Cleveland Clinic's holistic center is on rapid ascent

From floor to ceiling, every bit of the new space for the Cleveland Clinic's Celia Scott Weatherhead Center for Functional Medicine is very intentional: Carpets to unify the space; fine art and light wood in reference to nature; noise reduction tools; hidden charting alcoves; soothing natural light; air and water filtration systems.

"When you talk about thinking about the holistic approach and really looking at the entire body and looking at optimal health, you have to think about all of these features that affect that, so that's what we did in this space," said Tawny Jones, the center's administrator and designer of the new space

The Center for Functional Medicine, which the Clinic has said is the first of its kind at an academic medical center, focuses on a holistic treatment of the root causes of health problems. Functional medicine is based on the evidence that lifestyle factors, such as nutrition, sleep, exercise, stress, relationships and genetics, contribute to disease.

The new 17,000-square-foot space, located in the heart of the Clinic's main campus in the Q building, aims to evoke a sense of healing for the thousands of patients the center expects to see in 2017. In December, providers began seeing patients in the new location, which is more than double the size of its previous space.

In its first two years, the center has seen explosive growth. Despite little advertising, it was full on its first day in September 2014 and only went up from there, quickly outgrowing the six exam rooms dedicated to it.

Thanks in large part to the added efficiencies and space of the new location, as well as the providers they began adding in preparation for the move, officials with the center expect to more than triple the number of physician and nurse practitioner visits in 2017 — which should come as good news to the roughly 3,000 patients currently on the waiting list.

Last year, there were 4,200 visits. This year, they anticipate 14,000.

"I think people are understanding that there are limits to drugs and surgery for treating chronic diseases," said Dr. Mark Hyman, director of the center and a well-known wellness expert. "People are understanding there are causes that are really driving the chronic illness that we need to deal with.

The center sets no requirements or restrictions on who can seek its services, Jones said. Though many are individuals who have seen multiple specialists and long suffered from chronic disease, some patients are perfectly healthy but want to figure out how to optimize their health.

Treatment plans focus on environmental, behavioral and especially lifestyle changes. Though providers sometimes refer patients to alternative medicine services — such as acupuncture, yoga, Chinese herbal medicine and others — the focus is on managing chronic disease or maintaining the status of healthy patients.

"I think that we are actually beginning to really understand that the consumer and the patients want a different kind of care," Hyman said.

In the new 17,000-square-foot space — about twice as large as its old spot — the center has 16 patient rooms as well as two offices for the two behavioral therapists who joined the team in 2017.

Each patient room, two of which are bariatric, combines a consult space and a traditional exam room. Across from the familiar exam bed is a desk that allows the patient to sit across from various providers as they discuss health history and treatment plans.

Prior to the first meeting, patients spend three to four hours filling out a medical history questionnaire. During their first visit, patients will spend an hour with a physician, an hour with a nutritionist and 15 to 30 minutes with a health coach. A medical assistant will recap the meeting, navigate them to the lab and explain the next steps.

The patient rooms are along a U-shaped hallway, which surrounds a large space where providers work. The providers' space is largely open, with five areas sectioned off. Each has space for a physician, medical assistant, nurse, health coach and nutritionist.

Before, and in many other spaces, Jones said, multidisciplinary teams are spread out, with physicians in one space, nurses in another, nutritionists elsewhere, and so on.

"In fostering collaboration, we took away the hierarchy between physicians and medical assistants and nutritionists," Jones said. "Let's put everybody in an environment where they can seamlessly speak to each other, hand off information (and address) their questions."

The new space, which was previously shell space, also features its own laboratory, telemedicine suites, meeting rooms, a room for patients to go through self-led educational programming and spaces for shared medical appointments where patients can learn from one another about their approach. Jones said some adjacent space remains if they decide to expand.

Based on the growth thus far, more expansion seems likely. The center has seen patients from 17 countries and 42 states. About 25% of the patients who come through are new to the Clinic entirely. In 2016, the center saw 1,400 new patients. This year, Jones said they anticipate 4,000 new patients.

Upon the recommendation of a friend, Kreis Beall came to the Clinic from Walland, Tenn., for an appointment at the center, for which she had waited five months.

Beall said she is a "very healthy 63-year-old," but internally, she was hoping to address some concerns. A couple of years ago, her wellness doctor diagnosed her with "leaky gut syndrome," which means that her body doesn't fully absorb all nutrients as it should. She feels fine — not good enough to call herself sick — but not great. She came to the Clinic in the hopes of finding a long-term approach.

Beall was thrilled with her first appointment in mid-December: the welcoming environment, the detailed discussion of her history, the dietary and lifestyle plans going forward — and the easy phone or email access to providers when she has questions.

"It's a huge commitment. You have to change the rest of your life — everything, your whole lifestyle to gain good health," Beall said. But she's excited to begin her path and hopeful for the future.

Right now, physician visits at the center are covered by most insurance plans. Coverage for nutritionists and some tests vary. The center has a financial counselor to help patients navigate this.

In the future, though, center leaders hope to prove value and drive changes in reimbursement.

Over time, the approach is less costly, Jones said, but she recognizes they have to prove that, making research into the cost-outcome equation of functional medicine the "linchpin" of the practice.

Looking forward, Hyman hopes to expand services and build community-based programs for population health "where we can scale this not just in the Clinic, but in the community providing access to thousands, even hundreds of thousands of patients in the community."

The center helps to lead the way for new thinking about how to solve chronic disease and helps make the Clinic more of a leader in health care.

"Right now, we're paying for volume in health care instead of value," Hyman said. "That's shifting, and we believe we're a key part of the solution."

"Cleveland Clinic's holistic center is on rapid ascent" originally appeared in Crain's Cleveland Business.