Healthcare Innovation Leader David B. Nash, M.D. Shares His Perspectives on the Current Moment in Population Health | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Healthcare Innovation Leader David B. Nash, M.D. Shares His Perspectives on the Current Moment in Population Health

March 16, 2018
by Mark Hagland
| Reprints
The Jefferson College of Population Health’s David Nash, M.D., shares his perspectives on the current moment in—and future prospects of—the population health management phenomenon

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?


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more...

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.

One of the things we’ve heard consistently from everyone is that you have to give physicians meaningful and actionable data. What is the key to working with that data, with physicians?

There are several keys involved. The feedback using that data, has to be timely, delivered by respected peers, and severity-adjusted, and you’ve got to teach the doctors “how to fish.” In other words, if you just say, “Here are your outcomes, they’re terrible, and you’d better improve,” you won’t get far at all. But if you show them how to improve, the doctors will stampede to improve. We never had the data before without the EMR, so that’s given us a huge opportunity.

What about the impact of the MACRA [Medicare Access and CHIP Reauthorization Act of 2015] law? Has it sent some physicians into a panic to become salaried?

Sure, absolutely, it’s related. Those 45-to-60 guys are getting bought by delivery systems or by insurance companies. UnitedHealthcare is now the largest doctor employer in America; I don’t think most people know that.

Are the analytics capabilities where they need to be? We hear from every single provider leader we speak with, that the analytics solutions are not yet what they need to be to be fully usable.

No, we’re not even close. The electronic charts are fine; anybody could do those. What’s missing is the population health tools. And we’re in orbit here with probably 10 companies claiming they’re doing population health analytics; and the vendors are generating a lot more heat than light right now.

How quickly will the tools become truly adequate for everyone’s purposes? Are we talking about, say, two years or so, here?

I would say it’ll happen in about two years. And let’s not forget that by 2020, 60 percent of Medicare payment will be at risk. So there’s strong economic incentive there to get these systems up to speed.

In other words, the burning platform is going to be there?

Yes, absolutely, for sure it will.

You and I have been talking about these subjects for over 20 years now. Looking back on the past two decades, and forward to what might come next, how optimistic, or pessimistic, are you, about the near-term future of this work?

Oh, I’m tremendously optimistic! In fact, I’m grateful that I’ve lived to see us reach the tipping point, totally. In a tiny way, that’s vindication. You’ve known me since the beginning, so you know.

And, looking back to 20 years ago, a lot of the knee-jerk resistance that we saw among most physicians in practice back then, is falling away now, correct?

Yes, it absolutely is. You’d have to be an uninformed citizen, to ignore the macro trends.

What would your core message be for our core readership audience, CIOs and CMIOs, and other senior healthcare IT leaders?

Here’s the message: your core audience has the technology to help reduce unexplained clinical variation, by showing the real data. And if they can move that agenda forward, that will help immeasurably. We’ll definitely need that help going forward.


The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
| Reprints
The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



More From Healthcare Informatics


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Thursday, December 13, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more substantial role in improving outcomes and reducing cost of cancer care.

In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

Related Insights For: Population Health


At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
| Reprints
The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more...

Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



See more on Population Health

agario agario---betebet sohbet hattı betebet bahis siteleringsbahis