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Shaping Better Outcomes for Patients, Medical Students and Physicians

Nov. 10, 2012

2012 Interim Meeting
Honolulu, Hawaii

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

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

This has been an extraordinary week for our country. On Tuesday, voters went to the polls to cast their votes in deciding who will lead this country during the next four years.

The 2012 Presidential campaign was compelling, intense and hard-fought – at times even troubling – as both candidates shared with American voters their respective visions and differing philosophies for how to best move our country forward.   

Of course, while the AMA leadership followed the campaign closely – our focus was not on the partisan divide – but on how, regardless of outcome, we could achieve AMA strategic and  policy goals.

Last Tuesday President Obama was re-elected.  We congratulate him and look forward to working with him as well as both sides of the aisle in the new Congress as we continue to tackle the many critical issues confronting health care and medicine. All the while keeping our eye on the ball—the strategy and policy goals of our AMA.

This latest exercise in democracy is quintessential America. Citizens from every state, representing every interest, every race and diverse points of view – coming together, leveraging their voices and their votes in helping shape the future of this country.

Our gathering reflects this national tradition.

Because here in this House of Delegates, physicians representing more than 185 medical societies – from every state, specialty and practice setting – also with diverse points of view….. occasionally markedly so – have come together to lend their voices and their insights in shaping medicine’s future.

Indeed, it is the fact that your 185 societies represent the vast majority of American physicians, allied with the fact that this assembly forms our policy and elects our Board and President, that gives the AMA the powerful voice it has nationally and in our nation’s capital.

Last year AMA membership increased for the first time in several years– I’m happy to report that it is up again – across all categories this year even though the year is not yet complete.

Membership . . . Advocacy . . . Practice Tools . . . Research and Education . . . and this House of Delegates comprise the AMA Equation – an equation that intersects with the lives of physicians each and every day. 

None of the accomplishments  Dr. Lazarus highlighted would have been possible without this body’s hard work and leadership.

The need for your voice and your leadership on the important issues affecting medicine has never been greater.

The changes we are experiencing across health care today are unprecedented. In fact, I think it’s fair to say that the changes we will experience over the next few years will mark the greatest period of change experienced by our, the past, or the next generation of physicians.

With so much change taking place and so much at stake, the primary question we need to ask ourselves is this:

Do we want our AMA to play a prominent role in shaping this change?

Of course our answer is a resounding YES. The answer is an obvious one. The implication of this answer is equally obvious: we have challenging and uncertain work ahead of us, but as the banners that hang at AMA Headquarters in Chicago assure us: Together we are stronger.

Today, I will share with you some of the ways our AMA is working to shape this change.

Dr. Lazarus has already highlighted elements of  the important work we are doing in Washington and alongside you in our statehouses. 

I’ll  spend my time updating you on the progress we’re making toward implementing the AMA’s rolling  5-year strategic plan in the mission areas that I outlined in detail last June.

Our plan focuses on three areas that reflect the policies of this House and that we believe are cornerstones for building a healthcare system that will enable sustainable practices and better health outcomes for patients. These three cornerstones are:

  • Improving patients’ health outcomes in ways that add value
  • Accelerating change in medical education to align physician training and education with the future needs of our health care system; and
  • Enhancing professional satisfaction and practice sustainability by helping physicians navigate delivery and payment models

These strategic goals are high aspirations – difficult and challenging objectives. And, as I said in June, have the commonality of shifting our work from process to outcomes, from convening to additionally doing through partnerships.

I’ve developed the habit of referring to these goals as our “moon shots” – plans that at first  may seem to exceed our grasp, yet ARE reachable if we focus, make the commitment and work strategically – together – to achieve them.

Of course, the initial moon shot was announced 51 years ago when President  Kennedy announced the audacious goal of landing a man on the moon and returning him safely to Earth.

At the time, many – including scientists – were skeptical. Many thought  Kennedy’s vision unrealistic – an overreach.

Many technologies necessary to achieve a moon landing didn’t even exist!

However, Kennedy’s vision and challenge sparked ideas and innovation. The rapidly assembled team of scientists began with an affirmative view that “we will send a man to the moon,” leaving them only to answer the question how to do it.

Similarly, we face questions when it comes to improving outcomes for patients, medical students and physicians.  Specifically:  

  • How will we improve  patient outcomes and as a consequence positively influence  the nation’s GDP – both in terms of value and on physiological capital?
  • By changing the structure of medical education for the first time in a century, how can we better align medical student training with the needs of tomorrow?
  • By defining elements in delivery systems that lead to physician satisfaction how can we force embedment of such that will allow practices to be enjoyable and sustainable?

How can we achieve these three most difficult things, these three moon shots?

Like Kennedy’s challenge, our long-range strategy is aimed at mobilizing the AMA, this House, the thousands of physicians you represent and the larger medical community.

The achievements that are possible through the fulfillment of this strategy will not only shape a better future for patients and physicians – but for the country as a whole.

Our plan will require new ideas and innovation.   The policies you pass and the vital work done through our Councils, Sections and Special groups will continue to fuel our plan.

Like Kennedy’s mission, we know we will not get there overnight, but the work is already underway.

Because changes to affect patient outcomes, medical education and our practice environments ARE and will continue to occur. We must make sure that these changes are beneficial. This requires that these changes be  shaped by physicians – thus our plan to do so under physician leadership. 

Your AMA Board of Trustees and the senior management team has spent much of this past year – not only carefully considering the question “How can we do it?” – but moving aggressively forward.

So let me update you on the progress we’re making, starting with our work toward improving health outcomes.

Improving Health Outcomes

As physicians our common purpose is to provide the best care possible with the goal of maximizing the health of our patients and our population.

 Health is an invaluable national asset.

But many variables contribute to poor health outcomes – from social and environmental determinants to the accessibility of health care and the choices our patients make.

Medicine is complex and ensuring all patients get the care they need, when they need it, is a Herculean task, as is preventing the development of disease

As physicians, we work to deliver the best care to our patients on an individual basis each and every day.

Now our strategic work toward improving health outcomes aims to help our medical profession do the same collectively

Our internal team lead by Karen Kmetik continues to meet with leaders and experts in the outcomes arena to better assess all the current work being done and to determine where AMA can make a meaningful and significant contribution.

We will begin by identifying a few conditions representing a broad swath of disease burden in our society. 

For these conditions, we will, working with numerous experts, most often derived from societies within this House, select specific long-term and intermediate outcomes—both clinical and patient-reported.

The result will be a national outcomes dashboard which we will be a central engine for the identification and promulgation of strategies to improve health  outcomes.

In this effort, we will partner with other leading organizations – including our federation partners -- that share common purpose—maximizing results by combining voices, expertise and reach—while making AMA’s distinct role apparent.

We will engage physicians; learn from them; and with communication, education, tools and opportunities for collaboration help them adapt and apply effective strategies that emerge —a role the AMA is uniquely qualified to play.

We will simultaneously bring to the work AMA’s deep expertise in addressing disparities, public health and ethics – powerful and natural amplifying disciplines for the AMA dashboard.

The work and goals required are ambitious.  But the payoff is well worth it.

By improving health outcomes, we can help our patients and population live healthier, more productive lives, while reducing the enormous costs associated with these diseases and conditions. 

In short, we can advance what the Nobelist Robert Fogal has termed the physiological capital of our nation.

The result we seek being nothing less than an AMA-driven enhancement of our nation’s GDP through the summation of cost savings that come naturally from improved outcomes plus the enhancement of productivity derived from improved physiological capital.

ACCELERATING CHANGE IN MEDICAL EDUCATION

Our second focus area gets ahead of the changes coming to health care delivery by working at the source – medical education. 

This is certainly not new territory for us. The AMA has been a leader in shaping medical education in this country for most of its existence – including developing the standards that were included in the historic Flexner Report in 1910.

More recently, in 2005, we launched the Initiative to Transform Medical Education to examine the gap between current physician training and the future needs of our health care system.

And we discovered a clear need for change . . .

  • More flexibility and individualized learning;
  • Training in teamwork;
  • Development of active, life-long learning tools;
  • Measures to promote continuous improvement and increased patient safety;
  • And aligning training to match the reality of the environment in which physicians ultimately practice

Seven years later – a number of schools have made incremental adjustments along these lines.

However, the fundamental structure of medical education remains unchanged; unchanged for a century  – which is why change has been only incremental.

This pace of this change now needs to accelerate dramatically.

Over the next five years, the AMA will effect changes to better align medical education and training with our evolving health care system.

Key objectives will include:

  • Developing new methods for measuring and assessing key competencies for physicians at all training levels to create more flexible, individualized learning plans
  • Promoting exemplary methods to achieve patient safety, performance improvement and patient-centered team care
  • Improving understanding of the health care system and health care financing in medical training
  • Enhancing development of teamwork throughout the medical education learning environment

To achieve these objectives, we will establish partnerships with select medical schools who propose innovative models to address these objectives.

Under the direction of Dr. Susan Skolechek – an authority in medical education – this work is well underway.

Earlier this week, I joined Susan at the AAMC meeting in San Francisco. There, we announced the process to select and support schools that seek to revise curricular structure around our targeted objectives – and form an AMA learning consortium around these coordinated restructuring efforts.

Medical school deans and others in the academic community have voiced great enthusiasm for what the AMA is leading, again based on the policies of this House, and we look forward to working with them to shape needed changes in medical education.

We intend to select 5-10 proposals in the Spring of 2013 and, after a year of program restructuring by the selected schools, launch the programmatic activity at these sites beginning in the summer of 2014.

SHAPING DELIVERY AND PAYMENT MODELS

Our third strategic goal is to enhance professional satisfaction and practice sustainability by shaping new payment and delivery models.

We want to help physicians not just cope – but proactively shape the conversation concerning how health care is organized, delivered and paid for in the future.

Toward that end, the AMA is establishing field research partnerships with 30 physician organizations in six states – from individual physicians to large integrated organizations.  This work is lead by Dr. Jay Crosson – a noted authority on practice and care structure – and has been coordinated with leadership of the medical societies from the six diverse states.

We’ll work with these practices to determine which elements for internal practice design and external practice relationships  best support both high quality patient care and long-term physician satisfaction and practice sustainability.

We’ll share the results with our members, so that each individual physician can choose what works for their practice in their community. 

Best practices with options is vital, because we  know that models that work for a large multi-specialty practice in Miami won’t necessarily work for a small practice in Muskegon.

We’ll also showcase the most effective and desirable models and – working with our Advocacy team -- build momentum for their adoption in both the public and private sectors.

Again – ambitious goals, but ones worthy of AMA leadership and commitment.

Physicians want and need help in navigating the rapidly evolving  health care environment – and through this initiative – the AMA will work to provide it.

Our aspiration here is nothing less than this: that in the future every member of this House would, without hesitation, recommend a career in medicine to their nieces, nephews and their own children for the personal and professional satisfaction this great profession offers

Not a Single Step but Many

As I said earlier, this strategic mission-focused  plan is built on the foundation of policies developed by this House and the considerable work done through our AMA Councils, Sections and Special Groups.

And this work must  continue.

Let me also state unequivocally that, while the work I outlined represents major new focused investments in important areas, other critical work also is ongoing – from our determined and focused work in Advocacy, to our support of critical topics such as graduate medical education.

There’s  a great deal of work ahead of us – but our opportunity to shape a better health care future – under physician leadership - has never been greater.

In closing, let me return to the “race to space” that President Kennedy ignited with his 1961 speech – and the iconic American hero who would ultimately play a starring role – Neal Armstrong.

Armstrong was one of the most humble and private heroes our country has  known. In fact, some journalists noted that it had been easier landing a man on the moon than landing an interview with Armstrong.

Armstrong said that while he was proud to be the Commander of Apollo 11, he refused to let his individual role overshadow the work of countless others who made it possible.

He said his achievement was the product of many minds and strong wills, reminding anyone who asked that it took a team of 400,000 to get the job done. Thousands of the world’s best engineers, scientists, researchers, support staff, and even seamstresses who carefully stitched together the space suits required to withstand extreme temperatures.

Following his passing earlier this year, his family released a statement that read in part:

“Neil Armstrong was a reluctant American hero who always believed he was just doing his job.”

Humble words about an extraordinary man.

But if Armstrong’s legacy teaches us anything – it teaches us that when quiet heroes work together toward a greater cause – they can accomplish great things.

Our medical profession is full of quiet heroes – women and men who do their extraordinary work each and every day – meeting the needs of America’s patients in various ways across the health care spectrum.

They do so admirably, but too often within a system that is not serving them well.

They deserve better. You deserve better. Our patients deserve better.

I truly believe this is the AMA’s “moonshot moment.”

Our quest to shape a better future for patients and physicians during this time of great change will differ from Armstrong’s feat .

Our work  will not culminate with a single brilliant step at one precise moment in time, but rather it will improve the lives of each of our 310 million citizens as well as each of our 900,000 physicians over a lifetime.

Years from now, let us be able to reflect on the fact that  the AMA, this House of Delegates –  each one of us – displayed  the courage and commitment to take on critical issues confronting our health care system and that we succeeded in landing it in a safe and better place for generations to come.

All the best for a successful and productive meeting. I look forward working with you in the days, months and years ahead.

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