- Geisinger will begin offering patients whole exome sequencing, or genomic sequencing, at no cost, CEO David Feinberg announced Sunday during a keynote session at HLTH 2018 in Las Vegas.
- The initiative builds off the integrated health system's collaboration with Regeneron Pharmaceuticals, which began in 2013 to sequence the DNA of MyCode Community Health Initiatives participants. More than 200,000 patients are participating in the MyCode program, which aims for earlier detection and identification of conditions like cancer and heart disease.
- Geisinger will sign up 1,000 patients in the new program over the next six months to roll out DNA sequencing as routine care practice, the company said.
For the whole exome sequencing effort, physicians will work with patients to understand and develop care plans. If a mutation is found, the patient will be notified within five days, and physicians will take a CME course on the diagnosed disease, Feinberg said.
The Danville, Pennsylvania-based system has been hiring genetic counselors and has also developed a genetic counseling chatbot to interface with patients and inform them of their disease state.
Feinberg told the enthusiastic HLTH crowd that the genetic piece is only "a sliver of what matters," as the system continues to advance efforts with social determinants of health.
Currently, Geisinger has 13 hospitals in its system. “I think my job is to close all of them,” Feinberg said. It's a provocative statement, especially coming from the very person who runs the facilities. But mainly, it's a high-profile example of a health system trying to manage care further upstream to improve population health, and thus better manage healthcare costs.
Geisinger has long had a reputation for innovation. For example, the system in recent years implemented a money-back guarantee.
Now, managing populations through social determinants of health is an area of focus. The idea that a ZIP code determines someone's health more than where they receive care is becoming a guiding principle for healthcare business strategies. The thinking goes — if you can head off preventable healthcare events, patients, insurers and providers will all benefit.
One major social determinant is food security. People who struggle to find enough to eat may be more likely to buy high-calorie food, which has a greater likelihood of contributing to Type 2 diabetes, Feinberg said.
Geisinger has tried managing diabetic patients by prescribing families fresh food, although there is still the question of whether such a practice is sustainable. The health system will have prescribed about 1.5 million meals by the end of this year and is scaling the program out to include obese patients and those with congestive heart failure, Feinberg said. “Metformin decreases A1c by one point, but carrots & quinoa can drop it by 2.5 points, plus our metformin is for the whole family," he said.
Geisinger is also offering free rides to people who live within 50 miles of Geisinger's catchment area. The destination doesn't even have to be a Geisinger facility; it could be a community card game. It's an effort to combat depression. “We know that loneliness and isolation have the same kind of negative health effects as obesity and substance abuse,” Feinberg said.
Historically, Geisinger has been a forward-thinking health system. As other health providers take on risk through value-based arrangements, these initiatives will become more important for evaluation.
The announcement came on the same day the National Institutes of Health opened enrollment for its precision medicine program All of Us. The effort will include collecting genetic information from some of the participants, and NIH is aiming to recruit 1 million people to contribute.