Despite the exciting changes in the evolving healthcare market, there is an overarching drive that will dictate the direction of innovation: the shifting nature of disease burden itself, said James L. Madara, MD, CEO and executive vice president of the American Medical Association (AMA). Speaking at the 34th Annual J.P. Morgan Healthcare Conference in San Francisco, Madara said this driver has radically changed in a way that has crept up on us. "It has changed from acute to chronic yet much of our healthcare structure is still tilted to the old paradigm of acute disease. The Centers for Disease Control and Prevention estimates that more than 80 percent of our $3 trillion healthcare spend is related to chronic disease. Science indicates that we will continue to spend more and more on chronic disease because we are converting previously fatal conditions to manageable, chronic conditions," Madara said. "One corresponding change is a shift in the site of care from inpatient to ambulatory. Given the central role physicians play in healthcare, we really need to understand, capture and analyze the function of physicians in this system. AMA is well positioned to do that. AMA serves as an organization of organizations, including all the state medical societies, all four branches of military medicine and more than 120 specialty associations."  AMA has three key focus areas which are products of its first long-term strategic plan, put into effect in 2012. 1. Radically restructure medical schools to meet future needs. Curricular content is updated all the time but the structure has been pretty much the same for almost a century. We need to move from time in the chair to measured competencies. We need to introduce new fields of practices such as implementation science and care delivery science. We need to educate in team-based ways rather than solitary ways and educate for adaptation of technological advances like telemedicine. We need to think about care continuity and also connection with community assets important in taking care of people with chronic disease.  Today's students are not deficient, Madara said, but "students' excellence is partly masked by the deficient curricular structure." To address these problems, AMA convened a group of 11 medical schools as an initial step to creating the medical school of the future. That has now expanded to 32 medical schools—about one-quarter of them all. "Each of these schools is working with others and have developed pieces of innovation. When they come together, we begin to see what the medical school of the future might look like." 2. Physician satisfaction and practice sustainability. AMA has been collaborating with some of the top management consulting firms since 2012. "We've identified a diverse array of addressable problems. Products already are emerging to address practice needs, such as modules around previsit planning. The goal is helping practices organize themselves so that patient visits are enriched interactions and collaborative with most of the data there. Technology continues to be important to drive these changes." There also are some problems. While no one wants to go back to paper, current EHR platforms don't work so well. They are good for claims and billing but not really good at all for organized clinical data needs at the point of care. EHR adoption has been "one of our most visible technological advancements in medicine but a study found that in an average eight-hour physician shift, they have 4,000 clicks. If each takes 2 seconds, that's more than 2 hours during that shift spent clicking through." 3. Improving health outcomes. A lot of work in this area focuses on the problem of chronic disease. Studies show that 86 million adult Americans are prediabetic and there is a high rate of conversion of those with prediabetes to diabetes. Ninety percent don't know they are prediabetic and those that did largely didn't know what to do about it although there are effective diabetes prevention progams. So, AMA is working with the YMCA and other organizations to share information and raise awareness.