Transformation in Health Care Organization: How Are Hospital Systems Adapting?

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The growing number of consumers using less traditional methods for accessing their health care is prompting many hospital systems to explore expanding their walk-in clinics and online access. Additionally, many hospital systems are exploring new ways to provide less expensive but still high quality care and are making investments in new ways to measure patient outcomes. A recent article in The New York Times highlights how the Cleveland Clinic is responding to these changes.

According to The New York Times, the Cleveland Clinic is transforming its focus from high-priced specialty care to disease prevention, chronic condition management, and primary care. Understanding the need to innovate, Dr. Delos (“Toby”) Cosgrove, the chief executive of the clinic, is developing ways to adapt to a challenging health care environment. He closed one of the clinic’s hospitals, Huron Hospital, replacing it  with the Stephanie Tubbs Jones Health Center, a family health center, which provides a more holistic approach to health care including cooking classes for patients with diabetes. The center also expanded its walk-in clinic hours and is developing strategies to encourage people who visit the emergency room for their routine care to instead visit the walk-in clinic. Dr. Cosgrove is also exploring the use of online platforms, such as HealthSpot stations, to conduct primary care visits.

In addition to the physical restructuring which is taking place, the Cleveland Clinic is experimenting with new payment models to deliver care less expensively. Medicare and many other insurers are now moving away from volume-based payments, instituting alternative payment models and creating stronger links between payment and quality.  The Cleveland Clinic’s efforts to implement payment and delivery system reforms, including an accountable care organization, are accompanied by robust computer systems to track management of patient care. In order to calculate the impact of their efforts, Dr. Cosgrove underscores the importance of measuring patient outcomes and assessing patient perceptions of value.

Work funded under the HCFO program generates evidence that helps to inform the policies and practices ongoing at the Cleveland Clinic and throughout the health care system. For example:

Ateev Mehrotra, M.D., Harvard Medical School, and colleagues explored a model that is moving care out of the hospital setting. They examined the impact of retail health clinics on health care utilization and costs. Specifically, they assessed whether the entry of retail health clinics into a community is associated with a change in the overall utilization of retail-clinic sensitive conditions—eight simple acute care conditions that make up the majority of retail health clinic visits—and estimated the impact on costs of the entry of retail clinics. The researchers hypothesized that retail health clinic utilization could substitute for emergency department and physician office utilization, thus decreasing costs, or encourage utilization by those who would otherwise stay at home, thus increasing costs. The objective of this study was to shed light on the potential benefits and drawbacks of policies that encourage retail clinic use. Additional information about Mehrotra’s study is available here.   

In response to the diffusion of “virtual” care models like HealthSpot, R. Adams Dudley, M.D., University of California, San Francisco, and colleagues examined the processes and quality of care provided by virtual physician websites for minor acute illnesses. They trained actors to present to doctors from the most frequently visited websites offering virtual care. The actors described symptoms for illnesses that the sites advertised they could treat and for which clear guidelines regarding appropriate treatment existed. The researchers described how care was provided–including measures of access, whether specific elements of history and physical exam were performed, and what testing or treatment was offered–and measured performance by evaluating physician adherence to established guidelines. The goals of this project were to understand the virtual care process, inform various stakeholders about monitoring and paying for virtual care, and identify ways to improve this model of care delivery. Additional information about Dudley’s study is available here.

Finally, HCFO grantee Andrew Ryan, Ph.D., University of Michigan School of Public Health, and colleagues evaluated the effect of the Medicare Hospital Value-based Purchasing (HVBP) program on quality of care during the program’s first year of implementation.  Specifically, the researchers compared how participating hospitals and non-participating hospitals performed on incentivized clinical process and patient experience measures, before and after the HVBP program began.  Among hospitals that participated in the program, the researchers also tested for differences in performance on incentivized and non-incentivized quality measures, before and after the HVBP program began.  The goal of this project was to provide an early evaluation of the HVBP program that will assist policymakers in refining this strategy in the future. Additional information about Ryan’s study is available here.