Mayo using big data, digitized know-how to improve care and extend its reach

Dr. John Noseworthy has been president and CEO of the Mayo Clinic since 2009. Along with its flagship facilities in Rochester, Minn., Mayo has other hospitals in Minnesota as well as Arizona, Florida and Georgia. In an interview with Merrill Goozner, editor of Modern Healthcare, Noseworthy talks about the impact of the Patient Protection and Affordable Care Act on the system, Mayo's partnership arrangements with other provider organizations, and how it hopes to employ “big data” to improve healthcare outcomes. The following is an edited excerpt.

Modern Healthcare: With so much political turmoil over the Affordable Care Act, what impact do you see it having on the Mayo Clinic?

Dr. John Noseworthy: If it is rolled out and fully realized, it would significantly impact the financial model of Mayo. It is basically about insurance coverage. There is going to be less reimbursement for hospitals and doctors, so we are planning the next stage, which is how do we redefine the way healthcare is delivered and experienced by patients. That's where we are making our investment to drive higher quality at lower cost. We can't affect what happens with the Affordable Care Act, but we can make our care safer and higher quality, more precise, at lower costs.

MH: Mayo has eschewed the strategy of trying to forge alliances with other organizations like we see around the country. What is your strategy in terms of making linkages?

Noseworthy: We looked at emergent acquisition strategy consolidation of services, and we didn't think that was in the best interest of patients. It's more of a business play to improve purchasing power, and so on. Mayo thought a better way to do this would be to work on the fragmentation of healthcare, and so we have digitized our knowledge of how we practice medicine and how we practice the business of medicine—the back office. We put that together in digitized tools that will be of value to medium- and large-sized groups around the country. … That has been the underpinning of what we call the Mayo Clinic Care Network, a large group of affiliated, high-quality practices around the country.

MH: A lot of people would probably like to affiliate with the Mayo Clinic. How do you choose whom you will partner with?

Noseworthy: All of the groups that we have accepted into this or have sought out and accepted all provide a very high quality of care locally in their markets. We have a due-diligence process of about six months where we exchange data right down to specific details about quality outcomes, how they manage the business, how they look after their patients. We see whether there is a cultural fit, because that is important as well.

MH: So Mayo's own internal guidelines are evolving, and you have adopted a huge project with United Healthcare's Optum unit to evolve those guidelines.

Noseworthy: All of us in healthcare have been trying to improve the quality of care, deliver safer care, more precise care. But we have had trouble getting at the denominator of the value equation: What does healthcare cost? Through our relationship with Optum and the creation of Optum Labs as the founding medical partner, we now have a way of looking at utilization of healthcare in a large way. Mayo has put its clinical outcomes data into the database and de-identified it. And Optum has put United Healthcare's claims data over two decades, which is more than 150 million covered lives for up to two decades. And now we are linking those two to see what are the desired outcomes, which patients did well, and what was the utilization of services that was important in them doing well. We are inviting other academic medical centers, large group practices, other payers, policymakers, device companies and so on, to put their data into Optum Labs in Cambridge, Mass., so that we can apply big data analytics to get real time answers to what works in healthcare and what doesn't work in healthcare.

MH: The organizations that affiliate with Mayo can use these guidelines, but how do they access them?

Noseworthy: If they join the Mayo Clinic Care Network, all of our tools, both for how we practice medicine and how we do the business of medicine, are shared with them in digital tools and there is a whole series of them that are part of that arrangement. They join in a subscription. If at the end of a year or two years or three years, they decide they are not getting value from it or if they are not meeting our needs in terms of the quality of their work, then it is a limited commitment and a subscription model. It is working very well. In two years, we have added 24 of these large units around the country, as well as one in Mexico City and one in Puerto Rico. And it's growing.

MH: Do they get access to Mayo clinicians as well?

Noseworthy: They have immediate access to Mayo Clinic through e-mail or phone contact. If they want to do an electronic consultation, either in real time or within 48 hours, that can happen. The turnaround has been very, very fast. If they wish after all that to send us the patient, of course we are glad to see them, but that is not a requirement. That's working very well.

MH: You have launched a major expansion in Rochester and have asked the state Legislature for some help. It has generated some controversy in Minnesota.

Noseworthy: In May, the Minnesota Legislature passed a bill that earmarks more than $550 million to be used in southeastern Minnesota, primarily Rochester and the surrounding community, to help provide the infrastructure for a destination medical center, to make certain that it is a model community for the people that work there and the people who come from 130 countries every year to visit there. None of the money goes to Mayo Clinic. It is for infrastructure to match investments that Mayo makes and the private investors make to build bio-businesses, hospitality and retail. We are expecting Mayo to invest $3 billion to $3.5 billion in the next 20 years and we expect to attract $2 billion to $2.5 billion from investors. As that money comes in and as jobs are created, the state money is released to provide the infrastructure, roads, transportation, sewers, bridges, that kind of thing.

Follow Merrill Goozner on Twitter: @MHgoozner