Q&A: AMGA CEO Fisher on promoting better performance in medical groups

Donald Fisher has been the president and CEO of the American Medical Group Association since 1980. The AMGA has 435 member groups with more than 150,000 physicians. Modern Healthcare reporter Andis Robeznieks recently talked with Fisher about the AMGA's initiative to promote high-performing health systems, its new consulting arm, its use of big data to help provider systems improve patient outcomes, its campaign to improve blood pressure control and its legislative agenda. The following is an edited excerpt.

Modern Healthcare: What is the AMGA's definition of a high-performing health system, and how would you like to see healthcare organizations rewarded for meeting that definition?

Donald Fisher: These are organizations that increase the quality of care, reduce costs, and provide patient-centered and coordinated care. Our definition has seven attributes that medical groups need to aspire to, such as organized systems of care, efficient provision of services, compensation practices that are in line with organizational goals, accountability, transparency and use of evidence-based medicine.

If you truly are delivering higher-quality healthcare at lower cost, you ought to be rewarded. So one of the legislative proposals we have floated on Capitol Hill is to carve out a separate bucket in the Medicare physician-fee update. It doesn't make sense that all physicians get the same update, when some are working as hard as they can to increase the volume and intensity of their services, while others are working very hard to reduce volume and intensity to provide greater value. It could be budget neutral. If you did that, you would very rapidly see a migration from a fragmented healthcare system to one that is really truly organized and delivering high-quality care.

MH: Describe AMGA's move into the consulting business and your goals.

Fisher: We realized that all AMGA members don't meet all the attributes of high-performing systems, and most providers rarely meet one or two of the attributes. We thought, if we are going to create this definition, we also have a duty to help not only our members, but also nonmembers on their journey to becoming a high-performing system. We started Jan. 1 and have hired four full-time consultants with extensive healthcare consulting experience. You can't work on all seven attributes at once, so we are focusing short-term on helping our members with their compensation practices—how they incentivize people to improve population health and how they link the patient experience, or quality metrics, with their compensation. Longer term, we will have a full consulting service to address the needs of healthcare organizations on their journey to becoming high-performing systems.

MH: What is happening with the AMGA's Anceta data-pooling initiative?

Fisher: We've got 31 medical groups, and many of them already have data coming into the data warehouse, covering 30 million patient lives over five to seven years. We want to use clinical and claims data to inform and accelerate AMGA's shared-learning process. We are linking our national hypertension campaign to get patients in our medical groups at 80% control of their blood pressure, using Anceta as the data vehicle for that. We have already begun to show quarter-by-quarter improvements among our members in attaining that 80% level. Six years ago, we identified a partner, Humedica, that would do the heavy lifting of data extraction, normalization, and reporting, allowing meaningful apples-to-apples comparisons. Optum Labs has acquired Humedica, and in the new platform they just released at the Healthcare Information Management and Systems Society meeting, they are combining the clinical data with the claims data.

We are actually doing predictive analytics. If you are assuming financial risk, whether it is a Medicare Shared Savings Program accountable care organization or Medicare Advantage, if you can identify that subset of patients who are likely to be hospitalized before that hospitalization occurs, just think of how many admissions you could defer, and how much better the patients would do in avoiding adverse conditions. Four predictive models have been built: for congestive heart failure; chronic obstructive pulmonary disease; pediatric asthma; and diabetes. Medical groups using this tool can look at their patient populations with those conditions and identify by name those patients who are likely to be hospitalized within a finite period of time. Then they can bring all their resources to bear on those patients to avoid that hospitalization. Optum identifies what the medical groups need to improve. But nobody ever tells them how to improve. In Anceta, we bring the groups together for shared learning on how to make those improvements. When they share their stories, it is really powerful to see how all the groups improve over time. It's one thing to get a data report that says, 'Here's how I am doing compared to my peer group.' It's another thing to get that, and then meet with your peers and talk about how you improve.

MH: Describe AMGA member groups' role in payment and delivery reforms.

Fisher: Many of our groups have started to work on Medicare and commercial ACOs. Many are in bundled-payment initiatives and are leading the development of new payments models, delivery-system innovations and comprehensive primary-care initiatives. We have 150 groups participating in our Measure Up/Pressure Down campaign for hypertension control. Three of the groups were recognized by the Centers for Disease Control and Prevention as 2013 Million Hearts Blood Pressure Control Champions: Dartmouth-Hitchcock, ThedaCare and Kaiser Permanente in Northern California. We've developed a new self-assessment tool that allows the medical groups to measure their own organizations against these seven attributes and see how far along in the journey they are with each one. We will collect and analyze that data, then we will focus our programs on helping those groups where there's the greatest need. For 2014, we will be rolling out the self-assessment tool to our members at no cost. We will use our consulting arm to help them become higher-performing systems.

We also are going to work with the government to try to improve, either through legislation or regulation, the whole ACO movement. And we would like to stabilize the Medicare Advantage payment rate to assure medical organizations about what they will be paid when they embark upon these programs.

MH: How is your own role changing?

Fisher: It has been a great ride. I don't think there has been a more exciting time to be in healthcare. We are seeing U.S. healthcare being reinvented for the benefit of patients, not for providers or for systems. We need to turn the fragmented care delivery system into well-organized, truly high-performing systems of care.