Payment & Delivery Models

How the American Medical Association influences policy on value-based care, AI in medicine and more


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Who can join the AMA? What issues does the AMA fight for? How does the AMA affect health care policy? What are AMA Sections? How is the AMA organized?

Our guests answer those questions and more at the 2024 Annual Meeting of the AMA House of Delegates. Adnan Munkarah, MD, is care delivery system president and chief clinical officer at Henry Ford Health System, and Narayana Murali, MD, is chief medical officer of medicine services at Geisinger Health. AMA Chief Experience Officer Todd Unger hosts.


  • Adnan Munkarah, MD, care delivery system president and chief clinical officer, Henry Ford Health System
  • Narayana Murali, MD, chief medical officer of medicine services, Geisinger Health

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Unger: Hello and welcome to the AMA Update video and podcast. Today we're at the AMA Annual Meeting, where I'm joined by two health system leaders to discuss how they influence policy on issues that are important to them and the profession. My guests today are Dr. Adnan Munkarah, care delivery system president and chief clinical officer at Henry Ford Health System, and Dr. Narayana Murali, chief medical officer of medicine services at Geisinger Health. I'm Todd Unger, AMA's chief experience officer. It's my pleasure to have both of you here today.

Dr. Murali: Thank you.

Unger: In addition to major roles, of course, at your health systems, each of you are leaders in the Integrated Physician Practice Session, which we call IPPS for short. Dr. Murali, why don't we just start with you? In a layperson's view of what the section does, give us a little bit of background. How does the IPPS fit into the AMA and the AMA annual meeting?

Dr. Murali: Fantastic. So if you really look at AMA, and you look at the House of Delegates, that is the heart of the AMA. So all policies that come in go to the House of Delegates and those policies are approved by the House of Delegates. The House of Delegates are about 700 members that are populated from the States, as well as specialty sections that represent the larger AMA across the country.

In addition to those delegates, there are 12 sections in the AMA. IPPS is one of those sections which basically has physician-led health systems and their executives as part of that team to provide influence in terms of the policy decision. So the section also gets an ability to propose a policy through its delegate to the House of Delegates. So it's almost like you're getting a policy through the Congress, and the Congress really reviews those policies.

Once it's adopted, that kickstarts the AMA's advocacy mission. So in other words, you have the voice of the people and the sections that influences the policy, which AMA subsequently advocates.

Excellent. And to a discussion we had a little bit yesterday, I just wanted to follow up on that. What distinguishes the physicians that are part of IPPS from, let's say, other sections? Dr. Munkarah?

Dr. Munkarah: So in the IPPS, you have physicians who are part of physician groups and have leadership roles in these physician groups, whether these physician groups are independent or part of large systems. So their voice is heard not only as a physician, but also as an executive in their respective group or in the health system they are sitting in. And we believe this is very important.

And the reason this is important is the following. Health care is a continuum. We cannot differentiate and separate between what happens in the ambulatory setting, in a private physician office with what happens in the hospital, with what happens in the post-acute care. And the reality is some of the challenges that we've had so far is that we have segregated these in silos in the past, and this has led to lack of coordination of care, finger pointing of where quality lies, where cost lies.

And we really believe that the IPPS is very well situated—and the AMA—to be able to bridge those gaps that existed in the past and promote that dialogue that we believe is very important for us to advance health care, bring the cost down, maintain quality, and outcomes up.

Unger: Now, that's a great piece of background for folks out there. And Dr. Munkarah, you're the current chair of the IPPS Governing Council. Talk a little bit about the top priorities this year.

Dr. Munkarah: So, like every section, on a yearly basis, we look at priorities in the governing council that we share with our group during our Annual and Interim meeting. And these priorities are guided by the AMA priorities, and we try to cascade them and look at them with specific ways of how we, in the IPPS, are able to move the needle on certain big items.

So there are four major priorities that I'm going to read, and then I'll give example on each of these. The first one is promoting sustainable payment models that enhance health care delivery. The second one is ensuring quality health outcomes for our patients and our communities. The third one is securing the future of the physician workforce. And the fourth is leveraging artificial intelligence in the future of health care.

And, as you can imagine, each of these is a big bucket and is very important for the future of health. The first one is promoting sustainable payment models that enhance health care delivery. All of us agree that health care, at the present time in the United States, is not sustainable with the cost that it's driving. Not pointing fingers to who carries the blame for that, but we collectively need to be part of the solution to bend that curve down, to start to decrease the pace at which the health the cost of health care is increasing.

And we really believe that providing value care—and I don't call it value-based care because people talk about value-based care immediately as a contract, is an insurance, as a financial element. To us, value care is making sure that you are promoting quality, promoting experience, and doing it at the most affordable cost. It does not mean that we should not be doing complex care. It does not mean that there are no times where cost is going to be expensive for a cancer drug or for a specific drug in specific complex disease. But it means we need to drive cost down.

And through the work that we have done in the IPPS, along with AMA, over the past four years, we really believe that we have advanced that initiative and that work significantly. We just had an amazing session at the present time with Carol Vargo, as well, the VP of Physician Sustainability—Physician Practice Sustainability, along with panelists, with Dr. Murali and Dr. Parodi—great engagement from the group. And there are many things that we have done from resolution that was adopted at the House of Delegate to collaborative groups that have worked across the aisle, as well as with other national entities.

At the level of improving quality health outcomes, one of the things that we focused on is accurate care at home. During the COVID crisis, it became very clear that there are things that we can manage at home. We can do it in a way that is safe. And the concept of hospital at home exists around the world for decades now. So this is not a new concept.

We feel that we are able to advance it and promote it for certain patients, eligible patients, in a way that this is going to promote outcome, make the patient and their family feel better, and possibly also limit the cost of care and what we are spending, sometimes, in the hospital. This is not only a financial saving, it can be, but it is, more importantly, deliver the care for the patient at the right site, the right time.

The third element is related to the future of physician workforce. We know that this is a challenge. Based on many publications that came from the AMA, we know that we are going to face a physician shortage over time. Part of the issue that we have faced before COVID, but definitely exacerbated by COVID, is the element of stress and burnout that all physicians are seeing. And the AMA has done a great job to. In survey, as well as try to provide more data that help us understand where we stand in that regard with respect to our physicians, and to start finding solutions that we can target and focus our approach.

We want to elevate the joy of medicine. We want to make sure that the physician satisfaction in their job continues to be where it used to be in the past. It is not only a matter of financial compensation. It is not a matter of working hard or not working hard. It's a matter of people feeling that they are doing what they are enjoying, which is taking care of patients. There is no physician who wants to be sitting and kind of—sitting in front of the computer and kind of drafting a long note.

What they want to do is sitting in front of a patient, and talking to them and engaging with them, and deliver the compassionate care that we need to do. And this is where the AMA and the IPPS continue to drive that. And again, we had a great discussion yesterday during our governing council meeting about how we are going to continue to advance that.

And the last element is the artificial intelligence element. We all understand the value of technology going forward. We know also the risks that are related to that. We feel that the physicians need to be around the table to discuss this, artificial intelligence. And this is where we feel the IPPS can play a significant role.

Unger: Well, let's talk a little bit more about that last one. It seems to be on everyone's mind. Dr. Murali, can you talk a little bit more about the IPPS's stance and vision in the world of AI?

Dr. Murali: Perfectly. So when IPPS saw a bold white paper from the Board of Trustees from AMA related to augmented intelligence, or ambient technologies that were tied to that, IPPS pulled together a group of all CMIOs from the multiple health systems, as well as physician practices that are part of the IPPS. And these CMIOs came in, provided their input to come up with a resolution.

Today, that particular resolution is going to the House of Delegates for adoption. And we have come up with some suggestions where we could actually augment the information that has come in from the Board of Trustees. So time will tell whether the House of Delegates adopt those resolutions or whether the Board of Trustees and the House of Delegates together will actually redirect and bring our teams to bring in value for that conversation as we go forward. So that's kind of the work that IPPS does, particularly in the space of policy, advocacy and how you engage with patients.

Unger: It's such a great example, just period, of how the House of Delegates works. And also, just something that you mentioned before, making sure that physician voices are heard, that physicians are at the table when we're exploring important technological advances, like what we're going through here now.

Dr. Munkarah, you outlined a bunch of the current priorities. I'm just curious because you've—the section has championed a number of initiatives over the past few years. Is there anything that's been particularly important to you?

Dr. Munkarah: So one of the things, we've talked about value-based care. I think value based care is an extremely important priority. And the reason we feel it's a priority, because one, we know as I mentioned, that our health care cost is not sustainable. It is—we owe it to our children, to our grandchildren, for generations to come, to be part of the solution for that.

And we know we don't have the right fix. There are a lot of models, and there are a lot of flaws in those models. We really believe that physicians sitting around the table is what's going to make that better—hearing the voice of the physicians, discussing and having a dialogue about what is working and what's not working. And it's not only the physician and the providers. It is the hospitals. It is the insurance plan. It is the employer. It is the federal government.

And we are very proud of the work that IPPS has done so far. Three years ago, we put a resolution forward related to payment models that got adopted. There was a report that was generated from the AMA related to that. In 2023, the AMA team started a collaborative, including workgroups, including IPPS members to sit down and talk and talking about data sharing and data aggregation. And we just had another playbook that was developed related payment models in that regard.

And again, this is not providing the solution, but elevating the discussion and dialogue, and having everybody who is part of that problem, I would say, or of that issue come together to identify solutions together and listen to each other. And the AMA has played a wonderful role coordinating that, being the individuals who are able to listen to all and try to create solutions going forward. And we are—I really feel that this is going to be a significant, important—I would not call it a project, but journey that the AMA, the IPPS and others will be embarking on for years to come.

Unger: Excellent. Dr. Murali, same question for you. Anything that you've particularly felt was important?

Dr. Murali: I concur with Adnan in terms of what he shared. So if you really think back about it, Adnan shared in the beginning that one of the key policy areas that IPPS was involved was prospective payment models, So a policy was developed for prospective payment models, and a resolution. That resolution went to the AMA in 2021, was adopted by the AMA in 2021. And subsequently, as a consequence of that adoption, the council came out with a report on where things stood with respect to value-based care.

And based on that, it went into the next charge of the advocacy group, as well as the PSG group, to identify which are the elements over the next 18 months to address from the value-based care prospect. So that's where the data sharing playbook came about. And then we have been involved very actively in the value-based care playbook from the standpoint of the different domains, whether it is from the standpoint of prospective or retrospective payment models, financial goals, best practices within a particular group, and then bringing together.

Initially when this journey started, I thought this is an irrational exercise. I thought that this was an exercise where trying to bring the health plans as well as the groups—because you have independent physicians. You have rural practices. You have groups that are in underserved areas. You have large health systems and midsize health systems. And you have the payers, and you have the payers coming in along with the ACOs. All of this was convened by the AMA.

So it was a great work. I would definitely ask people to read the 72-page document that really lays out the best practices and allows you to start thinking about how do you negotiate and how do you move the ball forwards in terms of value-based care. The other point is the implication of value-based care itself to the AMA, to the physicians, to the patients and the payers.

This is a big project. Right now, 93.5 million lives in this country are covered under the umbrella of value-based care with ACOs. 25% of them take both upside and downside risk. And if you took a survey of all the health plans, the latest survey reports, at least in 2023, suggested that 73% of the payers were moving towards value-based care. So what the IPPS can do with the power of the AMA and its advocacy at the center is very, very important.

Unger: I love, too, just that example because, for people out there that don't understand how health policy works or what it does, what you outlined there is that it sets an agenda for advocacy and also for the mission work that goes on with the AMA to turn an idea into reality and expand that. That brings me to the final question I'll ask both of you. For others that find this interesting—this kind of work, and want to join you in the activity of policy making—what should they do?

Dr. Murali: So, Adnan, do you want to go first?

Dr. Munkarah: So I—first being engaged, attending, contributing to the dialogue is extremely important. To me, I always look at it as if I want to—If there is a problem, complaining about it is not going to solve it is. We need to be part of the solution. And I really think that what we have done in the IPPS and with the help of the AMA staff, who have done a great job coordinating, navigating, helping us develop what we need to develop, is having people around the table, and having discussions, and having these dialogues, whether it is in our annual interim—or interim meetings, whether it is in work groups and workforce, whether it's engaging in specific projects that we have talked about in—getting involved with health systems.

As I said, we cannot—we do not believe that this is a physician versus the rest of the health care institutions issue. We are part of the solution. And physician can be a significant—play, a significant leadership role in that. And I really believe that having people being engaged and involved, sometimes we agree, sometimes we disagree.

But it's OK. Having that professional, open-minded dialogue to look at solutions—as Murali was saying, setting—when they were having the work on that playbook for prospective payment models and the different domains that they are looking at, you had the insurer sitting around the table. You had some of the other third party vendors, you had the physicians sitting around the table. This is the kind of work that we need to try to solve problems, to advocate for what we believe is important for our patients. The physicians are sitting there, listen to the patients all the time.

And we—this is where we are here, to take care of patients, to take care of our community and make them better. So engage, sit there, whether you agree or disagree with it. And you need to be patient that some of these things take time, and it's OK. This is a problem that has been created over a century. It cannot be solved over a week. So it is something that we need to continue to work on it and be persistent, because we need to solve it and we can solve it.

Dr. Murali: Adnan hit all the key points, So what this organization is about is getting the collective wisdom of the group. And the first step in that is to become a member. Once you become a member, you recognize what are all the value streams that are available under AMA to address it. So number one, there are educational sessions. So you could walk into an Annual or an Interim meeting and join our educational sessions that are across the 12 sections, depending on your area of special interest.

It could be in academics. It could be as a young physician. It could be as an international medical graduate. It could be as part of the Integrated Physician Practice Section. It could be part of OMSS, and so on and so forth. So that is number one step. In addition to education, there are opportunities for research, as well as leadership and tools that are available for physicians.

But more importantly, as you become a member or you suggest that your organization becomes a large member of the AMA, it gives you tools to address questions related to physician satisfaction, burnout and how do you go about evaluating it? And how do you address it? Christine Sinsky, as well as their group, are doing phenomenal work in that space. So that is the second area. The third is research, because all of this data is converted into research, published in the JAMA, gets the necessary space from the standpoint of perpetuating and educating that larger group.

And the fourth piece, from the standpoint of it, is advocacy. So as you get involved, have these open discussions, bring in the collective wisdom of the group, you are creating resolutions. Those resolutions get adopted. They transform into policies. The policies drive the advocacy. And AMA is a very powerful organization to advocate for the physicians under these circumstances, and it doesn't stop there. You could become a member of the AMA as a medical student, as a resident, as a young physician, or as part of an organization, small groups, rural, big and other groups.

Unger: Dr. Murali, Dr. Munkarah, this has been a great discussion. Thank you so much for joining us today. You kind of said the major step to participating in this kind of work, and that's becoming an AMA member. You can do that by visiting That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes. Find all our videos and podcasts at Thanks for joining us today. Please take care. 

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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