Keynote Address: Delos Cosgrove President and Chief Executive Officer, Cleveland Clinic

1. Health Care Model
for the 21st Century
Health Datapalooza IV
June 4, 2013

2. 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

3. Organization Structure
• Not for Profit
• Group Practice
• Physician Leadership
• Salaried
• Annual Professional Review
• 1 Year Contract

4. 6.4 Million Patients
Cleveland
Clinic
H
Fairview Hospital
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

5. Transport Team

6. Hospital Transfers
0
5,000
10,000
15,000
20,000
25,000
2005 2006 2007 2008 2009 2010 2011 2012
#

7. "There are decades where
nothing happens;
and there are weeks
where decades happen."
Lenin

8. Economics
Inflection
Point

9. Transparency - Castlight
9

10. Hospital Rankings
A Patient’s View

11. “This will
take courage
to do…”
Nancy Pelosi

12. • ACCESS
• Quality
• Cost

13. CCHS Emergency Departments
Door to Doctor
#
Minutes
2010
50
30
10
Target = 30 minutes
14.5
2011 2012 2013

14. Nurse on Call
200,000

16. 0
250
500
750
1000
1250
2008 2009 2010 2011 2012
#
thousands
Same Day Visits

17. Hospital Transfer Dashboard

18. MyChart Users
0
200
400
600
800
1,000
1,200
1,400
1,600
2002 2004 2006 2008 2010 2012
#
thousands
1.5 M

19. iPhone App:
• Test Results
• Messages
• Appointments
Future / Past
• Preventive Care
• Health Summary-
Meds, Allergies,
Problems,
Immunizations
MyChart
MyChart
2
3

20. Cleveland Clinic iTriage

21. DrConnect Physicians
0
1,000
2,000
3,000
4,000
5,000
6,000
2005 2006 2007 2008 2009 2010 2011 2012
#
4,800

22. Referring Physician Hotline
0
1,000
2,000
3,000
4,000
5,000
6,000
2013201120112011 2012
#/
Month
100,000 k

23. Online Appointment Requests
0
10,000
20,000
30,000
40,000
50,000
2000 2002 2004 2006 2008 2010 2012
#

24. • Access
• QUALITY
• Cost

27. Graft Patency
%
Patent
IMA
SV
60
100
90
80
70
2 13864
Years
1210

28. Survival
%
Survival
IMA
82.6%
SV
71%
p < 0.0001
60
100
90
80
70
2 10864
Years

29. 20
40
60
80
100
C
Cleveland Clinic
STS National
NEJM Article
Internal Mammary Artery Usage
Primary Cardiac Bypass
%
19981986 2012

30. BIG DATA
Explorys
• 14 Healthcare systems
• 40 million lives
• 200 Hospitals
• 100,000 providers
• Predictive modeling for PCI

31. Watson Goes to
Medical School

32. University Hospital Consortium Quality
Rank
30
40
50
60
70
80
1
Rank
101
80th
2010
♦
♦♦♦♦♦♦♦♦♦♦♦♦♦
♦♦♦♦♦ ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ ♦♦ ♦♦♦♦♦♦ ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ ♦♦
♦♦♦♦♦♦♦♦♦♦
♦♦♦♦♦♦
♦
♦
♦
49th
2011
20th
2012
50 7525

33. 50
60
70
80
2008 2009 2010 2012 National
(AHRQ)
Patient Safety Survey
%
78

34. 15
20
25
30
CCHS Heart Failure Readmissions
< 20%
21%%
20112010 2012 2013

35. 0
100
200
300
102
#
Per
Month
CCHS Patient Safety Indicators
≤83
20112010 2012 2013

36. Chief
Experience
Officer
Dr. Jim Merlino

37. CC Experience

38. Open Medical Record

39. Patient Greeters

40. Art In Medicine

42. Diane Von Furstenberg
Patient Gown

43. Physician HCAHPS Scores

44. 0
20
40
60
80
100
2008 2009 2010 2011 2012 2013
Patient Satisfaction
Rate Hospital
%ile
Rank
74
90th %ile

45. •Access
•Quality
•COST

46. Prostatectomy
All Cases
4,000
5,000
6,000
7,000
8,000
2009 2010 2011
$
per
Case
23%

47. Lab Tests Avoided
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2011 Feb Apr Jun Aug Oct Dec
#
thousands
12,082
5,388
0
2
4
6
8
10
12
14
20122011
$1.2 Million

48. Newborns
12
10
3
2 2 2
0
5
10
15
Fairview Hillcrest Main Huron Lakewood Marymount
Avg #
per
Day

49. Ashtabula County Medical Center
H
Euclid Hospital
H
Marymount Hospital
H
Obstetrics
H
Cleveland
Clinic
Lakewood Hospital
HH
H
Fairview Hospital
H
Lutheran Hospital
H
South Pointe
Hospital
H
Hillcrest Hospital
HHHuron Hospital
HH

50. Virtual Home Visit

51. Premature Mortality
Behavior
40%
Medical Access 10%
Genetics
30%
Social
15%Environment
5%
• Obesity
• Sedentary Life
• Smoking

54. Smoking Rates
Cuyahoga
USA
Ohio W/O
Cuyahoga
14
24
2003 2004 2005 2006 2007 2008 2009
Rate
Cuyahoga
USA
Ohio

55. Trans
Fats

58. Curve Membership
Fitness Center
Yoga Classes
Weight Watchers

59. Weight Management
• Weight Watchers
• Curves
• Shape Up & Go
• Fitness Centers
• Yoga
• Farmer’s Markets
• Vending Machines
• GO! Foods
360,000 LBS Lost

60. Employee Health Plan
PMPM Costs
220
260
300
340
380
420
Q104
Q204
Q304
Q404
Q105
Q205
Q305
Q405
Q106
Q206
Q306
Q406
Q107
Q207
Q307
Q407
Q108
Q208
Q308
Q408
Q109
Q209
Q309
Q409
Q110
Q210
Q310
Q410
Q111
Q211
Q311
Q411
Q112
Q212
Q312
Q412**
Q1 04 to Q4 09 PMPM Q1 10 to Q3 12 PMPM
Expon. (Q1 04 to Q4 09 PMPM) Expon. (Q1 10 to Q4 12 PMPM)
Average yearly increase PMPM 2004 – 2008: 7.6%
Average yearly increase PMPM 2009 – 2012: 2.0%
$
2004 2005 2006 2007 2008 2009 2010 2011 2012

61. “No one cares
how much
you know,
until they know
how much
you care.”
Theodore Roosevelt