Cleveland Clinic 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 Marymount Hospital 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 Health Education Campus
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