Cleveland Clinic CEO: Criticism, Reluctance Slowing Value-Based Care Transition

Cleveland Clinic CEO Toby Cosgrove, MD, said the transition to value-based care is being slowed by "criticism, misunderstanding and a reluctance to do things differently," according to a Harvard Business Review blog post.

Dr. Cosgrove said all health systems must embrace the challenge to improve quality while lowering costs, and "whether providers like it or not, healthcare is evolving from a proficiency-based art to a data-driven science."

This includes moving from freelance physicians to hospital-employed physicians and from one-size-fits-all community hospitals to vast hospital networks organized around centers of excellence. Dr. Cosgrove said what makes Cleveland Clinic different dates back to its founding 92 years ago as a physician-led group practice that runs a hospital — not a hospital that employs doctors.

He highlighted two ways the system is working to lower costs and improve quality.

Mining data. Dr. Cosgrove said the system has integrated care through shared protocols and the same electronic medical record platform at all of its 75 care delivery sites. By collecting provider performance data and making it transparent, Cleveland Clinic reduced central-line infections by more than 40 percent and urinary-tract infections by 50 percent.

The system also established a value-based care team that seeks to eliminate unnecessary practice variation by developing evidence-based care paths across diseases. The team is also tasked with improving care coordination so patients move seamlessly through the system, reducing unnecessary hospitalizations and emergency room visits.

Lowering costs. Cleveland Clinic created a Cost Repositioning Task Force to work with all caregivers across the system. The task force assesses everything caregivers do and how much the system spends. "Now, as part of the purchasing process, dozens of doctors gather to discuss the merits of certain products," wrote Dr. Cosgrove.

Furthermore, remembering the cost of any of the thousands of supplies used during surgeries typically isn't part of physicians' medical makeup, wrote Dr. Cosgrove. "To remedy that, we've taped price lists to supply cabinets in some ORs."

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