While it was important to settle the questions surrounding the ACA – after all, no industry likes uncertainty – the train had already left the station. The only question was how fast it would reach its destination, and we in the healthcare industry couldn’t sit on our hands waiting to find out.
As the adage says, “If you don't create change, change will create you.” Many health care organizations – including Cleveland Clinic – set about creating change several years ago, addressing issues of patient access, cost and quality.
Even before the Supreme Court’s ruling, healthcare reform-related changes were taking place here at Cleveland Clinic. We’ve pioneered the role of medical records in healthcare. We're hiring more primary care doctors. We’re keeping people healthy through preventive wellness programs and better coordination of care. We've expanded our outpatient facilities, as the inpatient hospital is replaced at the epicenter of healthcare by at-home care and outpatient services.
The Affordable Care Act is not the end, but another step – albeit a very important step that is expected to provide insurance coverage to 32 million Americans. At the same time, the law will cut payments to doctors and hospitals.
The simple fact is that we will see more patients while getting paid less to do so. The only way to make that a sustainable model is to find a way to cut costs, while maintaining, or even improving, quality and outcomes.
However, the healthcare community can’t do it alone. Society at large needs to do its part and that starts by making healthier lifestyle choices.
As important as healthcare reform is, a national push toward wellness could have an even greater impact. We have to reduce the burden of chronic diseases in this country, including the leading contributor to chronic disease- obesity.
According to a recent study in the Journal of Health Economics, obesity’s price tag now totals $190 billion per year, or more than 20 percent of U.S. health care costs. Another way to look at it is that the obese have medical costs that are $1,429 higher annually than the cost for people of normal body weight, according to the U.S. Centers for Disease Control and Prevention.
The point is, if we truly want to control healthcare costs, we have to control this epidemic of obesity that is known to cause heart disease, diabetes, high cholesterol, high blood pressure, cancer, liver and gallbladder disease, and other significant health problems.
The Affordable Care Act  addresses this by requiring that preventive care be provided without a patient co-pay. That’s certainly a start. But individuals must make the effort to exercise more, eat healthier and stop smoking.
This doesn’t absolve the healthcare industry from making cost-saving decisions too, which we are already working toward.
This month we rolled out pilot projects that will help doctors manage patient care. Nurse care coordinators will maintain contact with patients between visits to help ensure they take their medications appropriately and come back for follow-up appointments. This will help patients manage their chronic disease and avoid hospitalizations.
Our electronic medical records system is set up to stop duplicate tests. Our physicians are integrated into 600 cost-savings projects. As they learn the costs of products and procedures, they can become an active part of the savings solution. In the past two years, $100 million have been removed from operational expenses.
Since our founding 91 years ago, Cleveland Clinic has worked as a group practice model, our physicians are paid an annual salary that stays the same regardless of the number of procedures they perform or the number of tests they order, more tests does not equal a bigger pay check.
Patient-centered care is achieved through our Institute model which allows a group of specialists to treat specific conditions within their area of expertise.
Working together, we can integrate hospitals more completely. The era is over when every community hospital could be all things to all people. Not every hospital should offer heart bypass surgery or neurosurgery. Not only is it costly to duplicate services in a region, but research has shown that consolidating services into centers of excellence leads to better outcomes. A surgeon who performs 350 heart-valve surgeries a year will have better outcomes compared to a surgeon who performs a variety of 200 heart-related surgeries a year.
Healthcare in the United States is some of the best healthcare in the world. For it to remain that way, we have to seriously address the issues of cost and quality. After all, the state of our nation is only as good as the state our health.

Dr. Cosgrove is CEO and president, Cleveland Clinic.