What a year!!!

As I reflect on 2011, from a health policy perspective, it has been quite a year indeed. Berwick is out, ACOs are in, and costs continue to rise. Employers are trying everything and corporate wellness and prevention is the "new green". The lines separating payers, providers and purchasers are blurring every single day as insurance companies buy doctor practices and hospitals too!! The New England Journal says Disease Management doesn't work and everyone believes one study based on the sickest Medicare patients only. It is increasingly difficult to separate out the "truth" from the background noise, especially as the noise gets louder and louder.

Personally, I am really looking forward to 2012 and the ongoing struggle to make health care more accountable, transparent, safer and more cost effective. I am confident that the Jefferson School of Population Health will continue to provide leadership in its research, teaching and dissemination agenda. Our journals, this BLOG, our Medpages column, our national conferences, continue to resonate with the key opinion leaders in healthcare across the nation.

I hope that you will continue to turn to us for informed opinions and solid evidence too about what is working and what is not. One thing surely still remains the same regarding the reform efforts and that is of course " No Outcome--No Income". I am convinced that the future belongs to groups that can make this pithy statement a reality for everyday practice. We are always interested in your views too. DAVID NASH

More on Accountable Care Organizations

The Jefferson School of Population Health just finished hosting a special two day invitation only advisory board on the current status of Health Reform. We had one dozen experts from all around the nation convene on our campus for a two day discussion of the details and an update on implementation challenges. It was sobering indeed!! At this juncture, I believe that most organizations are NOT culturally ready for the hard work of true accountability.The heart of a real ACO, whether with Medicare or commercial patients, is the realization that clinicians will have to self evaluate, measure what they do everyday, and be willing to engage in the gut bustingly difficult work of improvement. The "shared savings" may in fact be minimal, especially in the early stages. It will take a commitment to practicing based on the evidence and a willingness to benchmark performance against regional and national leaders. A tall order for any organization and in my view, most are not at all ready for this cultural paradigm shift. Who will make it---organizations with a hierarchical doctor culure, accustomed to profiling and willing to police members within their own ranks. The Ochsners, Geisingers and Mayos of the world will be able to make it work, very few others have the skill sets necessary at this juncture. Stay tuned for more posts from our amazing advisory board and for publications that will come from our deliberations together. DAVID NASH

Population Health Colloquium--MARCH 2011

As the nation comes to grip with all the implications of Health Reform, and a renewed interest in work site wellness, prevention, care coordination and value based purchasing, the School of Population Health is presenting a forum to explore all of these issues. The Population Health Colloquium is a three day event co-located with two sister conferences on the Medical Home and Palliative Care set for March 13, 14, 15 and 16 in Philadelphia. Our School will also be conducting a pre conference work shop on the fundamentals of Population Health with lectures by four of our leading faculty members. Our special Sunday night March 13th "Book Event" is a great opportunity to meet more than half a dozen nationally prominent authors who will discuss their recent books, sign copies, and take questions from the audience about their work in health care. Our kick off speaker, Dr Nancy Snyderman, is the Chief Medical Correspondent for NBC National News and herself, an expert on care coordination, patient empowerment, and prevention. I am hoping to see scores of readers at our Colloquium and look forward to the ensuing dialogue. For more information go to www.populationhealthcolloquium.com. See you then!!

Greater Philadelphia Assoc of Health Underwriters-- GPAHU

Health Underwriters are the real sales force for insurance carriers across the nation. One of their largest membership organizations is here in Philadelphia--the Greater Philadelphia Assoc of Health Underwriters. I had the privilege of giving the plenary address to their entire 500 strong membership on Thursday, October 7th. I was asked to "sort out" health reform for them and to render my opinion about its implications in our marketplace. Well,no easy task for sure!!I told them my best understanding of the ACA is this---NO OUTCOME-NO INCOME---meaning, that we will face unprecedented levels of public accountability for what we do everyday as providers AND that we will come to be paid only after we achieve certain levels of outcome. Hence, No outcome--No income!!! This is a tough message--one filled with uncertainty and the possible erosion of professional autonomy too. Following my remarks, a leadership panel that included persons from Independence Blue Cross, Aetna, Cigna, United and Coventry made brief statements about their role and then we all took questions from a moderator. The insurance industry is clearly challenged by ACA and all of its implications. The carriers are in a watchful waiting mode, thinking about new markets and new opportunities too. GPAHU is an important part of the payment landscsape and the role of the broker under reform is still not clear. One thing IS clear---business as usual is out of the question!! DAVID NASH

Reflections on Two Plenaries

In the past two weeks I traveled to Chicago twice to deliver two plenary talks on topics of great concern to the faculty and students of the Jefferson School of Population Health. On June 3rd, at the Association of American Medical Colleges Second Annual Meeting on Integrating Quality (IQ)into the Medical College Curriculum I admonished the representatives from more than 60 medical colleges to train the trainers---get faculty fired up about quality and safety and then let them train the house officers and medical students. The shortage of appropriately trained faculty in our field is the rate limiting step to getting the tenets of quality and safety more securely into the modern curriculum.

On June 10, at the Annual Meeting of the Facutly Practice Solutions Center of the University Healthsystem Consortium, I urged Practice Plan leaders from across the country to prepare now for health reform in the ambulatory arena. This means helping physicians from every clinical department to measure and evaluate the quality and safety of the care they deliver in the office setting. I envision that health reform as it relates to the office practice of medicine will mean ---No outcome, No income!! That is, doctors will be paid when we reach our evidence based clinical goals, and if we fail, we will be paid less or not at all. A brave new world for all of us.

The Jefferson School of Population Health, and its faculty and staff, are recognized leaders in medical school curriculum reform and preparing clinical faculty for the realities of a payment system based on clinical accountability. These two issues are among many that we are busily researching,analyzing and speaking about.

How is your organization tackling curricular reform and preparing for practice under the new bill?? What innovative approaches are you using and what can we all learn from one another??

SHAPE THE FUTURE

SHAPE THE FUTURE---In a stirring and forceful speech, President Obama delivered a bipartisan centrist message that appealed to our character as a nation. Noting that we cannot fix the economy without fixing health care and promising not to increase the deficit he inherited, the President called for mandated insurance coverage for all Americans. Recognizing that the status quo is untenable, he called for the creation of an insurance exchange and for the so called "public option" to be created whereby those without insurance currently, could get coverage ----noting that it might take up to four years to implement. He also explicitly linked our need to reduce waste, improve quality, reduce hospital acquired infections and practice better team based care to the set of tools needed as part of the solution. From a policy perspective the speech clarified his own views and reinforced the notion that we have to build on the existing system. He did not disconnect insurance from the place of employment, he did not call for a major Medicare overhaul and he did not create major new federal bureaucracies to make his plan operational. Much more work needs to be done but I believe he effectively re--set the clock, re--set the arguments, and crafted a political umbrella under which lawmakers can now operate together. DAVID NASH MD MBA, Dean, Jefferson School of Population Health, Phila, PA

What Health Reform Plan??

The Obama administration is working in overdrive to create a health reform package that could possibly be passed this summer. That is the headline we are all reading. The challenge, among many, is "what exactly is the proposed plan?"Like you, I am very concerned that the real work is being done in the basement of the White House by a very small number of non elected leaders. Sure, the press has been pretty good to date with a "down payment" on reform via the ARRA and lots of talk about the benefits of the infusion for information technology. However, the actual proposed legislation is leaking out in bits and pieces as the various interest groups inside the Beltway try hard to get their hands on real information. I hope we keep our eye on the four pillars of reform---create value, insure everyone, change the payment system and promote coordination. The pillars represent real reform, everything else is tinkering around the edges. At the Jefferson School of Population Health we are tracking these developments carefully but we need your help too. We must continue to press for transparency here and we must make sure that the four pillars are embodied in any legislative proposal. I am interested in your views too. DAVID NASH

Population Health Colloquium and then some!!

This past week our team from the Jefferson School of Population Health hosted the ninth annual Population Health and Disease Management Colloquium at a beautiful hotel on the river front in Philadelphia. Despite the worst winter storm of the season, and nearly eight inches of snow, we had a full house for three days of learning. What I took away from our meeting is the emerging confluence amongst wellness, prevention, disease management and care coordination. It seems to me that these concepts are fundamental to the pending reform of the health care system and the leaders who were present made a strong case for making reform happen. The American Recovery and Reinvestment Act (ARRA) , otherwise known as the Stimulus Bill, explicitly recognizes these issues and calls for billions of dollars to be spent upgrading the public health infrastructure of the nation and creating a Center for Comparative Effectiveness Analysis. Our conference, and of course, the Jefferson School of Population Health, are part of the answer for health reform. Also this past week I was featured in a story about care coordination in the Philadelphia Inquirer and a radio interview for National Public Radio WHYY in Philadelphia. We are working tirelessly to get the message out that reform can only happen when we rationalize how care is delivered, increase the evidence basis for health care, and change the pernicious incentives as they are currently structured. I hope that our national leadership is up to this tough task. Thanks for your participation, DAVID NASH