Weil and Guterman: Mayo Clinic's Model

By Henry Weil and Stuart Guterman
Tuesday, September 29, 2009; 4:10 PM

A recent Post article asked whether the Mayo Clinic's better patient-care outcomes and lower costs provide a model for the rest of the health-care system, or if it's a "a mirage."

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.

These systems exist and succeed in the current environment, but that success is made more challenging by the payment system. Nothing in the current setup encourages collaboration among providers, and those who attempt to provide care more effectively and efficiently often are penalized by a loss in revenues. The challenge to policy makers is to provide an environment in which better practices are rewarded rather than punished.

Several recent developments offer promise of movement in the right direction, including the stimulus funding to support comparative effectiveness research and health information technology. Critically, most of the health reform legislation includes provisions to test different organizational models for providing better care at lower cost.

The benefits could be substantial. It has been estimated by researchers at the Rand Corporation and the Dartmouth Medical School that 30 percent of current U.S. healthcare expenditures -- 30 percent of $2.5 trillion, or $750 billion a year -- is spent inefficiently, on care that is not supported by clinical evidence. While the precise numbers may be debated, these figures provide some indication of the potential savings to be had from more effective, more efficient health care: Eliminating just 15 percent of the estimated inefficiency in the health-care system would yield savings of more than $100 billion per year, or more than $1 trillion over the next ten years -- essentially funding currently proposed reforms.

The promise of savings of this magnitude should be attractive to everyone, regardless of political or ideological orientation.

Dr. Henry Weil is assistant dean for education at the College of Physicians and Surgeons of Columbia University at Bassett Healthcare in Cooperstown, New York. Stuart Gueterman is assistant vice president of the Commonwealth Fund for the program on payment system reform.

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