Ian Morrison

Most policy wonks, consultants, CEOs and venture capitalists live a bicoastal existence, jetting between San Francisco, New York, Boston and Washington, D.C., and occasionally touching down at O’Hare. They fly over the rest of Amurrica, often believing, mistakenly, that nothing new or interesting happens there.

Regarding health care, they are wrong. Many of the more innovative health care organizations, including regional coalitions, health plans, hospitals and health systems, can be found in the middle of America. I have had the opportunity to work with many of those organizations over the years, but I would draw attention to Ohio as a good example of quiet innovation where institutions are making a difference without all the fanfare and self-promotion of California and Massachusetts.

Midwest Successes

Ohio is the nation’s seventh most populous state, with more than 11 million residents, and has proven to be a critical swing state in national elections. It’s a state with several significant cities, including Cleveland, Columbus, Cincinnati, Dayton, Toledo and the Akron/Canton metropolitan area (if people share an airport name, I figure they don’t mind being lumped together). I have had an opportunity to visit several institutions in the state and have been impressed at many innovations and health care successes.

Cleveland. If you are going to have a heart attack, have it on the doorstep of the Cleveland Clinic. Under the leadership of pioneering heart surgeon Dr. Toby Cosgrove, Cleveland Clinic continues to earn its reputation as a global leader in high-quality care and as a key generator of medical innovation. Much less heralded, though equally impressive, is the story of University Hospitals Health System (UHHS) in Cleveland, which has undergone a massive financial turnaround in the last four or five years under CEO Tom Zenty’s leadership. UHHS is on its way to Vision 2010, investing over a billion dollars in new development.

Dayton. At the nationally recognized Kettering Health Network, CEO Frank Perez is leading the system in rapidly implementing personal health records, not just for his own hospitals’ patients, but for the community at large. This ambitious, patient-centric initiative will help patients manage their own health and provide information to local physicians, improving the timeliness and quality of patient care.

Canton. Aultman Health System, providing nationally ranked quality in its facilities, has a long history of delivering high quality at low cost. Since 1985, Aultman has built its own health plan, Aultcare, which serves 500,000 members in the local area (mostly through PPO products). Aultman Hospital doesn’t need any other managed care contracts, as its value proposition to local employers is that it can deliver care better and more cheaply by taking the insurance dollar out of the community. This is a rare and high-performance example of virtual integration. CEO Ed Roth quietly builds on the Aultman legacy to provide the value proposition for the Canton community.

Cincinnati. The Greater Cincinnati Health Council celebrated its 50th anniversary recently. The council has been a pioneer in many areas of regional cooperation among hospitals and other stakeholders. Its pioneering work under current CEO Colleen O’Toole and her predecessor Lynn Olman has included path-breaking innovation in transparency of cost and quality measurement and reporting, in quality improvement, and in regional health information networks. These and other initiatives have won accolades and awards from the Joint Commission and from the Robert Wood Johnson Foundation. The council spawned a long-standing regional health information organization (RHIO), Healthbridge, which remains one of the few successful and self-sustaining RHIO business models in the country, and is a tremendous platform for communitywide health management and disease management initiatives. Somehow Healthbridge has overcome the difficulties of infrastructure, privacy, complexity, standards setting and lack of organizational commitment that have dogged so many of the RHIO efforts nationally.

Dublin. Ohio Health is building a brand-new hospital, Dublin Methodist, to serve the expanding local community in the Columbus suburbs. CEO Cheryl Herbert and her team have created, and are about to open, a new, evidence-based-designed facility that promises to be one of the highest state-of-the-art health care facilities in the country. Dublin Methodist is a living laboratory of how organizational culture and design can be melded to deliver a superior health care experience.

Three Lessons from Ohio

I am sure if I looked, I would find similar good work in other parts of the state. So to any Ohioans I’ve left out, please don’t take offense. But my general point is this: While Ohio is not at the top of the pile in being one of the high-quality/low-utilizing states, like Oregon and Minnesota, it has significant innovations in finance and delivery that are worthy of attention. I would make three observations about those innovations:

Leadership matters. In all cases, the institutions I ran into were blessed with good leaders—in many cases, two and three generations of such leaders. Leaders make a difference; it’s not just a bumper sticker.

Local is good. Sometimes it’s easier to get people around a table to act locally than to make plans and policy globally. This is not always the case: “All politics is local” they say, and my observation is that the more local it gets, the more vicious it gets. But somehow these local leaders have found a way to bring stakeholders together.

Look everywhere. The nation’s business and policy elites need to stop flying over the middle of America and actually touch down, watch and listen to what is going on. You all might learn something.

Ian Morrison is an author, consultant and futurist based in Menlo Park, Calif. He is also a regular contributor to H&HN OnLine. This article 1st appeared on September 4, 2007 in HHN Magazine online site.