1.

Porter & Teisberg, 2014,Cleveland Clinic

a. What is the Cleveland Clinics 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 clinics 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 Clinics branding, as it looks to
expand more.

c. Identify the Clinics 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 patients 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 staffs 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 Geisingers success
with ProvenCareSM.
There are four factors that contributed to Geisingers 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 doesnt 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/cons associated with such a policy, both of which can be
unsettling for the provider and also the hospital performing the procedure. Using
Geisingers 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. Geisingers
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 patients 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
dont have the facilities and capabilities that Geisingers 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.