Case studies
Case: The Cleveland Clinic

Recalling his “aha moment” at Harvard in 2006, Dr. Toby Cosgrove, the CEO, remembers, “I couldn’t get the fact out of my mind that we would lose market share and lose employment for our community.” Dr. Cosgrove concluded, “Cleveland Clinic cannot continue to just get the best outcomes in patient care. It is not enough.” So he investigated the Mayo Clinic and learned that part of its advantage is its community engagement.

Dr. Cosgrove realized that his vision had to extend to all of Cuyahoga County and include some bold and explicit strategic investments. A chief wellness officer (CWO) joined the C-suite and the clinic’s mission was modified to focus on wellness of the county. The clinic is investing $30 million in nonfinancial social assets to help individuals adopt healthier behaviors and reduce health care costs by more than 10 percent, or $1 billion in Cuyahoga County alone—a significant return for the community and a “hook” to attract future employers.

To make this Big Hairy Audacious Goal (BHAG) a reality, CWO Dr. Roizen is working to realize the clinic’s long-term goal through both internal and external initiatives. This is his passion—and his challenge is to make it everyone’s passion. Internally, 33 wellness groups have been launched (one at each clinic site) to test new ways of doing business and new investments in the wellness of employees.

The Cleveland Clinic’s funding of employee health insurance is a good example of a new way of doing business. The clinic assumes a certain fraction of employees’ health care costs provided the employees each do five things every year: get their blood pressure measured, get their waist measured, have their blood tested for TB, develop a plan for healthy living, and take one of five general health risk assessments. Initially many individuals said, “Oh, I don’t want to do that,” but nonparticipation is an option that few can afford; virtually everyone employed by the clinic has started complying.

Externally, the investment is in programs targeting top themes and at-risk neighborhoods. For example, the clinic is providing free tobacco cessation programs to everyone in the county. Initial results look encouraging. To date, the program has cost the Cleveland Clinic about $92 per year of life saved. Compare this to the cost of saving a year of life when high blood pressure is an issue—$30,000 to $60,000. The same approach is being taken with nutrition. The Cleveland Clinic is both educating the population and helping make healthy food available.

The results of these social investments are beginning to be tracked. Measures include

  • Percentage of employees contributing ideas, and percentage of ideas tested and institutionalized
  • Adherence to programs and cause of deviations
  • Percentage of population with healthier habits overall and percentage of population that shifted from unhealthy to healthy habits each quarter
  • The per-capita health care cost in the county compared with Ohio as a whole

In Dr. Roizen’s words, “The realization that Cleveland Clinic has to take care of our employees and the community is gradually transforming us into a much more socially responsible organization.”

Although it is premature to discuss results, the excitement inside the clinic is palpable. Over the next 12 months, results should start being seen inside the clinic and at the base level in the community. As indicators come in, the program will adjust and if successful be emulated elsewhere.

Posted on 9/3/2008