October 02, 2019
David Nash, MD, MBA, kicked off the second annual Health Care Quality Congress (HQC) 2019 in Dallas, Texas with his session entitled, “Population Health and Quality: Two Peas in a Pod.”
Dr Nash discussed how managing population health can help improve health care quality. He said his session would highlight, “how did we get into this mess; what is population health; and where do we go from here?”
Dr Nash began his session by explaining the issues currently facing health care to the audience. According to Dr Nash, health care must reallocate, and the health care system faces tough decisions.
He then explained that the conceptual framework of population health is influenced by health outcomes, health determinants and policies and interventions. Among health outcomes and their distribution within a population, morbidity, mortality, and quality of life of a patient are impacted. Further, according to Dr Nash, policies and interventions that impact health determinants impact social, environmental and individual aspects of a patient.
He explained that health care waste comes in 3 categories: behavioral, operational, and clinical. He noted that of roughly $3 trillion of spending, there is $1 trillion of waste.
“Opportunities to eliminate wasteful spending in health care add up to $1.2 trillion of the annual $2.2 trillion spent nationally.”
“When we reduce error, we reduce waste,” he stressed.
He then stressed that the definition of population health does vary. He said the original definition encompassed health outcomes and their distribution within a population which impact morbidity, mortality and quality of life. He continued that it also focused on health determinants that influence distribution impacting medical care, socioeconomic status, and genetics, and finally policies and interventions that impact social, environmental, and individuals’ determinants.
Dr Nash then explained that the conceptual framework of population health is influenced by health outcomes, health determinants and policies and interventions. Among health outcomes and their distribution within a population, morbidity, mortality, and quality of life of a patient are impacted. Further, according to Dr Nash, health determinants that influence distribution—including smoking, unhealthy diet, physical inactivity, and alcohol, which account for roughly 40% of all deaths—impact medical care, socioeconomics and genetics. Finally, policies and interventions that impact health determinants impact social, environmental and individual aspects of a patient.
According to Dr Nash the US currently spends 2% of health care spending on population health. He explained, however, that chronic disease, which equals 80% of total disease burden, has no dedicated federal funding stream.
He explained that the major themes moving forward should include transparency, accountability, and “no outcome, no income.”
Dr Nash said in order to meet these themes, the health care system must change the culture. He explained that this is a multistep process. Included in Dr Nash’s process is:
- Practice based evidence;
- Reduce unexplained clinical variation;
- Reducing slavish adherence to professional autonomy;
- Continuously measure and close feedback loop; and,
- Engage with patients across the continuum of care.
He also said that it is important to connect at the individual level, especially in this time of technology, and he referenced the use of Amazon’s Alexa in the future.
Dr Nash ended his session with a quote from John P Kotter from Harvard Business School:
“The institutionalization of leadership training is one of the key attributes of good leadership.”
In response to this quote, Dr Nash translated it into his own words saying:
“One of the obligations of the leaders of today, is the training of the leaders of tomorrow, and that’s what you and I are doing here today, tomorrow, and the day after.”