Dr Barbara McAneny Discusses Addressing Chronic Preventable Diseases and Social Determinants

What happens outside of the physician’s office is important to a patient’s health and the American Medical Association (AMA) is working to extend the physician’s and better measure social risk factors in addition to medical ones, explained Barbara L. McAneny, MD, president of the AMA.

Transcript

What steps is the American Medical Association taking to improve patients’ engagement in their own health? How is AMA working to curb preventable disease?

The chronic preventable diseases are enormous in this country. We spend $3.3 trillion every year on healthcare, and 90% of that is on chronic disease. Diabetes and heart disease and now, to some extent, cancer are chronic diseases, which need to be managed. You don’t manage those diseases well in hospital, you don’t even manage them, really, in a physician’s office. A lot of them are diseases that need management outside of the office.

So, take diabetes and prediabetes, which is still reversible, and there are millions of Americans who have this and have no idea, but a physician has 15 minutes with a patient 4 times a year, perhaps, but then the patient goes out and their lifestyle—what the eat, how much exercise they get, whether or not they are taking their medications appropriately—that happens out in the patient’s home and in their community.

So, the AMA is working in our diabetes prevention project to try to extend the reach of physicians by trying to partner with other entities so that we can assist patients to learn how to manage this disease. Part of that will require looking, for example, at food deserts. If you live in an area where there are no grocery stores and the only vegetables have been sitting on the convenience store shelves for 3 weeks, you’re probably not likely to eat those and choose those. We’re going to have to work with communities more.

So, the AMA is working to create those alliances and those consortiums that will help patients do a better job of taking care of themselves.

Social determinants of health are becoming more of an issue on which providers are focusing. How is AMA working with organizations in the community that are addressing social determinants?

For the social determinants of health, one of the things that people don’t realize is that the most important factor in your outcome from a disease is your ZIP code. So, when we are grading physicians right now on what their outcomes are, and we don’t know what that social determinant is, we don’t know what ZIP code they’re in, we don’t know if they have a caregiver, we don’t know whether or not they can afford their copays and deductibles, all of those social determinants are not being measured.

So, one of the things that the AMA is taking on, which I think is incredibly important, is how do we measure that? And how do we code for that in a respectful fashion, so that we can look at what that problem is? You can’t address a problem until you know how to define it and what the magnitude is. We’re working to create a coding system, which will take us, unfortunately, a few years, probably, but we’re working to develop a coding system that will allow us to be able to stratify patients according to those risk factors, as well as what is your tumor type, and are you also diabetic and all the other medical risk factors that are part of it. Because then we can truly judge whether or not a physician is doing the job we’re hoping they’re doing. You know, if they’re starting out with someone whose hemoglobin A1C is 14, and then get it down to 9, they’re doing a great job. But they would still be penalized under our current system.