Each year, the U.S. spends nearly $3 trillion on health care – about $9,225 per person – which accounts for about one-fifth of the U.S. economy. Once one of the most stable sectors of the American economy, health care is in the throes of unprecedented change, driven by a potent mix of technological advances and mandates to contain costs and improve quality. At the forefront of this transformation is the Mayo Clinic, one of the nation’s leading health systems, which cares for more than 1.3 million patients annually in its own hospitals and many more indirectly through the Mayo Clinic Care Network. The network is made up of 35 independent hospitals or systems that have satisfied Mayo quality standards and have been granted access to Mayo intellectual support and, for highly complex patients who can’t be treated at home, fast-tracked clinical services.
U.S. News Hospital of Tomorrow keynote speaker Dr. John Noseworthy, president and chief executive officer at Mayo Clinic, spoke with U.S. News about some of the changes affecting the nation’s health care system and Mayo’s approach to improving health care for tens of thousands of patients inside – and outside – its walls. (The interview has been edited for clarity and length.)
What are two or three of the biggest health system changes over the last year?
Dr. John Noseworthy is president and CEO of the Mayo Clinic.Courtesy Mayo Clinic
There’s a very strong focus on transparency that will [uncover] a lot of sins, [shedding light on] quality and safety and all of the parameters that the consumer is increasingly going to be paying attention to – as are payers. And we are transitioning, hopefully, from process measures [Did the doctor prescribe aspirin?] to outcomes measures [How did the patient do?], though that’s still in the early days. The outcomes that we measure are death, falls, retained foreign objects [following surgery], hospital-acquired infections, and those kinds of things. More complex aspects of health care, such as efficiency, accuracy, and appropriateness of care, are more difficult to measure, but we’ll find ways to get there.
[Measuring outcomes] is terribly important; this is an appropriate direction for medicine to go. Patients should know about [their hospital’s performance]. Actually, hospital administrators should know about [the push to develop better ways of measuring their performance], so they can drive higher quality, which will then ultimately translate into payment for better outcomes. That’s the general direction in which the government is going, and the payers [such as self-insured employers and insurance companies] will follow. This is huge, it’s a good thing, and it’s a big change. [The big question is] just how that change is managed, so that appropriate incentives and sharing of data are all put in place.
What other developments strike you as critically important?
Mergers of four of the five largest private insurers obviously is big news, as is Secretary [of Health and Human Services Sylvia] Burwell’s declaration that CMS [the Centers for Medicare and Medicaid Services] is going to pay for [improved] outcomes in a very aggressive timeframe. The repeal of the sustainable growth rate formula [which calculated the fees that Medicare paid doctors] also has [propelled the development of] alternate payment models and gotten everybody working pretty hard together.
Consolidation has become a powerful force in the health care marketplace. What are your thoughts on this trend?
For the private sector, such as bio-tech, pharma, device companies and so on, to work together with payers and providers to come up with solutions that work in a STEM-innovation country is a good thing. … But [a push by hospitals to] get bigger so that we can have purchasing power on the back end – on the business side of life – and not deliver it to the patient in the form of better care, that’s [a problem]. We decided not to go with consolidation – to get bigger by owning more hospitals, so we can drive out costs and win. Ours is a much more patient-centered, front-line approach to deliver the knowledge to the patient so that they get better care, saving money that way.
Can you talk about how Mayo accomplishes this?
For 150 years we’ve been evolving team-based care, with salaried physicians focused on the patient. That’s our culture; that’s what we’ve done forever. As we’ve grown over the years, and extended our reach, scaling that [up] is difficult. … Even when you get really good people – and fortunately everyone in medicine wants to do the right thing – the system isn’t set up to foster that.
With our humanitarian mission, how do we share what we’ve learned? We decided the best way is to digitize it. We put those care models into a sharable data system, called “Ask Mayo Expert,” which can be accessed as a subscriber to members of the care network. If you’re a brain surgeon, and I’m a neurologist, and [someone else] is a psychiatrist, how do we share patients with dementia who, let’s just say, need a shunt? What are the key problems when you get the three of us together? We put that into a digitized format so that when it’s searched by an internist, or neurologist or a neurosurgeon – someone who says, “Gee, I’m just neurosurgeon, I wish I had a neurologist to talk to – [he or she] can pull this up and say, “At Mayo, this is how they manage it.”
We have thousands of those scenarios readily accessible on the desktop of physicians and nurses in the health system. Immediately they’re thrown into a [scenario] showing what a team looks like for a specific patient problem. When they do that, they can also see who at Mayo clinic created that knowledge set and how to contact them with additional questions. That has enabled us to keep 80 percent of the patients in [their local hospital], whether it’s in Pikeville, Kentucky, or Santa Barbara, [California], or Hanover, New Hampshire. If that information is not enough, of course, they can call; we’ll do a video consult. Ten or 15 percent of patients ultimately need to go [to Mayo] because of the complexity of their care, but that’s how we share our knowledge.
What pitfalls do you see ahead for patients?
Narrow networks of providers put patients at a big disadvantage. They can’t leave the network unless they pay out of pocket, because these highly complex [conditions] are obviously going to be extraordinarily expensive and not covered by insurance. The American public doesn’t know yet that when they buy [certain kinds of low-cost] insurance products, they will have to cover a lot of the cost themselves when they go outside the network.
Does that have implications for hospitals?
Payers are shifting the financial risk for expensive care that’s not reimbursed over to the providers – the payers are trying to “de-risk” themselves. But a hospital system only has a certain amount of money to care for a population. They don’t want a lot of patients leaving their system to go somewhere else for another opinion because they’ll lose control of the expense of caring for that patient. [They keep control by restricting patients] to a narrow network. It sounds good, if you say it fast, from a business standpoint. For patients, especially those with complex care needs, not all systems are sufficiently deep to manage their concerns. [Their doctors and hospitals] may not have seen that kind of problem with the frequency of a center of excellence, which sees them all the time. It can disadvantage that patient quite a bit; one of the centers’ of excellence strategies is to show that, although we may not be in other people’s networks, we can actually save them money because we see this stuff all the time and do [can care for them] safely and efficiently.