Editorial
POPULATION HEALTH MANAGEMENT Volume 17, Number 1, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2014.1711
Population Health Management 2014.17:1-2. Downloaded from online.liebertpub.com by Uc Davis Libraries University of California Davis on 01/15/15. For personal use only.
Population Health: Moving Forward David B. Nash, MD, MBA
I
I also am alarmed about our headlong rush to form Accountable Care Organizations and Patient-Centered Medical Homes without a deeper understanding of how we must first change the very cultural fabric of clinical practice. We must recognize, explicitly, the role of unexplained clinical variation in our day-to-day work and the need to practice based on the best available evidence by closing the feedback loop with every clinician. Our nation must develop a primary care strategy first before we can build the components of the delivery system called for by the ACA. I am worried about ‘‘meaningless use’’ of health information technology – that is, the notion that the currently available electronic medical record companies will magically answer all of the questions we have regarding making health care safer and more efficient. We are a long way from such a dream, and the recent research evidence would suggest that we are making only modest progress in improving the accuracy of prescriptions. I am distressed when I encounter movies and related stories in the lay press detailing the impact of our system failures on patients. I would urge all of you to watch The Waiting Room, a recent film based on patient stories from the Alameda County Medical Center in downtown Oakland, California. This 80-minute film, with no narration, simply tells the story of the failure of population-based care in our country as patient after patient, largely persons of color who are poor, shows the sequelae of a lifetime of lack of access to the most basic types of medical care. Finally, I regard with alarm our current inability to create measures that will support the Triple Aim. The Triple Aim, as articulated by Don Berwick and others in the late 1980s, calls for a focus on population health, the individual experience of care, and per capita costs. We need better measures for the first leg of this Triple Aim and they do not appear to be forthcoming currently. Should the measures of population health be tied to national goals like Healthy People 2020 or other leading health indicators? This is a challenge for the researchers and analysts in our field. Despite all of my worries, I am actually very optimistic about the future. There are many reasons for my optimism. First, I fundamentally believe that we are in the midst of a progression from isolated pay- for-performance programs, to procedural bundles, to carve-out for capitation, to the practice of true population-based care. This will lead us, in my view, to a ‘‘no outcome, no income’’ world.
had the privilege of addressing some of the senior executives at the 2013 Care Continuum Alliance (CCA) Annual Forum in Phoenix, Arizona in October 2013. Excerpted below is an edited version of my after-dinner remarks during the opening night of the program. First, let me share with you some very important accomplishments in the field of population health. I am very proud of the achievements of the great companies that are represented here this evening and the entire Board of Directors of CCA. I wish to acknowledge, especially, Mr. Christopher Coloian, our Board Chair, and Mr. Fred Goldstein, our fearless interim leader. CCA’s strategic plan calls for promoting, convening, fostering learning, and advocating for population health, and provides an outstanding framework for the future. We also should view with pride the national move from volume to value-based payment. This transition will allow the population health movement to take hold, and it is fitting that the theme of this program is focused on the implementation of population health. I am very pleased to share with you updates about our journal, Population Health Management, as our success is your success. The quality of the research we are receiving from around the world, based on the number of papers submitted and our improving impact factor, is testimony to the maturation of population health as a scholarly discipline. I am gratified that our nation was able to reaffirm the basic tenets of the Affordable Care Act (ACA). Tens of millions of our fellow citizens will have access to care, some of them for the first time, which I hope will help to improve the quality of life in our country. We know that no other nation in the Western world treats health insurance as we do; hopefully, ACA will make personal bankruptcy because of unpaid health care bills a relic of the past. Finally, I am very proud of the Jefferson School of Population Health ( JSPH) and our students, across 26 states, who are taking courses online with us. The textbook we have developed, Population Health – Creating a Culture of Wellness, is now well on the way to its second edition; further testimony of the scholarly accomplishments of many of you in the audience. Despite these many accomplishments there is, regrettably, much to be alarmed about. I am especially concerned about a January 2013 report from the National Research Council of the Institute of Medicine entitled Shorter Lives – Poorer Health, which ranks the United States as #17 (just behind Slovenia) when compared to all other nations in the world regarding our collective quality of life.
Jefferson School of Population Health, Philadelphia, Pennsylvania.
1
Population Health Management 2014.17:1-2. Downloaded from online.liebertpub.com by Uc Davis Libraries University of California Davis on 01/15/15. For personal use only.
2
I am excited and hopeful about consumer activation, engagement, and empowerment. After all, we are patients only 1% of the time and we must move away from what others have called ‘‘the medical mainframe’’ model of care to m-health and e-Health. I’m excited about the private exchanges, as they ultimately will lead to the ‘‘retailization’’ of health care. As we move from a world of defined benefit to defined contribution, companies will achieve stability and a cap on their medical expenses. They will seek low-cost, high-quality, narrow networks wherein transparency and accountability will be the rule of the day. I also am hopeful because of my work with students of all ages each and every day. Our JSPH students, most of whom are working professionals in our health care system, as well as the hundreds of medical, nursing, pharmacy, and allied health students on the campus of our great university at
EDITORIAL
Jefferson in Philadelphia are my inspiration. They have an optimism that is infectious. They will embrace a world of consumer engagement and a paperless future. Finally, I am confident that the energy, creativity, and sheer guts present in this room will help us to overcome all of the challenges that our great industry faces, and that we ultimately will succeed.
Address correspondence to: David B. Nash, MD, MBA Jefferson School of Population Health 901 Walnut Street, 10th floor Philadelphia, PA 19107 E-mail: [email protected]
POPULATION HEALTH MANAGEMENT Volume 17, Number 1, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2014.1711
Population Health Management 2014.17:1-2. Downloaded from online.liebertpub.com by Uc Davis Libraries University of California Davis on 01/15/15. For personal use only.
Population Health: Moving Forward David B. Nash, MD, MBA
I
I also am alarmed about our headlong rush to form Accountable Care Organizations and Patient-Centered Medical Homes without a deeper understanding of how we must first change the very cultural fabric of clinical practice. We must recognize, explicitly, the role of unexplained clinical variation in our day-to-day work and the need to practice based on the best available evidence by closing the feedback loop with every clinician. Our nation must develop a primary care strategy first before we can build the components of the delivery system called for by the ACA. I am worried about ‘‘meaningless use’’ of health information technology – that is, the notion that the currently available electronic medical record companies will magically answer all of the questions we have regarding making health care safer and more efficient. We are a long way from such a dream, and the recent research evidence would suggest that we are making only modest progress in improving the accuracy of prescriptions. I am distressed when I encounter movies and related stories in the lay press detailing the impact of our system failures on patients. I would urge all of you to watch The Waiting Room, a recent film based on patient stories from the Alameda County Medical Center in downtown Oakland, California. This 80-minute film, with no narration, simply tells the story of the failure of population-based care in our country as patient after patient, largely persons of color who are poor, shows the sequelae of a lifetime of lack of access to the most basic types of medical care. Finally, I regard with alarm our current inability to create measures that will support the Triple Aim. The Triple Aim, as articulated by Don Berwick and others in the late 1980s, calls for a focus on population health, the individual experience of care, and per capita costs. We need better measures for the first leg of this Triple Aim and they do not appear to be forthcoming currently. Should the measures of population health be tied to national goals like Healthy People 2020 or other leading health indicators? This is a challenge for the researchers and analysts in our field. Despite all of my worries, I am actually very optimistic about the future. There are many reasons for my optimism. First, I fundamentally believe that we are in the midst of a progression from isolated pay- for-performance programs, to procedural bundles, to carve-out for capitation, to the practice of true population-based care. This will lead us, in my view, to a ‘‘no outcome, no income’’ world.
had the privilege of addressing some of the senior executives at the 2013 Care Continuum Alliance (CCA) Annual Forum in Phoenix, Arizona in October 2013. Excerpted below is an edited version of my after-dinner remarks during the opening night of the program. First, let me share with you some very important accomplishments in the field of population health. I am very proud of the achievements of the great companies that are represented here this evening and the entire Board of Directors of CCA. I wish to acknowledge, especially, Mr. Christopher Coloian, our Board Chair, and Mr. Fred Goldstein, our fearless interim leader. CCA’s strategic plan calls for promoting, convening, fostering learning, and advocating for population health, and provides an outstanding framework for the future. We also should view with pride the national move from volume to value-based payment. This transition will allow the population health movement to take hold, and it is fitting that the theme of this program is focused on the implementation of population health. I am very pleased to share with you updates about our journal, Population Health Management, as our success is your success. The quality of the research we are receiving from around the world, based on the number of papers submitted and our improving impact factor, is testimony to the maturation of population health as a scholarly discipline. I am gratified that our nation was able to reaffirm the basic tenets of the Affordable Care Act (ACA). Tens of millions of our fellow citizens will have access to care, some of them for the first time, which I hope will help to improve the quality of life in our country. We know that no other nation in the Western world treats health insurance as we do; hopefully, ACA will make personal bankruptcy because of unpaid health care bills a relic of the past. Finally, I am very proud of the Jefferson School of Population Health ( JSPH) and our students, across 26 states, who are taking courses online with us. The textbook we have developed, Population Health – Creating a Culture of Wellness, is now well on the way to its second edition; further testimony of the scholarly accomplishments of many of you in the audience. Despite these many accomplishments there is, regrettably, much to be alarmed about. I am especially concerned about a January 2013 report from the National Research Council of the Institute of Medicine entitled Shorter Lives – Poorer Health, which ranks the United States as #17 (just behind Slovenia) when compared to all other nations in the world regarding our collective quality of life.
Jefferson School of Population Health, Philadelphia, Pennsylvania.
1
Population Health Management 2014.17:1-2. Downloaded from online.liebertpub.com by Uc Davis Libraries University of California Davis on 01/15/15. For personal use only.
2
I am excited and hopeful about consumer activation, engagement, and empowerment. After all, we are patients only 1% of the time and we must move away from what others have called ‘‘the medical mainframe’’ model of care to m-health and e-Health. I’m excited about the private exchanges, as they ultimately will lead to the ‘‘retailization’’ of health care. As we move from a world of defined benefit to defined contribution, companies will achieve stability and a cap on their medical expenses. They will seek low-cost, high-quality, narrow networks wherein transparency and accountability will be the rule of the day. I also am hopeful because of my work with students of all ages each and every day. Our JSPH students, most of whom are working professionals in our health care system, as well as the hundreds of medical, nursing, pharmacy, and allied health students on the campus of our great university at
EDITORIAL
Jefferson in Philadelphia are my inspiration. They have an optimism that is infectious. They will embrace a world of consumer engagement and a paperless future. Finally, I am confident that the energy, creativity, and sheer guts present in this room will help us to overcome all of the challenges that our great industry faces, and that we ultimately will succeed.
Address correspondence to: David B. Nash, MD, MBA Jefferson School of Population Health 901 Walnut Street, 10th floor Philadelphia, PA 19107 E-mail: [email protected]
