Cleveland Clinic

Transforming Healthcare

CCHS Mission

• Care for the sick

• Investigate their

problems

• Educate those

who serve

Dr. William E. Lower Dr. John Phillips

Dr. Frank E. Bunts Dr. George W. Crile

Organization Structure• Not for Profit

• Group Practice

• Physician Leadership

• Salaried

• Annual Professional Review

• 1 Year Contract

2003 2005 2007 2009 2011 2013 2015

Professional Staff 3,200

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2003 2005 2007 2009 2011 2013 2015

Caregivers 48,000

18 Cleveland Clinic NEO

Family Health Centers

9 CCHS NEO Hospitals

CC Main Campus

Average Severity

CLEVELAND

CLINIC UCLA Mayo Mass Gen Johns Hopkins

2.3

Cleveland Clinic Florida

Cleveland Clinic

Lou Ruvo

Center for Brain Health

Cleveland Clinic Canada

Sheikh Khalifa Medical City

Cleveland Clinic Abu Dhabi

6.4 Million Patients

Cleveland

Clinic

HFairview Hospital

Lakewood Hospital

H

Lutheran Hospital

H

Ashtabula County

Medical Center

H

Euclid Hospital

H

Hillcrest Hospital

H

South Pointe

Hospital

H

Marymount Hospital

H

Cleveland

Clinic

Florida

HMedina

Hospital

HLorain Family Health

And Surgery Center

FHC

Elyria Family

Health CenterWestlake Family

Health Center

FHC

FHC Lakewood

Family Health

Center

FHC

Strongsville Family Health

and Surgery Center

FHC

Brunswick Family

Health Center

FHCWooster Family

Health Center

FHC

Independence Family

Health Center

FHC Solon Family

Health Center

FHC

Chagrin Falls Family

Health Center

FHC

Beachwood Family

Health and Surgery Center

FHC

Willoughby Hills

Family Health Center

FHC

FHC

R.E. Jacobs

Health Center

Lou Ruvo Center

for Brain Health

Las Vegas, Nevada

FHC

Cleveland

Clinic

Toronto

FHC

S.T.J.

Health Center

HC

Twinsburg Family

Health Center

FHC

2 Million MyChart users

• Test Results

• Messages

• Appointments

• Preventive Care

• Health Summary

MyChart

Transport Team

Hospital

Transfers25,199

Acute Admissions 190,000

162,000

& Observations

Outpatient Visits 5.9 Million

20141997

Research Activity

20122006 201020082004 20142002

2,160

2000

Patents Granted712

2007 201120092005 201420032001

44

20112010 20132012 201420092008

1,234

974

High ImpactPublications

Residents & Fellows

2007 201120092005 20142003

1,757

1,362

Resident Programs

NY

Presbyterian

Montefiore Cleveland

Clinic

Univ.

Michigan

Johns

Hopkins

914

MCAT Scores

Wash.

Univ.

Harvard Johns

Hopkins

Columbia DukeYale CLEVELAND

CLINIC

Univ.

Chicago

Univ.

Penn

12.0

Health Education

Campus

Watson Goes to Medical School

Ohio Univ. Heritage College of

Osteopathic Medicine

South Pointe Hospital

Virtual Reality

Economics

InflectionPoint

Dramatic and Rapid Change

Medicare Payment Cuts

Total

$415 Billion

20222016 2018 20200

-80

-20

-40

-60

-100

2014

$Billion

s

NIH Funding

1995 2000 2005 2010

$30Billion

$11Billion

2015

Volume-Based Value-Based

Fee-for-Service Outcomes

Payment Structure

Value-Based Purchasing

2013 2014 2015 2016

70%45%

20% 10%

30%

30%

30%25%

25%

30%40%

20% 25%

Patient Experience

Clinical Process

Care Outcomes

Efficiency

Acute Care Well Care

Population Health

Chronic Care

U.S. Hospital Beds

20131991

923,000

796,000

Medicare Beneficiaries

2014 2016 2018 2020 2022

54 Million

61 Million

Accountable Care

Organizations

2011 2013 2015

734

82

Retail Clinics

2010 2012 201420082006

2,243

202

Retail Clinics

QualityReports

Hospital ReportedQuality Metrics

201320072005 2009 2011 2015

115

10

HHS NQMCCMS

4,456

202

Quality Measures

3,801

CostReports

High Deductible Insurance

36%

19%

2009 2014

Healthcare Inflation13%

2.5%

1980 1990 2000 2010 2015

Patient-Generated

DataQuality Metrics

Other Health Professionals

Telemedicine

Lack of Genomic

Knowledge

Reimbursement

Retail-Based Clinics

EHR Frustration

Transparency in Office Notes

Algorithms

Super and Cloud

ComputingScorecards

Online Health Social

NetworksPatient

Satisfaction

Online Reviews;

Getting YelpedRelative Value

Units

Acceptance

Depression

Anger

Denial

Time

Morale

Change Curve

Bargaining

“Courage in the face of reality...”

Satya Nadella

CEO, Microsoft

Strategy

Transform to value and use

as basis for System growth

Focus of Our Work

• Transform our

care model and

organization to

value

• Grow through

strategic

relationships

Internal External

Goals

Patients First

Continuously

improve

quality, safety

and patient

experience

Caregivers

Make CC the

best place to

work

Affordability

Provide high

value care

Growth

Responsibly

develop to

sustain our

mission

Objective: Improve the health of every patient

Setting the Plan

for the Future

Transformed

CCF

TODAY

What does a

transformed CCF

look like?

New to us Our DNA

SpecialtyCare

PopulationManagement

Two Distinct Yet

Interrelated Roles

Care ModelCommunity-based

medicineSpecialty referral

destination

Payment Shared savings Fee-for-service or

episode-based

Patient Base

Attributed lives Referrals (physician, self)

NeedsWith or without a

specific health need Specific health need

Two Approaches

SpecialtyCare

PopulationManagement

Cleveland Clinic

Integrated Care Model

AffordabilityQuality

Access

Access

Access. Anytime, Anywhere.

Same Day Visits

20122010 2011 20132008 2009

1,130,255

687,000

2014

Shared MedicalAppointment

20122009 20112010 2013

6,124

678

2014

Healthspot

Healthspot

MyCare Online

Virtual Visits 523per month

2014 2015

CCHS ED Wait Time46

minutes

12minutes

12 Minutes

2011 2012 2013 2014 2015

Quality

CC Experience

Patient Greeters

Art In Medicine

Diane Von Furstenberg

Patient Gown

Care Giver Uniforms

Unit Coordinator

Radiology Tech

Lab Tech

Food Service

House-keeping

Patient Transporter

Pastoral Care

Staff

Physician

Respiratory

Therapist

Resident Nurse Clinical

Tech

Open Medical Record

Massage Therapy

Pet Therapy

Prayer Room

Rate Hospital

2011 2012 2013 2014 2015201020092008

Florida

Community

89

51

Main 90CMS 90th %ile

Patient Safety Indicators

≤ 69 / month

72

215

2013 201420122011 2015

Hospital Acquired Infections

≤ 15 / month

22

38

2013 2014 2015

All Cause Readmissions

≤ 13%

13.1%

14.4%

2013 20142012 2015

Complaints &

Grievances

1.4per 1K

2.1per 1K

2013 2014 2015201220112010

Affordability

Premature Mortality

Behavior

40%

Medical Access 10%

Genetics

30%

Social

15%Environment

5%

• Obesity

• Sedentary Life

• Smoking

Trans

Fats

• Weight Watchers

• Curves

• Shape Up & Go

• Fitness Centers

• Yoga

• Farmer’s Markets

• Vending Machines

• GO! Foods

>500,000 LBS Lost

220

260

300

340

380

420

Employee Health Costs

$

2004 2015

2004-2009

7.5% 2010-Q22015

2.5%

2014-15 Efficiencies$513M

Clinical

$275M

Indirect /

Admin

$172M

Hospitals

$60M

Other

$6M

My Two Cents

$7,259,251Savings

1,033Ideas

Care Path Progress

106

Guides

37 Pilots14 EMR

Enabled

Stroke Cost Per Day

Pre Care Path Post Care Path

$3,402$2,553

25%

Multiple Myeloma Drug Cost

Pre Care Path Post Care Path

59%$150,000

$61,000

Thyroid Surgery Cost Per Case

Main Campus

2013

Marymount

2014

$3,100$2,600

16%

2014 2015 2016

ORI Joint Implant

Vendor Consolidation

$27

16%

Million

$32Million

AffordabilityQuality

Access

VALUE

- Theodore Roosevelt

until they know how much you care.“

“

No one cares how much you know,