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One Model for Health Reform

A CAP Discussion on How One Hospital Is Delivering More Efficient, Higher-Quality Care

John Podesta and Dr. Delos M. Cosgrove’s discussion at CAP demonstrates that health reform can work and examines how its implementation can be improved.

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The Center for American Progress has been fighting for health care reform since its inception, and now that reform has become a reality, the need to explore more efficient and effective ways to deliver higher-quality care to patients has become more crucial than ever. One American hospital, the Cleveland Clinic, is far ahead of the curve in improving health care delivery. President Obama cited the hospital as an example of what health care reform should be trying to move toward. “They’ve set up a system where patient care is the number one concern, not bureaucracy,” said Obama at a White house news conference on July 22, 2009. “Those are changes that I think the American people want to see.”

President and CEO of the Cleveland Clinic Dr. Delos M. Cosgrove appeared at the Center for American Progress to discuss with CAP President John Podesta how his organization achieves such higher results than its peers. Cosgrove provided invaluable insight into the reasons why the hospital is such a pioneer in the medical profession when it comes to organization, administration, doctors’ compensation, tracking patients’ records, and quality control. If hospitals across the United States learn from the Cleveland Clinic’s model, then health care reform could become a successful reality for Americans everywhere.

Cosgrove claimed that one of the most crucial differences between the Cleveland Clinic and other hospitals is that it is not organized around doctors but around patients. “We adopted the mantra of ‘patients first,’” said Cosgrove. What this means in practice is that the Clinic does not divide its specialists into different departments and tries to better integrate primary care and surgery. All their physicians, surgeons, and specialists are grouped around addressing patients’ needs rather than doctors’ preferences.

The Clinic even allows patients to see their charts to increase transparency. “Let’s just turn it loose on the patients. If you want to see your chart, here it is,” said Cosgrove, arguing that more hospital-patient transparency translates into better, more efficient, and lower-cost care.

For Cosgrove, putting patients first means focusing more on the health side of the equation rather than waiting until someone falls ill to begin caring for them. “I realized I had never looked after a healthy patient in 40 years,” said Cosgrove. The Cleveland Clinic has aggressively targeted smoking and obesity. All of its campuses are smoke-free, and the clinic has offered free smoking-cessation programs to help people quit smoking.

Its community efforts reduced the incidence of smoking in Cuyahoga County, where the Cleveland Clinic is located, from 28 percent to 18 percent in a four-year period. Trans fats, soda, and candy bars have been excluded from the clinic, and other programs encourage patients and employees to exercise.

Coordinating and integrating care is another factor in the clinic’s success, helping bring together different perspectives on treating patients. The Cleveland Clinic is not organized around a separation of surgery and medicine, like most hospitals. Doctors are instead organized into institutes based on their area of specialization. Brain surgeons, for example, work with neurologists and psychiatrists in the clinic’s Neurologic Institute, rather than with cardiac or colorectal surgeons as they would in a traditionally organized hospital.

The Cleveland Clinic has also improved the quality of care by keeping all of its patients’ medical records in electronic form. This has allowed the hospital to increase patients’ ability to move between hospitals and care facilities.

Cosgrove and Podesta’s discussion illustrated that, while there may not be one magic solution for making our health care system’s implementation better and more cost-effective, there are many lessons that health systems across the United States can learn from the Cleveland Clinic about how to deliver more efficient, high-quality care to their patients. Providers come to the Cleveland Clinic from all over the country to see the clinic’s model, and return home to brainstorm ways to improve their own clinics and hospitals as health reform unfolds.

For more on this event, click here

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