Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. William Morice, President of the Mayo Clinic Laboratories

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Dr. William Morice, President of the Mayo Clinic Laboratories · Becker’s Healthcare - Clinical Leadership Podcast

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Thank you for tuning into the Becker's Healthcare Podcast. I am Molly Gamble,
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vice President Editorial, and today I'm catching up with Dr. William Maurice.
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Dr. Maurice is president of the Mayo Clinic Laboratories.
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He has been with the Mayo System for 23 years,
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including roles as Professor of laboratory Medicine and pathology with Mayo
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Clinic School of Medicine and Division Chair of Laboratory Medicine and
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Pathology. Dr. Maurice, thank you so much for joining me today.
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How are you and where do we find you?
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Um, uh, thank you for having me on number one. I, it's,
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it's a great pleasure to join you. Uh, I'm doing well. Uh,
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I've actually been at Mayo for, for longer than I've been here since 87.
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I've lost counted the actual years cause I came here for medical school and
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graduate school and, and never left. So I've been here for a long time.
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And that's where you find me today is in Rochester, Minnesota.
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Great. Well you took an opportunity that could have made you younger and,
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and you correct me, which I appreciate. I had my facts wrong there, Dr. Marie.
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So you've been there 87. That's says old as I am actually. So . Um,
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really, really impressive longevity.
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Yeah, it's the cold weather. It keeps you cryopreserved, so that's good.
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Well, let's talk a little bit about the lab. You know,
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I thought we could start there.
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The lab has always been so important to diagnostics and care delivery,
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but it seems like Covid 19 really threw labs into the center stage as
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everyone and their brother just gained at least a bit more familiarity with
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diagnostics and lab testing. My, you know,
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hearing my 95 year old grandmother talk about p c r tests, for instance. Um,
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how did renewed reliance on labs throughout the pandemic come home to
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affect your work?
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Well, um, I think that the, the visibility, obviously,
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as you mentioned right away, uh, it's a part of healthcare. Uh,
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even most people that choose laboratory medicine pathology as a medical career
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often do so after they've done other areas of practice. For myself,
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I did internal medicine first, um, just because it's not, so even within the,
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within the practice of medicine, it's not so obvious of the career choice.
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So that immediate visibility, um, was really quite, uh,
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profound and also need for understanding, right, uh,
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for people to really understand what is the role. Because now you have a test.
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First of all, where did the test come from? What's, what is the, um,
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you know, what is the entire life cycle of a test and meaning,
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what does it take to bring a test up?
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Because I remember early days March of 2020, uh, I was in Washington,
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DC as part of the American Clinical Laboratory Association's board meeting.
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I'm now the, actually the chair of that board. Um,
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and we were called to the Pence White House to,
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to meet with the Pence team on testing. And they, you know,
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that was the day that Trump made the announcement that every American that
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wanted to test or needed a test was gonna get a test and the test didn't exist.
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So I think it just,
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the whole idea of what does it take to build a test infrastructure?
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What does a test mean for an individual? What kind of information do you need?
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Because it's not just a test, but what does it mean for you?
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All that stuff was really thrust into the, into the, into the limelight for a,
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for a prolonged period of time. I mean, it was well over 12,
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16 months that we're really talking about testing once some way,
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shape or form as a major, a major news story globally.
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Do, do you think it did anything for expectations? You know, I remember too,
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you were talking about the early days of the pandemic and I,
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I think there was some frustration depending on where you were in this varied
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city to city, but wait times for test results. Uh,
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do you think by better understanding the entire, you know,
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test creation in individual testing like you mentioned,
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do you think the public gained more information and understanding of
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turnaround times or,
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or do people continue to have like Uber eats DoorDash expectations for
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immediate results like they do in most things right now?
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Well, I certainly, I think that, um,
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it created consternation for all of us that needed a test that they were so
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inaccessible. And I, and I, I think it really,
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it raised people's expectations about, um,
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cuz we've been able to do home testing for a long time. It's been a relatively,
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a very minor part of the overall testing, uh,
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landscaping the United States and globally.
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There's a real now and much more of an interest in this.
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It's probably not at the height of where it was say in now omicron wave of
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covid,
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but still there's I think a societal expectation that there's gonna be more
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accessibility to testing. Um, and,
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and also there's been a massive investment in the infrastructure cuz a lot of it
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was just that the inf the reimbursement of labs is such that it didn't really
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drive a lot of, uh, excess in the supply chain on tests.
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So now there's been a massive global investment in testing infrastructure.
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That's part of the dialogue we have to have in healthcare going forward is what
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are societal expectations around testing?
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How do we use what we've invested in to get us ramped up to provide testing for,
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for individuals and for patients, and how do we carry that forward? Uh,
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I think that's really important and it, and it,
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it is a societal question because, uh,
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as much as we think about convenience and the inconvenience of having to wait
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for a test,
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we also know that outcomes in covid were directly could be directly linked to
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access to testing, right? So, so areas and, and,
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and populations that lower access to testing tend to have poor outcomes.
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So we now really see this as part of the whole landscape of disparities as well
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as access and convenience.
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Dr. Maurice, let's talk a bit more about Mayo Clinic. You know,
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you mentioned you've been there for about 35 years,
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an exceptional place for healthcare, both on a national level,
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international level.
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Can you share some points of pride with me about Mayo's clinical or lab
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capabilities? I,
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I'm really talking to someone who heads up a lab at the best of the best in what
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American healthcare can be and can do. I'm,
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I'm curious if you have any stories that can encapsulate the possibility of what
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can be achieved at Mayo Clinic.
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Yeah, I'd love to. Obviously I've devoted my whole career to the place and, um,
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and I've obviously, and Mayo has done so much to enrich my own personal life,
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professionally and done so, I think does so much for,
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for healthcare in this country and globally. Uh,
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and I think it's important that institutions like Mayo Clinic really continue
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to, to, to be a,
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a voice in healthcare where healthcare is going specifically for diagnostics is
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very interesting in that. Um, so we have 150 plus year history, right, uh, of,
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of, of our institution, uh,
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very unique founding here in in rural Minnesota and then spreading from there.
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But if you look back,
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diagnostics a and laboratory medicine were actually one of the, the earliest,
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um, investments by the Mayo Brothers.
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We think of the Mayo Brothers and surgeons,
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but a lot of the very early innovations in diagnostics actually came out of Mayo
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Clinic, whether it's intraoperative frozen section, which was, you know,
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at the turn of the century or the first grading of tumors, uh, by Dr.
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Broders in the 1920s. It just goes on and on. And so the question is, you know,
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why, you know, why is that so important?
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Why was that so important to the Mayo Brothers and to the,
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to the early founders of Mayo Clinic? Um,
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and it really goes back to our model of care is is and what I'm really proud of,
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what's kept me here are values our Franciscan values,
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but teamwork is one of those key ones.
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And so the whole Mayo Vision was that you would have physicians and providers,
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healthcare professionals that focused on the need of the patient that when a
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patient came through the front door Mayo Clinic,
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they had a team of people that were all their,
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their primary job was working together, right?
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To understand and what came to be very serious and complex illnesses that
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couldn't get answered elsewhere, people were coming here.
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Information for that is actually the data.
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Any team functions best when there's clear understanding of the context i e the
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data, right? And, and good communication of that. So I think this,
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this whole investment of labs is really seeing labs cuz labs generate 70,
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80% of the quantitative data in the medical record, right?
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So the idea that diagnostics were so key for a team-based practice
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of medicine and the first integrated medical practice to work,
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that's the pride that I take in working at Mayo. And I, I tell people,
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I don't know if I would've done pathology but would've been at Mayo Clinic
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because we are as pathologists and laboratory in such an integral part of the
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care teams, um,
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what makes me really proud is the fifth year history of Mayo Clinic Labs because
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that through that activity of the reference lab,
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we've been able to open that team-based model of care outside of our campuses,
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right?
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Because patients can interact with the data and the providers and we can inform
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the care of that patient without them being around our campus through Mayo
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Clinic Laboratories. And so it, but it all,
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it forms a very much a symbiotic relationship where interacting with patients on
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the outside brings information into our institution that we can then learn from
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and share more information. Um,
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and so one real tangible example of that is we've had a long history of
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neurologic, very strong neurology practice.
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We see patients that come in many times after they've had other cancers or
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neoplasms and they have disorders of their neurologic system that are very
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difficult to understand and diagnose.
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Well it turns out that your brain and your central nervous system expresses over
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80% of the proteins in your body. So when you have something like a cancer,
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you can start to get antibodies to those proteins or immune reaction to the
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proteins or autoimmunity that can cause very specific and treatable,
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but sometimes irreversible if not treated neurologic diseases.
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And we now have a laboratory in Rochester that is staffed by
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neurologist who are seeing these patients and identifying these new,
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cuz there's so many, there's these new patterns of disease,
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but then we can make available to the outside world. So, so it's really that,
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that kind of ability to make the, the Mayo Clinic model more inclusive.
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That that, that's part of my real pride in working at Mayo Clinic,
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in lab medicine at Mayo Clinic Labs.
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And even the story of the origins of lab at Mayo Clinic. You know,
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you mentioned the Mayo Brothers are known predominantly for being surgeons,
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but also one of their fo first focus areas was the lab.
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That kind of goes back to your earlier remarks about how pathology sometimes
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blends into the background.
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It doesn't always receive the recognition that it should.
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Yeah. And it's just because we interact with it and I think that's coming,
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it goes back to the pandemic. Cuz most of the time when we think about the lab,
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we think about going to the doctor, doctor orders a test, test comes back.
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The interaction is very much with that, with that provider haven't been there.
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But then you start to step back.
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Covid forced us to take the macro view of testing.
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What does testing do for healthcare? What does testing do for society?
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How should testing be used going forward?
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And also the focus on the need for innovation, right? Because everything,
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whether it's covid and a new pathogen or what I just described,
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it's also a real hotbed for innovation. So we have to really think about that.
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Um, and last but not least in the,
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we are in the era of now big data and we just think now about large language
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models and everything else.
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If you think to the fact that 70 to 80% of data coming into the health rate
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comes out of the laboratories, even from a healthcare perspective, uh,
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and healthcare delivery,
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you still have to start thinking about that in a much different way.
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Mm-hmm. . Mm-hmm. ,
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I wanted to get a sense from you about how much of a concern over utilization
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of, of diagnostics or lab testing is.
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And I it seems as though there's so much, so,
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so much in healthcare is scarce right now or in short supply and it's been that
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way actually for, you know, for a number of years.
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But the issue of over the utilization,
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it doesn't seem like it gets the attention or the amount of conversation that it
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once did. Dr. Maurice, I'm curious, what's your view on this?
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How pressing of a problem is it, have we come, have we made any progress in,
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in accounting for it through data like you may mention of,
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or is it still something that is persistent?
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Um, I think it's still a hill that we have yet to climb. And I think it's a,
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it is a problem for, for my profession, for laboratory medicine.
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It's a problem for healthcare. But if you think about laboratories, um,
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that over utilization,
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I think that some of the studies have suggested that 30% or more of tests are
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overutilized you know, 30%, there's 30% excess in testing that's performed.
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It really does a few things that are really bad for patients and bad for
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healthcare. First of all, there's just the waste of the, of the testing itself.
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Second of all, it really forces, it,
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it drives you to think about something more as a commodity as opposed to an
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asset, right? So if we're over utilizing tests, we think oh,
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we can just do so many tests. We're now,
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that's one of the things that precludes us from seeing the value in testing for
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healthcare and for individuals. Um,
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and then last but not least is that that data actually drives
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more over utilization. So my passion and my, my background is,
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and expertise is in the diagnosis of blood cancers and particularly difficult to
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diagnose blood cancers, uh, a certain part of the immune system.
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And most of the time I would see patients getting evaluated for these diseases.
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Often it's because there've been overutilization of other tests that made the
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doctor think, oh no, I gotta rule out this rare cancer, right?
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As opposed to if we'd been more intentional about how we use the entirety of the
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laboratory,
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we can really focus those high power tools on the patients that really need it.
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What we're seeing is if we don't do that now,
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there's pushback from payers to actually pay for the test. So on the one hand,
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especially going into Covid now coming out,
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the promise was on individualized medicine or personalized medicine,
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which really connotes a deep level of diagnostics around each person so you
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really understand their disease. Those tend to be more expensive tests.
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If there's not a strong rationale to a payer for why they're being performed,
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they just see a more expensive test that's probably driving a more expensive
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therapeutic.
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So what it does ultimately is it actually decreases access to the more
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specialized care cuz over utilization is forcing payers to think of things more
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in bulk and just trying to drive out cost as opposed to creating value with the
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laboratories.
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That makes sense. Can you, just to make sure I understand you clear,
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can you walk me through an example of the lab data,
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the testing data actually driving more utilization?
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I think you just did at a high level on how payers receive it,
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but can you almost walk me through if,
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if there were a specific case you could illustrate for me so I better understand
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that, that thought?
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Sure, sure. So a, a really good example would be in cancer care again, right?
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And if you think now we are starting to migrate or,
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or really progress our thinking in medicine to think of can most
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organs we think of as organ-based cancers, right? There's lung cancer,
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there's colon cancer, there's breast cancer.
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To where now we're really understanding these as pathway diseases.
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Meaning there's certain,
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there's certain pathways by which cells grow and differentiate and know when to
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stop growing that can get perturbed in different sites in the body.
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And when they do, they can lead to cancer.
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And so the drugs are more targeted at those pathways, right?
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So we get much more specific treatment.
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The way we detect those is with typically with expensive next generation
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sequencing tests. And so those tests are much more,
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when we think of tests as being a few hundred dollars, that's one thing.
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When you think of tests being five, $6,000, it just gets a lot more attention.
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What I think payers are seeing is they see, uh, uh,
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an an increase in the use of these tests, right?
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So they can see now their lab spend is going up,
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it's going up on these more esoteric tests. Um,
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and at the flip side is they can also see the specialty farmer going up,
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but then they try and link them together in their databases.
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They don't see any rationale. So they'll see a patient get a, you know,
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a very expensive test, maybe get one or two cycles of a drug.
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They can't actually match that.
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The test results drove the prescription of the drugs. So now they just say,
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well let's put in a lot of prior authorization just so it's not too many people
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get this test cuz So it's the only tool that they have as opposed to let's work
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with academic medical centers,
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let's work with medicine to develop treatment guidelines so that we actually
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think about the testing as part of that treatment guideline cuz then will then
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drive the use of the therapeutics. So that's an example that's seeing thousands,
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you know, of of,
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of these tests being performed without any kind of care-based rationale for the
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performance of the test and then driving expensive drugs. Hope,
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hopefully that makes sense.
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No, it does. Thank you. Thank you very much for the example. Um, yeah,
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I'm curious about that. I think you, you raised some,
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some really good stats there.
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You know how it's still a hill we have to climb 30% or more of tests are
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overutilized also.
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I i I think it's a really interesting point you raised about how it can drive
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one to think about testing as a commodity more so than an asset.
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Is that something that you've seen as a long-term like cultural risk almost and
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how diagnostics are,
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are treated and thought of in a system?
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Yes, it is a,
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it's a risk for healthcare for patients and it lies on both ends of the
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spectrum. Because on the flip side, there's often,
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when we talk about over-utilization and you think about less expensive tests,
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we know there's a lot of tests that are actually underutilized and particularly
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in the management of chronic illnesses. And that kind of goes back to, um,
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when you, the, to me,
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if we start to think about diagnostics as a tool that can help us to bend the
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cost curve in healthcare, which we have to do as to how do you use he,
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how do use diagnostics across that continuum of care.
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Cuz we probably are under utilizing at home or easily accessible tests to help
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manage chronic diseases to make sure patients don't get into trouble like
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diabetes or heart disease, right?
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So we might have underutilization at that end of the spectrum and
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overutilization at other ends.
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So really thinking about what diagnostics can do holistically to drive value in
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healthcare across the board from, you know,
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intensive episodes of care around cancer to the management of chronic diseases,
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I think is where we need to go.
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And that's why being smart about how we use the test,
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the purpose and the value that they're creating in each episode will be really
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important. And, and there again, we had those conversations in Covid.
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How can we make them persist when we talked about screening tests and their
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value in helping protect people from the spread of disease and those things,
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right? You have to think about, it's not just a test,
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it's a question you're trying to answer and the setting that it's in,
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that we all have to come together.
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And so it really is very much a healthcare issue.
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Mm-hmm. We've talked a bit about covid,
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we've talked about about Mayo and its history.
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We've talked about still some challenges that the system needs to confront.
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Let's talk about what's new, what's a relatively new or emerging issue. Dr.
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Marie said it's been commanding a significant amount of your attention as of
18:15
late. Uh,
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I would love to learn more about it and also why you find it so compelling or
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concerning in this moment.
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Um, it really twofold. I'll talk about the, the,
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the medical side first and then sort of the, the, the,
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the policy side second. Um, so I think on, on the medical side,
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it's an extraordinarily exciting time and I think I, I have the benefit of,
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again, growing up and being, I I tell people I'm home ized .
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I mean I've only been in Mayo, so, but to be,
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it's a very boundaryless if you think about it,
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it's a whole ethos of our institutions around teamwork and then we tend to be
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boundaryless in our areas of care. So I don't think about a machine,
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I think about the lab and I think about radiology and I think about the patient
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and I we're entering an era where all this data can start to flow together.
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Uh, digital pathology is sort of the last, will be one of the last strongholds,
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if you will, of the old way of practicing, like practicing laboratory medicine.
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Once we get to where the actual histology is digitized and we can see continued
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evolution of things like chat, G p t and large language models,
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you can start to imagine where having all this information can come together
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much more rapidly and seamlessly for a patient. So the,
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so the lab rather being as symptomatic of fragmentation and care is actually a
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solution. We think about tools that sit on top of diagnostics,
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whether they're radiology or labs that actually create a much more seamless
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experience for a patient and let them know where they need to go, access care,
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what level, et cetera, et cetera. To me that's a,
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that's a super exciting time cuz that's what I've always thought about is that
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the,
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the whole purpose of this is to get as much information around that patient and
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the provider, the physician to really create meaning for them.
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And so this is a time we could actually achieve that in,
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in ways that we never could before. Um,
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so that's my passion is driving towards that and again,
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thinking about everything from at-home testing to the really esoteric stuff that
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we do at Mayo Clinic. In that equation,
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the concern that I have really is around, uh, around policy. Uh, particularly,
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uh, you know, in my role at the American Clinical Laboratory Association,
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we still have the protecting access to Medicare Act, which is, you know,
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if there's not another delay, we'll see a drop in reimbursement. Uh,
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for many of the, of the, of the more commonly ordered tests,
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labs are already financially strapped.
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Laboratories are one of the three pillars along with surgical procedures and
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radiology that support a lot of hospitals. So it could be destabilizing there.
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So on the one side we see this promise,
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but then you see the risk of particularly reimbursement being dropped because
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again, we're not thinking about the value of the labs, but rather just the cost.
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And the cost is such a small fraction of overall healthcare.
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And then there's regulatory things as well. How do we continue to work with, uh,
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you know,
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to work with other stakeholders so they can feel like we're safely innovating.
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The labs need to be, they're,
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they're really at this intersection between the practice,
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the medicine and science and technology.
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So we need to really be thoughtful about regulatory practices that might govern
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that.
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Zooming in on the policy side first, and then I'll share a thought with the,
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the medical side that you just described, Dr. Maurice,
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but you had mentioned the payers are being a bit more rigorous and challenging
21:20
or prior offing the daylights out of those specialized expensive
21:25
tests that can be ordered.
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And what you just described here is a drop in reimbursement for commonly ordered
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tests.
21:30
So it seems like both the extraordinary and the ordinary are going through their
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own sets of reimbursement struggles.
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Yeah, they are. It's a bit of a silly crib, if you will. Um, they're the, uh,
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you'd at both ends. Um, but it does,
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it's just a real need to understand not just the role of
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laboratories in healthcare,
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but also to have a mind towards how that translates into the economics of
21:57
healthcare and the sustainability of healthcare. So we can have more informed,
22:00
either create for payers the tools that they need, that they, cause look,
22:04
payers don't really,
22:05
they use the private payers use things like prior auth because they just don't
22:09
have very many uh, um,
22:11
mechanisms or levers they can pull to control some of these things.
22:14
So we have to understand that context and, and really focus on that. And,
22:19
and same on on the, like I,
22:21
like we talked about how do we start to create their payer databases.
22:24
There's lots of places where you can go and create the financial models that
22:27
demonstrate the economics of the,
22:29
of the situation that will actually get to more to reimbursement policies
22:33
that will actually drive healthcare behaviors in the direction that we wanna go.
22:38
And a less frictionless way for patients.
22:40
Cause it's really patients that get stuck in the middle. But that's,
22:43
we have to really view it in that way.
22:44
That's why I'm excited in my role now as the president and CEO of Mayo Clinic
22:48
Labs, that's my focus now is thinking about that,
22:50
that taking my 35 years of experience if we count medical school and trying to
22:54
pivot that now to think about these issues. Mm-hmm.
22:57
. And then the other part you mentioned about the digital pathology
23:03
kind of last frontier in so many ways as you just described,
23:05
for patients especially.
23:07
But what struck me as you were talking about that where all that data lives
23:10
together is how much more upstream opportunity there can be for, for patients,
23:15
for care teams to have all that information stored in one place to be able to
23:20
build upon it. It, it seems like so much of healthcare,
23:23
there's so many problems downstream that seems like such a great and bright
23:27
opportunity further upstream that could really be seized and a lot of value
23:32
derived from.
23:33
I I couldn't agree more. And I think that's, look,
23:37
I I I love that I've been at Mayo for my career. Uh,
23:40
my wife loves it cuz she's from Minnesota, so we've raised our family here. Uh,
23:44
but uh,
23:44
but the reality is that we need to think about ways that that knowledge and that
23:48
places like Mayo and others, there's been many great healthcare institutions.
23:52
How do we make that more scalable for patients, right?
23:55
Mayo Clinic Laboratories and getting the testing out there was,
23:57
was a first step in that.
23:59
As we think more upstream and about how this data is coming together and created
24:03
the digital technologies like Drer's vision around Mayo Clinic platform for
24:07
Mayo. Those are the things that start to make that knowledgeable, scalable.
24:10
Because if we're not thinking about access,
24:13
if we're thinking about just building ivory towers,
24:15
then we're not doing what we should be doing for healthcare. So, so I,
24:17
I think that's the excitement for me is to think upstream cuz that's where that
24:21
scalability of knowledge and knowledge exchange comes from.
24:26
Well, Dr. Maurice, we've touched on so much in this interview, but you know,
24:29
one thing we haven't talked about is,
24:30
is your role and your professional journey.
24:33
And like I had mentioned the introduction, you,
24:35
you hold the number of roles at Mayo.
24:38
I'm curious if you have any advice for colleagues listening who may like you
24:43
transcend boundaries of specialist, researcher, executive,
24:47
what is most important as you find yourself thriving in each of these related
24:52
but distinct roles with Mayo Clinic?
24:55
God, um, it's, uh,
24:57
I think the one thing is that follow your curiosity. Continue to learn,
25:03
continue to be open. I mean, everyone, I think my,
25:06
where I am in my career is that I'm just been blessed to be around a lot of
25:10
really smart people that have taught me lots of different things. And, and so,
25:13
and then you just continue to accumulate different sorts of perspectives that
25:17
become valuable to you and hopefully valuable to others as you go through your
25:21
career. Um, so, and, and, uh,
25:23
and the other thing is to really identify your passions and, and go with them.
25:27
You know, it's, it's, uh,
25:28
I've always been a very inquisitive person just because, you know,
25:31
you were born when I was starting medical school doesn't need id to stop being
25:35
inquisitive at this point, right? So I think those are, those are the things.
25:39
But, um, surrounding yourself with good people, being curious, being humble, uh,
25:43
hopefully I, I I embody some of those things.
25:45
I think those are the real keys to me.
25:47
Yeah.
25:49
Is there anything we didn't touch on in our time together that you'd like to
25:51
make mention of?
25:54
God? Well, we talked about a lot, so, um, I don't know. I think we,
25:58
I think we touched on the, on the, on the high points for sure. Great.
26:01
Now we might get transcendent to the areas I shouldn't talk about on the
26:04
podcast.
26:05
Like the fact that I actually sing in public every year at Christmas for my,
26:09
for the town halls, which stuff like that, which probably I shouldn't do,
26:12
but .
26:14
Well that's even all the more impressive given you are, you know,
26:17
a lifelong red Rochester. I, I don't know if you live there, Dr. Maurice,
26:21
but she nonetheless worked there for 35 years and sing every year. Um,
26:24
you can't be that bad. So, , um, I, I wanna thank you for your time.
26:28
I learned a lot from you today.
26:30
Thanks for sharing your thoughts with our listeners and helping us see and
26:34
remember the value of labs specifically. I,
26:36
I wanna wish you continued to lock in your, in your role with Mayo.
26:39
Well, thank you very much and again, really a pleasure. Uh,
26:42
thanks for having me on and I, I've really enjoyed it.