Facility, insurer seek to create a 'healthy city'

Move toward preventive health

Improving the health of patients in your hospital is a large enough challenge, but imagine taking on the well-being of an entire city. Well, that's exactly what The Cleveland Clinic and Medical Mutual of Ohio are doing in Solon. Their collaborative initiative, called "Healthy Solon," seeks to improve the health of the entire town through prevention.

As part of the initiative, the Cleveland Clinic is providing free medical screenings and health care advice to anyone who lives or works in Solon, a city of about 25,000 people just southeast of Cleveland. The goal of the program is to educate participants and encourage them to take an active role in their own health through walking, smoking cessation, and stress prevention programs, as well as improved nutrition.

A shift in focus

Getting involved in this initiative was important for the Cleveland Clinic because it was in line with a shift in focus that the organization has been taking, says Daniel Sullivan, MD, a staff physician who specializes in internal medicine.

"It's important predominantly because of our big shift as an organization, to where we are now focusing on wellness," he says. "This is a dramatic shift from how many of us were trained; we've been trained to wait for illness to come to us and treat it — rather than focusing on prevention."

The rationale behind this shift, he continues, "is that we've identified that there are a variety of illnesses that are preventable, and if we can make a difference in prevention that will have a big impact on outcomes."

In addition, says Sullivan, such a program fits comfortably within the facility's mission. "Our focus is all about patient outcomes and experiences — whether they are inside or outside our walls," he emphasizes. "Health care is becoming prohibitively expensive, and if we can make an impact outside our walls to make it less costly inside them, it will make it easier for employers and people who are self-insured."

What's more, he points out, hospitals in the United States are now scored by many national organizations, such as The Joint Commission, on outcomes. "If someone has diabetes, whether they are treated within or outside our walls, if they are under our care and if they have a good outcome that will affect our scores positively," he observes. "Companies look at these outcomes in deciding whether to use the Cleveland Clinic."

Not only is it important to have good outcomes in terms of national measures, he notes, "but every insurance company is measuring us as well."

Targeting a city

The "Health Solon" initiative got its start in December 2006, when the initial groundwork was laid. "Medical Mutual was looking at trying to improve their outcomes within their insured customers, and in reviewing the demographics, they saw they had a large number of insured in Solon," says Sullivan. "They figured it would make a lot of sense if they started a pilot program there." Medical Mutual wanted to partner with a city, and Solon has a "phenomenal" community center with exercise rooms, pools, and so forth, Sullivan says.

"When they started the process, they contacted us and asked if we wanted to be partners and we said absolutely yes," he says, adding that it is unique to see the three different types of organizations — which are sometimes on opposite sides of the fence — working together.

A key part of the program involves monthly gatherings at the community recreational center, each with a different focus. "For example, this past Saturday it was men's health," notes Sullivan. "I was one of the speakers. I gave a brief talk, and then invited the other speakers — a wellness expert and a former Cleveland Cavaliers [basketball] player — to address the group." In addition, free screenings were provided for blood sugar, cholesterol, and so forth, and free first-aid kits also were handed out.

Impact on the hospital

If the program is successful, might it not actually hurt the Cleveland Clinic down the road if admissions are reduced? "Potentially, yes, but health care is not just local anymore," notes Sullivan, pointing out that because of its reputation the Cleveland Clinic draws patients from all over the world. "Our perspective is to put the patient first, and do the right thing. If we do that, then as a business, we will succeed — rather than focusing on the economic model, which does not necessarily put patients first."

The participants are not yet able to determine if the program is succeeding, says Sullivan. "Right now, in terms of measuring outcomes, we and Medical Mutual are working together to find out the best way to capture data," he says. "It's a little tricky, because you have to identify people from Solon who participate in the program. Our IT people are looking at it; we have an [electronic medical record], but we still need to create a match between people from Solon who are also with Medical Mutual and who also participate. We hope to have that available by early 2008."

Clearly, both the Cleveland Clinic and Medical Mutual have great interest in these data, Sullivan continues. "Medical Mutual wants to see if they should expand this program to other areas, because healthier clients help keep costs down," he explains. "And of course, we have an interest in showing that we care about fostering good outcomes, because it makes it more likely that insurers and employers will choose us for their health care services."

(For more information, contact Daniel Sullivan, MD, at sullivd1@ccf.org.)