Mayo Clinic chief: How to overcome fragmentation

Noseworthy offers roadmap for health care industry

To ensure a sustainable health care system, the country must address fragmentation and variation in health care, as well as overhaul current payment models to reward providers who deliver high-quality, efficient treatment, according to Mayo Clinic President and CEO John Noseworthy.

Writing in the Harvard Business Review, Noseworthy explains that although the Affordable Care Act (ACA) has increased access to insurance for many, it has not addressed the key drivers of health spending.

Addressing fragmentation

In response to the rapidly changing market, health care has seen a growing number of mergers and acquisitions in recent years.

However, Mayo Clinic has taken a different approach that focuses on knowledge sharing, Noseworthy writes. He contends that fragmentation in variation in care is best addressed by creating tools that share knowledge among providers as they care for patients in disparate communities.

Mayo's 'affiliation' strategy
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Sept. 2011: Mayo welcomes first partner to new network
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July 2012: Network now includes five hospitals, one cancer center
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Sept. 2012: Mayo adds NorthShore to its expanding 'affiliation' network
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May 2013: Mexican hospital joins Mayo's network

According to Noseworthy, the approach is based on a knowledge-management system that he hopes will lead to safer care, better outcomes, fewer redundancies, and ultimately more savings. The electronic archive contains evidence-based protocols, order sets, alerts, and care process that physicians can use to find answers to clinical questions, search national guidelines and resources, and find relevant educational materials for patients.

The system was used to support the creation of the Mayo Clinic Care Network, according to Noseworthy. The network includes 21 health systems and hospitals in the United States, Puerto Rico, and Mexico—"all of which use Mayo Clinic-vetted knowledge so that other patients can benefit from our 150-year history of innovating and improving patient-centered care," he writes.

Improving patient care

Noseworthy argues that the proliferation of quality measures and programs has a limited ability to improve quality and transparency for patients. To address the major variation in patient care and experience, Mayo Clinic has embraced engineering principles and systematically designed and enacted quality-improvement efforts at all its location across the nation.

Noseworthy writes that additionally the nation must "embrace the elusive goal of value—higher quality of care at lower cost." To do so, the nation needs payment models that tie reimbursement to patient-centered care and quality outcomes in both private insurance and government-funded programs.

Creating a sustainable future

Noseworthy writes that investment in health care is "critical at this time." He notes that Mayo is investing in areas such as individualized and regenerative medicine. Additionally, the system has invested in the growth and knowledge of its staff, relying on team-based methods to enhance learning about new regenerative medicine therapies and to drive improvements in care quality.

However, Noseworthy says that the government must match investments made by the private industry. "Funding for National Institutes of Health and other agencies is essential for the health of Americans and the economic vitality of our country," he writes, adding that recent funding cuts for medical research have put the country's "competitiveness, economic security, and future at risk" (Noseworthy, Harvard Business Review, 10/11).


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