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Why US health systems expand overseas — Cleveland Clinic, UPMC, Sanford and Bon Secours Mercy Health leaders weigh in

Some of the United States' largest and most reputable health systems are expanding their international presence, taking their mission statements and high-quality healthcare services and operations to Europe, South America, Asia and Africa, among other parts of the world. 

International expansion affords health systems the opportunity to bring their top-tier care services and protocols to more people, closer to home, while also creating additional resources to improve their clinical and research practices as well as their reputations.

Leaders from Cleveland Clinic, UPMC, Sanford Health and Bon Secours Mercy Health System told Becker's Hospital Review about the biggest challenges and opportunities they face when expanding overseas and what they're most excited about in the future:

For health systems that wish to share details on their international expansions, contact Alan Condon at acondon@beckershealthcare.com.

Bill Peacock. Chief of Operations, Cleveland Clinic: The biggest challenge is also the biggest reward — understanding the healthcare needs of the people in that region and bringing world-class care to address those needs is no small task. As we expand internationally, we are 100 percent committed to making sure each Cleveland Clinic location is an extension of who we are and the care we provide. There is significant effort that goes into expanding our footprint, but the impact fulfills our ethical obligation to grow and responsibility to bring the best care to patients — regardless of where they live — because everyone deserves high-quality healthcare.

No matter the path we take, our mission — to care for life, research for health and educate those who serve — is being fulfilled, and that is exciting. We are able to provide seamless and uniform quality and experience of care across our global enterprise. Advancements in technology continue to profoundly alter the pace of discovery and innovation that impacts our patients, caregivers, communities and how we practice and research medicine. Across our global enterprise, new technology will allow us to break through long-standing bottlenecks in scientific discovery and shrink the amount of time to find solutions. This means researchers can get to discovery faster — expediting our ability to find medicines, cures and vaccines — providing better care for patients around the world.

Luis Garcia, MD. President, Sanford Health Clinic (Sioux Falls, S.D.): Sanford World Clinic is an initiative designed to provide developing countries around the world with innovative approaches to improve the health and well-being of individuals, families and communities. We develop unique models of care in collaboration with partners to meet the specific needs of each country. We partner to provide operations support, care delivery and research primarily at clinics in Costa Rica, Ghana and New Zealand. 

Many of the challenges that health systems are navigating in the U.S. are similar in other parts of the world, including workforce shortages, financial headwinds and even access to broadband in remote areas. For example, in New Zealand — where Sanford Health is partnering to provide medical services in a general practice primary care clinic — the country is facing a shortage of primary care physicians. In Costa Rica and Ghana, where Sanford Health also has World Clinic operations, both countries need more specialty physicians. 

Financial challenges exist as well, with different reimbursement models and currency fluctuations. Ghana's inflation rate has been about 30 percent in the last six to 10 months. In Costa Rica, the dollar is at its weakest ever — 20 percent reduction since last June. Just like in rural areas of the U.S., the lack of reliable internet can also create challenges at times. However, the official patient record in many parts of the world is still paper, which is very different compared to the U.S. Different EMR systems also exist, making it difficult to pull comparable clinical and operational data.  

Understanding the different cultural norms and attitudes about healthcare from patient behavior to medical practices is also crucial. For example, Ghanaians are not used to scheduling medical appointments. They come in the morning and expect to wait to see a provider. In Costa Rica, most births in the private sector are delivered via C-section. In Ghana, the C-section rate is only around 15 to 17 percent. 

Healthcare is evolving in the U.S. and around the world. What unites us is a shared goal of proving better outcomes to those we serve in the most efficient way possible. Continuing to learn from each other's successes and failures will help all countries enhance care delivery for the patients and communities we have the privilege of serving. Virtual care is an exciting opportunity across the globe, especially in areas such as behavioral health, radiology and education. Sanford Health is also exploring opportunities to share talent globally (matching the supply and demand), which excites me as we look to the future.  

Brian Smith. Bon Secours Mercy Health System (Cincinnati) Liaison to Ireland, member, Bon Secours Health System Board: As a health system, we are used to moving quickly — identifying opportunities to better care for patients and moving fast to make them a reality. With a partnership like the one between Bon Secours Mercy Health and Bon Secours Health System in Ireland, we needed to learn to slow down — to be responsible and responsive, humble and open to ideas, to listen and ask questions — so that we could move quickly together as one team. This has helped us to create a good discipline for the future.

As a team we have worked together to identify scalable opportunities that make sense — culturally, operationally and from a best practice perspective. We are moving forward collaboratively and strategically as a result. Bringing together the skills and best practices of both leadership teams has been phenomenal and has helped us grow as an organization, ultimately providing better care and opportunities for patients and associates.

Additionally, the Irish market is strong and growing, and the service and care we provide is highly valued which bodes well for the future — especially as we prepare to open Bon Secours Limerick Hospital in 2025.

Charles Bogosta. President, UPMC (Pittsburgh) International: By growing overseas, UPMC is able to bring life-changing medicine to more people, close to home. At the same time, this strategy creates additional resources — both financial and intellectual — to fuel the clinical and research mission of UPMC, a leading academic medical center, while enhancing our reputation and that of Pittsburgh.

We're excited to continue expanding high-quality services in our focus countries, particularly Ireland and Italy, while adding new partners in new places, such as Croatia, when we find the right opportunities. We are generally owner-operators of the healthcare facilities and programs that we establish so we set a high standard for our involvement.

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