Health System Reform: Why Now?

By Robert Nesse, MD, chief executive officer, Mayo Clinic Health System

In my previous writing for this Accountable Care column, I stated that to embrace our current health care challenges and move toward solutions, we must address three questions:

  • What can we do to solve the problems of health care in America?
  • What are fundamental attributes that medical groups must have to succeed in the future?
  • Why should we do it now?

You can read the answer to that first question here, and the answer to the second here. In this column, let me address the third question: Why should we in the healthcare industry tackle delivery system reform now ?

If — as you listen to the debates and watch your peers make moves — your take-away could be as narrow as that we have to change because we are scared of the implications of the Affordable Care Act, or that we must do this to preserve our contracts. If this is your view then you don’t understand our opportunity.

One hundred and four years ago, the founder of my group, Dr. William Mayo addressed the graduating class of a medical school in Chicago. On that day he said the following: “The best interest of the patient is the only interest to be considered…” I and many physicians and physician practices have embraced some version of that comment as our primary value ever since that time. However, that was not his entire sentence. The full sentence goes as follows: “The best interest of the patient is the only interest to be considered and in order that the sick can have the benefit of advancing knowledge, a union of forces is necessary.”

The “union of forces” that Dr. Mayo was talking about then was the integrated group practice of Mayo Clinic. Since then, many physician groups have evolved and have become successful innovators of the group practice model — such as those represented by the Council of Accountable Physician Practices and others on this website. Now it’s our turn to take it to the next level.

Why must we change now? Because we have known for decades that system reform is necessary because our health care costs are unsustainable, but haven’t had the national will or motivation to learn from the best, move forward, and continue innovating.

We must change because we care about our patients, and they are telling us that they have had it with the cost increases and the fragmentation of their care, which they confront daily as they interact with typical medical practices in this country.

We must change now or risk losing more control of our practices. Physicians and physician groups are the best arbiters of healthcare for our patients, not the insurance industry, the government, or employers. If physician groups don’t claim this space and engage creatively with others, we will lose ground.

We must change because we can change. Group practice is the prototype for an accountable health care system and, with appropriate innovation, is the best model for the future of care for America.  Many of us already know how to do effective care coordination. Some of us were the early adopters of the electronic health system, providing information to IT companies as they worked to develop user-friendly clinical information systems. Some of our models include hospitals, and have experience in reducing readmissions. All over this country, physician groups have amassed a wealth of knowledge and experience that our nation can leverage now.

Finally, we must change because there is no choice. Regardless of whether you want to participate in a government-approved accountable care organization or a commercial health plan project, as a physician that is part of a medical group, you WILL participate in accountable care.

System transformation and new models of care for Americans will require a union of forces. I am a staunch believer that true health care reform will emerge from the work of medical group practices. We are the union of forces of which Dr. Mayo spoke.

This is an historic opportunity.  Our patients are counting on us. Let’s get to work.

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  • Tomas

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