For decades Mayo Clinic has enjoyed a worldwide reputation for outstanding health care. After reading in a June issue of The New Yorker that Mayo-Rochester managed to care for its Medicare population at costs below the national average, I contacted the clinic to determine how cost and quality are balanced there.
The Mayo-Rochester Health Plan provides health coverage for 68,000 Mayo employees and family members. Two-thirds of enrollees select the "universal" plan which features higher premiums and lower deductibles. One-third of clients choose plans with lower premiums but higher deductibles and co-payments. The latter plans are preferred by younger, healthier employees.
Most preventive health services are included at no additional charge. There are no waiting periods for coverage to begin and no exclusions for pre-existing illness. All expenses related to an illness or injury are covered beyond a fixed deductible.
The population of the coverage area is 85 percent white with a broad socio-economic mix. Unemployment among members hovers at the 7 percent level. Similar plans are offered at Mayo sites in Arizona and Florida.
Independent of the Health Plan, Mayo Health System provides care through 67 clinical practices which it owns in Minnesota, Iowa and Wisconsin. These practices employ 900 physicians. Primary care physicians are salaried with bonuses based upon research, education, and attainment of quality standards in clinical practice. The Health System recognizes the crucial role of accessible, primary care in promoting health. Mayo is striving to close the income gap between primary care physicians and sub-specialists.
A goal of Mayo-Rochester Health Plan is to change the model of health care from one that is driven by symptoms to one that is focused upon prevention. A data information desk provides personal health updates. Ask Mayo Clinic, a "hotline" manned by registered nurses, provides continuous coverage for all health inquiries.
Two acute-care "convenience" clinics in Rochester provide alternatives to emergency room visits. A Healthy Living Center enrolls 15,000 members for physical fitness and health counseling services. Partial subsidies are offered for membership, and the membership fee decreases with the frequency of use of the facility. The Center encourages membership by less active adults.
Mayo-Rochester links all clinical components with an electronic health record so that everyone involved in a patient's care has legible access to the same information. The plan uses a formulary that is 70 percent generic. Prescription refills are managed electronically. Each week a therapeutics committee meets to evaluate new medications and treatment. A Quality Academy continuously works to improve all services.
When chronic diseases such as diabetes, rheumatoid arthritis and cancer are diagnosed, physicians use uniform protocols to manage the condition. My physician contact observed, "As the progress of medicine has allowed previously fatal, acute diseases to become manageable chronic diseases, the delivery system must change to both manage and prevent chronic disease."
New treatment plans strive to reduce complications, lessen days in hospital, avoid untested and unnecessary therapy, and make follow-up more convenient for patients.
Are these practices adaptable to other communities around the country?
Mayo-Rochester contains costs by facilitating access to primary care, emphasizing prevention of disease, reducing paperwork and standardizing care in accord with proven clinical guidelines. To implement these measures elsewhere clinical practices, hospitals, long-term care facilities and pharmacies must be integrated. That is the major stumbling block for communities such as Chattanooga where small, independent practices abound.
Without integration of services under a shared budget, clinical care resembles a racing shell in which each oar is of different length and each oarsman follows his own rhythm. Both quality of care and cost containment ultimately depend upon careful coordination of every aspect of care.
I am grateful for the time and assistance of Ms. Jean Jacobs and Dr. David Herman at Mayo-Rochester.
Next, I will consider personal responsibilities in controlling costs of health care.
Contact Clif Cleveland at firstname.lastname@example.org.