Ep 179 – The End of the Pandemic: Transitioning to a High Value System, with Dr. David Nash

Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world.

Joining us in the Race to Value this week is David B. Nash — an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.”  In this episode, we discuss insights from Dr. Nash’s research on COVID-19’s impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system.


Episode Bookmarks:

01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health.

03:30 Have we learned our lessons from the COVID disaster?

05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator.

05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.”

06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!”

06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.”

07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China.

08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations.

09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport.  1.2M died from COVID-19, and it is back to business as usual.

09:30 Societal issues (e.g. structural racism, inequality) persist in our country.

10:00 What is the True North for American Healthcare really?  ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings)

10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse).

11:30 How Philadelphia is suffering an exacerbation of  pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities).

11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia.

13:00 The persistence of health inequities and social injustice since the transatlantic slave trade.

13:30 COVID-19 blasted a searing light on social determinants of health!

14:30 “You can’t have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article).

15:00 Employer engagement in health equity transformation.

15:30 “The emergence of the payvider model has given value-based care additional energy.”

17:00 The evolution of medical and nursing education to improve health equity.

18:00 Testing of innovations at scale during the pandemic (e.g. telehealth, hospital-at-home, physical infrastructure changes, novel medical devices).

18:30 The extension of Medicare telehealth flexibilities and the extension of the Acute Hospital Care at Home Program through 2024.

19:00 Bridging the digital divide in Philadelphia through the provision of telehealth services at Jefferson Health.

20:00 The economic incentives that led to the rapid adoption and diffusion of innovation.  What is next for digital health post-pandemic?

20:45 The opportunities for applying precision medicine in cancer care and generative AI in healthcare.

22:00 “Amazon, Walgreens, Walmart, and CVS are the Big 4 disruptors of technology innovation in healthcare. This is where the action is.”

24:00 The existential threat of Artificial Intelligence and the forthcoming technological singularity.

25:00 Personal reflections on the disruption of ChatGPT in healthcare and medical education.

26:00 The need for clinical rotations of medical residents in retail-based healthcare settings (e.g. Walmart, Oak Street, Walgreens, Iora Health).

27:30 AI should not need to be a threat to physician autonomy.

28:00 The collision of moral and fiduciary responsibility in healthcare.

28:45 Referencing Dr. Nash’s article, “Population Health is the New Public Health” – “The virus exposed a truth that the public health paradigm is outdated and insufficient.”

30:00 Public health spending is $400 per person in the U.S. (compare that to healthcare spending at a rate of $10k per capita).

31:00 Dr. Leana Wen – “Public health saved your life today. You just didn’t know it.”

31:30 The structural, financial, and cultural challenges of public health and why it is not an attractive career trajectory for physicians.

32:30 The leadership needed to fix public health.

33:00 Dr. Nash expresses his concerns about the not-for-profit governance of health systems that overemphasis profit motives.

34:00 Putting C-Suite leaders at personal financial risk for improving population health and health equity. (a controversial idea to find our True North!)

36:30 Reference Don Berwick’s article: “Salve Lucrum: The Existential Threat of Greed in US Health Care”

38:30 Addressing the challenges of pharmaceutical drug shortages.

41:30 The emerging focus on SDOH tools and measures for optimization of provider EHR workflows.

46:30 The Four Horsemen of the Mental Health Apocalypse (e.g. Opioid, Alcoholism, Depression, Suicide) – how COVID-19 and social isolation exacerbated the crisis.

47:30 The PTSD of the younger generation due to their pandemic experiences.

48:00 How life expectancy in Blue Zones is impacted by community relationships and the need to overcome tribalism in the U.S.

48:45 The incontrovertible evidence of how one’s health is affected by the political party of a state’s governor.

49:30 Putting mental health training, research, and payment on par with traditional health services delivery.

51:30 Realigning economic incentives for physicians as the be all, end all starting point for healthcare transformation.

53:00 Dr. Nash provides his perspective on Risant Health (the value-based care merger between Kaiser Permanente and Geisinger).

55:00 Parting thoughts from Dr. Nash on what it will take to heal our country in the post-pandemic era.