From Twinkle to Wrinkle: The Cleveland Clinic Approach to Population Health

Value-based care models align the interests of the patient with those of the payor and provider. “When this alignment works, all three stakeholders win — especially the patient,” says Cleveland Clinic internist Robert Jones Jr., MD. This is the goal of Cleveland Clinic’s department of Population Management and its Medicare Accountable Care Organization.

““Underpinned by data incorporation and an alignment on quality standards, our clinically integrated network optimizes the coordination of our patients’ care, which improves outcomes. Wellness and prevention are stressed in value-based care, and our goal has shifted toward helping our patients access proactive healthcare that focuses on wellness and preventing health problems before they occur,” says Nirav Vakharia, MD, President of Cleveland Clinic’s Medicare Accountable Care Organization.

Co-branded products

Over the last several years, Cleveland Clinic has developed relationships with insurance companies to provide value-based population health management. These relationships allow both parties to combine resources and expertise in order to maximize the value provided to patients and employers while also providing an exceptional patient experience.

Over the last several years, Cleveland Clinic has developed relationships with insurance companies to provide value-based population health management.

The co-branded health insurance plan, Cleveland Clinic + Oscar, is one example of these developing relationships. Launched in 2018, Cleveland Clinic + Oscar was the healthcare provider’s first entry into the health insurance market with a product bearing its name. The product currently serves more than 11,000 Ohio members in eight Ohio counties. Members receive free, 24/7 telemedicine, access to health apps, and personalized support from care teams to help navigate their care.

“Co-branding is an important part of our strategy in terms of sharing risk and signaling that shared risk in the market. We know the Cleveland Clinic brand carries a lot of weight for patients who are making coverage decisions,” say Dr. Vakharia.

“Every patient who comes through our doors receives the highest level of healthcare from Cleveland Clinic,” Dr. Jones adds. “Regardless of their payor, our goal is to deliver great outcomes at appropriate costs. This streamlines care for our providers as well, allowing them to focus on the patient and not their insurance status.”

Risk sharing and bundling: is this a sustainable model?

In the population health model services are coordinated and bundled, risk is shared between payors and providers rather than episodic, fee-for-service care.

“We’re focusing on the outcomes we can drive on behalf of our patients. If care is uncoordinated and a patient has complications or is readmitted, providers are penalized because the care wasn’t good enough, or organized well enough, to meet the patient’s needs,” says Dr. Vakhaira.

For patients who get most of their care at one healthcare organization like Cleveland Clinic – primary care and specialty care – the population health model holds providers accountable for health outcomes over a specific period of time.

“We have been moving toward increased risk-sharing agreements with payors, and expect that risk sharing will eventually be forced by the insurance market. At Cleveland Clinic, we’re getting ready for that now when we can still adjust the pace as needed,” Dr. Vakharia says.

So is the model financially sustainable for healthcare providers?

“That depends,” according to Dr. Vakharia. “It depends on the strength of your care model. Five years from now, when we are at full-risk, we effectively become the insurance company in that we would accept a certain dollar amount per month for all of a patient’s care. The objective is to keep the patient healthy, so they need less expensive healthcare. Any savings derived from keeping that patient healthy would be used to fund our operations and grow in scale. If we can pull all that together, it would be highly advantageous. If we cannot, we would end up with a loss because the patient cost significantly more than we were paid. The challenge is to develop a robust care model that is financially sustainable as we take on more risk.”

Looking ahead

Innovative competitors and the commoditization of primary care may drive continued changes in population health management, says Dr. Vakhaira. “I think we’re going to start to see more specialization in primary care in order to meet the needs of certain groups of patients. Larger, more established players who deliver superior patient experiences in less time may peel off some of the younger, healthier patients. But the value of an integrated health system is that we care for you from twinkle to wrinkle. We can take care of a patient when she is a child with a sore throat, then work together with the patient with a focus on wellness during adulthood, and later, when the aging patient may require more care,” he concludes.