Dr. David Nash on Population Health: Physicians Don’t Grasp It

Aug. 8, 2018
David Nash, M.D., one of the best-known pioneers in the world of population health management and related areas, discusses the population health landscape with Healthcare Informatics

In late June, Thomas Jefferson University’s College of Population Health and Navvis, a St. Louis-based population health company, announced what officials attest is the country’s first private sector-supported academic chair in population health—The Navvis Professorship of Population Health at Thomas Jefferson University.

The professorship, funded by Navvis, will aim to support the work of a dedicated faculty member at the Jefferson College of Population Health. “The academic research will be national in scope, with the goal of improving intervention effectiveness in real-world applications. will focus on identifying methods and best practices to create systemic, effective and scalable improvements in health, officials stated in the June announcement.

David Nash, M.D., is one of the best-known pioneers in the world of population health management and related areas, and is the dean of the Jefferson College of Population Health. In a statement at the time of the professorship announcement, Dr. Nash said, “Establishing an endowed professorship devoted to the health and wellbeing of whole communities is an invaluable investment in humanity.” He added, “This professorship, the first collaboration of its kind between an academic entity and a private sector company, demonstrates a commitment to translating the scientific method into real-world practice. We are grateful for the support that will ultimately empower people to take charge of their health through research, education, and programs.”

In a recent interview with Healthcare Informatics, Nash discussed the importance of this professorship, while also touching on broader population health issues and the landscape at large. Below are excerpts of that discussion.

What does the professorship represent in this current healthcare market and what do you see as its potential impact?

We think this is a paradigm shift and a watershed event, by having private-sector support for an endowed chair in our field. We believe this is the first ever [of its kind] in this field, making it really important. We will go recruit a major national scholar, hopefully a disruptor, who will help us bring this field to “2.0.” We have done a pretty good job; this month is the 10th anniversary of our college. And the Navvis professorship is the turning point for getting us to the very next level.

David Nash, M.D.

How would you describe what the population health landscape looks like, at a broad level, right now?

Let’s take population health management first. In population health management, the biggest issue at the moment now is the speed, or trajectory, in the movement from volume to value. We are in a valley, between two peaks—the peak of private practice fee-for-service and the peak of global payment. So the question is, how fast can we get out of this valley and make it from one mountain to the next? No one knows the answer, and that’s the scary part. We believe that based on the best available evidence, no matter which party you’re in, 60 cents of every Medicare dollar will be attached to an outcome measure in 2019. So we are moving inexorability from volume to value.

That said, this is not a done deal and it’s going to be a continued struggle, quite frankly. [Many] people are hoping to put a little steroid cream on this [problem] and assume it will be gone by the morning.

What are the pioneers doing in population health that those who are behind can learn from and replicate?

There are 10 schools of population health in the U.S. and we are tracking all of them, meeting and talking with their deans, in an attempt to raise all boats and help promote the field. There is tremendous energy in this arena. We have a text book, Population Health: Creating A Culture Of Wellness, that has been deployed in 80 graduate schools of medicine, nursing, public health, and health administration. And we are deep into preparing the third edition. We are still sculpting the field; we’re not done with the statue yet.

What are the biggest population health problem areas right now, as it exists today?

It’s a long list. Among the challenges is the lack of EMR [electronic medical record] connectivity, and the EMR in its current format is really an electronic chart. It’s not a source of information; only a source of data. The evidentiary basis of practice is still pretty modest. Eighteen percent of what we do is based on grade A evidence, and that in turn leads to inexplicable variation in what doctors do and inexplicable variation in price. This is a crisis. And then finally, medical error is the third leading cause of death in our country, regrettably.

Can EMRs, as they exist today, handle population health work, or are separate tools needed?

It depends on what camp you are in. We hope that Healthy Planet [Epic’s population health platform]—and the tools from its peer group from major vendors such as Cerner and Allscripts—will mature. In the meantime, there are a dozen add-on tools in play. We don’t have any research evidence to claim that one is more effective than another.

Do physicians and others have a common sense of what population health truly is? Can it mean different things to different people?

I honestly think they have no idea. They have never been exposed to it and they haven’t been taught this anywhere. They are learning as we go. The average well-trained physician in private practice has no real concept of any of this. As the payment system changes, their level of interest will increase. As we go from on the road from volume to value, their levels of interest will exponentially change.

We are still sculpting the new field. People are much more open than they were 10 years ago. Historically, we started the college two years before health reform when this vocabulary was largely unknown. We have come a long way. As you change the economic incentives, behavior will follow.

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