The American Medical Association's efforts to improve healthcare are deeply affected by the regulatory domain, so "we're working closely with agencies to craft a more sensible future," said James L. Madara, MD, the group's CEO and executive vice president, speaking at the 34th Annual J.P. Morgan Healthcare Conference in San Francisco. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), in particular, is a big deal. Changes are going to come rapidly, he said. Rules will be released before the fourth quarter of this year, and come into effect in January 2017 to affect payment in 2019. "A lot will have to happen quickly. It seems daunting but we have practice working through challenging impelmentation issues, such as ICD-10."   Another critical element healthcare must become immersed in is the innovaton that's needed, said Madara. "We have to meet challenges with innovative products and services." That's not limited to new products and solutions but extends to optimizing existing products and services. Madara said a systems engineering view will help because a systems engineer will tell you that when you drop a new product into a system, many other things are affected. A complete view and understanding of the healthcare system is required to really craft these products that will have to be flexible or have variations on a theme. To help in this area, AMA has produced interactive digital modules and also works with startups to ensure that the granularity of workflow is understood for better work at the initiation of products so they can be more optimized.  Madara also mentioned Health 2047, a new Silicon Valley innovation company, that he said "will be the crown jewel of the innovation ecosystem of AMA." The company will have three business tracks: partnering, condevelopment in which AMA work with an emerging growth company; and solutions that address white spaces. "We think having a direct bridge between our content experts, physician communities and the technology resources of the Silicon Valley should lead to a more targeted, optimized, coordinated rapid cycle of solutions. All of that also needs to be done attentive to and adapted to the emerging regulatory environment."  Madara also discussed the misconception of physician feedback, that maybe the community is not ready for technological advances. However, robotic surgery and a whole series of technological tools and advances that actually work well are rapidly adopted, he said. "That's a signal to the community that if a technology is introduced and not adopted, there's a canary in the coal mine there telling you that the technology itself is suboptimal." There is a great variation in practices across the nation that isn't going away, he added.  Physicians are motivated by patient care and things they believe in, Madara said. "If they're asked to do box checking on process measures they don't think have an evidence base, it really deteriorates the relationship between the physician community and regulators.  "We have to get the hearts and minds of physicians back," said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services. "I think we've lost them." Referring to Meaningful Use and other federal mandates, "when in doubt, do less and figure it out. Good ideas piled on top of other good ideas become bad ideas pretty quickly. They sink with their own weight. We've got a great opportunity to rapidly advance medicine and science."