“We've stayed away from mergers and acquisitions,” Noseworthy says of the 23-hospital Mayo system. “Mayo doesn't see how that would help us provide better care.”
Instead, Mayo has embarked on a “subscription model” to share order sets, research breakthroughs and second opinions. So far, the organization is doing this at about 20 sites. Noseworthy expects that number to grow by 50% to 100% over the next few years. The fee is “proprietary,” he says, and based on the subscriber's size and expected use of materials.
Noseworthy, who ranks No. 15 on this year's roster of the Most Influential, says Mayo has approached “groups that we respect” for participation. And Mayo has been approached by organizations “at risk for being bought out” and looking for a competitive edge in their markets, he says.
Cleveland Clinic has entered into or is developing a number of clinical affiliations with other organizations. These include a population-management alignment being negotiated with the eight-hospital, Toledo, Ohio-based ProMedica system; a cardiology and research affiliation with nine-hospital MedStar Health, Columbia, Md.; and cardiology and oncology affiliations with two-hospital Cadence Health, Winfield, Ill.
In these relationships, Cosgrove, ranked No. 16, says Cleveland Clinic monitors quality metrics and takes responsibility for results. The affiliation that garnered the most attention, however, is the strategic alliance the organization entered into with for-profit Community Health Systems, a 132-hospital publicly traded system, to improve cardiovascular services, advance telemedicine and reduce supply costs.
“It's not that we bought them or they bought us,” Cosgrove says. “I liken it to we're 'going steady.' They won't date another not-for-profit, and we won't date other for-profits.”
Community has announced merger plans with Health Management Associates, Naples, Fla.