Over the years, the Mayo Clinic has built a reputation by drawing presidents, princes and ordinary citizens to its world-class facilities.

These days, the hospital system is using technology to do just the opposite -- help more patients benefit from Mayo's medical expertise without the expense and disruption of travel.

The Rochester-based hospital system has spent the past year forming alliances with a select group of hospitals, an arrangement that gives doctors online access to Mayo's clinicians as well as a way to promote a partnership with one of the world's premier medical brands.

"It's key that Mayo Clinic remain relevant," said Dr. David Hayes, medical director of the Mayo Clinic Care Network, which now has 11 affiliates. "We're trying to have the types of connections in places that we think might be valuable down the road."

The strategy allows Mayo to broaden its reach at a time when health reform efforts are touching off waves of consolidation. The trend has been underway for years as a way to buttress the rising costs of care, but the federal Affordable Care Act has quickened the pace and forced new alignments. Physician practices are merging or getting bought up by health care systems and even insurance companies to try to prepare for cost-cutting and uncertainties ahead.

Hospitals in the Mayo Clinic Care Network pay an undisclosed subscription fee for online consultations and for access into Mayo Clinic's research on what it regards as best treatment practices. St. Elizabeth Healthcare in Edgewood, Ky., on Wednesday became the latest organization to join the network.

"It's not about money, it's not about reimbursement," said attorney Tim Johnson of the Minneapolis law firm Gray Plant Mooty, who represents health care organizations. "It's about getting your name out there. For Mayo, it's a concern that some of these organizations will affiliate with the local university, say, and they're trying to get their foot in the door first."

The Cleveland Clinic launched a similar affiliates program seven years ago, focused largely on cardiovascular surgery. Houston-based MD Anderson Cancer Center and Geisinger Health System in Danville, Pa., also have non-ownership partnership arrangements.

Such alliances are a creative and less expensive way to build allies, analysts say, particularly as more patients get treated in outpatient settings and as the federal health law calls on hospital systems to line up as "accountable care organizations" to reduce costs.

Mayo has used what it describes as a "rigorous vetting process" to establish affiliations in Minnesota, Arizona and Florida -- states where it operates major centers to treat complex illnesses. But it also has used the networks to plant its flag in new markets or to fortify outposts against competitors.

It has signed up hospital systems in western Minnesota and the Dakotas, where competitors such as Sanford Health are already operating. And at least one organization, Heartland Health in St. Joseph, Mo., severed ties between its cancer center and MD Anderson to sign an exclusive deal with Mayo.

Second opinion

Dr. Scott Charette, a vascular surgeon at Altru Health System in Grand Forks, N.D., has used the online consulting feature a half-dozen times since May 2011, when Altru became the first organization to sign onto the Mayo Clinic Care Network.

The process is simple, Charette said. He logs onto a confidential website, types up his thoughts, and a nurse attaches relevant patient data, such as lab reports, CT scans or ultrasound images. Mayo clinicians send a response within 48 to 72 hours.

The consultations often help solidify his thought process, Charette said. In a couple of cases, Mayo provided patients a reassuring second opinion for no extra cost to them.

"You have your own idea what would be good in an unusual situation, but sometimes you're out here on your own, and you don't have a lot of specialists in your field to bounce things off of," he said. "It's good to get their input."

Since signing on, more than 56 clinicians with Altru have sought e-consultations involving some 310 patients, hospital officials said.

For Karen and Bill Buck, the connection with Mayo helped the couple, both in their 70s, avoid a seven-hour drive from Grand Forks for surgery after an Altru doctor found a second cancerous tumor in Bill's colon a year ago. "It's added comfort to have that kind of expertise down at Mayo joining with the wonderful doctors here," Karen Buck said. "We feel like we're getting double our money."

The Mayo Clinic's Hayes stressed that the goal is not to grow the network for the sake of growth, but to have strong strategic alliances with strong health care organizations. Mayo is involved in the care of about 20 million patients worldwide each year, but wants to grow to 200 million a year within the next few years.

The network is one way to get there, while remaining "top of mind" as a referral for patients with more complicated illnesses, Hayes said.

"Even if we're keeping more patients locally in Grand Forks," he said, "it's the ones that are the most top of the pyramid of complex care -- the kind of patients we love to see -- we want the Mayo Clinic to be the first place people think of and send their patients to us. That's where were think we can hit a home run."

Jackie Crosby • 612-673-7335