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,