One of the joys of touching base with David Nash, M.D., is sharing perspectives and always learning something new from someone who absolutely has his finger on the pulse of change. Dr. Nash, who is virtually a one-person healthcare publishing industry, first spent many years as a board-certified internist, and then over time became deeply involved in promoting care quality improvement and advocating for policy change in healthcare. And Nash, who has a book-length curriculum vitae, has spent decades thinking about what the healthcare system should look and act like.
What’s more, back in 2008, David Nash created the first U.S. academic institution focused on population health, establishing the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, where he has long been based. “When we established this school, we took a big risk in 2008, calling it a ‘school of population health,’” he told me this summer when I called him for an interview as I was writing my September cover story on population health. “I got the name from the 2011 book Crossing the Quality Chasm [published by the federal Institute of Medicine], where they use the term,” he noted.
So clearly, David Nash is someone who sees the future of healthcare; and he’s also someone who sees population health, in its broadest sense, as the future of healthcare. And one of the things I asked him when we spoke back in June was, did he see the healthcare industry reaching a point of critical mass these days, where we’re moving beyond just a small number of nationally known integrated health systems pushing the frontiers of population health? And his answer was, yes. In fact, Nash said, one day after the Supreme Court had affirmed the constitutionality of the Affordable Care Act (ACA), “I would say, as of yesterday, we’re at a tipping point,” referring to the greater policy clarity coming out of the high court’s policy ruling. “Now,” he said, you’ll be able to look beyond the Kaisers, the Geisingers, the Ochsners,” for examples of hospitals and health systems moving strongly to manage the health of whole populations.
What’s more, he agreed strongly with me that the trend towards managing the health of broad populations also dovetails perfectly with broader trends towards continuous clinical performance improvement work, continuous outcomes measurement, and increased transparency and accountability, all trends being pushed strongly by the payers and purchasers of healthcare.
I’ve long talked about a concept I refer to as the “black box of clinical care”: that historically and traditionally, physicians went through extremely rigorous training in medical school and residency (and fellowship, if specialists), but then were largely left alone to practice without any requirement for transparency or accountability, save for situations involving medical malpractice cases or government investigations. But, I added, all that is now changing, as concepts of evidence-based medicine, outcomes measurement, value-based purchasing, and accountable and coordinated care, are shifting the landscape rapidly. “That’s absolutely right,” Nash told me. The new reality for physicians is that “You can run, but you can’t hide,” he said. “We released the first open surgery report 22 years ago [in Pennsylvania]; and now, because of technology, the Internet, and the ongoing healthcare crisis, all those elements are pushing healthcare in a new direction. And the notions of standardization of practice, practice guidelines, benchmarking, and closing the feedback loop” for practicing physicians and clinicians, “those are the tactics, and they’re being carried forward by population health strategies.”
On a personal level, it’s always great to have one’s perceptions validated by an industry sage like David Nash. More broadly and importantly, it seems that population health really is beginning to emerge strongly on the radar screens of executives in hospitals, medical groups, and health systems nationwide, in forms that could be sustainable over time.
There’s still a lot to be learned, at both the individual organizational, and the industry, levels. But the pioneers are starting to create footpaths that could soon become highways. To learn more, please listen into our upcoming Healthcare Informatics webinar on population health, which will be presented by yours truly on Thursday, September 20. I’ll be joined by Randy Thomas, vice president of portfolio strategy and design at Premier healthcare alliance, who will add to some of the case studies I’ll be presenting, with insights into what leaders and organizational members of Premier are learning in this area these days.
This is one of those areas in which far more is not known than is known at this point; but it is gratifying to see the population health wave growing, and growing relatively quickly. If this is a wave—and I think it is—expect to see bigger, higher-cresting waves building in this area soon.
