If the definition of insanity is “doing the same thing over and over again and expecting different results,” as we’ve often heard, then the opposite of insanity is innovation. At least, that’s the philosophy at Geisinger, where innovation is viewed as a “fundamentally different approach to solving a problem” that’s tied to quantifiable outcomes, says Karen Murphy.
In this interview, she talks about the “data-driven” approach that was used to create the recently-launched Steele Institute, what the organization hopes to achieve, and what she learned by traveling across the country speaking with thought leaders. Murphy also discusses how organizations (both large and small) can create a culture of innovation, her passion for public health, and her journey from ICU nurse to CEO to State Secretary of Health.
- New ways to leverage AI & machine learning
- Value of working in public health
- Statewide initiative to improve access to behavioral health services
- Her early days in nursing: “That experience still influences me.”
- A culture of innovation – “Start small and communicate the why.”
- The move to value-based care
- “We’re not going to transform if we don’t start lining up incentives.”
I wish I had found public health earlier in my career and went from the public to the private sector, because I think that’s what makes the best public servant — one that is informed.
It’s taking that population health component and looking at the needs of the rural community, while using a global budget to address them.
That’s what really is what prompted me to go to CMMI — watching people every day who wanted to make a difference and wanted to improve care, but didn’t have a way to do so given the fee-for-service environment.
Innovation is a culture. Leadership needs to really communicate that innovation is a value to the organization and encourage everyone to look at fundamentally different approaches to solving problems.
The industry as a whole is not producing the outcomes in every category that we really would like to see, and the cost equation is just unsustainable. And so we have to look at doing things differently.
Gamble: One area we’ve heard that’s ripe for innovation is consumer experience. There seems to be a lot of opportunity to improve the way patients engage with their providers, and even with healthcare organizations. Are you finding that?
Murphy: Absolutely. We work in a tremendously complex system that is sometimes very difficult to navigate, and we are committed to changing that. Geisinger’s value is really in caring for patients and improving the patient experience, and so that’s an area where we’ll be dedicating a lot of work.
Workflow is another area where we feel technology can help us through artificial intelligence and machine learning. We’re going to be exploring ways in which we can leverage those technologies in ways that we haven’t attempted before.
Gamble: Right. Now, looking at your own background, can you talk about your time with the Pennsylvania Department of Health? I’m sure that was a very interesting experience.
Murphy: It was a fabulous experience, both at the federal and state government levels. I always say that I wish I had found public health earlier in my career and went from the public to the private sector, because I think that’s what makes the best public servant — one that is informed. But the experience was really fantastic, and I learned the importance of public health when I was at the State Department.
There are two things that stand out most definitively from that time. One is the horrific nature of the public health crisis with opioid abuse. The state is doing great work in this space to improve outcomes, and I’m happy to be able to continue that work at Geisinger.
The second is rural health. While I was with the State Department, we worked on an initiative to transform rural hospitals in Pennsylvania, and I’m happy to say Geisinger is participating, both as a payer and a hospital. The initiative will take a multi-payer global budget to rural hospitals, which can take them off of fee-for-service and allow them to transform in a way that makes sense for their community, and enables them to maintain — or hopefully even improve — access to care. It’s taking that population health component and looking at the needs of the rural community, while using a global budget to address them. Those were two areas I worked on that were very important to me.
Gamble: Do social determinants of health come into play in this initiative?
Murphy: Yes, definitely. Participating hospitals are required to submit a transformation plan to the federal government and the state, and all of the social determinants will be considered – transportation, food insecurity, behavioral health, etc.
Gamble: I’m glad you mentioned behavioral health. Do you believe we’re going to see more focus on improving access to care?
Murphy: Absolutely. Within the Steele Institute, we’ll be looking for innovative ways to access behavioral health specialists and be able to connect those who require services with a provider. We have a shortage in nearly every area in Pennsylvania, with the exception of Philadelphia and Pittsburgh.
Gamble: You also spent time with the Center for Medicare and Medicaid Innovation. Can you talk about what your focus was in that role, and some of the lessons you learned from it?
Murphy: Of course. While I was with CMMI, I led the work on the State Innovation Models Initiative. We worked with 38 states and territories on inculcating health innovation into state government. Nearly a billion dollars was invested to help state governments more effectively use their regulatory and policy levers to improve health and healthcare delivery, and lower costs.
Gamble: And that was done through different types of initiatives?
Murphy: Yes, it looked at partnering with Medicare and Medicaid agencies, as well as commercial payers. It looked at population health initiatives and other ways to leverage technology to accomplish those goals.
Gamble: Right. And in your career, you started out as a critical care nurse. I would bet that provided you with a unique perspective of the challenges care providers face in meeting patient needs.
Murphy: Absolutely. I spent a good portion of my career as a registered nurse in the intensive care unit, and then went on to hold administrative positions, eventually being named president and CEO of that organization (then Moses Taylor Health Care System). That’s what really is what prompted me to go to CMMI — watching people every day who wanted to make a difference and wanted to improve care, but didn’t have a way to do so given the fee-for-service environment. So it was a fabulous experience for me.
Gamble: Are there times during your career when you’ve really benefited from understanding the challenges facing nurses.
Murphy: Yes, but I’d say it helped me better understand the challenges of all types of providers. As an ICU nurse, you interact with all types of providers and systems, and it benefited me having that background. Later on during my administrative career, it helped as well. I learned new things every day; that experience still influences me and enables me to do my job better.
Gamble: And I’m sure it also highlights just how much the nursing role has evolved in recent years.
Murphy: Yes. If anything, what has changed most for nurses is the complexity of healthcare. Those who work in the hospital setting in particular face challenges that are very different from when I was in those shoes.
Gamble: And that’s where it comes into play having steering committees and getting as much user input as possible.
Murphy: That’s right. It’s why nursing is at the forefront of our steering committee.
Gamble: Now, Geisinger, of course, is a large health system, but for smaller organizations that want to use innovation to improve the way they provide care and engage with patients, do you have any best practices on how to incorporate innovation into their strategies without breaking the bank?
Murphy: It comes down to culture. You need to create a culture of innovation. It certainly makes it easier if you have resources, but I think innovation is a culture. Leadership needs to really communicate that innovation is a value to the organization and encourage everyone to look at fundamentally different approaches to solving problems.
My advice is to start small and focused, and to communicate, communicate, communicate the importance of innovation — why do we need to innovate? Why is it important that organizations innovate? The answer to that is the industry as a whole is not producing the outcomes in every category that we really would like to see, and the cost equation is just unsustainable. And so we have to look at doing things differently; coming up with new ways to improve provider satisfaction, improve outcomes for patients, and of course, decrease costs.
Gamble: The transition to value-based care is a big step in that direction. Do you believe that the industry is making progress in reaching that goal?
Murphy: I do. At Geisinger, value-based care is a priority. I think commercial payers are also looking at value-based strategies, because we’ve all recognized we are just not going to move to transform our industry if we don’t start lining up the incentive. It’s very expensive system and the prices are very high, but the system is set for us now to do more, regardless of the outcome. I think we’ve all recognized that we need to go to a value-based system, it’s just a matter of getting past the obstacles.
Gamble: That makes sense. Well, that’s about all I have for now. This has been great, and I think our readers will be interested in what the Steele Institute is doing, as well as your perspective as Chief Innovation Officer.
Murphy: Thanks, Kate. I appreciate the opportunity to speak with you.