How AI could bring Mayo-quality health care to everyone

My wife, Autumn, has spent nearly a quarter of the past four years in ERs and hospitals, untangling and battling three chronic conditions — and a shamefully broken U.S. medical system.

We live in Washington, D.C., with top-rated hospitals in our backyard. Yet her experience has been eye-opening and often horrifying, especially for a nation that spends twice as much on medical care as our rivals.

What it's like: ERs so hauntingly jammed she's often stacked like cargo in hallways, on a stretcher, waiting double-digit hours for care.

Well-intentioned and often talented nurses overwhelmed and overworked.

Doctors forbidden from, or uninterested in, working with experts beyond their domain to solve complex conditions. It's random luck if you get a specialist willing to even show up to your hospital room.

You need a forensic detective to hunt down medical records scattered across random portals and hospitals. And then a miracle to get anyone to piece them together for clues. "It feels like riding a stationary bicycle when you need to be somewhere," Autumn says.

And we're the lucky ones, with blue-chip insurance, a sophisticated understanding of the system and resources to attack problems. Most patients don't have those things.

All of this left us infuriated and hopeless — until we landed in a small Minnesota city and glimpsed medical nirvana: the Mayo Clinic in Rochester. It was like discovering a foreign land — or seeing a future that could and should be.

The best part: I soon discovered AI could easily help unlock the best of Mayo for everyone. Dr. Gianrico Farrugia, a gastroenterologist who's president and CEO of the Mayo Clinic, told me he's racing to show the federal government and other hospitals how to replicate the Mayo magic.

How it works: Mayo doctors work as teams. They're paid to heal, not to operate or medicate. Nurses handle four or so patients — fewer than we've experienced at even some of the best hospitals back home.

Everyone is kind and talented. Rooms are clean. Every appointment begins on time. Imaging and blood tests get scheduled immediately, not after months of anxious waiting. Results land instantly in your online portal.

But the real difference-maker: Doctors and patients leverage massive databases of medical information, sorted and analyzed by AI, then channeled into 500 different algorithms to help find cures and better serve patients.

It's a real-time, real-world fusion of man and machine, helping patients get healthier, faster by tapping into superior medical data about you and others with similar conditions.

Consider cases like Autumn's: She has several different things wrong requiring expertise across many domains. Few, if any, humans could piece together this puzzle alone. This is where AI could make a big impact — now.

Mayo recently signed a deal with Microsoft to expand and expedite its own frontier AI model to further scale and refine this work. Both Mayo and Microsoft are fine-tuning the AI with hopes of sharing it broadly.

"None of this works unless health data is arranged maximally for humans and AI agents," Farrugia told me. "What makes it work or scalable is organizing all the knowledge so doctors can use it optimally and so agents can use it optimally, so we get the best data to help patients."

The catch: "I could give this to every hospital — and they can't use it." That's because most hospitals lack the technology, money, systems and focus to use health data drawn from patients and broader pools.

The government needs to force hospitals to change, with "carrots and sticks," Farrugia said. A new data architecture needs to be formed ASAP. Done right, this would be a life-changer for the chronically ill like Autumn, who often get the worst, least coordinated attention.

Here's the kicker: A variety of studies show Mayo is cost-competitive, and works with private insurance as well as Medicare and Medicaid.

Scaling Mayo's system everywhere

Illustration: Aïda Amer/Axios. Stock: Getty Images

It's a national disgrace that a nation so rich, so innovative, provides such crappy care to our sickest Americans. Most pay new Cadillac prices for used Ford Escort outcomes.

This isn't OK: We could simply admit our failure and rebuild the health care system, using Mayo as the base model.

Mayo is built on three core principles:

Doctors are paid flat salaries. No bonuses for more procedures, scans, tests or visits. They're paid to heal. American health care's original sin is fee-for-service: We pay most doctors for volume, so we get volume. Mayo removed the incentive to overtreat, and the entire culture reorganized around the question that should drive all medicine: What does this patient actually need?

Doctors work as teams, not individual know-it-alls. Mayo practices multidisciplinary medicine. So gastroenterologists, liver specialists and surgeons all work together to evaluate complex cases like Autumn's. The doctors do this in days, under one roof, with constant communication. Compare that to the standard American experience: months of siloed referrals, repeated tests and specialists who, maddeningly, never speak to each other.

Patient-first culture. This was the most striking thing to us: Every person from surgeons to desk clerks seemed caring and kind. They were obsessed with understanding Autumn and smartly diagnosing her before recommending any actions. As someone who started and has run two companies, I can tell you: Cultures are controllable and scalable. We should demand this of every medical institution in America.

And here's proof these principles scale: They aren't unique to Rochester.

Kaiser Permanente pays salaries to its physicians and coordinates care for 12 million members. Cleveland Clinic pays flat salaries with one-year contracts and annual reviews. Geisinger built integrated, team-based care in the hills of rural Pennsylvania, hardly a talent magnet on paper. Intermountain in Salt Lake City shows promise in spreading Mayo...

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