The Mayo Clinic wants you to see the doctor less

May 24, 2018

You probably know the Mayo Clinic for its doctors and from a few of the Google searches you've done when your lower back was hurting. But how about the next big thing in medicine, which could be artificial intelligence or a merger with Amazon, JPMorgan Chase and Berkshire Hathaway?

Well, no promises yet, but Dr. John Noseworthy, the president and CEO of the Mayo Clinic, has entrepreneurial plans for the hospital that opened in 1889. 

Noseworthy spoke with us about how the company is investing in startups (contrary to previous plans) and how they hope to better predict complicated diagnoses in patients. Below is an edited transcript of the interview.  

David Brancaccio: So it's my understanding that there's some systemic change that you're pushing over at Mayo, in terms of the business operations, but I don't understand why. You're an incumbent. You have done very well under the present system. Why are you thinking of working with smaller companies and so forth?

John Noseworthy: Well, it's a transformative time in health care, and everyone says that, David. But advances in technology and software and diagnostics are coming so quickly and Mayo has so much, so many intellectual assets, that it's important for us to bring these to scale, and we can only do that if we partner with others.

Brancaccio: So you're having conversations, for instance, with what I would call a startup company.

Noseworthy: Many startup companies. Five years ago, we changed our policies to bring and encourage a culture of entrepreneurship amongst our physicians and scientists, which we hadn't really had. We have a lot of entrepreneurial physicians and scientists, always have, but we've wanted to be so careful about that bond between the physician and the patient, which is so important when you have a salary-based model of teamwork. Answering patients' questions, you don't want to have patients conflicted: "Is their physician conflicted with what they're telling me?" So we had to build that policy very carefully so we don't destroy what's been such a trusted name in health care.

Brancaccio: Well, you don't want your doctor distracted with his cool entrepreneurial venture or her cool entrepreneurial venture.

Noseworthy: Absolutely. And we don't want the patient to wonder whether they're getting the advice that's really right for them.

Brancaccio: So that's interesting. So it was discouraged before, but about five years ago, you started over?

Noseworthy: About five years ago, we realized that we were behind, and we had so much to offer, and it's been very successful. We've had, I think, 80 startups in the last five years and some very large partnerships. We're open for that kind of work with life sciences companies, device companies, AI companies, and so on, to speed the change that's necessary to manage patients who have very serious or a very complex illness, which is what we excel at.

Brancaccio: Well, you have maybe the greatest brand in medicine. But what do you, beyond that, bring to the table? Is it money? Is it expertise?

Noseworthy: I think it's really expertise, David. Our model is the physicians are seeing the patients and say, "Gee, what is the unmet need of this group of patients and how can we get there?" And with big data, with AI, with robotics, with nanotechnology, with advances, all of that can come forward. We bring that know-how and partner with engineers and developers and software people and so on. And we're looking for investments to help make that go more quickly for our patients.

Brancaccio: Now this may be cool, this may be especially interesting to investors, but if you're a patient, do you see a payoff here? Because there's a lot of problems that need to be fixed in medicine that patients are very concerned about.

Noseworthy: Well, but I think they see that Mayo's part of those solutions for them. So how do we predict who's going to have a sudden death problem if that runs in the family? How do you best predict that using artificial intelligence, would be another. How do we take our advances in aging to reverse the senescent cells that are causing the patient to worsen more quickly? We need a partner to do that.

Brancaccio: A big headline of the year so far has been indications that Amazon, which is this amazing retailer but also innovator in the tech space, is interested in the health care field. What do you make of that?

Noseworthy: Well, I think this is an example of the opportunity in health care. We don't have a high-quality, sustainable, affordable health care system in America. And folks are looking at that and saying "What could I bring to that?" Of course, Amazon, JPMorgan Chase and Berkshire Hathaway can bring capital, logistics, know-how, technology, price transparency, and they've reached out to us and we've talked with them about what the opportunities are, and I think there are great opportunities there.

Brancaccio: Because some insurance companies saw a threat, but that's not how you see it?

Noseworthy: We don't see it as a threat, we see it as important and as exciting. All of this disruptive investing and coming together will, we believe, help with the problem that every American is facing, and that is how are they going to pay for health care.

Brancaccio: Do you see the Mayo Clinic as leading on this or following? And for people who haven't followed the health care field in terms of its innovative approach, let me put it this way, are you an outlier in this area? 

Noseworthy: Well, many people are leading in this space. Certainly, we would like to think Mayo Clinic is one of the leaders, particularly in the area where where we focus primarily: those patients with very tough, complicated diagnostic problems and patients who have serious and complex need for surgical and other procedures. We've been a leader in that area for a very long time.

Brancaccio: And on this point that you raised about the costs of health care, I understand if there's a fancy, new, high-tech technique that could improve outcomes, that would be extremely important. But if it's really expensive, that creates other problems.

Noseworthy: It does create other problems. There's so much waste in the health care system, and perhaps 20 or 30 percent of that comes from not getting the answer right the first time. And what we're most interested in is things that will get us that answer the first time, get it right the first time, so the patient knows what's ahead of them. And then, do what the right thing to do is, and if it's something very expensive and it's life changing or curative — and we've seen examples of that — that saves money in the long term.

Brancaccio: That's so interesting you point this out. In other words, repeated trips back into the medical system to figure out what's really going wrong with you is an expensive proposition.

Noseworthy: It's probably 30 percent of the health care costs — it's total waste. And meanwhile, there are patients who have things that can be cured or managed better, and time goes by and they get worse. So that's what we focus on.