Mayo CEO: Government Needs to Fund Health Care Innovation

John Noseworthy (A. Kotok)

John Noseworthy, president and CEO of the Mayo Clinic in Rochester, Minnesota, told an audience today that the U.S. government needs to fund scientific discovery to maintain U.S. health care quality and affordability, especially funding for National Institutes of Health (NIH). Noseworthy made his remarks in a speech at the National Press Club in Washington, D.C.

Noseworthy called on government to fulfill its role of funding research on scientific discovery and payment mechanisms to be able to reward excellence across the health care spectrum. Noting his presence in Washington, D.C., Noseworthy said “I want to take this opportunity to ask Congress and the White House to invest in innovation.” Those innovations, he says include “a payments system that recognizes the different levels of care and rewards quality and value at each level,” as well as overhauling Medicare’s payments structure.

Innovation is needed, says Noseworthy, because life expectancy in the U.S. is slipping. Mayo Clinic received about $220 million of NIH’s $30 billion in spending in 2012. He called NIH funding “critical to research, scientific discovery, technology, engineering and math, strengthening our economy. It must be preserved.”

Responding to a question from the audience, Noseworthy said the sequester — the across the board spending cuts imposed by Congress on Federal agencies — while portrayed as a 2 percent reduction in funding, translates into a cut of $47 million for the Mayo Clinic in one year. Half of the money, he says, comes out of patient care and half comes out of research. “We can’t do as much research,” says Noseworthy. “We can’t hire the young people to move that agenda forward, and it slows us down.”

Noseworthy stressed the need for data-driven innovations to meet the demands of an aging population with high-quality care. He described a “spectrum of care” that begins with routine and preventive medical services, such as regular checkups and the management of simple chronic diseases. At the next level is intermediate care, requiring more extensive services for emergencies such as heart attacks and procedures delivered at a hospital like a knee replacement or gall-bladder surgery.

At the highest level is complex care, needed by only a few people — maybe one in a thousand — where patients get very sick or the diagnosis is not clear, and need cutting-edge treatments from teams of specialists. After intermediate and complex care, patients then move back to primary care, where their regular care givers take over.

The Affordable Care Act, says Noseworthy, takes important steps to improve primary care, but he adds, “more work is needed to create and assure high quality across this spectrum of care for all Americans.” He calls recognition of this spectrum a key step in true health care reform, and without this recognition, “it will be impossible to accomplish high quality care delivery linked to payment reform.”

Noseworthy points out that the health care system gets into trouble when patients churn in the wrong part of the spectrum and providers do not coordinate delivery of their services. That’s when costs skyrocket due to inappropriate or duplicate testing that results in poor quality or unsafe care. To improve delivery, says Noseworthy, “We need data both on the desired outcomes of care across the spectrum and the total cost of care over time.”

Mayo Clinic, says Noseworthy, is developing a business model based on integration rather than consolidation, which is happening elsewhere in the health care industry. The clinic, says Noseworthy, has developed one of the largest medical records systems in the world, an innovation that the clinic established in 1907 with the first unified medical record. “Everything related to a patient’s care is immediately available to Mayo care givers and patients,” notes Noseworthy.

In addition, most local patients at the clinic also allow their records to be used in medical research, which made it possible to build the Rochester epidemiology project, and which enables Olmstead, Minnesota to be “one of the few places in the world where researchers can study diseases, causes, and treatments in a defined geographic population.”

Noseworthy says Mayo is building a “knowledge content management system” with best practice protocols, hospital orders, patient, and education materials. He says the system will pay off for patients in “safer care, better outcomes, fewer redundancies, and cost savings.” That knowledge is dispensed through a tool called AskMayoExpert that provides physicians with answers so they can deliver safe, high-quality care, and which the clinic offers to its partners and clinical care network.

Noseworthy described Mayo Clinic’s research alliance with Optum, a subsidiary of United Healthcare Group. The joint venture, called Optum Labs, brings together clinical and cost data that can provide insights into better outcomes, as opposed to measuring the various delivery processes. “By analyzing quality and cost, we create value,” says Noseworthy. The alliance combines anonymized clinical and claims data on 5 million Mayo Clinic patients and Optum’s cost-of-care data on 109 million patients collected over 2 decades.

Optum Labs, says Noseworthy, will become more valuable with other medical centers, research universities, pharmaceutical and medical device companies, and payers joining in. It will make possible, he says, “a data-driven transparent system to identify what works, how much does it cost, who’s doing it best.” It will also make possible systems that reward services providing the highest value.

Read more:

• Student Develops Heart Health Management Smartphone App
• Grant to Fund Patient-Sourced Health Outcome Measures
• More U.S. Primary Doctors Using Electronic Health Records
• Report: U.S. Health Care Needs to Adopt Learning Culture
• Special: Health Care Experts Propose Sweeping Cost Control Changes

*     *     *