University Hospitals, the region's second largest health system, is trimming $100 million during the next two years as it prepares for a future of declining state and federal reimbursements. The health system, whose network of hospitals and clinics employs about 16,000, has "no plans for major layoffs," said Dr. Achilles Demetriou, COO of University Hospitals. "But constantly, we look at efficiencies and moving people around in parts of the organization depending on performance," Demetriou said, adding "if a unit is performing better than others, we may shift." While Demetriou declined to provide specifics, he described the initiative as a "transformation" and not just cost-cutting. UH executives, he said, were looking at expanding some areas that could improve revenues and keeping others flat by managing costs. And money may be saved by changing models of care, he said. Leaders at the system are asking where the best place may be for a patient to get the best care at the best cost. For instance, they are asking if a physician is always needed or whether a nurse practitioner might be better for a job, Demetriou said.