Donor Spotlight on AMGA Chief Medical Informatics Officer John Cuddeback,
chief medical informatics officer, John Cuddeback, M.D., Ph.D., leads AMGA’s
analytics team, bringing together AMGA member organizations to improve
population health through clinical and financial benchmarking and through
predictive models. A longstanding believer and supporter of the Foundation’s
work, we are honored that he has become a Cabinet Leadership Donor.
AMGA Foundation: As AMGA’s Chief Medical Informatics
Officer, what inspired you to become a cabinet leadership level donor for the
Campaign for a Healthier America?
Cuddeback: AMGA is unique. We advocate for aligning payment
incentives with population health, and our educational programs and Foundation
initiatives help members redesign their delivery systems to manage population
health. It requires a system approach. That’s the team-based model of care that
our members are committed to. But there also has to be a business case for
moving from volume to value. Provider organizations need to be able to benefit
from the investments they make in population health, sharing in the future
savings that result from better health. That’s why AMGA’s unique combination of
advocacy for value-based payment with education and collaborative shared
learning is so important.
But health depends on much more than health care. Vision 2025 expands AMGA’s
focus to include the social factors that also influence the health of
individuals and populations, supporting members as they lead this broader
transformation within their communities.
AMGA Foundation: In what ways do you see data analytics
advancing over the course of the next decade in support of healthier
Cuddeback: We think of “precision medicine” in terms of the
genome and highly individualized therapies. They will no doubt lead to big
changes. But even today, there’s an untapped opportunity to use available data
to develop multi-variable predictive models that are much more informative than
any single clinical parameter.
Two AMGA members, Premier Medical Associates in Pittsburgh and Mercy in St.
Louis, are using such a model for shared decision-making. For each person with
prediabetes, the model estimates their risk of progressing to diabetes and also
the likelihood they will benefit from the interventions studied in the Diabetes
Prevention Program. The DPP study was a landmark clinical trial conducted in the
late 1990s and stopped a year early because both interventions—an intensive
lifestyle program and prescribing metformin—were so effective. The model
identifies one-fourth of people with prediabetes who will gain 2–3 times the
average benefit seen in the DPP study, and one-fourth who will see essentially
This model, developed at Tufts with PCORI funding and using data from AMGA
members through OptumLabs, can help to prioritize people with prediabetes for
intervention, and it’s a much better predictor than A1c, which most clinicians
currently use. More than 25% of patients in the highest-risk quartile have an
A1c in the low end of the prediabetes range, and 15% of those in the lowest-risk
quartile have an A1c in the high end of the prediabetes range.
AMGA Foundation: What is #1 on your population health wish
Cuddeback: Ultimately, population health comes down to
making the best decision for each person, accounting for their individual risk
factors. That’s why these multi-variable predictive models are so important. We
developed another one for diabetes as part of AMGA Foundation’s Together 2 Goal®
campaign, and we’re working with Johns Hopkins on yet another.
But for members to use these models for shared decision-making, we have to
splice them into the clinical workflow at the point of care—we have to get them
into the EHR. They’re complex formulas, so it would be a lot of work for each
member organization to program them and test them within their own EHR.
Fortunately, there are emerging industry standards, supported by all the
leading EHR vendors, that will allow these models to be hosted in the cloud and
used for each patient at the point of care. That’s my wish—to see wider adoption
of these standards, so these population health models can inform shared
decision-making for every patient.
AMGA Foundation: What is the most exciting trend you are
seeing in terms of improvements in chronic care due to AMGA Foundation’s
Cuddeback: I love the way AMGA Foundation frames its
campaign goals in terms of the number of patients whose lives our members have
improved. It’s much harder to track the trajectory of each individual with a
chronic condition than it is to follow a series of cross-sectional measures at
the population level, as most organizations do. But AMGA Foundation’s approach
puts the emphasis on the patient, and that’s the most meaningful way to chart
I’m particularly excited by the expanded scope that Vision 2025 represents. I
remember my first AMGA Annual Conference in 2007, where I heard Health Partners
and others talk about working in their communities to address social challenges
and to become more sensitive to cultural issues. I’m proud to be part of an
organization whose members are leading the way on so many fronts to improve
health, as well as health care.