An interview with David B. Nash, WG’86, Founding Dean, Jefferson School of Population Health.
David B. Nash, WG’86, M.D. is vibrant. He is thrilled to receive the 2012 Joseph Wharton Award for Social Impact. He is enthusiastic about his life’s work of teaching, and founding the Jefferson School of Population Health in Philadelphia. He is rejuvenated by his family (Esther, Jacob, Rachel and Leah — “We’re half of the Old Testament!”). He invigorates others to care about improving the nation’s health. David is one of the lucky ones who has figured out how to grab life by the horns and take it for a ride.
And he does consider himself lucky. Since leaving Wharton, he has campaigned for, as much as taught that we must improve public accountability for the outcomes of medical care, we must measure quality and safety, and we must sound the alert that medical error is epidemic in our country. He can feel vindicated because, “These issues were not at all popular in 1986. Today, these are front-page news. How many people can say that their work interests directly coincide with the principal domestic agenda of the country?” I asked him to explain his passion in layman’s terms.
What is population health science, and why is this new distinction important?
“Population health” is a term coined 35 years ago to encompass the spectrum of determinants that have an impact on health. The “laying on of hands” (active medical care) accounts for only 15% of a society’s well-being. The other 85% is all about caring for the population in other ways — recognizing that education, genomics and people taking more responsibility greatly affect health outcomes of the population.
For example, alcoholism, smoking and obesity are central to 40% of all deaths in this country. Population health would say that traditional doctor care, one individual at a time, cannot fix this problem. We need a different approach. We need to teach healthy lifestyle behaviors. We need a patient-centered medical home. We need economic incentives (for doctors and patients) designed to promote health and keep people well. And we need all kinds of things under the umbrella of what we call “population health.” Population health argues that we need a new approach to what looks like a medical problem, but is really indicative of complex social problems in the population.
Our tax dollars go to Medicare to pay for bariatric surgery for the morbidly obese when we know that a $.02 tax on sugar-sweetened beverages will dramatically decrease adolescent obesity. So that’s a great microcosmic example of what drives our healthcare costs. We create rules to pay for bariatric surgery, hospitals then build bariatric units, and surgeons get rich, when what we really need is a societal attack on obesity on all fronts.
Then the things that induce people to smoke or abuse alcohol, which result in expensive treatments for liver, cardiovascular or cancer problems, depression, and more …
Very similar! Population health says that, by addressing these kinds of social problems, we can improve people’s health and dramatically drive down healthcare costs. Thomas Jefferson University was founded in Philadelphia in 1824 as Jefferson Medical College. You are the founding Dean of the Jefferson School of Population Health (JSPH), established in 2008. Why was this school created? We must create leaders who can address the issues central to reforming the healthcare system. Our graduates are armed with tools and techniques, such as performance improvement strategies, lean thinking, systems analysis and change management.
JSPH provides innovative education through four master’s degrees. Public health is a traditional program, and then three programs are exclusively online master’s degrees Health Policy, Health Economics and Outcomes Research, Quality & Safety, — the last two being unique in this country.
You chaired the Technical Advisory Group (statewide experts) to the Pennsylvania Health Care Cost Containment Council for more than a decade and continue to do so. What are three practical ways to save costs?
The cornerstone of what we call Health Care Cost Containment Council (HC4) is to drive market share, based on outcomes, and promote public accountability. It’s the philosophy that better information will drive patients to institutions that produce better outcomes. It doesn’t actually drive down costs, but it has accomplished critical results that add value to the system. It has reduced mortality, reduced hospital-acquired infections, reduced waste and, at the end of the day, saved thousands of lives! So our advisory group gives HC4 insight on what kinds of information the public needs to make better purchase decisions.
Can you give some examples?
Sure. We (HC4) pioneered the public reporting of outcomes for open-heart surgery in 1991. We pioneered the public reporting of outcomes for heart attacks. We pioneered the recognition that you can get an infection in a hospital in a famous report published in late 2006.
What is an important metric in healthcare that Americans should pay attention to?
The United States spends $8,000 per person per year, including children, on healthcare. Do you believe we are getting $8,000 worth of healthcare per person each year? We are bankrupting Medicare. If we don’t make major changes, as called for in the Institute of Medicine report this past week, and reduce waste, then we are headed over the fiscal cliff with healthcare.
How do you get things done?
I go to sleep early and get up early. I take good care of myself, which is important in the fast-paced world. I eat right. I don’t smoke and hardly drink. It sounds corny, but it’s really important. If everyone took care of themselves, it would be wonderful. Then, I have a wonderful supportive family. I’ve been happily married to another doctor for 32 years. And great co-workers. I’ve been very lucky having been at Thomas Jefferson University for 22 years with the same executive assistant from the day I walked in the door. And wonderful colleagues at my school, who are incredibly helpful and part of the team. Some people think that I’ve created this school by myself, but that’s clearly not the case.
Currently, you serve as Editor-in-Chief of five major national journals, including American Journal of Medical Quality, Population Health Management, and Biotechnology Healthcare. You also speak and blog. Is there one driving message you hope to communicate?
The message is all about creating a new kind of leader for the future. The most important job that leaders have is to create leaders for the future. If I have a legacy, I hope it will be all the students whom I have taught.
What do you like to read?
Historical biographies of leaders throughout history who confront their own challenges and how they persevered. I like reading about Thomas Jefferson (of course), Lincoln, FDR, John Glenn, a few select World War II admirals and Churchill. Recently, I visited the Morgan Library in New York. They had some of Churchill’s early work, including a report card that said he would never amount to anything.
What did you learn at Wharton that sticks with you?
“Process, process, process.” That was one of the favorite expressions of Samuel P. Martin, the head of the Clinical Scholars program and a powerful person at the school. He taught that paying attention to the process often leads to a good outcome.
David Nash was named the Founding Dean of the Jefferson School of Population Health (JSPH) in 2008. This appointment caps a 22-year tenure on the faculty of Thomas Jefferson University. He is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy. JSPH provides innovative educational programming designed to develop healthcare leaders for the future. Dr. Nash is a board-certified internist who is internationally recognized for his work in outcomes management, medical staff development and quality-of-care improvement. In 1995, he received the top recognition award from the Academy of Managed Care Pharmacy. He received the Philadelphia Business Journal Healthcare Heroes Award in October 1997, and was named an honorary distinguished fellow of the American College of Physician Executives in 1998. In 2006, he received the Elliot Stone Award for leadership in public accountability for health data from the National Association of Health Data Organizations. In 2009, Dr. Nash received the Wharton Healthcare Alumni Achievement Award.
Repeatedly named to Modern Healthcare’s list of Most Powerful People in Healthcare, Dr. Nash takes on national activities covering a wide scope. He served as Chair of a National Quality Forum Technical Advisory Panel and is member of the Board of Directors of the Care Continuum Alliance (formerly DMAA). Dr. Nash is a principal faculty member for quality-of-care programming for the American College of Physician Executives in Tampa, Florida, and is the developer of the ACPE Capstone Course on Quality. He also leads the academic joint venture between ACPE and the JSPH.
Dr. Nash is a consultant to organizations in both the public and private sectors. He has chaired the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council for more than a decade, and he is widely recognized as a pioneer in the public reporting of health outcomes. In December 2009, he was named to the Board of Directors for Humana, one of the nation’s largest publicly traded healthcare companies. In March 2011, he joined the Board of Directors of Endo Health Solutions, a publicly traded pharmaceutical company headquartered in Chadds Ford, Pennsylvania. From 1998 to 2008, he served on the Board of Trustees of Catholic Health Partners in Cincinnati, Ohio, where he chaired the Board Committee on Quality and Safety. Through publications, public appearances, his blog and an online column on MedPage Today, Dr. Nash reaches more than 100,000 people every month. He has authored more than 100 articles in major journals. He has edited 22 books, including Connecting With the New Healthcare Consumer, The Quality Solution, Population Health: Creating a Culture of Wellness, Demand Better! and, most recently, Health Care Quality: The Clinician’s Primer.
Dr. Nash received his BA in economics (Phi Beta Kappa) from Vassar College; his MD from the University of Rochester School of Medicine and Dentistry; and his MBA in Health Administration from the Wharton School at the University of Pennsylvania. While at Penn, he was a Robert Wood Johnson Foundation Clinical Scholar and Medical Director of a nine-physician faculty group practice in general internal medicine.
Dr. Nash lives in Lafayette Hill, Pennsylvania,with his wife of more than 30 years, Esther J. Nash, MD. They have 25-year-old fraternal-twin daughters and a 21-year-old son. He is an avid tennis player.