Mayo Clinic is pledging to transform hospital medicine through a $5 billion expansion of its Rochester campus that will reshape the city's skyline and bring care to patients — rather than the other way around.

The clinic over six years will erect five buildings, including a nine-story patient care complex, that will connect via a "skybridge" to the existing campus. Mayo hosted Gov. Tim Walz and other dignitaries Tuesday to publicly launch the project.

A key goal is to create "neighborhoods" where patients with similar conditions receive all of their care, rather than segmented departments that have patients walking and traveling across campus for consultations and tests, said Dr. Craig Daniels, a physician leader of the project. Online tools will prepare patients for admission before they arrive and acquaint them with the hospital's relocated entrance.

"Some patients really have a once-in-a-lifetime journey to Mayo Clinic and they arrive here with concern, with fear," he said. "We need to honor their arrival by replacing that fear with hope and confidence that we are doing the right things for them."

The expansion fulfills Mayo's commitment to the Destination Medical Center plan hatched a decade ago to maintain Rochester as a global health care destination. Minnesota pledged $585 million in state, Olmsted County and Rochester taxpayer funds over 20 years for civic improvements to reach that goal.

"We are seeing, today, the reality of that," said Rochester Mayor Kim Norton, who served in the Legislature when Destination Medical Center was created in 2013. "We are seeing the manifestation of that commitment that we all made together."

The expansion comes at a challenging time, even for Mayo, with its international reputation for care for complex and mysterious diseases. While the health system is showing signs of economic recovery, its operating income declined by 50% last year because of rising staffing costs and capacity problems that left its hospitals stuck with patients who couldn't be discharged on time.

Daniels said the project is the largest in Mayo's history but similar in goals to the invention of a pneumatic tube system a century ago that conveyed medical records across campus and inspired team-based patient care. It is part of a broader initiative to replace Mayo buildings that are outdated with modern technology.

Upgrades are underway at Mayo's hospitals in Mankato, La Crosse, Wis., Scottsdale, Ariz., and Jacksonville, Fla.

"We need to build new space and invest in technology for our patients and for our staff," Daniels said. "We can't ask them to continue to practice in a difficult environment. We need to give them the tools and resources they need in order to make health care fantastic again."

Construction will start in early 2024 with the demolition of existing Mayo buildings. The health system still needs support from the city of Rochester for traffic designs, including the permanent closures of 3rd Avenue SW. and 4th Avenue SW. between Center Street and 2nd Street SW.

Parking will shift during the project, but should increase to 1,300 spaces in the end with the construction of two ramps. A Mayo spokesperson said the health system will keep neighbors updated about the project, including the construction of the patient complex that will thread between two churches.

The project doesn't require a legislative exemption to Minnesota's hospital bed construction moratorium, because it will keep Mayo under its licensed capacity of 2,059 beds, Daniels said.

Inpatient care will continue at the St. Mary's campus on the west edge of town, but not at the Rochester Methodist Hospital building downtown, which instead will host clinical trials, outpatient clinics and medical classrooms, said Dr. Amy Williams, Mayo's executive dean of practice.

The old Lourdes High School building will be converted into a logistics center and connected to the Mayo campus by a tunnel.

Mayo was heavily invested in planning and preparation for the project last spring when it threatened to pull the plug if lawmakers passed legislation it opposed. The gambit worked for Mayo, disrupting plans to give nurses more direct authority over their staffing levels and create an affordability board that could penalize high-cost hospitals.

Walz negotiated alternatives with lawmakers following Mayo's threat, and was on hand Tuesday to celebrate the expansion of Minnesota's largest employer.

Mayo is going "above and beyond" by investing in its birthplace and expanding in ways that will improve health care for generations, he said. "There is no more important place on the planet and no more important work being done for humanity than is being done in this spot in Rochester, Minnesota."

Hospital leaders have bemoaned the shortage of transfer options when patients are ready to leave — which results in the boarding of patients in inpatient beds and backlogs lasting hours or days in emergency rooms. Minnesota gave $18 million in financial relief to hospitals just for the amount of boarding they reported in the first five months of 2023.

Williams said the project will help by investing in personal health technologies that allow more patients to recover from hospitalizations at home with monitoring by Mayo.

Mayo wants to "blur the lines" separating inpatient, outpatient and online care on its campus, she added, because patient needs often get missed in the handoff from one to the other. If that blended approach works, it could offer lessons to other hospitals that reduce costs and improve care, she added.

"We're hoping this is a learning lab for the world," Williams said.