HR: Data over the last 20 years indicates a trend toward patients requiring fewer nights in hospitals, despite an increasingly aging population in the U.S. Can you share AMGA's perspective on this trend?

JP: The trend is reflective of many factors, but particularly, positive changes in the delivery system and preferences of patients towards outpatient care. More organizations are using a population health approach to manage complex patients and focus on preventative care. In addition, telehealth, remote monitoring, and an increasing number of surgeries in ambulatory practice settings are all moving us in this direction. We think these are all good trends. The industry is moving to a value-based system while also responding to patient needs and preferences.

HR: Speaking of telehealth, consumers are receiving care at more than 3,500 retail clinics nationwide. What do you see for the future of medical groups in a more consumer-centric world where patients can access care anywhere, anytime? How can medical groups effectively compete?

JP: AMGA members utilize a group practice model that houses coordinated services under one roof. Ancillary services and specialists communicate through a unified health record. Many are also using Lean methodologies to streamline the patient experience. So, I have confidence in the ability of AMGA's medical groups to respond in a variety of ways that do not increase fragmentation.

For example, Wellmont Medical Associates, serving 23 counties in Northeast Tennessee and Southwest Virginia, is building urgent care centers to respond to retail medicine. Off-hours and walk-in availability will help patients avoid costly visits to the emergency room, while still coordinating care within the medical group practice.

HR: After spinning off physician practices in the nineties, health systems are once again employing physicians-even though they are frequently losing money on this approach. Does this financial model make sense?

JP: I believe it does make good economic sense as Congress and the private market continue to move towards value. Under that payment model, building a large, sophisticated, and aligned network that is robust enough to manage a large population-and deliver on quality and cost-is critical. Without employed or affiliated physicians, organizations won't be able to do the type of value-based contracting that we see as the future of payment.

In the interim, the business may look unprofitable, depending on how accounting systems apply and allocate the cost of ancillary services throughout the system. AMGA also recommends that systems benchmark the best-in-class data that we offer—to identify efficiencies in physician compensation, executive compensation, productivity, and staffing.

HR: There's much discussion around the transition to value. What are the challenges AMGA members are encountering when trying to make it work?

JP: AMGA members are all along the risk continuum, from those still doing fee-for-service up to full capitation. However, many have been preparing over recent years for both upside and downside risk in everything from developing staffing with care management and IT analytics to unified electronic health records and care redesign.

AMGA's most recent risk survey identified a definite move to accepting more risk in federal and commercial programs. However, there are still a number of barriers impeding this transition. Those range from sharing data with health plans to not getting claims data in a timely, accurate, or standardized manner. The reporting on quality measures becomes a barrier to moving forward due to the cost of information technology resources. We'd like to see a harmonization of quality metrics and simplification to reduce costs that are being diverted now from providing care.

HR: Any last thoughts to share?

JP: I'm an optimist. I've seen groups throughout the nation work collaboratively to improve care and provide better value. For example, AMGA supports quality improvement initiatives. We're in the second year of a diabetes campaign that includes more than 150 AMGA member systems and their physicians to measurably improve care.

In just one year, we've improved care for more than 600,000 patients on clinical indicators like blood sugar, blood pressure and cholesterol. I believe that if all stakeholders come together, we can work together to improve care and provide more value.