Becker's Hospital Review

66 THOUGHT LEADERSHIP MetroHealth CEO Dr. Akram Boutros on Healthcare in 2030 By Emily Rappleye B efore Ohio ex- panded Medicaid in 2014, 28,000 uninsured, low-income patients in Cleveland relied on a program called Metro- Health Care Plus for access to healthcare. Launched by Cleveland-based Metro- Health System, the success of this program helped pave the way for Medicaid in Ohio. We checked in with Akram Boutros, MD, pres- ident and CEO of MetroHealth and an internist, to talk about the success of the program. Here, Dr. Boutros discusses how MetroHealth's status as the safety-net health system in a consolidated, mature market affects its strategy, how Care Plus affected Ohio residents across the state and how he expects today's healthcare trends to play out over the next 15 years. Note: Responses have been edited lightly for length and style. Question: What is special about your market, and what do you have to work into your strat- egy that maybe you would not elsewhere in the country? Dr. Akram Boutros: We have a fairly consolidat- ed market with two nationally and internationally renowned health systems — Cleveland Clinic and University Hospitals — that are the dominant forces regionally. e MetroHealth System is the third larg- est, with the Sisters of Charity Health System trailing behind in size. It is also a fairly consolidated market on the physician level. Close to 90 percent of the phy- sicians in the city of Cleveland are employed by one of the health systems. As a result of the maturity of the market, we have had to find new ways to embrace the retail revolution and have done so through smaller, more dispersed clinics. ese are express care, school-based clinics, physician practices and drug store-based clinics. is market has a very high poverty rate and since MetroHealth's mission is to lead the way to a healthier community, we have to focus on prima- ry care delivery in a very deliberate, effective way. Nearly 52 percent of our patients are on Medicaid or uninsured. Q: A recent study showed costs of care for patients in the MetroHealth Care Plus pro- gram were almost 28.9 percent lower than the Medicaid spending cap allowed by the gov- ernment and that it was successful in improv- ing the quality of care for patients with dia- betes. Can you tell me a little bit more about what that program does and its significance or impact? AB: ere has been much discussion on whether Medicaid expansion works or not. ere has been re- search that shows Medicaid expansion increases the utilization of emergency services and may not be able to provide enhanced outcomes. e MetroHealth Care Plus program demonstrated that an established, mature and focused patient-centered medical-home program can achieve Institute for Healthcare Im- provement's triple aim for Medicaid expansion by providing appropriate access, improved outcomes and lowered costs by reducing unnecessary emergen- cy room visits and inpatient admissions. Our study showed we saved $41 million a year for 28,000 patients. at's approximately $2,000 per patient per year, which is also significantly more than other shared-savings and total cost-of-care programs have achieved. We think our success helped, in large measure, to expand Medicaid in Ohio, or at least overcome opposition to its expansion in Ohio.

• Cover