The Father of Population Health says America needs a new strategy for primary care.
COVID crashed the system, says Dr. David Nash, Founding Dean Emeritus of the Jefferson College of Population Health. That’s both the title of his new book and the subject of a recent interview on the Healthcare Rethink podcast.
“In the [spring] of 2020, it’s fair to say that my email exploded globally with people coming to me and saying, ‘You know that population health stuff you’ve been talking about for 10 years? Seems like it might be pretty important now,’” Dr. Nash recalls.
COVID was the “knockout punch” that debilitated the medical system and exposed the social determinants of health—poverty, racism, lack of access to primary care, and even the cultural vulnerability of American exceptionalism—that led to the system’s catastrophic failure.
Sorting through the wreckage, Dr. Nash says we can learn from our mistakes and make critical changes to prepare for the next healthcare crisis. To begin, here’s what Dr. Nash says we must do to reinvent primary care.
1. Realign economic incentives.
We can’t expect providers to prioritize keeping people healthy until we stop paying them to wait for people to become sick.
“We’ve lost our True North,” Dr. Nash says. “The way to get back onto the compass of True North is to realign economic incentives of the most senior leaders so that they’re held accountable for improving health, reducing disparities, reducing inequality.”
Instead, most health systems are still operating on a fee-for-service model, earning reimbursement only reactively by delivering healthcare interventions.
“If you get paid more for doing more and not thinking about the True North of improving health, you’re going to do more—and we’re darn good at doing more,” Dr. Nash says.
How do we shift economic incentives? In part, by tackling the next two initiatives.
2. Support payer-provider collaboration.
As a fully integrated provider and payer, Geisinger serves as the ultimate example of payer-provider collaboration.
“They’re considered one of the best models of a community-based tertiary delivery system, connected directly to their own health plan,” Dr. Nash says. “What does all this mean? They have every economic incentive to keep people healthy, to do basic stuff like [keep people] out of the hospital.
However, even outside this “payvider” model, health systems and payers can start to significantly improve outcomes and reduce inequities by sharing data. When providers and payers move beyond the fee-for-service transactional approach, they can see they are each holding data that can be used together to improve preventative care. By working together, for example, they can identify members in need of primary care physicians, transportation to medical appointments, or access to nutritional food options.
“Get the computers to talk to each other to create these models,” Dr. Nash says.
3. Reimagine education to train the physician of the future.
Notably, this new medical world will require an entirely different type of physician. In 35 years as a primary care physician, Dr. Nash doesn’t recall ever asking patients about the food in their refrigerators. However, social determinants of health are becoming a core part of the training for his daughter who is a physician.
Improvement here is a two-pronged approach. First, the curriculum must be expanded to train all primary care physicians to consider social determinants when treating patients. Then, they must be given tools to make a difference—the ability to, in effect, write a prescription for food, transportation, legal help, or whatever is negatively impacting their patients’ health and quality of life.
“I’ve always seen doctors as social activists, and that’s really the core issue here,” Dr. Nash says. “We’ve lost that in medicine. If doctors can’t be activists to improve health, well, that’s part of what we have a sworn oath to do.”
For more from Dr. David Nash, watch the full podcast below, and check out his new book, “How Covid Crashed the System: A Guide to Fixing American Heath Care.”
