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Brian Griffin
The Cleveland Clinic has integrated its health services across its main campus and regional hospitals, clinics, and other facilities through investments in its electronic medical record system and other technologies. This integration allows for continuity of care as patients access different levels and sites of care. The Cleveland Clinic is also shifting from a fee-for-service to a value-based payment model and taking on increased accountability for the health outcomes and costs for its patient populations. To support this transition and reduce costs from chronic diseases, the Cleveland Clinic has developed a comprehensive wellness program for its over 38,000 employees that focuses on reducing risk factors like smoking, obesity, and physical inactivity.
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Brian Griffin
- 1. Evolution of aSeamless Health Service The Cleveland Clinic Experience Brian Griffin, MD
- 2. Talk Outline • ClevelandClinic – overview • Integration across geography • New US health care realities • Wellness for our staff/employees
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- 4. CCHS Mission • Carefor the sick • Investigate their problems • Educate those who serve Dr. William E. Lower Dr. John Phillips Dr. Frank E. Bunts Dr. George W. Crile
- 5. Organization Structure • Notfor Profit • Group Practice • Physician Leadership • Salaried • Annual Professional Review • 1 Year Contract
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- 7. Cleveland Clinic Today •$6.2 billion • Medical group that runs a health system • Highly specialized main campus • Global reach • Employed and Independent Physicians
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- 9. Top 5 Hospital #1in Heart Over 21 years
- 10. 6.4 Million Patients Cleveland Clinic H FairviewHospital Lakewood Hospital H Lutheran Hospital H Ashtabula County Medical Center H Euclid Hospital H Hillcrest Hospital H South Pointe Hospital H Marymount Hospital H Cleveland Clinic Florida H Medina Hospital H Lorain Family Health And Surgery Center FHC Elyria Family Health Center Westlake Family Health Center FHC FHC Lakewood Family Health Center FHC Strongsville Family Health and Surgery Center FHC Brunswick Family Health Center FHC Wooster Family Health Center FHC Independence Family Health Center FHC Solon Family Health Center FHC Chagrin Falls Family Health Center FHC Beachwood Family Health and Surgery Center FHC Willoughby Hills Family Health Center FHC FHC R.E. Jacobs Health Center Lou Ruvo Center for Brain Health Las Vegas, Nevada FHC Cleveland Clinic Toronto FHC S.T.J. Health Center HC Twinsburg Family Health Center FHC
- 11. NEO Family HealthCenters Brunswick
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- 14. Cleveland Clinic Lou Ruvo Centerfor Brain Health Las Vegas
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- 16. Integration depends onIT • 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
- 17. EMR is ourIntegrator • 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
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- 19. Volume-Based Value-Based PaymentFee-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
- 21. New to usOur DNA Specialty Care Population Management Two Distinct Yet Interrelated Roles
- 22. Care Model Community-based medicine Specialty referral destination Payment Sharedsavings 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 Specialty Care Population Management
- 23. Holistic Patient CareView Medical Cognitive and Behavioral Functional Social Patient Centric 23
- 24. Care System Cleveland ClinicIntegrated Care Model Retail Venues Home CC Clinic Community - Based Organizations Ambulatory D&TIndependent Physician Offices Hospitals Rehab Skilled Nursing Facilities MyChart EmergencyPost-Acute (other)
- 25. Solid Progress… • Patient-CenteredMedical 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
- 26. National Network Owned &Partnered
- 27. 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.
- 28. Hospital Readmissions Reduction Program FYPenalty 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
- 29. Intensive Review of Cardiology Morethan one in five patients admitted for HF will be readmitted within 30-days of discharge! Important fact!
- 30. Value-Based Metric SNF 30-dayreadmit rate 0% 10% 20% 30% SNF Connected Care Network Other SNFs 20% 28% (n=50) (n=8)
- 31. Cleveland Clinic Wellness: Staff andEmployee Health
- 32. Chronic Disease 4 FactorsCause 84% • Tobacco • Food Choices & Portion Size • Physical Inactivity • Stress
- 33. Premature Mortality Behavior 40% Medical Access10% Genetics 30% Social 15%Environment 5% • Obesity • Sedentary Life • Smoking
- 34. • 81% ofhospital admissions • 91% of all prescriptions • 76% of physician visits Chronic Disease Impact
- 35. Employee Health Plan •Self insured • 38,000+ employees • 82,000+ covered lives • $350M claims
- 36. Employee Health Goals •Build a Culture of Wellness • Support Healthy Life-Style Choices • Promote Personal Responsibility • Control Costs
- 37. Wellness Program • HealthyEnvironment Office • Chief Wellness Officer • Nutrition • Smoking Cessation • Fitness Center • Weight Watchers • Curves Memberships
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- 39. Smoking Economic Impact • $3,400per employee/year • $92B annual cost • $10B annual cost second hand smoke
- 43. EHP Tobacco Users 8.9% 5.3% 20092010 2011 2012 2013 20142008
- 44. Obesity Impact • $1,429Additional Medical Cost • $12.8B Absenteeism • $30B Reduced Productivity • $2.8M Additional Fuel Costs
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- 46. Millions Served –Stenting Now Here!
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- 51. Weight Management • WeightWatchers • Curves • Shape Up & Go • Fitness Centers • Yoga • Farmer’s Markets • Vending Machines • GO! Foods 158,000 LBS Lost
- 52. 6 Chronic Diseases •Asthma • Diabetes • Hypertension • Hyperlipidemia • Smoking • Obesity Those with none – “The Healthy”
- 53. 2009 2010 20112012 2013 2014 2015 55% 9% Chronic Disease Enrollment
- 54. Pebble Pedometers • 10,000step challenge • On-Line download • 30,000 distributed • 17 Billion steps walked
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- 56. Premium Differentials 4.3% Lowerthan 2011 Premiums 9% Higher than 2011 Premiums 21% Higher than 2011 Premiums
- 57. EHP Care Management Enrollment 1,000 16,000 20092010 2011 2012 2013 2014 2015
- 58. 220 260 300 340 380 420 Employee Health Costs $ 20042015 2004-2009 7.5% 2010-Q12015 2.8%
- 59. EHP Evolution 2005 – 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
- 60. Keys to Success •Leadership • Culture change • Environment • Social & coaching • Chronic disease management • Effective incentives