Q: If healthcare is just now entering the 19th century, as you said, what will it take to get us into the 21st? Will we have to wait 200 years, or will it come faster than that?

A: Oh no, I think we're in the midst of just huge change right now, and I think what it's going to take is winners and losers. We're going to have organizations that figure it out and also have a viable business model, and they're going to be different than what we see now, with this compartmentalized, fragmented, mom-and-pop industry.

That change could be painful. It's kind of like the grocery business 120 or 130 years ago – the supply chain issues and the consolidation and what have you put almost all of the small grocery stores out of business. On the other hand, the amount of household resources that use to go toward groceries – it used to be up to about 30 percent of discretionary money for a household – has gone down to low single digits now. And guess what's happening to healthcare.

I think this change is going to be extraordinarily fast. I think it's going to be quite disruptive, and I think there will be winners and losers. And my only wish would be that I was younger. If I had my experience and my knowledge now, and I were just beginning, in the midst of this transformation, I could do some real damage.

Q: What's immediately in Geisinger's sights, going forward? What do you hope to accomplish in the next two years or so?

A: Well, we're doing a lot of scaling and generalizing experiments. We basically feel pretty comfortable, knock on wood, that a lot of our value reengineering here that's been enabled by information technology is sustainable within our market and within our particular fiduciary structure. But the question is how much of it is scalable and generalizable, outside of Pennsylvania.

We're doing that experiment in three was. Number one, our insurance company is going outside of Pennsylvania and working with other, non-Geisinger providers. Number two, we're consolidating on the provider side, so when you move to Scranton, when you move to Harrisburg, when you move to New Jersey with AtlantiCare, the question is whether we'll be able to do in those markets what we've been able to do here.

And the third is xG. We've created a very interesting joint venture, for-profit with Oak Investment Partners (which invested $40 million in the initiative), and we're attempting to take our data analytics, our care management and a lot of our predictive modeling out to lots of other entities on both the provider and payer side.

I guess one more thing that we're really committed to – and we've recruited new leadership into the information technology area, on both the provider and payer side – we're interested in getting distributed data out there, we're interested in the functionality aspects. I would love to see Geisinger set the pace on applications, and to move to a much more open-source platform, as opposed to this incredibly rigid, incredibly proprietary pipe that we're now dependent upon for our EHR.

Those would be some of my visions for the future.

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