Brian Griffin

Evolution of a Seamless Health Service

The Cleveland Clinic Experience

Brian Griffin, MD

Talk Outline

• Cleveland Clinic – overview• Integration across geography• New US health care realities• Wellness for our staff/employees

ClevelandClinic

Cleveland Clinic

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

Clinic Building 1921

Cleveland Clinic Today

• $6.2 billion• Medical group that runs a health system• Highly specialized main campus• Global reach• Employed and Independent Physicians

Main Campus

Top 5 Hospital#1 in Heart

Over 21 years

6.4 Million Patients

ClevelandClinic

HFairview Hospital

Lakewood Hospital

H

Lutheran Hospital

H

Ashtabula County Medical Center

H

Euclid Hospital

H

Hillcrest Hospital

H

South PointeHospital

H

Marymount Hospital

H

ClevelandClinic

Florida

HMedinaHospital

HLorain Family HealthAnd Surgery Center

FHCElyria FamilyHealth Center

Westlake FamilyHealth Center

FHC

FHC LakewoodFamily Health

Center

FHC

Strongsville Family Health and Surgery Center

FHC

Brunswick FamilyHealth Center

FHCWooster FamilyHealth Center

FHC

Independence FamilyHealth Center

FHC Solon FamilyHealth Center

FHC

Chagrin Falls FamilyHealth Center

FHC

Beachwood FamilyHealth and Surgery Center

FHC

Willoughby HillsFamily Health Center

FHC

FHCR.E. Jacobs

Health Center

Lou Ruvo Centerfor Brain Health

Las Vegas, Nevada

FHC

ClevelandClinic

Toronto

FHC

S.T.J. Health Center

HC

Twinsburg FamilyHealth Center

FHC

NEO Family Health CentersBrunswick

NEO Hospitals

Cleveland Clinic Florida

Cleveland ClinicLou Ruvo

Center for Brain HealthLas Vegas

15

Cleveland Clinic Abu Dhabi

Integration depends on IT• Electronic medical record – EPIC

- Outpatients – now inpatient- Connectivity to all facilities- Imaging availability

• PACs- Imaging availability throughout NE Ohio

• New informatics- Smart apps- House calls - virtual

EMR is our Integrator• Preventive care status • Family history• Past events• Problem list• Internal mail• Dr Connect• My Chart

Increasingly dependent on physician extenders to provide care and health information 24/7 – use of Nurse on Call Services – partnered with Rigney Dolphin

MyChart – mychart.clevelandclinic.org

Volume-Based Value-Based

Payment Fee-for-Service Outcome Based

Incentives Volume Value

Focus Acute Episodes Populations

Role of the Provider Single Episodes Care Continuum

Information Retrospective Real-time & Predictive

The New World

New to us Our DNA

SpecialtyCare

PopulationManagement

Two Distinct Yet Interrelated Roles

Care Model Community-based medicine

Specialty referral destination

PaymentShared savings or Total Cost of Care (TCOC)

Fee-for-service or episode-based

Patient Base Attributed lives Referrals (physician, self)

Needs With or without a specific health need Specific health need

Two Approaches

SpecialtyCare

PopulationManagement

Holistic Patient Care View

Medical Cognitive and Behavioral

Functional Social

PatientCentric

23

Care System

Cleveland Clinic Integrated Care Model

Retail Venues Home

CC ClinicCommunity - Based

Organizations

Ambulatory D&TIndependent Physician Offices

Hospitals

Rehab

Skilled Nursing Facilities

MyChart

EmergencyPost-Acute(other)

Solid Progress…

• Patient-Centered Medical Homes : Disease Base

• Care Paths – specific algorithms in record

• Bundles – paid by time based episode

• Medicare ACO – Accountable Care Organization

– responsible for lives over time

• Medicaid Expansion - bundled

…More to Go

National Network

Owned & Partnered

Hospital Readmissions Reduction Program

• Section 3025 of the Affordable Care Act established the HRRP, which requires CMS to reduce payments to hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.

Hospital Readmissions Reduction Program

FY Penalty Based on readmission rates for:

2013 ≤ 1% Medicare payments HF, AMI, PNA

2014 ≤ 2% Medicare payments HF, AMI, PNA

2015 ≤ 3% Medicare payments HF, AMI, PNA, COPD, THA/TKA

2016 ≤ 3% Medicare payments HF, AMI, PNA, COPD, THA/TKA

2017 ≤ 3% Medicare payments HF, AMI, PNA, COPD, THA/TKA, CABG

No change

Intensive Review of Cardiology

More than one in five patients admitted for HF will be readmitted within 30-days of discharge!

Important fact!

Value-Based Metric

SNF 30-day readmit rate

SNF Connected Care Network

Other SNFs

0% 10% 20% 30%

20%

28%

(n=50)

(n=8)

Cleveland Clinic Wellness:

Staff and Employee Health

Chronic Disease 4 Factors Cause 84%

• Tobacco

• Food Choices & Portion Size

• Physical Inactivity

• Stress

Premature Mortality

Behavior40%

Medical Access 10%

Genetics30%

Social15%Environment

5%

• Obesity• Sedentary Life• Smoking

• 81% of hospital admissions

• 91% of all prescriptions

• 76% of physician visits

Chronic Disease Impact

Employee Health Plan

• Self insured

• 38,000+ employees

• 82,000+ covered lives

• $350M claims

Employee Health Goals• Build a Culture of Wellness

• Support Healthy Life-Style Choices

• Promote Personal Responsibility

• Control Costs

Wellness Program• Healthy Environment Office• Chief Wellness Officer• Nutrition• Smoking Cessation• Fitness Center• Weight Watchers• Curves Memberships

Smoking Survival

Non-Smoker

Smoker

Age

%

100

0

80

60

40 50 70 10060 80

40

20

SmokingEconomic Impact

• $3,400 per employee/year

• $92B annual cost

• $10B annual cost second hand smoke

EHP Tobacco Users

8.9%

5.3%

2009 2010 2011 2012 2013 20142008

Obesity Impact

• $1,429 Additional Medical Cost

• $12.8B Absenteeism• $30B Reduced Productivity• $2.8M Additional Fuel Costs

December 13th-19th, 2003

Millions Served – Stenting Now Here!

TransFats

Farmers Market

Weight Management

• Weight Watchers• Curves• Shape Up & Go• Fitness Centers

• Yoga• Farmer’s Markets• Vending Machines• GO! Foods

158,000 LBS Lost

6 Chronic Diseases• Asthma• Diabetes• Hypertension• Hyperlipidemia• Smoking• Obesity

Those with none – “The Healthy”

2009 2010 2011 2012 2013 2014 2015

55%

9%

Chronic Disease Enrollment

Pebble Pedometers• 10,000 step challenge

• On-Line download

• 30,000 distributed

• 17 Billion steps walked

Health Status Letters

Premium Differentials4.3% Lower than 2011 Premiums

9% Higher than 2011 Premiums

21% Higher than 2011 Premiums

EHP Care Management Enrollment

1,000

16,000

2009 2010 2011 2012 2013 2014 2015

220

260

300

340

380

420

Employee Health Costs

$

2004 2015

2004-20097.5% 2010-Q12015

2.8%

EHP Evolution2005

– 2007

2008 –

2009

2010 –

2011

2012 –

2013

2014• Not hiring

smokers

• Ban trans fats

• Free fitness, weight loss, smoking help

• Ban candy & sugar soft drinks

• Health Choice premium rebate

• Chronic disease mgmt

• Gold, silver, bronze premiums

• Expand to spouses

• Pebble tracking

Keys to Success• Leadership• Culture change• Environment • Social & coaching• Chronic disease management• Effective incentives