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Live from ACE14: Is population health the secret sauce?

We gathered some great insights today from David Nash, MD, MBA, the founding dean of the Jefferson School of Population Health, the only population health school in the

Dr. David Nash discusses population health with Russ Cobb at ACE14.

United States. I talked with him after his opening address at our annual user conference, Allscripts Client Experience (ACE). Here are some highlights from our interview:

Q. What’s wrong with health care in the U.S.?

A. A report from the Institute of Medicine described U.S. health care this way: Shorter Lives, Poorer Health. Despite spending more money on health care than any other country, the U.S. population health ranks #17 worldwide, just behind Slovenia. As many of us know, that’s because the unhealthiest 5% of the population drives 50% of the spend. It’s time for Americans to stand up and demand better health care. The status quo isn’t going to work anymore.

Q. What is population health?

A. There’s an academic definition of population health that has three components. First, there are health outcomes, such as morbidity, mortality and quality of life, and how those appear in a population. Second, there are health determinants that influence distribution – things like medical care, socioeconomic status and genetics. Finally, there are the policies and interventions at social, environmental and individual levels that affect these determinants.

Taking a broader view of population health, we have to recognize that what happens in the delivery system is only about 15% of the story. The other 85% happens outside the hospital. It’s patients’ diets, behaviors andgenetics, and things that occur in workplaces and in homes.

Q. What’s the importance of the electronic health record (EHR) in addressing population health?

A. First, let’s look at the benefits on an individual level. We use Allscripts TouchWorks® EHR, and just a couple of days ago I needed this tool to help a patient. He’s a new patient with an abnormal EKG. I could look up previous tests in his EHR and show the patient how they’ve changed over time. It enabled me to make good decisions, right in the office with the patient.

Second, let’s look at the population level. I can look at all of my patients with high blood pressure and see how I’m doing this year, how I’m doing compared to my partner and more. You can’t see these trends without tools like TouchWorks EHR.

Q. What are some of the changes we have to make in the healthcare community?

A. We have to change the culture of clinical training. The very core of traditional physician training is to look at one patient, one problem at one time. But we need to learn from everyone’s experiences, have better access to organized information, and overall be better connected.

We also have to change how we get paid. At the Jefferson School of Population Health, we’ve tried to summarize the Affordable Care Act in four words, “No outcome, no income.” That’s the world we’re heading towards and physicians need to change or get left behind.

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