On March 13 in Philadelphia, David Nash, M.D., founder of the first U.S. academic institution focused on population health, establishing the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, headed the 13th Population Health Colloquium, with its goal to provide forward thinking and meaningful continuing education for healthcare professionals to help prepare them to find solutions to the myriad challenges that healthcare currently faces.
Day one of three of the colloquium included an array of industry experts who addressed many healthcare issues and showcased their current initiatives, products and programs being implemented around the country and abroad. While Jeffrey Brenner, M.D., spoke passionately about managing high risk patients, Susan Frampton, Ph.D, stressed the importance of putting patients at the center of care, and John Walker, M.D., CMO at Cornerstone Healthcare in High Point, N.C., gave his expert advice on how to build a population health program within a medical home, it was Nash, a leading light for the population health movement, who was the star of the day.
In the midst of the day’s activities, Nash was able to sit down with HCI Assistant Editor Rajiv Leventhal to talk about his goals for the colloquium, the state of population health, its pioneering elements, and its main IT foundations. Below are excerpts from that interview.
This is the 13th Population Health Colloquium. What do you hope to achieve at this one, and what main discussions do you want to inspire?
Well, our field of population health is still in its early stages. Our school is not even four years old. So I think we’re helping to define where we hope reform will go as evidenced by the talks this afternoon. [For instance], you can call it an accountable care organization (ACO), but if all that means is that you have created a larger delivery system by virtue of more hospitals, that is not something that will improve outcomes, transparency, patient satisfaction, and certainly won’t bend the cost curve. What can determine a good outcome, other than medical care? Community support, care coordination, nutrition, socioeconomic status are all the messy things that go into population health. The other message that we are trying to transmit is to the hospital industry, who needs to be paying attention to this. Because the notion of more is better—more patients filling more beds—that is a dangerous cycle for the future. But this will be a very complicated message to deliver to the traditional hospital. I’m pretty confident that our industry can make this change, but it will be an uphill battle.
Population health is certainly a concept that is blossoming now. What are its pioneering elements?
If you look at the literature, some of the first peer reviewed papers on population health go back 35 years. One of the founding fathers of the field is Dr. David Kindig, who is still alive and working at the University of Wisconsin-Madison. He used to be a hospital president in Philadelphia, and he came to the realization 35 years ago that they were admitting the same patients over and over, and that just wasn’t going to work. This is something that didn’t get traction until very recently because of the cost. In other words, incredibly, the only reason people are paying attention now is because [healthcare] is 20 percent of the GDP (gross domestic product). If it were instead 5 or 10 percent percent of the GDP, we wouldn’t even have this conference. The hospital industry better realize that we need to fix healthcare because it is the core component of the federal deficit.
And who is doing the best work now in the field?
Many of the people here at this conference are doing the best work. We heard Jeffrey Brenner (executive director, Camden Coalition of Healthcare Providers) speak today, and tomorrow we will hear from Jeffrey Kang, senior vice president, health and wellness solutions, at Walgreens, which currently has five ACOs. Who would have ever thought that your corner pharmacy would be where you go to get primary care? But when you think about it, you might be in your doctor’s office three times a year, but you’re in your local Walgreens 30 times a year. So we need new models, new people, and new energy. That’s what this is all about.
What are the main IT foundations in population health?
We do not believe that the big IT companies are the only answer. We certainly support the Cerners and Epics [and other big vendors], but the answer lies with tools on top of that. We need a registry, and we need comparative data in real time at the doctor level. The electronic chart is one thing, and that’s fine. But the analytics to provide population based care—that comes from elsewhere, and that remains a big challenge for us. In terms of meaningful use, sure at the individual doctor level, you deserve a bonus for writing a prescription online, but that is not the fix. The fix is, “show me how I’m doing with all of my patients today so I can improve for tomorrow.” And you don’t need a two million dollar technology [budget] to get that done.