In June, when President Barack Obama kicked off his summer campaign to raise Americans' awareness of the need for healthcare reform, he chose in a speech in Green Bay Wisconsin to emphasize two top concerns this way:

“We have to ask why places like Geisinger Health System in rural Pennsylvania [and] Intermountain Health in Salt Lake City … can offer high-quality care at costs well below average, but other places in America can't.”

Coincidentally, Food Management was scheduled to visit Geisinger just a few days later. Obama's question provided an additional reason to look into the structure and culture of the system's approach to managing foodservices. Here's what we found…

Not your typical 400-bed hospital

When you exit from I-80 East and drive south into Danville, you notice right away that the town — and the Geisinger facility — are not what you expect.

You are in the heart of Pennsylvania's old anthracite coal region, 250 miles from Cleveland and 160 miles from New York City. Danville is classic, rural Pennsylvania, with a population of about 5,000. Geisinger, the largest employer in the region, employs about 13,000, more than 8,000 of them in Danville facilities.

The campus that spreads out before you doesn't look anything like a typical 400-bed acute care hospital. Its facilities dominate the town's northeast quadrant.

AT A GLANCE Geisinger Health System: www.geisinger.org Primary Locations/Beds: Geisinger Medical Center-Danville (404), Geisinger Wyoming Valley (2 campuses/237) Marworth Center (91) Employees: 12,766 (head count, not FTEs) Community Practice Sites: 40 (statewide) Retail Foodservice Sales: $7 million Points of Service: 8 (on Danville campus), 3 (at other system locations), The Pine Barn (a campus hotel and restaurant whose operation is contracted out) GPO: Premier Key Foodservice Personnel: Bruce Thomas, associate vice president, guest services; Steve Cerullo, director of foodservice, Geisinger Health System; Lynne Brown, director of foodservice, Northeast Region; Tammy Almquist, manager of enivronmental and foodservices, Geisinger Marworth Rehabilitation Hospital.

There are large office and utility buildings, a high rise tower, administrative centers. From a distance, it looks more like a large corporate headquarters than anything else. And perhaps that's because in many ways it is — Geisinger is a fully integrated health system with about $2 billion in annual revenue from operations that range from acute care to health insurance to community practice operations. The health insurance plan alone has 212,000 members.

My first interview is with Bob Davies, vice president of system services. He likes to talk about the system's traditions, which have always focused on a closed group practice model and providing service to the communities it serves. Physician-managed, and founded in 1915 on a service model inspired by the Mayo Clinic, “we serve 43 counties in Pennsylvania,” he says.

“Our peer group would include the large academic medical centers in major cities. We have always focused on measuring and improving outcomes and controlling costs and have been pretty successful in these efforts, which is why we are often cited.”

How does foodservice fit in?

“Patient feeding is an integral part of care and recovery for our patients,” he responds. “We pay a lot of attention to ensuring that our dining and foodservices are integrated with physician care. Foodservice is also an important employee benefit, and while we do not subsidize it, we want to ensure that it is a great value for employees.”

In recent years, the system has had a lot of growth, but it has sought to manage that growth carefully, Davies adds.

“Thirty years ago, we had about the same number of beds we have today, but only 1200 employees. What is amazing is that our foodservice facility is almost the same size as it was 36 years ago, when I started here.”

In fact, while Geisinger's main employee cafeteria was upgraded a few years ago, its seating and serving areas are designed primarily for practicality, not for show. They are undersized given the traffic patterns the facility serves.

The situation will improve in a few years when Geisinger completes its Hospital for Advanced Medicine, a large project now under construction. Most of the ground floor is slated for retail and patient foodservice and will provide a much needed expansion.

A focus on wellness and systems

My next stop is down the hall, at the office of Bruce Thomas. A past board member and outgoing president of HFM (the National Society for Healthcare Foodservice Management), Thomas has become well-known in the foodservice community in recent years.

A graduate of Penn State's Hospitality School, he worked in the hotel and restaurant industry before joining Geisinger' in 1987. Although he acknowledges, “I never saw myself working for very long in healthcare,” Thomas eventually went on to become foodservice director, and then, after earning an MBA, moved on to his current, system-wide role in 2006.

In it, he has administrative responsibility for foodservices, the Henry Hood Conference Center, housekeeping, mail operations, a print shop, patient transport, the Pine Barn Inn (an on-campus hotel) and business travel and reimbursement.

I ask him if that isn't an awful lot to have on a single plate.