Interim Meeting

Doctors as disruptors? AMA CEO says medicine’s future demands it

Tensions surrounding health care today are evident to patients and physicians. When it comes to alleviating those tensions and shaping practical changes to improve care, the onus is on physicians to lead the way, said AMA Executive Vice President and CEO James L. Madara, MD, during his address at the opening session of the 2018 AMA Interim Meeting.

Health care has “vast structural gaps, which will undoubtedly require long-term work,” he said. “And if these large projects do not start with physicians, we’ll find in a future where, once again, optimally supportive infrastructure is lacking. The need to fill these gaps is fundamental—and will remain so—regardless of what health care system exists 10 or 20 years from now.

Treating medicine’s sore spots

In highlighting the barriers to a healthier America, Dr. Madara highlighted many pain points: an increasing chronic disease burden, disorganized clinical data at the point of care, and a lack of tools and systems to maximize physician efficiency. 

The AMA is working to address those pain points right now, particularly in its three strategic focus areas—reimagining medical education, improving the health of the nation by confronting the rise in chronic disease, and attacking the dysfunction in health care. 

The Association also is taking a longer view, with projects that have the potential for generation-spanning results, such as: 

  • The recent expansion of the AMA’s efforts in medical education to include residency training, via a $15 million grant program. The project’s aims include fostering a more fluid transition from medical school to graduate medical education.
  • The creation of First Mile Care, a spinoff company of Health 2047, the innovation company the AMA founded in Silicon Valley. Using what Dr. Madara called “an Uberized approach,” First Mile Care aspires to build a network of 100,000 digitally certified lifestyle coaches across every ZIP code in the United States. 
  • A new Digital Health Implementation Playbook maps out key steps, best practices and other resources to accelerate digital health adoption. In its first week, the Playbook was downloaded by more than 1,200 physicians.

Need for innovations that facilitate

Technology can change health care for the better, but finding the right innovations remains paramount to creating a more cohesive practice environment, Dr. Madara said.

“New solutions must facilitate, not complicate medical practice,” he said. “These solutions must save time, not take time.” 

In drawing attention to some troubling developments physicians are confronting, Dr. Madara pointed to the results of a new joint study by the RAND Corporation and the AMA. The study found that physician payment models are becoming more complex and the pace of change is increasing, creating challenges for physician practices that may hamper quality of care and efficiency.

“This study captured with rigor the complexity of today’s clinical environment and how an overemphasis on data entry, paperwork, insurance hassles and a multitude of payment models weighs heavily on physicians,” Dr. Madara said. Physicians “want to deliver the very best care to patients but are wary of exposure to downside financial risk.” 

Doctors pointed to a lack of timely, trusted data available to them to make practice improvements. The AMA is working to change that with projects like the Integrated Health Model Initiative and another Health2047 spinoff, Akiri. Each of these projects aim to gather data that can help improve practice efficiency and patient outcomes. 

In the tech world, these kinds of innovations might be called “disruptive.” That phrasing is less commonplace in medicine. But the AMA is a body of scientists. In highlighting Copernicus’ discovery, five centuries ago, that the sun is the center of the universe, Dr. Madara noted that scientists are history’s original disruptors.

“In working toward solutions, we always have to start at the right place—the place where the larger truth about health care exists,” Dr. Madara concluded. “This is not found at the administrative level, orbited by patients and physicians. It’s found at the patient-physician relationship level. This relationship is the sun in our health care solar system. This is where problems must first be defined and where we must focus our solutions.”  

Read the full text of Dr. Madara’s 2018 AMA Interim Meeting speech.