cleveland city council 3-10-11

8/6/2019 Cleveland City Council 3-10-11

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A Healthcare Model

for the 21st

Century

A Healthcare ModelA Healthcare Model

for the 21for the 21stst

CenturyCentury

Prepared forCleveland City Council

Prepared forCleveland City Council


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Cleveland Medical MartCleveland Medical MartCleveland Medical Mart


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Cleveland Medical MartCleveland Medical MartCleveland Medical Mart


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Nothing ispermanent but

change.

Heraclitus

540 BC

Nothing isNothing is

permanent butpermanent but

change.change.

HeraclitusHeraclitus

540 BC540 BC


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Patients

Diseases

Treatments

Delivery System

Caregivers

Cost

PatientsPatients

DiseasesDiseases

TreatmentsTreatments

Delivery SystemDelivery System

CaregiversCaregivers

CostCost


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Cleveland PopulationCleveland PopulationCleveland Population

300300300

500500500

700700700

900900900

195019501950 196019601960 197019701970 198019801980 199019901990 200020002000 201020102010

#Thousands

##

ThousandsThousands


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Cuyahoga County PopulationCuyahoga County PopulationCuyahoga County Population

.5.5.5

111

1.51.51.5

222

196019601960 197019701970 198019801980 199019901990 200020002000 201020102010

#Millions

##

MillionsMillions


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East Cleveland PopulationEast Cleveland PopulationEast Cleveland Population

20,000

30,000

40,000

1960 1970 1980 1990 2000 2010


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Infant

Mortality

95%

InfantInfant

MortalityMortality

95%95%


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Infectious Disease

Eliminated

Infectious DiseaseInfectious Disease

EliminatedEliminated


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Life ExpectancyLife ExpectancyLife Expectancy

196019601960 201020102010

AgeAgeAge

197019701970 198019801980 199019901990 200020002000656565

707070

757575

808080


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Causes of Death1960

Causes of DeathCauses of Death19601960

Heart Disease

Cancer

Stroke

Accidents

Infant Mortality

Pneumonia

Heart DiseaseHeart Disease

CancerCancer

StrokeStroke

AccidentsAccidents

Infant MortalityInfant Mortality

PneumoniaPneumonia


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Causes of Death2009

Causes of DeathCauses of Death20092009

Heart Disease

Cancer

Stroke

COPD

Accidents

Alzheimers Disease

Diabetes

Heart DiseaseHeart Disease

CancerCancer

StrokeStroke

COPDCOPD

AccidentsAccidents

AlzheimerAlzheimers Diseases Disease

DiabetesDiabetes


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1,636,0001,636,000


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72,50072,500


17/86


18/86


19/86

Face TransplantFace TransplantFace Transplant


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Face Transplant TeamFace Transplant TeamFace Transplant Team


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19491949 1952195219441944

19221922

19571957

CCHS Hospitals BuiltCCHS Hospitals BuiltCCHS Hospitals Built

19071907

1968196819311931

19551955


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Aging FacilitiesAging FacilitiesAging Facilities


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Huron TraumaHuron TraumaHuron Trauma


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Lakewood edLakewood ed

Lakewood TraumaLakewood TraumaLakewood Trauma


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Hillcrest EDHillcrest EDHillcrest ED


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Euclid

Hospital MovesHospital Moves

Glenville

HH

HH

1952

Hillcrest

Doctors

HH

HH

1968


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Cleveland SchoolsCleveland SchoolsCleveland Schools

00

5050

100100

150150

200200

19661966 20102010

##

174174

108108

38%38%


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HospitalsGreater Cleveland

HospitalsHospitals

Greater ClevelandGreater Cleveland

00

1010

2020

3030

4040

##

201020101990199019701970

45%


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Length of StayLength of StayLength of Stay

00

22

44

66

88

1010

DaysDaysDays

19601960 20102010

7.87.8

4.84.8

3 days3 days


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Surgery SettingSurgery SettingSurgery Setting

INPATIENT

OUTPATIENT

00

2020

4040

6060

8080

100100

19801980 19841984 19881988 19921992 19961996 20002000 20042004 20082008

%%


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Outpatient RevolutionOutpatient RevolutionOutpatient Revolution

600600600

400400400

200200200

198319831983 200820082008198819881988 199319931993 199819981998 200320032003

utilizationutilization

200%200%

#Millions

##MillionsMillions


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Medicare Home CareMedicare Home CareMedicare Home Care

00

55

1010

1515

2020

$Billions

$$BillionsBillions

20012001 20022002 20032003 20042004 20052005 20062006 20072007 20082008 20092009 20102010


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US Bed CountsUS Bed CountsUS Bed Counts

1,0001,0001,000

900900900

800800800

198319831983 200820082008198819881988 199319931993 199819981998 200320032003

#Thousands

##

ThousandsThousands


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Beds/1,000 PopulationBeds/1,000 PopulationBeds/1,000 Population

Bed/1,000

Bed/1,000

00

11

22

33

44

Orland

oOrl

ando

Cleve

land

Clev

eland NY

CNYC

Tampa

Tampa

Minn

eapolis

Minn

eapolis

E.B

ayAre

a

E.B

ayAre

a

Sacra

mento

Sacr

ament

o

Wash

ington

Wash

ington


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Cuyahoga County AdmissionsCuyahoga County AdmissionsCuyahoga County Admissions

Est2010

Est2010

20002000 20022002 20032003 20042004 20052005 20062006 20072007 20082008 2009200900

100100

200200

300300

400400

#Thousands

##

ThousandsThousands

20012001


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Hospital OccupancyHospital OccupancyHospital Occupancy

%%

6565

7575

7070

20052005 20062006 20072007 20082008 2011201120092009 20102010


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4040

4545

5050

5555

20042004 20062006 20082008 20102010

%%

Payer MixPayer MixPayer Mix

GovernmentGovernment

CommercialCommercial


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00

44

88

1212

1616

20052005 20072007 20092009 20112011

Decreasing ReimbursementDecreasing ReimbursementDecreasing Reimbursement

CommercialCommercial

GovernmentGovernment

InflationInflation

%%


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CABG ReimbursementCABG ReimbursementCABG Reimbursement

$Thousands

$Thousands

Constant DollarsConstant Dollars

2525

3131

2020

2424

2828

3232

20042004 20062006 20082008 20102010


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Health Care Percentage of GDPHealth Care Percentage of GDPHealth Care Percentage of GDP

198019801980 199019901990 200020002000 201020102010

20

18

16

14

12

10

8

2020

1818

1616

1414

1212

1010

88

2017

Est.

20172017

Est.Est.

%%%


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Potential Revenue ImpactPotential Revenue ImpactPotential Revenue Impact

-200

-150

-100

-50

0

-200

-150

-100

-50

0

$Millions

$Millions

-174-174

20122012

20132013

20142014

20152015

20102010

20112011


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Reporting RequirementsReporting RequirementsReporting Requirements

20052005 20092009 20102010 20122012 20142014

10101010

5555

3030

7070 8383

1010

5555


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Right Facility

Right Time

Right Care

Right FacilityRight Facility

Right TimeRight Time

Right CareRight Care


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Cl l d Cli iCl l d Cli iCl l d Cli i


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Cleveland ClinicFamily Health Centers

Cleveland ClinicCleveland ClinicFamily Health CentersFamily Health Centers

Brunswick


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Avon Family Health & SurgeryCenter

Avon Family Health & SurgeryAvon Family Health & Surgery

CenterCenter

&


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Twinsburg Family Health &Surgery Center

Twinsburg Family Health &Surgery Center

H C i H l h C


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Huron Community Health CenterHuron Community Health CenterHuron Community Health Center

H C it H lth C tH C it H lth C tH C it H lth C t


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Huron Community Health CenterServices

Huron Community Health CenterHuron Community Health Center

ServicesServices

Primary CarePrimary Care

OB/OB/GynGyn

PediatricsPediatrics

StrokeStroke

RheumatologyRheumatology

UrologyUrology

GIGI

PulmonaryPulmonary

CardiologyCardiology DermatologyDermatology

PodiatryPodiatry

Dialysis CenterDialysis Center

DiabetesDiabetes

CHF/ AntiCHF/ Anti--CoagulationCoagulation

Cardiac RehabCardiac Rehab

Kidney CareKidney Care

PharmacyPharmacy

Behavioral HealthBehavioral Health

ImagingImaging

LabLab Navigation CenterNavigation Center

Community ResourceCommunity ResourceCenterCenter

CCHS H it lCCHS H it lCCHS H it l


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CCHS HospitalsCCHS HospitalsCCHS Hospitals


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Average SeverityAverage Severity

00

1.51.5

2.02.0

2.52.5

Cleveland

Clinic

ClevelandClinic

1.01.0

0.50.5

UCLAUCLA MayoMayo Mass

Gen

MassGen

John

Hopkins

JohnHopkins

T t TT t TT t T


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Transport TeamTransport TeamTransport Team


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Hospital TransfersHospital TransfersHospital Transfers

00

10,00010,000

12,00012,000

14,00014,000

#

200920092008200820062006

8%

8,0008,000

6,0006,000

4,0004,000

2,0002,000

20072007 20102010

HH


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6 Million Patients

ClevelandClinicFHCFHC

Elyria FamilyHealth Center

Westlake FamilyHealth Center

FHCFHC

Lorain FamilyHealth

and SurgeryCenter

FHCFHC

LakewoodFamily Health

Center

FHCFHC

Strongsville Family Healthand Surgery Center

FHCFHC

Brunswick Family

Health Center

FHCFHC

Wooster Family

Health Center

FHCFHC

Independence FamilyHealth Center

FHCFHC

Solon Family

Health Center

FHCFHC

Chagrin Falls FamilyHealth Center

FHCFHC

Beachwood FamilyHealth and Surgery Center

FHCFHC

Willoughby HillsFamily Health Center

FHCFHC

Avon FamilyHealth Center

FHCFHC

HHFairview Hospital

Lakewood Hospital

HH

Lutheran HospitalHH

Ashtabula County Medical Center

HH

Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH

South PointeHospital

HH

Marymount Hospital

HH

Medina Hospital

HH


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Cleveland Clinichas one of thebest health

informationsystems in thecountry

Cleveland ClinicCleveland Clinichas one of thehas one of the

best healthbest health

informationinformationsystems in thesystems in the

countrycountry

President Barack Obama

July 22, 2009

President Barack ObamaPresident Barack Obama

July 22, 2009July 22, 2009


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0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

200 400 600 800 1000

Hospital VolumeHospital Volume

A

Risk

#


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Not all Hospitals can be

all things to all people.

Not all Hospitals can beNot all Hospitals can be

all things to all people.all things to all people.

Cuyahoga CountyCuyahoga CountyCuyahoga County


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Cuyahoga CountyLive Births

Cuyahoga CountyCuyahoga County

Live BirthsLive Births

0

5

10

15

20

25

1990 2000 2008

#Thousands

-30%

HH


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HHFairview Hospital

Lakewood Hospital

HH

Lutheran HospitalHH


H

Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

Obstetrics

ClevelandClinic

H

H

H

H

H


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NewbornsNewbornsNewborns

12

10

2 2 20

5

10

15

Fairview Hillcrest Huron Lakewood Marymount

AvgAvg ##

perper

DayDay

Adult HH


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AdultPsychiatry

HHFairview Hospital

Lutheran HospitalHH


H

Euclid Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

ClevelandClinic

Lakewood Hospital

HHH

Huron Hospital

HH

Hillcrest Hospital

HH

H

H

H

H

Heart SurgeryHeart SurgeryHeart Surgery


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Heart SurgeryLakewood

Heart SurgeryHeart Surgery

LakewoodLakewood

0

50

100

150

200

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

##

ODH Minimum= 250

Programs consolidatedPrograms consolidated

HH

H t S


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HHFairview Hospital

Lakewood Hospital

HH

Lutheran HospitalHH


Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

Heart Surgery

ClevelandClinic

H

H

H

HH

P di t iP di t i


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HHFairview Hospital

Lakewood Hospital

HH

Lutheran HospitalHH


Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

PediatricsPediatrics

ClevelandClinic

H

H

H

HH

Neonatal ICU


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HHFairview Hospital

Lakewood Hospital

HH

Lutheran HospitalHH


Euclid Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

H

HCleveland

Clinic

H

Neonatal ICU

Inpatient HH


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InpatientRehabilitation

HHFairview Hospital

Lutheran HospitalHH


Euclid Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

ClevelandClinic

Lakewood Hospital

HH

H

Huron Hospital

HH

Hillcrest Hospital

HH

H

H

H

H

HH

Skilled Nursing


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HHFairview Hospital

Lutheran HospitalHH


Euclid Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

ClevelandClinic

Lakewood Hospital

HH

H

Huron Hospital

HH

Hillcrest Hospital

HH

H

H

H

H

Skilled Nursing

Community

Trauma CenterTrauma CenterTrauma Center


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Trauma CenterLevel 1 & 2

Trauma CenterTrauma Center

Level 1 & 2Level 1 & 2

0

1

2

3

CLE Colum KC Denver Portland Pitt Indianapolis LV Orla ndo Cinci

# per# per

1,0001,000

sq milessq miles

MedianMedian

33

44

Trauma CenterTrauma CenterTrauma Center


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Trauma CenterLevel 1 & 2

Trauma CenterTrauma Center

Level 1 & 2Level 1 & 2

0

0.5

1

1.5

2

2.5

3

3.5

44.5

KC Denver CLE Colum P ortland Pitt Indianapolis LV Orlando Cinci

# per# per

1 Mil1 Mil

PopulPopul..

MedianMedian

33

44


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HH

Trauma


75/86

HHFairview Hospital

Lutheran HospitalHH


Euclid Hospital

HH


HH

Marymount Hospital

HH

Medina Hospital

HH

ClevelandClinic

H

Lakewood Hospital

HHH

Huron Hospital

HH

Hillcrest Hospital

HHH

Trauma

Trauma


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HH

Fairview Hospital

Lutheran

HH

Euclid Hospital

HH


HH

Marymount Hospital

HH

ClevelandClinic

H

Lakewood Hospital

HH

Huron Hospital

HH

Hillcrest Hospital

HHHH

Trauma

METROHEALTH

HH

Staffed Bed OccupancyStaffed Bed OccupancyStaffed Bed Occupancy


77/86

Staffed Bed OccupancyLakewood

Staffed Bed OccupancyStaffed Bed Occupancy

LakewoodLakewood

40

60

80

100

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

5555

Licensed Bed OccupancyLicensed Bed OccupancyLicensed Bed Occupancy


78/86

Licensed Bed OccupancyLakewood

Licensed Bed OccupancyLicensed Bed Occupancy

LakewoodLakewood

20

40

60

80

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

3535



79/86

Staffed Bed OccupancySouth Pointe

Staffed Bed OccupancyStaffed Bed Occupancy

South PointeSouth Pointe

40

60

80

100

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

6363



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Licensed Bed OccupancySouth Pointe

Licensed Bed Occupancyce sed ed Occupa cy

South PointeSouth Pointe

20

40

60

80

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

3131



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Staffed Bed OccupancyMarymount

Staffed Bed Occupancyp y

MarymountMarymount

40

60

80

100

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

71



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Licensed Bed OccupancyMarymount

Licensed Bed Occupancyp y

MarymountMarymount

40

60

80

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

54


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Licensed Bed OccupancyHuron

p yp y

HuronHuron

20

30

40

50

60

70

80

Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1

%%

2005 2006 2007 2008 2009 2010

2727


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The occasion is

piled high withdifficulty, and wemust rise with

the occasionsowe must thinkanew and actanew.

The occasion isThe occasion is

piled high withpiled high withdifficulty, and wedifficulty, and we

must rise withmust rise with

the occasionthe occasionsosowe must thinkwe must think

anew and actanew and act

anew.anew.

Abraham LincolnAbraham Lincoln


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cleveland city council 3-10-11

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