Home Health Care Dr. David Nash: “No outcome, no income” should be basis for pop...

Dr. David Nash: “No outcome, no income” should be basis for pop health’s transformation

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There are plenty of colleges offering medical degrees, nursing degrees and physician assistant degrees. But a degree in population health? That’s rare. Yet it’s exactly what the Jefferson College of Population Health offers.

Founded in 2008, the college is part of Thomas Jefferson University in Philadelphia. As the nation’s first college of population health, it provides graduate programming in everything from health policy to healthcare quality and safety. JCPH is also serving as the academic partner of the 19th annual Population Health Colloquium, a conference taking place on March 18-20 in Philadelphia. The event will cover topics like patient engagement, elder care and population genetics.

Dr. David Nash, a board-certified internist, is the founding dean of the Jefferson College of Population Health, and as such he advocates for better clinical outcomes and social determinants of health. In a phone interview, Nash weighed in on precision medicine, value-based care and his vision for the future of population health.

Below is an edited version of the Q&A.

MedCity: Why was the Jefferson College of Population Health created?

Nash: Eleven years ago, Jefferson University was a health sciences university. The president of the university at that time did a strategic planning process, which called for the creation of a new school. This was two years before the Affordable Care Act. We took the department of health policy and made that the core for the new school. We struggled as to what to call it, but I think we made the lucky decision to call it “population health” two years before health reform.

We decided to make it graduate training only and to make most of it available asynchronously online. We created from scratch five masters degrees online: health policy; healthcare quality and safety; population health; health economics and outcomes research; and population health intelligence, which is our trademark term for data analytics and artificial intelligence. Then we have an in-person, on-campus degree in public health.

We also do a couple of very innovative things. We’re the editorial home of four journals. We’re also the home of the 19th annual Population Health Colloquium.

MedCity: At JPM earlier this month, you said precision medicine and population health are “not at loggerheads.” Why do believe they’re, as you said, “synergistic concepts”?

Dr. David Nash

Nash: Here’s our thinking: Precision medicine, cellular therapy and genetic therapy certainly are synergistic with population health. We see precision medicine almost as a prerequisite to helping improve population health.

One visual is to think of going upstream and shutting off the faucet rather than constantly mopping up the floor and wondering why it takes so long. You go upstream by going to the heart of the issue. One such area is your genetic makeup. If we could harness that early on, imagine the improvement in health we could make.

It’s actually very exciting. We — Jefferson — offer Color Genomics screening for free to all our employees. We’ve had 6,000 employees take advantage of this in the first six months. How does this improve health? In a private consultation with each person’s doctor, the doctor can recommend screening. That’s another way that precision medicine and population health are linked at the hip.

MedCity: What can hospitals and health systems do to improve population health?

Nash: We want hospitals to keep patients out. You know that blue hospital sign? Imagine one day when that sign means health and happiness. That’s what our college is trying to do in a nutshell — change the very meaning of what that sign is about.

Health has much more to do with reducing income disparity, maternity leave, housing, drug abuse counseling, mental health counseling — all the things that sound like social work but actually contribute more to health than any medical school could hope to accomplish.

MedCity: How can population health management efforts help forward the shift to value-based care?

Nash: After you stop mopping up the floor, we have a four-word explanation for the move to value-based care: “No outcome, no income.” It’s all about going upstream and saying that in order to achieve payment in the system of the future, you have to achieve certain clinical outcomes. We are training leaders for a future that will be characterized by “no outcome, no income.”

It might mean building subsidized housing for the poor. It might mean changing the elementary school lunch to reduce obesity. This is a very different way of looking at health.

MedCity: How can we benefit from reliance on the social determinants of health?

Nash: What do we know from research? The principal predictors are poverty and housing. The one most important thing people need to improve health is housing, and the second is access to good food.

In Philadelphia, one out of four people lives in poverty. Of those, half of them live in deep poverty, which means they cannot put food on the table. So one-eighth of the population’s in deep poverty.

The paradox is that to really improve health, we have to improve social services. That’s complicated today. But the answer to the riddle is not to build another hospital.

MedCity: What are the biggest challenges preventing progress in the field of population health?

Nash: The payment system, because we’re still largely paid to do more. When you realign the economic incentives, you’re going to change how medicine is practiced. I believe the answer here is bundled payment, global fees, capitation — anything that moves us on the road to risk will reduce profligate spending and improve outcomes.

MedCity: What is your vision for the state of population health in 10 years?

Nash: Ten years — who knows. I’ll give you three years. My three-year vision would be greatly improving access, improving housing, reducing disparities in income, really paying attention to clinical outcomes that matter (like reducing high blood pressure and reducing obesity) and being financially rewarded appropriately for these clinical outcomes.

We have legitimately made great progress, but we still have an awful lot of work to do.

Photo: elenabs, Getty Images

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