Cleveland Clinic CEO and President Toby Cosgrove, MD, believes that the medical center is ready to “lead the charge” in delivering better patient outcomes and faster care, all at a lower cost.
Toby Cosgrove, MD
To that end, the Cleveland Clinic has established a Value-Based Care Team, made up of physicians, nurses and other experts who will work together to translate “better, lower cost and faster” into everyday practice. Services are rationalized across the network, with multi-specialty teams using system-wide resources to deliver the right care at the right place for every patient, at the right time with the right cost.
“Value is the centerpiece of Cleveland Clinic’s strategy,” said Associate Chief of Staff for Clinical Integration Development, Dr. David Longworth, who heads the Clinic’s Value-Based Care Steering Committee. “We are focused on two areas. One is to eliminate unnecessary practice variation by developing evidence-based care paths across diseases. The other is comprehensive care coordination to allow patients to move seamlessly through the system so that we reduce unnecessary hospitalizations and ER visits.”
According to Dr. Longworth, the TeamCare model helps to:
- Increase throughput.
- Reduce the cost-per-unit of service.
- Improve patient and provider satisfaction.
“In the past, each physician had one medical assistant who simply roomed the patient and took vitals,” he explained. “All the chart work was done by the physician, often at home in the evenings, adding several hours of work to their day and extra time to the entire process. Now, physicians go home at the end of the day with all their charts closed.”
The TeamCare model helps the Cleveland Clinic improve its Patient Experience ratings in a number of measured metrics, including:
- 22.8 percent improvement in wait time at clinic.
- 10.7 percent improvement in wait time in exam room to see provider.
- 8.9 percent improvement in the time the provider spent with the patient.
While the Value-Based Care Team may be a concept borne of the new world of health care, the Cleveland Clinic has a rich history of improving patient outcomes. In 2000, the Clinic became the first hospital in the U.S. to publish its outcome measures and now publishes outcome books for every department, comparing itself to the best available benchmarks.
The Cleveland Clinic further changed the way it delivers care by developing Institutes to house medical and surgical specialties, working under one Institute leader and one budget. In some Institutes, inpatient and outpatient care are co-located, and Institute leadership is charged with defining what diseases and conditions each Institute cares for, developing a set of shared outcome measures for which the team is jointly accountable. Leaders also identify the skills that need to be brought together to care for patients with the sets of conditions the team treats.
Institutes are given autonomy to pursue different implementation approaches and are expected to share insights with others. For example, the Neurological Institute created a website so that others at the Clinic could learn how it was developing performance measures and decide whether to use a similar approach.
In the case of a primary care pilot program, Value-Based Care relies on a team approach that leads to a higher-efficiency practice style. Responsibilities are shared among two medical assistants and the physician, with each individual functioning to the highest level of their scope.
For each patient visit, a medical assistant brings the patient to a treatment room and obtains vitals and additional medical history information, which they immediately enter into the patient’s electronic medical record. The medical assistant remains in the room during the examination, acting as a real-time transcriber for the doctor’s notes and orders, which are also sent immediately to the physician’s inbox for verification and signature so the assistant can schedule any follow-up tests or procedures before the appointment is complete. At the same time, the physician’s second medical assistant is getting the doctor’s next patient set up in another treatment room.
Value-Based Care also helps the Clinic reduce costs. In fact, in just under a year, the direct cost per patient encounter dropped by 7.5 percent while the number of patient encounters per day increased by 16.4 percent.
The hospital lowers costs in other ways as well, such as avoiding 12,082 lab tests in 2011 and 2012 for a savings of $1.2 million and lowering the cost of lung transplant surgery by 11 percent. Cleveland Clinic also is getting patients into treatment faster, with the total number of same-day visits increasing by 14 percent and the average emergency room door-to-doctor time reduced to 17 minutes.
These strides are helping Cleveland Clinic reach the Top 20 of the University HealthSystem Consortium’s (UHC) quality index, earning UHC’s Rising Star award by improving inpatient centeredness, mortality, equity, efficiency, effectiveness and safety.
The Cleveland Clinic model is a good example of how health systems can develop evidence-based models to generate higher quality care at a lower cost. What are other hospitals and health systems doing to redesign care delivery paths? Let us know what’s working.