areas like admissions, readmissions, ER visits, reduced cost of care by 7, 8%, and improved quality. So that has occurred repeatedly. We’ve been able to increase throughput in primary care through improvements in efficiency, pretty substantial improvement. And I mean that’s basically it. You know, reduce utilization, reduce total cost of care, improve quality.
SK: I mean it’s really admissions, readmission ED, maybe length of stay, I guess. It would really depend on the acuity of the facility, right?
ES: Yeah. So we’re working on something right now for length of stay. This is not available yet, but we’re working on it to develop an app that will enable this. But we’ve spent a year studying discharge from the hospital. And we’ve identified about 4 areas, about 60 things that if they don’t occur at 48 hours before or 24 hours before a target discharge, that discharge will be delayed. So we’ve identified the things that are most accountable for unnecessary, avoidable extra days in the hospital. And what we’re trying to do is create automated prompts so that those things that have to get done – again, it’s not rocket science. These are things related to pharmacy, respiratory therapy, DME, physical therapy, etc., where – but if something didn’t get ordered when it needed to get ordered, that patient’s in the hospital for another day. Or worse, they go home and they didn’t get something that they need.
SK: Yeah. No, no, it makes sense, right? We didn’t order that; you gotta stick around, you know.
SK: All right. So we’re getting past our time window here, but I want to take you to the sort of a common question that I like to ask. And I’m with – just to remind, I’m with Earl Steinberg here from xG Health Solutions. And I love this conversation. I could keep going, but I want to be respectful of your time. But my favorite sort of last question, Earl, is, you know, a founder of a new company, right, even though you’re sort of leveraging systems that have been in place or developed, you’ve taken those systems and built a brand new company, and you’re sort of out in the market, evangelizing what you do. And I always like to ask what’s it like to be a founder for you? You know, sort of an entrepreneur, the brand new business, and what’s it like to work at your company? What’s the culture like?
ES: So I love building things. So and as I said early in the conversation, for 35 years my career’s been focused on trying to improve quality and cost effectiveness. So it’s very easy getting up in the morning with the idea of coming into work to improve the care that people are receiving and reduce the cost. And we benefit from an incredible license. Geisinger has licensed to us in perpetuity all of the healthcare performance improvement IP that it’s had 3 years ago, and that it develops through 2022. So over a ten year period, everything that that great place develops in that category, we have a license to. But you know just getting IP doesn’t equal having a product or a service that you can deliver.
ES: In a scalable fashion. So a lot of the work that we do is transforming that raw IP into marketable services and products. The second question that you asked was what about –
SK: Culture and how –
ES: Yeah, the culture, yeah. Well, so people are here because of passion. So people are passionate about wanting to improve care, do right by patients. And they are excited about the connection to Geisinger, which both Obama and Bill Clinton cited as sort of the prototype for what we need. Now not everybody might agree with it, but I mean if I were getting care, and I was, as you know, a professor at Hopkins, but I’m used to being at really good places. Geisinger is a great place.
ES: But anyway –
SK: It’s worth moving to Eastern Pennsylvania for, right?
SK: I said it’s worth moving to Eastern Pennsylvania for.
ES: Yeah. I haven’t, but –
SK: I know, I know you haven’t, but I’m just saying.
SK: Well listen, I loved speaking with you. Thanks so much for doing this. I think we covered a lot of ground, and I think the people that listen in will learn a lot. So Earl, thank you very much.
ES: Well, thanks for having me. I appreciate it and it was a pleasure talking to you.
SK: Same here.
TS: Wow. Thanks, Earl Steinberg for visiting the Breaking Health Podcast. It’s great to hear such energy and passion around healthcare. I’m happy to have you visit us on the Breaking Health Podcast. Steve Krupa, as always, thank you. Did another excellent job with this interview. And to our listeners, thank you for joining us, for listening in, and don’t forget to tune in next week for another tale of innovation.