In his job description as executive director of the managed care division for Cleveland Clinic, Michael McMillan is accountable
for business relationships with health plans and employers. McMillan is focused on making the Clinic—one of U.S. News & World Report's top three hospitals—available to members of every health plan and managed care organization.
"Our objective is to make sure that every patient in the United States who wants access to Cleveland Clinic has that access.
Our job is to build those relationships across the board on a national basis and globally," he says.
McMillan's goal might sound somewhat ambitious. After listening to the plans Cleveland Clinic already has in motion, one thing
is clear: the Clinic wants its reputation for excellence to be felt far beyond the shores of Lake Erie.
"[Cleveland Clinic] is a national referral center, a major player in the local, regional and national marketplace. We are
also an international provider, so we work in all those arenas with employers, insurers and other organizations to make sure
everyone can get access to Cleveland Clinic," McMillan says. In making its services available to as many patients as possible, Cleveland Clinic has been proactive in building relationships
with managed care organizations and health plans.
Ethical resolution
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"We have about 120 relationships with health plans that translate into 500 or 600 individual business deals," explains McMillan.
"We have relationships with all of the major national organizations because of our nationwide presence, including our business
operations in the Florida marketplace."
Patients First
Delos "Toby" Cosgrove, MD, Cleveland Clinic CEO, has laid a foundation upon which to build this growth strategy with his "Patients
First" approach. It declares the primacy of patient care, patient comfort and patient communication in every activity the
organization undertakes. "Patients First" demands a focus on measurable quality. By setting standards, collecting data and
analyzing the results, Cleveland Clinic delivers value through improved outcomes, better service and providing a healthier
future for patients, according to Dr. Cosgrove.
"We have grown into a national and international provider with respect to the patients who come here for care. National and
international insurers rely on this organization as a destination for their most complex patients," McMillan says.
Outcomes and value
The Cleveland Clinic Health System is the result of a succession of mergers. The mergers combine community hospital and physician
care with the expertise of an academic medical center and physician group practice, McMillan explains.
"We have gone through the full evolution in the last 10 years from a health plan point of view. Cleveland Clinic has moved
from risk taking and capitation into a fee-for-service marketplace," he says. "And now we are looking to the future—not only
managing the cost side of the equation, but managing quality by focusing on value and outcomes. We are gearing up to live
in a world where outcomes will drive our business and inform the decisions of consumers and referring physicians. This is
the beginning of the era of consumer-directed health choices. If you can focus on outcomes and focus on value, you'll improve
quality, and patients will get exactly the care they need in the right location and at the right time."
McMillan says he is focusing on the effort to link outcomes and payment and create a method to recognize value. "It creates
the opportunity to tie clinical outcomes and efficiency together so that patients can make choices based on objective data
and overall quality can be improved," he says.
