Gregg Masters 00:08 This episode of PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand messaging alive via original or value-added digitally curated content for omni channel distribution and engagement. Connect with us at www.popupstudio.productions Welcome everyone I’m Gregg Masters Managing Director of Health Innovation Media the producer and co-host of pop Health Week and publisher of ACOwatch.com. Joining me in the virtual studio today is my partner, colleague and lead co-host of pop Health Week Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm. Today’s show is sponsored by the Population Health Colloquium, which is celebrating its 20th anniversary. For more information including the power-packed faculty and impressive agenda, or to register, go to www.populationhealthcolloquium.com. David B. Nash MD MBA is arguably the Dean of population health and the recently minted Founding Dean Emeritus at the Jefferson College of Population Health. He’s making an encore appearance on the show, we get an update from Dr. Nash on population health in the age of COVID-19. And the many insights the pandemic has exposed given our aging and predominantly RVU driven healthcare economy. Dr. Nash also previews the upcoming virtual 20th anniversary edition of the Population Health Colloquium on October 5, 6th and 7th is impressive 11 year tenure as Dean completes 30 years on the university faculty. After voluntarily stepping down as Dean, Jefferson Health, asked Dr. Nash to take on additional responsibilities including Special Assistant to the Chief Physician Executive and serves as a member of the board of Jefferson Health’s ACO, one of the largest in the nation. And with that understated introduction to one of the nation’s most celebrated and respected physician leaders out of the way, Fred, over to you. Let’s get to hear from the fact of Dean of population health.
Fred Goldstein 02:28 Thanks so much, Greg. And David, welcome again to PopHealth Week
David Nash 02:32 Great to be together virtually.
Fred Goldstein 02:34 Yeah, fantastic. another virtual show, once again, you keep climbing in the record books for the most appearances on PopHealth Week. It’s fantastic. Have you again,
David Nash 02:42 thanks. And great to be in my home studio here in suburban Philadelphia. Just sorry, we couldn’t be face to face.
Fred Goldstein 02:49 Absolutely. So let’s start out a little bit. Obviously, there’s a lot going on with the pandemic where we’re both living within that doing healthcare thinking within that, etc. Where are we with the pandemic and its relationship to population health?
David Nash 03:02 Well, listen, Fred and Gregg, I’ve had the busiest six months of the last 12 years since we started the College of Population Health of Jefferson. Let me tell you the quick story. When we closed shop on the fateful Friday, the 13th of March, I came home that weekend, I went back in on Monday to grab a few files. I said to my longtime assistant who’s been with me every day for 30 years, I said, let’s just bring home two weeks worth of stuff. I’m sure we’ll be back. Boy, was I dumb. But in the ensuing, especially the first 90 days at home, I’m happy to report Fred that I had a tsunami of incoming emails from all over the world, which selfishly was gratifying for me, despite the horrible aspects of the pandemic, on a very selfish level. I had people reaching out who literally went to Google, put in population health, what do we do now? And you know, I’m like the fourth thing on the list. And I had to do triage on all the incoming email because it was impossible for me to personally get back to everybody. So look, it’s been an amazing journey. And to answer your question, I think the pandemic put an incredibly bright light on everything we’ve been talking about for more than 10 years. And stuff that people really didn’t want to think about most, especially those pesky social determinants, and the impact on health care, and the going upstream to shut the faucet. All the things we’ve been talking about even you and me together. In the last five months, the whole world is beating a path to our front door. So it’s been on the one hand horrible, and on the other hand, very gratifying.
Fred Goldstein 04:56 Yeah, it’s nice to see the transition, obviously. And then are you’re beginning to see these fruits of any of that, where people are beginning to say, how do we now impact or fix that?
David Nash 05:05 Yes, slowly. So let me give you a couple of examples. You know, certainly in the private sector, we’ve seen unbelievable interest and investment and venture capital private equity money going into what I’ll call the social determinants industry, right. And we’re not going to name names here, but lots of new companies who are harnessing the various social service agencies and so on. So a renewed interest in those social determinants certainly really important. On the quality and safety side, I think the notion of the incident command structure at every hospital big and small, even across a monster like Jefferson, health, 14 hospitals, the incident command structure was really like a rebirth for performance improvement, right? Every day, we’re going to huddle every day, we’re going to send out a new practice guideline. Every day, we’re going to ask frontline workers, what could we be doing different and better? And, you know, kudos to the leaders like Jefferson, Dr. Jonathan Gleason, Dr. Bruce Meyer, our chief medical officer, you know, amazing what they were able to do when the platform is engulfed in flames. People are ready to change. So now can we continue to promote that? So one is the social determinants two is that incredible culture of incident command, which is really closing the feedback loop on a daily basis, adopting guidelines and standards and evidence-based practice all the stuff we care about. And then the third big operational thing, no surprise to our listeners, is what I’ll call, you know, telehealth, digital health. We wound up that mechanism, we had a five year running head start because Steve Klasko and John Hollander, we trained 1000 practitioners to do telehealth, and we were doing 10s of 1000s of visits a month by April and May.
Fred Goldstein 07:04 Wow,
David Nash 07:04 Now from my perspective, now, is this going to be an enduring change? Can we get funding in the right direction? And most importantly, can we reach communities, especially communities of color with this new technology? So I think the social determinants, I think Incident Command, I think tele health, I mean, unbelievable amount of social change.
Fred Goldstein 07:29 So David, one of the things you’ve been discussing for years, is this no outcome? no income mantra?
David Nash 07:35 You know, wow, I think people are paying way more attention to that than ever before. The big challenge is going to be will these value-based payments continue? Look at this moment, roughly 25 to 30 cents of every Medicare dollar is connected to some measure of an outcome, right? We know that. I mean, you got to believe no matter who wins the White House, that with all the federal spending, and the deficit, and getting us out of the pandemic disaster, anybody who’s you know, thinking clearly here, it’s got to agree that the only way out of this mess is no outcome, no income, we’re gonna pay based on what you achieve and building this bridge between health and health care. I mean, that’s what population health is all about. We’ve been talking about this for 10 years, you know, I’m tired of talking about it. But at least now, I think people are paying much greater attention.
Fred Goldstein 08:40 So So David, on the rest of this, you also get the situation where this is clearly shown that those primary care practitioners who are capitated
David Nash 08:49 Wow,
Fred Goldstein 08:49 are doing well and going forward, you see the hospitals recognizing that they can’t just go back the same way to try to make up for the loss or ,
David Nash 08:57 Gosh Fred, I am so glad you brought this up, because this is sort of the secret issue that nobody wants to talk about, right? So let’s frame it up. And I’m going to be calm, cool and collected in my explanation. But here is the truth. We know that the guys and gals in private fee for service practice, even in a group setting on the RVU, you know, hamster wheel, they got hammered because they were effectively closed down for 90 days. The folks in the capitated world even in the global capitation world they did great. And that represents I think the future of where we’ve got to go and what’s the evidence behind this, I think a couple of things, more money in Medicare at risk than ever before. That’s the bellwether. And then if you look at the private market, the Oak Street, going public having an amazing IPO event, surprising the entire marketplace, that shows you that the smart private money is betting on this new primary care, largely capitated largely care, coordinated Medicare Advantage model, that’s where we’ve got to go. So, again, the pandemic powered up the ability to get something like Oak Street out the door. And that’s a representation of where primary care has to go.
Fred Goldstein 10:22 So let’s go to this other leg of population health, which is our public health system.
David Nash 10:27 Wow.
Fred Goldstein 10:27 How do we integrate that? Are there things we can do better to bring that back into the ballgame?
David Nash 10:33 Well, let’s remember that on a national basis, our public health spending is under $200 per adult, right? I mean, it’s a crime. And the public health system is always working behind the scenes, and it’s successful when you don’t know about it. Most people only bump into it when you know there’s a salmonella outbreak at your favorite delicatessen. Right? And then oh, my God, then you hear all about the public health issue. So public health has been like a poor second cousin that never gets invited to Thanksgiving, as it relates to the health care system. So we have to have a resurgence in funding in the appropriate training in the prestige that’s associated with public health. You can trace the bifurcation to 1965 and the signing of the Medicare bill, right, because that just took hospitals with Rocket Power, NIH with Rocket Power in the public health community, you know, was sort of crawling wrong, just like a turtle 275 bucks per person. That’s public health spending in the United States versus, you know, $20,000 a year for a family to get health care coverage, right. I mean, it’s a sin. And so, as we know, in the quality community, every system is perfectly designed to achieve exactly the results it gets. Why was anybody so damn surprised when the public health system basically collapsed under the weight of the pandemic?
Fred Goldstein 12:07 Is your sense of this? Now, there’s this whole community out there, some looking at public health as oh, we’ve let them go. And some looking at public health as the problem, where we’re how do we come out of that thing? Where does that go?
David Nash 12:21 Well, this goes all the way back to medical school, public health, school population health, we need a total reorientation of what’s important. Let’s start with putting epidemiology, behavioral economics quality and safety. I mean, we’ve been talking about this for 10 years, and I personally been talking about it for 30. So let’s get this into the medical school, nursing ,pharmacy, school colloquium, and get it into the curriculum, and teach all this stuff so that our practitioners understand these basic tenets. It’s just amazing to me, that we were caught literally with our pants down, you know, Fred, for our amazing viewers and listeners, you know, raise your hand, if you think that the system that brought us to the edge of the abyss is the system that’s going to take us safely into the future, you know, it ain’t gonna work. So we got to build a new system. And I’m hoping that the pandemic in the bright light will help us to tackle the social determinants, the quality culture, the tele health, and the new primary care models, just like we’ve been talking about.
Fred Goldstein 13:38 And David, do you think these medical schools that have gotten to these ultra hyper-specialized approaches, you know, we’re going to just drill down where you’re dealing almost with an individual cell?
David Nash 13:48 Yeah, it’s not gonna happen. It’s gonna happen. You know, my money is on places, hopefully, like Sidney Kimmel, Medical College, at Jefferson. Certainly, I’m privileged to be on the board of the Geisinger Commonwealth School of Medicine with an unbelievable class, representing the largest number of first time in their family college graduates. That’s what we need in medical school. How about the Bernard Tyson School of Medicine at in California, the University of Houston’s brand new medical school, this is where the action is. And those schools are going to build the doctor of the future and she is going to kick ass and do it. Right.
Fred Goldstein 14:30 That sounds fantastic. And we’ve been very fortunate to have a number of those medical school Deans on this show to talk about the really unique work they’re doing and the way they’re re re-envisioning medical training. It’s really fantastic to see it. Let’s get to this other training opportunity, which is the population health colloquium that’s coming up in a few weeks.
David Nash 14:51 Right. So I’m super excited, Fred, look, we were going to be in person in Philadelphia for our 20th anniversary. If you could believe I remember when we had 150 people on our campus at Jefferson in an auditorium. And then in 2019, we had 700 people at the beautiful Loews Hotel in downtown Philadelphia. So the 20th-anniversary event is October 5, 6, and 7. It’s all virtual. The platform is spectacular. There’ll be some pre-recorded material, then there’ll be live interaction. The faculty are amazing. I mean, we’ve got Kavita Patel, we’ve got Will Schrank. We have Bobby Pearl. We have everybody you could think of who’s been on television in the last six months, we’ve got them in person, and virtually ready to answer questions ready to get into it. I mean, Karen DeSalvo from Google, I mean, you name it, we’ve got them. And I think they’re excited about the opportunity to have even a broader audience, and a broader impact. And boy, if there ever was a time to have a pop health meeting, now’s the time. So I’m fired up about it. I wish we could be in person, but this would be the next best thing.
Gregg Masters 16:11 And if you’re just tuning into PopHealth Week, our guest is Dr. David B. Nash, Founding Dean Emeritus of the Jefferson College of Population Health and principal curator of the Population Health Colloquium, now celebrating its 20th anniversary. For more information, go to www.populationhealthcolloquium.com. And now for a personal invitation to the colloquium by its co-chair.
David Nash 16:36 Hi, I’m Dr. David Nash, Founding Dean Emeritus of the country’s first College of Population Health on the campus of Jefferson University in Philadelphia, it is my distinct honor and privilege to invite you to the 20th anniversary of the Population Health Colloquium, this year, October 5, 6 and 7, totally virtual event, but with a great opportunity for interaction with all of our faculty from across the country. every sector, we’ve got the leading individuals, everybody you’ve seen on television in the last five months, talking about the pandemic, their faculty at our event. So colleagues, I hope you’ll join us October 5, 6 and 7, the Population Health Colloquium. That’s the website, go there right now to register. And I guarantee you’re going to have a wonderful interactive opportunity to get totally up to speed on where our broken health care system has to go. Thanks so much for listening. See you virtually October 5, 6, and 7.
Fred Goldstein 17:47 Yeah, and I know that technologically, it’s a fantastic platform, obviously, some of the speakers you talked about, and the focus has shifted a bit given where we are right. It’s gonna be a little bit more on COVID. And the Coronavirus and population health right.
David Nash 17:59 Yeah, I don’t think we have to explain too much about what’s population health for this event? I hope not. And it’s not all COVID it’s certainly going to be what will a successful future look like? And you know, clearly the pandemic will be the platform that we’re going to use, but it’s everything we talked about. We’ve got the top telehealth people, the top new primary care models, the top social determinant companies are all coming. I mean, you name the sector, we’ve got the one of the most or two of the most prominent representative.
Fred Goldstein 18:32 And that’s one of the things that’s always stunned me around population health. When people say who should be going to a population health conference or or what does it impact? It impacts everybody. I don’t care if you’re a supplier, you’re a vendor, you’re a pharmaceutical manufacturer, you’re a hospital person, everybody is touched by population health.
David Nash 18:50 Well, thanks, thanks for saying that. Fred. You know, I am asked that pretty frequently, you know, should I go? So my current answer is which no, bring the whole family, right, because this is going to affect everybody from the chief medical officer, of course, the total transition of the chief population health officer which we first described almost 10 years ago, in the Rita Numeroff survey. We certainly have a large number of information technology firms coming some of the leading companies, worldwide Onnovacer, Philips, we’ve got the top managed care and health promotion company, Humana as our partner and of course we’ve got the College so, you know, we’re we’re really excited. I’m grateful to our sponsors, and to our university who hung in there with us and have continued to support and fund the event.
Fred Goldstein 19:52 Yeah. And really, when you think about it, 20 years, what a congratulations to you, the folks at Jefferson. The conference, people, everybody that’ made this happen. And it’s also an interesting conference for me always. Because not only do you get the theoretical stuff or the academic stuff, which is great and abundant, but you get real-world application stuff, which I always find fascinating.
David Nash 20:14 You bet. We’re gonna have all of the key leaders from every sector. I mean, that’s the take-home message.
Fred Goldstein 20:21 The hospital folks, are there, the pharma that really great. And where are we with the Hearst Health prize in that?
David Nash 20:29 Well, I’m glad you brought that up, too. So our colleagues at Hearst from Greg Dorn on down the entire team, we got the largest number of applications this year than ever before. And this is our fifth anniversary for Hearst Health and they’re committed going forward into the future. So we’re going to have that component of the meeting live and Greg Dorn and I are going to do our thing. And we’re going to hold up that check. And I don’t know who the winner is. You know, even as the chair of the advisory group and all of the judges, I still don’t know who the winner is. So we’re looking forward to learning the fifth annual winner. It’s been an amazing journey with our colleagues from Hearst Health more important than ever before. And we’re grateful for their ongoing commitment to
Fred Goldstein 21:19 can you give us for the audience that hasn’t heard about the Hearst Health Prize maybe doesn’t know a lot about it, sort of what it is how you apply, what kinds of things happen with that the review committee, there’s
David Nash 21:28 so thanks Fred sure. So this is a national competition for an organization we want to recognize with $100,000 check. And there’s a runner-up check as well now. But typically, these are not for profit organizations, delivery systems, unbelievable creative, folks. And the goal is to show the national panel of judges that you’ve made the greatest impact on improving health, which is what of course population health, and being the bridge between health and health care is all about. And you know, we’ve had some fantastic winners and incredibly creative individuals, everything from behavioral health to maternal and fetal health, to homeless health to, you know, American Indians. I mean, you name it, we’ve had amazing response nationally. And as I said, I’m grateful to the national panel of judges, a group of very prominent individuals. This has been a huge team effort with Hearst Health. And my partner is Dr. Greg Dorn, their senior-most physician over all of Hearst Health, it’s been an amazing partnership. So we’re grateful to them.
Fred Goldstein 22:05 And as you said, these winners have really done something this isn’t just a rubber stamp, they’re gonna deep review process of yours.
David Nash 22:53 You and I have walked the floor together Fred and interviewed every one of the previous winners. In October on October 5, 6, and 7, we’re going to have a panel discussion of the previous winners. So they’re going to be on stage with me virtually, answering questions talking about their journey, and I hope for the first time ever, they’re going to describe what they do with that $100,000. And can they you know, show us moving forward that they are going to continue their commitment to improving the health of the population.
Fred Goldstein 23:28 Yeah, and I would tell anybody in population health, if you want to listen to some really cool ideas,
David Nash 23:33 this is the place to go
Fred Goldstein 23:34 in your community or through your health system that’s the thing to listen to.
David Nash 23:39 Well I’m looking forward to having all the previous winners together. This is a unique opportunity. And it’ll be great to have Dr. Greg Dorn with us again. And you know, he’s been incredibly strong advocate. Look, Hearst is a big company, right? So to have Hearst Health behind this, and all of their companies are doing well. And they’re all about population health, gathering the data, tackling the social determinants practicing based on the best available evidence, when you look at the Hearst family, they’re totally aligned with what population health in our college is all about.
Fred Goldstein 24:15 And speaking of the college, let’s talk a little bit about that. What sorts of services they’re offering there. Now, it always seems to be something else, something new something.
David Nash 24:24 You know, I like my new title, Fred, you know, Founding Dean Emeritus, so I don’t have to worry too much about the day to day. Thank goodness Dr. Billy Oglesby. He’s got the helm, at least for now. There is a national search. So if you want to be the dean, moving forward, now’s your time to get a hold of Spencer Stewart who’s running the national search for my successor. But yeah, we’ve got some new programs mostly in population health, what we call pop health intelligence, pop health analytics, predictive analytics, augmented intelligence. All of that health policy, the quality and safety and some new doctoral programs and really on the ground practical doctoral degrees, even so if you want to be an operations, you want to be an academics, we’ve got the pathway. And of course, it is all online. So we were way ahead, making, you know, we look pretty smart now making a tough decision 12 years ago, when nobody wanted to be online turned out to be pretty smart. Thank goodness, it was mostly a lucky decision back then. But it turned out to be really prescient.
Fred Goldstein 25:38 And we’ve obviously siloed ourselves a bit because we have now multiple schools and colleges of population health, we have schools and colleges of public health schools. Do you see that beginning in any sense to come together or more?
David Nash 25:52 Well look, we’ve always said that public health was still the core of what population health is all about. And I still contend that that’s true. But population health community looks a lot at the economics, and the quality and safety and the information technology, core, public health, really still doesn’t focus on those issues. But we welcome them into the broader family, there’s room for everybody. Look, we’re going to need on a national level more people in our field than ever before. And our application pool is reflective of what’s going on across the country, mainly, that young people want to be a part of the solution instead of an ongoing part of the damn problem. So our College of pop health and most schools of public health are seeing a resurgence in the number of applications.
Fred Goldstein 26:47 Yeah, if anything woke people up to public health and population.
David Nash 26:52 We don’t think I don’t have to explain this every day like I did for years.
Fred Goldstein 26:58 David, decades, but maybe now the flowers are blooming?
David Nash 27:02 I hope so. I hope so. It’s really an I appreciate all your help in getting the word out to the to the population. Well, thanks
Fred Goldstein 27:10 so much, Greg. And I really appreciate that. And any final thoughts you have around go forward for population health, where it moves next or grows next?
David Nash 27:20 Sure. Well, I’ll tell you what I tell our new fellows and some of our incoming students, many of whom are mid-career people, you know, these are not, they didn’t just fall off the, you know, the truck. So look, what could be more important right now, right, and then helping our broken system to pay attention to what really matters. And what really matters is preparing to get healthier. And no matter what happens then with a second surge or another pandemic, let’s tackle all the issues of equity. And let’s go upstream and shut that faucet. And let’s teach this stuff in the curriculum of all the health profession schools. I can’t think of a career that’s more important now than population health. So I’m sorry that it took a pandemic to make it front-page news. But on the other hand, I think our time has come. And I’m just grateful that I’m still around to be a part of it.
Fred Goldstein 28:29 Well, that’s fantastic. Thanks again, David, for joining us. Back to you, Greg.
Gregg Masters 28:33 And thank you for that is the last word for today’s broadcast. I want to express my deep gratitude to our special guest the distinguished David B. Nash MD MBA, arguably the Dean of population health For more information go to www dot populationhealthcolloquium.com This is Greg masters saying bye now.