Bobbi Pritt, M.D. (00:04):

Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic and your host for today's episode. I'm excited to be here today with Mayo Clinic Laboratories' CEO and president, Dr. Bill Morice, to get the latest news. And then Jane Hermansen will join to talk about laboratory outreach, including the value that outreach programs bring and how to maximize your program. But let's start with Bill and the news. Bill, welcome back.

William Morice II, M.D., Ph.D. (00:32):

It's good to be back, and I love this role of the color commentator on the news. It's a lot of fun.

Bobbi Pritt, M.D. (00:38):

It's wonderful. Yeah, and it's like, what's hot? What's new? So, of course, AI is always a good topic for what's hot and there's some really exciting things going on. In fact, you just came back from the Platform conference at Mayo Clinic what, a little while ago, so I'm sure you have lots to talk about with that.

William Morice II, M.D., Ph.D. (00:56):

Yes. It was very eye-opening, and there was news there that I think was right on the heels of the announcement from Mayo Clinic about working with Microsoft on developing a frontier model.

Bobbi Pritt, M.D. (01:07):

Yeah.

William Morice II, M.D., Ph.D. (01:07):

I don't know if you saw that.

Bobbi Pritt, M.D. (01:08):

I did. This is big news. So, Mayo Clinic and Microsoft are collaborating to develop a frontier AI model for healthcare. And it's my understanding now that the frontier AI model is sort of the next generation. I don't know if you want to elaborate a little bit on what frontier AI means compared to some of the older terms we've been using.

William Morice II, M.D., Ph.D. (01:28):

Yeah, it's funny. You know, when I started medical school, I'll never forget, they said, you know, your lexicon, your internal world dictionary, is going to double in your first two years of medical school. And it feels like that's happening now in AI, too. But the only difference between then, which was 1987 for me, and now is that now I just put it into a search and the AI itself answers the question for me. So, it's a little weird, but, frontier models, I think, really are the next iteration of foundation model. And it's really just another advancement of computing power that is even more predictive. It searches and collates across a broader set of data more deeply and uses that computing capability to do better forecasting or predictive, you know, filling in the blanks on the future. And so that's really the deal that has been announced between Microsoft and Mayo Clinic, is to take all this longitudinal Mayo Clinic data and get that computational power that Microsoft has to create something that will be very transformative in that it allows a scaling of Mayo Clinic knowledge in new ways, right? So, it goes back to something you and I have talked about for a long time, in how do we take the knowledge that in someone like your brain or my brain, and that comes from our collective wisdom at Mayo Clinic, how do we make that more accessible? And I think that's really the goal here.

Bobbi Pritt, M.D. (02:43):

Yeah. How can we use Mayo Clinic knowledge to help more patients around the world? And I love how this is purpose-built for healthcare, and it's my understanding it's initially going to be deployed within Mayo Clinic's trusted environment so it can be continuously tested and refined and improved.

William Morice II, M.D., Ph.D. (03:00):

Yes. That's my understanding as well. I mean it is hot off the press, but clearly trust building or maintaining trust in this age of AI and people's sensitivity around their data and just make sure the right decisions are made. Because so much of this now becomes, do you trust? Look, we trust Waymo. We get in the car now and trust it's going to take us someplace. So, we can get there, but it's really important that this is done correctly. Because if there's any missteps, it's going to be very detrimental for not only the people affected, but also just for the advancement of healthcare using these tools. So yes, that's my understanding as well.

Bobbi Pritt, M.D. (03:34):

Yeah. And it's just to build on that, it's my understanding that it's going to be trained on de-identified clinical data, so there will be protections for people and their private data, and then it will be improved with the real-world use.

William Morice II, M.D., Ph.D. (03:48):

Yes. And that's, I think, the other advanced capability of frontier models is that it's continuously improving, right? So, it's taking all the data inputs and continuously improving its modeling.

Bobbi Pritt, M.D. (03:59):

Yeah. Well, while we're on the topic of AI, another news story that I thought was quite interesting is at Boston's Children's Center, OpenAI, a company that we're all probably very familiar with, is using their system and did a study identifying 18 rare disease diagnoses. I believe that researchers looked at 376 previously unsolved rare diseases using an AI model and confirmed 18 new diagnoses. So, it's still a small component of that 376 unsolved diagnoses. But for those 18 people that didn't have a diagnosis that now do, I think that's a huge step forward. It's very promising.

William Morice II, M.D., Ph.D. (04:42):

Yeah, it's interesting because it shows both the promise and the challenges with AI, right? On the one hand, there were 18 people that had a diagnosis where one did not exist before. And that was through the power of AI. But still, it only solved a small fraction. Everything we've talked about, it's still healthcare, it still has a lot of legacy data architecture, legacy workflows, legacy things. It still needs to be navigated, and it still requires human knowledge and input to help really optimize these tools. That's the flip side of it is like, ideally what the tools will do is help us be more effective in our jobs. And I think they can be, but our jobs will change a little bit. But our job’s, kind of central, core purpose, and that is helping, as laboratorians, create information and convey it in a way that helps make sense to a provider and a patient, a doctor and a patient, and helps inform their care.

That's still going to be really required for that because of the complexities in healthcare and because of the individuality that you see in patients and in doctors. And so, it goes back to the Godfather of AI, a guy named Geoffrey Hinton, who actually I think got the Nobel Prize for AI. You know, 10 years ago, he made this pronouncement that radiologists were not going to be needed in like five years because AI was going to replace them. And I just read a very interesting article that actually has shown the opposite has been true. So, you look 10 years later and when he said that radiologists would be replaced, and there's more of a need for radiologists than ever. And I think it's because of all these other things that I just discussed, you know, just all the other complexities that really go into healthcare delivery that we as deliverers have to really be engaged to ensure that it continues.

Bobbi Pritt, M.D. (06:18):

Yeah, I've seen similar studies and analyses looking at how our jobs will change and for a significant proportion of us, it may be that they'll change very significantly, but there'll still be a need for our skills, especially in healthcare. And that there will be very few people in healthcare where their jobs will be completely replaced. So, I think just understanding our role in all of this and making sure that we're up to date, that we keep all of those ethical aspects of healthcare in our mind when we're using these new AI tools, will be important. But that we're going to be continuing to be a part of the process. I like the terminology AI-assisted or AI-augmented, because that's where I really see the most value.

William Morice II, M.D., Ph.D. (07:01):

I totally agree. And as you know, you as an educator, premier educator, I do think that's one area that we're going to really see change, is education. Both for existing people, those that are already in the work, and especially those that are trainees now. So, exciting times.

Bobbi Pritt, M.D. (07:16):

Yeah, definitely exciting times. Well, thanks Bill for the great discussion about AI, and I'm sure it's a topic that will come up again.

William Morice II, M.D., Ph.D. (07:22):

It's not going away anytime soon.

Bobbi Pritt, M.D. (07:30):

Welcome to today's deep dive. We're pleased to be joined by Jane Hermansen. Jane is the manager of Mayo Clinic Laboratories' Outreach Support Program, and she's here to share insights on the value that outreach programs bring to their organizations across the industry. Thank you for joining us today, Jane.

Jane Hermansen, MBA (07:48):

Oh, thank you. I'm so happy to be here.

Bobbi Pritt, M.D. (07:50):

Yeah, and this is such an important topic. You know, let's start with the basics. Can you start by telling us what laboratory outreach is, and what your team does?

Jane Hermansen, MBA (07:59):

You know, that's the first question we have to have with everyone that we actually talk to, because it starts with the basic definition of outreach, and it means something different to just about everybody. So, where we start is to say, outreach testing is testing that has a choice, outpatient testing that has a choice. If a patient is lying in a bed in a hospital, there's no choice as to where that testing is performed. But regardless of whether the physician is employed by the organization or they're independent, often we see that there's a lot of leakage, and patients aren't using the hospital-based laboratory for their outpatient testing. So, we call it discretionary outpatient testing, and business that has a choice. And it may come from employed physicians, may come from independent physicians. That testing might come from skilled nursing facilities in your community, or perhaps even other hospitals across the community or the region. But if we stick with the thought that it's business that has a choice and it's discretionary, that really covers it all for outreach.

Bobbi Pritt, M.D. (09:01):

Yeah, that makes a lot of sense. So, now let's go to the second part of my question then. What does your team do?

Jane Hermansen, MBA (09:07):

We have such a great time. So, we've got a wonderful team, highly, highly experienced and skilled outreach professionals that have worked in the industry for many, many years. And what we do is we work with our clients across the nation, hospital laboratories, and help them expand their outpatient footprint. And it might be from something as simple as answering a very easy question, a tactical question about how they're managing their departments today, or it could be all the way to helping them set a very large strategy for outreach program growth and expansion across their region. So, anything as simple as a very tactical question all the way through to a very strong and in-depth consultation activity. And, we do it all.

Bobbi Pritt, M.D. (09:53):

Well, that's great. And so we've covered the basics. Let's go into the value of outreach programs. I'm sure most people could think of a few things, but let's hear the full answer from you because you've given this so much thought.

Jane Hermansen, MBA (10:06):

You know, this is the elevator speech, right? So, when we look at it, we actually talk about all of the many benefits, and for us, we see it as job security, right? But there is so much more to it than that. I've been with Mayo Clinic for a long time, and I've seen how the growth of our outreach program has impacted and helped our laboratory department grow and be stronger and more effective across our entire practice. So, I really see the outreach program as a synergistic part of the healthcare delivery system. And to me personally, I see it almost as a moral imperative for an organization to serve the outpatient needs of their community. It's not just a laboratory test, it's so, so, so much more than that. But when we think about it, just specific at the level of the community-based hospital, the first piece is that continuity of care, the integrated data in that medical record.

So that same laboratory test that's done in the outpatient environment is now going to be carried through, and it's going to be on the same technology as the testing that was done for that patient when they were in inpatient. So physicians can follow their patients, they can track their progress, patients can track their own progress, and it's fantastic to actually drive patient care. And especially when we look at chronic disease management today, because tracking your data is going to influence and help you understand whether or not you're getting better or if your condition is worsening. So, that's the first one. How does that one sound? Good?

Bobbi Pritt, M.D. (11:36):

Oh, that was great. What else do you have?

Jane Hermansen, MBA (11:39):

Next one? Did you know that the outpatient laboratory touches between four and five times more patients than any other service line in an organization? And what we find is when patients have a favorable experience with their outpatient experience with laboratory, they're much more likely to use other services from that healthcare system. And if they are doing their testing for a commercial laboratory in a strip mall, they're more likely to go to the strip mall to get their healthcare. If they're really having a hospital presence and the hospital brand attached to their laboratory testing, they're going to seek the hospital healthcare system services for imaging, physical therapy, infusion therapy, whatever those other service lines are. So, laboratory becomes the feeder for those other services as well. That's number two. I have three more to go.

Bobbi Pritt, M.D. (12:30):

Well, I'll just quickly comment, Jane. It makes sense. But the laboratory is often the patient-facing component. It's what they see. And if the lab's not doing it right, or if the lab doesn't have a presence, then they may not even think of the healthcare organization.

Jane Hermansen, MBA (12:45):

And I think the phlebotomist is the hands of the laboratory and often the face and the listening ears and the caring piece. So, if we can actually have great people, frontline people, to influence the perception of the community on our care, we have already have really started off on the right foot with our patients.

Bobbi Pritt, M.D. (13:04):

Absolutely. Well, I'll let you go to the other three.

Jane Hermansen, MBA (13:06):

You bet. So the others are a little bit more business-oriented, I guess. So I'm a lab scientist by training and background. And I would have days in the lab when we were busy and days in the lab when we weren't busy. And what we find is that we want all those volumes to come in. We'd rather be busy. And when you're using your staff and you're using your equipment to its fullest, what you see is that the cost per test is going down in your laboratory. And when we look at capitated payments in an environment where we're so careful about costs, wouldn't you want to lower your cost per test? So by fully utilizing all of your laboratory to its fullest, you're going to reduce your overall cost per test because you're spreading your overhead across all of those different procedures. So, there's that financial aspect. And we also know that the outreach programs are vastly profitable because they are using that existing capacity within the laboratory. So, we see between a 30 and 40% contribution margin for nearly every outreach program that we work with because they are using that capacity.

Bobbi Pritt, M.D. (14:09):

Wow, that's amazing.

Jane Hermansen, MBA (14:10):

And then, the last two are really more about accountability. And one of the aspects of the outreach program is related to the accountability to the providers, and the great service that we provide, the excellent turnaround time, the quality of results, but also through the relationship that we have with our providers. We're able to actually help them understand and value the relationship with the laboratory. So when another laboratory comes in and starts talking to the doctors and saying, "Hey, I've got this fancy, fancy test, it's got a pretty chart and a graph, and it only costs $15,000," the physicians may be more likely to reach back to the hospital and say, "Hey, what do you think about this?" And I think that when you have those strong relationships in place, you're less likely to have some of that very expensive leakage and perhaps limit some of that inappropriate testing.

And then the last piece is really about accountability and representing your brand across your entire community of patients, employers, providers, the same people that are your outreach customers from a community-based hospital laboratory perspective. Same people that are your customers are the same ones that you're going to church with. The same ones you're sitting in the baseball stands with. You run into them in the grocery store. And there's a certain amount of accountability representing your organization's brand and bringing that service to the community as an extension of the organization you work for. So, it's all good stuff. That's how I see it.

Bobbi Pritt, M.D. (15:36):

I love that, Jane. The whole idea that you're part of the community, you're serving the community, it shouldn't stop just in an inpatient setting. It should go out into the outpatient setting for all those reasons you just mentioned, continuity being a big one. So, I have one last question for you.

Jane Hermansen, MBA (15:53):

You bet.

Bobbi Pritt, M.D. (15:54):

And it's another with three this time. What are the three most important things lab leaders can do to get the greatest value from their outreach program?

Jane Hermansen, MBA (16:04):

Oh, super question. And the things that they need to do, honestly, is to treat the laboratory outreach program like the for-profit service line that it is. And the laboratory needs to be able to message that to leadership as well. But if you're going to treat it like a for-profit service line, what do you need to do? First, you need to make sure you've got the staff in place to do that. And we find many places do not have anyone dedicated to managing or leading the outreach initiative. And it ends up being something that a laboratory leader is doing part-time. It's a hobby, and a hobby is never going to be able to turn into a business. So, we want to make sure that they have staff in place to manage it. The next piece you need to have is you need to know your numbers.

And what we find is that most lab outreach programs don't have a good feel for what their profitability is. They may not even know their net revenue; their numbers may be buried. So for them to have some discipline around the financial data is really important. And then the last piece that they need to do is be able to communicate not only those financials, but also then the other key performance indicators and the metrics that you need to show your outreach program's success. Whether it is through patient satisfaction data, customer satisfaction data, physician data, maybe it's through improved turnaround times because you're setting your testing up more frequently. It might be through managing your cost per test, through bringing those additional volumes in. So there are a lot of ways that you can actually tell your story. Some metrics are internal, some metrics may be external. So, I think it comes down to that staff being able to tell your financial story and then having the KPIs in place.

Bobbi Pritt, M.D. (17:53):

That's great, Jane. And while you were talking, I just thought of another question. I hope that's OK. So, this is more about just looking ahead. Healthcare is changing rapidly and outreach is evolving along with it. What trends or developments do you see emerging that could shape outreach over the next, say, five to 10 years?

Jane Hermansen, MBA (18:15):

I think we're going to see a lot more, and we've already seen quite a bit of it already, is just the patient engagement and the patient consumerism. So consumerism around, perhaps, price sensitivity. So we need to make sure that we are being affordable and providing laboratory services that are accessible to the patients across our communities. And that's something that a lot of outreach programs today are really taking a look at to make sure that they have a good plan going forward. And then I think that this is a gift that the pandemic brought us. I don't know if it brought us many gifts, but this is one that it did, was to help people understand the value of laboratory testing. But patients now want to be able to collect their own specimens. They want to be in the driver's seat around their diagnostics.

And in many states, as you know, we have direct-to-consumer testing as an option. So, patients want to be able to order their own lab tests and get their results because the more data they have, the more power they have to actually take care of their own care, which I think is fantastic. And then the other piece we're moving toward more and more is self-collection. And I think that if we can have great self-collection and ensure a high-quality specimen, we're going to have much more compliance in areas where patients before had to book an invasive procedure in order to actually get their testing done. So, I think we're going to see more engagement from the consumer side. So that's one thing. Another kind of a challenge or threat I see is just if the hospital leaders, laboratory leaders, are not treating their laboratory outreach program like the business or profit service line that it is, and communicating that value, that value might not be recognized by hospital leadership.

And then when an independent laboratory comes in and puts a nine-figure check on someone's desk in the executive office and says, "Hey, I want to buy your lab from you because you know it's hard, you don't have staff, reimbursement is hard. You don't want to hire all those phlebotomists, and oh my goodness, you can't do couriers." Think about it. You know, these are things that everybody should be able to do, but they tell this story, put a big dollar value on it. That's a really, really seductive piece. So, I see that as a huge challenge to make sure that laboratories are able to demonstrate and communicate their value to executives so that they're not tempted to sell the laboratory off to an outside company. And as we know, it's not aligned the same, and the power and control of your diagnostics, I believe is going to ensure your long-term success as an organization, and to let go of that precious, precious resource. I don't see anyone winning in the long run.

Bobbi Pritt, M.D. (20:58):

That's such a great point, Jane. Everything you've said is so important, but it really just goes to show something we've talked a lot about on this podcast: the importance of laboratory leaders being at the table, talking to their hospital leaders, making sure they have those connections so that they can have these types of discussions. And the lab leaders can come in and speak up when someone comes in and puts that big, you know, multi-figure check on the desk and offers to buy the lab. So the lab leaders can really justify and discuss the value. And hopefully the hospital laboratory leaders already know about the value because they already see lab leaders as colleagues, valued colleagues.

Jane Hermansen, MBA (21:41):

Absolutely.

Bobbi Pritt, M.D. (21:42):

It's a great discussion, Jane. Thank you again for joining us today. Such a pleasure.

Jane Hermansen, MBA (21:47):

I appreciate the invitation. Thank you so much. Take care.

Bobbi Pritt, M.D. (21:55):

Let's wrap up with the top takeaways and how to learn even more about the topics we've discussed. In the news today, we discussed two stories highlighting the use of AI in healthcare. And if you are curious about the use of AI in diagnostics, we've included two articles and a podcast in the show notes that explore its evolving role in our field. And then in the deep dive summary, Jane joined me to discuss how laboratory outreach programs could be a strategic advantage for laboratories. Mayo Clinic Laboratories' upcoming Leveraging the Laboratory Conference is a great opportunity to learn more about outreach. This year's event will take place in Rochester on September 23rd and 24th, and it will focus on how innovative approaches and strategic decision-making can drive meaningful results for outreach programs. We've included a link to learn more in the show notes, along with a resource hub featuring articles, podcasts, on-demand education, and tools to support your program. Thank you for joining us today. If you haven't already, make sure to subscribe so you never miss an episode. Next time, we will be talking about how clinical diagnostics help manage bleeding disorders. I hope you can join us.