mayo health system: a decade of achievement

Mayo Clin Proc, August 2003, Vol 78 Mayo Health System 1047

Mayo Clin Proc. 2003;78:1047-1053 1047 © 2003 Mayo Foundation for Medical Education and Research

Historical Vignette

From the Division of Gastroenterology and Hepatology and InternalMedicine (P.W.C.) and Department of Surgery (S.S.), Mayo Clinic,Rochester, Minn. Drs Carryer and Sterioff were Chairs of MayoHealth System Operations and Governance Committees, respec-tively, from 1998 through 2002. Dr Carryer is currently Chair of boththe new Mayo Health System Board and the Mayo Health SystemOperations Committee.

Address reprint requests and correspondence to Peter W. Carryer,MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200First St SW, Rochester, MN 55905 (e-mail: [email protected]).

Mayo Health System: A Decade of Achievement

PETER W. CARRYER, MD, MBA, AND SYLVESTER STERIOFF, MD

I n 1992, the Mayo Clinic in Rochester, Minn, faced sev-eral major challenges. It was confronted with an array of

efforts at both the state and the national level to change theway health care was funded and delivered. Mayo ClinicRochester received more than half its patient volume fromwithin a 120-mile radius, which included portions of Min-nesota, Iowa, and Wisconsin. Mayo leaders anticipatedinsurance and delivery system changes imposed by theHealth Care Financing Administration (now called theCenters for Medicare & Medicaid Services) that includedlimited patient access across defined geographic bound-aries. Such changes might have greatly limited the abilityof many patients to travel to the Mayo Clinic for their care.Competing specialty groups sought to acquire regionalphysician practices that had traditionally sent patients withcomplex conditions to the Mayo Clinic. In addition, man-aged care organizations were growing and thriving in theMinneapolis-St Paul area, just 80 miles away, and to alesser extent in other nearby communities. This movementput some of Mayo’s referral activity at risk.

Health care groups across the United States were deal-ing with similar concerns. One frequent response involvedacquisition of regional physician practices, especially byhospitals, to create vertically integrated provider networks.It was hoped that such systems would increase referralflow, create a provider base for insurance contracting, pro-vide an advantage over competitors, and improve regionalor community health care delivery. All too often, however,these provider networks failed to achieve desired financial,quality, and integration goals. One report based on 2001 dataassessed the loss for hospital-owned multispecialty practicesat more than $75,000 per physician.1 Such networks alsofound it challenging to align and engage these new providerswithin a culture of integrated delivery systems.

The Mayo Clinic, however, had a model it believedwould work. Mayo had experienced considerable success

through acquisition of its 2 Rochester, Minn, hospitals in1986, which in turn allowed subsequent integration ofclinic and hospital operations. This integration hadachieved major efficiencies and improvement in its patientcare delivery. It was hoped that this model could be dupli-cated with similar success in both the surrounding regionand in the other Mayo Clinic locations.

Mayo Clinic’s response was to create its own regionalprovider network. Mayo’s patient-oriented vision, strongreputation for quality, considerable resources, model ofintegrated physician and hospital engagement, strong phy-sician leadership base, and previous success performingoutreach in many surrounding communities prepared it forthis endeavor.

The Mayo Clinic sought to acquire a number of success-ful physician practices, and many of the community hospi-tals associated with these practices, and to integrate com-munity clinic and hospital activities, preferably on a singlemedical campus. It sought to infuse this process with MayoClinic values and resources, to engage the practices in theMayo Clinic model of continuous quality improvement,and to align these operations, to the extent possible, withthose of Mayo Clinic Rochester. The ultimate goal was tocreate a high-quality, financially self-sufficient providernetwork with unencumbered patient access to the MayoClinic for complex specialty care.

The initial vision and structure for the Mayo HealthSystem were due in large part to the efforts of Michael B.O’Sullivan, MD, and James G. Anderson, the first pairedphysician and administrator leaders of the Mayo HealthSystem. Their plans were launched with the acquisition of a6-member medical practice in Decorah, Iowa, in early1992. Later that year, the much larger (87 physicians)Midelfort Clinic in Eau Claire, Wis, merged with LutherHospital to become an integrated medical center and thesecond member of the Mayo Health System. The MayoHealth System has since grown to its current complement of13 wholly owned organizations employing more than 600physicians and 11,100 allied health staff who practice in 62communities in portions of 3 states. Each organization con-sists of either a stand-alone, taxable clinic or a functionallyintegrated hospital and clinic. Most of these organizationsalso have several regional satellite operations. The MayoHealth System now includes 13 clinics or combined clinicand hospital medical centers, ranging in size from 4 to 160

For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.

Mayo Health System Mayo Clin Proc, August 2003, Vol 781048

physicians and incorporating 14 owned hospitals, 8 ownednursing homes, and several other hospital and nursing homefacilities under management contract (Figure 1).

Now, after a decade of development, the Mayo HealthSystem has been deemed a success as judged by a widespectrum of measures, including growth over a broad geo-graphic area, recognition for use of “best practice” qualityindicators, regional patient satisfaction, network financialsuccess, regional patient referrals to Mayo Clinic Roches-ter, physician and administrator leadership development,and system-wide integration actions. These achievementshave occurred despite challenges related to local competi-tion, culture development, access to capital, and building ofinfrastructure.

It is reasonable to ask why the Mayo Health System hasthrived as a vertically integrated regional health care deliv-ery system during a time when other equally ambitiousintegration projects have not. Several factors have contrib-uted to its success: (1) true physician leadership, whichhelps maintain patient-focused activities throughout thesystem; (2) acquisition of physician groups of demon-strated quality; (3) system framework that allows contin-ued local operational control, local leadership, and soundlocal accountability, introduced before acquisition; (4) aconsensus-driven approach to system development; (5)Upper Midwest location with smaller communities, lessmanaged care, and prior provider consolidation; (6) truecommitment to community-based health care solutions

with rebuilding of local infrastructure and recruitment ofboth primary care and specialty providers; (7) the MayoClinic’s reputation for efficient, high-quality health caredelivery; and (8) considerable Mayo Clinic resources avail-able to support a regional health care delivery system.

This article describes how the Mayo Health System wascreated and has developed over the past decade. It high-lights the benefits that have accrued to its patients, commu-nities, and physician practices as well as the value it hasbrought to the Mayo Clinic. It is hoped that this experiencewill provide helpful insights to other groups strugglingwith similar challenges.

10 Mayo Health System Building BlocksThe creation of a large physician and hospital network

required a multitude of planning sessions and critical decisionmaking. These, in turn, have resulted in both outstandingachievements and a variety of “educational” setbacks. Thisdiscussion focuses on the 10 “building blocks” that we thinkhave contributed most to the overall success of the network.

1. Vision.—The initial vision for the Mayo Health Sys-tem has not changed over time. It seeks to link high-qualitycommunity care systems with the outstanding specialtycare of Mayo Clinic Rochester in order “to achieve thehighest standards for medical care and health improvementin the communities in which we live and work.” It builds onthe Mayo Clinic primary value: “The needs of the patientcome first.”

Figure 1. Current map of the Mayo Health System with its 13 service areas.



Key underlying principles written into each merger con-tract include requirements for physician leadership, localeconomic self-sufficiency, relative local autonomy in op-erational decision making, and a commitment to local qual-ity of care.

Branding issues were resolved early for the MayoHealth System. To maintain respect for local cultures andorganizations and to distinguish the regional network fromthe Mayo Clinic’s primary specialty campus, the MayoHealth System elected to use the original or geographic titlefor regional clinics and medical centers. Each local name isfollowed by the endorsing line, “Mayo Health System” (forexample, Austin Medical Center-Mayo Health System).

Provider collaboration across all Mayo sites is encour-aged through a philosophy of “partners in care.” Clinicaldepartments are encouraged to plan and interact with theirpeer groups across the entire region. Administrative col-laboration results in the sharing of scarce resources amongthe component entities. Patient choice of a referral center ishonored, and the Mayo Clinic strives to be the worthyrecipient of the referrals it receives.

2. Governance.—Mayo Health System organizationsare owned solely by Mayo Foundation, except for 1 jointventure, Franciscan Skemp Healthcare in La Crosse, Wis,which has dual corporate sponsorship by Mayo Foundationand the Franciscan Sisters of Perpetual Adoration. Theinitial covenant between any health center, clinic, or hospi-tal and Mayo Clinic is designed as a permanent arrange-ment, with a view that the merged entities will worktogether for long-term success and benefit to the communi-ties they serve.

Mayo Health System’s governance includes a tieredmultiboard structure. Each local entity reports to the MayoClinic, and ultimate authority resides with Mayo Founda-tion, the parent organization of Mayo Clinic Rochester.Regularly scheduled meetings are held between localMayo Health System leaders and Mayo Clinic Rochester’sBoard of Governors to optimize communication and plan-ning. Continued involvement of community board mem-bers emphasizes the importance of engaging communityleaders in decisions about management and services appro-priate for each location.

The Mayo Clinic has reserved certain authority for over-sight and determination of policy, and the same Mayo-defined reserved powers apply to all entities. These re-served powers are unchanged from the inception of thehealth system and include approval of strategic plans ofindividual practices, annual capital and operating budgets,fee schedules, new programs and services, compensation,changes in employee benefits, incurrence of debt, anytransfer of assets other than in the ordinary course of busi-ness, large capital expenditures by item or aggregate pro-

gram, professional staff requests, rights of corporate mem-bers under state law, and bylaw amendments, mergers, orother fundamental changes.

The Mayo Health System was designed to include re-gional administrative governing boards. These boards wereinitially grouped geographically and were representational.For example, the 4 boards for Iowa, Minnesota, west cen-tral Wisconsin, and La Crosse had members from each ofthe practice sites in those regions. Mayo maintained themajority control on the governing boards by a delegatedappointment system. In actuality, there has not been a voteon a controversial item that split strictly along the lines ofMayo Health System entity representatives vs Mayo Clinicrepresentatives. The appeal to each regional board memberis to consider his or her role in serving the system ratherthan allegiance to any particular entity or program.

Although each organization joined the Mayo HealthSystem with full knowledge of the other entities within thesystem, there was no sense of linkage among the sites—infact, some had been competitors. After several years ofbeing asked to perform joint planning for system-widequality initiatives, to distribute allocated capital fundstransferred to the Mayo Health System by Mayo Founda-tion, and to periodically assist adjacent organizations withtheir health care delivery, the Mayo Health System sitesbegan to see the benefits of sharing of resources within thesystem, economies of scale, and joint strategic planning.As trust has grown in nonrepresentational functions such ascapital planning and allocation, strategic planning has ledto discussion and approval (January 2003) of the concept ofa single board (Figure 2). This new Mayo Health SystemBoard has 16 members, half of whom are regional practiceleaders and half who are Mayo Clinic Rochester leaders,including 2 members of the Mayo Clinic Rochester Boardof Governors. The single-board concept recognizes that theMayo Health System is a cooperative health system withgeographic alliances and cooperation across service lines.The benefit derived from improvements in managementand governance has augmented support for the single-board concept. This decade-long process of change exem-plifies the principle that governance is not a static processbut rather an evolutionary one.

3. Strategic Planning.—The Mayo Health System per-formed its first thorough strategic planning effort in 1995.This effort focused on defining the mission and principlesfor the system, a vision for linking education and researchbetween the Mayo Clinic and the Mayo Health System, anddefining the organizational options for linking the clinicalpractices across all entities. Since then, there have been 2broadly based planning efforts focused on the entire MayoHealth System strategy and annual update efforts focusedon a few new core goals for the system.



The last comprehensive strategic planning effort for theMayo Health System occurred in 2001. A major impetusfor this exercise came from the Mayo Foundation Board ofTrustees, who inquired about long-term plans for growth inthe overall size of the system and in the specialties withinthe system. This analysis sought to align and optimize allMayo Clinic patient care activities across the region. Whileseeking to accomplish this task, Mayo Health System orga-nizations recognized that their own strategic plan goals,both individual and as part of an integrated system, neededto derive from and be consistent with those of the MayoClinic in Rochester. It also became clear that the previousMayo Health System core goals meshed with those ofMayo Clinic Rochester. These core goals included growthand integration, financial success, staff and patient satisfac-tion, quality and service, innovation and scholarship, andthe future of the health care environment.

A major initiative within the most recent strategic plan-ning effort was a rigorous, data-driven review of past andfuture provider growth plans at each Mayo Health Systemorganization. This review yielded anticipated system-wideprovider growth plans of 5% to 8% per year. This growthincluded both acquisition of current providers within com-munities and incremental additions. These data allow amore robust joint planning effort for growth and patientaccess in all Mayo Health System locations, includingMayo Clinic Rochester. The data also have stimulatedconsiderable debate about the implications of growth onthe availability of limited strategic capital to accommodate

that growth, implications for specialists at the Mayo Clinicin Rochester, and the ability of the Mayo Health System tomanage the local cultural and group dynamics created bytoo rapid an infusion of new young providers into a site.Most of the requested growth came from 2 of the largerorganizations that are each building new facilities, and thisissue has yet to be fully resolved.

4. Operations.—The main operational arm for MayoHealth System patient care issues is the Medical DirectorsCommittee. It is composed of physician medical directorsof each of the 13 primary organizations and several MayoClinic leaders. Key support subcommittees for this groupinclude operations, information technology, and perfor-mance measurement (eg, quality oversight).

Each Mayo Health System organization has a pairedphysician and administrative liaison from the Mayo Clinicworking with it and attending periodic local board andmanagement committee meetings. These vital liaisons tothe local practices serve as mentors, coaches, consultants,problem solvers, advocates, and purveyors of Mayo Clinicculture.

Some Mayo Clinic leaders engaged with the Mayo HealthSystem also serve on the Mayo Clinic’s Clinical PracticeCommittee, the operational oversight body for the MayoClinic Rochester practice. This presence allows needed prac-tice links in terms of alignment of practice philosophy, re-source and policy deployment, and issue resolution.

Major operational activities for the Mayo Health Systeminclude the use of integrated work groups to study and imple-

Figure 2. Current reporting structure for the Mayo Health System (MHS). FSPA =Franciscan Sisters of Perpetual Adoration.



ment system strategic core goals. Such goals include deliver-ing high-value, safe medical care to our patients, developingsystems for “seamless” health care delivery within andamong the practice sites, providing care in the most appro-priate location for our patients, becoming a highly desirableemployer in each of our practice communities, and optimiz-ing peer group interactions across all our systems.

5. Quality Assurance.—The Mayo Health System wascreated in large part by acquiring, supporting, and integrat-ing medical groups that were already performing reason-ably well and that had an interest in delivering high-qualityhealth care services. Those organizations clearly under-stood and supported the premise that their participation inthe Mayo Health System meant that the Mayo Clinic wouldemphasize and nurture their focus on the delivery of qualityhealth care. One result of the many efforts directed towardthis quality focus is that 4 Mayo Health System organiza-tions have won national awards for health care qualityduring the past 4 years.

The Medical Directors Committee recognized early onthat quality oversight would be an important functionwithin the Mayo Health System. Therefore, a performancemeasurement committee was appointed to serve that pur-pose. This committee has developed a quality “dashboard”to monitor and promote quality efforts across the MayoHealth System. This dashboard highlights actions in 5areas: preventive services, clinical outcomes/disease man-agement strategies (both acute and chronic), patient safety,patient service, and physician credentialing.

An early initiative within the Mayo Health System wasthe introduction of disease management strategies at eachorganization. This activity uses support and resources from asimilar effort at the Mayo Clinic in Rochester. Initial actionsincluded the implementation of 8 preventive service guide-lines throughout the system and development of manage-ment strategies to improve care for patients with diabetesmellitus. Subsequently, management strategies have beendeveloped for 2 more chronic diseases. Results now comparefavorably with those of many health care organizations re-ceiving recognition for their efforts in treating these diseases.

A major patient safety effort was initiated soon after theInstitute of Medicine report To Err is Human2 was pub-lished in 2000. A collaboration was launched that included15 teams from the Mayo Health System and 5 teams fromMayo Clinic Rochester and other health care organizations.Each of these teams has been progressively implementing12 identified safety initiatives, including nonpunitive re-porting policy, use of oral syringes only for oral medica-tions, removal of concentrated electrolyte solutions frompatient areas, establishment of sliding-scale insulin proto-cols, staff safety education, and integration of standardpreprinted orders. This large 2-year effort has been highly

successful, and it is gaining recognition as a model forother health care systems.

Another patient service initiative addresses “open ac-cess” for patients at most Mayo Health System sites. Thischange in the appointment process allows patients to de-cide when they would like to be seen, rather than grantingan appointment time most convenient for their physician.During the past 4 years, 28 Mayo Health System locationshave taken part in a Mayo Clinic collaborative effort re-lated to open patient access.

6. Leadership Development.—Early in the develop-ment of the Mayo Health System, the need for a broad baseof physician leaders within both the newly integrated medi-cal centers and the stand-alone clinics became evident. Forseveral larger organizations, it became necessary to transferMayo Clinic physician leaders and administrators to MayoHealth System entities that lacked such depth. However, theintention over time has been to develop and promote theseleaders from within each Mayo Health System site.

The Mayo Health System has chosen to partner with theExecutive Development Center of the Carlson School ofManagement at the University of Minnesota to help createleadership courses for the Mayo Health System. This jointeffort has received high praise from participants. Numer-ous leadership courses are available to Mayo Health Sys-tem staff on the Mayo Clinic Rochester campus. In addi-tion, the Mayo Health System offers 2 several-day sessionsannually at a nearby retreat center. One session is designedfor senior leadership teams, and the other is directed towarddevelopment of the next generation of leaders within eachMayo Health System organization. Peer group interactionsand orientation to Mayo Clinic culture are major benefitsderived from these sessions.

To standardize and package leadership training content,the Mayo Health System has developed a modular ap-proach to education. Courses are updated annually, andtheir content focuses on 7 leadership modules: strategicleadership, people leadership, business know-how, profes-sional leadership, communication, interpersonal skills, andpersonal attributes. Although both junior and senior leader-ship courses use these modules, the course content for thesenior leaders has a stronger strategic focus.

Enhancement of local Mayo Health System board andgovernance functions is another priority. To meet this sys-tem need, the Mayo Health System hosts a 2-day annualretreat in Rochester for Mayo Health System public trust-ees and their senior medical center leadership teams toenhance local governance and strategic capabilities. Localsuccession planning and annual leadership and boardevaluations are requested and encouraged.

7. Administration.—A major operational advantageconveyed to member groups within the Mayo Health Sys-



tem is central administrative support, a central office withkey resource personnel who can call on a wide variety ofadditional business support personnel from throughoutMayo Foundation. An administrator from the central officeis assigned to each Mayo Health System organization, andall senior administrators meet regularly to align, optimize,and advance their business functions. The central supportcosts amount to about 1% of Mayo Health System’s totalexpenses. Additional administrative resource requests arecharged to the sites requesting them.

Centrally based resources used extensively by MayoHealth System organizations include communications,contracting and payor relations, disease management strat-egies, facilities, finance and accounting, human resources,information technology, leadership education and develop-ment, marketing, patient financial services and compli-ance, physician recruitment, supply expense management,and systems and procedures.

8. Finance.—An important requirement implementedat the founding of the Mayo Health System was that eachparticipating organization must remain financially sound.Each entity must “sustain the practice” (be able to fullysupport its own practice), including both operating ex-penses and working capital needs. At the outset, Mayorecognized that this requirement for local financial ac-countability also necessitated local autonomy in daily op-erations. In recent years, the Mayo Health System has had atarget annual operating margin of 5% to allow sufficientfunds for current operations, replacement of needed equip-ment and facilities, and growth and development of thesystem. Organizations integrated with their local hospitalsare better able to achieve this level of financial perfor-mance. Most small hospitals have been granted “CriticalAccess Hospital” designation by the federal government,which allows government reimbursement on a cost basis asopposed to a prospective payment basis, and this designa-tion helps their financial performance.

In 6 of the first 10 years of operation, the Mayo HealthSystem has either sustained itself financially or come closeto doing so. The annual operating margin is now about2.0% to 2.5%, with a net operating income in the range of$18 million. In 2003, net medical revenue for the MayoHealth System will be about $1 billion (Figure 3).

The original Mayo Clinic capital investment in theMayo Health System went primarily toward market-basedreimbursement for tangible assets of the acquired clinicsand for limited infrastructure improvements of acquiredhospitals in many of the communities.

In 1998, a Mayo Health System finance committee wasestablished to provide central financial planning. Capitalallocation from the limited annual pool of allocated fundsfrom the Mayo Foundation has been the major task for

this council. Representatives include chief executives andfinancial officers from several Mayo Health System orga-nizations as well as both Mayo Health System and MayoClinic Rochester leaders. Formulas have been advancedto allocate capital funds based on a combination of localaccumulated depreciation and local operating perfor-mance. The capital appetite always greatly exceeds avail-able supply, but the perceived fairness of the allocationprocess has allowed a better understanding of financialissues throughout Mayo Foundation and has deflectedmany of the concerns of Mayo Health System leaders onthis issue.

9. Integration.—Clearly, a major benefit to the MayoClinic and to our many Mayo Health System organizationsis the ability to share resources, patient referrals, and medi-cal information across all sites. Many initiatives have beentried, with variable success. Mayo Health System organiza-tions have worked to avoid competition with other mem-bers of the system for the same patients and resources. Thediffusion of knowledge and understanding among MayoClinic and Mayo Health System providers has been a slowbut progressive process.

To facilitate planning and integration, many joint lead-ership and governance sessions have occurred. Educationalefforts within Mayo Clinic Rochester have helped with thiseffort. During the past year, joint strategic planning be-tween the Mayo Clinic and the Mayo Health System hasaccelerated to promote a dialogue regarding issues such asalignment of growth and access strategies. One such issueis the persistent tension between Mayo Clinic Rochesterdepartments and Mayo Health System organizations re-garding regional access to certain specialties such as car-diac surgery and neurosurgery.

A shared electronic medical records system is a highpriority for the Mayo Health System, and this goal is nowbeing realized. The sharing of clinical notes and laboratorydata between Mayo Clinic and Mayo Health System loca-tions has been determined to be most important. To achievethese goals, the Mayo Health System is completing a “Mas-ter Patient Identification Index” and a shared “IntegratedClinical Data Repository.”

Departments and peer groups from the Mayo Clinic andthe Mayo Health System are encouraged to meet periodi-cally to share ideas, continuing medical education efforts,and other resources. Several clinical departments have ex-celled in this effort.

10. Strategic Value. For Patients.—Patients have ex-perienced increased value from their local medical ser-vices since these organizations have joined the MayoHealth System. This value manifests as an increased num-ber of local care providers, local availability and relativelyseamless referral for more specialized care, a heightened



emphasis on local medical quality and efficiency, im-proved local facilities, increased local health education andcommunication, improved ability to recruit and retain high-quality medical staff, and increased prospects within localcommunities for a long-term and stable health care deliverysystem. Patient satisfaction surveys and patient outcomestudies have confirmed these benefits.

For Communities.—In many communities whosemedical staffs joined the Mayo Health System, a finan-cially stable delivery system was at risk. By integrating thelocal physician and hospital activities with those of theMayo Clinic, these communities have greatly strengthenedtheir likelihood of preserving a local health care option fortheir citizens in these financially distressed times for medi-cine. This benefit is particularly relevant for rural Midwest-ern communities, which are at the low end of the Medicarereimbursement spectrum.

Besides being a source of local pride and conveniencefor its citizens, local medical centers are a major source ofjobs and local revenue. A recent study of the economicimpact of the Mayo Health System in Minnesota during theyear 2000 revealed that the system had a direct and indirectimpact amounting to $570 million and more than 6000jobs. The Mayo Health System is among the largest privateemployers in southeastern Minnesota.

For Mayo Clinic.—The driving force to create a re-gional physician and hospital network was the need toensure that regional patients could continue to access theMayo Clinic for their specialty health care needs. However,as the number of facilities and geographic area served havegrown, it has become increasingly clear that the MayoClinic has accepted a new challenge of building and sup-porting a community-based health care delivery system.The region is 250 miles in diameter, involves portions of 3states, and contains more than 2.5 million people.

1400

No.

of

phys

icia

nsR

evenue in millions ($

)

1400

1200

1000

800

600

400

200

0

1200

1000

800

600

400

200

0

Revenue Physicians

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

Since the health system’s inception, physician-referredpatients from current Mayo Health System locations toMayo Clinic Rochester have increased from 4800 to14,000 patients per year. The number of patients coming tothe Mayo Clinic from counties within 120 miles of Roches-ter has also increased, from 64,000 to 96,000 patients peryear. This increase in the number of regional patients hascreated concerns about access capacity for national andinternational patients and has generated considerable dis-cussion within Mayo Clinic Rochester. The Mayo Clinicremains a national and international referral center as wellas regional health care provider.

Building on principles of relative local autonomy andfinancial self-sufficiency, the Mayo Health System hasbeen able to sustain itself financially in recent years, and inthe future, it should be able to fund its growth and practiceinnovation as well. This financial achievement is in starkcontrast to that experienced by most regional referral net-works in the United States.

ConclusionOverall, the Mayo Health System has grown and devel-

oped as a complement to the Mayo Clinic in most respects.Its focus on quality, referral activity, peer group interac-tions, strong regional community presence, and robustspirit as a professional partner of the Mayo Clinic have allcontributed to its highly successful first decade. The futurelooks bright for continued success.

Figure 3. Actual and planned growth of the Mayo Health System in terms of physiciansand net revenue.

REFERENCES1. Medical Group Management Association. Cost Survey: 2002 Report

Based on 2001 Data. Dubuque, Ia: Kendall/Hunt Publishing Co;2002:63.

2. Committee on Quality of Health Care in America, Institute of Medi-cine. In: Kohn LT, Corrigan JM, Donaldson MS, eds. To Err isHuman: Building a Safer Health System. Washington, DC: TheNational Academies Press; 2000.


mayo health system: a decade of achievement

Documents