The Cleveland Clinic’s The Cleveland Clinic’s Journey from Volume to Journey from Volume to Value in the Era of Value in the Era of Healthcare Reform Healthcare Reform David L. Longworth, M.D. David L. Longworth, M.D. Chair, Medicine Institute Chair, Medicine Institute Associate Chief of Staff, Clinical Associate Chief of Staff, Clinical Integration Development Integration Development Cleveland Clinic Cleveland Clinic
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The Cleveland Clinic’s Journey from Volume to Value in the Era of Healthcare Reform
The Cleveland Clinic’s Journey from Volume to Value in the Era of Healthcare Reform. David L. Longworth, M.D. Chair, Medicine Institute Associate Chief of Staff, Clinical Integration Development Cleveland Clinic. Practicing internist and ID physician for 32 years - PowerPoint PPT Presentation
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The Cleveland Clinic’s Journey The Cleveland Clinic’s Journey from Volume to Value in the from Volume to Value in the
Era of Healthcare ReformEra of Healthcare Reform
The Cleveland Clinic’s Journey The Cleveland Clinic’s Journey from Volume to Value in the from Volume to Value in the
Era of Healthcare ReformEra of Healthcare Reform
David L. Longworth, M.D.David L. Longworth, M.D.
Chair, Medicine InstituteChair, Medicine Institute
Associate Chief of Staff, Clinical Integration DevelopmentAssociate Chief of Staff, Clinical Integration Development
Cleveland ClinicCleveland Clinic
About Me…About Me…About Me…About Me…
• Practicing internist and ID Practicing internist and ID physician for 32 yearsphysician for 32 years
Leads: Morris, Spalding, Partin,Fogleman, Piar, Weber, ORI Clinical Expert(s), Coordinated Care, CI
StructuredDocumentation
Order Sets
Decision Support(ex: “Bundle Busters”)
CareCoordination
ProcessMeasures
OutcomesMeasures
Patient-EnteredData
Hip / Knee“Vespa”
Technology-ReadyComponents
Hip / KneeArthroplasties
Care Guide
Purpose of this Guide:
The Cleveland Clinic Orthopaedic and Rheumatologic Institute performs more than 1200 primary Total Hip Arthroplasties (THA) per year, making it one of the higher volume surgeries in the Cleveland Clinic. THA is also one of the most variable surgeries performed in the United States, with cost1 procedure, implant selection, length of stay (LOS), infections and re-admission rates, and post-operative management2 varying greatly between and within most systems. 19
Comprehensive Care CoordinationComprehensive Care CoordinationThe Second Key CompetencyThe Second Key Competency
Comprehensive Care CoordinationComprehensive Care CoordinationThe Second Key CompetencyThe Second Key Competency
• Aligned across the continuumAligned across the continuum
• Focus on high risk patientsFocus on high risk patients
• Primary and specialty carePrimary and specialty care
• Leverage technologyLeverage technology
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VBC = Care TransformationVBC = Care Transformation
Clinical Leadership is Critical21
ContractingContractingContractingContracting
• We are aligning contracting with the We are aligning contracting with the clinical enterpriseclinical enterprise
• Multidisciplinary contracting team with Multidisciplinary contracting team with Physician and Finance Co-ChairsPhysician and Finance Co-Chairs
• Subject matter content experts for Subject matter content experts for specialty carespecialty care
Jointly-established quality standardsJointly-established quality standardsReward for quality and efficiency Reward for quality and efficiency
Drive to better outcomesDrive to better outcomesDrive to improve value for patients, providers and payersDrive to improve value for patients, providers and payers
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The Quality AllianceThe Quality AllianceFour Strategic ObjectivesFour Strategic Objectives
The Quality AllianceThe Quality AllianceFour Strategic ObjectivesFour Strategic Objectives
• Superior practice quality and efficiency
• Document high-quality care
• Recognize superior performance
• Distribution vehicle for CCICM 24
Over 5,000 Provider MembersOver 5,000 Provider MembersOver 5,000 Provider MembersOver 5,000 Provider Members
As of 1.11.13
Total Membership = MD/DO/DPM/Team-Health ED (3,545) + AHP (1,535)25
PCP37%Specialist
63%
Most providers are specialists
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We are moving to population We are moving to population management in all primary care practices management in all primary care practices
We are moving to population We are moving to population management in all primary care practices management in all primary care practices
• 260,000 lives260,000 lives• 240 providers240 providers• 39 practices at 29 sites39 practices at 29 sites• Team based careTeam based care
- Testing different models of PCMHTesting different models of PCMH- Embedded care coordinators, pharmacistsEmbedded care coordinators, pharmacists- Enhanced accessEnhanced access
• Epic registry functionEpic registry function• Advanced IT population management and Advanced IT population management and
analytic capabilities in developmentanalytic capabilities in development
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Other care transformation tacticsOther care transformation tacticsOther care transformation tacticsOther care transformation tactics
• Wellness widgetWellness widget
• E-visits E-visits
• Shared medical appointmentsShared medical appointments
• Distance healthDistance health
• Other lower cost sites of serviceOther lower cost sites of service
• Rationalizing sites of service Rationalizing sites of service distributiondistribution