Mayo v. McAllen – The Battle for the Soul of American Medicine?
In a June article in the NewYorker, surgeon and writer, Atul Gawande brought life to the landmark ‘small area analysis’ work of team Darmouth, i.e., Wennberg, Fisher, et al. The Darmouth crew has been studying and documenting the widespread and unjustifiable variations of medical practice patterns by US geographic regions for quite some time.
Gawande’s genius insight was to put a timely face on this ‘value proposition inequity’, by comparing Medicare’s practice patterns and cost profiles from two demographically comparable Texas communities – El Paso and McAllen.
For historical context, this inexplicable and unjustifiable range of practice variance including cost profiles, is not news. I recall circa the 1986 timeframe when Deak Wooten, the then Director of Blue Cross of California’s ‘Prudent Buyer’ plan (an innovative PPO), under the stewardship of Leonard Schaeffer (pre Wellpoint roll-up, or better yet ‘Mashup’ of healthplans), presented the concept of ‘small area analysis’, stressing the need to minimize variation both as a quality enhancing as well as cost savings ‘management initiative’. Yet, here we are today, some 20 plus years later, and the concept is only making its way into the American psyche as a result of the intense national debate we are witnessing relative to US health reform initiatives.
While Gawande brings the issue to main street, the bigger and perhaps more strategic question is nested in his narrative on ‘who will ascend to “anchor model” status in US medicine’, Mayo or McAllen? Few in the popular press or even healthcare sector seem to focus on the profound implications of even calling the question!
Worse yet, Gawande cautions:
“Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing.”
This strikes me as an urgent call to action. Especially when considering, when Gawande refers to “Mayo”, he’s referring to that class of medicine as represented by Geisinger, Kaiser, Cleveland Clinic, Intermountain Health, and other group practice cultures that have spawned progressive integrated delivery system (IDS) network models; where ‘integrated’ means merging both direct care & financing platforms.
If the “Mayo’s” of the world fail, then there is no hope for a public/private market solution to the chronic ‘whack a mole’ phenomenon of US health care. The government will step in and put the private sector out of it’s collective misery – not a picture I favor!