Dr. Sherine Gabriel, Dean of the Mayo Medical School at the Mayo Clinic

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Mark Masselli: This is Conversations on healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret the second open enrollment period has officially ended
for Americans to sign up for health cove rage on the Affordable Care Act. Analyst
predicts the numbers will have exceeded the administrations expectations.

Margaret Flinter: And the recent SMS suggest th e number was higher.

Mark Masselli: A number of Americans vote to be doing their taxes un til they get closer
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to the April 15 deadline and won’t discover they will pay a penalty for a lack of
coverage until it’s too late.

Margaret Flinter: This could be the teachable moment for those Americans who just
weren’t aware of their tax liability o r the fact that they would qualify for subsidies if they
bought insurance through the exchange.

Mark Masselli: It does offer an interesting solution for folks who didn’t sign up for health
coverage by the end of the open enrollment. Many Americans were getting different
messages about the Healthcare Law depending on where you live.

Margaret Flinter: And no matter where you live in this country Mark you are likely to
have heard of the Mayo Clinic. One of the most vulnerable and respected health
institutions in this country and our guest today is the Dean of the Mayo Medical School
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which is building a new medical school that’s focused on 21 century care.

Mark Masselli: Dr. Sh ern Gabriel we will talk about the need for creating better medical
training models that reflect the dramatic changes that are under weighing the healthcare
system.

Margaret Flinter: And Lori Robertson Managing Editor of FactCheck.Org will be
checking in . She is always seeking to uncover misstatements made about health policy
in the public domain.

Mark Masselli: But no matter what the topic you can hear all of our shows by going to
CHC Radio and as always if you have comments please Email us at CHC Radio or find
us on Facebook or on Twitter. We would love hearing from you.

Margaret Flinter: Now we will get to our interview with Dr. Sherine Gabriel in just a
moment.

Mark Masselli: But first here is our producer Marianne O’Hare with this week’s he adline
news.

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Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. The
Obama administration is allowing a Special Health Law in Roman period from March
th th
15 to April 30 for consumers who realized well filling out their taxes they owe a fee for
not signing up for coverage last year. Especially the moment period applies to people in
37 states covered by the federal marketplace . There were some state run exchanges
are als o expected to follow suit. They will still have to pay the fine which for last year
which for last year was $95 or 1% of their income whichever is greater. The
administration also said it sent out the wrong information to 800,000 people to help
them calc ulate whether they received too much of its subsidy. Those affected are being
notified by email or telephone and are being asked to wait to file their taxes until after a
new 1095 - A form is sent in early March. Meanwhile and their first since officials b egan
gathering such data insurers paid less to critical care hospitals in January in the same
month last year. Experts believe it’s the public pressure and private pressure to drive
down cost as one of the reasons. Insurers are attempting to save healthc are cost by
lowering the hospital bill so they are more aggressively bargaining with hospitals and
investing in programs that do lower hospital utilization rates. And a new (inaudible
03:16) on HIV Aids, a new compound has been so successful in blocking the virus
scientists are impinge up their efforts. This approach creates a y shaped protein with
both head and tail inhibiting the virus’s pathway for infection on two fronts. Researchers
are calling this the broadest a nd most potent entry inhibitors so far having thoroughly
having blocked infect ion in monkeys for up to a year. I am Marianne O’Hare with these
Healthcare Headlines.

Mark Masselli: We are speaking today with Dr. Sherine Gabriel, Dean of the Mayo
Medical School at the esteemed Mayo Clinic in Rochester, Minnesota as well as the
Mayo Medical School planned to open in Arizona. Dr. Gabriel is an internist specialized
in epidemiology and rheumatology. She has been a co - director of education for the
Mayo Med ic al Center for translational science activities. Since 2006 she served as a
President of the American College of Rheumatology. From 2007 to 2009 she earned
her MD at the University of Saskatchewan College Of Medicine and completed her
residency at Mayo Clinic College of Medicine. She is the recipient of the Mayo
Distinguished Educator Award. Dr. Gabriel welcome to Conversations on Healthcare.

Dr. Gabriel: It’s my pleasure to be here.

Mark Masselli: Yeah, yeah. Well the Mayo Clinic is somethin g that I think everyone in
the country knows but perhaps they don’t fully understand the Mayo Model of Care and
maybe you could illuminate our listeners if you will about that service team Model of
Care.

Dr. Gabriel: The model of care centers around thre e basic tenets. One is patient
centered culture. It’s in the air we breathe here I think and that provides everything we
do here so I think I would say first and foremost it’s that patient centered culture and
then secondly a culture of teamwork. This is not a place to build an empire because we
all work in teams and that again is across the entire institution and then thirdly I would
say it’ s the people who are here. We have managed to and we continue to recruit
individuals who are not only excellent at what they do but whose personal values and
professional style align with our culture here and so at the end of the day it really is
about the people who work here really at all levels.

Margaret Flinter: Well Dr. Gabriel Recognition of Patients Centered Medical Homes
certainly brought a new focus on that in terms of very specific things that we are asked
to do in healthcare and I would be curious of the PCMA standards as they have been
developed for providers all o ver the country. Do they get at this heart of what it means
to have patient centered care above and beyond any individual standards?

Dr. Gabriel: So any sort of standards really don’t get an entire concept but what they
can do is bring attention to it and help us begin to think about a sort of complicated
construct like patient centeredness and begin to think about how we would measure it,
how we would and you know if you can’t measure, you can’t improve it. How can we
begin to get our arms around the complicated construct so I think there is a real need
for standard? They begin to put us on a path helping to define that construct mor e
clearly for everybody in order that we can measure it, in order that we can improve it
and be able to demonstrate our patient centeredness to society.

Mark Masselli: You are currently as I think many people in the country are in this
process of reimagi ning, reinventing medical training to take into account their sort of
rapid change landscape that we are seeing in healthcare. Can you describe for our
listeners the innovative approach that you bring to medical training and helping you
achieve your goals?

Dr. Gabriel: Well at Mayo Medical School our goals is to train th e next generation of
physician leaders in patient centered team based science driven high value healthcare.
In order to make an impact it’s important for us to aim to train the sugg estion leaders of
tomorrow and the first important tenet of the way we train them is patient centered and
then also the foundation of science will always be first and foremost and team based
and everybody is trying to move towards a high value medical mode l where we are
providing just the absolute best quality for a price that American Society can manage
and so that’s what we are trying to do at Mayo is just kind of simply stated we like to s ay
that we are transforming how, what and where we teach at Mayo Medical School so
how having a lecture at the front of a lecture hall, students sitting in seats for hours on
and we are moving towards a blended learning platform where we are bringing
education technology to bear in ways that haven’t happened. I t has happened in higher
education elsewhere but not so much in medical education and so we are in
collaboration with ASU who are helping us with the online delivery piece we are
changing what we teach bringing in as required curriculum for the first time disciplines

that we call the science of healthcare delivery. And so we are training our students to
not only giving them the tools and knowledge to help appeal the healthcare system.
Thin gs that basically none of us learned in medical school but we belie ve the next
generation of physician leaders is going to need to know. We now envision Mayo
Medical School as a National Medical School and so we are expanding our footprint to
build a four year branch school at our Mayo Arizona Campus and also working with our
community partners at all of our sites. We believe it’s important to expose the next
generation of physician leaders to as many different practice opportunities and medical
challenges as possible and we want to leverage the very large nat ional footprint of
Mayo Clinic to provide those kinds of educational experiences.

Margaret Flinter: Maybe I could go in a little bit different direction than I was planning to
and talk about the who you are teaching it to? Maybe you could tell us a little bit about
who are you reaching out to and trying to engage as medical students and is that one of
your focus areas as we think about diversity, as we think about workforce surges, as we
think about primary care.

Dr. Gabriel: Yeah and so it’s cha llenging you know recruiting a medica l student is a
challenging task. Because we are a small school we only admit and in our Khan S chool
in Rochester, Minnesota 50 students per year and when we opened a four year branch
school in Arizona it will be about the same size and we believe that size is important,
that small size is important and we have actually learned that as we learn ma ny things
from our own students. And so when we engage our students in as much of our
strategic planning and thinking about the future of t he medical school as possible and
when we talk to them about expanding the school they helped us understand in a much
more personal way how valuable it was to them to have that small community and the
ties that they were able to build across and among one another and so that’s why we
have decided or at least one of the reasons we decided that we are going to keep the
school the same size in Arizona you know double the size by replicating that kind of
small intimate environment. So with respe ct to what kinds of students we recruit we
really go back to our vision and we try to align our recruitment strategies in our
admission policies to that vision so we look for leadership experience. A patient
centered care is there anything about their experience that really resonates with science
driven of course we look for that scientific foundation and then the high value healthcare
piece we are looking for student to appli cant who think about healthcare as the future of
the healthcare system and are engaged at some level with this national debate. Again
to maintain our alignment with where we want to go as a school when we think about
our admission strategy we try to tie i t to that vision but in order to be a national school
just to get back to that and in order to serve all of those goals diversity has to be a part
of that and has to be central to that because I think there is good literature now as the
more complex the ta sk that you are trying to solve the more valuable having a diverse
team to solve that become and so we look at diversity in all of its definitions. Obviously
diversity in terms of backgrounds , diversity in terms of race and gender and sexual
orientation and religion and diversity of thought so we try to look at that construct as
broadly as possible and try to bring to bear as many diverse applicants as possible
again who align with our vision and our culture at Mayo.

Mark Masselli: We are speaking today with Dr. Sherine Gabriel, Dean of the Mayo
Medical School at the Mayo Clinic in Rochester, Minnesota as well as the Mayo Clinical
School planned to open in Arizona in 2007. You know Dr. Gabriel I want to pull the
thread a little on this new value you have introduced to or the sort of science driven care
and we are certainly all familiar with that. The healthcare is moving towards a patient
centered care and patient centered medical h omes will be the norms but we are also
entering in a new area in medicine where personalized medicine and genomics are
game changer sort of science driven. How do you see these advances being
broadened to the broader scope of the work at Mayo Clinic as we ll as the clinics around
the world and how will it impact the art of the medical education moving forward. Well it
basically is an extension of what we and frankly many other medical institutions have
already been doing and science is pushing us to consider genomics in ways that we
haven’t in the past. We are recognizing for example that the primary determinants of
health were first of all are the social determinants of health and behaviors which is also
becoming a very important part of medical education and more important part of
medical education certainly than what I trained and genomics so those two things
together are the primary determinants of health and so to the extent that we can focus
our medical educati on and our models of care towards those two areas the more we are
going to be able to impact health and again if the primary tenet is the need to the patient
come first then we have to pay attention to genomics, we have to pay attention to the
social deter minants of health.

Margaret Flinter: Well Dr. Gabriel it’s hard to imagine where you find time in addition to
your duties as Dean of the Mayo Medical School to serve as the cha ir of the
methodology committee at PCORI the Patient Centered Outcomes Research Institute
and I suspect that your Mayo experience and background informs some of that work
that certainly PCORI has made many grants for research and it really kind of brings
together the two things the science and t he patient centeredness. And maybe we can
share with our listeners a little bit about the work that PCORI is doing in have there
been any what you would consider promising breakthroughs today.

Dr. Gabriel: Well you know first of all when the United States GAO called and said we
would like you to serve as a capacity.

Margaret Flinter: You don’t say I am too busy.

Dr. Gabriel: Yeah you don’t really say well I am kind of busy this week so I was truly
honored to be appointed, to PCORI and it was a very, very exciting experience I have to
say and it really is ground breaking. PCORI is all about patient centeredness. First two
letters of PCORI but they are taking the patient centered concept to a much higher level
in the context of outcomes research and so imagine a research study where patients
are involved every step of the way so they help to find the research question to be
studied in the first place. They help with the design of the study, understanding what
are the best measurements from a patient’ s perspective, they help explain the outcome,
they help disseminate the results I mean that’s really the vision of PCORI and it was

ground breaking at that time and it was just very exciting to be a part of that and as you
say PCORI is shaping outc omes research and hopefully in forming medicine for the
future. Now avoiding the question have there been any promising breakthroughs
because the grant have only gone out in the last couple of years and I think the answer
to that is not yet but stay tuned . I think there is some very exciting work that’s been
funded by PCORI and just early results are coming out now but they should be coming
out in the next years too.

Mark Masselli: Dr. Gabriel we remind our providers that at our primary care sites that
the challenges are not necessarily the hundred minutes a year that patients spend with
us but rather the other 526,000 minutes a year that they spend in outside of the
healthcare facilities so we have this whole issue abou t s ocial determinants of health,
pov erty and housing, food and security, unemployment how much focus are you placing
at Mayo and the underlined causes in the predetermined it’s a poor health and how is
prevention playing a role in the evolving model of care and medical education as well?

Dr. Gabriel: Well a lot of that comes under that new required curriculum that we have
that we are calling the science of healthcare delivery and by the way that terms have
beginning to g ain grounds so other institutions are thinking about that as well and so we
do talk about the social determinants of health and it’s very important for our students
again if the goal is to train the next generation of leaders to understand what the
determi nants of health are and the role that healthcare has to play and healthcare is
actually left of a health determinant than genetics and a social determinants of heath put
together so to the extent th at our students understand that, that our providers
understand that and hopefully we will be able to inspire some of our students to actually
play a big role there whether it’s the healthcare provider or on the health policy side of
things it’s just import ant to highlight that and of course preventio n has always been a
part of our education and it continues to be a part of our education process but her job
as healthcare provider is to improve society’ s health to be able to understand at a
deeper level what are the determinants of health for our society and our communities
and that’s what we are focusing on in this new curriculum.

Margaret Flinter: We had been speaking today with Dr. Sherine Gabriel, Dean of the
Mayo Medical School at the Mayo Clinic at Rochester, Minnesota. To learn more about
her work please go to @MayoClinic on Twitter. Dr. Gabriel thank you so much for
joining us on Conversations on Healthcare today.

Dr. Gabriel: It’s been my pleasure thank you.

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Mark Ma sselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about Healthcare Reform and Policy. Lori Robertson is
an award winning Journalist and Managing Editor of FactCheck.Org a non - partisan,
non - prof it consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson : Is there a connection between illegal immigration and the recent
measles outbreak? That’s what representa tive Mel Brooks suggested but while it is
difficult to pinpoint precise origins of disease outbreaks there is no evidence supporting
the link between the recent outbreaks and illegal immigration. In a radio interview
Brooks a republican from Alabama said that the immunization practices in the home
countries of immigrants who are living in the US illegally could be responsible for
outbreaks like the recent spread in measles. That outbreak includes most of the 102
cases in 14 states in the month of January. It is likely that the outbreak originated from
outside the US but the director of the CDCs National Center for Immunization and
Respiratory Diseases has said illegal immigration isn’t the likely culprit. Americans
returning from travel abroad or foreign visitors could have brought measles to Disney
Land Parks in California. The countries under investigation as a possible source
include Indonesia, India and the United Arab Emirates. For part of 2014 the CDC was
able to pinpoint the origin for 280 cases of measles. It counted 45 direct importations to
the disease which included 40 US residents returning home and 5 foreign visitors. Onl y
3 of the transfers came from the America. As for countries vaccination rates back in the
1980s Central American Countries had low rates of measles vaccinations but that’s no
longer the case. Since 2000 those countries rates for 1 year olds have been la rgely on
par with what have exceeded that of the United States and that’s my FactCheck for this
week. I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major politi cal players and is a project of the Anna Bird Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked Email us at
CHCradio.com. We will have FactCheck.org Lori Robertson check it out for you here on
Conversa tions on Healthcare.

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Each week conversations highlight a bright idea about how to make wellness a part of
our communities in everyday lives. Vaccinations are considered one of the great public
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health achievements of the 20 century reducing fatali ties for most common and failed
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diseases by up to 99% but in the 21 century some of those numbers just aren’t
stacking up. As recently as 2009 only 45% of the nation’s preschool aged children had
received all of their recommended vaccinations and booste rs and researchers at the
Children’s Outcome Research Program at Children’s Hospital in Colorado decided to
take an in depth at the problem.

Primary care practitioners are so overstretched. There are so many competing
demands. There are so many financial problems they are having that it’s rather
impractical and they also require at a level of technical expertise that sometimes they
don’t have.

Dr. Allison Kempe heads up the children’s outcome research program and she
conducted a study on what would help to generate better compliance with the required

vaccination s which is a goal of the government’s healthy people 20 - 20 initiative and she
found that when parent’s received timely reminders from their state and local health
departments parent’s were much more likely to get the vaccinations and boosters for
their children that they needed more than if they simply relied on reminder from their
primary care provider.

Dr. Allison: What our study did was to centralize those efforts so it didn’t take away
from the primary care providers but it helped them to do the reminder recall for their
practice essentially using a state registry so this was much more efficient and m uch
more cost efficient .

Dr. Kempe says that her research shows that when a reminder message can be
generated for an entire population across communities it takes the onus in the burden
off of the primary care and pediatric practices. Her study showed th at those affects
were pretty significant.

Dr. Kempe: In a fairly short 6 month period in the counties where this was done
centrally about 19% of children who are not up to date became up to date versus about
13% in the practice based recall state which o n a population level within 6 months is
really very powerful.

Dr. Kemp e’ s work suggest that a regional or state immunization information system like
the one in her home state of Colorado could provide the most efficient means of
outreach and the study also suggest that there is a cost savings with a centralized state
or county run database and reminder system both in terms of the vaccines themselves
and a reduced medical cost as fewer children fall ill.

Dr. Kempe: Particularly Potosi’s, Measles and even H Influenzae, Haemophilus
influenzae and you have one case of Haemophilus Meningitis can co st tens of
thousands of dollars. The cost of not preventing these illnesses are very high.

A state health department driven vaccination program that assist private practices in
vaccine compliance for their patient population improving vaccination rates of young
and vulnerable children while improving the public h ealth now that’s a bright idea.

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Margaret Flinter: This i s Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University.

Streaming live at wesufm.org and brought to you by the community health center.