1 1

Crafting Strategic Relationships

“One Size Does Not Fit All” Ann Huston

Chief Strategy Officer

Josette Beran

Executive Director

Strategic Partnering & Network Integration

2

• $7.6B in Annual Revenues; Not-for-Profit

• Academic Medical Center

• Medical Group that Runs a Health System

• 47,000 Caregivers

• >3,400 Employed Physicians & Scientists

• >1,700 Independent Physicians

• 6.2 Million Total Annual Patient Visits

• Global

Cleveland Clinic Today

3

Cleveland Clinic strategy

shapes all of our

partnering activities

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The Strategy

With Patients First,

transform to value and use

as basis for system growth

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Cleveland Clinic Roles

Specialty care referral center

Community care and population

manager

Innovative Academic Medical

Center

Services provider “CC Inside”

Our partnership activities serve our

strategies

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Two Aspects of Our Agenda

INTERNAL

Transform our

care model and

organization to value

EXTERNAL

Grow organically and

through strategic

relationships

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Cleveland Clinic Integrated Care Model

Retail Virtual

CC Clinic Community - Based

Organizations

Ambulatory D&T Independent Physicians

Hospitals

Rehab

Skilled Nursing Facilities

MyChart

Emergency Post Acute

Care System

Self/

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• Jointly-established quality standards

• Reward for quality and efficiency

• Drive to better outcomes

• Drive to improve value for patients,

providers and payers

Employed Physicians Independent Physicians

Data/

Analytics

Health

Plans

Physician Alignment Through

the Quality Alliance

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Integrating a Post-Acute

with Select Medical

Develop world

class post-acute

care delivery

Expand post-

acute access in

NE Ohio

Leverage capital

and capabilities

Post-Acute Provider

10 10

Training the Next Generation

with Ohio University

Innovation in

patient-centered

medical care

New model of

community-based

care for NE Ohio

Competency-based

medical education

focused on primary

care delivery

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Two Aspects of Our Agenda

INTERNAL

Transform our

care model and

organization to value

EXTERNAL

Grow organically and

through strategic

relationships

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Framework for Growth

Engineer growth in

core

Enter new geographic

markets

Preserve revenue

through

contracting

Diversify thru new

businesses

& models

Lead with consumer-focused products with

demonstrably differentiated value

Strategic Partnerships

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Acquisition of Akron General

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6 Systems

100,000 Employees

$14B Revenues

42 Hospitals

33% Inpatient Share

3 Health Plans

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Hospitals

Ambulatory Sites of Care

• Network

products

• Innovations

Cooperative

• Joint

management of

populations

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• Clinical expertise

• Physician/clinician integration

• Outcomes-based sourcing

• Track record

• Analytics

• Strong member networks

• Contracting expertise

• Track record

FEATURES

• Analytics

• Provider-centric model

• Physician/clinician integration

• Evidence-based health sourcing

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Extending System of Care

Through Cardiac Network

Specialty Network of Affiliated Hospitals and Alliances • Clinical expertise and infrastructure

• 25 affiliates

• 7 members in national network

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Crafting and Managing

Strategic Relationships

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Objectives

• Grow volume/lives

- Service area share

- Complex cases

• Attain necessary capabilities

• Realize benefits of scale

• Minimize capital outlay and risk

• Extend and differentiate our brand

• Leverage and monetize value we create

• Leadership – care and model

• Advance the strategy

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Key Considerations

• Care delivery remains local

• Regional, integrated systems as

core functional unit

• Unrealized advantages of scale

• Mergers difficult to realize

• Culture and values trump all

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Strategic Relationships

Consulting

Service

Agreements

Affiliations

& Alliances

Joint Ventures

Enterprise Joint

Operating Agreements

Member Substitutions

& Mergers

LOOSE

TIGHT

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Making It Work

• Cultural fit

• Sufficient mutual value

• Clear, shared objectives

• Sustained effort and management

• Commitment to relationships and

the work

Mindfulness in every interaction

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Case Study

Akron General – Cleveland Clinic

Full Member Substitution

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Acquisition of Akron General

• $700M health system

• Adjacent and important market

• Financially challenged

• Initial minority position

• 6-year call right

• Exercised full member at 1 year

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Integration Process

• Effective November 2015

• 18-month phase-in

• Driving to full integration, N.B., not

homogeneous

• Position AGMC as hub of southern region

- Drive clinical intensity

- Draw to CCAG from southern region

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Functional Integration

Approach

• Wholesale change – move out, we own you!

• Umbrella – Name and logo over both but

operations remain separate

• Balanced – CCHS aligned; Integration well-

paced yet prudent

- Systematic and well-managed

- Collaborative

X

X

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Integration Principles

• Patients First

• Ensure integrity of Enterprise

– finance, legal, compliance

• Expand synergies / efficiencies

• Achieve strategic positioning

• Align with IT implementation

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Integration Timeline

Wave

I

Wave

II

Wave

III

Wave

IV

Wave

V

Wave

VI

Wave

VII

11/1 -

12/31

Q1

2016

Q2

2016

Q3

2016

Q4

2016

Q1

2017 4/17

18 Months

Fully in CCHS

18 Month Integration Timeline

Integration Roadmap

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Connected Partial Full

EVS

Nursing

Call Center

Revenue Cycle

Supply Chain

EPIC

Clinical

Programs

Integration Framework

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Functional Integration

• Quality & Safety

• Patient Experience

• Clinical Transformation

• Compliance

• Finance

• Government Relations

• Human Resources

• Information Systems

• Legal

• Marketing

• Communications

• Medical Operations

• Nursing

• Support Services

• Facilities

• Supply Chain

• Physician Alignment

• Planning

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Clinical Services

• Unified CC clinical programs

• Clinical leadership alignment

• Flexible approaches

• Initial focus: cancer, cardiac, post-acute

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Integration Management

Process

• Formalized infrastructure

• Defined priorities

• Work teams in cadence

• Strong collaboration

• Ongoing issues resolution

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Management System

Integration Council

Regional

Governance Council

• Set strategy for region and CCAG

• Hospital Presidents & Institute Chairs

• Meets Monthly

• Oversee integration plan

• Functional Area Stakeholders

• Meets Weekly

• Drive day-to-day operations

• CCAG management

• Meets Weekly

CCAG

Management Team

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CC-CCAG Touch Points

• Governance – joint board members

• CCHS Leadership

• Physician Alignment

• Regional Planning

• Regional Operations

• Medical Operations

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Tools and Templates

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Finance

AGHS Integration Objective

Scope Document

Wave I & II (11/2015- 3/2016)

GOAL: Integration of key financial business operations

for gained efficiencies, standardization, and

overall integration

Key Considerations: Phased approach for understanding current

state, and building to desired state

Team Leads: CC: Steve Glass, Tony Helton

CCAG: Dave Frigo

Initiatives: 1. Financial Accounting

2. Revenue & Reimbursement

3. Tax & Compliance

Timeframe: 11/2015 – 3/2016

Issues/Risks: Competing priorities (EAS approved projects,

workday, CTMS, Medina) , and cross-

department dependencies (ITD, HR, SCM)

Measures: # facilities integrated into rev cycle, etc.

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Functional Area

Assessment Summary

38 38

Functional Area Department

Assessment

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Prospects will be managed in a pipeline portfolio, once they

are categorized as good candidates to further develop,

they will be migrated to its own “deal”

The Integration phase will be composed of

Objectives -> Initiatives -> Project Plan (task)

Objectives

Objectives

Objectives

Initiatives

Tasks

AGHS Integration Tasks

IBMA

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Integration Council Status Report

Progress Review

Risks Issues Key Next

Steps Successes

Targ

et

Co

mp

leti

on

2015 2016

Q

4

Q

1

Q

2

Q

3

Q

4

Objective 1: Finance

1.1 Initiative: Financial Accounting

a.

Phase I-

Crosswalk

Analysis

12/

2015 *

Additional $

efficiencies identified

b.

Phase 2-

Develop

interface

03/

2016 *

Anticipate

>$500K investment

c.

Phase 3-

Myanalytics

planning

Q1

2016 *

d.

Phase 4-

Myanalytics

implementatio

n

Q2

2016 *

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Critical Success Factors

• Align with the strategy

• Find the right partner

• Carefully select priorities

• Put hard issues on the table

• Actively manage work

• Mindfulness in every interaction

• Celebrate successes

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How’s it Going?

• Mutually positive

• 300+ caregivers involved

• >$20M in savings to date

• Managing “on diversion”

• Having fun!

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Success Video

External Link:

https://www.youtube.com/watch?v=BjK-uW6GTCQ