Inside Cleveland Clinic’s Skilled Nursing Strategy

The Cleveland Clinic followed a familiar path to boost its care coordination efforts, building partnerships with trusted skilled nursing facilities and relying on its own staff to ensure quality.

And the Ohio-based health care provider has the results to prove that the model can work.

“What our data has told us, and has been consistent over the last two to three years — we do experience lower 30-day readmissions, and a lower length of stay at the SNF level,” Cleveland Clinic associate chief of specialty and ambulatory pharmacy Don Carroll told Skilled Nursing News; Carroll also leads the provider’s Center for Connected Care.


That success comes as the provider’s network, the Cleveland Clinic Medicare Accountable Care Organization (ACO), announced a new initiative earlier this year to begin accepting downside risk.

Under the Track 1+ model, the ACO could face a loss sharing rate of 30% if it doesn’t meet certain shared-savings metrics — along with a 50% shared-savings reward if it succeeds. The plan has had a solid track record according to the Cleveland Clinic, posting $42.2 million in total savings in 2016, of which it received $19.9 million in shared funds.

Part of that success has come with partnering with high-quality SNFs, Carroll said.


“We have chosen not to be owners in the space, so we need strong community partners,” he said, adding that savvy SNFs recognize the value in taking a risk on collaboration. “They know they’d rather be in with us in these quality efforts than out.”

Cleveland Clinic still maintains some level of control over its partnerships, dispatching a physician and nurse practitioner to its ACO-affiliated locations to meet each recently admitted patient. The SNF partnerships also include a data-sharing initiative that allows Cleveland Clinic employees to view the medical records of patients after they’ve left the facilities, and even onward to future care settings.

“Medically, we know what’s happened there during their entire stay,” Carroll said.

These themes — information sharing, strong performance data, and a willingness to collaborate in both directions — have frequently been cited as a recipe for success in shared payment models. Those trends also frequently come up as the top requirements for hospitals considering new skilled nursing partnerships.

As Joseph Kiernan, chief strategy officer of the New Jersey-based Ocean Healthcare network said at a recent industry conference: “If you want to come in and have meetings, that’s great — in God we trust, but everyone else must bring data.”

And if that data includes solid evidence of reducing costs, a SNF just might earn itself a preferred place in a quality referral network.

“We have a growing Medicare ACO, and managing those costs is going to be critically important,” Carroll said.

Written by Alex Spanko

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