Clinical Innovators: Delos “Toby” Cosgrove and a New Model of Care Delivery at the Cleveland Clinic

By Katlyn Nemani

Delos “Toby” Cosgrove, MD, is the legendary CEO of the Cleveland Clinic and a renowned cardiac surgeon. As CEO, Dr. Cosgrove presides over a $6.2 billion health care system that includes locations in Ohio, Florida, Nevada, and the United Arab Emirates. His leadership has emphasized patient care innovation with a focus on patient experience, including the reorganization of clinical services into patient-centered, organ, and disease-based institutes. He has launched major wellness initiatives for patients, employees, and communities.

I recently interviewed Dr. Cosgrove to discuss the future of cardiovascular medicine and the evolving strategy of the Cleveland Clinic.

Cardiology and cardiovascular surgery have changed significantly since you entered the field. What do you see as the biggest trends impacting these specialties?

Cardiology and cardiovascular surgery have changed immensely over the years. We are seeing higher-risk patients, but surgery is becoming less invasive and mortality is declining. With new technologies, we can do more for patients today than ever before. A key focus is also prevention. We know many factors that cause heart disease, so it’s important to discuss prevention with patients.

You have re-oriented the strategy of the Cleveland Clinic to focus more on value—and reorganization from clinical departments to clinical institutes. Can you discuss the changes you have made and how they affected the delivery of care?

If it weren’t for the patient, none of us would have jobs in health care. Our philosophy is “patients first.” We decided to re-organize ourselves around our patients, where they can see all of the experts in one place who impact their condition. Our neurological institute, for example, has all of the caregivers that would treat any patient with neurological, neurosurgical, or psychological problems, putting the patient at the very center of the care delivered. Similarly, at our Heart and Vascular Institute, we have all of our physicians who focus on the cardiovascular system housed under one roof. This encourages collaborations that simply do not take place at other hospitals. This model also fosters much better collaboration among physicians, nurses, and others who are involved in the care of that patient. They physically work together and see the same patients with the goal of providing the best care to each individual patient.

We believe our salaried physician model fosters collaboration, too. Our doctors are paid the same amount regardless of how many procedures they perform or the number of patients they see. This reduces unnecessary tests and procedures and encourages our physicians to consult with their colleagues to find the best and most efficient treatment course for each patient. The result is better outcomes for our patients.

The Cleveland Clinic has been held up as a model for the country by President Obama. What are the features of the Clinic that are most transferrable to other settings?

The current US health care system was designed in the 1950s. As we know, to prepare for the future, we must drastically change for how we deliver care going forward. We must provide quality care more efficiently and at less cost. We’ve been working to integrate care, reduce duplication of services, drive operational efficiencies, and reduce overall costs. We have met and discussed with hospitals across the country to learn, share, and discuss best practices. Hospitals, employers, and the public at large need to also have a strong focus on wellness and prevention—that is most transferrable.

Could you tell us more about why the Cleveland Clinic has chosen to focus on prevention and what initiatives it has taken to promote health and wellness?

It’s incredible to think that heart disease is the leading cause of death in the United States when so many of the biggest risk factors are preventable. Our toughest job as physicians is to convince our patients to lose weight, eat a healthier diet, exercise, and stop smoking. These are difficult changes for people to make after a lifetime of making bad lifestyle choices.

At Cleveland Clinic we encourage our employees to live an active, healthy lifestyle by incentivizing them through our employee health insurance plans. They receive deep discounts on their premiums if they exercise regularly, maintain a healthy weight, and quit smoking. These are the kinds of changes we need to make if we want to overcome heart disease as a nation.

US News & World Report has ranked Cleveland Clinic as the leading hospital for cardiology and heart surgery every year since 1995—what are some of the unique features that make it successful?

Our Heart & Vascular Institute is the largest cardiovascular practice in the United States, and our physicians see more patients with heart and vascular conditions than any other hospital. And these are often very sick patients. This means that conditions that other hospitals may see a few times a year are likely treated every single day by our doctors. Our physicians then become expert specialists on diseases and treatments that physicians at other hospitals may only encounter occasionally. For the patient, that experience translates into better and smarter care.

Under your leadership, the Cleveland Clinic has extended its reach to other parts of the country and the world. What is your vision for the geographic expansion of the Clinic?

We’re looking at new ways of integrating that do not necessarily involve acquisition. Hospital systems are working together to achieve operational efficiencies, for example, by integrating back-office services. As a nonprofit health care system, part of our mission is medical education. We see great value and opportunity by collaborating with others around the world and sharing knowledge. In this ever-changing health care environment, we must continue to learn from others as they learn from us. In the United States, we are seeing consolidation in health care across systems.

Keywords: Heart Diseases, United Arab Emirates, Patient Care, Life Style, Cardiovascular System, Religious Missions, Risk Factors, Cardiac Surgical Procedures, Education, Medical, Leadership

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