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Managing Transformational Change in Healthcare: The Integration of Mayo Clinic
Robert E. Nesse MD
Chief Executive Officer
Mayo Clinic Health System
Associate Professor of Family Medicine
Mayo School of Medicine
nesse.robert@mayo.edu
What Will Happen??
An Imperative for Integration
• THEORY: ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth.
• PRACTICE: In process at a location near you.
Top 3St. Paul, Minnesota
Dubuque, IowaRochester, Minnesota
The Midwest Challenge
Red Wing
Zumbrota
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Upper Midwest Competition
• Competition as of April 2011
Hospital Intensity Index-Medicare Total Cost
Last 24 months of life- 2008
• St Mary’s Hospital- Rochester .76 $59,000
• Abbott Northwestern Hospital .98 $56,000
• Fairview-Southdale .84$57,000
• Fairview-University .96$81,000
• MCHS Austin .69 $47,000
Hospital Intensity Total Medicare Cost
Note: Hospital Intensity reflects patient inpatient days plus # of visits and services
Dartmouth Atlas 2012
Accountable Care and Integrated SystemsImplications
Business
• Disruption in referrals
• Increased financial risk
• New model Contracts with commercial insurers
• Cost sensitivity will heighten expectations of “consumers”
• Government policies still in development and vague
Practice
• In depth knowledgeof cost, patient outcomes of service lines
• Rapid application of best practices
• Cultural acceptanceof best practice models
• Population health management tools, expertise
• Efficient, seamless care across organizations
R. Scott Gorman. Mayo Clinic Az. 2011
The Statements of Mayo Clinic
• Primary Value • The needs of the patient come first.
• Mission • To inspire hope and contribute to health and well being by providing
the best care to every patient through integrated clinical practice, education, and research.
• Vision • Mayo Clinic will provide an unparalleled experience as the most
trusted partner for health care.
• Core Business • Create, connect and apply integrated knowledge to deliver the best
health care, health guidance and health information.
• Value Proposition/Differentiation Statement • Mayo Clinic combines knowledge, integrity, and teamwork into a
uniquely effective, integrated model of care
What are the fundamental requirements for success ?
• A network of providers• virtual?
• Alignment of purpose
• Coordinated care delivery
• Practice Analytics
• Financial alignment
Population Health Resource Relationship2010 data from Mayo Clinic HSER
COST Chronic Disease Services
Population% of community
50% 5% 3+
45% 45% 1-2
5% 50% 0
% of Spending
Multi-disciplinaryCare Teams, Home
Monitoring+
“Medical Home”Utilization EducationCommunity Support
+Wellness, Risk ScreeningShared Decision Making
Health Education
Changes for the MCHS• Integration
• One Mayo Clinic strategic and operational plan• Regionalization and System model for MCHS. A “union of forces”
• Shared Services and a Mayo Model of Community Care for our system • “Pain, Gain, Explain”
• Accountability for high value care
• Expanded capability for translational research and education in new models of care
• Implications of the Mayo Clinic plan • Knowledge to delivery.• Transform the outpatient practice• Increased services and service lines to support the region• Maintain/improve quality and lower cost over time
Why us? Why now?
•“Somebody has to do something and it is just incredibly pathetic it has to be us” Jerry Garcia
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