Recently, The Scope was honored to connect with Dr. Jerry Penso, M.D., M.B.A to discuss the ripple effects of the COVID pandemic in the healthcare industry, who is driving meaningful disruption in the space, and the need for consistency and predictability in value-based care delivery.
Dr. Penso is president and chief executive officer at AMGA, a trade association that represents medical groups and other organized systems of care, including some of the nation’s largest, most influential integrated healthcare delivery systems.
Dr. Penso previously served as chief medical and quality officer for AMGA and president of AMGA Foundation. Under his leadership, the impact of AMGA’s quality programs grew to improve care for 26 million patients.
Prior to joining AMGA, Dr. Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG), the largest integrated healthcare delivery system in San Diego.
(Answers edited for style and length.)
What innovations in the last 1-3 years do you feel will permanently change the healthcare industry and why?
I have seen the accelerated adoption of several innovations in care delivery by AMGA members during the COVID pandemic. Early in the pandemic, the use of telehealth—including video, audio and remote monitoring technology—skyrocketed as physician practices needed to continue to care for patients while keeping them safe at home. Telehealth is now incorporated into most practices and if we can get the regulations and reimbursement right, will remain an important component of how medical care is provided.
Another innovation that I am convinced will grow is hospital at home. We can use a combination of technology, in-person visits, video visits, and continuous biometric monitoring to safely treat conditions that previously required care in the hospital setting. Studies have shown that hospital at home can result in cost savings, higher patient satisfaction, and improved outcomes. Finally, I have seen many AMGA members develop innovative programs that address health equity and engage with community partners. I have seen the impact of applying more comprehensive data to address social determinants of health and help health systems create tailored solutions that overcome barriers to better health. In the future, I think we will see even more applications of new types of data to solve real community needs.
Who (organizations or people) are the most meaningful disruptors in healthcare today and why have others failed?
We have seen an explosion of new entrants into the care delivery space. Private equity, health plans, and health systems have increased their purchases of physician groups, creating new financial models for the practice of medicine. Remote monitoring and telehealth companies have found new ways to interact with the healthcare ecosystem. We have also seen growing uses of artificial intelligence that are driving operational efficiencies and increasing clinical effectiveness. In order to succeed, these disrupters must provide value and meet the needs of payers, consumers, and the healthcare team. The winners will be those disrupters that can provide better convenience, access, and an enhanced patient experience.
What areas of healthcare do you think are most in need of change?
Quite a few. My background is healthcare quality, and we need to develop learning health systems that continuously improve the health of those served. This means using all available data to monitor critical outcomes and creating teams that are accountable for performance. We also must continue to move payment models to value to ensure that we provide not only great care, but care that is affordable. We also need to improve the patient experience through better systems and human interactions grounded in empathy.
What does value-based care mean to you? Can you provide us some examples in action?
Value-based care usually refers to payment models that reward higher quality at lower overall costs. It may involve rewards or penalties for certain quality indicators, cost of care targets, or other specific measures. There are agreements between the providers and payers around which population is included in performance calculations, how to measure performance, the covered time period, and the amount of financial risk for the provider group. AMGA members, which are multispecialty medical groups and integrated health systems, are ideally designed to deliver value-based care. They have invested in the infrastructure—including information technology, care management, quality improvement, and operational systems—to manage the quality and cost of care for a defined population. For example, AMGA members have been leaders in participating in CMS’ Medicare Shared Savings Program, which creates incentives for providing higher quality and lower costs for Medicare beneficiaries.
What are the biggest challenges and obstacles to making your vision of a value-based care future a reality?
For value-based care to work, there needs to be consistency and predictability in how the program is administered. Rules that change each year create havoc for a provider group, as it takes time to adjust care processes, update data systems, and then educate the entire team. In addition, there needs to be a long-term commitment from federal and commercial payers so that planning and deployment of resources make financial sense. There also needs to be comprehensive data exchange between the parties so that all aspects of the care and cost can be managed. The most important ingredient to success, however, is trust. Value-based care requires a new type of relationship between payer and provider, and this requires a true partnership on achieving better health care.
Where do you like getting your industry news from? Which industry thought leaders do you listen to and why
I am fortunate to work for a leading healthcare trade association in the Washington, D.C. area, where getting up-to-date information is not a problem. I have a great team that continuously tracks and analyzes what is happening the complex healthcare environment. I also rely on the leadership of AMGA members, CEOs and other healthcare executives, who are creating the health care of the future. The expertise, vision, and commitment of these leaders always inspires me.
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