1. Managing Transformational Change in Healthcare: The Integration of Mayo Clinic Robert E. Nesse MD Chief Executive Officer Mayo Clinic Health System Associate Professor of Family Medicine Mayo School of Medicine nesse.robert@mayo.edu

2. What Will Happen??

3. An Imperative for Integration THEORY: ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth. PRACTICE: In process at a location near you.

4. Top 3 St. Paul, Minnesota Dubuque, Iowa Rochester, Minnesota

5. The Midwest Challenge

6. Red Wing Zumbrota

7. H H H H H H H H H H HH H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H H HospitalClinic/Other H Fairview H Allina H Gundersen Lutheran Upper Midwest Competition Competition as of April 2011 H H H H H H H H H H H H H H H H Rochester

8. Hospital Intensity Index- Medicare Total Cost Last 24 months of life- 2008 St Mary’s Hospital- Rochester.76$59,000 Abbott Northwestern Hospital.98$56,000 Fairview-Southdale.84$57,000 Fairview-University.96$81,000 MCHS Austin.69$47,000 Hospital Intensity Total Medicare Cost Note: Hospital Intensity reflects patient inpatient days plus # of visits and services Dartmouth Atlas 2012

9. Accountable Care and Integrated Systems Implications Business Disruption in referrals Increased financial risk New model Contracts with commercial insurers Cost sensitivity will heighten expectations of “consumers” Government policies still in development and vague Practice In depth knowledge of cost, patient outcomes of service lines Rapid application of best practices Cultural acceptance of best practice models Population health management tools, expertise Efficient, seamless care across organizations R. Scott Gorman. Mayo Clinic Az. 2011

10. The Statements of Mayo Clinic Primary Value The needs of the patient come first. Mission To inspire hope and contribute to health and well being by providing the best care to every patient through integrated clinical practice, education, and research. Vision Mayo Clinic will provide an unparalleled experience as the most trusted partner for health care. Core Business Create, connect and apply integrated knowledge to deliver the best health care, health guidance and health information. Value Proposition/Differentiation Statement Mayo Clinic combines knowledge, integrity, and teamwork into a uniquely effective, integrated model of care

11. What are the fundamental requirements for success ? A network of providers virtual? Alignment of purpose Coordinated care delivery Practice Analytics Financial alignment

12. Population Health Resource Relationship 2010 data from Mayo Clinic HSER COST Chronic Disease Services Population % of community 50% 5% 3+ 45% 45% 1-2 5% 50% 0 % of Spending Multi-disciplinary Care Teams, Home Monitoring + “Medical Home” Utilization Education Community Support + Wellness, Risk Screening Shared Decision Making Health Education

13. Changes for the MCHS Integration One Mayo Clinic strategic and operational plan Regionalization and System model for MCHS. A “union of forces” Shared Services and a Mayo Model of Community Care for our system “Pain, Gain, Explain” Accountability for high value care Expanded capability for translational research and education in new models of care Implications of the Mayo Clinic plan Knowledge to delivery. Transform the outpatient practice Increased services and service lines to support the region Maintain/improve quality and lower cost over time

14. Why us? Why now? “Somebody has to do something and it is just incredibly pathetic it has to be us” Jerry Garcia