Feasibility Study for System-Wide Expansion of Integrated Practice Units at Cleveland Clinic
Overview
This feasibility study examines the viability of expanding Integrated Practice Units (IPUs) across Cleveland Clinic's 16 clinical institutes to accelerate organizational transformation toward value-based care delivery. The analysis assesses the clinical, financial, regulatory, and operational feasibility of scaling from 4 to at least 12 fully operational IPUs within 36 months, identifying key risks and recommending evidence-based implementation strategies.
What this feasibility study covers
- Executive Summary: Overview of Cleveland Clinic's transformation strategy and IPU expansion goals
- Systems Assessment: Identification of five interdependent dynamics including incentive misalignment and cultural resistance
- Economic and Financial Analysis: Evaluation of financial viability and value-based contracting infrastructure
- Market Assessment: Analysis of demand drivers including aging population and employer interest
- Regulatory Analysis: Alignment with ACA, Medicare Shared Savings Program, and accreditation standards
- Risk Analysis: Strategic, operational, and tactical risks with mitigation strategies
- Final Recommendations: Six evidence-based action steps with timelines and success metrics
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Feasibility Study for Cleveland Clinic
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Executive Summary
Cleveland Clinic is a nonprofit, multi-specialty academic health system based in Cleveland, Ohio, with $6.7 billion in annual operating revenues and 43,000 employees serving 6.4 million patients across a regional, national, and international network. Since 2004, under CEO Dr. Delos Cosgrove, the Clinic has pursued a sweeping organizational transformation anchored in the principle of Patients First, restructuring all main campus services into 16 multidisciplinary clinical institutes organized around diseases and organ systems rather than traditional medical specialties.
This feasibility study examines the viability of a proposed program to accelerate the system-wide expansion of Integrated Practice Units (IPUs) across all 16 clinical institutes at Cleveland Clinic. IPUs are dedicated, multidisciplinary care teams that manage a specific patient condition through the full care cycle, from initial diagnosis through treatment, rehabilitation, and follow-up, using standardized care pathways and shared, publicly reported patient health outcomes. As of 2015, only four IPUs had been formally established, despite 106 care paths having been identified across the system. The central problem is the uneven pace of this transformation: the absence of fully operational IPUs across most institutes undermines the Clinic’s strategic goal of becoming One Cleveland Clinic and limits its ability to compete for value-based payment contracts, employer partnerships, and complex referrals based on measurable, condition-specific outcomes.
The SMART problem statement developed defines the goal as expanding from 4 to at least 12 fully operational IPUs, covering 75% of the Clinic’s 16 clinical institutes, within 36 months.