Cleveland Clinic CSO Discusses Growth and Priorities

Jim Cotelingam looks back on his first year as chief strategy officer for the health system and looks ahead to future growth initiatives.

In August 2021, Cleveland Clinic announced that Jim Cotelingam, who had served as interim chief strategy officer since February of that year, would be the health system's permanent CSO.

Cotelingam, who originally joined the health system in 2019 as the executive director of strategy, helped establish the system's five-year strategic framework, which aimed to double the number of patients served by the renowned health system over that time period.

Following his one-year anniversary as CSO, Cotelingam spoke to HealthLeaders about the past year and what he hopes to accomplish in the upcoming year, and he shares his excitement for the system's upcoming growth strategies.

This transcript has been edited for clarity and brevity.

HealthLeaders: How was your first year as the permanent CSO for Cleveland Clinic?

Jim Cotelingam: It's been a fantastic year, and that's in large part due to the great colleagues that I get to work with. The fellow caregivers here at Cleveland Clinic, the administrative leadership, the physician leadership have been so supportive and welcoming.

Having worked here for a few years before also was helpful. I already knew some of the organization's workings and how to get work done within the organization.

We were able to accomplish a lot during the course of the year. We strengthened our external focus with market insights and market data, something that the leadership team has appreciated. I was able to deepen relationships with other leaders, peers, physician leaders, and other stakeholders. Relationships are incredibly important to the work that strategy leaders do. I was able to move some strategic initiatives forward; trying to get answers to some tough questions, maybe asking some questions that hadn't been asked before. For all of those reasons, I look back at the year as successful and a really nice start.

We had an initiative with the Alice Walton Foundation in Northwest Arkansas to help build a health system there to serve the broader region, and we made a lot of progress this year in terms of identifying potential partners in the market, developing strategy for what we want to accomplish working together. That's just one example of work that Cleveland Clinic has been able to advance over the last year with a great partner.

HL: What are Cleveland Clinic's growth plans and how have you been working toward those this past year?

Cotelingam: Cleveland Clinic, overall, continues to grow by building, innovating with technology, and partnering. As a healthcare leader, we want to serve as many people as we possibly can, where and how they want to receive care.

We're pursuing growth in a variety of ways:

1. Growth in our existing markets, providing more access, strengthening relationships with our physicians, providing services in the right locations, all of those sorts of activities we continually look at.

2. Opportunities that are outside our existing markets. For example, the Northwest Arkansas opportunity that I mentioned, with the Alice Walton Foundation.

3. Opportunities in diversified spaces that we normally don't think health systems are in but we have the opportunity to contribute to and benefit from, in areas like innovation with a startup.

We've pursued growth in all these ways. I'd be remiss if I didn't note one of the signature growth initiatives for the clinic, not something that I personally was directly involved in because it started [prior to when I] was in my current role, but the opening of Cleveland Clinic London was a huge achievement for the organization. You don't typically see US-based health systems open greenfield hospitals in new markets internationally.

HL: What pain points are you looking to address during your second year as CSO?

Cotelingam: We're at a challenging time as an industry overall. This isn't a Cleveland Clinic-specific comment, [but] a comment about the whole provider side of the US healthcare industry. Current performance, the outlook for the near term, is top of mind for most health systems, because of all the challenges that we see. In this environment, access and growth are tremendously important.

Sometimes people will say, 'Well, how can you think about growth in a time where performance is challenging for hospitals and health systems?' And my thought is we don't really have a choice. With the inflation that we're seeing, such as agency nursing costs, or pharmacy expenses, or other expenses across the industry, it's harder for hospitals and health systems to manage expenses. We also know that strong payers will limit their revenue increases to hospitals and health systems. Volume or growth is really the main lever that hospitals and health systems have to drive performance; we have to stay focused on it even in a challenging environment.

The other thing that will be on our agenda is continuing to evolve our thinking around disruptors, the non-traditional competitors in the healthcare space. We want to continue to understand these non-traditional competitors in the healthcare space, where they compete with us, where we need to partner potentially with them to help serve the communities that we're in.

We've been in some discussions with various disruptors, trying to understand the mutual benefit that we would both have from working together. We're in the middle of that process.

HL: What initiatives are you looking forward to continuing to lead?

Cotelingam: All the initiatives around growth are exciting to me. Growth is incredibly important for any health system, so whether it's initiatives around physician alignment—we have a very strong physician alignment model here at the clinic called the Institute Model. But [in] many communities that we serve, the institute model is not the only way in which physicians want to partner with Cleveland Clinic.

There are other approaches to alignment, and it's exciting to focus on those. Providing more access to patients is exciting. We continue to develop our capabilities around value-based care and population health. We have opportunities to continue to grow some of our leading service lines to continue to reach more patients that want to see us. And then finally, we have various initiatives around consumers and making sure that we are as connected to consumers as possible.

In environments like the one that we're in right now, where it's operationally challenging, it's easy for organizations to put strategy on the backburner and say we need to focus on our current operational environment. And I get it. But strategy is about answering a key question: Are we doing the right things? Being able to prioritize is even more important in today's environment. As I think about what hospitals and health systems need to do in an environment like this that we're in today, we can't lose sight of strategy.