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Geisinger Health System shares maternal healthcare practices

JHF Team arrives on the Geisinger campus in Danville.

Nestled in the hills of northeastern Pennsylvania is one of the commonwealth's leaders in healthcare innovation. Geisinger Health System played host on July 17 to more than two dozen Pittsburghers eager to learn from its best practices around maternal care.

Geisinger, with its flagship hospital in Danville, about 70 miles northeast of Harrisburg, serves nearly 3 million patients across eastern Pennsylvania and southern New Jersey. It has managed the Northeastern arm of the Pennsylvania Perinatal Quality Collaborative (PA-PQC) since 2018. Geisinger is experienced with sharing their work to improve healthcare on a broader scale, and they exposed JHF's visitors to their maternity bundled payment model, opioid use disorder programming, model for midwives, and measurement dashboards.

Patient Safety Fellows speak with Geisinger staff.

Joining JHF in Danville for the study tour were partners from JHF's Reinvesting in Health initiative, two JHF summer interns, and a team of this summer's Patient Safety Fellows. In the morning, staff met with Dr. John Bulger, Chief Medical Officer at Geisinger Health Plan, to discuss the maternity bundle payment they have had in place since 2009. As an integrated delivery system, Geisinger manages all facets of the patient experience from payers to providers to administration oversight. This enabled them to implement a bundled payment for maternal care to work towards standardizing unjustified variations in their maternal outcomes. The bundle has supported Geisinger to set up best practice elements with milestones at each visit and trimester, then at delivery and postpartum.

The visit continued with meetings about Geisinger's Free2BMom and women's health opioid use disorder (OUD) programs. Geisinger staff discussed ways to reduce stigma, to better integrate behavioral health and patient advocacy staff into multi-disciplinary care teams, a new Right of Access form, and processes and challenges around screening. Notably, Geisinger discussed their quality improvement initiatives around substance use disorder screening during pregnancy and time to severe hypertension treatment that were generated in response to the PA PQC Learning Collaborative kickoff in April.

Geisinger staff shared their various models for midwifery integration at the community hospital level, as well as at their specialized tertiary care hospitals. They noted the value that midwives add to perinatal care but emphasized that "women are cared for by the appropriate provider in the appropriate facility." Care teams differ at each Geisinger facility based on patients' needs. .

The day concluded with a powerful first-person story from a patient participating in the opioid use disorder program shared her experience. She is now 36 weeks pregnant. Speaking to the stigma and fear that often plagues pregnant moms with OUD, she said: "I trust these doctors and nurses. You won't get your baby taken away. I won't get in trouble for getting help."

Though Geisinger's unique context gives them an advantage to innovate faster than other systems with less control over all the pieces of the patient experience, ultimately Geisinger demonstrated their willingness to think outside the box and focus on best practices and patient outcomes as the primary drivers of their work.

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