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Cleveland Clinic Transforming Healthcare CCHS Mission 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 .
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