Mayo - The Mirage of the Mirage

I have always been intrigued with how the Mayo Clinic (and Cleveland Clinic) succeeds in the same vein as organizations like Kaiser and Group Health. They all are regarded as "the best" - those healthcare organizations which provide high quality care at a lower price and with high patient satisfaction - but Mayo and Cleveland Clinic have to do it in a predominantly FFS (fee for service) environment which rewards Volume over Value, in contrast to the capitated environment of a Kaiser or Group Health.

Sort of like the old joke about Ginger Rogers - she had to do everything Fred Astaire did, but she had to do it backwards and in heels. I blogged on this issue a bit back in September, 2009 when I described futurist's Joe Flower's discussions of "How to Mayo Up".


I recently stumbled upon a Washington Post article from September, 2009 entitled "Is the Mayo Clinic a Model Or a Mirage? Jury Is Still Out". It suggests their success is due to the fact that "their patients are wealthier, healthier and less racially diverse than those elsewhere in the country" - and thus they can make more money and have better outcomes. Therefore, their model of care cannot be easily replicated (unless you have the same type of wealthy, healthy patients I assume). Hmmmm... I could see why one might say that on a superficial level, but it really disrespects what they have done at that Clinic over a hundred-year plus odyssey. And yes, that success has brought in some money - but their core ideals are the same as they ever were.

I thought a follow-up opinion piece called "Mayo Clinic's Model" summarized Mayo's success factors very well. It was written by Dr. Henry Weil (assistant dean for education at the College of Physicians and Surgeons of Columbia University) and Stuart Guterman (assistant vice president of the Commonwealth Fund for the program on payment system reform). Here are some of the salient parts:

"Mayo's performance is no mirage. In fact, there are multiple examples of health systems -- the president and other policy makers also have cited Geisinger, Cleveland Clinic, Bassett, Kaiser Permanente and others as models for health-care reform -- that consistently and reliably achieve similar results: providing good care at low cost, with high patient satisfaction."

"What these systems have in common is that they are integrated systems that employ their physicians, emphasizing patient-centered care, better outcomes, and prudent stewardship of health-care resources, with accountability for results. A group of these systems met in Washington earlier this month to discuss how the elements of their success could be adopted more broadly in the context of health-care reform. They concluded that comprehensive care, collaboration, integration, and measurement and accountability, as well as strong corporate leadership, were key to their success and could provide an example for other systems."

So would this be easy to replicate in any environment (rich or poor)? No way. But is it something for all of us to strive for? Absolutely!