1.

Porter & Teisberg, 2014,Cleveland Clinic

a. What is the Cleveland Clinic’s overall strategy for improving value for patients? Identify
the critical components and their rationale.

In the words of Dr. David Longworth, the Cleveland Clinic employs a two-fold strategy revolves that
around patient value. The clinic focuses on cutting down unnecessary treatment and practice by
following an evidence based approach in treating diseases. In addition, it also ties in comprehensive care
that seeks to maximize patient comfort and ease of access while reducing redundant hospitalizations
and emergency room visits. The clinic manages to do this by developing an Institute approach where it
houses both medical and surgical specialists, as well as both inpatient and outpatient care. Each Institute
has a leadership that is in charge of identifying the specific disease and care that the Institute specializes
in. By doing this, the clinic can provide quality healthcare while reducing cost, patient time spent at
hospitals, and optimizing specialist’ skillsets.

b. Where has the Clinic made the most progress? What are the areas for improvement?

The clinic has made the most progress in implementing an integrated electronic medical record system.
Named MyChart and MyPractice among other functions, the system uses a single data warehouse
sorted by patient for ease of access. These records include digitized data, images, test results, reports,
and more. Lab computers and other medical devices that practitioners use transmit patient data and
results directly to the data warehouse to be consolidated. MyChart is an application that allowed the
physician and the patient to see the same information as well as maintain up to date contact
information in order to request appointments, visits, and prescription renewal. MyPractice tied in the
clinical data with administrative data that allowed physicians to see all previous patient encounters
within the Cleveland health system.

While the Cleveland Clinic has set a standard for the medical community, there are still areas of
improvement. One such area is in regards to the clinic’s affiliate program. Physicians at the affiliates
were not always clinic employees and compensation models differed based on the affiliate site. While
the main clinic treated patients quickly and efficiently, affiliate programs are not yet at this level. This
may have an adverse effect on Cleveland Clinic’s branding, as it looks to expand more.

c. Identify the Clinic’s various approaches to growing its practice. Which growth initiatives
should the Clinic expand and why?

The Cleveland Clinic has been looking overseas for places to expand its practice and unique brand of
health care. Some locations that are already overseas include Abu Dhabi and Canada, with the possibility
of more locations in China, the UK, and Turkey. The Cleveland Clinic should continue to invest heavily in
IT to better facilitate their physicians and patients. Thus far, implementations of the MyPractice and
MyChart electronic medical record systems have proven to be successful in aiding physicians best treat
their patients and allowing patients access to their medical records and physicians. The Cleveland Clinic
should continue to develop tools using information technology, all while being mindful of the fact that
increased technology use might actually cause a decrease in quality of patient care. In addition to
expanding to Canada and Abu Dhabi, the Cleveland Clinic should seek to expand to places like China or
India. These countries offer the clinic a chance to conduct research in the “epicenter” for contagious
diseases due to the enormous population density.

2. List the key success factors for hospitals to improve value from the Edwards 2011 reading

There are three major success factors in hospitals improving values for patient treatment, pursuing
quality and access for patients, staff involvement, and standardizing and simplifying care processes. The
first factor focuses on the patient experience while they are in the hospital. This includes coordination
among physicians and hospital staff during the entire length of the patient’s stay at the hospital.
Another consideration is the atmosphere of the hospital, for example, the North Mississippi Medical
Center (NMMC) redesigned its emergency department with help from the community after learning
there are a large amount of discontent with the current design. This was done in an effort to put the
patient experience first and improve the efficiency at which the patient can be served. The second
factor, staff involvement in the patient experience, is closely tied into the first. Hospital staff must be
motivated and engaged with patients in order to provide the best patient care and experience possible.
One example, from St. Vincent, achieves this by making sure that all staff are part of different councils
that seek to identify issues and areas for improvement. Since this effort is staff driven, solutions are also
likely to be implemented. Other solutions involve physicians from different units provide care for
patients with similar conditions, in a service line format. This improves the efficiency of the hospital and
also raises the quality and experience for the patient themselves. The most important aspect among all
this is that fact that these changes and ideas are staff driven, based on patient needs and the staff’s
ability to address that need. The final factor for hospitals to improve their value is by standardizing and
simplifying hospital processes to improve the patient flow and better serve the patient during their stay.
Some ways that this was implemented was through increased use of information systems. The NMMC
placed physicians on the IT team to involve them in developing systems to better benefit hospital
processes. This was how the electronic record system for the NMMC was developed, with input from
physicians on the data that the wanted the records to capture. By putting physicians on the IT team, the
NMMC found that there was more user satisfaction from physicians and less compatibility problems.

3. Casale, 2007, Shah

a. List and describe four factors that contributed to Geisinger’s success with ProvenCare SM.

There are four factors that contributed to Geisinger’s success: easy access, information continuity,
continued innovation, and teamwork. Geisinger redesigned his appointment system to promote easier
clinical access for the patients. After the redesign, same day appointments almost doubled, along with
patient satisfaction and physician productivity. Geisinger also invested almost $100 million in developing
an electronic health record system (EHC). The EHC acts as a central system for more than 3 million
patient records. Patients can register online and see their medical records. Geisinger continues to
compound on these efforts by innovating to improve patient experience and quality. He uses
ProvenCare to procure metrics that are used to promote enhanced performance from the medical
centers and the physicians. One way this is implemented is through the EHC, which forwards automatic
“health maintenance and best practice” alerts to physicians as well as schedule reminders and drug
warnings to patients. Finally, in addition to designing and innovating systems to better serve the
patients, Geisinger also tries to incentivize improvements to promote teamwork and productivity. By
tying a portion of base compensation to productivity and performance targets that include quality of
care and patient satisfaction, Geisinger actively pushed his physicians to do the most that they can.
Results have shown that it is working, with productivity rising almost doubling and increased patient
satisfaction.

b. List and describe the three advantages and three disadvantages for a provider (hospital
and/or physician group) becoming an insurer.

Advantages:

1. More efficient delivery process without the need of a third party being the
intermediary.
2. Hospitals generate more revenue that can, in turn, be used to invest in the
community, health system, and patient base. Geisinger Health Plan is an example of
this as it adds almost $1.3 billion in revenue to Geisinger Health System.
3. Localized health care decisions. Current plans with third party intermediary
companies issue mandates that are often not indicative of the local situation. With
hospital providing health care, these kinds of mandates and decisions can be kept in
the local realm.

Disadvantages:

1. State and federal insurance laws can be demanding and dissuade hospitals from
becoming their own provider.
2. A hospital's health plan needs its own executive leadership, but it cannot be left
alone. It needs molding and support just like any other branch of an integrated
delivery network.
3. Hospitals need to be vigilant and make sure that the health care plan doesn’t
encroach on plans offered by other providers in their area.

c. What are the pros and cons of offering warranties for health care services for a provider
in the US?

The use of warranties on medical procedures, similar to warranties on consumer goods, is an interesting
concept on what it would mean for the insurance provider. There are many pro/con’s associated with
such a policy, both of which can be unsettling for the provider and also the hospital performing the
procedure. Using Geisinger’s ProvenCare as an example, the use of warranties may reassure insurance
providers to greenlight higher quality care and procedures without the fear of suffering financial
consequences of a procedure gone badly. Geisinger’s ProvenCare sets a high premium based on the
medical problem that creates a powerful incentive for the hospital and doctors to get the procedure
right the first time, or suffer the financial consequences of housing and treating a patient a second time.
While this is all in the patient’s favor, the warranties, like any consumer goods warranty, have fine print.
In the event that there is complication that is covered, the patient can only return to the hospital that
they received the initial treatment and procedure, and nowhere else. In addition, there are questions as
to whether such warranty policies can be applied in health care systems that don’t have the facilities
and capabilities that Geisinger’s health system has. While there are certain pros and cons with
implementing such a warranty system, the idea is inherently sound. It encourages insurance providers to
insure costlier and better quality care, incentivizes hospitals and physicians to get the procedure right
the first time, and makes sure that the patient returns to the same hospital in the event of complication.