Q&A: Geisinger's CEO talks leadership, Amazon and his ideal healthcare system
Geisinger CEO David Feinberg wishes Amazon luck in its latest venture — but says he is staying at the Danville, Pennsylvania-based integrated health system he's been leading since 2015.
Feinberg made headlines early this year when reports surfaced that he turned down an opportunity to lead the Amazon-Berkshire-J.P. Morgan joint effort, opting instead to stay with the lower-profile Geisinger.
In an interview with Healthcare Dive, Feinberg shared his views on the ideal American healthcare system, leaders he admires and what we can expect from Geisinger in 2019.
The year has been busy for health system, from building out population health initiatives like SpringBoard Health and Fresh Food Farmacy to offering patients whole exome sequencing through MyCode Community Health at no cost.
The programs use Scranton, Pennsylvania, as a testing ground.
"We bring it all to Scranton because we think if we can show it in one city, all of our stuff, then we have the playbook that we can take to other communities that we serve," he told Healthcare Dive. "And we’re happy to share that playbook with anyone, because we want people to be healthy."
Here are the highlights of our conversation with Feinberg.
HEALTHCARE DIVE: What's in store for the year ahead?
DAVID FEINBERG: I think we'll be launching a national genomics program in 2019 and we'll probably be — maybe this is the wrong word — franchising our Fresh Food Farmacy outside of our boundaries. Those are two programs that I think we want to share more broadly and are trying to figure out the ways to do that in 2019.
In thinking about leadership and styles or methods of leading, who or what are your biggest influences? Who is leading or has led well or differently, so well or differently that they've earned your admiration?
FEINBERG: I'm a big fan of Abraham Lincoln. I think he's a guy who made decisions that were really hard and gut-wrenching and not always popular. He's somebody I've always looked up to. I'm a big fan of what Martin Luther King has done.
I would say today that the ones who I've learned the most from, from a leadership standpoint, are the incredibly powerful women who are saying enough is enough, we need equality and equity. Sometimes that's my 26-year-old daughter, or my wife, or incredible physician colleagues I have here or physician executives who are women. I just think it's fantastic what's happening and I'm learning so much from them.
You turned down the Amazon-Berkshire-J.P. Morgan job to stay at Geisinger. Can you walk me through that decision-making process?
FEINBERG: So, I'm a good guy and I don't like to kiss and tell. I wish that organization the absolute best of luck. I think Atul [Gawande] is a spectacular leader, and I think time will tell about that. To me, there was just, well —everything we talked about so far is what is so exciting to me, as far as that goes. I don't really want to get into that. I never said anything. The media said stuff and I put out one statement. So I don't want to get into it. Some of it is fake news and all that. I think it's a great organization coming together.
I have great respect for Kaiser. If you look at Kaiser's history, it started in the same way. Kaiser, which was making ships, said, 'We think healthcare is too expensive.' They got out of the ship business and obviously have been doing really well in the medical business. The Kaisers today are certainly Jamie Dimon and Warren Buffett and Jeff Bezos, and that they are saying healthcare is too expensive and not easy to use and we want to fix it and start with our own workers is phenomenal.
I think it's great, and they're right, it's too expensive and hard to use and doesn't have a great outcome. We'll watch them and wish them the absolute best of luck.
Can you describe your ideal American healthcare system? I know it’s tough to talk about healthcare as a monolith, but what would your ideal system look like for patients, for providers, for payers, for pharmacists?
FEINBERG: For me, the ideal healthcare system would be proportionate to the true things that determine health. So, 20% of health outcomes — whether you're going to have life in your years and years in your life —has to do with having access to good doctors and hospitals. Let me put that 20% aside and say, 'Hey, we're working on that stuff.' But it's the other stuff, the other 80% that determines 80% of your morbidity and mortality — and that is your genetic code, your ZIP code, your socioeconomic status, your behaviors, your lifestyle, all those things. And so the ideal healthcare system that we need to get to is putting at least 80% of the resources and 80% of the people and 80% of the thoughts into that stuff.
We keep focusing on the 20%, but it doesn't drive the difference. You can be born in Philadelphia today, two miles apart, you can go to the same doctors — the exact same doctor in the exact same hospital, treated by the exact same nurses, and you have a life expectancy difference of 25 years.
When I was born, 56 years ago, the chances of me getting Type 2 diabetes was one in 100. If I were born today, one in three. So we can talk about the cost of medications, we can talk about closing care gaps and making sure diabetics get their eyes screened — Google can now screen the retina better than some ophthalmologists, and that's great — but to me, what we need to start to do is talk about how to get people not to have Type 2 diabetes. We spend more on obesity in the United States than we do on defense. So, when we talk about decreasing healthcare costs, just obesity alone is probably 5% of GDP.
Those kinds of things happened in my lifetime. I think in the rest of my lifetime we need to focus on the proven social and behavioral norms to get people healthy again.
For some people it's making sure they have access to food. For some people it's making sure they have the ability to have literacy to understand health issues. For some people it's making sure they're in an environment where people aren't shooting one another. For others it's making sure they have hope and don't have to turn to substance abuse. It's alcohol in moderation, it's exercise, it's the built environment.
So the healthcare system I would design would spend most — I'd say 80% — of its efforts on those things, and then we actually don't have to worry about how much that MRI costs because we probably just decreased demand for MRIs by 50% and decreased demand for inpatient beds.
The healthcare system, the one we all spend our time thinking about, is starting to reform itself anyway. It's getting better. I think the quality has improved over time. I think the technology is kind of fantastic. I think as people move more toward value those things will continue to improve, but most of my efforts would be on that other stuff, because that's the stuff that matters. We just don't think that way in this country, in the right way.
To get medicine approved for diabetes, for example, you have to get FDA approval that the medicine is safe and that it works, right? It has efficacy, those are the two things. To show that food works for diabetes, it's obviously safe and it certainly works, but they ask these other questions: Well, is there a return on investment? Is it worth the investment to do it?
We don't ask the return on investment question for everything in the medical industry, we only ask it for the preventative stuff. All we have to do is flip that question. Let's do all the preventative stuff without asking that question. We know it works and it's safe. And then when we ask things on the medical side, let's ask, 'Well is there really a return? Does this drug really extend life so long that it's worth it?'
If we start doing that, I think we would change the complete trajectory of our system and it would turn into lower costs for healthcare so it would become affordable again, and it would be higher quality because a lot less people would be lining up for the care. That, for me, is the healthcare system that we've got to strive to get.
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