Dr. Jerry Penso took the helm at AMGA in early October, succeeding Donald Fisher, who passed away earlier in the year. Fisher ran the organization for 37 years. Penso wants to build on Fisher's legacy and believes that group medical practices are ideally positioned to lead the nation in the migration from fee-for-service to a value-based payment and care environment. Penso spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
Modern Healthcare: You replaced someone who had been at AMGA for a long time, and unfortunately passed away, to create that void. What are some of your thoughts about how you'd like to lead the organization?
Dr. Jerry Penso: Don Fisher was an incredible leader who changed American healthcare. He emphasized that the delivery system matters and that the delivery system that emphasizes coordinated multispecialty care is the preferred system of care. During his tenure at AMGA, he saw that model of care go from being on the sidelines to being seen as the preferred model of care throughout the nation, and that is his legacy.
I am so fortunate to have that foundation. So, what I see is an opportunity to take AMGA—450 members, 175,000 physicians treating 1 in 3 Americans—and make it even stronger; to make us the preferred national partner for our members and those who should be our members, in moving along in this journey toward value and toward high-performance health.
MH: As you think about trying to position AMGA in that way and grow your membership, what kind of things are you hearing from the industry? What are they missing and what can AMGA offer?
Penso: I want to make AMGA stronger, more powerful, more relevant. On the stronger point, we want our members more engaged. There are so many opportunities through our education programs, our meetings, our benchmarking program, that members can utilize.
The second thing is I want us to be more powerful. We want to take our value agenda to Capitol Hill, leveraging the strength of our membership, but really using our members and our communication channels to amplify the message that we have more impact.
And finally, we want to be relevant. We want our advocacy work to make a difference in the lives of our members, their physicians and their patients. We do that through our quality programs and through our education programs that work not only with the leaders of these organizations, but further into their organizations with their physician leaders, with their nursing leaders, their pharmacy leaders, so we can actually help them learn as fast as possible how to deliver higher-value care.
MH: All associations in D.C. run into this. You have members who are part of multiple organizations and associations. How do you continue to differentiate what you do and ensure that members still get value out of AMGA?
Penso: First of all, we have a diverse group of members. We have members who are affiliated with hospital systems. We have independent groups. We have academic groups and we have groups that are part of for-profit systems. It's important that we find areas that unify us and where all these groups can find value. Our overall focus, though, is on the ambulatory group practice side of the equation.
MH: Let's delve into the value equation. The Trump administration has tapped the brakes on the move to alternative payment models, certainly from a mandatory status. Where does AMGA sit on that particular agenda?
Penso: The current administration doesn't talk as much about value as the previous administration and one of their priority areas is decreasing the regulatory burden on physicians and providers. We fully support that. So what we've done is pivot our priority to developing regulatory relief policies that reward value-based providers. Our focus in working with this administration is emphasizing that value is inevitable, but we can do it through the lens of regulatory relief.
The other issue that we think is beneficial is that the previous administration did push, perhaps even too fast, on some of the initiatives toward moving to value. It takes time for these organizations to retool. Fee-for-service will be unsustainable, but it takes time to develop the culture, the policies, the information technology, the human resources, the care coordination. You can't just turn that on a dime. We will work with this administration to help our groups make that transition successfully by making sure that the programs are ready for prime time.
MH: Let's talk a little about MACRA. What's your sense of your membership and how prepared they are for MACRA?
Penso: I would say, in general, our members are ready. They are organized, remember, in a way that allows them to be accountable for a population. They'll have primary care and specialty care, often they'll have, if not a formal, then an informal relationship with their local hospitals and post-acute care settings. They have the information technology systems. They have the care coordination systems and they have the strong community ties because of their size that have made them understand how to partner effectively. If you put all of that together, they are ready for this transition. I think the question is how do we catalyze this, how do we add the right ingredients so that this can move forward more rapidly?
MH: A related topic is quality measures and metrics. What's your sense of the need for the system to retool, or at least rethink, how metrics are done?
Penso: I have spent years working on this, both as a practicing physician at Sharp Rees-Stealy Medical Group in San Diego, and I lead AMGA's quality and population health programs. I also meet with our quality collaboratives, which are anywhere from 20 to 40 AMGA members focused on improving outcomes in a specific condition, so I think I have a good handle on what works with measurements to move the needle to get better outcomes.
No. 1, less is often more. You need to have fewer measures, ones that are meaningful to the providers and their patients to get the best outcomes. In our best practices collaboratives, we set a rule that we are only going to have three measures maximum on each of those collaboratives that work to improve care.
For example, working on adult vaccines, there are a number of vaccines that we could move the needle on, but we focus just on two: flu and pneumonia. We did a small collaborative with just seven of our members and within a year, we improved dramatically with 190,000 vaccines given that wouldn't have been given without that program. Because of that, we have expanded that to 40 groups and my guess is we'll have in the millions of patients getting vaccines for pneumonia and flu that wouldn't have gotten it.
