Integrated health care delivery systems such as that pioneered by the Mayo Clinic, Rochester, Minnesota, have been heralded for their low-cost, high-quality care and greater efficiency. With all eyes on potential new models for health care delivery—particularly in the imaging field, where skyrocketing costs and questions about appropriate utilization have created a climate ripe for additional cuts to reimbursement—ImagingBiz.com speaks with Glenn Forbes, MD, a radiologist at Mayo and former CEO of the Rochester clinic, on radiology’s role in the health system of the future.
ImagingBiz: Why has integrated delivery caught on in some markets, but not in others? What are the obstacles to this health care delivery model?
Forbes: Integrated delivery systems have caught the attention of a large segment of those discussing health care reform for a number of reasons. Some very demonstrable goals are being achieved in terms of outcome, delivery, and affordability, so people are wondering, what’s different about integrated delivery, and is that a template we should emulate? There are already many integrated delivery systems around the country. Some are large; others are smaller. At Mayo, we have worked on this model for over a century and have a lot of experience with it. Why does it seem to work in some areas and not others?
It takes a certain level of commitment to fundamental values and principles. The first is focusing on the needs of the patient. Everybody has to get together and make a fundamental commitment to service. The second principle is working collaboratively as a team toward that end. It’s not about what’s best for myself or my particular area—it’s subjugating all that.
This is nothing unique that can’t be achieved, but historically, a lot of our delivery of medicine in the United States is very fragmented. We’ve got hospitals on one side of the street, we’ve got physicians on the other side; there are specialists in one building and primary care physicians in another. That fragmentation has put us where we are, and bringing that all together in one system requires that first fundamental commitment to values and principles. You have to build a culture around that, embedding it in your governance and policy, and frankly, that takes time.
There are also a few obstacles: The pieces of health care service are embedded in a conventional model, and that’s hard to overcome. If you’re a hospital and own all your hospital operations, to start suddenly collaborating with a physician practice is very difficult. It takes time and a lot of effort, so part of the impediment is leaving the model we have now and transitioning into another.
Another point I’d make is that as we go through this social reengineering process of national health care reform, we have to change how we resource and pay for care. We believe here that payment reform is as critical as delivery reform as we change national health care. We need our incentives for payment aligned in the right way. If those incentives don’t drive a team approach, then that itself is an impediment. Part of it is the model and part is the structure of our payment. Both need to be changed to an interdisciplinary approach.
ImagingBiz: What is it about integrated delivery that promotes the efficient delivery of high-quality care?
Forbes: This goes back to one of the fundamental issues: focusing on the needs of the patient. If we’re making that the fundamental premise of an integrated delivery system, then how do we define quality? Patients want a good outcome and a safe outcome, and obviously, they want accessibility in terms of service and affordability. That has to supersede some of our individual interests as clinicians. An interdisciplinary model, bringing different specialties together to work collaboratively, allows your institution to operationalize a lot of common processes better, aligning your incentives in a way you might not be able to do if you’re not integrated.
An example of that: If a man comes in with leg pain, the first question shouldn’t be who has his or her hands on the ultrasound transducer. The patient has leg pain and wants to be helped. On the delivery side, we’re thinking, “Is this a neurologic problem? Is this a vascular problem? Is this a muscular problem?
Who’s the best person to assess that?” Let’s say that you figure out it’s a vascular problem. What do you need to do to increase the blood flow? Radiology plays