In this episode of Enabling Health Value, we welcome Dr. Denis Cortese, former President and CEO of Mayo Clinic, to explore the critical elements necessary for achieving patient-centered care. Dr. Cortese, a prominent figure in healthcare transformation, draws on his extensive experience to discuss how the union of forces—spanning clinical integration, outcomes measurement, and value-based care models—is essential for delivering high-quality care at a lower cost. He emphasizes that while payment models play a role, the primary focus should always be on what’s best for the patient, advocating for a system where patients are at the center of all healthcare decisions.
Podcast Transcript (Bookmarks)
01:30 Denis Cortese, M.D. – one of America’s most eminent medical executives and thought leader in healthcare transformation.
05:00 Dr. Cortese discusses his career at the Mayo Clinic. (Dr. Cortese started in 1970 as a clinician before serving as President and CEO of Mayo Clinic Rochester from 2002-2009.)
07:00 Inspiration from the Mayo Brothers — “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.” (Commencement Address, June 15, 1910)
08:00 The importance of outcomes measurement in patient-centered care.
10:00 Early experiences with outcomes measurement at the Mayo Clinic.
11:00 “Studying your results are fundamental in providing better care for patients, getting better outcomes, and improving safety and service.”
11:15 How clinical integration and teamwork leads to a lower total cost of care.
13:00 How value measurement has evolved to align with new models of payment.
14:00 “Payment models are not the driver. The driver should be what is best for patients.”
14:45 The unintended consequences of across-the-board cuts to reimbursement rates on health value.
15:45 “The focus is not to figure out how you save money. The focus is on how you get the best quality at the lowest cost.”
16:30 CMS challenges with ACO participation during the early stages of APM experimentation.
17:00 Will recent changes to ACO REACH force exits in the program?
17:30 Lack of patient access to care as an ongoing challenge in the Traditional Medicare program.
19:00 Being hyper-focused on bending the cost curve can detract from the broader goals of patient-centered care.
21:30 Value-based care is all about putting patients at the center of the universe.
22:45 Prioritizing the needs of other stakeholders in healthcare only protects the system at the detriment of patients.
24:00 Patients need a seat at the table in reforming healthcare!
25:30 The failures of the current system in improving care outcomes for patients with chronic disease.
26:00 How tertiary prevention hurts hospital profit margin (unless your revenue is predominantly capitation-based).
27:00 Developing a value-based care infrastructure through system engineering, process workflow optimization, and data analysis.
28:30 The need for interoperability in healthcare.
29:30 Lack of interoperability was a failure of the EHR “meaningful use” incentive program.
30:30 Perfecting the science of health care delivery through system engineering and precision medicine.
31:30 Opportunities for improved clinical integration, care coordination, and tertiary prevention supported by new payment models.
33:00 Fee-for-service means nothing more than, “I make money when you are sick.”
34:00 How the origins of fee-for-service led to overutilization and out of control healthcare spending.
35:30 The flawed rationale of using price controls to reform healthcare.
36:30 RVUs for procedures are over-valued (especially in comparison to cognitive services provided by PCPs).
37:30 “Our chaotic delivery system is a totally rational business rational response to the way we’re paying.”
38:00 Creating a more dynamic model of value-based care that is financially viable for health systems.
38:30 Intimidating MA plans and enacting sweeping reimbursement cuts are not productive reform efforts.
39:00 Health system-led insurance companies and salaried physicians can create opportunities for value-based care.
44:30 Community-based health systems that are exemplars in value-based care (e.g. Banner, Dignity, Geisinger, Health Partners, Rush).
47:00 Specialty-based centers of excellence that are exemplars in value-based care (e.g. Johns Hopkins, Penn, Stanford, Mayo Clinic).
48:00 Servant leadership and shared vision as common attributes of the nation’s leading health systems.
50:00 CEO compensation should be linked directly to quality. The majority of earned profits should be reinvested back into communities.
51:00 CEOs don’t need to be the highest paid in the organization. (What about the doctors and nurses who can actually deliver the goods?)
52:30 The best CEOs do not lead with threats of firing others – they lead with a unifying vision for patient-centered care.
53:00 The greed of CEOs in extracting excessive compensation, while underpaying workers on the frontline delivering care.
55:00 Comparing the heroism of those in service during D-Day to healthcare workers during COVID-19.
56:00 Devaluing frontline workers will lead to continued burnout and moral injury in healthcare.
57:00 Leadership lessons from the Mayo Clinic in supporting their workforce in delivering patient-centered care.
60:00 A shared vision to eliminate wasteful spending in healthcare (a $1 trillion opportunity!)
62:00 Don’t confuse a vision for high value care with infrastructure (e.g. building platforms, research, patents).
63:00 Training medical students for future success in measuring value-based outcomes, working in teams, etc.
64:00 Key levers of success — how leadership is prioritized over underlying infrastructure.
65:30 The mission of Lumeris in delivering on the promise of value-based care.