Crain's Cleveland Business

100 YEARS OF

HEALTH CARE

Cleveland Clinic has pioneered medicine since 1921. PAGE 2

CITY LIVING Experts and advocates say Akron has only begun to satisfy the demand for downtown apartments.

PAGE 18

FOCUS: Telehealth takes a new role.

PAGE 10

CRAINSCLEVELAND.COM I AUGUST 23, 2021

Virtual rebranding brought challenges Unique approach drove change to Guardians

BY KEVIN KLEPS

Aside from expansion teams and clubs that moved from one city to another, a Major League Baseball team hadn’t undergone a major rebranding since 1965.

Houston’s switch from the Colt .45s to the Astros was a bit before the days of Twitter, where almost every new uniform has far fewer fans than an NFL team’s backup quarterback. And the meetings about the Astros’ impending switch weren’t done via Zoom.

The latter was the case for many of the discussions involving the Cleveland Indians’ switch to the Guardians, which was announced Applicants for home repair loans administered by CHN Housing Capital range from families living in well-maintained but aging houses to owners of extremely dilapidated properties. | MICHELLE JARBOE

REPAIR RELIEF?

Advocates see chance to heal aging homes, neighborhoods BY MICHELLE JARBOE Unaddressed home repairs are a nearly billion-dollar problem in

the Cleveland area. With a one-time flood of federal pandemic relief funds flowing to the region, housing advocates are asking whether there is an opportunity to tackle that deferred maintenance — and to craft a sustainable framework to improve aging residential real estate.

See REPAIR on Page 20

NEWSPAPER

VOL. 42, NO. 31 l COPYRIGHT 2021 CRAIN COMMUNICATIONS INC. l ALL RIGHTS RESERVED

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THE

last month and will become effective after the 2021 season.

“At the very least, it’s probably the first major sports rebranding that’s been accomplished completely remotely,” said Dudley Versaci, the chief strategist for Sports Car Brand Creative — the custom agency employed by the Cleveland baseball club to design the Guardians’ new look.

Versaci is a 34-year-old former director of business development at Doubleday & Cartwright, a Brooklyn, New York-based firm that led a redesign of the Milwaukee Bucks and was the creative force See GUARDIANS on Page 21

Local colleges experience some fundraising successes

BY AMY MORONA

Conducting a donor call over Zoom can be less than ideal for those in college advancement offices.

“It’s sometimes scary to make an ask in person, let alone using technology that you’re afraid is going to freeze up,” said Greg Sanders, Lakeland Community College’s vice president of institutional advancement and executive director of The Lakeland Foundation.

His team pivoted, adapting and

LAND SCAPE

learning quickly during the pandemic. It became second nature and even a strength in some situations.

But a bigger hurdle loomed.

“There’s a tendency to pull back and say, ‘The world is shut down, this isn’t the right time,’ ” he said. “But we’ve challenged ourselves to continue to communicate, to continue to provide information. Based upon the feedback I’ve received from the donors, that was greatly appreciated.”

See FUNDRAISING on Page 22

A CRAIN’S CLEVELAND PODCAST

8/20/2021 1:35:56 PM

HEALTH CARE

100 years of group care at Cleveland Clinic

BY LYDIA COUTRÉ

Cleveland Clinic’s evolution from a single hospital on Euclid Avenue, opened in 1921, to a global health care powerhouse has given it both the ability and responsibility to care for its communities in ways not possible 100 years ago.

“When we were founded, we were a single small hospital, so it was impossible to contribute to community at an integrated level,” said Dr. Tom Mihaljevic, Cleveland Clinic president and CEO. “But now, with a large integrated health care system, we have a big responsibility.”

As the largest employer in Ohio, the Clinic has a responsibility to maintain those jobs and ensure they are wellpaid, family-sustaining jobs, which then contributes to the stability, health and wellness of communities, he said.

The Clinic can help address community stability, racial disparities and other societal problems, which is what the system will focus on through the second century of its existence, Mihaljevic said.

The Clinic’s model of care — group practice, physician-led, nonprofit — has not changed, said Dr. Toby Cosgrove, former president and CEO of the Clinic.

“I think (Cleveland Clinic) will be one of the continuing leaders in research, education and clinical care in the world, which it is now recognized generally as the number two hospital in the United States and around the world,” Cosgrove said. “That’s a pretty fine distinction.”

Though the scale and reach of what is now an international, integrated health care system was unfathomable in 1921 when the Clinic opened its doors, the principles set out by its founders have been the backbone of its work in the century since. Cleveland Clinic is a “substantially different organization” than the one founded by Drs. Frank E. Bunts, George W. Crile Sr., William E. Lower and John Phillips, but the core tenets have remained.

“Our mission for many years — caring for the sick, researching their problems and educating those who serve — those basic tenets of patient care, research and education, continue to live with us to this day,” Mihaljevic said.

TEAM-BASED CARE

Clinic co-founders Bunts, Crile and Lower served together in World War I and later recruited Phillips.

As the first truly modern war, World War I and the considerable number of casualties and injuries caused by new weapons meant that the medicine practiced had to be more regimented and organized, said John J Grabowski, Krieger-Mueller associate professor of applied history at Case Western Reserve University and the senior historian for the Western Reserve Historical Society.

“That’s where (the Clinic founders) picked this up, and I think particularly Crile, looked at a way not only of group practice but how to make medical care more efficient,” he said. “And I think that’s what we see in the Cleveland Clinic. ... “I think it’s hard for us to imagine what a leap that was from hospitals or physicians who operated very much independently at one point rather than in a team.”

The idea that a team of providers can better serve patients was “revolu-

Cleveland Clinic’s campus is displayed via an aerial view in 1968. | THE CLEVELAND CLINIC CENTER FOR MEDICAL ART & PHOTOGRAPHY

Dr. Nicholas Smedira performs heart transplant surgery at Cleveland Clinic. | KOHLBACHER PHOTO

tionary” at the time, Mihaljevic said.

The Clinic’s history of clinicians working together to solve problems was evident on a large scale during the unprecedented pandemic that capped its 100 years of growth. Clinic caregivers worked together within the system, as well as with other health systems in the region and beyond at unprecedented levels.

From Northeast Ohio systems working together to hospitals across the state collaborating to coordination across levels of government with health providers, the cooperative spirit of the Clinic’s founders framed the pandemic, said Dr. Robert Wyllie, the system’s chief of medical operations.

Although the Clinic is a large health system, employer and anchor for Northeast Ohio, “there are some things which are too big for us on our own,” he said, listing infant mortality and the opioid epidemic as two other examples that have fostered collaboration in recent years.

DISCOVERY

May 15, 1929, became known as the Cleveland Clinic Disaster, when volatile nitrocellulose X-ray films in the basement of the original outpatient clinic combusted. The explosion sent poisonous gas throughout the building, and 123 patients, visitors and

caregivers died from gas inhalation, including co-founder Phillips.

“The Clinic is started, and it gets rolling during a very prosperous decade,” Grabowski said. “At the end of the decade, it is hit with this tragedy, and then it goes into the depression and it survives through all of that, which I think is something of a great consequence.”

The 1950s and 1960s were transformative for Cleveland Clinic in its research milestones, Mihaljevic said, highlighting a few key discoveries.

In the 1950s, Dr. Irvine Page made groundbreaking research in the area of hypertension. Dr. F. Mason Sones discovered moving cine-coronary angiography at the Clinic in 1958, allowing to see inside the blood vessels of the heart as never before possible.

This laid the path for the work of his colleague, Dr. René Favaloro, who in 1967 pioneered coronary artery bypass surgery. These cardiac discoveries transformed how not just the Clinic, but the entire world takes care of patients with heart disease, Mihaljevic said.

“That work really put Cleveland Clinic on the world’s map,” he said.

In the mid-1970s, the Clinic began acquiring land and by 1986 owned nearly all of the land between East 88th and East 105th streets and Ches-

ter and Cedar avenues — roughly 140 acres and much of today’s main campus. The Clinic’s growth in the 1970s and ’80s occurred as Cleveland’s industrial economy and population were plummeting, Grabowski said.

“I think it becomes apparent within the city at that point that the future of the community is going to be in substantial part linked to medical care and to general innovation,” he said.

The founding of Cleveland Clinic Florida in 1988 made the Clinic the first academic medical center to establish full-service hospital and clinic facilities outside of its home state.

In 2004, the first class entered the Cleveland Clinic Lerner College of Medicine, a partnership between the Clinic and Case Western Reserve University. The two institutions in 2019 opened their joint Health Education Campus, a four-story, 477,000-squarefoot building designed to encourage multidisciplinary interaction and collaboration among students.

Education and research are key parts of the Clinic mission, Mihaljevic said.

“As one of our founding fathers said, we do not just have a commitment to our patients of today, but we also have a commitment to our patients for tomorrow,” he said. “So that’s the reason why this year, we made the largest investment into research and education in our history.”

The Clinic committed $300 million to the Cleveland Innovation District, a public-private partnership that aims to create 20,000 jobs and billions of dollars of economic impact in Cleveland over a decade. The $565 million partnership announced earlier this year was forged by the Clinic, University Hospitals, MetroHealth, Case Western Reserve University and Cleveland State University with the support of JobsOhio.

GROWTH

The 1990s brought a decade of mergers to Northeast Ohio as both the Clinic and University Hospitals

were in an effective hospitals arms race, each bringing independent hospitals into their networks. During that time, the Clinic transformed from a single hospital to a vast network of hospitals in Northeast Ohio, adding Marymount, Lutheran, Fairview, Euclid, South Pointe, Hillcrest and Lakewood hospitals.

In the early 2000s, the Clinic set its sights abroad, opening Cleveland Clinic Canada downtown Toronto in 2007 and signing an agreement to provide care in Abu Dhabi in 2006, which laid the groundwork for Cleveland Clinic Abu Dhabi — a hospital that opened in 2015.

The Clinic has since continued its international reach, partnering with a medical group in China in 2018 to open a hospital in Shanghai; forming a strategic advisory council with a health system in the Bahamas to improve care delivery and building a hospital in the United Kingdom — Cleveland Clinic London is slated to open in early 2022.

As the Clinic enterprise goes global, it remains proud of its Ohio roots, Mihaljevic said.

“Cleveland is in our name, so our attention to our presence in Ohio continues to be very strong,” he said, pointing to the hospital it is building in Mentor, which will expand the system’s footprint in that portion of Northeast Ohio. Its acquisitions in the past several years of Akron General Health System, Union Hospital in Dover and as of this year, Mercy Medical Center in Canton, collectively stretched the Clinic’s boundary south.

Asked if the Clinic plans to continue broadening its geographic footprint from its Northeast Ohio base, Mihaljevic said the Clinic sees Ohio as a broader state. The system is “very cognizant” of its privilege and responsibility to care for fellow Ohioans, he said.

The Clinic’s tri-point model of care, research and education has been a powerful model, said Beth E. Mooney, chair of the Clinic’s board of directors.

Together, the three pieces have kept Dr. Wilma Fowler Bergfeld, a senior staff dermatologist at the Clinic, with the health system for decades.

She first joined the Clinic in 1964.

The ability to do clinical research, teach and practice, while having the flexibility to assume leadership roles both in and outside of the Clinic have made her career a fulfilling one. All of this was underscored by a community of supportive physicians, she said.

The Clinic, its mission and expertise have “honed, grown, matured and become world-class” in the past century, said Mooney, who joined the board in 2007 and became chair a little over two years ago.

“It’s larger, it’s different, it’s probably nothing that anybody could have envisioned 100 years ago,” she said.

“But what I think is really exciting is we are the stewards, I like to say, of the next 100 years, and so how we invest in technology, how we invest in care protocols, how we invest in new treatments is going to be the launching (pad) for what I think is going to be an incredible and distinguished next 100 years.”

Lydia Coutré: lcoutre@crain.com, (216) 771-5479, @LydiaCoutre

2 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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Cleveland Clinic opens its doors on Feb. 28, 1921. The Clinic starts as a single building on Euclid Avenue at East 93rd Street.

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A new outpatient clinic opens in 1931 beside the original clinic, where the explosion two years prior rendered the building unusable. (On May 15, 1929, volatile nitrocellulose X-ray films in the basement of the original outpatient clinic combusted in an explosion and sent poisonous gas throughout the building, where 123 patients, visitors and caregivers died from gas inhalation.)

1950s Dr. Frank Bunts in one of the operating rooms in the 1920s. | CONTRIBUTED

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On May 15, 1929, an explosion of X-ray films resulted in a fire that killed 123 patients, visitors and caregivers. | CLEVELAND CLINIC

1980s

Over this decade, the Clinic grows from 17 buildings on 62 acres to 30 buildings on 100 acres. It becomes the city’s largest private employer in 1988, totaling 9,134 employees.

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1988

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Cleveland Clinic Florida opens in Cypress Creek — the system’s recognition of the opportunity to expand its integrated, academic group practice-based delivery system beyond Cleveland.

Dr. F. Mason Sones performs a cardiac catheterization. | CLEVELAND CLINIC

1990s

The Clinic builds a network of regional hospitals and family health centers, growing from a single hospital to a vast health system over three years. It adds Marymount Hospital in 1995, Fairview Health System (including Fairview and Lutheran hospitals) in 1996 and the Meridia Health System (Hillcrest, Euclid, Huron and South Pointe hospitals) in 1997.

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The Clinic’s reputation as a force in medical care and research continues to grow, particularly in the area of heart care. In 1956, Drs. Donald Effler and Lawrence Groves perform a “stopped heart” operation, and in 1958, Dr. F. Mason Sones discovers moving cine-coronary angiography, which ultimately leads to Cleveland Clinic’s pioneering work in coronary artery bypass.

2004

The first class enters the newly formed Cleveland Clinic Lerner College of Medicine.

Shown is Cleveland Clinic team that performed a pioneering “stopped heart” surgery on a 17-month-old boy, using a heart-lung machine designed by Dr. Willem Kolff, far left. | THE CLEVELAND CLINIC CENTER FOR MEDICAL ART & PHOTOGRAPHY PHOTOS

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2000s

The Clinic’s international expansions begin to take root. It signs an agreement to provide care in Abu Dhabi in 2006. Cleveland Clinic Canada opens in downtown Toronto in 2007.

Cleveland Clinic children’s ward in the 1960s. | DEBORAH OSBORN CUNNINGHAM

2009

Cleveland Clinic Lou Ruvo Center for Brain Health opens to patients in Las Vegas.

2010s

The Clinic’s web expands in Northeast Ohio, integrating into its network Akron General in 2015 and Union Hospital in 2018. Cleveland Clinic Avon Hospital opens in 2016. Mercy Medical Center joins in 2021.

Cleveland Clinic Abu Dhabi provides care for patients in the Middle East. | CLEVELAND CLINIC

2015

Cleveland Clinic Abu Dhabi opens.

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2019

The final beam is placed on the Cleveland Clinic London facility, which is expected to open in 2022.

2020

Cleveland Clinic was among the first academic medical centers to offer COVID-19 testing. | THE CLEVELAND CLINIC CENTER FOR MEDICAL ART & PHOTOGRAPHY MARKETING DIVISION

The Clinic was among the first academic medical centers to offer COVID-19 diagnostic testing.

Throughout the pandemic, the health system has treated COVID-19 patients, worked to maintain access to care, participated in dozens of COVID-19 related studies, authored hundreds of publications and worked on the frontlines of the global pandemic.

Dr. Brian Donley, right, CEO of Cleveland Clinic London, and Tony Bellas, site manager for London-based Sir Robert McAlpine, watch the “topping off ” ceremony at the Clinic’s London facility in 2019. | CLEVELAND CLINIC AUGUST 23, 2021 | CRAIN’S CLEVELAND BUSINESS | 3

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For Scott Phillips Jr., the wait and the preparation are over.

He’ll be doing NFL scouting at the Senior Bowl in Mobile, Alabama, next February, as a prelude to the 2022 draft, after deciding the time was right in the business for him to move on from day-to-day management of the Keller Williams Greater Metropolitan brokerage in Rocky River and Pepper Pike.

After promoting Michael Repasky to CEO of the 450-agent Keller Williams franchise that serves the Cleveland area and turning over duties as operating principal to fellow owner Jake Lohser, Phillips has cleared the field to turn his love of football into his next career.

“This was definitely the master plan,” Phillips said in an interview after a day of watching players at the University of Akron. “My goal was to get the company in position from a personnel and production standpoint so that if I passed the torch of leadership to others I could do it on a high note. With (Repasky) as CEO, the company is ready to go.”

Phillips said he’s following advice he received at an early age that in order to “have a big life, build a big business to create opportunities to grow. The company is now big enough to have a CEO paid to run it.”

His football ambitions are well known among acquaintances. Indeed, his Crain’s Cleveland Business profile for 40 under 40 in 2015 concludes with his goal to join pro football.

It’s a path that he took at 5 or 6, after he saw how happy his father was following a Cleveland Browns victory. There have been some hiccups along the way, however. A torn leg ligament in January 2011 put an end to his playing days as a quarterback at six minor league and arena teams, including the former Canton Legends. He had played quarterback in high school at Notre Dame Cathedral Latin in Chardon. He had tried out as a walk-on at Ohio State University but didn’t make the team.

“I wasn’t ready for the golf shirt as a coach,” Phillips said, but his desire for a role with pro football was rekin-

Scott Phillips Jr. has switched from helping house hunters and running a brokerage to sizing up football talent as a scout. He’ll continue to own part of a major local Keller Williams franchise.

dled as his son, now 9, began playing football. He attended the Scouting Academy and Elite Scout School online, as well as two days in person this year at the Senior Bowl Scouting Clinic in Mobile.

“There are lots of ways to enter residential real estate. You can do it through drones, photography, administration and as a Realtor,” said Phillips, who is 38. “In pro football, the ways in are through playing or managing, which often includes scouting. Most people who do this are in graduate school or just out of college.”

In a way, he’s already got a proven playbook for picking talent.

Over his residential brokerage career, including the last seven captaining Keller Williams Greater Metropolitan after buying into the franchise, Phillips said he has interviewed thousands of prospects, especially as the brokerage grew by about 100 agents in each of the past couple years.

However, he said that is unlike picking talent for pro football.

“You have candidates who are all very close to each other in skills and will get million-dollar contracts,” he said. “There’s no comparison to hiring an agent who works for commission.”

For his own part, the skills from selling real estate and managing brokers give Phillips a background for the soft side of scouting. His social

networks abound with comments on various pro players and prospects.

There even are polls over who he would pick for a certain play or position. He also has oodles of such analysis on his Twitter accounts, one now using the handle @scott-nfl and another @CoachScottJr. Ryan Young, a fellow principal of Keller Williams Greater Metropolitan who runs the Young Team, said in an interview that he admired his colleague’s goal the same way you admire a young person who says they want to grow up to be president.

“You admire it. But I literally thought he would never do it,” Young said. “I remember him telling me about his goal to get into pro football when I first met him. I give him credit for having the vision to do something and mapping a way to do it. I admire him.”

Additionally, Young noted that Phillips already has shown he can juggle multiple pursuits. Phillips’ business interests also include co-owning Guarino’s restaurant in Little Italy, where he started working at 13.

“He’s not a 40-hour-a-week guy who puts in his time and that’s it,” Young said. “He’s been 60 hours a week at Keller Williams all this time.

And 20 hours for the restaurant and 20 for coaching. That will be rearranged. It’s like the goal of anyone who starts a business who builds it and a leadership team and becomes chairman. He’ll still be involved.”

Repasky, who has known Phillips since their college years, said he sees his role as continuing the culture that is present at Keller William Greater Metropolitan.

“The key to our success is continuing to activate the talent we have,” he said.

Phillips’ goal is to join the Browns as a scout in the future. His hopes also include landing a coaching position. To that end, he’s staying put in Cleveland.

His 40% interest in Keller Williams Greater Metropolitan will also remain intact as successors take the reins.

“It’s not like they can’t reach me anytime by phone if they need me,” Phillips said.

Stan Bullard: sbullard@crain.com, (216) 771-5228, @CrainRltywriter

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4 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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Ohio wants to set the standard for personal data privacy laws

BY KIM PALMER

Ohio Lt. Gov. Jon Husted believes the Ohio Personal Privacy Act should become the national standard guiding data rights laws for consumers and businesses.

The recently introduced House Bill 376 is imperative, Husted said in an interview, because as he sees it, federal and state laws don’t adequately protect consumers’ rights to their own information or provide business guidelines for what can and cannot be done with someone’s personal data.

“In Ohio law, consumers have very few protections, or there’s very little definition about what of your data is yours and how you can have control of it,” Husted said. “For a lot of consumers, that’s a big concern.”

The bill was announced July 24 by its two legislative co-sponsors — Reps.

Rick Carfagna, R-Genoa Township, and Thomas Hall, R-Madison Township — and Husted, who also serves as the director of InnovateOhio, which aims to create a culture of innovation in state government by using technology.

The legislation has been two years in the making and creates an Ohio-specific paradigm that builds what Husted calls “a privacy framework” for consumers to have access to what data companies collect; control of the accuracy of that information; to delete information not required to be kept by law; and to “opt out” of the sale of their

private data to a third party.

Ohio joins more than 20 other states that have introduced or passed data privacy legislation. Because the language was developed with input from more than 80 consumer advocates, businesses, legal and technology experts, Husted believes Ohio’s bill provides the right balance of interests.

“We don’t want to overly regulate businesses,” Husted said. “What we’re trying to do is find a balance between consumer and business rights.”

He added, “Businesses want liability protection. They want to know if they are doing the right thing and something goes wrong, they have protections.”

The bill would provide business protections that other states do not have in an industry that is just now grappling with the value of personal information.

The Ohio bill, like others around the country, would include a 30-day grace period for businesses accused of mishandling consumer information or not abiding by data disclosure and deletion regulations to correct errors. Unlike other states’ legislation, though, it would not give individuals the right to sue companies directly if the business misused, mishandled or inadequately protected private data. The right to go after bad actors lies solely with the Ohio Attorney General’s office.

This and the protections the law would give to companies makes it more attractive than privacy laws passed and enacted in California and

Herath

Husted

the European Union, said Kirk Herath, chair of the CyberOhio Advisory Board and one of the bill’s authors.

“I can guarantee you that if this bill passes, a handful of states will model it since we still have about 47 states that haven’t passed any privacy laws,” said Herath, a professor at Cleveland State University’s Cleveland-Marshall College of Law. He recently retired as vice president, associate general counsel and chief privacy officer for Columbus-based Nationwide Insurance.

The Ohio bill ties liability protection for businesses acting in good faith to privacy framework developed by the National Institute of Standards and Technology. Herath described those guidelines as best practices created by expert communities in a “politically neutral space.” The California law, which most companies have used as the standard since it was the first such law enacted in 2020, was created in part by a citizen-led ballot initiative and enforced by an advisory group, he said.

The national standards organization

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has no enforcement powers but has helped develop cybersecurity protocols that serve as a national model for data privacy.

“NIST develops a community led framework by going region by region providing workshops and asking people what is important in creating new guidelines,” Herath said. “There’s no enforcement action, there’s no politics.

It’s all about how to design something that is scalable and flexible enough that everybody can follow.”

If the privacy bill becomes law, businesses that employ reasonable precautions and meet NIST’s industry-recommended standards would be afforded an affirmative defense against legal claims under the law.

“Tying the law to the NIST standard is what we think is unique about Ohio’s bill. That and making it very clear what rights business, as well as consumers, have,” Herath said.

The bill in its original form would apply only to companies with annual gross receipts more than $25 million and that derive more than 50% of profits from the selling of private data. It does not apply to a company’s right to collect data for internal use, such as marketing.

Do not, then, expect the bill, were it to become law, to end the advertisements that show up after you have conversation in earshot of Alexa or conduct a web search for a similar product. As long as that information is not being sold to an outside company, firms can

use personal data for internal purposes.

Tony Robinson, senior security analyst at Hurricane Labs, a Cleveland-based cybersecurity service firm, said this is where the bill falls short of protecting less tech-savvy consumers.

He believes a consumer should have to opt in to receive targeted advertisements and other marketing, rather than have to take it upon themselves to find the means to opt out. The Ohio bill would require disclaimers informing consumers of how their data is used and making available the means to opt out — though it would be up to the individual to do so.

“You have to know where to look to cancel data collection,” Robinson said.

“Companies can bury that option three menus deep and make it difficult to get there.”

The law does “check a lot of the right boxes” he said, and it would likely be an improvement over the California law that has been amended multiple times since it was introduced in 2018.

House Bill 376 has not been assigned a committee. Husted contends that although there is much support for the bill, there is no guarantee privacy standards might change in the near future.

“You are never going to introduce a bill that’s perfect upon introduction,” he said. “That’s why they call it the Ohio Revised Code.”

Kim Palmer: kpalmer@crain.com, (216) 771-5384, @kimfouroffive

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ENERGY

The biggest U.S. electrical grid braces for green energy The decision that could open the floodgates to renewable power across much of the eastern U.S. came in early July after months of closeddoor haggling within an organization many Americans don’t know exists.

PJM Interconnection LLC runs the country’s biggest electricity grid, a vast web of wires spanning parts of 13 states from the Jersey Shore to the Mississippi River, including Ohio, and covering much of coal country. Its low profile is a measure of its success.

PJM prides itself on keeping the lights on at a time when blackouts have plagued power grids in California and Texas, sometimes with deadly results.

That reliability comes at a cost. Critics say PJM’s capacity auctions, which require utilities to secure power three years in advance as a type of blackout insurance, have propped up inefficient fossil fuel energy suppliers and led to billions of dollars in excess costs for customers. The switch to clean energy transforming other U.S. grids has barely touched PJM — it gets only 6% of its power from renewable sources such as wind and solar, compared with more than 40% in California and more than 25% in Texas. That disparity is likely to get more attention after climate scientists warned last week that the planet is likely to warm by 1.5 degrees Celsius in the next two decades, with more severe heating to follow if the world doesn’t take drastic measures to cut fossil fuel use.

Hundreds of electric utilities, power plant operators and energy traders who belong to PJM and vote on its decisions have been fighting over renewable power for years. Some, serving states with ambitious climate change goals, want to push forward on solar, wind and batteries. Others want to keep their old gas- and coal-burning power plants alive as long as possible.

But the July decision, aided by the Biden administration’s regulatory support, looks set to give the climate advocates a boost. The result could be a massive buildout of offshore wind on the Atlantic Coast, from Virginia north. That would not only revamp PJM’s entire system, but it could also dethrone natural gas as the country’s No. 1 power plant fuel by 2028, according to Morgan Stanley analyst Stephen Byrd. About 27,000 megawatts of offshore wind — roughly the capacity of 27 nuclear reactors — are being planned, and 33% of that is in PJM territory, he said. Renewables’ share of U.S. power production will go from 10% this year to 27% by 2030.

“More states want to take control of their destiny and achieve a certain mix of power plants, with the whole goal of decarbonizing,” Byrd said.

“They are going to do that, plow through regardless of the market rules, and it’s clear they have that legal right to do that.”

Keeping the lights on PJM’S primary mission is straightforward enough: keep electricity flowing, without fail, to 65 million people — one-fifth of the U.S. population. The ways it does so can be incredibly complex, and not all of them are open to public view.

Day and night, PJM orchestrates the flow of electrons over 85,100 miles of high-voltage cables connect-

DANIEL ACKER/BLOOMBERG

BY DAVID R. BAKER AND NAUREEN MALIK/BLOOMBERG

PJM’S EXTENSIVE SCOPE PJM Interconnection LLC operates the nation’s largest electricity grid. Its web of wires spans parts of 13 states, including Ohio.

Dayton Power and Light Ohio Valley Electric Corp.

Duke Energy Ohio Kentucky Other PJM coverage

American Electric Power

Ohio Valley Electric Corp.

` Population served: Approximately 65 million ` Generating sources: 1,379, with diverse fuel types ` Generating capacity: 180,086 megawatts ` 2018 GWh of annual energy: 806,546 ` Transmission lines: Over 84,000 miles ` Members/customers: 1,018 ` Annual billing: $49.8 billion ` Square miles of territory: 369,089 SOURCE: PJM

ing the Illinois prairie, the cities of Ohio, Appalachia’s coal and shale gas country, Washington, D.C., the New Jersey suburbs and the northern edge of North Carolina. Some 1,400 generators supply the energy, all of it tracked on walls of video screens in a control room at PJM’s Valley Forge,

which its 1,000-plus members buy and sell electricity. In 2007, PJM created a capacity market for utilities to buy contracts that ensure the delivery of power even during peak demand and supply disruptions. Texas has nothing like it. But consumer advocates say PJM’s obsession with always having more than enough juice “MORE STATES WANT TO TAKE CONTROL jacks up homeOF THEIR DESTINY AND ACHIEVE A owners’ monthly bills. One estiCERTAIN MIX OF POWER PLANTS, WITH mate, from WilTHE WHOLE GOAL OF DECARBONIZING.” son Energy Economics, pegs the — Stephen Byrd, Morgan Stanley analyst overspending at Pennsylvania, headquarters. Each as much as $4.4 billion a year. (A PJM state can help supply the others. spokesperson disputes that figure, Contrast that with Texas, which has saying it fails to account for savings largely blocked off its grid from its that result from the extra capacity neighbors. The Lone Star State paid and adds that PJM is working with the price for its isolation in February, stakeholders to address their conwhen a deep freeze plunged millions cerns about procurement.) of customers into the dark and cold for nearly a week, causing at least $20 For PJM, markets came first billion in economic damage and leaving more than 200 people dead.

The organization was born as a Managing the grid isn’t the only cross-border experiment at a time way PJM keeps the lights on. The or- when electricity grids were still ganization also runs markets in spreading across the nation. In 1927,t

6 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

hree utilities — one in New Jersey and two in Pennsylvania — formed a joint power pool in which each company could buy electricity from the others’ plants. The world’s first such venture, it meant that those plants able to supply power at the lowest price would be tapped first, cutting costs for all three utilities. The experiment proved a success and began to expand. Baltimore’s utility signed up in 1956, and with it, the arrangement became the Pennsylvania-New Jersey-Maryland Interconnection: PJM. Curiously, for most of its existence, PJM was operated by a department of just one of its member utilities. It wasn’t until 1997 that it became fully independent, the same year it opened its first bid-based energy market and the Federal Energy Regulatory Commission approved it as the nation’s first independent system operator, or ISO. In 2002, after a series of new regulations intended to encourage increased competition in power markets, FERC would dub PJM the country’s first regional transmission organization, or RTO. Think of the RTOs and ISOs (there are seven, total) as the nation’s Grid

Keepers: They oversee everything from transmission of electricity to the markets and auctions that set prices, and even the regional advanced planning for estimated power use (and distribution) in the years ahead.

They decide who’s in and who’s out when it comes to supplying our electricity. No new plant, whether powered by sunshine or coal, can plug into the grid without the grid operator’s permission.

PJM has since grown into an odd hybrid. It’s technically a private corporation, but it functions as a membership organization. Its more than 500 voting members can set policy through votes on internal committees, but it also has a staff and governing board that make their own decisions. Member companies often have wildly divergent interests, and their debates — held in private — can get heated. One participant described it as having not just one 800-pound gorilla in the room, but a dozen, each used to getting its way.

“Every now and again, you’ll get some really passionate advocacy in those settings,” said Asim Haque, PJM’s vice president for state policy and member services. “They can yell at each other and then go eat lunch together. I’ve seen that happen multiple times.”

PJM’s geographic expanse has long been one of its biggest strengths.

But now states with conflicting agendas are jockeying for position. Kentucky, Ohio and West Virginia — coal country states — are often at odds with Maryland, New Jersey and other places that see offshore wind farms as big new job generators.

“Unfortunately with PJM, what they have probably done is sunk to the lowest common denominator, to only having to meet the needs of the least aggressive state in their footprint” in terms of adding renewables, said Jon Wellinghoff, FERC’s chairman under President Barack Obama.

That tension finally came to a head in 2018 over the capacity market’s “minimum offer price rule,” known by the dismal acronym of MOPR. The rule set a price floor on power plants that receive state support, to prevent them from gaining an unfair advantage against unsubsidized plants in the capacity auction bidding.

First implemented more than a decade ago, MOPR was designed to prevent large energy companies from artificially depressing prices in the market, and it specifically targeted new natural-gas-fired power plants being built across the mid-Atlantic region at the time. In 2016, several power plant operators petitioned FERC to expand MOPR to counter the potential advantage gained by nuclear plants that were receiving subsidies from Ohio and Illinois. In 2018, PJM pitched its own MOPR overhaul to FERC to include the increasing number of state-subsidized plants — particularly nuclear plants.

But that proposal specifically exempted renewable power plants that were being built to meet state climate goals. A few months later, in June 2018, FERC ordered PJM to extend the MOPR price floors to renewable power such as wind and solar.

Clean power advocates said the move was an attempt by appointees of former President Donald Trump to block new renewable projects from the capacity market. Incensed,

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officials in Illinois, Maryland and New Jersey threatened to pull out of that market. Some members grumbled that PJM was propping up coal plants and picking a pointless fight with the states. The fight proved so contentious that, after FERC granted approval to the revised MOPR rule in 2019, PJM’s annual capacity auction was delayed for two years as members quarreled over it. Virginia’s utility, Dominion Energy, did actually exit PJM’s capacity market before the delayed auction was finally held in May. “Instead of using the last five years to try to find a way to use the markets to assist the states — and really the planet — in making a dent in carbon pollution, we’ve been working on ways to make clean energy more expensive,” Kathleen Barrón, executive vice president for government affairs and public policy at power plant company Exelon Corp., said at a March meeting with FERC about the rule.

The backroom fight included not just Exelon, with its large fleet of nuclear plants, but American Electric Power, Calpine, FirstEnergy, NRG Energy, Public Service Enterprise Group, Vistra and other power giants — which were all looking to protect their own plants and plans.

Neil Chatterjee, who served as FERC chairman under Trump, defends the rule as an important means of maintaining PJM’s prized reliability. He said California — whose grid now veers close to blackouts when the sun sets on its solar power plants during heat waves— shows what can

happen when a state government pushes the switch to renewables too quickly.

“What is happening in California in particular you could very easily see happening in PJM if politicians make decisions about PJM’s future resources,” Chatterjee said.

And, in fact, the one auction held under the expanded MOPR wasn’t so bad for renewable power after all.

Overall auction prices plunged. Nuclear plants suffered as expected, with some operators saying they might have to close reactors. Renewable power generators fared better than predicted, and the low prices did little to help coal. Chatterjee said the results disprove “some of the ‘sky is falling’ rhetoric” from MOPR opponents.

“I find it very difficult to justify a wholesale market change in the immediate aftermath of an auction that quite frankly didn’t reflect those concerns,” he said.

But Richard Glick, the new FERC chairman, said the impact of MOPR on new renewable power generators, especially offshore wind, would become evident in future auctions if it isn’t changed. Fixing the rule now “matters a lot,” he said. States won’t be able to achieve their climate goals “if FERC keeps on adopting barriers to markets in terms of achieving greenhouse gas emissions reductions.”

Left out One voice generally not in those internal PJM debates? State govern-

ments. They do have some say within PJM’s decision-making system, but it’s largely advisory. Each state has a consumer advocate who can cast a vote, but they’re easily drowned out by the hundreds of companies. An association of state utility regulators, the Organization of PJM States, acts as a liaison to the various capitals, but it has no formal power.

That grates on lawmakers like Lorig Charkoudian, a member of Maryland’s state legislature who serves on the public utilities subcommittee. She promised her voters action on clean power. But PJM answers to only one government agency — FERC — and not to her or her colleagues.

“What they keep saying is, ‘We’re neutral on state policies,’ and technically, that’s accurate,” Charkoudian said. “But it’s obviously undermining our policies.”

Public Service Enterprise Group Inc., one of PJM’s three founding members, is trying to build a 1,100-megawatt wind farm 15 miles off the coast of New Jersey’s southern tip. Under MOPR, that farm and others planned nearby wouldn’t be able to compete in the capacity market, said PSEG CEO Ralph Izzo.

They’d lose an important source of income. Plus, the state’s utilities would still have to buy capacity contracts from other power plants to meet PJM’s reserve requirements, even though they wouldn’t actually need those contracts, because they’d be getting their power from

the wind farms.

“It’s structured to ignore offshore wind, as if it’s not there,” said Izzo, who doesn’t like being at odds with an organization his own company helped create. “New Jersey will end up paying twice for that capacity.”

President Joe Biden’s election — and his administration’s commitment to a carbon-free grid by 2035 — altered the conversation. Leadership of FERC passed to Glick, who didn’t agree with MOPR in the first place.

“The fact is, we have to figure out if the commissioners believe the current approach is just and reasonable, and if not, we have to change it,” Glick said. “My opinion is that it’s probably not.”

It became clear that regulators would change PJM’s rule if PJM didn’t do it first. So in a series of votes in June and July, PJM’s members and board gutted the rule.

If approved by FERC, the decision could end up driving many coal plants out of business and pave the way for row after row of offshore wind turbines along the mid-Atlantic shore, creating a whole new industry for coastal states.

There are still hurdles. PJM’s process for vetting new power plants that want to connect to the grid was designed for a time when it would receive maybe 250 connection requests in a year, almost all for plants burning natural gas, said Ken Seiler, PJM’s vice president for planning. Now the number has jumped to almost 1,000 projects per year, 93% of them renewable, he said. Many don’t have fi-

nancing yet and may never get built.

The company is looking for ways to streamline the process, perhaps analyzing projects in batches.

“You don’t quadruple a queue and expect to turn out the same results as quickly,” Seiler said. “I would argue yes, it takes more time, but we usually get the answers right.”

And another fight is already brewing within PJM over who will get to build the transmission lines serving all these new clean power facilities, where they’ll get built, and how they’ll be paid for. Many states that rely on PJM’s grid have grand plans for carbon-free power, and they’ll need PJM’s cooperation, like it or not.

“Your average person who cares deeply about these issues doesn’t know that there’s this almost shadow government — this shadowy body that has all this authority,” said Maryland’s Charkoudian.

Some state officials say that under new CEO Manu Asthana, who took over last year, the company is making more of an effort to work with states. PJM has formed a partnership with the New Jersey Board of Public Utilities to plan and approve transmission lines linking some of those wind farms to the grid. It’s also created an office of state policy solutions, under Haque.

“They obviously have a different philosophy than the previous administration,” said Joseph Fiordaliso, president of New Jersey’s Board of Public Utilities. “It’s much more conducive to team play.”

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AUGUST 23, 2021 | CRAIN’S CLEVELAND BUSINESS | 7

PERSONAL VIEW

Young professionals should go on offensive in plotting career paths

RICH WILLIAMS FOR CRAIN’S CLEVELAND BUSINESS

BY DAN FOX

EDITORIAL

Fresh start E

ven if it’s not official by the calendar, summer is over.

(Sorry to break it to you.) School is starting, more companies are bringing people back to the office ... and the pandemic, thanks to the highly contagious Delta variant of the virus that causes COVID-19, has kicked into a higher gear.

We’re glad that, for the most part, kids are back in classrooms. Data show that remote education, particularly for younger students, is not as effective as learning in person.

It’s imperative that schools remain open, primarily to support children on an educational journey that has been disrupted since March 2020. Schools also play a critical role in our return to normal life. We need schools to be open so parents aren’t trying to juggle the role of part-time teacher with their work life. School shutdowns also make it hard for companies to address labor challenges, which have been exacerbated by parents being pulled in multiple directions.

The Wall Street Journal, in an article last week, examined what it called “fresh COVID-19 stress” as families revisit backup plans for work and education in case further COVID surges lead to classroom shutdowns. Jonathan Hyman, an employment attorney (and father) from Avon, told the Journal, “Last year, businesses were generally more understanding” about cutting workers slack as the contended with family issues while kids were learning from home. But as schools reopen, the paper noted, “some employers are taking a less accommodating stance.”

That desire to get people back to the office, at least parttime, is understandable, even as it runs into COVID case numbers that are getting worse. In an update last Tuesday, Aug. 17, for instance, the state reported 3,235 new COVID cases — the third day in the past week exceeding the 3,000 level. Prior to that, the state said, “there hasn’t been a single day with over 3,000 newly reported cases since February.”

Vaccinations across the state continue to tick up, which is good. But for children ages 12 to 17 years old, only 35% are currently vaccinated, according to state data. That’s not so good, and it needs to rise sharply to minimize the chance that schools return to shutdown mode. The Centers for Dis-

ease Control and Prevention reported that rates of COVID-associated hospitalizations in children under age 5 had tripled in the first half of July. Young children, as of yet, cannot be vaccinated. It’s the responsibility of those eligible for vaccination to do so, reducing the risk to young kids and helping to keep schools open.

Can people do this? It’s increasingly frustrating that our capacity to fight about masks and vaccines seems to exceed our capacity to fight the pandemic.

The Ohio Chamber of Commerce last week again sounded an alarm about House Bill 248, the Vaccine Choice and Anti-Discrimination Act, which would prohibit business owners and other employers from requiring vaccinations and vaccination status disclosures from their employees. The chamber first came out in opposition to HB 248 in June, but it engaged the subject again because the Ohio House’s Health Committee is scheduled to revisit the bill this week.

In a statement, chamber president and CEO Steve Stivers said, “It’s time for lawmakers to stop trying to dictate workplace policies that interfere with the ability of employers to ensure the safety and wellbeing of employees and others who enter places of business. Businesses continue to do the best they can in responding to the many challenges and consequences of the COVID crisis. They don’t need to be micro-managed by the government telling them how to best run their business.”

The bill at its core “conflicts with Ohio’s at-will employment laws, which allow employers to dismiss an employee for any reason, without warning,” the chamber argued. Stivers added, “It’s ironic that, since the beginning of the pandemic, many of the same lawmakers who have been pushing back against what they see as government overreach are the ones now calling for more government controls on business. No legislator can claim to be pro-business and at the same time support efforts to restrict an employer’s ability to manage their workplace free from government interference. The Ohio Chamber is simply asking for them to be consistent.”

That shouldn’t be too much to ask.

Executive Editor: Elizabeth McIntyre (emcintyre@crain.com) Managing Editor: Scott Suttell (ssuttell@crain.com) Contact Crain’s: 216-522-1383 Read Crain’s online: crainscleveland.com

Most of us feel some form of relief as we emerge from COVID-19 lockdowns and continue to navigate the disruptions caused in most of our organizations. However, with the emergence of the Delta variant, this “normal” we all desire likely will not return in the immediate future.

Crisis and uncertainty have a way of making us all go into a defensive posture. By that, I mean that we put off major decisions and Fox is an put our lives on hold, waiting until the crisis associate ends so that we can move forward. While this professor of law defensive mode is understandable, it can at Ashland have serious long-term consequences in our University. lives and careers.

Having spent a good part of my career educating young professionals and positioning them to have meaningful and rewarding occupations, I worry that so many have put the development of their careers in a holding pattern. It has not helped that many young professionals have been isolated, working from home, and worried about their jobs. For young professionals, it is time to go on the offensive — to move away from the static defensive mode of the past 18 months and take advantage of an emerging future where you can position yourself to thrive in the post-COVID economy.

One of the most rewarding ways to go on the offensive that will continue to benefit you for years to come is to develop new skills and expertise. Consider adding credentials to your resume, obtaining certifications, and stacking certifications to gain the skills and expertise that will lead to quicker career advancement.

Pursuing a licensure is another way to distinguish yourself and position yourself for future career opportunities. I am convinced that the post-COVID economy will need employees with credentials and specialized knowledge more than ever before.

Another avenue worth pursuing is obtaining a Master of Business Administration (MBA) degree. This year alone, corporate recruiters are expected to prioritize MBA graduates in their hiring efforts, returning to pre-pandemic levels that dropped significantly in 2020.

Compensation for those who hold MBAs is expected to increase this year after dipping about 10% last year. Clearly, now is the ideal time to pursue graduate-level learning opportunities to grow your knowledge and make yourself a stand-out candidate in an increasingly competitive market.

Organizations are wrestling with numerous issues as we emerge from this pandemic. Volunteer to help solve some of your organization’s issues and take on the challenge. This is not the time to expect compensation up front, but instead, to take a leap of faith.

If you immerse yourself and help solve some major issues for your organization, the compensation likely will follow. If it does not, think of the experience you will gain and the future earning power that experience will provide you. Future employers will want to hear how you stepped up and helped your organization during the pandemic.

While working from home has its advantages for young professionals, the separation from the senior and experienced management team is not good for career advancement.

Virtual meetings provide little time to interact informally with management and receive the advice and nurturing one only receives in the in-person setting. Take advantage of getting back in the office setting as soon as you safely can. You will be able to better position yourself to leverage career advancement opportunities in that environment.

By being proactive, building knowledge and skills, and remaining involved and visible in the organization, young professionals can emerge from the disruptions of COVID-19 with a bright future. Moving away from a defensive strategy and going on the offensive will make all the difference.

Write us: Crain’s welcomes responses from readers. Letters should be as brief as possible and may be edited. Send letters to Crain’s Cleveland Business, 700 West St. Clair Ave., Suite 310, Cleveland, OH 44113, or by emailing ClevEdit@crain.com. Please include your complete name and city from which you are writing, and a telephone number for fact-checking purposes.

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8 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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PERSONAL VIEW

9 reasons why the Indians’ ballpark renovation deal stinks

BY WILLIAM T. EBERHARD

Enough!

Thanks to past abuses that have lubricated the path, our “leaders” have decided to appropriate hundreds of millions of dollars from citizens irrespective of community need by launching a plan for an unnecessary lavish upgrade to Progressive Field in exchange for extending the Cleveland Indians’ cushy lease, which expires in 2023.

There are nine reasons why this deal should be quashed.

1. Process: Cleveland’s profane legacy of officials saddling taxpayers with irresponsible deals hatched behind closed doors, spending and giving away hundreds of millions of dollars, and driving our debt sky high has got to stop. This is not how democracy is designed to work. Both Cleveland and Cuyahoga County have councils that represent citizens who have been unforgivably and repeatedly excluded from these processes.

2. Ignoring citizens’ needs and interests: This community’s most pressing capital need is for a new justice center. We don’t need another upgrade — and the debt that goes with it— for the ballpark. We need a need a functional and appropriate justice center.

3. Taxpayer burden: Extending the sin tax repeatedly is not how to manage capital projects. This community’s diseased culture of allowing officials to push projects that bind us to pay for decades for their mistakes has already cost us dearly with our sports facilities, the albatross medical mart, the convention center and Hilton Cleveland Downtown projects.

4. Tenants amortize improvements: Taxpayers have been subsidizing the cheapest owner with the lowest payroll in baseball for years. In a real estate transaction — which is what the ballpark lease is — the tenant (the team) amortizes the cost of constructing the facility and any and all alterations with his or her rent so that the landlord (the community) is repaid their money for construction and related expenses. Under the proposed $435 million deal, the Dolans are putting in $150 million, $67.5 million of which would go to a ballpark renovation project — another obscene gift to the Dolans from taxpayers.

5. The ballpark doesn’t need improvements: The proposed wish list is lavish and unjustified. We have paid handsomely for decades for ballpark improvements, thanks to the original lease. The ballpark was already renovated with additional sin tax dollars in 2014 and 2015. Per the terms of lease, the county has paid $55 million for major improvements since 2008 alone.

6. The Dolans should pay: The Dolans bought the Indians for $323 million in 1999. Today, the team is worth an estimated $1.2 billion. The Dolans have ample collateral to pay for improvements if they need to borrow.

The Indians’ payroll is $48.4 million — the lowest of all teams. (For comparison, Mike Trout of the Los Angeles Angels will make $37.2 million this year.) The Tribe pays only $3.2 million a year in rent. Their pre-COVID revenue in 2019 was an estimated $290 million, according to Forbes. If they have a wish list of ballpark betterments, let them fund it with their own cash or a rent increase that amortizes every public dollar invested like a normal real estate deal.

7. The proposed design is irresponsible: The wish list of ideas includes “repurposing” the Terrace Club, making the left field gate more open to views of the city — by the way, you can’t see around or over Rocket Mortgage FieldHouse from there — adding an “inner ring” around the ballpark, improving the upper right field boxes, adding private terraces, adding larger social ar-

Eberhard is managing partner of Eberhard Architects and president of the Cleveland Architecture Foundation.

eas behind the dugouts and a lounge behind home plate, redesigning Gateway Plaza and modernizing the clubhouses. We have given the team $67 million for upgrades and repairs since 1994. If the team has elected to spend it on things other than modernizing the clubhouse, that’s on the team. (It’s worth noting the team is obligated by the lease to make repairs under $500,000, with the public responsible for major capital repairs that cost more than $500,000.)

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8. A questionable “sell”: The supposed justification for this Dolan giveaway is that the ballpark is the 11th-oldest facility in Major League Baseball. Irrelevant. Fenway Park and Wrigley Field — the two oldest in the U.S. — are among the most popular in baseball.

The “leaders” lied when they told us the formerly named Quicken Loans Arena was no longer competitive when it was in the top 7% of all such facilities in the U.S. in attendance and events and was good enough for us to land the 2016 Republican National Convention.

County Executive Armond Budish said, “Updating Progressive Field is much less costly than building new.

New venues typically cost about $1 billion without considering any maintenance or repairs over time. This is a responsible investment in a public asset to maintain its competitiveness.” Lies.

A survey of the cost of all major league ballparks constructed in the past 10 years renders Buddish's claims on the cost for a new facility to be a real exaggeration.

9. History of incompetence: Let’s not forget the painful incompetence of our so-called leaders in pushing the medical mart/convention center projects. Our convention center was supposedly too small and too old to be competitive, so they assembled a team we paid millions that failed to manage the “guaranteed maximum” budget they promised, only to delete the parking garage and renovated Public Hall completely and reduce the size of the new convention center to the same size as the one we tore down.

The medical mart was never properly vetted when every expert in the country predicted failure. It failed. It was too small and there was no demand for it whatsoever. We were told the building was 235,000 square feet, but it has fewer than 100,000 square feet of rentable area.

It was so poorly designed that it apparently cannot be adapted for any other purpose. It has gone from barely occupied to vacant, despite name and program changes. Only half of the debt — $519 million — will be paid off by 2027.

The 600-room Hilton Cleveland Downtown deal — with $276 million in debt and no parking capability — requires that taxpayers also pay Hilton a subsidy of $8 million to $20 million each year if they don’t make any money. When the deal was announced in 2013, Cleveland Scene observed, “The fine people of Cuyahoga County front the risk, and Hilton Worldwide walks with the benefits.” Our “leaders” are, at best, fools.

The Dolans say they have no plans to move the Indians. Let them take their lowest-paid team and sign a new lease that gives SOMETHING financially adequate back to the community in return for the obscene deal the team has had for 30 years.

It is time that the “officials” who hatch these irresponsible schemes are dismissed for malfeasance.

Public improvements must be addressed in public based on need with officials who have a covenant with their constituents to be responsible stewards of our money.

AUGUST 23, 2021 | CRAIN’S CLEVELAND BUSINESS | 9

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8/19/2021 2:23:29 PM

DIGITAL DIVIDE The pandemic has increased awareness that digital equity is a need for health care.

HEALTH CARE

PAGE 12

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Down from pandemic peaks, but higher than before COVID-19

BY LYDIA COUTRÉ After a seismic shift from in-person to

virtual care in the spring of 2020, telehealth volumes have dropped from their peak and stabilized at a new version of normal, proving what health care providers in Northeast Ohio hypothesized from the early days of COVID-19: The use of telehealth will never return to pre-pandemic levels.

Virtual care has secured a place in health care access and delivery.

“And everybody’s trying to figure out what that place is,” said Dr. Vik Bhalla, chief medical officer of Summa Health Medical Group.

The role of telehealth in part will be determined by the decisions payers and regulators make in the coming months as temporary flexibilities they offered, which helped hospitals adapt to the skyrocketing need for virtual care, taper off and expire.

“WE’RE JUST REALLY EXCITED TO HAVE HAD THIS OPPORTUNITY TO KIND OF STRETCH OUR WINGS HERE AND TRY SOME DIFFERENT WAYS TO CONNECT WITH PATIENTS.” — Dr. Steven Shook, the Cleveland Clinic’s lead for virtual health

Given the dramatic growth in patient demand — and what is now a patient expectation — for telehealth, Northeast Ohio hospitals are preparing to continue offering virtual options and, in some cases, are looking to innovate with that technology.

The proliferation of telehealth in the past year-and-a-half, though it occurred under awful circumstances, has allowed health care providers an opportunity to explore new ways to better reach patients virtually, said Dr. Steven Shook, the Cleveland Clinic’s lead for virtual health.

“We’re just really excited to have had this opportunity to kind of stretch our wings here and try some different ways to connect with pa-

tients,” he said, adding that the system is continuing to listen to both patients and providers to see where else to take the technology to best serve patients.

Before March of 2020, telehealth was a small portion of the work at University Hospitals, with less than 11,000 virtual visits in 2019. Last year, the system recorded more than 417,000. And in the first six months of 2021, there were more than 176,000, indicating telehealth is here to stay, said Stacy Porter, UH's vice president for Consumer Centric Strategy.

The Cleveland Clinic leapt from roughly 37,000 virtual visits in 2019 to 1.2 million in 2020. Though it is fully open for in-person care, the Clinic anticipates 20% of visits this

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ed uity

Difficult to plan Along with the public health emergencies declared at the federal and state levels came a lot of flexibilities around telehealth, which accommodated the skyrocketing use of virtual care. What those look like going forward will likely factor into how much health care organizations can focus on telehealth and virtual care, Bhalla said.

“This is all being debated from the federal government on down,” Bhalla said. “We don’t know where it’s going to land, and that really is going to be the driver of all of this.”

This summer, the State Medical Board of Ohio announced that it would be resuming in-person visit requirements on Sept. 17 — 90 days after Gov. Mike DeWine ended the state of emergency in Ohio — after suspending them in March 2020.

Shook

Bhalla

The federal public health emergency was extended in July for another 90-day period, but when it does end, the flexibility that supported the telehealth ramp-up ends with it. Payers and regulators are exploring ways to build a new framework around telehealth, but providers don’t have clarity on how those will take shape.

“It’s very difficult to plan a way forward that best serves our patients without knowing what the regulations are going to look like, what we’re going to be allowed to do and frankly what we’re going to be able to get reimbursed for,” Shook said. “So I think there’s a lot that’s still up in the air.”

Porter said the health care industry locally and nationally continues to gather stories and evidence to support the value, cost savings and improved health outcomes when digital health is part of a patient’s care path. She is hopeful that this evidence will motivate insurers to make decisions to keep permanent the flexibilities in some way, shape

or form.

In April 2020, Albert Ferreira, MetroHealth’s director of telehealth operations, told Crain’s he believed a new standard of care had been realized Ferreira with the explosion of telehealth use. At the time, he hoped that during the process stakeholders would grow to appreciate the value of telehealth and shed any misconceptions.

Now, Ferreira said that while not everyone is on board with telehealth and virtual care, progress has been made much further than before the pandemic, and faster than would have been possible had COVID-19 not forced folks toward virtual care.

“I think that what has come out of this is that we realize we have to kind of have a blend of both in-person as well as virtual patient care delivery of services,” he said.

Based on what he’s heard, Ferreira said he thinks the payer community and state and federal legislators are looking at telehealth with a “totally different perspective” than they did before the pandemic.

“They’re seeing that the value and the benefits are much greater than what people had anticipated prior to the pandemic,” he said.

“And I think a lot of that is definitely

attributed to the fact that we have a lot more data, and a lot more use cases to analyze and experiences that can provide us direct feedback on what maybe people believed before the pandemic.”

New uses, new ways to think UH is committed to growing its digital health capabilities, not just in virtual visits but also in remote patient monitoring and other parts of the digital consumer experience, Porter said.

“How do we really get creative

ter said. UH is looking at how to offer on-demand care virtually for patients who wish to seek care immediately, but for a need that wouldn’t be considered urgent, she said. The system is looking at how it can understand in real time its clinical capacity across the enterprise, recognizing that 10%-15% of its scheduled provider capacity goes unused every day as a result of late appointment cancellations or noshows.

“We’re really excited about new opportunities to think about how we offer care,” Porter said.

Shook said the Clinic is looking

“WHAT WE WANT TO DO IS IMPROVE PATIENTS’ OUTCOMES, AND WE WANT TO BE ABLE TO PROVIDE CARE AT A LOWER COST, AND WE THINK VIRTUAL HEALTH CAN DO BOTH OF THOSE THINGS.” — Dr. Steven Shook, the Cleveland Clinic’s lead for virtual health

and more patient-friendly ... in how we can care for patients who maybe need a higher level of care than just coming in for an outpatient appointment, but perhaps don’t need the level of care to be admitted to one of our facilities — and what do those options and those offerings look like?”

There are emerging use cases and new ways to think about care delivery that don’t exist today, Por-

at the growth of telehealth, but not just to grow its virtual health business for the sake of doing more virtual visits.

“What we want to do is improve patients’ outcomes,” he said, “and we want to be able to provide care at a lower cost, and we think virtual health can do both of those things.”

Lydia Coutré: lcoutre@crain.com, (216) 771-5479, @LydiaCoutre

GETTY IMAGES/ISTOCK PHOTO

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year will be virtual.

Before the pandemic, Summa Health hadn’t used telehealth beyond a retail platform for acute care. It wasn’t part of the continuity of care or in use for primary care or specialty visits. After a rapid system-wide implementation of telehealth in the spring of 2020, roughly 60% of visits with Summa Health’s medical providers were virtual during the peak last year. Now, it’s closer to 5%, and Bhalla estimates that the norm will remain between 5% and 10% going forward.

To shepherd the future, hospitals have to be good stewards of the past.

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Digital connectivity and equity are increasingly seen as vital to health

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From behind the plexiglass barrier of her improvised help desk in the hall of the Scranton Castle senior apartment complex, Marielee Santiago passed out masks, hand sanitizer, COVID-19 info and asked residents, “How’s it going with your laptop?”

In partnership with DigitalC (a nonprofit focused on improving Greater Cleveland’s digital literacy and access) and with funds from Dollar Bank, MetroHealth System had helped connect units in the building with laptops, internet service and computer training, though COVID-19 limited the education piece. So, along with representatives from DigitalC and an AmeriCorps member, Santiago, director of transformative knowledge and education at MetroHealth’s Institute for H.O.P.E. (Health, Opportunity, Partnership and Empowerment), staffed the temporary desk at the West 25th Street facility, part of the Cuyahoga Metropolitan Housing Authority.

She taught a patient how to connect online with his provider for a prescription, showed another how to send a photo of his rash to his doctor via MyChart and helped a resident follow up with her psychiatric appointment remotely when all behavioral health visits were being done virtually or telephonically.

Before her leadership role, Santiago, a social worker and leader within the Hispanic community, connected patients with resources for lowcost internet and educated them on their broadband access.

The pandemic has heightened awareness, buy-in and understanding that digital equity is truly a need for health care, Santiago said.

“There may have been providers that didn’t think (about it) before, or didn’t have that lens before until they came across this pandemic and realized, ‘Wow, I have a whole slew of patients that are not able to access virtual care and telehealth appointments,’ ” she said.

MetroHealth is not alone in supporting digital access in the community. The Cleveland Clinic, DigitalC, TransDigm Group Inc. (NYSE: TDG) and the Lubrizol Foundation announced a partnership last year to provide affordable highspeed internet for Fairfax residents to address disparities in internet coverage.

University Hospitals this summer announced it would team up with PCs for People, a nonprofit providing refurbished computers, to help patients stay connected with laptops, hot spots and three months of broadband service to eligible UH patients. UH is also building WiFi towers on two of its locations and is engaged in a broadband expansion project in East Cleveland.

The Federal Communications Commission selected MetroHealth to participate in the digital equity program, making the system eligible to receive up to $901,000 in federal funds over the next three years for its work at the CMHA facility and in the Clark-Fulton neighborhood.

DigitalC this summer received a

Thy Trang Hoang Trinh, center, and Jaweria Shah, right, help Scranton Castle resident Hector Castro sign up for MetroHealth’s MyChart. | COURTESY OF METROHEALTH

Metr

$20 million combined commitment “We know that income, educafrom the Jack, Joseph and Morton tion and employment are much Mandel Supporting Foundation and more important factors in people’s the David and Inez Myers Founda- health overall than health care,” said tion to help it expand caSheon, who consults for pacity and speed up adopthe Clinic, UH and Digition of its broadband talC through her consultinfrastructure, which Digiing firm, Public Health IntalC CEO Dorothy novators. “And so if health Baunach said is a call to care can help people get get people connected and connected to the internet, ensure it has the right imso that they can get an edpact on health, education ucation, get jobs, increase and economic opportunitheir income, their health ty. is going to improve.”

Baunach Virtually connecting to a provider can help, at A 'groundswell' least temporarily, break of recognition down barriers posed by other social determinants Amy Sheon, a Cleveof health. For instance, land-based digital health connecting remotely alequity consultant, said lows a patient to seek care there has been a “groundwithout having to find swell” of recognition to intransportation, miss work clude digital connectivity or secure child care — all as a social determinant of Sheon of which may be difficult health — the economic and social conditions that impact for an in-person visit.

Telehealth in and of itself, howhealth.

With a greater reliance on digital ever, won’t change the upstream tools (such as patient portals, health conditions that have put up those trackers and remote monitoring de- barriers and caused certain popuvices) comes the potential to in- lations to face them, Sheon said. crease disparities between those Meaningful digital connectivity who have the skills and access to the can help address multiple barriers tools and those who don’t, and while also helping patients get actherefore, to increase existing health cess to their doctors, either for virdisparities as well, according to a tual visits or through the patient paper, “Digital inclusion as a social portal. determinant of health,” published in March.

The importance Hospitals are “highly motivated” of connectivity to connect with their patients electronically, said Sheon, an author of Stacy Porter, vice president of the paper. Virtual care’s benefits Consumer Centric Strategy for UH, were obvious during COVID-19, said she considers digital equity to when, in many cases, it was safer for be a social determinant of health. patients and health systems to con“If you would have asked the nect remotely, and it enabled pa- question five years ago, or maybe tients to continue care when, na- even two years ago, I think we would tionally, there was a drop-off of have all had to pause and think preventive care and chronic illness about what does that even mean?” management. she said. “But today, it seems so Even more impactful, she said, is clear that absolutely, that is a risk the ability for patients to get con- point; it’s a factor.” nected so they can use the internet Porter expects to see a formalized for everything it helps people do to- movement toward digital connecday. tivity being universally considered a

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MetroHealth manager Ann Ortega, right, shows a Scranton Castle resident how to get connected to the internet on a senior center “Digital Day.” | COURTESY OF METROHEALTH

social determinant of health, just as tobacco use or physical activity are.

The issue will only become more intense and the gap more transparent going forward, she said.

Dr. Akram Boutros, MetroHealth president and CEO, was publicly discussing the importance of digital connectivity and the lack of internet availability in the neighborhoods surrounding the system’s main campus well before the pan-

demic. He called attention to the issue at MetroHealth’s 2019 annual meeting, where he committed to connecting neighbors within a 3-mile radius of the campus to affordable, high-speed internet with the help of community partners.

The initial commitment of 100 households with a goal of 1,000 also included providing free training (in English and Spanish) on how to use computers and a free laptop —

though other initiatives that connected homes with devices during the pandemic have allowed the system to shift its focus a bit for the device portion of the initiative, Santiago said. So far, they’ve connected more than 350 households through the initiative.

MetroHealth first began screening patients for social determinants of health with the 2019 launch of its Institute for H.O.P.E., which opted

to add digital connectivity to the standard set of screening questions.

Dr. Steven Shook, Cleveland Clinic’s lead for virtual health, said the system routinely collects information on a number of social determinants of health, including tobacco and alcohol use, financial resource strains, transportation needs, food insecurity, housing stability, intimate-partner violence,

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physical activity, stress, depression and social connections.

Information on digital literacy and broadband access is not specifically collected currently, but Shook said the Clinic sees an opportunity to do that, and it’s something leaders are discussing.

“What we wanted to do first I think is really get a sense of where our opportunities are to improve first, and that starts with just being able to measure what the digital divide is so that we can target our interventions appropriately,” he said.

UH and other providers are understandably excited about the doors telehealth has opened and the new, creative ways they can offer care to patients, Porter said.

“But we can’t do that and lose sight of those patients who need and require more traditional types of care, or who need more help, more coaching, more access,” Porter said. “We are committed to not leaving any patient behind, and so that has to be part of our focus.”

Until every individual in every neighborhood has the ability and knowledge to connect across the digital divide to telehealth and other resources, “we have not succeeded,” DigitalC's Baunach said. “(It’s) incumbent on the education system, on the health care system and on the economic development and opportunity system to make sure that every person can thrive and has equal access to this fundamental infrastructure,” she said. “It’s just like water or electricity back in the 20th century. We’ve shut off these neighborhoods from their basic fundamental access to things that determine social determinants of health.”

Lydia Coutré: lcoutre@crain.com, (216) 771-5479, @LydiaCoutre

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volved in the creation of its reCOVer Clinics for people who'd contracted the virus.

Dr. Tariq Cheema thinks back "From the business standto last December, when point for each of these patients, COVID-19 patients packed his there's lab, cardiology and pulhospital, some of whom would monary workups and, since be stabilized and discharged, we're utilizing a number of our but then eventually die. existing specialists even within There was one particular their own offices, when you look woman, Cheema said, who inat the overall reCOVer Clinic, spired him to help conceive and that in itself from the standpoint found a post-COVID-19 recovery of the hospital practice brings clinic at the Allegheny Health revenue," Lago said.

Network near Pittsburgh. This At the two-hospital, not-forpatient was in her early 30s, a profit system Edward-Elmhurst mother of four and had no Health outside Chicago, adminchronic medical conditions. She istrators knew its patients would seemed to be doing O.K., so they end up traveling to academic sent her home. medical centers like Northwest"But she'd rapidly had a deern or Rush when symptoms recline in her lungs, and ended up curred, and they saw an opporback in the ICU on a ventilator tunity. and eventually passed away.

"We're really the first health That was the turning point for system that's not an academic me," said Cheema, who is the system to develop these clinics" clinic lead at the Allegheny in the area, said Samantha RoHealth Network Post COVID-19 driguez, system manager for Recovery Clinic. "We started seeneurosciences programs and ing those types of cases where acute care services at Edward-Eleverybody thought that they mhurst Health. "We didn't want were out of the woods, and then to lose our patient population they would get discharged, and a when we knew that we had these couple of weeks later show up in resources available within our the emergency room in comsystem." plete cardiac arrest and pass Edward-Elmhurst Health's away." post-COVID-19 program opened Cheema and his colleagues at in July, and the system estimates the Allegheny Health Network it will see around 650 patients Post COVID-19 Recovery Clinic during this fiscal year. Postwanted to create a specific proCOVID-19 patients are integratgram for patients who'd had ed into 12 neurologists' weekly COVID-19 that would facilitate calendars for 24 appointments check-ins after they recovered that are held open until demand from their initial illnesses. So far, goes down. These neurologists they've been slammed. were already seeing the bulk of "The minute we opened this post-COVID-19 cases, and they clinic, we got bombarded with refer patients to other in-house cases," Cheema said. specialists as needed.

Health systems across the Norton Children's Hospital in country are opening postLouisville, Kentucky, integrated COVID-19 clinics to care for its post-COVID-19 clinic for kids people who have a wide range of and adolescents in conjunction symptoms and are desperate for with its infectious disease clinic. reassurance that they're not goInitial visits last an hour and cliing nuts. Many doctors don't nicians collect detailed histories know what to do with patients from patients. Because postpresenting with up to eight COVID-19 care remains fairly symptoms ranging from shortundocumented due to its novelness of breath and fatigue to ty, it made sense to triage initial anxiety and tingling in their finreferrals to infectious dis“WE’RE TRYING TO LIMIT DOWN THE ease specialSCOPE ... SO THAT WE DON’T ists, said Dr. Blatt, a COMPLETELY OPEN THE FLOODGATES.” Daniel pediatric infec— Dr. William Lago of the Cleveland Clinic tious diseases physician.

"There are plenty of times gers. where people come in with long Up to one-fifth of COVID-19 COVID-19 symptoms from their patients will develop long-haul primary care doctor, and then symptoms. Because there is such we diagnose them with somea wide range of symptoms that thing different," Blatt said. "That's don't have clear causes, caring where having an infectious disfor those people involves a long ease specialist really, really helps string of lab and diagnostic testout." ing, detailed intake histories and Norton Children's doesn't rereferrals to all kinds of specialquire patients to have had a posiists. tive COVID-19 test in the past to All that work generates monaccess the clinic. "If we had to ey, said Dr. William Lago, a famirule it out ahead of time, it ly medicine physician at the wouldn't be a very effective clinic Cleveland Clinic who was in-

because we would miss some people, and we would also bias our judgment ahead of time," Blatt said. "But obviously lab tests that we get ahead of time help our diagnosis. The more information we get, the better."

The Cleveland Clinic has limited patients to referrals from within its system and to people who previously tested positive for COVID-19, in large part because of the huge demand. What started off as a small clinic at an outpatient practice with one advanced practice provider and one physician assistant has grown into its own office with three additional doctors, a fulltime nurse, a technician and one receptionist and scheduler.

"We're trying to limit down the scope a little bit so that we don't completely open the floodgates.

We realize there's a huge demand for this," Lago said. "Eventually, we will open up to patients outside of the Clinic and we'll be able to take people who have supposed COVID that we have no way of proving."

Another reason some systems are limiting post-COVID-19 recovery care to people with a documented history of the disease is insurance coverage. Insurance companies only assigned a diagnosis code for post-COVID-19 pulmonary rehab therapy at the Allegheny Health Network about six weeks ago, for instance.

The Allegheny Health Network has had to figure out ways to get treatment covered for patients who never tested positive for COVID-19 and were never hospitalized — who, for example, caught the virus at the beginning of 2020 when there was no testing. That might entail administering cardiopulmonary exercise tests to measure breathing and

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FOCUS | HEALTH CARE Dr. Tariq Cheema, division director of pulmonary, critical care, sleep and allergy at the Allegheny Health Network near Pittsburgh, talks with patient Dean Girdwood.

Cheema was instrumental in opening the system’s post-COVID-19 care clinic.

heart functioning, which can uncover problems that aren't detectable when patients are at rest. And insurers often resort to the oldie-but-goodie method of limiting access to treatments: step therapy.

"You have a patient who's coming in with shortness of breath or a cough, and you want to get a CAT scan because we know that both post-COVID can affect the lungs pretty rapidly, but there are a lot of insurance companies that will not actually allow you to get those CAT scans" because the diagnostic test isn't usual for someone with just that symptom, Cheema said. "We will have to get smaller tests like a chest X-ray that shows issues and leads to an insurance company approval. It's not clear cut as it would be in any other disease."

Cheema estimates that postCOVID-19 will join the ranks of COPD, heart failure and diabetes as one of the most common chronic diseases in the U.S., with billions of dollars spent on these patients.

And depending on how the pandemic progresses in parts of the country where it's resurging, these clinics might stick around for quite a while.

At New Jersey specialty hospital Deborah Heart and Lung Center, patient volume expectations exceeded initial projections by almost 50%, said John Hill, vice president of pulmonary services. The hospital will run the numbers in November to determine whether

its integrated clinic will become an established part of the pulmonary clinic that's opening next February, he said.

Deborah Heart and Lung Center is seeing the need for this care diminish as the vaccination campaign continues, access to monoclonal antibodies improves and masking rules are in place in certain settings, Hill said.

Still, the hospital's postCOVID-19 program is seeing about three new patients a week, including those traveling from New York, Delaware and Pennsylvania. Deborah Heart and Lung Center physicians can treat heartand lung-related symptoms, and they refer patients to neurologists closer to home for those symptoms.

Health systems are likely to maintain their post-COVID-19 programs and clinics for at least another year, their representatives said.

In addition to generating revenue, these clinics can bolster the chains' regional reputations.

"We're getting notoriety and clout as the premier place for children with long COVID to go get treatment," said Blatt from Norton Children's. "And we didn't have to invest a lot to do it. We just had to be thoughtful about it."

Gillespie is a reporter for Modern Healthcare, which is a sister publication of Crain's Cleveland Business.

SPONSORED CONTENT

Just what the doctor ordered Imaging center offers another option to Northeast Ohio patients

By SHANNON SMITH, CRAIN’S CONTENT STUDIO-CLEVELAND

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avigating the health care system is not always as simple as following doctor’s orders.

From steep medical bills and busy waiting rooms to the need for highquality imaging, the complexities of the medical world can make it difficult for a patient to take charge of their own health care. One local facility, however, is working to ease some of these struggles.

Julie Jacono MetroHealth

Dr. Thomas Krewson Lumina

Lumina Imaging and Diagnostics is an independent outpatient imaging center that aims to make medical care more patientcentered and streamlined, while still offering expert results that can be half the cost of hospital-based imaging tests, such as a CT or MRI, done at large institutions.

Lumina, which has partnered with the MetroHealth System and FUJIFILM Healthcare, has locations in Medina, Mentor and Solon, with a West Side office expected to open later this year.

Lumina facilities were recently awarded three-year accreditation in both MRI and CT from the American College of Radiology, in recognition of their high standards of imaging care.

According to Lumina’s leadership, consolidation among the region’s health care systems has resulted in higher costs for patients and their employers, and less patient control over their own medical decisions, including a move toward more hospital-based imaging. As a result, options can be limited as to where and how a patient interacts with the health care system.

“We have seen a loss of choice and a loss of convenience,” said Lumina’s medical director Dr. Thomas Krewson.

“We know that getting an MRI or CT is a stressful event, and so we set out to make a difference for patients by improving their all-around imaging experience at our Lumina facilities, while maintaining high standards for

quality that patients expect from a large health care provider, all set in a more comfortable environment close to home, often at a substantially reduced cost.”

For example, if your doctor orders an MRI or CT scan, many patients are only given the option to have that test performed in a hospital setting, where there is often a long wait for an appointment and little transparency about costs. The experience usually includes busy waiting rooms and delayed test results that aren’t sent directly to the patient.

Lumina is able to reduce costs for patients by over 50% without sacrificing the quality of imaging, according to Krewson.

The benefits of facilities like Lumina do not stop at the patient level.

At Lumina, the focus is on creating a seamless experience for each individual, and Lumina guarantees a 24-hour turnaround on imaging results from fellowship-trained radiologists. Appointments are available at a variety of times, including evenings and weekends, and most visits are completed in under one hour. Through its partnership with FUJIFILM Healthcare Imaging,

The benefits of facilities like Lumina do not stop at the patient level.

Employers can get better coverage for employees at a more reasonable price, allowing them to expand their coverage and benefits without increasing their costs, said Julie Jacono, strategy director at MetroHealth.

rising health care costs, or massively decrease benefits, which then hurts employees,” Jacono said. “They don’t understand that they can sort of meet in the middle and have comprehensive coverage if you carve out certain transactions and force these things to happen.”

In addition to CT and MRI scans, Lumina also has partnered with MetroHealth to offer preventive lung cancer and coronary artery calcium screenings.

“Most leaders of companies feel like their choices are to continue to accept

This advertising-supported section/feature is produced by Crain’s Content Studio-Cleveland, the marketing storytelling arm of Crain’s Cleveland Business. The Crain’s Cleveland Business newsroom is not involved in creating Crain’s Content Studio content.

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CRAIN'S LIST | HEALTH CARE COMPANIES Ranked by local full-time equivalent employees RANK

COMPANY

LOCAL FTE STAFF 6-30-2021 1-YEAR CHANGE

HEALTH CARE CATEGORY

DESCRIPTION

YEAR FOUNDED

TOP LOCAL EXECUTIVE

1

DISCOUNT DRUG MART INC. 211 Commerce Drive, Medina 44256 330-725-2340; discount-drugmart.com

2,521 2.8%

Pharmacy services

Regional drug store chain

1968

Don Boodjeh, CEO

2

MEDICAL MUTUAL OF OHIO 2060 E. 9th St., Cleveland 44115 216-687-7000; medmutual.com

2,342 -0.7%

Insurance underwriters

Health insurance company

1934

Rick A. Chiricosta, chairman, president, CEO

3

STERIS 5960 Heisley Road, Mentor 44060 440-354-2600; steris.com

1,937 1 0%

Medical equipment and imaging

Infection prevention products and services provider

1987

Daniel A. Carestio, president, CEO

4

EMBASSY HEALTHCARE 25201 Chagrin Blvd., Suite 190, Beachwood 44122 216-378-2050; embassyhealthcare.net

1,200 1 —

Senior and long-term care services

Short/long term skilled nursing, assisted living

—

Aaron Handler, president; George Repchick, CEO

5

SPRENGER HEALTH CARE SYSTEMS 3885 Oberlin Ave., Lorain 44053 440-989-5200; sprengerhealthcare.com

1,043 2 -11.6%

Senior and long-term care services

Senior housing and care continuum services provider

1959

Nicole Sprenger, CEO; Michael Sprenger, COO

6

DANBURY SENIOR LIVING 8230 Pittsburg Ave. N.W., North Canton 44720 330-497-6565; danburyseniorliving.com

952 -6.4%

Senior and long-term care services

Senior living provider offering independent living, assisted living and memory care

1997

Bill Lemmon, CEO

7

NOMS HEALTHCARE 3004 Hayes Ave., Sandusky 44870 419-626-6161; nomshealthcare.com

921 3 4.9%

Physicians - physician groups

Independent multi-specialty physician group

2001

Joshua G. Frederick, CEO

8

QUADAX INC. 7500 Old Oak Blvd., Middleburg Heights 44130 440-777-6300; quadax.com

759 —

Medical technology

Health care revenue cycle software and services provider

1973

John Leskiw, president

9

INVACARE CORP. One Invacare Way, Elyria 44035 440-329-6000; invacare.com

442 -3.5%

Medical equipment and imaging

Medical device manufacturer for the home and post-acute care markets

1979

Matthew E. Monaghan, chairman, president, CEO

10

APPLIED MEDICAL TECHNOLOGY INC. 8006 Katherine Blvd., Brecksville 44141 440-717-4000; appliedmedical.net

400 —

Medical technology

Manufacturer of feeding devices, accessories and surgical products

1986

George J. Picha, president, CEO

11

UNITY HEALTH NETWORK 2750 Front St., Cuyahoga Falls 44221 330-923-5899; unityhealthnetwork.org

331 2.2%

Physicians - physician groups

Primary care and specialty physician network

2004

Robert A. Kent, president

12

FIRST CHOICE HOME HEATH OF OHIO 1457 W. 117th St., Cleveland 44107 216-521-2222; firstchoiceohio.com

300 0%

Home health care

Home care, staffing and wellness services provider

1998

Charles Slone, CEO

13

OHMAN FAMILY LIVING 10190 Fairmount Road, Newbury 44065 440-338-8220; ohmanfamilyliving.com

265 -1.9%

Senior and long-term care services

Post-acute health care system

1965

George H. Ohman Jr.; Anderson C. Ohman Sr., copresidents

14

PARTSSOURCE INC. 777 Lena Drive, Aurora 44202 330-562-9900; partssource.com

260 19.8%

Medical technology

Health care technology and service marketplace for medical device supply chain

2001

Philip Settimi, president, CEO

15

PREMIER PHYSICIANS CENTERS INC. 24500 Center Ridge Road, Suite 375, Westlake 44145 440-895-5038; premierphysicians.net

250 0%

Physicians - physician groups

Independent physician group

1994

Bassem Haddad, president

16

QUALCARE LLC (HOME INSTEAD - MENTOR) 7334 Center St., Mentor 44060 440-257-5800; homeinstead.com

230 0%

Home health care

Home care services provider

2000

Therese Zdesar, president, CEO

17

MIM SOFTWARE INC. 25800 Science Park Drive, Suite 180, Cleveland 44122 216-455-0600; mimsoftware.com

221 39.9%

Medical equipment and imaging

Medical imaging software company

1999

Andrew Nelson, CEO

18

COMFORT KEEPERS OF GREATER CLEVELAND 8111 Rockside Road, Suite 110, Valley View 44125 216-595-3681; greatercleveland.comfortkeepers.com

200 —

Home health care

Non-medical in-home senior care

2001

Paul Burke, president, CEO, owner; Mark Shee, CFO, owner

18

HOME INSTEAD CLEVELAND EAST 7650 First Place, Suite H, Building B, Oakwood Village 44146 440-914-1400; homeinstead.com/116

200 0%

Home health care

Non-medical home care

1996

Margie Orth, general manager; Scott D. Radcliff, president; Jeannie Radcliff, vice president

18

KEMPER HOUSE STRONGSVILLE & HIGHLAND HEIGHTS 10890 Prospect Road, Strongsville 44136 440-846-1100; kemperhouse.com

200 —

Senior and long-term care services

Residential care facilities focused on Alzheimer's and dementia

1999

Kristin West, president

18

RETINA ASSOCIATES OF CLEVELAND 24075 Commerce Park, Beachwood 44122 216-831-5700; retina-doctors.com

200 —

Physicians - physician groups

Ophthalmology practice

1974

David G. Miller, managing partner

22

APEX DERMATOLOGY 5800 Landerbrook Drive, Suite 100, Mayfield Heights 44124 833-279-7546; apexskin.com

150 0%

Physicians - physician groups

Medical practice specializing in medical, surgical and aesthetic dermatology

2011

Jorge Garcia-Zuazaga, president, CEO

23

BRENTWOOD HEALTH CARE CAMPUS 907 W. Aurora Road, Sagamore Hills 44067 330-468-2273; brentwoodhealthcarecenter.com

140 -6.7%

Senior and long-term care services

Provider of assisted living, memory care, long-term care and rehabilitation services

1989

Brent Classen, president

24

ECHO HEALTH INC. 810 Sharon Drive, Westlake 44145 440-835-3511; echohealthinc.com

128 32%

Medical technology

Provider of payment solutions for the health care and insurance markets

1997

William Davis, chairman, CEO

25

GEOCARE INC. (HOME INSTEAD - PARMA AND NORTH OLMSTED) 26777 Lorain Road, Suite 406, North Olmsted 44070 440-734-7441; homeinstead.com/257/home-instead-senior-care

110 10%

Senior and long-term care services

Non-medical home care provider

1998

Geoffrey Moore, president

Research by Chuck Soder (csoder@crain.com) | Information is from the companies. This list includes for-profit companies based in Northeast Ohio that generate most of their revenue from health care-related products and services, excluding hospitals. NOTES: 1. Company estimate. 2. As of March 1. 3. Full-time only.

Get 95 companies and 180-plus executives in Excel format. Become a Data Member: CrainsCleveland.com/data

16 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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DATA SCOOP

NEO law firm Top, bottom of Health Care Companies list very different rankings remain flat

BY CHUCK SODER

BY JEREMY NOBILE

In the wake of what turned out to be an unpredictable yet ultimately profitable year for the legal services industry overall in 2020, net employment of lawyers and support staff remained relatively flat year-over-year in Greater Cleveland and the surrounding area, according to an analysis of the Crain’s 2021 Law Firms list.

Diversity among attorneys in the industry here, however, improved marginally, albeit coming from a pretty low base.

There are just fewer than 3,000 attorneys (2,979) working for 77 Northeast Ohio law firms on the full digital list (the list also first appeared in the Aug. 16 edition of Crain’s Cleveland Business). That is just 11 fewer lawyers than were reported around this point in 2020.

Partners comprise 55% of that group (1,647 lawyers).

The top 10 largest firms account for about 40% of those lawyers.

The largest players remain the same as in years past and consist of outfits like Jones Day, BakerHostetler, Benesch, Tucker Ellis and Thompson Hine.

While still at the top of the list, Jones Day and Baker both have shrunk their attorney bench in this region by about 16% in the past decade.

Benesch and Tucker Ellis, on the other hand, have grown 47% and 33%, respectively, over that same time frame.

Thompson Hine is effectively flat, as it has decreased by three lawyers in the past 10 years.

In terms of demographics, the full attorney group analyzed is made up of 70% men and 30% women.

Among firm partners, 78% are men and 22% are women.

Women gained one percentage point over men compared with 2020 in both the partner and full attorney groups.

On the diversity front, individuals identified as minorities comprise 6% of the full attorney class — the same as last year — and 5% of partners. The latter represents a one percentage point increase over 2020.

But that doesn’t necessarily tell the full story. The 77 firms on the list added 17 minority attorneys (a 9.7% increase) and 11 minority partners (a 16.7% increase), but in each case it’s an increase from a small base. Thus, they still make up a very small portion of attorneys and partners on the list.

Ethnic and gender diversity has long been an issue in law firm ranks.

Making improvements there is something legal services providers continue to grapple with.

So the Northeast Ohio market certainly isn’t alone in that, though demographics here are poorer than within the industry at large.

According to a February report from The National Association for Law Placement, attorneys working at law firms were 37% women and 18% diverse in 2020. Among firm partners, 25% were women and 10% were diverse, according to NALP. Jeremy Nobile: jnobile@crain.com, (216) 771-5362, @JeremyNobile

The big companies at the top of the Crain’s Health Care Companies list look much different than the tiny ones at the bottom.

For instance, though the full Excel list includes 95 companies, it includes only one pharmacy, Discount Drug Mart, which appears in the No. 1 spot with 2,521 full-time equivalent Northeast Ohio employees.

Likewise, the No. 2 company, Medical Mutual of Ohio, with 2,342 full-time equivalent local employees, is the only company on the list in the

“insurance underwriters” category.

The rest of the top 25 is dominated by senior living companies, big physician groups, medical product makers and home health care providers.

But go beyond the top 25, and the industry makeup changes substantially. For instance, among the 95 companies are 40 with fewer than 10 employees. That group includes 15 businesses in the “Fitness and wellness” category — a category that shows up just once in the top 50.

Combined, the 95 companies on the full list have 17,068 full-time

equivalent employees as of June 30, and 92% of those employees work for companies in the top 25.

Combined employment increased by just 0.4% over the prior 12 months, judging by data for the 81 companies that submitted figures for both years.

The list includes Northeast Ohiobased companies that primarily focus on providing health care-related products and services, excluding hospitals. It’s built from the Crain’s Health Care Directory, which includes the companies on this list and other organizations that don’t

qualify for the list, such as nonprofits and local branches of companies headquartered elsewhere. The directory is currently available in Excel format and will be printed in our annual Book of Lists at the end of 2021.

Neither the list nor the directory are comprehensive. Visit bit.ly/3AYnUSC to submit for both. And to get the digital version of the list or the directory, visit the Crain’s Data Center: CrainsCleveland/data.

Chuck Soder: csoder@crain.com, (216) 771-5374, @ChuckSoder

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AUGUST 23, 2021 | CRAIN’S CLEVELAND BUSINESS | 17

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AKRON

Downtown Akron’s residential development just getting started

BY DAN SHINGLER

Downtown Akron has been on a residential tear over the last couple of years, with several big projects unveiling hundreds of new apartments, and more seeming constantly to enter the pipeline.

But if you think the city’s center has all the housing and residents it can support, downtown backers, economic development experts and those building some of the current projects have news for you: Downtown is only just beginning to meet its housing needs. It can support hundreds or even a thousand more apartments, planners say. Developers of current projects say they’ve been encouraged enough by their initial experience to want to do more.

“In my mind, we’re nowhere close,” said Welty Building Co. CEO Donzell Taylor, asked if he thought downtown Akron residential development was reaching a saturation point.

“Akron needs 4,000 to 5,000 apartments close to the central business district to even come close to meeting the need that’s out there,” Taylor contends.

“I think we’re a long way away from that.”

Taylor might have his finger more firmly on the pulse of Akron’s downtown housing market than nearly anyone else. He’s not just a builder, but a landlord. He largely brought Akron’s big Bowery redevelopment project across the finish line, putting 92 new luxury apartments on the market at the beginning of 2020.

If you want one, though, it might be too late. Taylor said in an Aug. 10 interview that he’s down to the last units available to lease.

“We have two units left. So, 90 of the 92 are leased. And I think 87 or 88 of them are occupied,” Taylor said. “We’re seeing very strong demand for the product we’ve put on the market, and I think others will see that same demand.”

He’s not citing demand for cheap housing with low rents, either. A studio apartment in the Bowery costs more than $1,000 a month, and the priciest, larger units go for more than $3,000 a month.

Rents have been rising in Akron, but the Bowery is still a high-rent district by Akron standards, as are many other new downtown developments.

Other projects are similarly reporting that they’re having little trouble renting new units downtown.

“We’ve delivered our first phase at the Standard. That included our common area and 31 units. As of today, we’ve got 30 of those 31 units leased,” said Christopher Mouron, executive vice president at Alabama-based Capstone Real Estate Investments. Mouron’s company is converting the former 22 Exchange student housing

The view from the upper-floor apartments at Akron’s Bowery District is a feature that has helped the project lease out quickly, developers say. | CONTRIBUTED

The former 22 Exchange student housing center is being redeveloped into The Standard in downtown Akron. | SHANE WYNN

complex at South Main and Exchange streets into 236 units of market-rate apartments.

Up the street where Main and Market streets meet, developer Tony Troppe cites a similar reception for his developments, which tend to be smaller and nestled into historic buildings in Akron’s arts district.

“Our most recent project was 20 units. We have two still available,” Troppe said, referring to new lofts he just developed in the Everett Building at Main and Market. “So, the absorption rate is solid.”

Across the street from the Bowery, The 159 — comprising 107 luxury apartments in the former Law Building, built by New Jersey developer Toy Rybak — also is leasing well. The project, like The Bowery, is meant for upscale tenants, and rents range from $1,200 to $2,500 a month.

It came to market later, in May, but Rybak said he has been pleased with how leasing is going so far. He said the building is about half leased and is

landing new tenants quickly.

“We have a 90% success rate when a person tours the building,” Rybak said, noting that a lot of his tenants are transplants moving to Akron from other cities and states. “We have people tour the building on Monday and they want to move in on Wednesday.”

None of this comes as a surprise to downtown backers, who have been saying for years that downtown needed and would support more residents.

That was illustrated, they say, when a 2018 study — one that helped spur The Bowery and other developments — showed that downtown could support another 1,500 residential units. The city hasn’t yet come close to building that many new units downtown.

Since the end of 2019, about 215 new residential units have opened downtown, most of them in The 159 and Bowery projects, the Downtown Akron Partnership (DAP) reports. Another 140 units are under construction, and more than 200 are planned beyond that. That leaves nearly 1,000 left to be

built to hit the 1,500-unit point.

The current pipeline includes 139 units being developed by Mentor’s Osborne Capital Group at the former BF Goodrich complex near Canal Place and nearly 100 units that remain to be developed at The Standard, but not 142 units already in place but being renovated at The Standard, DAP reports.

Also in the pipeline are 60 apartments to be developed by Cleveland’s Weston developers at the CitiCenter Building at High and Bowery streets, along with other smaller projects, said Kimberly Beckett, DAP’s director of business relations.

DAP has long worked to convince developers to do more downtown and is more than pleased with the recent development it has seen, Beckett said.

“We’re definitely excited about the progress we’ve made,” Beckett said.

“Everyone knows we’ve had such challenges in the last couple of years, but things have gone along really well. It shows people are interested in living downtown. The demand is there. And

of MTD is expected to close this year pending regulatory approvals. Stanley said the deal for the remaining 80% of MTD will be funded “with a combination of cash on hand and proceeds from debt incurrence, which we expect to include support by new credit facilities.” Privately held MTD makes lawn tractors, mowers, snow blowers, handheld outdoor power equipment and garden tools for both residential and professional consumers under

brands that include Cub Cadet and Troy-Bilt. Stanley said MTD has 7,500 employees and posted revenues of more than $2.5 billion in the last 12 months.

trolling Board signed off on funding for the estimated $445 million project.

The building will serve as an anchor for the nascent Cleveland Innovation District, a public-private push to create 20,000 jobs and spur billions of dollars of investment. State economic development leaders and the heads of three major hospitals and two universities unveiled their vision for the innovation district in January. The Clinic pledged $300 million toward the

that’s exciting.”

The city also is pleased, said Akron Mayor Dan Horrigan, who has made rebuilding Akron’s population a keystone of his administration and has fostered more housing with a 15-year tax rebate on all new construction in town.

“I’m very satisfied, so far, with what we’ve seen construction wise and development wise,” Horrigan said. “But we’re always looking to do better.”

To do a lot better, downtown will likely need to attract a few more amenities that downtown residents will need and want, developers say. Those include convenience stores and perhaps a grocery store or other fresh food vendors, in addition to existing restaurants and new ones that are expected to open.

Some of that’s already happening. At The Standard, for example, Mouron said he has had success attracting several retail tenants, including Walgreens, Muggswigz Coffee & Tea, Big Mamma’s Burritos, Jimmy John’s, Hair Geek and D.P. Dough calzones.

But at the top of everyone’s wish list is a grocery store. Taylor, Horrigan and Capstone’s Mouron said they’ve all been trying to get a grocery interested in downtown, but have consistently been told that more residents need to come first.

Mouron said he even has tried to get a bodega to open in town — something Rybak also wants to see.

“I tried a bodega company and got as ridiculously aggressive as we could muster,” Mouron said. “But they still weren’t ready to jump into downtown Akron.”

Taylor said he has been working to get a grocery downtown, too, but noted he and the city will have to be patient.

But he sees a natural progression in which, once a grocery and other amenities do come downtown, development will only continue at a more rapid pace.

“I’ve struggled mightily to get a grocery store in downtown Akron, and part of the challenge is there just aren’t enough people there,” Taylor said.

“You have to reach critical mass with enough people. But when you do, the amenities that will make it really take off will follow.”

Taylor was one of several developers who said they were not only pleased with their recent projects but would do more downtown if the opportunity arose.

“You never know, when you’re the first one in,” Taylor said. “Now, having gone through the pandemic, I’m very confident about the city being a good place to do more of this kind of development. ... It’s a bull residential market downtown.”

Dan Shingler: dshingler@crain.com, (216) 771-5290, @DanShingler

THE WEEK POWERING UP: Power tool maker Stanley Black & Decker Inc. announced Tuesday, Aug. 17, that it agreed to pay $1.6 billion in cash for the 80% of Valley City-based outdoor power equipment maker MTD Holdings Inc. that it didn’t already own.

New Britain, Connecticut-based Stanley bought a 20% stake in MTD in a $234 million deal that was announced in the fall of 2018 and closed in early 2019. The purchase of the remainder

A PATH FORWARD: A state legislative panel approved a $100 million, forgivable loan to help finance a planned pathogen research center on the Cleveland Clinic’s main campus.

On Monday, Aug. 16, the Ohio Con-

initiative, to help pay for construction of a headquarters for the health care giant’s new Global Center for Pathogen Research & Human Health. At that time, public officials mentioned a $100 million loan that would require legislative approval. But details about the financing weren’t available. A project summary submitted to the controlling board shows that the loan will carry a 25-year term and an interest rate of 1.12%.

18 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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REPAIR

From Page 1

The front porch sags at a house on Cleveland’s East Side. | MICHELLE JARBOE

Home repair program flooded with applicants CHN Housing Capital started advertising home repair loans of up to $20,000 early this year. Before the end of April, the $1.68 million publicly funded program was maxed out. But the applications kept on flooding in.

80 Home repair loan applications

Researchers from the Federal Reserve Bank of Philadelphia estimate that it would cost $781 million to resolve the repair needs of owner- and renter-occupied homes in the Cleveland metropolitan area. That’s a conservative figure, based on 2019 data.

And that number does not include the costs of repairing vacant properties, some in decent shape, others decrepit.

Deteriorating homes have ripple effects. They depress property values and make streets feel less desirable — and sometimes less safe. Over time, they can become costly challenges for taxpayers, as local governments shoulder the burdens of code enforcement, displaced families and demolition.

“This is a really important topic, and a really under-discussed topic,” said Eileen Divringi, a community development research specialist with the Philadelphia Fed, during a virtual program hosted by the Ohio Fair Lending Coalition in April.

In the Cleveland area, nearly 33% of occupied homes need repairs, according to a report produced by Fed researchers and PolicyMap, an online data and mapping platform. But for a variety of reasons, many homeowners with low to moderate incomes cannot borrow against their properties to make basic investments in the roofs, porches, basements and electrical systems.

The typical Cleveland-area household with repair needs is facing a $2,700 bill, based on Divringi’s math, which predated the coronavirus pandemic, supply chain disruptions and spikes in the costs of lumber and other materials. A higher share of Black homeowners and renters reported repair needs, and the average repair costs are highest for homes occupied by single women with children.

During an interview, Divringi said that banks have little incentive to make modest home repair loans.

Small-dollar loans require the same amount of work as larger loans, with less profit. Yet she and her colleagues have identified substantial demand nationwide for home repair funding of $10,000 or less.

Some borrowers can’t get conventional home equity loans because of credit problems. Elderly owners with paid-off houses are living on fixed incomes and are unable or unwilling to take on debt.

Other homeowners don’t have enough equity in their properties. Either they have moved in recently or they live in neighborhoods suffering from decades of disinvestment and the long hangover from the 2006 housing bust.

Equity was a hurdle for Oneida Cedeno, who sold her longtime home in Cleveland in December and bought a four-bedroom house in Middleburg Heights. Not long after closing, she was shocked to discover that a damaged basement wall necessitated major repairs and waterproofing.

Cedeno, 47, is disabled. She’s also the caretaker for her son and two nieces.

She managed to secure a $20,000, interest-free repair loan from CHN Housing Capital, a nonprofit lender that is seeing firsthand how much demand exceeds supply.

CHN oversees a home repair program funded by Cuyahoga County and the Cuyahoga County Land Reutilization Corp., also known as the Cuyahoga Land Bank. The Cleve-

88

60

40

20

4 February

March

April

SOURCE: CHN HOUSING CAPITAL * THROUGH AUG. 10

land-based lender offered up $1.68 million in loans early this year.

That money ran out in less than two months.

Nearly 300 applicants are on a waiting list for the program, which is open to households that earn up to 120% of the area median income.

That cap is about $94,300 for a family of four, according to the U.S. Department of Housing and Urban Development.

The repair loans are soft second mortgages. That means borrowers do not have to make any payments until they sell their homes or refinance.

There are special provisions that turn the loans into grants for low-income disabled veterans and elderly homeowners.

“God bless them,” Cedeno said of CHN. “I don’t know what I would have done. There’s no way. How do you get another loan on top of the loan you have? And pay more? Especially when it’s just me and the kids.”

CHN sends out a construction manager to evaluate each home for acute repair needs. Then the nonprofit helps the homeowner solicit bids for the job. The loan money

May

June

July

August*

CRAIN’S CLEVELAND BUSINESS GRAPHIC

flows directly to the contractor or contractors when the work is complete.

“They walked me through the process,” Cedeno said. “They don’t just leave you. They don’t just give you the loan. They come and inspect, too.

They make sure that the job is done right.”

So far, the CHN program is assisting 88 households. Asked about the unmet need, Greg Perelka, the executive vice president of lending operations, laughed. “It’s never-ending,” he said.

Kevin Nowak, executive director of parent organization CHN Housing Partners, said he is talking to public officials about other potential funding sources for home repair. Housing groups are closely watching how local governments decide to spend money from the American Rescue Plan Act, the federal pandemic relief bill signed into law in March.

Cuyahoga County is set to receive $240 million over two years. Cleveland will receive just over $511 million. The first tranche of money has arrived, and local governments are preparing to submit preliminary

Cleveland, inner-ring suburbs drive demand for home repair loans

More than 350 households have applied for home repair assistance through CHN Housing Capital. Most of those homeowners are on a waiting list for loans, in hopes that more money becomes available.

City Number of applicants Cleveland 188 Garfield Heights 33 Maple Heights 29 Bedford Heights 28 Shaker Heights 16 South Euclid 14 Euclid 13 Bedford 8 Parma 7 Cleveland Heights 7 East Cleveland 6 Warrensville Heights 5 University Heights 5 Richmond Heights 3 Brooklyn 3 Lakewood 2 Parma Heights 2 Fairview Park 2 Oakwood Village 2 Newburgh Heights 2 North Olmsted 2 Mayfield Heights 1 North Randall 1 Middleburg Heights 1 Strongsville 1 Broadview Heights 1 Olmsted Township 1 Lyndhurst 1 Mayfield 1 SOURCE: CHN HOUSING CAPITAL

spending plans to the Department of the Treasury by Aug. 31.

Some of the money will go toward offsetting government revenue losses. The rest can be used, with some

flexibility, to meet pandemic response needs or address health and economic woes caused or exacerbated by the crisis.

During a presentation in May, Cleveland Mayor Frank Jackson’s administration included “critical home repair” as one of many difficulties that the federal infusion might address. The city and county didn’t respond to interview requests about how home repair fits into their spending priorities.

“Our county is in need of some pretty serious home repair when it comes to a century-old housing stock.

You just see communities and homes kind of deteriorate,” said Keesha Allen, executive director of the Home Repair Resource Center in Cleveland Heights. The nonprofit has been trying to expand its long-running loan program, for borrowers rejected by banks, to other communities.

Toni Jones, housing director for the nonprofit Bellaire Puritas Development Corp. on Cleveland’s West Side, said there’s a particular call for hands-on outreach to homeowners and flexible funding. Many existing loan programs exclude applicants based on credit scores, while grant programs limit the types of repairs — no garage maintenance or driveway work, for example — or require owners to have insurance and be current on property taxes.

The ideal approach will blend public, philanthropic and private money to support grants for people who cannot make payments and more versatile loans, including small-scale loans, for people who can, Nowak said.

“ARPA allows for us, if we do it right, to have a base of capital ... to build to the scale we need,” he said, describing a possible two- to fouryear rollout of a more holistic home repair system.

“This shouldn’t be a typical program,” he added.

Michelle Jarboe: michelle.jarboe@ crain.com, (216) 771-5437, @mjarboe

20 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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Crain’s Cleveland Business names Amy Stoessel associate publisher

GUARDIANS

From Page 1

behind the launch of Inter Miami CF in Major League Soccer. At Doubleday, Versaci worked with Kimou Meyer, a designer known as Grotesk who is now a senior creative director at Jumpman.

The Indians and Sports Car began discussing a potential rebrand last summer, after the baseball club first said it was looking into the possibility of changing a name the franchise has held since 1915. By October, the parties had agreed to a consulting deal, and in the early months, the groups explored some preliminary ideas.

The Indians said 1,198 options for names were on a list at one point — a figure Versaci said is accurate.

“You kind of start with basically a cost benefit analysis from a creative strategy point of view,” Versaci said.

“What are the potential strengths here, what are the vulnerabilities in terms of media and market acceptance, and you analyze those things that way.”

The process of elimination, he added, also resulted in additions, since uncovering strengths and vulnerabilities for certain options led to some names being put back on the drawing table.

When the Indians announced the name change, the team said it spent 140 hours interviewing fans, community leaders and members of the club’s front office about the switch.

The custom agency, according to Versaci, tacked on another 60 hours of discussions with local “influencers” and other sports industry analysts.

Sports Car’s virtual meetings with the Indians were held once every two weeks at the start. Eventually, the discussions took place weekly, and then twice a week. The setting, one that has become all too common during the pandemic, didn’t hinder the process, the custom agency’s chief strategist said.

“I think there’s a common conception that inspired creative takes place over the water cooler, and I actually think that Zoom is a relatively functional way to do a project like this, because you can bring a lot of people together and have them share concepts or ideas that they’ve been developing,” Versaci said. “And that tends to send other people in different directions or inspire work in other directions.”

‘A mile long’ The Sports Car Brand Creative team — which, according to Versaci, had “somewhere north of 12” people working on the project in the last year — was assembled after Nike put the Indians in touch with Meyer.

The custom agency had a group of artists ranging “from Europe to South America to Hawaii,” Versaci said. The group had what the Indians and the agency believe was a creative approach: assembling talent to task, which meant people were on and off the project at certain points, depending on the needs at the time.

The four-figure list of name options was narrowed during 14 rounds of vetting. Near the end, a handful of possibilities were considered “side by side,” as the group broke down the branding options of each, Versaci said.

“If we went back and looked at the sketch boards, they’d be like a

BY CRAIN'S CLEVELAND BUSINESS

Indians owner Paul Dolan talks to members of the media during a press conference announcing the name change to the Guardians on July 23. | JASON MILLER/GETTY IMAGES

sion and dedication when looking to tell our clients’ stories in unique Amy Stoessel, who has served as and surprising ways.”

Stoessel, 46, a graduate of Ohio managing editor for custom and special projects at Crain’s Cleve- University, joined Crain’s in 2006 as land Business, has been promoted sections editor. After nine years in the newsroom, she transitioned in to associate publisher.

Jim Kirk, group publisher for 2015 to a new role overseeing cusCrain’s Cleveland and its sister tom content and special projects. am beG Eable brands CRAIN ’ S C L Ein V EChicago, L A N D B UDeS I N E S S | S E P T E M B E R 3“I- 9 , 2excited 018 | toPA 21 play a role in leading troit and New York, anCrain’s Cleveland Businounced the move on ness,” said Stoessel, who Thursday, Aug. 19, to staff lives in North Ridgeville members in Cleveland. with her husband, Eric, In her new role, Stoessel and their daughter, Sarah. will oversee ad sales as well “It has been an honor to as custom content and all be part of this organizaother revenue efforts at the tion for more than 15 publication. She will report years, and I look forward directly to Kirk.

Stoessel to continuing to build “Amy has shown tremendous success in launching new upon its strong tradition of excepproducts and identifying new reve- tional journalism and leadership in nue opportunities in the six years the business community.”

Prior to joining Crain’s, the since first single-handedly launching, and then overseeing and grow- Northeast Ohio native worked for ing the Crain’s Cleveland custom 10 years at daily newspapers, servcontent platform,” Kirk said. “She ing as managing editor of both The approaches her day-to-day job with (Lorain) Morning Journal and the the intensity and heart of a news ex- Ashland Times-Gazette in Ashland, ecutive and applies that same pas- Ohio.

Advertising Section Designated hitter Franmil Reyes is shown in a mock-up of the Cleveland Guardians’ blue uniforms for the 2022 season. | CLEVELAND INDIANS RENDERING

mile long,” the agency’s chief strategist said.

Guardians emerged as a leading contender early in the process, because the name could be tied to Cleveland’s history (via the iconic Guardians of Traffic statues), plus be used to invoke deeper meanings (such as “pride, resiliency and loyalty,” the Indians said in making the announcement) and inspire some creative activations around the new moniker.

Throughout, Guardians “felt like the brand name that could most thoroughly answer to all of the demands of the project, and was something that just felt like it represented Clevelanders on a visceral level, from what we understood during all of our interviews,” Versaci said.

‘Letting it sink in’ The rebranding had some limits on the creative side.

The Indians wanted several familiar elements — including the colors, the use of a “C” as the club’s letter mark and script lettering in the word mark — to remain. Doing so, senior vice president of marketing and strategy Alex King told Crain’s, ensured that the transition would be as “seamless” as possible.

Keeping the core elements from the previous brand didn’t hamper the process, Versaci said.

“I think there’s a misconception around creativity in that it should not have boundaries,” the Sports Car executive said. “I think creativity is actually made more potent by having borderlines.”

The new name has been met with mostly positive reviews.

Brian Collins, the chief creative officer of the design agency bearing his last name, told Advertising Age that the Indians “managed to keep the verbal cadence of the brand,” while unveiling a moniker that

“doesn’t carry any of the toxic baggage” of the current name.

Todd Radom, a New York-based designer and sports branding expert, described Guardians as an “aspirational” name, one that is “very organic and directed toward the city itself.”

Assessments of the design, featuring a “Fastball” logo that will serve as the club’s primary visual representation, have, as expected, been more mixed.

“The visual part, you want to absolutely get right, because you can’t put the toothpaste back in the tube once it’s out,” said Radom, who likes the moniker much more than the new logo.

Hennes Communications managing partner Thom Fladung said the club has “to accept that there is a faction of people who are never going to be happy” about the name change.

The club is viewing the momentous change, which has taken place as the franchise is negotiating with the city and Cuyahoga County about a lease extension and a proposed makeover of Progressive Field, with the big picture in mind.

“We know it’s going to take time for folks to grow into and form a bond with (the name),” King said. “I think that’s totally natural.”

Some members of the Sports Car team that designed the brand have read many of the critiques since the July 23 rollout. Versaci, who said “the incentive structure of the internet” too often “doesn’t reward positivity,” isn’t among them.

“I’d say that time will tell,” the custom agency’s chief strategist said. “With these things typically, the biggest barometer is letting it sit for a while and letting it sink in. It’s hard to get a read off of the initial reactions.”

Kevin Kleps: kkleps@crain.com, (216) 771-5256, @KevinKleps

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AUGUST 23, 2021 | CRAIN’S CLEVELAND BUSINESS | 21

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FUNDRAISING

From Page 1

Lakeland is one of the local colleges reporting a stronger-than-anticipated year of fundraising even amid the financial crunch leveled by the pandemic.

“The relationships that we’d begun and nurtured prior to the pandemic really started to bear fruit from a giving standpoint,” Sanders said.

The college had a goal of raising $1.7 million. It exceeded that by more than a million dollars, securing $2.74 million of philanthropic attainment for the recently closed fiscal year 2021. The figure encompasses all the projects his office has had some involvement with, including cash, inkind gifts, pledges, planned gifts and public funding opportunities.

The Council for Advancement and Support of Education looks at charitable giving to colleges around the world. For the fiscal year that ended in June 2020, giving to institutions in

the United States clocked in at a reported $49.5 billion. The group said that number was “virtually unchanged” from the previous year.

It’s still too early to tell how things shook out nationwide for the most recent fiscal year, according to Ann

Kaplan, CASE’s senior director of the Voluntary Support of Education survey. Anecdotally, she’s hearing positive things, perhaps due in part to the strong correlation between the stock market and increases in giving.

“Even when everything around us

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is in a kind of turmoil, if that platform of wealth is stable, philanthropy tends to fare well,” Kaplan said.

Richard Konisiewicz, Ursuline College’s vice president for institutional advancement, admits his team was a little nervous when the pandemic began. Officials at the Pepper Pike campus kept the faith.

“We’re a Catholic institution and we are filled with hope, all the time,” Konisiewicz said.

They brought in about $300,000 more than expected. Support from alumni and the board of trustees was especially strong. Some board members, Konisiewicz said, give in a “very magnificent way.”

The college carefully crafted the message shared. Officials zeroed in on the best talking points to amplify, like an American Enterprise Institute study that ranked Ursuline as the top college in the country for student mobility and a national nod earned by its nursing school.

“We talk about our students, we talk about our faculty, their successes, even sometimes the staff,” Konisiewicz said.

Telling the stories of the university community is important at the University of Akron, too. Kim Cole, vice president of advancement and executive director of the university’s foundation, said it’s vital to provide context that paints a full picture for donors.

Officials at UA gathered information from places like the financial aid office, the bursar’s office and its ZipAssist resource program for students to convey current needs.

“If I say, ‘We really need student scholarship support this year because our students are in the worst financial shape they’ve ever been in their lives,’ we had to be able to show

that in some data and tell them how we knew that,” she said. “It can’t be based off some anecdotal notions.”

The university reported gifts totaling $19.8 million in fiscal year 2021, a 16% uptick. About $6.2 million of that is earmarked for student scholarships, with $2.6 million of that able to be used immediately.

UA is one of nearly 30 higher education institutions and countless nonprofits in the region. That’s a lot of people and places all looking for donor dollars.

Cole said UA isn’t worried about competition, though. The alumni base is its main advocacy group. Support from that sector rose 20% compared with the previous year. Local corporations and foundations, she said, also “really take care of us.”

“The great thing about the University of Akron is that it’s rooted in this city, and this city really feels that the university is theirs,” she said.

And as a new fiscal (and school) year begins, there are new challenges to navigate.

“Who are the next generation of donors going to be, who are the next major gift prospects?” asked Lakeland’s Sanders. “If you look at the pipeline, that’s an area that’s been challenged by the pandemic.”

The college hopes some of its hallmark events can be held in person again later this calendar year. Officials are keeping close tabs on the Delta variant and its potential impact.

“Things like our Hall of Fame induction ceremony, our donor scholar breakfast, we really want those to be in person,” Sanders said. “Those are really important moments in the year of the foundation.”

If not, they’ll be ready to pivot.

Again.

22 | CRAIN’S CLEVELAND BUSINESS | AUGUST 23, 2021

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