Table of Contents
Strategic Rationale
Cleveland Clinic’s Shared Medical Appointment (SMA) program has been operating in small numbers since 1999. A formal SMA program originated from a 2010 directive by the then-CEO, who foresaw a convergence of systemic pressures demanding new models of care to improve access. SMAs were designed as a force multiplier program, a single innovation that benefits patients, providers, and the health system simultaneously by expanding access, protecting quality, and improving the patient and provider experience. They unlocked clinician capacity and convenience without increasing headcount or sacrificing quality, reinforcing the Clinic’s reputation for pairing clinical excellence with operational innovation.
“Our capacity, our clinicians’ time, is one of our most precious resources. There's more demand than there is capacity, and that's never been truer for healthcare systems.”
– VP, Access Transformation
Overview
Visit format: SMAs are ~90 minutes with 10-12 patients who share similar conditions. They are not designed to replace regular appointments with providers but rather to add an extra layer of care to treatment plans.
A physician, a facilitator (ranging from RNs, RDs, and CDEs), and other clinical support staff provide individualized care within a group setting, including orders, prescriptions, and private exams. Patients will see the same provider in follow-up appointments.
Patients can spend more time with providers than in a standard one-on-one appointment and connect with other patients.
Virtual-first shift: Post-COVID, virtual SMAs make up the majority of sessions due to convenience and both provider and patience preference.
Breadth of offerings: Over 100 types of SMAs are offered, including those for chronic pain, cardio-obstetrics, brain health & wellness, long COVID, nutrition, weight management, acupuncture, and menopause. Cleveland Clinic has over 350 providers conducting SMAs.
Reimbursement: SMAs are billed as standard office visits, and their design follows the elements of an E&M visit.
Operations: A small central team (medical director and program administrator) created workshops, training, and on-demand webinars to educate the providers and facilitators. A SharePoint library houses templates, privacy waivers, and playbooks to standardize and accelerate replication.
Time Frame
2010-present
Scale
~450,000 SMA visits; ~300,000 of those delivered virtually since 2010
~70,000 SMA visits per year on average
The first pilots began with chronic conditions, such as asthma and diabetes, as well as women’s health. With strong results in efficiency and satisfaction, the model was replicated across service lines. Clinical champions and early adopters within each department drove scale.
Cleveland Clinic has expanded SMAs to incorporate shared nursing for pre-op education, shared social worker appointments, and other labor-intensive appointments that are often delayed due to clinical support team availability.
Goals and Competitive Advantage
Reshape how clinical capacity is created
Redefine access from a scheduling constraint to a system-level performance driver
Ensure every patient is matched with the right provider, in the right format, at the right time
Improve provider productivity and well-being, as well as patient experience
Deliver both high-touch and high-throughput care
Results
Some clinicians experience an increase between 60% to 80% in productivity after integrating SMAs (based on change in visit volume)
Enables providers to see 6-8 extra patients per SMA conducted compared to one-to-one appointments conducted in the same 90 minute period
Next-available appointment reduced by ~50% on average
Patient and provider satisfaction reported as high; sustained spread driven by clinician advocacy and repeat patient uptake
New patient acquisition
Level of Investment
Minimal incremental cost. The model leverages existing clinicians and clinic space. Aside from the medical director and program administrator, early investments were primarily time and coordination, developing templates, training facilitators, and standardizing workflows
ROI achieved once 6-7 patients attend a session, though the number of optimal patients varies with the type and length of the visit being leveraged
Lessons Learned
Start small, prove it, then scale. Early proof-of-concept and easy-to-move metrics (fill rate, patient “would return”) built momentum and credibility. As the Director of SMAs noted, “buy-in comes because something works, and bad news spreads a lot faster than good news.” Starting slow and proving success in visible ways allowed Cleveland Clinic to expand into the largest SMA program that exists today.
You don’t fix access by adding staff. You fix it by rethinking the visit. Innovation in access comes from redesigning the encounter itself. Group formats, team-based care, or asynchronous models unlock hidden capacity that staffing alone can’t create. Leveraging existing people and infrastructure made the economics straightforward and persuasive to administrators.
Prove the force multiplier, then let champions carry it. Cleveland Clinic didn’t spread SMAs through mandates; they spread through momentum. Once physicians saw peer-led results, higher efficiency, and happier patients, champions within each specialty became the engines of replication with only minimal centralized program coordination staff.
Virtualization expands, not replaces, connection. Patients valued the group dynamic even online. It preserved the sense of community while eliminating in-person barriers to care and adding convenience.
Preserve the human relationship while automating the rest. Standardize/centralize the processes that can be automated (routing, intake, scheduling) but never automate the provider-patient connection. That’s what sustains outcomes and experience.
