Thursday, August 8, 2013

A new model of health care — for the well - Health

As it prepares for Destination Medical Center expansion to transform its Rochester campus, Mayo Clinic is also changing the concept of medical care.

Instead of only responding to injury and illness, Mayo has begun treating patients who are already well to help them get even healthier, with everything from its new wellness center to smart-phone apps to reach out to them.

For people with stable chronic illness, that might mean improved general health. For athletes, it could mean boosting performance at the new Sports Medicine Center opening next spring. For people without health problems now, it may mean an overall wellness plan that will head of potential future problems such as heart disease.

"We want Mayo to be the destination for anybody in the world, whether they access via the Web or come to Rochester, Minn. in person," said cardiologist Dr. Douglas Wood.

"We're searching for a deeper relationship" with people, he said. "That's how Mayo will actually be the destination medical center and the reason people will seek Mayo again and again and again."

More of that type of interaction could multiply the number of patients Mayo sees. Clinic CEO Dr. John Noseworthy has said that Mayo expects to create "a meaningful interaction with 200 million patients and people each year" by 2020.

Last year, Mayo directly treated more than 1 million patients.

"Meaningful interaction" can include services like providing vetted medical information over the web, education through the Mayo Medical Edge column, answers via next-day Mayo Medical Laboratory test results sent nationwide and through Mayo Clinic Care Network e-consults.

Mayo changes rhythm of care

Mayo Center for Innovation administrator Barb Spurrier said patient needs are "the very core" of Mayo's mission. That's why Mayo is reaching out with e-consults that allow patients to get direct delivery of primary care at their own health provider's clinic or even in the patient's own home.

Mayo providers are "changing the rhythm of care" away from the doctor's office and toward local care, such as electronic data monitoring, sometimes with smart phones.

A Web-based care plan can become an integral part of the patient/provider care team concept — and it can work even if the patient checks in from halfway around the world.

Wood said Mayo is asking what its patients need and searching for tools to fulfill those needs.

In June, for example, Mayo announced it will partner with drchrono to broadly offer it's vetted patient information via iPad in an effort to increase the use of electronic health records and to "save time, increase revenue, improve patient care."

At the Mayo Clinic Healthy Living Project at the Rochester Dan Abraham Healthy Living Center, patients will create wellness goals in consultation with a care team.

"Under each of the goals, we'll tell you, 'here are the things you can do,'" said Wood. Mayo will provide updates about how the patient is doing in comparison to goals.

Spurrier said the mission is not just to transform the patient experience, but to transform how the experience feels so that the patient feels engaged in the wellness process.

She focuses on "the humanity of it all." Some patients on dialysis might want to be freed from the medical institution and do dialysis in the comfort of their own homes. Others might want the security of the medical center.

Instead of responding to the nation's health policy and designing health centers around it, Mayo leaders are approaching health care from a "design-thinking" standpoint — figuring out how do design the system so it works best to raise the health of patients, many of whom are well but want to improve their health and decrease their risk.

"It's about the user need, and how do we meet that in the best way," Spurrier said.

Transforming wellness

Now is the time, Wood said, to transform the delivery of health care into the delivery of wellness.

The Healthy Living Project and Office of Wellness at Dan Abraham opening next year will offer patient-goal-oriented services focused on nutrition, physical activity, stress management, sleep and mind/body "resiliency," said Dr. Donald Hensrud, author of the Mayo Clinic Diet Book and medical director for the project.

Those programs will revolve around the concept of "individualized wellness," he said.

Yolch said the new programs will build upon the existing practice, adding an integrative-health suite with massage and acupuncture, along with a focus on mind, body and biofeedback. Yoga, Tai Chi, Qigong, sleep programs, journaling, relationship programs and a meditation room will be available.

The program will even teach them how to eat healthfully on a daily basis. Patients will cook in a "participation" kitchen with a chef coaching. Patients will use a pantry of real foods, along with a virtual pantry from which they can design healthy meals by reading food labels. They will also mimic dining out to learn how to order healthy foods.

It will be designed to be fun, yet serious, targeted and individualized to each patient's goals.

Before patients arrive for a two- or three-day session, they will complete self assessments so Mayo experts from a variety of specialties will have a working knowledge of the person's needs.

Patients will undergo a multi-day program of aerobics testing, functional-muscle testing and blood tests, Yolch said.

Then, a wellness coach will say, "OK, here's the picture of your health today."

That wellness coach will continue connecting with the patient even after the person leaves Rochester.

That's a core aspect of Destination Medical Center that many might not fully understand; Mayo will increasingly connect with patients worldwide, raising Rochester's profile internationally.

Key to success, Hensrud said, will be the final phase of the program, which will be maintaining a health provider-to-patient connection once the patient leaves Rochester to help the person continue health improvements.

"The goal will be to have a wellness plan when they're ready to leave," Hensrud said. "Nobody's cracked the 'behavior' nut in a significant way — and we're going to try to do that."