Casey Ross | June 15, 2016
The MetroHealth System, Cleveland’s oldest medical institution, is undergoing a rapid — and seemingly paradoxical — shift in business strategy: It is trying to stop patients from coming to the hospital.
In a series of recent moves, the health system has sought to lessen patients’ reliance on its flagship medical center in Cleveland by increasing access to primary and preventive care services at other MetroHealth facilities.
The effort, which involves new insurance products and a sharper focus on convenience and accessibility, promises to shake up Cleveland’s highly competitive hospital market and help MetroHealth compete with its larger rivals, Cleveland Clinic and University Hospitals.
Instead of fighting an uphill battle with the Clinic and UH to cater to the region’s inpatients, MetroHealth is shifting the battlefield to focus on grabbing a greater share of its outpatients.
“If you look at our outpatient expansion, we’re going from 850,000 visits to 1.2 million visits,” MetroHealth’s chief executive, Dr. Akram Boutros, said in a recent interview with The Plain Dealer. “That’s a big change, and that’s the effort you need to get people out of the hospital.”
MetroHealth has sought to accelerate its evolution by opening new locations across the region. It acquired several medical facilities from HealthSpan, which is ceasing operations at year’s end, and has also acquired about 40,000 of HealthSpan’s patients, a 20 percent increase in MetroHealth’s patient base.
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And last week, Boutros announced a new partnership with Medical Mutual of Ohio to help further expand MetroHealth’s market share. The two organizations launched CLECare, a new HMO insurance product designed to cut premium costs for its members by 15 percent.
CLECare would achieve those savings by offering employers, and covered employees, a narrow network of providers to serve patients. The bulk of medical services, including doctor visits and tests, would be provided by MetroHealth at its outpatient centers and hospitals across Cuyahoga County. A small subset of the most complex medical procedures, such as transplants, would be provided by the Cleveland Clinic.
The partnership allows MetroHealth to tap into a growing pool of consumers looking for relief from rising premiums and other out-of-pocket costs, said Mark Votruba, associate professor of economics at Case Western Reserve University’s Weatherhead School of Management.
“MetroHealth is trying to exploit its position as the low-cost provider in the area,” Votruba said, adding that consumers have become much more price conscious with the increasing shift toward high-deductible insurance coverage.
The health system’s partnership with Medical Mutual also represents a new way of sharing risk in the market: Both organizations are betting that the cost of caring for patients can be reduced significantly by seeing them more frequently and offering better coordinated services.
“If we don’t take care of the patients well and they’re not satisfied, we have financial risk just like [Medical Mutual] has risk,” Boutros said.
The health system has also rolled out a new program called Select Direct, which allows patients to access primary and preventive services through a fixed monthly payment of between $40 and $85. The program does not require patients to pay a deductible or co-pays.
It remains to be seen how well CLECare and Select Direct will work out for MetroHealth and its patients. But the decision to offer the programs underscores the health system’s effort to broaden its appeal in the region’s health care market.
MetroHealth has always been known for serving a low-income population and offering high-quality trauma care. But it also wants to position itself as the best option for commercially insured patients who are more price conscious and want health services to be convenient.
Boutros noted, for example, that the health system will soon roll out “bed-less hospitals” in Cleveland Heights, Parma and Brecksville. The facilities will have nearly all the services of a traditional hospital – emergency rooms, operating rooms and specialty care – without any inpatient beds.
“The whole idea is to keep you (as an) outpatient, keep you closer to home, and give you as much as possible,” Boutros said. He added that those facilities will help prevent people from coming into the main campus off West 25th Street, which MetroHealth wants to devote to care of patients with more complex medical needs.
Over the next year, MetroHealth expects to finalize plans for a broader rehabilitation of the main campus. Boutros said the project, which will include replacement of its main hospital building, will keep the health system anchored in its mission to care for the sickest patients, regardless of their ability to pay.
“If we don’t do this,” he said, “we’re going to have two separate health systems – one for the haves, one for the have nots. That’s just not acceptable.”
Source: Cleveland.com