Tremendous change is coming fast to the health care industry by way of the Affordable Care Act, fueled by economics, consumer demographics and technology, and focused on access, quality and cost, according to Toby Cosgrove, M.D., president and CEO at the Cleveland Clinic.

And the term “access” is changing because of the reform law, he told more than 3,000 insurance officials attending AHIP 2013 in Las Vegas. “Access has always been referred to as insurance, not how you actually get to see a provider.” But Cosgrove walked payers through what “access” means today.

Cleveland Clinic operates a 300-nurse call center to serve patients who have health questions or issues, and changed policies and procedures to support patients being able to see a physician much quicker than they traditionally have. Last year, the organization had one million same-day appointments, with 98 percent of patients asking for one getting it.

Access also means having patients be able to access their medical information. More than 1.5 million patients are using the clinic’s MyChart personal health records software from Epic Systems Corp. because the clinic changed policy and automatically opts all patients into having a PHR, with patients having to opt out if they don’t want one. Cleveland Clinic also operates a physician referral line to quickly put primary care doctors in touch with specialists, with thousands of such calls generated monthly.

The results of these and other initiatives have dramatically improved Cleveland Clinic’s quality measures in less than four years, Cosgrove said. In 2012, the clinic ranked 80th of 100 participating hospitals in the University Hospital Consortium’s quality measures. The ranking improved to 49th out of 100 in 2011, 20th out of 110 in 2012, and Cosgrove expects a top 10 rating in 2013.

But the road to quality improve has had bumps. The heart failure readmission rate has been the toughest problem to tackle, Cosgrove noted, with a 21 percent rate in 2012 compared with 25 percent in 2010.

The efforts to improve quality also brought new policies to improve patient satisfaction, with the current 74 percent satisfaction rate substantially higher than five years ago, Cosgrove said. It started with making everyone a caregiver, whether they are a physician, nurse, janitor or park the cars. The medical record was opened via PHRs five years ago, visiting hours have been eliminated so a patient can receive guests anytime, and full-covering gowns were introduced.

Other quality programs resulted in avoiding lab tests, with 5,388 avoided in 2011 and about 14,000 avoid so far in 2013. Further, the clinic started to lead the charge to better health by example. “There’s no smoking on facility grounds and we stopped hiring smokers; and by the way, it’s legal,” Cosgrove said. Existing employees who smoke were encouraged to quit and the current employee smoking rate is six percent. The Cleveland Clinic also offers free smoking cessation programs to all residents of Cuyahoga County, which includes Cleveland. Further, the clinic got rid of junk food, snacks and sugary drinks.

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