Ten Steps to Achieving Value-Based Care at the Mayo Clinic

Rosemary Frei, MSc

November 2013, Vol 4, No 9 - Value in Oncology

Phoenix, AZ—The staff at the Mayo Clinic are working to “bend the cost curve” and optimize resource utilization efficiency while continuing to provide high-quality care to their large population of patients, said Kari Bunkers, MD, Chief Medical Information Officer, Mayo Clinic Health System, and Medical Director, Mayo Clinic Office of Population Health Management (OPHM) at the American Medical Group Association 2013 Institute for Quality Leadership conference.

The OPHM is aiming to transform the approach to care from fee-for-service to value-based care within the next 2 or 3 years. The Mayo Clinic is focusing on a data-driven, team-based approach to coordinate care for its patients based on each individual’s needs, she said. These efforts are not specific to cancer care, but the majority of them also apply to oncology.

“Team members will practice to the fullest extent of their licensure, which frees up providers to concentrate on the most complex patients,” said Dr Bunkers. “Analytical systems will help us stratify the population to identify what level of care is appropriate for which patients. And care coordinators can spend time following up with the patients that are most at risk for complications, and intervene to optimize their care and reduce their likelihood of hospitalization.”

Dr Bunkers, together with her Mayo Clinic colleagues Robert J. Stroebel, MD, Medical Director, Midwest Office of Population Health Management, and James Yolch, Administrator, OPHM, provided information about the central parts of their plan to transition to value-based care.

The Mayo Clinic’s approximately 4000 physicians care for nearly 1.2 million patients annually in the Midwest, Southwest, and Southeast.

“Our current model has some proactive disease management…but in general, it is an acute care system that sees a patient when they schedule a visit or show up in the emergency department or hospital,” said Dr Bunkers. “It relies on patients to manage their disease and follow-up, which is often confusing, especially to our frail elderly population and our underserved members who require the most care and are at the highest risk for adverse outcomes.”

Efficiently meeting the complex care needs of these individuals is one of the central goals of the Mayo Clinic’s new model. Mr Yolch noted that these needs represent an opportunity to implement the Institute for Healthcare Improvement Triple Aim Initiative of improving patients’ experience of care, and reducing the per-capital cost of healthcare.

Key Steps to Transforming Patient Care
The 10 key components identified by the Mayo Clinic include prevention, community engagement, wellness, team-based care, patient engagement, access optimization, care coordination, smooth care transitions, and effective chronic condition management and palliative care.

They also have aligned 3 key principles—partnering, caring for patients every day, and additional services for high-risk groups—with the programs led by a physician and administrative partner to outline their population health management framework. The focus, said Dr Bunkers, is on a gradual shift and adoption of the 10 elements in the framework.

“For example, we are introducing the concept of team-based care by having a nurse and a provider share an office, and also by identifying team members who will gradually start sharing a panel of patients and assume overall accountability for that panel,” she observed.

“We are determined to deliver better-coordinated care for patients, with a better overall experience, through engaging them in ways that work for them, and by focusing on health, wellness, and outcomes,” noted Dr Bunkers.