at Geisinger Health System

Qal‘at al Maḑīq, Syria

at Geisinger Health System

Qal‘at al Maḑīq, Syria

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The rising prevalence and cost of Type 2 diabetes has doctors at Geisinger Health System turning to food as a form of medicine. They're prescribing free, fresh food to low-income patients.(Image credit: BigFishDesign/iStockphoto/Getty Images)


News Article | December 22, 2016
Site: www.eurekalert.org

DANVILLE, Pa. - A study conducted by Geisinger Health System in collaboration with the Regeneron Genetics Center (RGC) has found that a life-threatening genetic disorder known as Familial Hypercholesterolemia (FH) is both underdiagnosed and undertreated. It was published in the peer-reviewed journal Science on Dec. 23 alongside another significant study from the same Geisinger-RGC collaboration known as DiscovEHR. That other study describes exome sequencing and analyses of the first 50,726 adult participants in the DiscovEHR cohort - all members of the Geisinger MyCode Community Health Initiative. In the FH study, the collaborators examined genetic variants causing FH in the DiscovEHR cohort and then compared the findings against the de-identified medical histories of these patients as contained in Geisinger electronic health records. Traditionally, in the United States, FH is diagnosed in patients with high cholesterol who also have a family history of early heart attacks and strokes. Genetic testing for FH is currently uncommon in clinical practice. FH is caused by a defect that makes the body unable to remove "bad" cholesterol from the blood. This cholesterol (low density lipoprotein cholesterol or LDL-C) then accumulates, often undetected, and can lead to early death from heart attacks or stroke - even in very young people. Results of the new study found many undiagnosed cases of FH and helped to define the extent of FH in the general population. "The study shows us that FH is about twice as common as it was once thought to be, and that large-scale genetic testing for FH helps identify cases that would otherwise be missed," said Michael F. Murray, M.D., Geisinger director of clinical genomics. "We now hope to use DNA sequencing to guide better management for patients." Among the many findings of the study were that 1 in every 256 people has a disease-causing mutation, or variant, in one of the three FH genes. It showed that participants with a deleterious FH gene variant had significantly higher "bad" cholesterol than those without an FH gene variant. They also had significantly increased odds of both general and premature coronary artery disease. "Being able to connect patient's de-identified medical records with their DNA data is an advantage that few others in this field have. Paired with the RGC's unique technological and analytical resources, we are able to make meaningful discoveries that may advance the implementation of precision medicine today and the development of new or improved medicines tomorrow," said Noura Abul-Husn, M.D., Ph.D., associate director of translational genetics at the RGC and co-author of the paper. The study identified 35 mutations, or variants, in the genes LDLR, APOB, and PCSK9 that have been determined to cause FH. Only 24 percent of people who carry FH-causing variants had sufficient criteria within their electronic health records to support a probable or definite FH diagnosis, meaning that without genetic confirmation, many of these patients would go undiagnosed and likely undertreated. Indeed, 42 percent of people with these FH-causing variants did not have a recent active prescription for statins, the first line therapy for cholesterol lowering. Among statin-treated people with FH-causing variants, less than half met goals for cholesterol lowering. "Geisinger is committed to translating this important research directly into improved care for our patients," said Geisinger Executive Vice President and Chief Scientific Officer David H. Ledbetter, Ph.D. "We have begun a major effort to confirm individual patient findings and inform individual participants and their doctors when genetic findings, that are known to cause illness, are discovered in our population," he said. FH is one of 27 genetic conditions being targeted at Geisinger. So far, nearly 200 patients - including 29 FH carriers - have already been informed they carry one or more disease-causing genetic mutations with consequences that can be treated. These conditions are mainly related to risk for cancer or cardiovascular illness. The effort to return individual results will continue as more findings are confirmed. For details see go.geisinger.org/results. The MyCode Community Health Initiative is a precision medicine project, originally launched in 2006, at Geisinger Health System in which Geisinger patient-participants have consented to donate blood and other biological samples to a system-wide biobank designed to store those samples for wide research uses and for genomic or precision medicine. The DiscovEHR human genetics study population for this analysis includes 50,726 adult Geisinger Health System patients who agreed to participate in the MyCode Community Health Initiative. More than 125,000 MyCode participants have consented into the program to date. MyCode volunteers have given informed consent to allow sharing of de-identified electronic health records, provide samples that can be linked to their health records for broad research, and permit re-contact for additional studies. Electronic health records for this group are available for a median of 14 years of clinical care. For patients who have been sequenced as part of DiscovEHR, Geisinger will confirm preliminary research findings in a lab facility that is certified to the Clinical Laboratory Improvement Amendments (CLIA) Act, the federal standard for clinical testing. Qualified Geisinger personnel will provide the results of confirmatory CLIA-certified testing to patients and their primary care providers along with genetic counseling and appropriate referrals to other specialists. Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care delivery models such as ProvenHealth Navigator® and ProvenCare®. As one of the nation's largest health service organizations, Geisinger serves more than 3 million residents throughout 45 counties in central, south-central and northeast Pennsylvania, and also in southern New Jersey with the addition of AtlantiCare, a National Malcolm Baldrige Award recipient. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 12 hospital campuses, two research centers and a 551,000-member health plan, all of which leverage an estimated $10.5 billion positive impact on the Pennsylvania and New Jersey economy. Geisinger has repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit http://www. , or follow the latest Geisinger news and more on Twitter and Facebook.


PubMed | Thomas R Graf Is Chief Medical Officer For Population Health And Longitudinal Care Service Lines At Geisinger Health System, Time Solutions, at Geisinger Health System, Daniel eng Is search Investigator For The Center For Health Research At Geisinger Health System and 2 more.
Type: Journal Article | Journal: Health affairs (Project Hope) | Year: 2015

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health Systems patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.


BOCA RATON, Fla.--(BUSINESS WIRE)--Integrated Dermatology Group (IDG), one of the country’s largest providers of dermatology care, has expanded its presence in Maryland by partnering with Dr. Hyland Cronin in the former practice of Richard J. Castiello, M.D. Dr. Cronin will serve as the Medical Director of the practice known as Integrated Dermatology of Chevy Chase, LLC. Dr. Cronin is a board certified dermatologist and specialist in skin cancer, Mohs micrographic surgery, and reconstructive surgery. She graduated Summa Cum Laude at the University of Notre Dame and received her medical doctorate degree from the West Virginia University School of Medicine. Dr. Cronin completed her Internal Medicine Internship at Loyola University and her Dermatology Residency at Geisinger Health System. Following her residency, she completed a fellowship in Mohs Micrographic Surgery under the direction of renowned Dr. Glenn Goldstein at The Dermatology and Skin Cancer Center in Leawood, Kansas. Dr. Cronin has authored numerous research publications along with book chapters and performs surgical treatment on more than 1,500 patients annually. She is strongly dedicated to the care of her patients and the treatment of skin cancer, with a focus on achieving excellent cosmetic outcomes. “By partnering with or selling to IDG, the dermatologist can focus on providing high-quality patient care while IDG manages the infrastructure and back-office operations of the practice, ensuring best clinical practices, outcomes, and long-term profitability,” said Jeff Queen, co-CEO of Integrated Dermatology Group. “For dermatologists who want to monetize all of their practices’ value, IDG has a program that allows them the opportunity to do so. These dermatologists are able to continue practicing dermatology while accruing additional income from the practices’ growth,” said Andrew Queen, co-CEO of Integrated Dermatology Group. IDG is continuing a systematic expansion. The Chevy Chase announcement comes on the heels of the recent announcement of its partnership in Washington D.C. (Integrated Dermatology of I Street, LLC), Boca Raton, Florida (Integrated Dermatology of East Boca, LLC), and Lone Tree, Colorado (Integrated Dermatology of Lone Tree, PLLC). For more information about one of the Nation's largest and fastest growing dermatology groups, with practices located across the country, please contact Integrated Dermatology Group at www.mydermgroup.com or call Jeff Queen at 561-314-2000, extension 1038. Headquartered in Boca Raton, FL, Integrated Dermatology Group is one of the country’s largest providers of dermatology care. The company has expanded its presence nationally by acquiring and partnering with dermatology practices across the United States. This exclusive model allows selling dermatologists to maximize the monetary value of their well-established practice while allowing them the choice of either retiring or remaining at the practice indefinitely. Simultaneously, IDG affords all dermatologists the unique opportunity of immediately joining an established private practice as a partner, not an employee, with the infrastructure, support, and resources the larger group provides. IDG's mission is to improve the quality of practice life for its dermatologists while adding to their financial success. As part of IDG, dermatologists focus on providing high-quality patient care while IDG removes the stress of day-to-day management by implementing best practices in the areas of compliance, financial services, human resources, payers and more. For additional information, visit www.mydermgroup.com.


News Article | November 17, 2016
Site: www.eurekalert.org

In order to promote standardized reporting of medically actionable information from clinical genomic sequencing, the American College of Medical Genetics and Genomics (ACMG) in 2013, published a minimum list of genes to be reported as secondary findings during exome or genome sequencing. The goal was to identify and manage risks for selected highly penetrant genetic disorders through established interventions aimed at preventing or significantly reducing morbidity and mortality. Subsequently, in 2014, the ACMG established the Secondary Findings Maintenance Working Group (SFWG) to develop a process for curating and updating the list of recommended genes periodically. Now, the ACMG has released a highly-anticipated Updated Policy Statement, "Recommendations for Reporting of Secondary Findings in Clinical Exome and Genome Sequencing, 2016 Update: a Policy Statement of the American College of Medical Genetics and Genomics," with four new genes added to the list of recommended secondary findings, along with the elimination of one of the earlier genes from the 2013 list. The new, updated secondary findings list - ACMG SF v2.0 - includes 59 medically actionable genes recommended for return in clinical genomic sequencing. The updated policy statement is available online ahead of print in ACMG's peer-reviewed journal, Genetics in Medicine, at http://www. . "The updated ACMG Secondary Findings list preserves the spirit and intent of the original list," according to David T. Miller, Medical Geneticist at Boston Children's Hospital, and co-chair of the ACMG Secondary Findings Working Group. "This new list also reflects ACMG's commitment to giving the genetics community a voice about which genes to include to further the goal of providing people information that can have a huge impact on their health outcomes," says Miller. "Applying the new process, while upholding the core principles of the original policy statement, resulted in the addition of four genes and the removal of one gene; one gene nominated did not meet criteria for inclusion at this time in the ACMG SF v2.0," said Michael S. Watson, executive director of the ACMG. Between March 2015 and May 2016, six nominations to the SF list were received and evaluated by the SFWG. One of these, PTCH1 associated with Gorlin syndrome/nevoid basal cell carcinoma syndrome, did not achieve SFWG consensus for addition due to insufficient evidence that knowledge of a known or expected pathogenic variant in the gene would alter medical management. Four other genes-- BMPR1A and SMAD4, associated with juvenile polyposis, ATP7B associated with Wilson disease, and OTC associated with ornithine transcarbamylase deficiency-- received a unanimous vote from SFWG members for addition to the list. One gene currently on the list, MYLK associated with familial thoracic aortic aneurysm and dissection, was removed. The ACMG Board subsequently reviewed and approved each of the six recommendations of the SFWG: exclusion of PTCH1, addition of BMPR1A, SMAD4, ATP7B and OTC, and removal of MYLK. The Updated Policy Statement also discusses more details of the adjudication process such as the nomination form, determination of an actionability score, the review process, etc. Moving forward, the SFWG plans to accept nominations from other medical specialty organizations. The ACMG also intends to develop resources to assist clinicians in medical management based on specific Secondary Findings. According to Dr. Christa Martin, director of the Autism & Developmental Medicine Institute at Geisinger Health System and co-chair of the ACMG Secondary Findings Working Group, "The SFWG is planning on updating the list once or twice per year at most; we're sensitive to the potential burden placed on clinical laboratories who will need to make changes to their bioinformatics analysis pipelines every time the list is updated. In addition, each revision will have a new versioning number and date of implementation for easy reference." Founded in 1991, ACMG is the only nationally recognized medical society dedicated to improving health through the clinical practice of medical genetics and genomics. The American College of Medical Genetics and Genomics provides education, resources and a voice for 2000 biochemical, clinical, cytogenetic, medical and molecular geneticists, genetic counselors and other healthcare professionals, nearly 80% of whom are board certified in the medical genetics specialties. The College's mission is to develop and sustain genetic initiatives in clinical and laboratory practice, education and advocacy. Three guiding pillars underpin ACMG's work: 1) Clinical and Laboratory Practice: Establish the paradigm of genomic medicine by issuing statements and evidence-based or expert clinical and laboratory practice guidelines and through descriptions of best practices for the delivery of genomic medicine. 2) Education: Provide education and tools for medical geneticists, other health professionals and the public and grow the genetics workforce. 3) Advocacy: Work with policymakers and payers to support the responsible application of genomics in medical practice. Genetics in Medicine, published monthly, is the official ACMG peer-reviewed journal. ACMG's website offers a variety of resources including Policy Statements, Practice Guidelines, Educational Resources, and a Find a Geneticist tool. The educational and public health programs of the American College of Medical Genetics and Genomics are dependent upon charitable gifts from corporations, foundations, and individuals through the ACMG Foundation for Genetic and Genomic Medicine.


News Article | November 18, 2016
Site: www.biosciencetechnology.com

In order to promote standardized reporting of medically actionable information from clinical genomic sequencing, the American College of Medical Genetics and Genomics (ACMG) in 2013, published a minimum list of genes to be reported as secondary findings during exome or genome sequencing. The goal was to identify and manage risks for selected highly penetrant genetic disorders through established interventions aimed at preventing or significantly reducing morbidity and mortality. Subsequently, in 2014, the ACMG established the Secondary Findings Maintenance Working Group (SFWG) to develop a process for curating and updating the list of recommended genes periodically. Now, the ACMG has released a highly-anticipated Updated Policy Statement, "Recommendations for Reporting of Secondary Findings in Clinical Exome and Genome Sequencing, 2016 Update: a Policy Statement of the American College of Medical Genetics and Genomics," with four new genes added to the list of recommended secondary findings, along with the elimination of one of the earlier genes from the 2013 list. The new, updated secondary findings list - ACMG SF v2.0 - includes 59 medically actionable genes recommended for return in clinical genomic sequencing. The updated policy statement is available online ahead of print in ACMG's peer-reviewed journal, Genetics in Medicine, at http://www.nature.com/gim/journal/vaop/ncurrent/abs/gim2016190a.html. "The updated ACMG Secondary Findings list preserves the spirit and intent of the original list," according to David T. Miller, Medical Geneticist at Boston Children's Hospital, and co-chair of the ACMG Secondary Findings Working Group. "This new list also reflects ACMG's commitment to giving the genetics community a voice about which genes to include to further the goal of providing people information that can have a huge impact on their health outcomes," says Miller. "Applying the new process, while upholding the core principles of the original policy statement, resulted in the addition of four genes and the removal of one gene; one gene nominated did not meet criteria for inclusion at this time in the ACMG SF v2.0," said Michael S. Watson, executive director of the ACMG. Between March 2015 and May 2016, six nominations to the SF list were received and evaluated by the SFWG. One of these, PTCH1 associated with Gorlin syndrome/nevoid basal cell carcinoma syndrome, did not achieve SFWG consensus for addition due to insufficient evidence that knowledge of a known or expected pathogenic variant in the gene would alter medical management. Four other genes-- BMPR1A and SMAD4, associated with juvenile polyposis, ATP7B associated with Wilson disease, and OTC associated with ornithine transcarbamylase deficiency-- received a unanimous vote from SFWG members for addition to the list. One gene currently on the list, MYLK associated with familial thoracic aortic aneurysm and dissection, was removed. The ACMG Board subsequently reviewed and approved each of the six recommendations of the SFWG: exclusion of PTCH1, addition of BMPR1A, SMAD4, ATP7B and OTC, and removal of MYLK. The Updated Policy Statement also discusses more details of the adjudication process such as the nomination form, determination of an actionability score, the review process, etc. Moving forward, the SFWG plans to accept nominations from other medical specialty organizations. The ACMG also intends to develop resources to assist clinicians in medical management based on specific Secondary Findings. According to Dr. Christa Martin, director of the Autism & Developmental Medicine Institute at Geisinger Health System and co-chair of the ACMG Secondary Findings Working Group, "The SFWG is planning on updating the list once or twice per year at most; we're sensitive to the potential burden placed on clinical laboratories who will need to make changes to their bioinformatics analysis pipelines every time the list is updated. In addition, each revision will have a new versioning number and date of implementation for easy reference."

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