A Mayo Model: The Collaborative Future of Medicine

As the Mayo Clinic moves to offer remote electronic expert consultation for doctors nationwide, they continue to innovate and set the standard for health networks expanding and consolidating resources in this precarious time for health care.

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After three hours of difficult labor, the new mother had a vaginal injury of a sort unlike any that Dr. Michael Brown had seen before. It wasn't an emergency, but it was uncomfortable. The obstetrician turned to his computer and searched the medical literature. Nothing relevant came up.

Then, he put in a request for an electronic consult with the Mayo Clinic, which has an affiliation agreement with his Grand Forks, N.D., hospital. Within 24 hours, a Mayo obstetrician got back to him, telling him about a similar case he had consulted on in Duluth, MN.

Brown treated the woman as recommended and three weeks later she had recovered. "For a bread and butter obstetrician like me, it's amazing to feel that the Mayo Clinic has your back," says Brown, who's 62 years old and also the mayor of Grand Forks, a small city that hugs North Dakota's eastern border.

It's examples like this that the Mayo Clinic hopes to foster as it rolls out a new strategy -- affiliating with hospitals and health systems across the country -- as a response to the chaotic healthcare environment.

Capitalizing on its reputation for superlative medical care, Mayo previously relied primarily on patients traveling to its main campus in Rochester, MN, as well as satellite campuses in Jacksonville, FL, and Phoenix and Scottsdale, AZ, and a regional health system in ­­­­­­­­­­­­­­­­­Wisconsin, Iowa and Minnesota. "Our model has been that the patients come to us," said Dr. John Noseworthy, Mayo's president and chief executive officer, at a February press conference. "Increasingly, going forward... we also wish to extend the reach of the Mayo Clinic, taking our knowledge, taking our experience, and sharing it with others."

"We're working on real-time e-consults."

For new affiliates, that means getting quick access to consultations from Mayo specialists and to an electronic database in which clinic physicians share dynamic medical information, as well as periodic advice about how to improve operations, for an annual subscription fee.

For Mayo, "it's a very smart market preservation and expansion strategy in a reforming marketplace," says Daniel Zismer, director of the master of health administration program at the University of Minnesota School of Public Health.

The strategy could be risky, potentially diverting management's attention away from the clinic's core business and diluting the value of its sterling brand, says Allan Baumgarten, a Minneapolis healthcare consultant. Yet business-as-usual is also risky in this era of health reform, notes Tom Cassels, executive director of research at the Advisory Board, a Washington, DC, consultancy.

And Mayo isn't alone in seeing new opportunities. Other well-known medical centers such as the Cleveland Clinic, M.D. Anderson Cancer Center in Houston, and Geisinger Health System in Danville, PA, have been pursuing a similar affiliation strategy. "We're all striving to find the model of medical care that will be most effective for tomorrow," says Fred DeGrandis, head of the Cleveland Clinic's Community Physician Partnership and Quality Alliance.

Mayo has captured the most attention because it's been moving more aggressively than other systems in the past year, triggering speculation about the nature and extent of its ambitions.

Across the country, hospitals and healthcare systems are buying up physicians' practices, merging, and acquiring each other at an accelerating rate -- under the assumption that consolidation will help them survive and thrive.

Some of those changes have been prompted by the federal health overhaul signed into law in March of 2010. Even if Republicans prevail in turning back that law, several health policy experts predict that this massive restructuring of the healthcare marketplace will continue.

That could have a negative impact on Mayo, which serves more than 1.1 million patients a year and relies on referrals from medical providers throughout the U.S. With consolidation and a related trend -- the creation of new medical networks that operate like managed care plans -- providers may be less willing to continue sending patients to the clinic. "When you look at Mayo's depth of sub-specialization, they need a vast market to draw patients from, and access to those patients is a concern right now," Zismer said.

But fear isn't driving Mayo's new strategy, executives insist. They say the clinic wants to be a leader in the effort to get hospital and physician groups to work together more effectively to improve quality and lower costs. "It's all about how do we build a sustainable, high value health care system," Dr. Noseworthy says.

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Judith Graham is a writer whose work has appeared in the Chicago Tribune, where she was a senior health-care reporter, as well as the The New York Times and The Washington Post. She is currently a mental-health reporting fellow with the Carter Center in Atlanta.

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