Geisinger cited for health plans claims violations

Danville-based Geisinger is being asked to take corrective action by the state after receiving citations for a series of violations from 2015 through 2018. 

An Affordable Care Act market conduct examination by the Pennsylvania Insurance Department (PIC) found violations within claims processing primarily involving mental health and substance use disorder services by Geisinger Health Plan and Geisinger Health Options. 

Acting Insurance Commissioner Michael Humphreys said Wednesday the examinations identified violations within claims processing, including claims being denied when they should have been paid.  

These denied claims were largely processed by behavioral health vendors, until 2019, when the company brought all behavioral health operations in-house, Humphreys said. 

“The Insurance Department’s top priority is consumer protection within the marketplace, and these examinations are an opportunity for the department to ensure that companies are held to high standards and consumers are receiving the benefits to which they are entitled,” said Humphreys. “The results of the exam will see some consumers receiving restitution, as well as expected process improvements within the company.” 

 Humphreys said Geisinger was cooperative during the examination, which covers the period from January 1, 2015, to March 31, 2016, and January 1, 2017, to March 31, 2018. A second claims experience period was added because the company indicated that it made several systems changes from 2016 to 2018, including the implementation of a new medical claims processing system. 

Geisinger issued a statement in response to the citation. 

“We appreciate the opportunity to partner with the Insurance Department on opportunities to improve, which is very much aligned with Geisinger’s mission to make better health easier for the communities we serve. The review period for this most recent Market Conduct Exam dates back as far as January 2015, and we’re pleased to share that the violations cited in the report have either already been remediated or we are in the process of addressing them.”

The examination also reported additional Unfair Insurance Practices Act violations relating to unclear communications with members, maximum out-of-pocket miscalculations, and incomplete claim files, PID said. 

 In addition, the exam found mental health parity violations, as complete and timely quantitative and nonquantitative treatment limitation (QTL and NQTL) analyses were not available, nor were QTLs and NQTLs applied correctly in some plans. 

Humphrey said Geisinger hired an outside consultant in 2019 to help address mental health parity. 

The department has ordered Geisinger to take corrective action to address the violations. Claims that were incorrectly processed must be reprocessed and accurately paid with applicable interest.  

PID said the company must adjust internal controls to address required claims notifications, accuracy and clarity in its communications with members, and oversight of producer appointments and terminations. 

The company must also reprocess all claims for which incorrect visit limits or cost-sharing were applied and provide restitution to policyholders that were required to pay more than that policy allowed. The company must provide proof of payment, including applicable interest, to the department as claims are reprocessed.  

Geisinger is ordered to pay a $125,000 penalty. 

 To date, approximately 60,000 Pennsylvanian consumers have received $5.87 million in restitution as a result of the department’s ACA market conduct examinations of other major health insurers. 

 The department said it will continue to monitor and verify that Geisinger’s corrective actions have taken place, including through quarterly reporting, as well as through a reexamination process in the future. 

PA Chamber president and CEO Gene Barr announces retirement 



Gene Barr, president and CEO of the Pennsylvania Chamber of Business and Industry, announced Wednesday that he will retire from his decade-long role as leader of the statewide business advocacy group in the second quarter of 2022. 

Barr joined the PA Chamber in 2003 as vice president of government and public affairs before he was elected president in 2011.  

“For the past decade, I’ve been fortunate to not only lead this organization, but to work with its talented staff, dedicated member organizations and our pro-growth allies in state government to create a stronger, more vibrant Commonwealth,” said Barr. “Working together, we’ve enjoyed numerous successes and while more work needs to be done to improve Pennsylvania, I am confident in the chamber’s strong leadership and staff to pave the way forward for continued success.” 

Prior to joining the chamber, Barr worked in government affairs for Harrisburg law firm McNees Wallace & Nurick LLC and was executive director for the Associated Petroleum Industries of PA. 

The PA Chamber has established a search committee to find a replacement for Barr, who will remain with the chamber until his successor is appointed and will assist with the transition.  

Nicholas Bertram, chair of the PA Chamber and president of The Giant Co. will lead the committee, followed by Brion Lieberman, vice chair of the committee and chief human resources officer at Geisinger. 

“We are sincerely grateful to Gene for his decades of service and commitment to the Pennsylvania business community,” said Bertram. “While we are certainly going to miss Gene’s leadership, I’m excited about this opportunity, which comes at a pivotal time, to shape our future. We’ll be seeking someone who not only builds on Gene’s legacy, but an individual who is passionate about the Commonwealth and will boldly lead our business community to the next level.” 

Geisinger employees sue over COVID-19 testing 

More than 70 Geisinger Health System employees filed a class-action suit against Danville-based Geisinger Medical Center and its affiliated hospitals and clinics, claiming its COVID-19 testing requirements for employees exempt from getting the vaccine force them to choose between their religion and their jobs.

Geisinger issued a vaccine mandate for all its employees in August. It require employees seeking a religious or medical exemption to do so by Sept. 10.

In a suit filed in U.S. Middle District Court Monday, the employees claim Geisinger did not warned them that by applying for a religious exemption, they would be required to be tested for the virus twice a week beginning Nov. 9, or face dismissal. They are asking the court for an injunction to halt the requirement so they can keep their jobs as the case moves forward.

Geisinger officials were not immediately available for comment. In a statement to PennLive, Geisinger said that its mandatory vaccine policy has already led to a 50% decline in the number of Geisinger employees testing positive and those out on quarantine.

“As a private employer, our mandatory vaccine policy and the process associated with it complies with the law, and similar policies have been upheld in state and federal courts,” the system wrote in its statement.

According to Geisinger’s mandate, employees exempt from the vaccine were required to be tested for COVID-19 on Nov. 9, 11 and 16. After that, tests are required twice a week. Failure to comply would result in dismissal.

The suit maintains that Geisinger is enforcing the mandate regardless of the religious views of its employees, calling the mandate a violation of their first amendment right to free exercise of religion.

The mandate effects all Geisinger employees, regardless of if they work in medical facilities or work from home. Geisinger’s rulemaking also has no support from any official mandate from the federal or state government, according to the suit.

The employees claim that Geisinger never told them that, despite the exemption, they would have to tested for COVID twice a week, wear a mask and be quarantined for longer periods of time than vaccinated coworkers. The suit says the PCR and Antigen tests required by Geisinger contain ethylene oxide, a carcinogen, which the plaintiffs must place inside their body through a nasal swab.

The suit accuses Geisinger of religious discrimination, civil rights conspiracy, violation of the equal protection clause, retaliation and violating the employees’ right to privacy and medical freedom.

The plaintiffs, represented by Williamsport-based attorney Gregory Stapp of Stapp Law, argue that Geisinger is retaliating against them because of their religious beliefs that keep them from getting the vaccine or being tested.

Several federal offices have issued rulemaking on vaccinations in the workplace including the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) and The Centers for Medicare and Medicard Services (CMS).

On Nov. 4, OSHA announced a new emergency temporary standard. As part of the standard, covered employers must develop, implement and enforce a mandatory COVID-19 vaccination policy, unless they adopt a policy requiring employees to choose between vaccination or undergoing regular testing and wearing a face covering at work.

The standard impacts two-thirds of the country’s private-sector workforce.

CMS issued its own interim final rule on Nov. 8, requiring most Medicare- and Medicaid-certified providers and suppliers to vaccinate staff within 60 days. However, staff who exclusively provide telehealth or telemedicine services outside of the hospital and do not have direct contact with patients or staff, are not part of the rule.


Reading Hospital, St. Luke’s and Hershey Medical make Newsweek’s World’s Best Hospitals list

Reading Hospital in West Reading and St. Luke’s Hospital in Bethlehem were among 13 hospitals in the state of Pennsylvania to be ranked by Newsweek’s list of the World’s Best Hospitals for 2021.

Reading was no. 92 on the list and St. Luke’s was 102.

Other Pennsylvania hospitals making the list included the state’s top ranked Penn State Health-Milton S. Hershey Medical Center in Hershey, which was ranked 77th on the list.

“We are proud to be named one of the best hospitals in the world. It is a testament to the outstanding quality care we provide to all patients on a daily basis,” says Donna Sabol, St. Luke’s senior vice president and chief quality officer.

A total of 334 U.S. hospitals made the global list.

“The hospitals on this list are at the forefront of adapting to these new challenges while providing top-notch patient care,” Newsweek said.

The magazine said the 2,000 hospitals named on the list, which covers 25 countries, stand out for their consistent excellence, including distinguished physicians, top-notch nursing care and state-of-the-art technology.

Also ranked were: Doylestown Hospital in Doylestown, 142; Lancaster General Hospital in Lancaster, 149; and Geisinger Medical Center in Danville, 304.

The entire list of Newsweek’s Best Hospitals in the world can be found here.

Penn State Health to acquire Holy Spirit Health System

After months of antitrust investigations, Penn State Health and Montour County-based Geisinger have agreed to move forward on a deal for the Hershey-based health system to acquire Holy Spirit Health System without approval from state and federal authorities.

Penn State Health announced last October that it signed a letter of intent with Geisinger to take ownership of the Cumberland County health system and its 306-bed hospital and 28 outpatient locations across four counties.

The acquisition was originally expected to be completed by June 30, but the sale date was extended after the Federal Trade Commission and the Pennsylvania Attorney General’s office asked to extend their investigations.

Neither the Federal Trade Commission nor the Pennsylvania Attorney General’s office have yet to approve the acquisition.

The two hospital systems agreed to move forward with the deal regardless of approval from either entity.

“The Federal Trade Commission and Attorney General began investigating the transaction shortly after it was publicly announced over a year ago,” said a Penn State Health spokesperson. “At this point, neither regulator has sought to preclude the parties from closing the transaction.”

The Federal Trade Commission and the Pennsylvania Attorney General’s office both declined to comment.

Holy Spirit Health System was acquired by Geisinger in 2014 and acted as a point of entry for the north central Pennsylvania hospital system to operate in the midstate.

Dr. Jaewon Ryu, president and CEO of Geisinger, said his team is confident that Penn State Health will continue the system’s tradition of faith-based care, something that it also did in its acquisition of the Berks County-based St. Joseph Medical Center in 2015.

“We firmly believe that this is the best path forward for all parties and most importantly for the communities within the Greater Harrisburg region that are served by the Holy Spirit team,” Ryu said.

There are currently no plans to disclose the financial terms of the deal, according to a spokesperson for Penn State Health.

The acquisition is part of Penn State Health’s 0, 10, 20, 30 strategy. The system aims to have patients be zero minutes from telehealth services, 10 minutes from a primary care provider, 20 minutes from a specialty care provider and 30 minutes from a Penn State Health hospital.

The East Pennsboro Township is set to act as a complement to Penn State Health’s incoming 108-bed Hampden Medical Center which is expected to be finished next summer.

“The transition of Holy Spirit into Penn State Health brings together two well-known and respected Central Pennsylvania health care organizations for the benefit of our region,” Steve Massini, CEO of Penn State Health, said in a statement. “It strengthens health care choices, preserves continuity of care for Holy Spirit patients and retains the system’s talented and experienced health care workforce.”

More than 2,400 Geisinger employees will be joining Penn State Health as part of the deal.

In a previous interview with the Central Penn Business Journal, Massini said that the deal with Geisinger allows Penn State Health to grow its practice sites and clinics in the region without building new facilities.

Massini said he was perplexed at the challenges the deal had in getting through the antitrust investigations.

“When you see how this fits in the community, what it does for competition and for jobs, I just don’t understand why this has taken so long and been such a challenge,” he said.

Update: Penn State Health and Geisinger have not.

Geisinger awarded $978,000 to improve telehealth services

Montour County-based Geisinger was awarded $978,000 from the Federal Communications Commission to upgrade the system’s telehealth services.

Geisinger, which operates Geisinger St. Luke’s Hospital in Schuylkill County, will use the money to buy telemedicine carts, tablet computers and other equipment such as hand-held cameras and stethoscopes.

Telehealth visits have skyrocketed during the COVID-19 pandemic, with providers conducting twice as many visits daily as the system’s monthly total, according to a written statement.

“Telehealth technology has allowed Geisinger providers to connect with patients while minimizing physical contact during the COVID-19 pandemic,” said David Fletcher, associate vice president for telehealth at Geisinger. “This ensures that our patients can maintain routine healthcare appointments, manage chronic conditions, and stay healthier overall even while staying at home.”

Geisinger is one of 514 organizations allocated money through the FCC’s COVID-19 Telehealth program, which has already awarded $189.27 million to health care providers across the country.

The FCC also awarded more than $499,000 to Lehigh Valley Health Network in Allentown, which is set to use the funds for videoconferencing equipment, software, tablets and network upgrades.

Geisinger study shows promise for detecting cancers

A blood test that can detect cancer early has shown what the Geisinger health network officials are calling “promising results.”

The study, called DETECT, uses a blood test developed by researchers at Maryland’s Johns Hopkins University. Geisinger used the test in a study of 10,000 women and found that it successfully screened for several types of cancer, including those for which there is no other screening test. Geisinger is a Pennsylvania-based health network headquartered in Danville, with locations throughout central, south-central and northeastern Pennsylvania.

Several participants in the DETECT (Detecting Cancers Earlier Through Elective Mutation-Based Blood Collection and Testing) study were found to have cancers, including ovarian cancer, for which there is no standard screening test. The test’s false-positive rate was low, meaning that very few people were referred for unnecessary follow-up testing or procedures.

“This test has the ability to detect cancers at an early stage when they are most amenable to treatment,” said Dr. David Rolston, chair of the department of medicine specialties at Geisinger and study co-investigator. “If the test performs well in further studies, this will be a particularly important advance as, at the moment, the only cancers that can be detected early are breast and cervical cancers in women and colon cancers in men and women.”

 Detecting cancer early allows for more effective treatment and higher survival rates, officials said.



A veteran advantage: At Geisinger, offering paid leave to reservists is raising morale and boosting recruiting

“One weekend a month. Two weeks a year.”

Chances are you’ve heard that phrase, either in an advertisement for the military reserves, or from an army recruiter in your youth.

That’s the average amount of time a military reservist must serve in active duty each year. And while it may not seem like much, fitting in those weeks and weekends while working a full time job can be stressful.

For the men and women who in the reserves, meeting the demanding needs of both military and civilian jobs is often a tough balancing act.  Concerns over using up paid vacation time in order to serve, or keeping up at work while away, can weigh heavy.

Vincent McKlosky, 33, understands those concerns well. He is a second lieutenant in the Army Reserves and works full time as a systems operations manager in surgery for Geisinger, the central Pennsylvania-based health care network.

Vincent McKlosky, second lieutenant in the army reserves and systems operations manager at Geisinger. – submitted

In recent years, McKlosky and his reservist peers at Geisinger lobbied for a paid military leave benefit, to restore a much-needed work/life balance to their lives. Geisinger, understanding that happy employees are productive employees, listened.

Early this fall, the company implemented a policy that grants 80 hours of paid military leave. No longer will Geisinger’s reservists have to use up vacation time, or take unpaid time off to fulfill their service requirements.

In addition, Geisinger will pay the difference of up to $10,000 dollars a year in salary if employees must take time away from work for active duty military service. The health and life insurance of the employee will also be maintained.

“As conflict is increasing, military training has become more labor intensive,” McKlosky said. “Before the benefit, there was lots of stress and anxiety around having to use your paid time off. Now there is a sense of relief, knowing our employer has our back.”

Christopher Grill, 32, is a former army captain, and the program manager for military and veteran affairs at Geisinger.  He says that as of Sept. 15, 32 Geisinger employees used the paid military benefit.

“It was our employees that brought this up,” Grill said. “They said, ‘Here is a challenge we are facing,’ and we listened to them. But we didn’t just listen. We took action.”

Reaction to the new paid military time benefit has been overwhelmingly positive, he said.

McKlosky said the benefit has restored his work/life balance.

“It’s nice to be able to book family vacations to Ocean City and actually use PTO for its intended purpose,” he said.  “I’m a better employee and a better serviceman for it.”

McKlosky and Grill are strong advocates for veterans in the workplace. Each champion the values that military service can bring to the civilian workforce.

From a young age, both had a desire to be a part of something bigger than themselves.

“I really wanted to give back and serve my community,” said Grill, who graduated from the United States Military Academy at West Point in 2010.

McKlosky felt the same calling. He is the latest in a proud military family to serve. “My father, uncle, brother- all were military,” he said.

Christopher Grill, former army captain, and program manager for military and veteran affairs at Geisinger, says 32 employees have used the paid-leave benefit since mid September. – submitted

McKlosky enlisted in the Navy in 2005. The GI Bill, which provides educational assistance to veterans, paid for his education at King’s College in Wilkes-Barre. Now, he uses his military skills at work.

“We have learned the ability to lead through difficult times,” McKosky said. “Veterans make good employees because they embody the qualities of integrity, a sense of duty and honor in your work. There is also the learned resiliency and every day initiative.”

It is those qualities that Geisinger wants in its employees, leading the company to actively recruit veterans, Grill said.

“Many veterans in the community ask me about Geisinger,” hel said. “Our paid military leave benefit absolutely helps with veteran recruitment.”

The company recently signed a partnership with the Army to guarantee an interview to all veterans who apply for employment.

“The technical skills that they bring with them are of enormous value, as are the soft skills, like leadership, problem solving and the ability to work under pressure,” Grill said. “Reservists come to work after using them all weekend and are able to implement those skills here, in the workplace.”

As an added source of support for veterans, Geisinger created an employee resource group to give veterans and reservists with a way to connect with one another.

For McKlosky, this supportive environment has inspired a high level of company loyalty. The ability to effect change in the workplace isn’t something he takes lightly.

“I was a big advocate for the paid leave policy and the company heard me,” he said. “They have shown a commitment to us, to their veteran employees. Because of that, Geisinger has my commitment for life.”



Geisinger receives $2.8 million to study genetic causes of high cholesterol

Researchers at Geisinger, the central Pennsylvania-based health system, received a $2.8 million grant to study the genetic causes of high cholesterol and, in time, improve detection and family screening for familial hypercholesterolemia, often referred to as FH.

People with FH have very high LDL cholesterol levels, and FH is the most common genetic cause of early, life-threatening cardiovascular disease. FH causes 20 percent of heart attacks before age 45, according to Geisinger. The disorder affects more than 34 million people worldwide and more than 1.3 million people in the United States, but less than 10 percent of these are diagnosed.

The grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health, will allow Geisinger to work with the FH Foundation, a nonprofit organization dedicated to research, advocacy and education about FH.

Family screening, known as cascade screening, has been shown to improve diagnosis rates, but an effective method for this screening has not been successfully implemented in the U.S.

“Familial hypercholesterolemia is profoundly underdiagnosed in the U.S., leading to premature death in the absence of proper identification and subsequent treatment,” said Amy Sturm, professor at Geisinger’s Genomic Medicine Institute and co-director of the MyCode Genomic Screening and Counseling Program, and one of the study’s principal investigators. “This study will focus on not only identifying FH, but also the development and design of innovative tools and programs to help individuals with FH encourage their at-risk family members to be screened for the disorder.”

FH is one of more than 30 conditions screened for in MyCode, Geisinger’s genomic medicine project. Since 2007, more than 250,000 people have enrolled in the study, which allow patients to work with their care providers to prevent or detect disease in its early stages, leading to better health outcomes.

Paid family leave policies take hold in Lehigh Valley

Charles Vail is a busy working dad. Together, with his wife Scheila, he raises a bubbly 3-year-old girl and two active 2-year-old twin boys.

With a bustling family life, it’s important to Vail that he work for a company that puts family first.  He found one, he says, in Merrill Lynch, the financial advisory firm, where, over the past 15 years he’s built a thriving career as a wealth management adviser, a job that allows him the flexibility to make time for his family.

Family first is especially important to the Vails now as they prepare for the birth of their newest addition. Scheila, a stay-at-home mom, is due in December.

Scheila and Charles Vail with their children. Charles, who works for Merrill Lynch, plans to use the company’s paid parental leave benefit when their fourth child is born next month. The policy provides peace of mind, he says. – Dawn Ouellette Nixon

Unlike the many of new working parents in Pennsylvania, the Vails are able to take advantage of a generous parental-leave policy. Merrill Lynch provides up to four months paid time off after the birth of a child to both moms and dads.

 The Vails are in a somewhat unique situation because Pennsylvania doesn’t have many statewide laws regarding parental leave, said Samantha Bononno, an attorney with Fisher Phillips, a national boutique labor law firm with offices throughout the nation.

“There is the Family Medical Leave Act,” Bononno says, “which is a federal statewide statute that provides up to 12 weeks of unpaid leave. Any employer in the U.S. with more than 50 employees must provide that. And for a lot of employees, that is the only option.”

While there are companies that offer some paid leave, most only offer paid maternity leave, Bononno said. Fathers or same sex parent partners are forced to take unpaid time off or to use vacation time.

“There are some generous policies out there for moms,” she says, “and that might include six to 12 weeks paid leave, but it is certainly not the majority.”

For the Vails, the opportunity for Charles to take paid leave after the birth of their newest child offers peace of mind at a time that can be fraught with anxiety.

Charles Vail, with his daughter Soleil, 3. – Dawn Ouellette Nixon

“It’s good to have that safety net,” Vail said. “If you are looking at the household as one unit, the mother and father, that time off is very important. You have to at least get into a rhythm, especially during the crucial first weeks, and that will allow you to be able to step away later.

“Adjusting to and caring for the new baby includes every member of the household, not just the mom,” he said.

The Vails believe that the time off after the baby is born is important not just for helping the mom out with the tasks of caring for the newborn, but for the dad to bond with the baby as well.

“Why is this just a woman’s responsibility?” Vail asked. “Mom’s got to heal, physically and mentally. And dad can help with that. It takes more than one to create a child.”

Creating loyalty

Merril Lynch’s generous parental leave policy benefits the company, too. It creates employee loyalty. According to some human resources professionals, a paid parental leave policies increase a company’s chances of hiring and keeping good employees.

“It sends the message that the company is invested in the employee and family,” says Scott Soloman, senior client executive at OneDigital Philadelphia, a Philadelphia-based human resources management firm. “That reinforces the idea that the company wants its workforce to succeed in all aspects of life, not just work. And when a company’s offerings are aligned with the needs of the employee, it increases engagement and loyalty.”

Merrill Lynch isn’t alone. Geisinger, a regional health care provider in Pennsylvania and New Jersey, recently implemented a two-week, paid parental leave benefit for its employees. This leave is open to all new female or male parents, whether by birth, adoption or fostering.

“Our employees have been asking us to consider this benefit for a few years,” says Brion Leiberman, vice president of human resources at Geisinger. “We took that feedback and used it. We listened.”

Offering paid leave makes Geisinger more attractive to new hires in today’s competitive labor market, Lieberman.

Brion Lieberman, vice president of human resources with Geisinger Health System – submitted

“Our demographic is in the prime age zone for having children,” he says. “The majority of our hires are between 22 and 40. And only 15 percent of companies today offer paid leave, so this is something that sets us apart. It absolutely gives us a leg up on the competition and increases company morale. Most importantly, it shows that we hear what our employees want and need and we respond.”

Since it was announced there has been an outpouring of positive responses from employees, he said. Many, including fathers, have already taken advantage of policy to bond with their newborn.

Labor law expert Bononno said companies that offer paid parental leave should follow Geisinger’s example and include men and women.  “If an employer is going to provide leave for women to bond with their newborn,” she said, “the same should be provided for men. Everyone should be treated equally.”

Of course, not every father or mother is fortunate enough to have paid parental leave. Some, like Keith Moser, a quality assurance officer for ULine, a Lehigh Valley-based shipping company, took a combination of paid time off and unpaid leave, secured through the Federal Family Leave Act, when his daughter Abigail was born 16 months ago.

For Moser, the time to bond with his child was invaluable.

Keith Moser with his daughter Abigail as an infant – submitted

“Time flies so fast,” he says. “These are precious moments and you miss a lot when you aren’t there. Society is sexist in that way, to say that a mom’s connection is more important than the dad’s. We are both parents equally.”

Keith Moser with his daughter, Abigail – submitted

Moser and his wife saved money to prepare for the unpaid time off, though he laments that a lot of other new parents can’t afford that.

“Federal paid leave would make sense,” he says. “It would bring families together and might even lower the divorce rate because of that increased family support.”

Moser finds it important to add that paid leave is not just good for employees and their families, but could also be good for the company’s bottom line.

“A happy employee is a productive employee,” he says.

And though Moser would support a federal paid parental leave mandate, he doesn’t believe this should be the only way paid leave is offered.

“It doesn’t need to be federally mandated if most company owners do the right thing,” he said.  “It just feels like the right thing to do. Supporting families is good for everyone.”

















Opioid crisis, telehealth are hot topics at LVB Health Care Symposium

Panelists speak on the state of health care today during a discussion moderated by LVB publisher Mike O’Rourke

Managing health care costs while providing the best possible patient care was the theme of the day for the health care movers and shakers who gathered for Lehigh Valley Business’ Health Care Symposium 2019.

Representatives from St. Luke’s Care Network, Geisinger Health Plan, Highmark Inc., and others, discussed our national health care crises before an audience of industry insiders Aug. 1 at DeSales University.

At the forefront of the conversation was the opioid crisis, and how employers are managing health care for employees with substance abuse and behavioral health issues.

While opioid-related claims have declined for Geisinger Health Plan, according to Perry Meadows, medical director of government programs for Geisinger Health Plan, opioid abuse remains a challenge.

“Most overdose deaths are not due to a single substance,” he said.

Overdose deaths are typically a combination of opioids, benzodiazepines and stimulants, according to Meadows.

Meadows also stated that the use of methamphetamines is growing as new opioid regulations make opioids harder to get access to.

One audience member, himself an employer, raised questions about how to afford drug abuse and mental health treatment for the younger family members of his employees.

“You have to balance the cost to benefit ratio,” said Meadows, who also opened up about substance abuse struggles in his own family.

Meadows then commented that 18-to-26-year-olds are not the costliest when it comes to health care. The most expensive claims are for those between the ages of 45 and 65, he said, who are increasingly battling anxiety, depression and addictions.

Affordability as a whole was an overarching subject of all the discussions, with the consolidation of local health care institutions into larger health giants raising concerns about rising costs.

“The reality is if those mergers didn’t happen, there would be communities without health care or hospitals,” said Kenneth Bertka, president of clinical integration at St. Luke’s Health Network, claiming that as the health care networks grow larger, the institutions are able to provide care to areas that had once been health care deserts.

Telehealth was offered up as another way to provide health care to areas that do not have easy access to it, and as our growing dependence on smartphones and technology allows us all to live a more remote lifestyle.

“We are expecting more,” said Benjamin T. Edelshain, vice president of clinical design and innovation for Highmark, Inc, who explained that health care customers are measuring their health care experiences against digital interactions with Amazon and Google.

“How do we use those engagement channels to reduce the total cost of care?” he questioned.

He offered virtual health care kiosks as one solution, digitally enabled to complete health assessments, installed in areas where health care is hard to reach.