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