Jun 25 2014
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Bringing a Business Lens to Healthcare — Spotlight: Health Q&A with Toby Cosgrove, Cleveland Clinic

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Toby Cosgrove, MD, CEO of the Cleveland Clinic, spoke about bringing a business lens to health during a panel discussion this morning at the Spotlight: Health expansion program of the Aspen Ideas Festival. In an article in this month’s Harvard Business Review, he wrote that “Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients.”

NewPublicHealth spoke to Cosgrove about this transformation just before the Spotlight: Health conference.

file Toby Cosgrove, MD, CEO of the Cleveland Clinic

Toby Cosgrove: The first thing we did is that for the last decade we’ve been very transparent around our quality, and we’ve released books on quality outcomes which are available both in paperback form and on our website. The second thing that we’ve done is we’ve consolidated services. For example, we started out having six hospitals in the system that provided obstetrics care, and now we’ve got three and are about to have two. And each time we’ve consolidated we’ve increased the volume of patients and improved the quality. We’ve done consolidations with pediatrics, cardiac surgery, rehabilitation, psychiatry, trauma and obstetrics. We think that it’s called the practice of medicine—the more you practice at it, the better you get at it, and every time we’ve done that we’ve seen that happen.

In Cleveland, for example, we partnered with Metro Health, a large network of health providers. We previously had five trauma centers in Cleveland. Now we have three and as we’ve done that, the mortality rate has improved 20 percent. So there are real activities that have begun to drive the business approach.

NPH: What are other ways that the Cleveland Clinic has been able to respond to consumer needs using a business model?

Cosgrove: We think you’ve got to do three things. You’ve got to have improved access, quality and affordability. The access is not just having insurance—the access is actually getting to see a provider, and last year we provided about one million same-day appointments in addition to our scheduled ones. We also took our emergency room wait times from 43 minutes to 11 by changing the system that we use. And in our call center we’ve reduced the number of dropped calls and improved the speed of answers. All of that is aimed at giving patients access to the caregivers. We also reorganized our internal system so that when you, say, have a neurologic problem, instead of coming to see a neurologist and then a neurosurgeon, you come into the neurologic institute where you can be seen in one location under one leadership of neurology, neurosurgery and psychiatry, so that you are seamlessly seen with all the specialties right there in one location. 

In terms of the quality, we’ve really jumped up our quality metrics and benchmarked ourselves against the University Hospital Consortium. We’ve moved up to number 14 out of about 110 university hospitals in quality and...we’ve changed our HCHAP (Hospital Consumer Assessment of Healthcare Providers) scores so we’re now in the 90th percentile in the country and the highest of hospitals with more than 1,000 beds.

In terms of affordability, we’ve engaged the entire organization about decreasing costs and identified $270 million we can save. So we are prepared to continue to provide high quality care, but we have to reduce the cost to be able to do that as our reimbursement has decreased. And all of our contracts with insurers starting next year will have a risk component to them.

NPH: How receptive have you found your colleagues to be?

Cosgrove: Right now a lot of physicians are going through Kübler-Ross’ stages of grieving. There was denial for a long period of time, then real anger across the physician community...and gradually we’re coming to acceptance and mourning, and hopefully we’ll be coming up the other side of that curve. So physicians are clearly having a tough time with this. They were all brought up in a different system and it’s moving rapidly.

Tags: Aspen Ideas Festival, Health Care Quality, Public and Community Health, Q&A