The president of Cleveland Clinic London talks about the group’s long heritage and why patients are the biggest winners in value-based healthcare deals.
A head and neck surgeon by training, Rob Lorenz, has been president of Cleveland Clinic London since June 2023. One of the fastest growing private healthcare groups, here he talks to Healthcare Today about where growth is coming from, why he thinks value-based purchasing makes sense, and where he sees the opportunities for artificial intelligence within healthcare.
“Our mission is very simple: we take care of patients, we research their problems and we educate the next generation of caregivers.”
As one of major private healthcare players, how do you see Cleveland Clinic London within the UK ecosystem?
It’s a really interesting presence we have here. Our heritage is as a nonprofit foundation. We have no shareholders, we don’t seek government support; we are self-contained. And our mission is very simple: we take care of patients, we research their problems and we educate the next generation of caregivers. That’s all we do, and everything revolves around those three pillars.
The organisation has been around for 104 years. London is our first international site, now in its fourth year, and we’ve brought the same model from the US.
In the US, we conduct about $500 million (£367 million) worth of research annually, and we’ve already begun building that programme here – both by investigating UK-specific health problems and by bringing new therapeutics into the country. We also educate around 2,600 people a year in the US, and are just starting to grow education here, training doctors, nurses, physiotherapists, and technicians. The aim is to be additive to the community of healthcare providers in London and across the UK, not subtractive
Where is the growth coming from?
Our payer mix here is roughly half private medical insurance (PMI), a quarter self-pay, and a quarter embassy-driven. When Newsweek ranks [healthcare] brands internationally, Cleveland Clinic is consistently recognised. It is currently the second-ranked healthcare brand worldwide. That reputation for quality, safety and innovation attracts patients not just from the UK, but from across Europe, Africa, the Middle East and beyond.
As for what draws patients here: they want faster access to care, greater control over their health, and access to the latest technologies and innovations. Those are exactly the areas where we focus – rapid access, new treatments, and a reputation for quality and safety. Last year our compound annual growth rate was 35% and unique patient numbers grew about 30%. This year so far our outpatient volumes are up another 12.5%.
“Our focus is on ensuring our existing services deliver real value in a sustainable way.”
One of the stories of the year has been the growth of the PMI market – how do you see opportunities in broader healthcare market, for example mental health?
Prevention is, of course, far more attractive than treatment once disease has set in.
In London, we began with a concentration on surgical and neuro-rehabilitation services. On the surgical side that includes heart and vascular, neurosciences, digestive disease, orthopaedics, ENT and urology. Alongside that, we have a 42-bed neuro-rehab centre for patients recovering from stroke, amputation or traumatic injury.
More recently, we announced our Cancer Centre, housing an all-inclusive breast centre, chemotherapy, radiotherapy, and nuclear medicine. That builds on our US reputation for complex tertiary and quaternary care. We already provide highly specialised services such as ECMO – essentially supporting patients with an external heart-lung system – and intraoperative MRI in neurosurgery, where imaging is repeated mid-operation to ensure nothing is missed.
While we’re not yet delivering preventive or paediatric care, our oncology services will grow, and over time we will broaden into areas such as prevention and mental health. For now, our focus is on ensuring our existing services deliver real value in a sustainable way. At present we have three London sites, and no plans to expand outside the capital.
Clinical negligence is on my mind because of the NHS Resolution figures that came up in the summer. How are you geared up to deal with clinical risk and clinical negligence liabilities?
First and foremost, we are physician-led – the person I report to is a surgeon and I’m a surgeon. That means decisions about everything from cleaning protocols to ordering supplies are guided by a patient-centred clinical perspective, not an administrative one. Clinical care is always our North Star.
Second, unlike the traditional UK model where individual providers often work across different hospitals and clinics, we directly employ the majority of our doctors. That creates a true group practice with tight governance. Multidisciplinary team (MDT) conferences are central: no patient undergoes an elective invasive procedure unless an MDT has reviewed the case and formally signed off – first on whether intervention is necessary, and second on whether it is the right intervention. Emergencies are handled differently, but for elective care that process is mandatory.
This model also allows us to indemnify our clinicians under the organisation’s umbrella. In practice, that means only those delivering consistently outstanding care are admitted to our medical staff, and we maintain rigorous oversight of standards.
You are building a new cancer centre in London. What is your perspective on consolidation, acquisitions, or strategic investment within the UK care sector? Is it opportunistic or planned?
One of the gaps we identified here was the lack of fully comprehensive cancer care. Chemotherapy and radiotherapy, for example, can have significant effects on the heart and lungs – yet often those specialties sit in different hospitals from where patients receive their cancer treatment. Our model brings everything under one roof. If a patient develops an infection, we have infectious disease specialists. If they have a bleeding disorder, we have haematologists. That integrated approach is what will make our cancer offering unique, and it’s why we are investing in a dedicated cancer centre here.
More broadly, as we grow, we will expand carefully into other areas of need – always guided by our three core pillars of clinical care, research, and education.
“Better care – with no re-operations, complications or extended stays – is less expensive than poor-quality care.”
Cleveland also recently signed a new multi-year deal with Bupa UK Insurance. Can you tell me how that deal works?
Take the example of a hip replacement that doesn’t work – the patient is still in pain, can’t walk properly, and is left with ongoing complaints. Why would you remunerate a provider – whether a doctor or a hospital – the same in that scenario as when the outcome is excellent? That’s the principle behind value-based purchasing.
We partnered with Bupa to pilot a value-based product: they agreed to pay us more if we demonstrated superior outcomes. After a year, we exceeded the quality and safety metrics, and Bupa rewarded us accordingly.
The win-win is clear. Better care – with no re-operations, complications or extended stays – is less expensive than poor-quality care. Patients recover faster, return to work sooner, and live pain-free. The payer saves money, and we build our reputation for delivering high-value care. Most importantly, the patient is the biggest winner.
We’re now expanding that partnership with Bupa and in discussions with other payers.
It is an industry wide theme and seems to be the same wherever you are in the UK no matter whether you are public or private. How do you recruit and retain healthcare professionals?
Very few people have left – the numbers are in the low single digits. It helps that we have a strong infrastructure and a hospital that never closes. Clinicians know that within our walls their patients will be safe – and that draws more consultants to bring their practices here.
On the nursing side, the organisation is deliberately flat, with little hierarchy. We foster a strong speak-up culture: if someone isn’t comfortable with a policy, a decision, or a situation, they can put their hands up. That openness is highly valued.
Reputation also plays a part. We are recognised globally for outstanding nursing. Our nurses come from around the world. Many see London as an exciting place to live and work, and they value the opportunity to build careers across continents within our organisation.
“Don’t be surprised if one of the biggest early shifts in healthcare AI is operational.”
Healthcare remains slightly ambivalent about AI. As your colleague Alex Adjei told us, it has been embraced wholeheartedly by oncology but cautiously by the rest of the sector. How do you see it?
Genomics, personalised cancer, imaging and pathology are clear examples of where AI is making a difference. But I’d add another area that often gets overlooked: the back office. People dismiss it as unexciting, but I think it’s hugely important. If we can streamline access, communication, billing and administration, we can free up resources for research and education.
Don’t be surprised if one of the biggest early shifts in healthcare AI is operational. Other industries are already far ahead, but healthcare is starting to catch up – and the impact could be profound.
The government’s plans to work with the private sector earlier this year was a distinct statement of intent. Where do you see the opportunities for the private and public sectors to work more closely together?
We’re excited about partnerships with the NHS. Where we can really add value is in complex disease – that’s why we brought tertiary care here.
For example, we had an agreement with NHS Devon Integrated Care Board to help with its long waitlist for aortic valve disease as well as some orthopaedic surgery. It set up what’s called a spot contract: would someone take 300 patients, meet the quality and safety metrics, deliver at a set tariff, and do it quickly? We did – and the results were excellent. Quality and safety were outstanding, patient satisfaction was extremely high, and we cleared the backlog.
The model is clear: when waitlists are long, the NHS can put out an offer, and we’re ready to step in with high-quality, safe care. We’re not looking for higher margins – the rates are the same as PMI – but we do feel a duty to assist when patients are waiting too long.
