American Medical Association CEO Dr. James Madara knows the association’s current goals are highly ambitious and difficult to attain. Madara even calls the objectives “moon shots” in reference to President John F. Kennedy’s ambition to put a man on the moon by the end of the 1960s. But he insists that, once implemented, they will significantly change American medicine.
Just as the technology needed for a successful moon mission didn’t exist at the time of Kennedy’s bold proclamation in 1961, Madara says new ideas and innovations are needed for the AMA and its members to reach their ambitious goals. “This is a time of historic change for medicine and physicians must play a leading role in shaping it,” Madara said.
The goals at the center of the Chicago-based AMA’s five-year strategic plan are:
“These goals are all very different from what we have today and would have a very significant outcome on American medicine,” Madara says. “Our challenge is that each of these goals are difficult; we need to focus our resources and our people and develop high-performing focus teams in each area.”
Internal AMA teams are addressing each of the three targets in partnership with other organizations, including medical schools and state medical societies.
For the first goal, the AMA is identifying conditions associated with significant disease burden and cost to society. The AMA will select a few for initial focus and work with other experts to improve long-term and intermediate outcomes. “We will engage physicians and learn from them, and with communication, education, tools and opportunities for collaboration, we will help them to adapt and apply effective strategies,” Madara says. “By improving health outcomes, we can help our patients and population live healthier and more productive lives while reducing the enormous costs associated with these diseases and conditions.”
The second objective would make changes to medical education, an area the AMA has helped shape for more than 100 years. “Curricula is updated every year, but the basic structure of medical education has remained intact since 1910,” Madara says.
The AMA is planning to form a consortium of medical schools that together will work to change the structure of medical education. This includes reevaluating the length of time prospective doctors attend school. “With the progress that has been made in the field of education, we want to shift from a time-defined curriculum,” Madara adds. “We want people with measured and proven competence coming out of our schools, and for some that may take four years, but for others it may not.”
Other educational objectives include developing new assessment models for physicians, improving their understanding of the healthcare system and healthcare financing and enhancing the role of teamwork in education.
For the third goal, the AMA is establishing field research partnerships with 30 physician organizations in six states. “We want to look at a variety of structures of payment and delivery and identify delivery systems that allow practices to be sustainable and physicians to be satisfied,” Madara says.
The association has identified several fundamentals it feels should be included in delivery and payment models. These include payment policies that reflect the diversity of physician services and levels of clinical integration and risk; the development of best practices for delivery that improve outcomes and health, increase productivity and save lives and money; and options that allow physicians to choose models that fit their type of practice.
In addition to developing its strategic plan, the AMA in the past year has worked to increase its marketing efforts and sharpen its mission statement. “One challenge we've dealt with is developing our narrative,” Madara says. “For an organization that touches society in so many ways, we noted that our narrative was not as sharply developed as it could be.”
The association's “AMA Equation” defines its work in five areas, the first of which is its membership. Roughly 20 percent of all American physicians are direct members of the association. Membership in 2012 is expected to grow by about three percent, Madara says.
In addition to its direct membership, the AMA touches the vast majority American physicians through its House of Delegates, the second part of the “AMA equation.” The House of Delegates consists of 185 different U.S. medical societies and serves as the association's policy-making body and elects its president and board of trustees.
The third component of the AMA Equation is its research and education work, exemplified by the Journal of the American Medical Association (JAMA), the highest-circulated medical journal in the world. JAMA and other AMA journals reach more than 425,000 medical practitioners weekly in both print and digital form, Madara says.
AMA's fourth concentration area is providing tools and resources for physicians' practices such as its AMAGINE IT portal. AMAGINE gives small and medium-sized practices access to more than 20 technology tools and resources. Earlier this year, the AMA announced a strategic alliance with AT&T to scale the platform nationally. The association plans to integrate AMAGINE with the AT&T Healthcare Community Online platform, giving physicians more collaborative tools.
The fifth part of the AMA Equation is the association's role as an industry advocate. The association is heavily involved in lobbying efforts in Washington, D.C., including in medical liability and physician payment reform and the Affordable Care Act. The non-partisan association supports the new law as it aligns with the AMA goal of providing affordable healthcare, but still feels portions of it need revision.
“There is a lot more work to be done, which is driven by our house policies,” Madara says. “With any large, complicated piece of legislation there are imperfections we need to address.”
The AMA is working to eliminate the Independent Payment Advisory Board formed by the act, as it feels the board will impose arbitrary across-the-board payment cuts to physicians, according to the association. Along with this, there are issues that pre-dated the law that still need to be addressed, including liability reform and replacing the Medicare sustainable growth rate (SGR) formula with a new payment system that rewards physicians for the quality of the care they provide, the association adds.