Dr. Maria Kobylinski, chair of primary care for Geisinger, oversees the operations of Geisinger’s 44 primary care practices and has noticed a number of changes in the past 10 or 15 years. Among them are the prevalence of urgent care facilities, the influence of online communication and education, the transportation issues of a rural area and the focus on prevention.
Where patients used to wait for an appointment with their doctor, they can now stop in at urgent care facilities at a time convenient for them for acute (upper respiratory infections, sore throats, etc.) as compared to chronic issues. Geisinger is also creating more urgent care sites connected to primary care locations, offering one place that can house both options.
“What we’ve started doing is attaching these urgent care works to our primary care offices, so when a patient comes into the office they can go to the left and go right into a care work and be seen for an acute problem, or go to the right and they would be in the primary care office,” Kobylinski said. “It’s really nice if the patient coming into urgent care is really too sick. We can do a nice warm handoff and let one of the physicians in the primary care office see them. That’s been a huge success.”
The internet helps patients with MyGeisinger, the hospital’s patient portal, and with educating patients about their condition.
“Patients can message their doctor on MyGeisinger with a minor problem and not have to always schedule an appointment,” Kobylinski said. “We’ve been expanding the number of patients in MyGeisinger.”
Minor follow-up care, like medication adjustments, can also be communicated through the patient portal, saving time for physicians and patients in their daily lives.
“Any time you don’t have to miss work is always a good thing,” Kobylinski said.
Patients today have often researched their medical condition online and come to appointments with informed questions and “a new kind of ownership” of their illness.
“It’s a much more intelligent conversation,” Kobylinski said. At the same time, she now tries to steer patients toward online sites, like WebMD, with reliable, trustworthy information.
With Geisinger’s “big, geographical footprint,” administrators recognized that transportation is a problem, especially for very sick patients.
“A little over a year ago we started Geisinger At Home, which allows us to take care of our sickest patients in their house,” Kobylinski said. “That’s been a huge success. Patients love it.”
Along with home visits, Geisinger has started tele-visits, called a tuck-in. Tele-visits allow the physician to electronically check in on a patient at the end of the day. This has reduced emergency room visits and returns to the hospital.
Geisinger’s mail-order pharmacy also saves time and money for patients, with the added benefit of working with a pharmacist who has direct access to the patient’s medical records, thus providing a layer of oversight to medicine interactions and adjustments.
“A lot of my patients love it because it’s so convenient,” Kobylinski said.
To accommodate people with transportation issues or fulltime jobs, Geisinger’s primary care offices have expanded their hours, offering some evening, early morning and Saturday appointments.
“Patients are always appreciative when we make that time for them,” Kobylinski said. “We’ve been really working on seeing them the day they call for an appointment.”
Preventing illnesses will take on a bigger role in the coming years, finding ways to manage risk factors and prevent the disease from ever developing.
“We want to make it easier for people to be healthy and to stay healthy,” Kobylinski said.
Educating patients and setting achievable goals is one part of this effort. Another is working on ways to address depression before it becomes a problem.
“We now screen all patients once a year for depression,” Kobylinski said.
If signs of depression are detected, they can be treated and managed, allowing the person to continue in their daily activities.
65 Forward benefits
To care for its aging population, Geisinger has opened two 65 Forward Health Centers, in Scranton and Kingston, that offer all-inclusive care in one site. Not just a doctor’s office, 65 Forward sites provide social activities like cooking classes and card games, physical activities and exercise rooms, and more personalized physician care.
“It allows the provider to spend more time with these patients and see them more frequently,” Kobylinski said.
Primary care physicians with 65 Forward will see a maximum of 450 patients, compared to the 2,100 patients Geisinger primary care physicians see.
Going forward, Kobylinski expects Geisinger will do more of the same things they’ve already started, always finding ways to be more accessible to their patients. MyGeisinger and tele-visits have worked so well that Kobylinski is looking at ways to use them more in the primary care field. Things like follow-up care for diabetes and stroke might be handled more conveniently for the patient through an electronic visit.
Geisinger constantly searches for ways to improve patients’ health and make their care more convenient for them.
“When I meet people from other health institutions (and discuss some of Geisinger’s programs), they say, ‘We don’t do that,’” Kobylinski said. “But it’s just second nature for us.”