2016 Acclaim Award Honoree

Cleveland Clinic
Enabling Today While Inventing Tomorrow – A Transformation Journey
Cleveland Clinic is a multispecialty academic medical center that integrates clinical care with research and education and serves as the hub of a multisite healthcare delivery system with local, national, and international reach. Four years ago, Cleveland Clinic started a formal multidisciplinary and enterprise-wide journey from volume to value. They recognized that redesigning their care models to standardized care, improve patient experience, and optimize outcomes was critical for sustainable success. Their work started to coalesce and support several extremely important initiatives that needed to become more focused and synergistic with each other.

  • Before 2010, Cleveland Clinic began preparing for National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification. Each NCQA “must have” was addressed: enhance access and continuity; identify and manage patient populations through data; pre-plan and manage care; provide self-care support and community resources; track referrals and follow-up; coordinate care; and measure and improve performance through continuous quality improvement. In 2010, NCQA Level 3 certification was achieved.

  • Three pilots were initiated which included 20% of Cleveland Clinic providers and 60,000 patient lives:

    • Team-Based Care Model. This model of care tested the theory that if a physician had assistance with documenting a patient’s visit, the visit would be more thorough and interactions between the physician and the patient would be more satisfying.

    • Macro Model (MD/APN/MA). This model optimized the care team by emphasizing the role of the advanced practice provider and adding a medical assistant to do pre- and post-visit planning.

    • Integrated Care Model (MD/RN). This model focused on building an effective team around the patient. The team included one registered nurse care coordinator per physician, eight medical assistants (for pre-visit planning), a clinical pharmacist, and a diabetes educator when applicable.

  • In early 2013, a pilot began, applying The Joint Commission (TJC) primary care medical home certification criteria. By fall 2013, Cleveland Clinic became the first organization to achieve Primary Care Medical Home (PCMH) Certification for Hospitals from TJC.

  • In 2016, the Centers for Medicare & Medicaid Services (CMS) announced Cleveland Clinic as the top Accountable Care Organization (ACO) first-year performer for the Medicare Shared Saving Program.

  • A stroke care path was the first care path developed by the Cleveland Clinic health system and made available enterprise-wide. To promote compliance, the care path is embedded in the electronic medical record, making it part of the workflow of every caregiver providing stroke care. The results of adherence to the stroke care path have been striking:

    • 63 percent of patients’ stroke scale (NIHSS) scores improved from admission to discharge; 25 percent of patients remain stable

    • 24.5 percent reduction in daily direct cost

    • Significant reduction in observed/expected inpatient mortality

    • Significant reduction in hospital length of stay