RamaOnHealthcare March 27, 2023
Achieving Organizational Excellence
Introduction: Today, RamaOnHealthcare talks with Jerry Penso, MD, MBA, President and Chief Executive Officer of AMGA, a trade association that represents medical groups and other organized systems of care, including some of the nation’s largest, most influential integrated healthcare delivery systems.
Jerry Penso, MD, MBA, President and CEO of AMGA
RamaOnHealthcare (ROH): Describe AMGA, the American Medical Group Association. Who are your members, and what do they look to AMGA for?
Jerry Penso (JP): AMGA is a national trade association, representing over 420 prominent medical groups, health systems, and other organized systems of care. Our members are typically large, multispecialty physician practices that coordinate care for a population of patients. We have members in every state, and they are often the largest provider of healthcare and the largest employer in their region. One distinguishing feature of our members is their model of care – they deliver longitudinal care for patients with varied and complex health needs in a variety of settings with a full range of treatment options.
These organizations look to AMGA to learn how to improve their clinical and operational performance. They want to provide healthcare of higher quality, with lower costs, an enhanced patient experience, and better value for their communities. AMGA convenes leaders of these systems to share best practices, benchmark their performance, and discover the latest trends in care delivery. AMGA is also a strong advocate for our members, promoting legislative and regulatory changes that support high-performance healthcare.
…organizations look to AMGA to learn how to improve their clinical and operational performance.
ROH: What do your members see as top challenges in 2023?
JP: Workforce issues are the top concern for many healthcare leaders in 2023. Dealing with COVID-19 exacerbated the preexisting stress and burnout among doctors, nurses, and other healthcare workers. Retention and recruitment are now severe challenges for most healthcare providers, driving large increases in wages and critical labor shortages in many hospitals and medical groups. These labor force issues are requiring leaders to rethink and redesign their care delivery systems.
Related to labor shortages are access issues for patients seeking care. Patients may unfortunately wait months to see a primary care or specialist physician, creating large backlogs and delayed treatment. Productivity is also affected by staffing issues, resulting in even longer wait times, decreased morale among the workforce, and worsening business margins.
ROH: One focus area for AMGA in the coming years is helping medical groups and health systems achieve organizational excellence. Can you describe what that means and specifically what value will AMGA bring to these groups?
JP: Medical groups and health systems proudly deliver care that meets the needs of their patients, providers, and communities. However, they need to continuously improve to ensure that their systems remain sustainable and resilient. AMGA has developed unique tools and programs that help group leaders assess their performance and develop their roadmap for success. One of these resources is the High Performing Physician Enterprise (HPPE) program. Through data and analysis, this program enables groups to pinpoint areas for improvement in seven domains. Examination of these domains– provider, financial, patient, value, operations, clinical outcomes, and governance and leadership – provides comprehensive insights that accelerate better organizational performance. AMGA also facilitates collaborative learning with similar organizations to jump-start their improvement journey. It is very powerful to see organizations translating the data generated through AMGA programs into real-world changes.
AMGA has developed unique tools and programs that help group leaders assess their performance and develop their roadmap for success.
ROH: How is AMGA addressing health equity, and what do you hope to achieve?
JP: AMGA has made addressing health equity a strategic objective. We have a long history of working with our members to address health disparities through our learning collaboratives and research initiatives. We have created a health equity steering committee to advise AMGA on how we can expand our efforts and have a greater impact. For example, one new AMGA initiative aims to uncover member best practices that address diversity, equity, inclusion, and health equity and then rapidly disseminate those findings. We plan to produce a toolkit to provide guidance to our members on their initiatives. We also will be hosting a fall roundtable for our members to discuss how to accelerate these efforts. Our hope is to be the resource for members looking for practical solutions that enable them to reduce health disparities.
ROH: What are your members telling you about the move to value-based payment models?
JP: While there remain serious barriers to moving to value, our members continue to participate in these programs and are investing in the infrastructure needed to succeed. The multispecialty, coordinated care model of AMGA members is ideally positioned for value. Our members tell us that they are interested in adopting more value-based payments, as long as there are long-term commitments from the payers to work collaboratively. For the federal programs, our members want consistency and stability in the regulations. Often rules change yearly and may even change within a single program as organizations advance to new levels of risk. These constant changes are costly and disruptive, requiring a retooling of workflows, changes in IT and finance systems, and education of providers and staff. In the commercial market, many plans are unwilling to share data, especially full claims data that are required to make accurate financial projections and to successfully manage the health of a population.
The multispecialty, coordinated care model of AMGA members is ideally positioned for value.
ROH: The healthcare delivery space has seen the emergence of many disrupters, with private equity, retail pharmacy, technology, and health plans. How will these disrupters change how healthcare is delivered in the coming years?
JP: The past few years have seen an explosion of new entrants into the care delivery space. The most dramatic trend has been the rapid growth of health plans acquiring physician practices and home care companies. This vertical integration, often focused on ambulatory care, unites the insurance and delivery aspects of healthcare. Retailers like Walgreen and Walmart are also growing their physician footprints, both through acquisitions and organic growth. Technology companies, including Amazon and many digital health companies, are expanding their role in the healthcare ecosystem. And finally, private equity has invested in specialty and primary care, inserting new capital into medical groups, and creating new competitors for physician employment. It is clear that not all of these disrupters will be successful. Healthcare is very complicated and creating sustainable systems that create value and improve patient outcomes is a huge challenge. We’ll likely see a shake-up in the coming years.
The past few years have seen an explosion of new entrants into the care delivery space.
About Jerry Penso
Dr. Penso previously served as Chief Medical and Quality Officer for AMGA and President of AMGA Foundation. Under his leadership, the impact of AMGA’s quality programs grew to improve care for 26 million patients.
Prior to joining AMGA, Dr. Penso served as Medical Director, Continuum of Care for Sharp Rees-Stealy Medical Group (SRSMG), the largest integrated healthcare delivery system in San Diego.