Doc puts focus on pop health

Thomas Jefferson University's David Nash, MD, speaks at Allscripts' client conference
By Neil Versel
11:03 AM
David Nash, MD, Thomas Jefferson University, Philadelphia

As thousands of physician practice managers, hospital CIOs and technology vendors gathered here to discuss meaningful use, interoperability and ICD-10 at the annual Allscripts Client Experience users' meeting, a featured speaker encouraged them to keep their eye on the real prize: population health management.

Population health is "so central to where the world is going to go," said David Nash, MD, founding dean of Thomas Jefferson University's School of Population Health in Philadelphia, the only such school in the nation. "It's the outcome we care about," Nash said, speaking on behalf of his programs.

[See also: Premier steps up on population health.]

Unfortunately, in a fee-for-service world, clinicians are forced to care more about the volume of patients they see and procedures they can perform than they do about outcomes and the health of populations.
Patient attitudes also are skewed: "I'm going to take my Lipitor my way to McDonald's, and you're going to pay for the Lipitor," Nash said of the current mindset.

The movement toward value-based payment is a "complete cultural change," he said. "This is bringing a whole new science of population health."
And that is where the IT world comes in. "We're going to need tools, all kinds of new tools," Nash said. "We need comparative data," he continued. "We're going to need the analytics behind it."

Nash, a practicing internist, is most interested in patient registries. "The registry is what gives me closure of the feedback loop," he said.

He wants feedback on whether patients take care of themselves in their daily lives, since most health practices take place outside of hospitals and clinics. Actual care delivery, Nash said, "That's only 15 percent of the story." Yet, 88 percent of health-related spending in the U.S. goes to medical services, with just 4 percent to healthy behaviors, according to a 2013 report on obesity from the Trust for America's Health and the Robert Wood Johnson Foundation, Nash noted.

[See also: Data is key to population health management.]

"It's not about what goes on in the hospital. Health is wrapped up into everything that we're all about," Nash said. "Outside of the box of the hospital, that's really where the action is."

To change the culture and cross the quality chasm -- a phrase coined by the Institute of Medicine in 2001 -- clinicians need to: practice based on evidence; reduce "unexplained clinical variation"; end their "slavish adherence to professional autonomy;" continuously measure and close the feedback loop; and, engage patients across the entire care continuum, Nash said.
"What do we need? Total public transparency," he said. And an attitude shift on the issue of professional autonomy that often drives physicians to ignore data from outside sources and disregard safety alerts from EHRs. "Get over yourself, doctor," Nash said in an interview with Healthcare IT News.

In his vision for the future, he would like to come into the office and see exactly how he is doing in key clinical areas such as preventive care, counseling on smoking cessation and flu vaccinations. Without a registry, he has no way of knowing.

The core of medical education has always been one patient and one problem at a time, but that is not how care should work, Nash said. "It's not about the seven magic minutes they're going to have with me maybe two times a year."