Becker’s Healthcare Podcast Transforming Serious Illness Care and High Reliability at Geisinger with Dr. Narayana Murali
Mar 9, 2026
Dr. Narayana Murali, nephrologist and CMO at Geisinger who leads system-wide care redesigns. He describes transforming advanced care planning to boost engagement among high-risk seniors. He outlines embedding palliative expertise, scaling high-reliability and zero harm practices, and expanding home-based, patient-centered care.
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Redesigning Advanced Care Planning Changed Outcomes
- Advanced care planning is most effective when embedded as a high-touch, longitudinal service for the sickest seniors identified by predictive tools.
- Geisinger enrolled ~1,800 high-risk patients, raising engagement from ~5% to ~45–50% and increasing timely hospice use.
Personal Loss Framed The Why For Change
- Dr. Narayana Murali shared personal loss to underscore why dying at home matters, noting both his mother and mother-in-law died at home.
- He connected that experience to seniors' preferences and the system gap between desires and typical outcomes.
Everybody's Job Becomes Nobody's Job
- When everyone assumes advanced care planning is 'everybody's job,' it often becomes nobody's job, producing late or missing conversations.
- Clear ownership and workflow redesign are required to make conversations happen reliably.