Top 3 Concerns at Healthcare Providers: Q&A With AMGA Chief

Jerry Penso shares insights from visiting more than 65 AMGA member organizations since October 2017.

You could say that Jerry Penso, MD, MBA, likes to travel. With purpose.

The former family physician at Sharp Healthcare in San Diego became president and CEO of AMGA in 2017, and he made a commitment to the organization that racked up thousands of frequent flyer miles.

"When I took the role, I promised the board of directors that I would visit 40 medical groups in 40 weeks. It started in October 2017 and ended in June 2018," Penso says.

After making that promise as part of his hiring process, Penso visited more than 65 AMGA members.

He joined Alexandria, Virginia­–based AMGA seven years ago as the organization's first chief medical and quality officer. Prior to working for AMGA, Penso was continuum of care medical director for Sharp Rees-Stealy Medical Group in San Diego.

AMGA—formerly the American Medical Group Association—has more than 400 medical group and health system members. More than 175,000 physicians practice at AMGA members.

HealthLeaders recently spoke with Penso to discuss his 9-month cross-country journey to visit physician practices and medical groups, and he reveals the three primary issues on physicians' minds. Following is a lightly edited transcript of that conversation.

HealthLeaders: Were there commonalities between healthcare organizations?

Penso: There were three issues that came up repeatedly at every medical group or health system that I visited.

1. Pressure on margin: Most of them are seeing or projecting flattening revenues, but expenses continue to rise based on a bunch of reasons from labor, to pharmaceuticals, to information technology. They are focused on the margin issue and are trying to figure out how to manage expenses.

2. Challenges in the move to value: Many see value as the future, and they understand that is the direction they need to go. However, there are challenges—struggles with the payers, care redesign, and grappling with some of the payment models.

3. Physician leadership and physician burnout: Senior leaders are finding they need a new kind of physician leader to help with the challenges they face—integration with other practices, the move to value, engagement of physicians in working with patients in new ways, and practice redesign. These responsibilities are contributing to burnout—more and more burdens are being place on physicians.

HL: Gauge the level of optimism you encountered during these visits.

Penso: It was one of the surprising things that I found—the medical group and health system leaders I met were surprisingly optimistic. They realize there are challenges with the payment models, redesigning care, and physician engagement, but these leaders are committed to their communities.

Our medical groups and health systems are often the largest employers in their areas. So, they are embedded in their communities. That commitment gives them a mission to improve the healthcare they provide for their friends, families, and others who live among them.

HL: What were the qualities of the top performers?

Penso: There were two keys to top performers.

1.  They had an organized system of care. They had infrastructure to deliver care in a systematic, coordinated, consistent, and reliable way, and a common electronic health record across their system. They also had good analytics to understand their population, and a care coordination strategy. They also had strong physician leadership to manage the group.

2. Top-performing medical groups had a culture of learning and collaboration. They are always working to improve care and outcomes, and they measure it. All of the components collaborate—the hospital, nurses, physician staff, and IT professionals all work together.

HL: How is the physician shortage impacting AMGA members?

Penso: I heard about physician shortage at many of the places I visited, but particularly in the rural areas of the country. Their challenge is to attract and retain physicians—especially primary care physicians.

Most practices are facing a demographic issue. Many physicians are older and nearing retirement. Figuring out a strategy to replace those physicians is on the minds of many of my health system and physician practice leaders across the country.

In response, they are figuring out how to deliver care differently, which will probably require more of a team-based approach. They want to make their practices more efficient and use their physicians exactly as they are needed, then use other providers such as advanced practice practitioners to provide care for patients. They are also utilizing technology such as telemedicine, so you may not need as many face-to-face visits with a physician.

HL: How do your members view the healthcare policies of the Trump administration?

Penso: In late 2017 and early 2018, there was a lot of uncertainty about the Trump administration—the direction they were going with healthcare. The unsuccessful effort to repeal the Affordable Care Act was on everybody's mind. AMGA members wanted some help understanding the direction of the administration. The previous administration had been very assertive in moving toward value, and they wanted to know whether the current administration was going to follow those policies.

We have seen a lot of movement in this administration toward value, so we are very encouraged. There is also a strong push toward regulatory relief. So, we think the direction under Alex Azar and Seema Verma appears to be favorable to moving toward value-based models.