David Nash, M.D., is one of the best-known pioneers in the world of population health management and related areas, in U.S. healthcare. For two decades, he has been leading change, and urging his fellow physicians and other healthcare leaders forward, to transform the U.S. healthcare industry from a volume-based payment and delivery system, to a value-based one.
Dr. Nash, the author of numerous books and countless articles, was named Founding Dean of the Jefferson College of Population Health (JCPH; itself a part of Thomas Jefferson University in Philadelphia) in 2008. He is also the Dr. Raymond C. and Doris N. Professor of Health Policy. He is a board-certified internist who is internationally recognized for his work in public accountability for outcomes, physician leadership development and quality-of-care improvement.
Dr. Nash will be chairing the Eighteenth Population Health Colloquium, to be held at the Loews Philadelphia Hotel in Philadelphia, next week, March 19-21. He and his colleagues at JCPH will be bringing together a host of national leaders in the population health/care management/value-based payment and delivery area, to discuss a broad range of important policy, payment, strategic, and operational topics in that broad area. He spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the current moment in—and future prospects of—the population health management phenomenon. Below are excerpts from that interview.
David B. Nash, M.D.
Starting at a “40,000-feet-up” level, what would your elevator speech be these days, to explain the strategic and operational landscape around population health?
My elevator speech is that we have to move from volume to value, to prevent the U.S. healthcare system from collapsing under its own weight; and whether the private sector does it first, or Uncle Sam does it first, someone has to do it. And [the path towards a value-based payment and delivery system] is moving inexorably forward.
One of the interesting things about the speeches that were made last week at the HIMSS Conference and elsewhere, by federal healthcare officials, was their stated commitment to compelling providers forward towards value, even as they also support the idea of free-market-driven healthcare change.
And we weren’t at HIMSS, but we were thrilled that Secretary Azar [Alex Azar, Secretary of Health and Human Services] and Administrator Verma [Seema Verma, Administrator of the Centers for Medicare and Medicaid Services] have explicitly embraced value-based payment.
So, I’ve been saying for some time that building the foundation for population health initiatives in the U.S. healthcare system has been a bit like what happened when they built the Transcontinental Railroad in the 1860s, where at one point, people were literally taking pickaxes and breaking ground in the Rocky Mountains in order to lay the first tracks there. Where would you say we are right now in terms of laying the broad foundation or population health management across the U.S. healthcare system?
I would say that we’ve got most of the track laid, and the train is running slowly, and we’re testing the track right now. That’s about where we are with this.
Is there enough of a critical mass of literature now to help guide those who wish to pursue a population health management path?
That’s a great question. We think there’s just enough critical mass now, yes, a lot of it communicated in our Population Health Journal. But the evidence to support the journey, has reached a critical mass, yes. The evidence we’re lacking is the critical timing. But the road to redemption is paved with V-B payment. How fast we can lay that down, now that is a problem.
Do most physicians in practice understand what’s going on now, on a broad level? And where are they in terms of their buying into the reality, and accepting where everything’s headed?
To be honest, I believe it [physicians’ buying into the reality of payment and delivery system change] is breaking down along age-related lines. Physicians 60 and over, and forget about it. Those 45 to 60? They’re grudgingly aware of what’s going on; they’re not really going to dramatically change what they do, but they’ll cooperate just enough to maintain their status. Those 30 to 45? They’re saying, count me in. Of course, there are exceptions in all the age categories; but in terms of broad generalizations, this one holds up.
Inevitably, then, with regard to most of the over-60 physicians in practice, you just have to work around them?
Totally! We totally have to work around them here. You have to kind of make a command decision, and move forward, and accept reality, and do what you can do.
So, looking at that key 45-to-60 group of physicians in practice, what are the critical success factors in engaging them to get cooperation to participate in transformational change?
Honestly, the key is pain. If you’re a primary care physician, you’re experiencing pain right now [with payment shifts], and things are going to change, and that will motivate you. If you’re a subspecialist, the economics aren’t there yet, so you won’t change dramatically. But as the pain level increases, you change. That’s what’s pushing physicians forward.