Fierce Q&A: Cleveland Clinic CEO dishes on his expansion goals

Karen Cheung

 Karen M. Cheung

What is one of the leading healthcare institutions working on? Expanding. FierceHealthcare caught up with Cleveland Clinic President & CEO Toby Cosgrove, M.D., about recent affiliations, its venture to open up shop in Abu Dhabi and partnerships for its innovations business. Hear why the organization thinks of itself as a caregiver, first and foremost, and why cost savings shouldn't be an excuse to cut corners.

FierceHealthcare: Cleveland Clinic is expanding at a steady clip, especially with regard to cardiology affiliations. What plans does the Clinic have to partner with others?

Toby Cosgrove

 Toby Cosgrove

Toby Cosgrove: The population in Northeast Ohio is declining and has been on the downward trend for some time. Combine that with the fact that hospitals are getting paid less but expected to do more, and it's clear that we have to come up with other ways to be more efficient with our resources while still being able to deliver high-quality care to our patients.

We are careful to partner with those who have the same values for quality outcomes and transparency.

FH: How will your partnerships help the hospital system and patients?

TC: Affiliation agreements allow us to leverage the clinical and intellectual expertise that Cleveland Clinic is known for to benefit patients in new markets and in other healthcare systems, extend our model of care outside of our home region, expand our services and bring in new sources of revenue.

We are approached frequently by others in healthcare wanting to know more about how they can make our model their model. Affiliations provide opportunities for Cleveland Clinic to do just that: to share our intellectual property and increase the quality of healthcare across the country.

Through affiliations, our partner hospitals and their patients have access to the academic, clinical and research components of Cleveland Clinic. This means access to clinical trials, evidence-based treatment protocols and additional research opportunities for physicians and patients.

FH: The "m-word" (monopoly) often gets tossed around whenever larger hospitals merge with physician groups and smaller community hospitals.  What's your take on the increasing number of partnerships and mergers that we're seeing in the industry?

TC: The healthcare industry is increasingly moving toward consolidating as the result of the changing reimbursement environment. Smaller hospitals and practices don't have the buying power, operational efficiencies, reporting mechanisms and the ability to invest in new technologies that the larger hospitals and systems already have.

We've invested hundreds of millions of dollars in our electronic medical records over the last 10 years, and we're now truly reaping the benefits. For example, we now have comprehensive care protocols called Carepaths that are developed by clinical experts and tightly incorporated into the electronic health record. The goal of Carepaths is to ensure a systematic approach to management for all patients. We started with stroke patients and are now moving into other conditions.

Merging with a large system allows smaller hospitals who otherwise couldn't make a financial commitment like this to benefit from our early adoption and investment in technology like this.

There are obviously pluses and minuses to every trend. We see mergers and acquisitions, and even affiliations, with Cleveland Clinic as opportunities to increase access to clinical trials, evidence-based treatment protocols and additional research opportunities for both physicians and patients, with the ultimate goal of improving the delivery of healthcare across the country.

FH: Your organization already has a presence in Canada and will move into Abu Dhabi next year. Why is the Clinic focusing its attention abroad? Are there plans to train providers in other countries?


"'Patients First' isn't just a slogan at Cleveland Clinic; it's our guiding principle."

TC: We're very excited for the opening of Cleveland Clinic Abu Dhabi. It will truly be an outstanding medical facility that will elevate the level of healthcare available to patients in the entire region.

The United Arab Emirates (UAE) government is paying to build the hospital, and Cleveland Clinic is collaborating with the government to care for patients in UAE. We are paid a management fee for our services so this relationship will come back to benefit our Northeast Ohio community.

Cleveland Clinic has a long-standing relationship with the people and government of Abu Dhabi and the UAE. We have had the privilege to treat Emirate patients and host medical professionals for continued medical education. Working with the government of Abu Dhabi, we identified a need in the region to provide compassionate, patient-centered care of the highest quality.

In addition to Cleveland Clinic Abu Dhabi, [Sheikh Khalifa Medical City], and Cleveland Clinic Canada, we have a continued focus on providing medical education internationally, through our Center for International Medical Education. We recently signed an affiliation agreement with a Saudi Arabian professional managed healthcare company, Healthcare Development Holding Co., to collaborate on medical education and training for healthcare providers in Saudi Arabia. Our office in Saudi Arabia will facilitate multiple Cleveland Clinic education and training programs and knowledge-sharing initiatives that focus on developing best practices to treat medical conditions that are prevalent in the region.

FH: Before the Center for Medicare and Medicaid Innovation released its list of ACO participants, many had predicted that Cleveland Clinic would be on the forefront of the Pioneer group. How is the Clinic working on a different path for accountable care outside of the CMMI program?

TC: We fully support the need to drive quality and reduce costs in healthcare. Our model of healthcare delivery at Cleveland Clinic as an integrated, group practice with salaried physicians is aligned with the values promoted by ACOs. We're currently testing various models within our health system that will help us determine how Cleveland Clinic most effectively provides accountable care.

FH: Another area for growth is Cleveland Clinic Innovations, which includes partnerships with MedStar Health and more recently, North Shore-Long Island Jewish Health System. What benefits does the business line of innovations offer the Clinic, as well as the community?

TC: For more than 10 years, Cleveland Clinic Innovations has been very successful in commercializing Cleveland Clinic technologies. We have seen over 48 spin-off companies and have seen a culture of innovation develop with our health system and our community. Under the Innovation Alliances, CCI provides other organizations the same high level of commercialization services it provides to our own clinicians. The Alliance provides access to an ecosystem that broadens their reach with strategic collaborators, venture investors and their stakeholders. We see this as an opportunity to have even greater potential to bring ideas from "the bench to the bedside," which will ultimately benefit the patient. 

FH: Many hospitals with various levels of resources watch the Clinic very closely as an example hospital on clinical care, patient experience and operational efficiencies. What advice do you have for them?


"Our cost-savings efforts have resulted in the same or better outcomes for patients, and that should be the norm, not the exception."

TC: Look critically at costs, but don't compromise quality or what's best for patients in pursuit of cost savings. Our cost-savings efforts have resulted in the same or better outcomes for patients, and that should be the norm, not the exception.

Focus on caring for the caregiver if you want to have a positive impact on patient care. We have trained all of our employees to think of themselves as caregivers, and now everyone knows that they have a role in putting patients first. The work of every person at Cleveland Clinic touches patients in some way, and therefore, we are all caregivers.

It is important to value and encourage transparency. Cleveland Clinic is committed to transparency and strives to make data easily accessible for our patients. We were the first major medical center to publish annual outcomes and volume information for our medical specialties. It is our belief that transparency and an open and consistent dialogue with our patients will result in fully informed patients. Informed patients are empowered patients and can take a more proactive approach to their own healthcare. Transparency also allows us to know our strengths and cultivate them, and at the same time, identify areas for improvement.

Healthcare is in an unprecedented time of change. We need to embrace the change and use it as an opportunity to truly improve the way we deliver care. We need to use resources more efficiently, reduce the burden of chronic disease on the system and encourage healthy lifestyle decisions like being physically active and not smoking--all with the overriding goal of doing what's best for patients in this country.

"Patients First" isn't just a slogan at Cleveland Clinic; it's our guiding principle. That is where we get our satisfaction and our motivation. If we keep patients first and foremost in our minds, we will ultimately be successful regardless of what is handed to us.

Editor's note: This interview has been edited for length and clarity.