10 Questions with Christopher Khoury of the American Medical Association

By Emily Peters

Across his 15-year career in healthcare, Christopher Khoury has worked in everything from biomedical engineering to hospital consulting. Now, vice president of Environmental Intelligence and Strategic Analytics at the American Medical Association, Chris is focused on helping physicians navigate the sector’s rapidly changing landscape. Chris sat down with CareCloud to talk about reading the fine print in value-based care contracts, the importance of health technology usability, and how to respect the humanity of patients and providers.

Emily Peters: Thank you for making time to talk with us today. Let’s kick off by having you tell us about your career path in healthcare. You originally started out in electrical engineering?

Christopher Khoury: It’s been a long journey. Like a lot of careers, some of it has been accidental. You don’t always know exactly what’s waiting around the next corner. After starting out as an electrical engineer, I got hooked on the combination of engineering, biology, and medicine and made a transition further into biomedical engineering. I went on to pursue graduate work, intending to get a Ph.D., but decided to join a startup that was focused on revolutionizing molecular diagnostics.

That was the first time I got a good sense of what the broad healthcare community wanted and needed. You don’t really know what goes on in the patient-physician world unless you step into their shoes. I learned just how crucial it is to understand exactly what is important for both the enterprise physician provider and the patient. By building a medical product for the physician community, I was able to better parse what was expected for a successful product and differentiate what works and what doesn’t work within this community.

healthcare is an incredibly human labor–intensive profession. As much as we look at technology for solutions, at the end of the day, it’s still a profession that deeply relies on the trust, the care, the expertise of physicians, nurses, and others to keep everything running.

After working at the startup, I took a turn into consulting for a number of years. That’s where I was exposed to the realities of healthcare in the United States, largely across sectors from pharmaceuticals to devices to hospitals and nurses and physicians. I walked away from the whole experience convinced that healthcare is an incredibly human labor–intensive profession. As much as we look at technology for solutions, at the end of the day, it’s still a profession that deeply relies on the trust, the care, the expertise of physicians, nurses, and others to keep everything running.

Emily Peters: Do you still think about the healthcare sector from that electrical engineering background, in terms of being a complicated system?

Christopher Khoury: Yes, I can’t remove that part of my brain. It’s so ingrained in me to look at things from a system perspective. Electrical engineers are good at analyzing systems like black boxes, feedback loops, and signals, and I still apply that part of my brain to the work we do at the AMA. There are times when you need to look at a very systemic level to understand why we have our challenges in healthcare today. At other times, it’s better to look at your own local environment and develop solutions to those challenges from a micro or local perspective. When you’re in independent practice, the questions that you ask yourself relate more to how your practice will succeed despite systemic constraints and the challenges you need to overcome to do great work and have a meaningful practice.

Emily Peters: Let’s talk about the changes ahead. We’re obviously at a point of health policy uncertainty with the political administration. What do you think medical groups should be looking out for? What would your advice to them be as we head into the next couple of years?

The burden is higher on the independent physician to find time to read up on changes despite long work days and the umbrella of responsibilities they face.

Christopher Khoury: It can probably feel overwhelming, whether you’re talking about the practice manager or physician on the front lines of a group. We’re all in an environment of information overload, and it’s easy to get overwhelmed. What do we do today? What do we do this year? There is a learning curve for physicians, practice managers, and others involved in the conversation. The burden is higher on the independent physician to find time to read up on changes despite long work days and the umbrella of responsibilities they face.

It may be too easy to look and say, “Oh, that’s not happening until 2018. This rule doesn’t apply yet,” but the reality is a lot of things — especially around payment for value, performance, and quality with EHRs and health IT — are steps that need to be taken today in order to set up for success in subsequent years leading to 2018, 2019, and beyond. It’s complicated. AMA has excellent learning resources available for physician leaders that distill down the complexity. It would be unwise for physicians to assume that they can ignore this for a couple of years and then get up to speed later.

Emily Peters: There’s a sense of “Oh, maybe I can take a breather now that Meaningful Use is wrapping up.” We have MACRA; we have other big initiatives coming. This is not the time to slow down, right?

Christopher Khoury: This is not the time to rest on your laurels. Meaningful Use (MU) has evolved into Advancing Care Information (ACI) with MACRA. The emphasis is on quality. It’s having the right tools and the discipline to report and implement quality, performance, and other practice improvements. What are practices doing that demonstrate that they can show improvement on a particular quality indicator? What steps are they taking that enable them to reach the highest possible levels of growth and transformation? At the same time, some penalties have been simplified or removed, and there is increased upside potential to those who do these things well.

Emily Peters: What’s your advice for independent medical groups from your own organizational change background? Do you have advice or recommendations for somebody who’s trying to implement a more value-driven policy for their practice?

Christopher Khoury: The first thing is: It takes a team. You certainly want to involve and empower your practice manager and physician leaders to be a part of this. I think you need to understand what options you have on the table and your best route in the specific market you’re in. Understanding, for instance, the percent of Medicare patients that are part of your practice is one example. There’s another big theme around physicians acting in a more preventative way and participating in larger initiatives around population health. New tools exist to help patients and practices prevent and manage chronic disease. Today, every physician has more tools available to them and their practice for solving that very big problem.

Emily Peters: What’s something you think is important for medical groups to work on?

Christopher Khoury: I think this applies to everyone, including hospitals, too. The value environment we’re in now is coming from a few different directions. One is from the government and from public payers, Medicare and Medicaid. That has its own regime of behaviors and performance and unique ways to measure and participate in those different programs. At the same time, commercial payers are undergoing their own movement to value-based care. Changes might be felt differently at the local market level. The burden on physicians to participate, in some cases in multiple programs, is high.

I think independent medical groups are not always fully aware of what’s required of them if they’re participating in different programs. They might be taking penalties that they’re unaware of. One of the steps medical groups should take is an inventory of which programs they’re participating in. What do those contracts say about performance, quality, or value? What are the reporting and measurement requirements imposed on them? How do they differ from one to the other? That is not an easy task, but we do find cases sometimes where practices have several contracts with private payers, each with their own set of requirements.

Emily Peters: Is there something that you’re seeing happening with midsize and larger medical groups that you find inspiring?

Christopher Khoury: It’s great to see mid to large single or multi-specialty groups carving their own independent path and blazing a trail. For instance, 41 entities of varying sizes participate in CMMI’s Transforming Clinical Care Initiative. We see practices engaging in new programs independently, either through the adoption of health information technologies or by participating in connected initiatives, whether that is clinical trials, research, or information sharing.

Emily Peters: What’s one thing you think every medical group executive should know in this current political landscape?

every medical executive should know that payment for value and the associated tools, methods, and models that relate to that broad category will be here to stay.

Christopher Khoury: It’s hard to ignore the political backdrop we’re all operating in. There’s an easy tendency to begin questioning everything and wonder about the uncertainty out there. I think every medical executive should know that payment for value and the associated tools, methods, and models that relate to that broad category will be here to stay. I don’t think we’re going to see a reversion back to an older model. Although it’s hard to know for certain, I think the march has begun toward modernizing healthcare delivery, and it will be very hard to stop. Great leadership is more important now than ever.

Emily Peters: Are you seeing something really exciting happening in the health technology space that’s maybe unexpected?

Christopher Khoury: There’s a lot. We constantly scan and track what’s interesting at the AMA. We’re seeing more companies focused on trying to give time back to the physician. We did a study a few months ago that concluded for every four hours physicians spend with patients, they’re spending another two at the EHR. Physicians are often frustrated and burned out because they don’t have enough time to do what they love best, which is patient care. We’re starting to see a second wave of digital tools, platforms, technologies with the stated goal of liberating the physician’s time and turning the focus back to time with patients.

I think we’ll start to see the rest of the health industry evolve around that theme, some more slowly than others. Usability and user-centered design, not just from the patient perspective, but also from the physician perspective, will become critical. At the AMA, we work closely on getting physicians and the health technology sector to engage with each other for the goal of making better products that benefit the patient-doctor relationship and ultimately patient outcomes.

Emily Peters: As we wrap up, is there anything else that you think would be important for medical group readers to know?

I think the next five to 10 years are highly critical. It will really be a test to see whether technologies are ultimately helping or getting in the way and whether new care delivery models are helping or complicating healthcare.

Christopher Khoury: We’ve had an incredible amount of change in the past 10 years. Some of it has been policy-driven, and some of it has been market-driven. At the end of the day, we are talking about human beings and professionals who carry an incredible responsibility to do great work and to help patients. I think the next five to 10 years are highly critical. It will really be a test to see whether technologies are ultimately helping or getting in the way and whether new care delivery models are helping or complicating healthcare.