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Focus and Impact: The AMA's Long-range Strategic Plan

James L. Madara, MD
Executive Vice President and CEO
American Medical Association

American Medical Association
Annual Meeting
Hyatt Regency, Chicago
June 16, 2012

Mister Speaker, Mister President, members of the Board, delegates, guests:

It was only a year ago that I introduced myself to you from this podium. During those brief remarks, I shared that it was the important work you do here in this House and throughout the AMA that attracted me to this vibrant organization.

I also described some of the commonalities between my tasks here at the AMA and those at other institutions I've been proud to work at – the University of Chicago, Emory, and Harvard.

The common thread running through all of these remarkable institutions is that each offers an opportunity to do work that has far-reaching impact.

I'm grateful to arrive each morning at a place that assigns me the task of making our mission statement come to life: "to promote the art and science of medicine and the betterment of public health." Nothing could be more satisfying.

The work of our AMA has "real life" consequences for America's patients and physicians. The decisions we make and the actions we take here have far-reaching implications on how health care is practiced and delivered in this country.

I've emphasized to the AMA staff that by influencing and shaping something as vital and universal as health care – we have a unique opportunity to change the world.

Now that may seem like a stretch to some, but in fact, the AMA has changed the world for the better during its 165-year history and I believe we can and will continue to do so in the future in an even more powerful way.

In a moment, I will outline a long-term strategic plan aimed at changing the world for patients and physicians. A plan focused on improving health outcomes, accelerating change in medical education, and shaping payment and delivery models that ensure high quality care and value while enhancing physician satisfaction and practice sustainability.

First, though, I'd like to touch on a topic that is simple but, I believe, profoundly important: How we conceptualize and describe our AMA.

When I became part of this organization, I had no idea how far our AMA reached into American medicine and the broader health care sector. And as I have learned, neither do the vast majority of Americans, including many of our physician colleagues.

During last November's Interim meeting, I pledged to you that I would work to ensure more patients and physicians in this country understood the important intersections the AMA has in their lives each and every day.

That work is well underway. Looking around at this meeting or perusing the pages of this year's Annual Report – you will see the many ways we are working to bring the AMA Equation to life.

An equation that seeks to capture the answer to the question: What is our AMA?

The truth is that while our AMA is many things, there are five core elements which, combined, capture it well.

  • First – the AMA is the Voice of physician organizations. You are that voice. Here in the House of Delegates – you give voice to more that 185 physician groups representing the vast majority of physicians in this country – a vast majority that, through you, determine AMA policy, and elect our Board and President. As a consequence this voice is respected in Washington, our statehouses, and other arenas of influence because it is the only one that represents all physician groups.
  • Second – the AMA is a forum for direct personal engagement for physicians through AMA membership. This past year, our membership increased modestly – and while we are pleased, we are hardly complacent. We continue to explore new and novel ways to connect directly with physicians – an obvious element linked to our success.
  • Third - We provide expertise helping physicians manage their practices –– valuable resources like CPT, our Practice Management Center and Health IT information and resources. This includes the AMAGINE platform and the strategic alliance we forged with AT&T earlier this year to scale it nationally.
  • Fourth - The AMA is a revered source of research and education, career support and practice enhancement. This includes our work in ethics, education, public health and our work in the quality arena. It includes JAMA and other AMA publications – circulated to more than 315,000 readers each week. JAMA is one of the most respected medical journals in the world and under the leadership of its Editor, Howard Bauchner, will become even more prominent as the AMA's nine Archives journals integrate the JAMA brand into their titles next January as part of the JAMA Network.
  • Fifth - The AMA is the authoritative advocate for physicians in Washington, in the Courts, alongside you in State Legislatures, and in the public through our Advocacy efforts. If in doubt – witness the $200 million that was returned to physicians earlier this year as a result of AMA's leadership in the United Healthcare reimbursement settlement. Or the AMA's prominent role in shaping ACOs so they work for physician practices; or other successes Dr. Carmel will highlight shortly.

Taken together, these five core elements: the House of Delegates; individual members;  Practice Management Tools; Research and Education; and Advocacy – comprise the AMA Equation. An equation that intersects with the vast majority of physicians – members and non-members in powerful and significant ways each and every day.

As I stated a year ago – no other physician group has the resources, expertise and opportunity to influence the future of health care in this country more than our AMA.

Over the next few days, this House of Medicine will form consensus around such pressing issues as: enhancing value of care, ensuring an adequate physician workforce, developing quality improvement efforts that are physician led, and critical issues related to health-IT.

While the AMA must always address the most challenging issues confronting our profession, prudence requires we simultaneously recognize that our resources, while deep and impressive, are by definition, finite.

We simply can't fight every battle of every scale and expect to have the type of impact we've had throughout our 165-year history.

Successful leaders in the business world learned this lesson early.

Bill Gates said that focus was a key part of his success.

And Steve Jobs built Apple around the idea of focusing on a small number of high quality, impactful and revolutionary products.

Their focus was critical in changing our world.

Likewise the AMA must bring a tighter focus to what we do so that our efforts are concentrated on the long term and our work will have the greatest benefit for our members, our non-member colleagues - also represented by this House – and, importantly, our patients.

Our AMA must never lose sight of its fundamental mission to promote the art and science of medicine and the betterment of public health.

A New Strategic Direction

So: What's the plan?

Today, I would like to update you on the progress the AMA Board and senior management team have made in refining the AMA's strategic focus over the next five years.

I know many of you have already heard something about this longer range strategic direction – either directly or indirectly.

A few months back, Drs. Wah, Gurman, and I conducted a series of conference calls with leaders from our Councils, Sections, and Special Groups, along with many of the executives from our state and specialty societies.

I greatly appreciate the letters and emails I received from many of you voicing your support for both the transparency and direction of these efforts.

But today, I want to make sure the important work we are doing is understood by all.

The process began last July when the Board convened for its annual planning session.

As the board considered the diverse and challenging issues confronting us, it became clear that to have significant impact on issues and move them forward in meaningful ways, a more focused approach was needed.

The AMA Board charged senior management to develop an approach that would guide us in crafting a rolling 5-year, strategic plan with emphasis on two dimensions:

Focus and Impact.

The Senior Management team launched a review of our mission-related activities. We started with the work being done in our Research, Education and Advocacy areas – because this work is so embedded in our mission and impacts physicians in several critical ways. Thus this initial plan focuses on the areas of the AMA equation circled here. We are committed to examining and strengthening all areas of the equation, but for this discussion, let me focus on Research, Education, and a piece of Advocacy.

Our planning process began with inputs from across the AMA. We asked the question: What is our foundation in these mission areas? The answer: our foundation is the product of this House – our House policy. And that served as our starting point.

This is just a partial list of House policies that guided the direction of our plan. Mercifully, I'll not read each here. 

Next, we looked at the environmental context of health care delivery and physician practice today. We considered the forces exerting pressure on physicians, patients and the current healthcare system – much of the underlying work here lay in the reports prepared for this House over recent years.

From there, we developed a short list of criteria which were approved by the Board – key questions aimed at helping identify issues where AMA engagement could have significant and meaningful impact. Questions such as:

  • Is the activity aligned with our mission?
  • Is it of urgent and critical importance to the future of health care?
  • Does it align with a broad base of physicians?
  • Can the AMA make a significant, measurable, positive impact?
  • Does the AMA have the credibility, competence, and resources to make a significant impact?
  • And, what's the likelihood of the AMA being recognized and getting credit for its role?

While these criteria may seem obvious, taken together they provided powerful guidance in the development of our long-term strategic direction.

This internal review was augmented with other important inputs, including the AMA Council on Long Range Planning and Development Stakeholder Report, which looks to identify issues and areas for AMA engagement.

In addition, we engaged a panel of external experts to review and evaluate our mission-related work and activities.

From this extensive work, three areas of focus emerged. They are: improving health outcomes, accelerating change in medical education, and shaping delivery and payment models that demonstrate high quality care and value while enhancing physician satisfaction and practice sustainability.

Having these three areas emerge is not all that surprising – because work in these areas is already the focus of so much of what we do at the AMA.

This work will require a strategic shift for the AMA – focusing more on outcomes, than process. And elevating our role from simply convening to partnering and doing – but it aligns completely with our current AMA agenda.

Let me touch on each briefly.

Improving Health Outcomes

The first is improving health outcomes.

For more than a decade, the AMA has provided leadership in developing and implementing quality and performance measures. We had the good foresight to convene the Physician Consortium for Performance Improvement.™

Now, our leadership in this area will evolve toward tracking and improving outcomes – work that will be important to the future of medicine and the health of our nation.

Our work in this area will build upon and complement the work of the AMA-convened PCPI®.

We believe enhanced AMA and physician engagement and leadership in the quality arena is timely and will be welcomed.

Together, we will pursue the following goals: demonstrate improvements in clinical and patient-reported outcomes; ensure health equity, reduce unwarranted variation in care, advance the quality and safety of health care; and contribute to the appropriate use of finite health care resources.

In order to achieve these goals, the AMA will identify a focused set of outcomes of high potential impact on the US population, and set a course of innovation and action to address them that encompasses a full lifecycle improvement.

We will begin by identifying 2-3 outcomes this year, eventually aiming for 7-10 on our "AMA dashboard."

The time to tackle such heady work is now. Improving outcomes for patients is not a possible scenario in our health care future – it's a certainty. As one former secretary of HHS recently said to me: "outcomes are the future". Physicians are the best qualified to craft and lead efforts toward improving health outcomes. Physicians engage directly with patients. Physicians lead health care teams. And this House has passed several resolutions aligned with this goal.

The payoff for doing this work right, and under physician leadership, is significant. By impacting health outcomes positively, we can improve patient satisfaction and reduce health care costs – lofty goals, but ones worthy of AMA commitment and engagement.  And, outcomes being "the future", Physicians must lead the way.

Accelerating Change in Medical Education

Next is accelerating change in medical education.

In response to dramatic change in the US health care system, including how care is organized, delivered and financed, along with mounting pressures of workforce capacity, the AMA will work to strategically reshape physician education in the United States.

Across the continuum of physician education, the gap between how physicians are currently trained and the future needs of our health care system continues to widen. The AMA will work to bridge this gap by accelerating bold innovation in medical education.

In keeping with the AMA's Initiative to Transform Medical Education and our historic leadership in physician education at all levels, the AMA will work to create a future state that better aligns education outcomes with the changing needs of the health care system.

Working closely with our Council on Medical Education and other strategic partners, including medical schools and health care delivery systems, we will work to catalyze the development and adoption of needed improvements in undergraduate medical education.

For example, our young colleagues need to understand how health care is financed and delivered so that they are fully prepared for their leadership roles in shaping the health care system of tomorrow.

Or promoting flexibility in medical student education that is competence-driven rather than calendar-driven training, allowing select students to reduce their medical education debt by combining the 4th year of training with the first year of residency.

Or promoting training that enhances the development of physician skills that better support physicians' roles in patient-centered team care.

The medical school initiative is central to the AMA's leadership across the spectrum of physicians' training. While focusing on undergraduate medical education, our voice in critical issues such as GME funding will not diminish or waiver.

We know undergraduate medical education must change. Our Council on Medical Education has clearly spoken to this need as have several House resolutions. Authoritative voices outside the AMA, including the AAMC and the Institute of Medicine, have also agreed. Our students are the future of this House, our future leaders in Medicine, we must now act on their behalf. As in the first focus area, these changes will come and physicians should lead the way.

Enhancing Physician Satisfaction

Our third focus area is identifying, shaping and promoting payment and delivery models that promote high quality care and value while enhancing physician satisfaction and practice sustainability.
We will, of course, continue our federal and state legislative advocacy. Working to shape emerging legislation in creating an improved delivery system. In short, a future with an array of practice models that provide better choices for patients and physicians.

While there is much uncertainty in today's environment, there are some things we do know.

Doctors want to practice in an environment that is good for them and their patients. Current and developing health delivery models want – and will need – to work with physicians who are satisfied with their practices, in order for all to succeed together.

Now, I know. Some of you may be astonished by the suggestion that health systems aspire to have physicians who are satisfied – it certainly doesn't feel that way to many of us.

But more and more – systems are recognizing the undeniable link that exists between physician satisfaction and good experiences for our patients.

The challenge is that identifying those factors driving physician satisfaction is a complex task and the complexity will likely vary across specialties and practice care settings.

The bigger problem, however, is that physicians have not been fully engaged in making these connections and shaping a better – and sustainable – future for their practices.

We aim to change that.

The AMA will initiate research activities and establish partnerships with individual physicians, integrated physician organizations, and others to help identify effective delivery models that provide both high quality patient care and physician satisfaction. We will define the common characteristics they share. The models we study will be as diverse as our membership – everything from small practices to integrated systems. 

We will then work to translate and disseminate these findings to provide physicians with the information they need to make good decisions about their future practice environments. This will include providing physicians with guidance on implementing change in their practices.

More important, we will use this information to drive and implement change across practice settings by showcasing delivery and payment models that demonstrate high quality and value while preserving, restoring and enhancing professional satisfaction for physicians.

Of course, uncovering the secrets to physician satisfaction will be no easy task. But I am pleased to say that we have hired the right person for the job – a colleague familiar to many of you.

Dr. Jay Crosson, MD, will join AMA management on July 1 in the new role of Vice President of Professional Satisfaction – Care Delivery and Payment. As a pediatrician and long-term practicing physician and executive at Kaiser Permanente, Jay brings the AMA extensive real world experience in care delivery systems and physician satisfaction.

The important work Jay will lead will enable the AMA and individual physicians to advance policies and practices that enhance physician satisfaction, empirically defined, while delivering the quality care and value our patients deserve.

The Road Ahead

So what lies ahead?

First let me be clear about one very important thing: this strategic direction is informed and driven by the wide-ranging discussions and activities of this House.

The work you do here is vital and will continue to fuel our strategy.

Remember, a rolling 5-year plan is dynamic – it is constantly refined and shaped by new information, insight and changes in the environment. We need continued input from this House and all its related bodies, just as we needed the inputs that have shaped this plan to this point.

Here's what lies ahead: the continued work of the House, Councils, Sections, Societies and Special Groups. The refinement and implementation of this long range strategic plan. Ongoing review and enhancement of all components in the AMA Equation, including direct membership. Work that is already well underway.

And, of course, further development and refinement of the work and activity needed to advance the three focus areas I just outlined. Doing so with the highest aspirations to improve our patients' health and well-being, grow the physician leadership of tomorrow and unleash the physician leadership of today.

I believe this is what our nation expects from our AMA.

In closing, there is no doubt the AMA has changed the world during its 165 year history. Whether it's been eliminating the quackery of the 19th century, transforming medical education in the beginning of the 20th, or leading efforts to enhance health quality today.

No other organization has done more to shape health and health care in this country than has our AMA. This is familiar territory for us. We know our AMA can do it. Working together, we can and will change the world for America's patients and physicians – for the better – under physician leadership.

That's the plan. That's our future.

I wish you a successful and productive meeting. And look forward working with you in the days and months ahead.

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