Cleveland Clinic: Transformation and Growth 2015 Mat we are undertaking would in many ways transform the world of medicine. Dr. Delos Cosgrove, CEO Cleveland Clinic was a multispecialty health care system based in Cleveland, Ohio, renowned for patient care and innovation. The Clinic treated patients from all 50 states and 147 countries. Overall, 72% of the Clinic's 6.4 million patients came from northeast Ohio,' 15% from elsewhere in Ohio, about 13% from other states, and 0.2% were international.1 International patients accounted for 1.7% of patients seen at the main campus. As of mid2015, the Cleveland Clinic Health System had 43,000 employees including 3,200 staff physicians, 10,965 nurses, and 1,710 affiliated community physicians. In addition to the main campus, the System included ten community hospitals in northeastern Ohio, 18 family health and ambulatory surgery centers, and 59 primary care offices located near Cleveland (Exhibit 1). The Clinic also had facilities or affiliates in ten other states, Toronto, Canada, and Abu Dhabi. Telemedical second opinions and virtual visits for patients were offered throughout the U.S. In 2014, total operating revenues for the health system were $6.7 billion, with $466 million in operating income (Exhibit 2).2 Charity care at cost represented about $211 million. The Clinic had significant revenue from philanthropic giving, and its investment portfolio stood at $6.5 billion. For decades, the Clinic had been highly ranked among US. hospitals. In 2015, [1.8. News and World Report ranked the Clinic fifth overall, with 13 specialties ranking in the top ten in the nation. The Clinic's Heart and Vascular Institute had ranked number one continuously for 21 straight years. The Clinic's rank increased to second in 2016. Delos M. Cosgrove, M.D., had become the Clinic's CEO in October 2004. His first act was to adopt Patients First as the goal for the entire organization. Over the ensuing decade, he set out to restructure care delivery and expand geographically. In 2007, the Clinic pioneered public reporting of outcomes across all practices. It also began reorganizing all services into institutes structured around diseases or organ systems, rather than around the traditional medical and surgical departments. In 2013, a Clinical Enterprise Management team was formed to unify clinical leadership and drive rationalization and standardization to create One Cleveland Clinic. Care pathways for 106 frequentlytreated patient conditions had been developed, and the Clinic was beginning to roll out dedicated multidisciplinary care teams in these areas. While some physicians initially had been skeptical of the effort to transform