Talking Value, Culture, and CAR-T with the CMO of Mayo Medical Labs

Curtis Hanson, MD, is a hematopathologist by trade. But as the chief medical officer of Mayo Medical Laboratories at the Mayo Clinic, he spends much of his time trying to create value in the health system with smarter, more efficient laboratory testing work.

While in Minnesota for the Mayo Clinic’s annual Transform meeting, Healthcare Analytics News™ sat down with Dr. Hanson to discuss the evolving role of CMOs, the culture of the prestigious medical practice and research firm, new and novel treatments like the recently-approved Kymriah, and more. This is the first part of that conversation.

Is the role of the chief medical officer in an institution changing right now?

The Mayo Medical Laboratories is uniquely organized. We work closely with the Department of Laboratory Medicine and Pathology here at Mayo, where all the laboratories exist and do the testing, and MML provides that front- and back-end connection to the marketplace and to the clients. It’s a little bit of an oxymoron, in that we don’t do the actual testing at MLL, but we make the connections and bring the power of Mayo Clinic laboratories to the issue.

So in the context of a referral laboratory, it really is changing. I think it’s due to changing technologies, changing expectations of providers, more involvement of payers into the work of laboratories The CMO really comes down to making sure that, strategically, the organization is aligned appropriately with medicine, medical care—also assuring that there is an appropriate connection between the business and the practice. That’s a heck of a lot harder than it used to be.

What makes it so much harder?

If I go back and I look at when I started in the late ‘80s, at that point in time I remember a senior individual told me that I’d go through one or two changes in the laboratory in my lifetime. The lifecycle of a technology was like 10 to 15 years. Things were pretty constant. What I’ve seen over the last 30 years is that lifecycle keeps getting shorter and shorter. Now the lifespan of a test or a technology is 2, 3, 4, 5 years.

Look at next-gen sequencing: It was a research tool with uncertain utilization, and now it’s routine. That’s happened in a handful of years. I remember working in a research lab when PCR [polymerase chain reaction] first came up. It took years to go from that research application to the clinical laboratory. I think that’s a reflection of how the lifecycle has shortened down. It puts a lot more pressure on that change and on that practice.

What does the attitude and culture of the Mayo Clinic do for its ability to innovate?

It’s the commitment from top to bottom. A lot of times you go into organizations and you might have commitments at the top level, but you don’t have it all the way down through the workforce.

Everybody has smart doctors. It’s the commitment of the allied health staff to take those values to action, in believing in what Mayo does. I don’t know that it’s really a Midwest thing, but I think it helps being in a small town. There’s less distractions here.

You talked before that question about the increasing involvement of payers into laboratory work. What is happening there?

It used to be uncommon that you’d get a laboratory test that cost more than a few hundred dollars. Now you have laboratory tests that are thousands, even 5-digit numbers. The complexity of those tests and the number of them have really grown. Payers, I think, legitimately ignored laboratories for a long time. It wasn’t on their radar. Once you start having multi-thousand dollar analytes that are being requested for payment, that’s going to get their attention.

Will that testing boom continue with all of these increasingly complex sort of precision medicine treatments, like CAR-T treatments? They’re going to be enormously expensive as well, but do you think one-offs like those represent a concept of value-based care?

I’ve got multiple comments there. I’m hematopathologist, so I’m very aware of CAR and its potential use and its proposed use in a variety of hematologic diseases. I’m acutely aware of its potential when you see some of the results.

When it comes to value-based care, though, it’s ultimately about outcomes. You can have fantastic technology, but if it doesn’t affect outcomes, that’s where value-based care kicks in. Whether CAR-T or gene editing become part of routine medicine will ultimately depend on outcomes. I know it sounds basic. Does it decrease hospitalizations. Does it prolong life? What are the measures that make it a value proposition?

Do you see the complexity of these treatments, with the amount of necessary testing and the cost, being prohibitive for their use in smaller hospital systems?

It’s hard to know. Certainly, in the short-to-intermediate term, just because of the complications that can occur with the treatment, you’ve got to be in a place that can handle that. That in itself will limit initial availability.

It may be a bad analogy, but I go back in time to remember when transplants were really restricted to high-end academic centers. Now you have transplants occurring in community hospitals. Next-gen sequencing was in the realm of high-end academic research labs, and now the industry—the IVD manufacturers have figured out how to get applications to smaller hospitals. That’s the American way. Eventually we’ll get there, but I think it depends on how well they can control complications.

Are there lessons to be taken from something like the growth of transplantation from specificity into ubiquity?

It’s time and education and understanding how to handle complications. Can you establish more standard ways to respond to or predict those complications? Then it can become a little more routine. Certainly with CAR-T or CRISPR, it’ll take some time to get to that point.