1. Porter & Teisberg, 2014,Cleveland 2014,Cleveland Clinic a. What is the Clevela Cleveland nd Clinic’s Clinic’s overall overall strategy strategy for imrovin imroving g val!e for atients" #dentify the critical comonents and their rationale. #n the $ords of %r. %avid ong$orth, the Cleveland Clinic emloys a t$o'fold strategy revolves that aro!nd atient val!e. The clinic foc!ses on c!tting do$n !nnecessary !nnecessary treatment and ractice by follo$ing an evidence based aroach aroach in treating diseases. #n addition, it also ties in comrehensive care that see(s to ma)imi*e atient comfort and ease of access $hile red!cing red!ndant hositali*ations and emergency room visits. The clinic manages to do this by develoing an #nstit!te aroach $here it ho!ses both medical and s!rgical secialists, as $ell as both inatient and o!tatient care. +ach #nstit!te has a leadershi that is in charge of identifying the secic disease and care that the #nstit!te seciali*es in. -y doing this, the clinic can rovide !ality healthcare $hile red!cing red!cing cost, atient time sent at hositals, and otimi*ing secialist’ secialist’ s(illsets.
b. Where has the Clinic Clinic made the the most rogress" rogress" What What are the areas areas for imrovement" The clinic has has made the most most rogress rogress in imlementing imlementing an integrated integrated electronic electronic medical record system. /amed yChart and yPractice among other f!nctions, the system !ses a single data $areho!se sorted by atient for ease of access. These records incl!de digiti*ed data, images, test res!lts, reorts, and more. ab com!ters and other medical devices that ractitioners !se transmit atient data and res!lts directly to the data $areho!se to be consolidated. yChart is an alication that allo$ed the hysician and the atient to see the same information as $ell as maintain ! to date contact information in order to re!est aointments, visits, and rescrition rene$al. yPractice tied in the clinical data $ith administrative administrative data that allo$ed hysicians to see all revio!s atient enco!nters $ithin the Cleveland health system. While the Cleveland Clinic has set a standard for the medical comm!nity, there are still areas of imrovement. ne s!ch area is in regards to the clinic’s aliate rogram. rogram. Physicians at the aliates $ere not al$ays clinic emloyees and comensation models di3ered based on the aliate site. While the main clinic treated atients !ic(ly and eciently, aliate rograms are not yet at this level. This may have an an adverse e3ect on on Cleveland Clinic’s Clinic’s branding, branding, as it loo(s loo(s to e)and more.
c. #dentify #dentify the Clinic’s Clinic’s vario!s vario!s aroache aroaches s to gro$ing gro$ing its ractice. ractice. Which Which gro$th initiatives sho!ld the Clinic e)and and $hy" The Cleveland Clinic has been been loo(ing overseas overseas for laces laces to e)and e)and its ractice ractice and !ni!e brand of health care. ome locations that are already overseas incl!de 5b! %habi and Canada, $ith the ossibility of more locations in China, the 67, and T!r(ey T!r(ey.. The Cleveland Cleveland Clinic sho!ld sho!ld contin!e contin!e to invest heavily heavily in #T to better facilitate their hysicians and atients. Th!s far, imlementations of the yPractice
and yChart electronic medical record systems have roven to be s!ccessf!l in aiding hysicians best treat their atients and allo$ing atients access to their medical records and hysicians. The Cleveland Clinic sho!ld contin!e to develo tools !sing information technology, all $hile being mindf!l of the fact that increased technology !se might act!ally ca!se a decrease in !ality of atient care. #n addition to e)anding to Canada and 5b! %habi, the Cleveland Clinic sho!ld see( to e)and to laces li(e China or #ndia. These co!ntries o3er the clinic a chance to cond!ct research in the 8eicenter9 for contagio!s diseases d!e to the enormo!s o!lation density.
2. ist the (ey s!ccess factors for hositals to imrove val!e from the +d$ards 2011 reading There are three ma:or s!ccess factors in hositals imroving val!es for atient treatment, !rs!ing !ality and access for atients, sta3 involvement, and standardi*ing and simlifying care rocesses. The rst factor foc!ses on the atient e)erience $hile they are in the hosital. This incl!des coordination among hysicians and hosital sta3 d!ring the entire length of the atient’s stay at the hosital. 5nother consideration is the atmoshere of the hosital, for e)amle, the /orth ississii edical Center ;/C< redesigned its emergency deartment $ith hel from the comm!nity after learning there are a large amo!nt of discontent $ith the c!rrent design. This $as done in an e3ort to !t the atient e)erience rst and imrove the eciency at $hich the atient can be served. The second factor, sta3 involvement in the atient e)erience, is closely tied into the rst. =osital sta3 m!st be motivated and engaged $ith atients in order to rovide the best atient care and e)erience ossible. ne e)amle, from t. >incent, achieves this by ma(ing s!re that all sta3 are art of di3erent co!ncils that see( to identify iss!es and areas for imrovement. ince this e3ort is sta3 driven, sol!tions are also li(ely to be imlemented. ther sol!tions involve hysicians from di3erent !nits rovide care for atients $ith similar conditions, in a service line format. This imroves the eciency of the hosital and also raises the !ality and e)erience for the atient themselves. The most imortant asect among all this is that fact that these changes and ideas are sta3 driven, based on atient needs and the sta3’s ability to address that need. The nal factor for hositals to imrove their val!e is by standardi*ing and simlifying hosital rocesses to imrove the atient ?o$ and better serve the atient d!ring their stay. ome $ays that this $as imlemented $as thro!gh increased !se of information systems. The /C laced hysicians on the #T team to involve them in develoing systems to better benet hosital rocesses. This $as ho$ the electronic record system for the /C $as develoed, $ith in!t from hysicians on the data that the $anted the records to cat!re. -y !tting hysicians on the #T team, the /C fo!nd that there $as more !ser satisfaction from hysicians and less comatibility roblems.
@. Casale, 200A, hah a. ist and describe fo!r factors that contrib!ted to Beisinger’s s!ccess $ith ProvenCare . There are fo!r factors that contrib!ted to Beisinger’s s!ccess easy access, information contin!ity, contin!ed innovation, and team$or(. Beisinger redesigned his aointment system to romote easier clinical access for the atients. 5fter the redesign, same day aointments almost do!bled, along $ith atient satisfaction and hysician rod!ctivity. Beisinger also invested almost D100 million in develoing an electronic health record system ;+=C<. The +=C acts as a central system for more than @ million atient records. Patients can register online and see their medical records. Beisinger contin!es to como!nd on these e3orts by innovating to imrove atient e)erience and !ality. =e !ses ProvenCare to roc!re metrics that are !sed to romote enhanced erformance from the medical centers and the hysicians. ne $ay this is imlemented is thro!gh the +=C, $hich for$ards a!tomatic 8health maintenance and best ractice9 alerts to hysicians as $ell as sched!le reminders and dr!g $arnings to atients. Einally, in addition to designing and innovating systems to better serve the atients, Beisinger also tries to incentivi*e imrovements to romote team$or( and rod!ctivity. -y tying a ortion of base comensation to rod!ctivity and erformance targets that incl!de !ality of care and atient satisfaction, Beisinger actively !shed his hysicians to do the most that they can. Fes!lts have sho$n that it is $or(ing, $ith rod!ctivity rising almost do!bling and increased atient satisfaction.
b. ist and describe the three advantages and three disadvantages for a rovider ;hosital andGor hysician gro!< becoming an ins!rer. Advantages:
1. ore ecient delivery rocess $itho!t the need of a third arty being the intermediary. 2. =ositals generate more reven!e that can, in t!rn, be !sed to invest in the comm!nity, health system, and atient base. Beisinger =ealth Plan is an e)amle of this as it adds almost D1.@ billion in reven!e to Beisinger =ealth ystem. 3. ocali*ed health care decisions. C!rrent lans $ith third arty intermediary comanies iss!e mandates that are often not indicative of the local sit!ation. With hosital roviding health care, these (inds of mandates and decisions can be (et in the local realm. Disadvantages:
1. tate and federal ins!rance la$s can be demanding and diss!ade hositals from becoming their o$n rovider.
2. 5 hositalHs health lan needs its o$n e)ec!tive leadershi, b!t it cannot be left alone. #t needs molding and s!ort :!st li(e any other branch of an integrated delivery net$or(. 3. =ositals need to be vigilant and ma(e s!re that the health care lan doesn’t encroach on lans o3ered by other roviders in their area.
c. What are the ros and cons of o3ering $arranties for health care services for a rovider in the 6" The !se of $arranties on medical roced!res, similar to $arranties on cons!mer goods, is an interesting concet on $hat it $o!ld mean for the ins!rance rovider. There are many roGcon’s associated $ith s!ch a olicy, both of $hich can be !nsettling for the rovider and also the hosital erforming the roced!re. 6sing Beisinger’s ProvenCare as an e)amle, the !se of $arranties may reass!re ins!rance roviders to greenlight higher !ality care and roced!res $itho!t the fear of s!3ering nancial conse!ences of a roced!re gone badly. Beisinger’s ProvenCare sets a high remi!m based on the medical roblem that creates a o$erf!l incentive for the hosital and doctors to get the roced!re right the rst time, or s!3er the nancial conse!ences of ho!sing and treating a atient a second time. While this is all in the atient’s favor, the $arranties, li(e any cons!mer goods $arranty, have ne rint. #n the event that there is comlication that is covered, the atient can only ret!rn to the hosital that they received the initial treatment and roced!re, and no$here else. #n addition, there are !estions as to $hether s!ch $arranty olicies can be alied in health care systems that don’t have the facilities and caabilities that Beisinger’s health system has. While there are certain ros and cons $ith imlementing s!ch a $arranty system, the idea is inherently so!nd. #t enco!rages ins!rance roviders to ins!re costlier and better !ality care, incentivi*es hositals and hysicians to get the roced!re right the rst time, and ma(es s!re that the atient ret!rns to the same hosital in the event of comlication.
