CHICAGO — Officials at Yale New Haven Health System redesigned the organization's clinical care model in such a way that they hope to nickel and dime their way toward a sustainable approach to improving quality and reducing costs.

In a session at the American College of Healthcare Executives 2015 Congress on Healthcare Leadership, senior managers described how they are unafraid to seek out clinical savings of as little as $200,000 for the $3.5 billion operation.

Speaker Alan Kliger, M.D., senior vice president of medical affairs and chief quality officer for the system, said attendees might be wondering why he presented a table of redesign savings that includes $214,000 from head and neck cancer improvements. The key is that the savings found there and in other nooks and crannies of the system are being captured through an approach that is designed to be sustainable across the system.

So, not only does that small savings get them closer to their goal of trimming $500 million from their budget in various ways, but it feeds a culture change throughout its clinical departments that aims to improve quality as costs fall.

As part of that goal, Yale New Haven is trying to fundamentally change the way physicians provide care, by giving clinicians information about how care in the system varies and what that variation costs.

The model doesn't work if it isn't applied across the board, because Yale New Haven officials are seeking a change that revamps the culture of care. The entire medical staff has to adopt the approach for it to not fall to the wayside over time, as many overhauls have in the past.

"We need to be sure the changes we are making stick," said Thomas Balcezak, M.D., chief medical officer for Yale-New Haven Hospital.

Their approach, which seeks to tie together quality and cost of care in comparable numbers, does require statistics previously unavailable. "We drive our analytics folks absolutely up a tree with our data requests," Balcezak said.