Transforming Healthcare CCHS Mission

• Care for the sick • Investigate their Dr. Frank E. Bunts Dr. George W. Crile problems • Educate those who serve

Dr. William E. Lower Dr. John Phillips Organization Structure • Not for Profit • Group Practice • Physician Leadership • Salaried • Annual Professional Review • 1 Year Contract Professional Staff 3,200

2003 2005 2007 2009 2011 2013 2015 Caregivers 48,000 45,000

40,000

35,000

30,000

25,000

20,000

15,000

10,000

5,000

0 2003 2005 2007 2009 2011 2013 2015 18 Cleveland Clinic NEO Family Health Centers 9 CCHS NEO Hospitals CC Main Campus 2.3 Average Severity

CLEVELAND CLINIC UCLA Mayo Mass Gen Johns Hopkins Cleveland Clinic Florida Cleveland Clinic Lou Ruvo Center for Brain Health Cleveland Clinic Canada Sheikh Khalifa Medical City Cleveland Clinic Abu Dhabi H FHC Ashtabula County Medical Center Cleveland H Clinic FHC 6.4 Million Patients Toronto Euclid Hospital Willoughby Hills Family Health Center HC S.T.J. H Cleveland Health Center FHC Hillcrest Hospital Clinic R.E. Jacobs FHC H FHC Health Center Lakewood Hospital H H Elyria Family FHC Lutheran Hospital South Pointe Beachwood Family Health Center FHC Hospital Health and Surgery Center Westlake Family FHC Health Center Lakewood H FHC Family Health Lorain Family Health FHC Center Twinsburg Family And Surgery Center FHC Solon Family Health Center H H Health Center FHC Fairview Hospital Independence Family Medina Lou Ruvo Center Health Center Hospital H for Brain Health FHC FHC Cleveland Las Vegas, Nevada FHC Clinic FHC Chagrin Falls Family Strongsville Family Health Wooster Family Florida Health Center and Surgery Center Brunswick Family Health Center Health Center 2 Million MyChart users MyChart • Test Results • Messages • Appointments • Preventive Care • Health Summary Transport Team Hospital 25,199 Transfers Acute Admissions & Observations 190,000 162,000 Outpatient Visits 5.9 Million

1997 2014 Research Activity 2,160

2000 2002 2004 2006 2008 2010 2012 2014 Patents Granted 712

44

2001 2003 2005 2007 2009 2011 2014 High Impact 1,234 Publications

974

2008 2009 2010 2011 2012 2013 2014 Residents & Fellows 1,757

1,362

2003 2005 2007 2009 2011 2014 Resident Programs

914

NY Montefiore Cleveland Univ. Johns Presbyterian Clinic Michigan Hopkins MCAT Scores 12.0

Wash. Univ. Yale Univ. CLEVELAND Harvard Johns Columbia Duke Univ. Penn Chicago CLINIC Hopkins

Watson Goes to Medical School Ohio Univ. Heritage College of Osteopathic Medicine

South Pointe Hospital Virtual Reality

Dramatic and Rapid Change

Economics

Inflection Point Medicare Payment Cuts

2014 2016 2018 2020 2022 0

-20

$ -40 Billion s -60

-80 Total

-100 $415 Billion NIH Funding $30 Billion

$11 Billion

1995 2000 2005 2010 2015 Payment Structure

Volume-Based  Value-Based Fee-for-Service Outcomes Value-Based Purchasing

30% 25% 20% 25% Efficiency 30% Care 30% 40% Outcomes 70% 30% Patient 45% 25% Experience 20% Clinical 10% Process 2013 2014 2015 2016 Acute Care Well Care

Population Health

Chronic Care 923,000 U.S. Hospital Beds

796,000

1991 2013 Medicare Beneficiaries 61 Million

54 Million

2014 2016 2018 2020 2022 Accountable Care Organizations 734

82

2011 2013 2015 Retail Clinics Retail Clinics 2,243

202

2006 2008 2010 2012 2014 Quality Reports Hospital Reported Quality Metrics 115

10

2005 2007 2009 2011 2013 2015 Quality Measures 4,456 3,801

202

CMS HHS NQMC Cost Reports High Deductible Insurance 36%

19%

2009 2014 Healthcare Inflation 13%

2.5%

1980 1990 2000 2010 2015 Patient- Transparency Generated Quality in Office Notes Data Metrics Algorithms Other Health Super and Professionals Cloud Computing Telemedicine Scorecards Lack of Online Health Genomic Social Knowledge Networks Reimbursement Patient Satisfaction Retail-Based Online Clinics Reviews; Getting Yelped EHR Relative Value Frustration Units Change Curve Denial Acceptance

Morale Anger Bargaining

Depression Time “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

Internal External • Transform our • Grow through care model and strategic organization to relationships value Goals

Objective: Improve the health of every patient

Patients First Caregivers Affordability Growth Continuously Make CC the Provide high Responsibly improve best place to value care develop to quality, safety work sustain our and patient mission experience Setting the Plan for the Future Transformed CCF What does a transformed CCF look like?

TODAY Two Distinct Yet Interrelated Roles

Population Specialty Management Care

New to us Our DNA Two Approaches Population Specialty Management Care Community-based Specialty referral Care Model medicine destination Fee-for-service or Payment Shared savings episode-based Patient Attributed lives Referrals (physician, self) Base

Needs With or without a Specific health need specific health need Cleveland Clinic Integrated Care Model Quality Affordability

Access Access Access. Anytime, Anywhere. Same Day Visits 1,130,255

687,000

2008 2009 2010 2011 2012 2013 2014 Shared Medical 6,124 Appointment

678

2009 2010 2011 2012 2013 2014

Healthspot Healthspot MyCare Online

523 Virtual Visits per month

2014 2015 CCHS ED Wait Time 46 minutes 12 minutes

12 Minutes

2011 2012 2013 2014 2015 Quality

CC Experience

Patient Greeters Art In Medicine

Diane Von Furstenberg Patient Gown Care Giver Uniforms

Staff Resident Nurse Respiratory Clinical Physician Therapist Tech

Unit Radiology Lab Food House- Patient Pastoral Coordinator Tech Tech Service keeping Transporter Care

Open Medical Record Massage Therapy Pet Therapy Prayer Room Rate Hospital CMS 90th %ile Main 90 Florida 89

Community 51

2008 2009 2010 2011 2012 2013 2014 2015 Patient Safety Indicators 215

72 ≤ 69 / month 2011 2012 2013 2014 2015 Hospital Acquired Infections

38

22 ≤ 15 / month

2013 2014 2015 All Cause Readmissions

14.4%

≤ 13% 13.1% 2012 2013 2014 2015 2.1 Complaints & per 1K Grievances 1.4 per 1K

2010 2011 2012 2013 2014 2015 Affordability Premature Mortality Medical Access 10% Behavior 40% Genetics • Obesity 30% • Sedentary Life • Smoking

Social Environment 15% 5%

Trans Fats

• Weight Watchers • Curves • Shape Up & Go >500,000• Fitness Centers LBS Lost • Yoga • Farmer’s Markets • Vending Machines • GO! Foods Employee Health Costs

420

380

340 2004-2009 $ 7.5% 2010-Q22015 300 2.5% 260

220 2004 2015 2014-15 Efficiencies $513M Other $6M Hospitals $60M

Indirect / Clinical Admin $275M $172M My Two Cents 1,033 $7,259,251 Ideas Savings Care Path Progress

14 EMR 37 Pilots Enabled 106 Guides Stroke Cost Per Day $3,402 25% $2,553

Pre Care Path Post Care Path Multiple Myeloma Drug Cost $150,000 59%

$61,000

Pre Care Path Post Care Path Thyroid Surgery Cost Per Case $3,100 16% $2,600

Main Campus Marymount 2013 2014 ORI Joint Implant Vendor Consolidation $32 Million 16%

$27 Million

2014 2015 2016 Quality Affordability VALUE

Access No one cares how much you know, “ “until they know how much you care. - Theodore Roosevelt