It’s time, says Dr. Patrice Harris, for the industry and policymakers to pay more attention to the critical connections that shape a person’s health. The brain, as she points out, is part of the body. Early childhood trauma can lead to poor health habits later in life. Diversity in the workforce can influence the equity of care. Those are some of the areas that Harris, a psychiatrist from Atlanta, hopes to tackle as the new president of the American Medical Association. The first African-American woman to hold the post, Harris will be inaugurated June 11 during the AMA’s annual meeting in Chicago. She talked with Modern Healthcare Managing Editor Matthew Weinstock about her goals. The following is an edited transcript.
MH: What are your priorities as you take over as AMA president?
Harris: I plan to amplify three things. The first is the importance of mental health as a part of overall health. The second is health equity and the related need to improve the diversity of the physician workforce. And finally, to raise the level of awareness around the need to assess and address adverse childhood experiences.
MH: What kind of movement are you seeing in the industry to create more of an integrated approach to mental and physical health?
Harris: We have seen progress toward the understanding that mental health is a critical piece of overall health. The words that you use—“part of physical health”—are words that I and many others use. But if we really think about it, we need to find another term because the brain is connected to the body and the brain is a part of our physical health.
Over the last decade or so, there have been many practice models and system models developed to enhance the integration of mental health to overall healthcare. I’ve led efforts here in Atlanta to build facilities where mental health, primary care and public health are all in the same clinic.
MH: What kind of things will you be advocating for either from the private sector or from regulators to continue that kind of integration?
Harris: One particular issue is to eliminate the need for prior authorization. When someone needs substance use disorder treatment, particularly opioid use disorder treatment and medication-assisted therapy, the need to get prior approval for that service delays care and in some instances could mean death.
Another area we’re working on is parity. President George W. Bush signed parity legislation into law more than a decade ago. But I hear often about instances where care is denied and not offered on the same level. The AMA will continue to raise awareness around parity and ensuring that all payers comply with parity laws—federal and state. We need to make sure someone is looking to see if payers comply with those laws. Once we know that, what strategies and tactics do we need to move forward to make sure those parity laws are enforced.
MH: Let’s talk about equity of care and diversity of the workforce. They’re different things but tied together.
Harris: We have, as a country, been talking about health disparities for some time and we know they exist in many areas. They exist regarding maternal mortality and morbidity. They exist in diabetes, hypertension and so many areas. Now we need to talk about health equity and what specifically can we do to ensure that everyone has equal opportunity to make choices around behaviors that we know are health-promoting behaviors.
The AMA made a recent recommitment to this issue. We are developing a center on health equity and recently hired Dr. Aletha Maybank to lead the AMA’s new efforts in that area.
One issue surrounding health equity is the need to address the other determinants of health. The AMA will continue to highlight the need to address the social determinants of health, continue to highlight how social determinants impact health disparities, and therefore the lack of health equity.
The diversity of the physician workforce is key. And we know that there have been some studies that show, particularly around African-American men, that they have improved health outcomes when seen by physicians who look like them. So federal and state legislative efforts that enhance opportunities for medical students of color, issues around student debt, issues around funding for pipeline programs—those are just a few of the areas that we know can contribute to a more diverse physician workforce.
MH: The American Hospital Association recently issued a report on health system governance. One area where they found a continued gap is diversity on boards. How can the industry create opportunities to foster more diversity at those leadership levels?
Harris: One suggestion that I’ve made is that everyone in the industry—every entity, every system—should do a self-assessment and look at their own hiring practices, their promotion and tenure practices.
Look at who’s on the admissions committees of medical schools. Work with the community on pipeline programs and perhaps fund community-based efforts to make sure that elementary school children, particularly from under-resourced communities, have opportunities so they can thrive in elementary school and junior high school, high school and beyond. We need to start early.
I said one of my priorities is around addressing adverse childhood experiences and a tiny piece of that is when we can address and perhaps prevent some of those experiences, that makes children healthier. Healthier children do better in school and again, up the pipeline.
MH: Talk a little bit more about adverse childhood events. How would you like to see the industry address this?
Harris: Adverse childhood experiences are potentially traumatic events that can have negative and lasting effects on a person’s health and well-being. This issue was first raised from a study (in the mid-1990s) completed jointly by the Centers for Disease Control and Prevention and Kaiser Permanente. From that study we learned that these traumatic events can range from physical, emotional or sexual abuse to parental divorce or even incarceration of a parent or a guardian.
There’s an ACE score and we know that children who have higher ACE scores have greater rates of heart disease, diabetes, depression and suicide.