brian griffin
TRANSCRIPT
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