Dr. Jonathan Welch, MD, MSc is Chief Medical Officer, Population Health at Geisinger, where he leads primary care and population health programs across the health system. Prior to Geisinger, he served as the Chief Medical Officer of Boston Medical Center HealthNet Plan / Well Sense Health Plan, where he oversaw the care of ~500,000 commercial, Medicaid, and Medicare members across New England. Dr. Welch is a graduate of the University of Wisconsin, Madison, The London School of Economics, and Harvard Medical School.

The Pulse: Do you mind giving us the background on how your career in population health began? 

Dr. Jonathan Welch: I started in global health, and worked with Paul Farmer and Partners in Health in Peru for two years before going to medical school. My experiences in Peru really started my life in population health and in healthcare.  For me at that age, it was a real playbook for how to do this work even 20 years on here in the United States.

At that time, I worked with the program for drug-resistant tuberculosis, which requires three years of intensive daily therapy with chemotherapy-style side effects. As you can imagine, it’s very challenging to stay on the medication, even when you have potentially seen a couple of your family members die from the disease. As a result, as a healthcare organization, you have to cast a much wider net in terms of addressing the patients’ socioeconomic situations and wellbeing than what I traditionally saw in the U.S. healthcare system. In Peru, we provided wraparound support for folks to help them stick with the treatment, like adding groceries to our daily community health worker visits, and holding group therapy sessions with a psychiatrist on the weekends.

The proof in the pudding for me at that early stage in my career was that the treatment outcomes within shanty towns in Lima were better than those at the U.S. National Center of Excellence for drug-resistant tuberculosis. We knew the difference wasn’t the medication regimen, which is a narrow, standardized treatment decision. It was the full constellation of interventions that we were bringing to patients that enabled us to exceed even what we were doing in the U.S. My experience in Peru gave me the insights I needed to identify gaps in the U.S. healthcare system, which are now the gaps that I work to fill day to day in my current job.

The Pulse: Can you share a little more about your work as a clinician?

JW: I started off in emergency medicine, and I still practice today. Every time I am in the emergency department (ED), I am a witness to clinical stories that show me how our health system can serve patients better. When I walk out of a room, I think about how the world would need to change for that patient not to have shown up in the ED. Sometimes it’s  simple, like an issue with immediate access to care before the decision to go to the ED. But sometimes it’s much more aspirational and transformative – like making cultural shifts or developing tools so that, years before that visit, people are comfortable talking around the dinner table about what they want when their bodies don’t work the way they used to.

Working in the ED inspired me to go into healthcare leadership and population health because I saw that I could complement the work I did on the ground treating patients with finding ways to impact larger groups of folks across a community, state, or even country.

The Pulse: I’d love to hear more specifically about your role at Geisinger, and what you’ve been working on there. 

JW: Our team’s work revolves around how we keep populations within our community healthier, and how we can deliver care that is high quality and responsive to the needs of our patients and communities. There are two major areas, which are interrelated. The first is the population health mandate to deliver better health outcomes at lower costs while maintaining high quality. Our population health work is spread broadly across the organization, whether it’s a social determinants of health program, or a nurse care manager who is interacting with a highly complex patient.

The second area is primary care, which we believe is one of the key front doors to good individual and population health. Accordingly, all of our primary care programs are linked to our population health efforts.

Finally, we strive to be excellent stewards of the healthcare resources we’re receiving, because it’s not lost on us that the growing healthcare expenses in our country are squeezing out other needed programs.

The Pulse: Could you share a little bit about the population health approach at Geisinger?

JW: One of the key components of population health is that we need to have total cost of care responsibility. Going in, we know that somebody might historically have $1,000 in healthcare expenses per month, and our challenge is to provide higher quality care at a lower cost. As an organization, we catch any savings and can reinvest them in care models that serve folks better.

At Geisinger, we have a structural advantage because we are a health system with a health plan, and we therefore have a high degree of overlap between patients in our clinics and members in our health plan. So when we’re caring for a patient, we are likely able to deploy our population health models, and we can do that with greater ease than a traditional health system.

The other key tenet of population health is to segment your populations by clinical needs and drivers of medical expenses. Then, the task is to create programming that directly addresses those issues. In my view, the precision in that targeting is one of the key developments in population health over the last two decades. 

The Pulse: I’d love to hear more about how that segmentation approach is applied to primary care at Geisinger, and how you think about empowering consumers in your health system.

JW: The first way we think about empowering our patients is to have a set of primary care offerings that are responsive to a variety of consumer needs. In the U.S., it’s common for our healthcare systems to provide a traditional vanilla primary care model for everyone, instead of presenting a variety of options that resonate with different kinds of consumers – or even resonate with a single individual over their lifespan.  

Our primary care model is unique to Geisinger. We have differentiated offerings that depend on the clinical needs of the people we serve, which is an example of how we segment our population and address the needs of specific groups with targeted programming.

First, we have general primary care clinics that serve all individuals – from children to older adults. We also have a set of primary care clinics centered around our most vulnerable populations, which tend to have prominent socioeconomic disparities. We complement these programs with other models that patients can transition to depending on their needs. Our senior-focused primary care model, 65 Forward, allows doctors to see patients for longer periods of time within an integrated care model focused on health and wellness. We also  have a program that is nationally known as PACE. This program is senior-focused too, but designed for the most frail individuals who would normally be confined to nursing homes for the rest of their lives. Through this program, frail seniors benefit from physical therapy, socialization opportunities, and the coordination of all the home services they need to stay independent within their own homes – at a lower cost.

Finally, we have a Primary Care at Home program for our most complex patients and members in our health plan. These patients tend to have such a high degree of complexity – socioeconomically as well as clinically – where there is a compelling case for us to do intensive interventions like at-home visits to check what’s in their medicine cabinets and identify barriers to good health.

Overall, the way I like to think about our work is that we are democratizing concierge medicine for a much wider group of patients – even and especially those individuals who have the fewest  resources around them. Our models reflect our belief that the populations we serve deserve better healthcare. Our patients can come to one of our clinics and see their doctor eight times a year for longer, 40 to 60 minute appointments – a level of care that is unheard of in our country. We want patients to be able to call our clinic and speak to someone there who knows their name and backstory. Having those organic and authentic relationships helps us respond to folks because we have a better sense for who they are. That way, if a quiet, stoic patient calls in with a concern, our antennae are up, because we know there has been a significant change.

The Pulse: Are there any adjustments you’ve made to your primary care models since the COVID-19 pandemic?

JW: One interesting thing that we saw over the course of the pandemic is an increase in virtual engagement with our primary care programs. Like every health system, we saw telemedicine visits increase. At the same time, asynchronous messaging through MyChart nearly doubled, especially in the area of medical advice. In order to empower our consumers with the information they want and need, we’ve been building structures and processes to respond quickly and effectively. A big part of this effort is making sure we have resources and processes for our providers, so that they can be supported in their efforts to respond to an increased volume of patient questions outside of regular clinical hours. 

The Pulse: What new developments in healthcare are you excited about in the coming years?

JW: One thing I’m really excited about, both for Geisinger and for the healthcare space overall, is digitally-enabled care models. I think these models have the potential to be much more responsive to consumer needs. Plus, one of the key ways to address the workforce challenges of resignations and healthcare worker burnout is through new, digitally-enabled care models.

Obviously, 2022 was a banner year for artificial intelligence (AI). What I am most intrigued by as a layperson is the shift from five years ago, when the talk was about AI for rote functions, versus today, when AI seems to have captured higher expressions of humanity like synthetic art, music, and writing. In the past, the practice of healthcare was felt to be fundamentally human and relationship-based, and therefore outside the bounds of these kinds of technology tools. I’m excited to see where or how some of these technologies might enter into the relationship element of healthcare in addition to the analytics enablement that they are already providing.

Interviewed by Elena Butler, January 2023.

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On Feb 16-17, 2023, Wharton is excited to feature more expert perspectives at our annual Wharton Health Care Business Conference. This year’s theme is ‘The Empowered Health Care Consumer’. Conference details and tickets are available here.