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 ama-assn.org/join. 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 ama-assn.org/podcasts. Thanks for joining us today. Please take care. [MUSIC PLAYING]
