Rochester Medicine

Ahead of the Curve

Mar. 26, 2015

David NashThe call came on Halloween in 2007. David B. Nash (MD ’81) was ushered into the office of the president of Thomas Jefferson University, where Nash had been recruited nearly two decades earlier. He had risen from a staff position to department chair of Health Policy, a post he was quite happy with. As Nash sat across from then-president Robert L. Barchi, MD, PhD, however, his relatively comfortable job vanished and another slid into its place.

“He said, ’You will build a new school for me,’” Nash recalls. “And, God help me, he looked at his watch and told me I had ten minutes to decide.”

In a daze, Nash walked back across the street to his own office and tried to tell his longtime executive assistant what had happened. Major changes were coming in health care, and Jefferson was taking a bold step to get ready. Nash had been chosen to lead the way, as founding dean of the Jefferson School of Population Health (JSPH).

“Calling it that was a brilliant stroke of serendipity,” Nash says, crediting Barchi for insisting on the phrase “population health” while it was still chiefly relegated to a handful of dusty, academic papers.

Not long after, however, discussions about population health began surfacing in back rooms of the US Capitol. As lawmakers were piecing together the Affordable Care Act (ACA), Nash was busy supervising the development of Jefferson’s groundbreaking, online curriculum. As the nationwide debate over health care was raging, the JSPH quietly opened in September 2009. That was nine months before the ACA, which necessitates a population health approach, was signed into law.

From the Beginning

Upon graduating from high school, Nash knew he wanted a career that combined business and medicine. He proudly arrived at the U of R carrying an honors degree in Economics from Vassar College, where he also completed a Pre-Med major. Determined to continue the pace, he decided to simultaneously earn a MD and a master’s in Community Health at the School of Medicine and Dentistry. But before the first semester was over, Nash was ready to quit.

“I flew home for Thanksgiving and told my father I was not going back,” Nash explains. “I was flunking genetics and barely passing anatomy. I was overwhelmed by all of the memorization. As an economics major, I had never taken a short-answer test. It was a complete culture shock.”

His father, however, strongly advised him to change his attitude and get back on the plane.    Nash dropped the master’s program to focus on his basic science courses, managing to plow through until his third-year rotations began. When he stepped into the Ob/Gyn unit at a local hospital, he felt like his dreams were finally coming true. But soon, he wanted to leave Rochester again.

This time, it was because of a sparkling brunette named Esther, whom he had sat next to at a regional conference of the Associated Medical Schools of New York and married less than two years later. She was a top student at Brown University’s fledgling Alpert Medical School, just over three hundred and eighty long miles east of Rochester. And there wasn’t room for her at the U of R. So Nash spent his final summer here trudging across campus, securing permission from his professors to finish most of his fourth-year requirements at Brown. He returned for his emergency medicine rotation and graduation. In true Nash fashion, after his residency, he earned a MBA from Wharton while also serving as a Robert Wood Johnson Foundation Clinical Scholar and the medical director of a nine-physician faculty group affiliated with the University of Pennsylvania.

In 1990, he began his first job at Thomas Jefferson University, running the Policy and Outcomes office. He eventually turned that office into a department of Health Policy, one of the first of its kind. He received an endowed professorship and earned tenure. He and Esther had fraternal twin girls and a son (now all in their twenties and working in health care).

 “I had climbed to the top of the hill,” Nash says.

But then the hill got bigger.

If We Don’t, Who Will?

As the nation’s health care providers come to terms with population health, Nash is a hot commodity.

“The last year has been the busiest year I’ve ever had in academic medicine,” he says.

David NashNash’s list of recent speaking engagements reads like a jumbled table of contents from a Rand McNally atlas: South Carolina, Illinois, Wisconsin, Nevada, North Carolina, Idaho, New York, West Virginia, Washington.

“Some of the invites come from people starting new schools or programs, asking for advice,” says the JSPH dean. “But really, most people just want us to explain what population health is. That’s what I spend most of my time on the road doing.”

Nash maintains a population health travel blog of sorts, called Nash on the Road. The MedPage Today columnist has published more than one hundred articles in major journals and edited nearly twenty books, primarily focused on various facets of population-based care. Hundreds of Jefferson students are earning graduate degrees in Health Care Quality and Safety, Health Policy, and Applied Health Economics and Outcomes Research, thus forming the nation’s first wave of population health care managers. At a moment when most of the nation’s health care leaders are scrambling to catch up, David Nash is holding the crystal ball.

“I was worried that I wouldn’t see this happen in during my career,” says Nash, who firmly believes – when all is said and done – that population health management will make health care in America much better and far more affordable for patients.

That is what has kept him motivated through the years.

“If places like Jefferson and Rochester ignore reality and don’t do this, just imagine the consequences,” Nash says, adding it is the responsibility of academic health professionals to lead health care reform. “We’re doing God’s work.”

What Is Population Health?

In its most fundamental sense, population health is a systematic approach to health care that aims to prevent and cure disease by keeping people healthy. Population health builds on public health foundations by:

  • Connecting prevention, wellness and behavioral health science with health care delivery, quality and safety, disease prevention/management and economic issues of value and risk – all in the service of a specific population, be it a city, a provider’s practice, a hospital’s primary service area, or pre-school children.  
  • Identifying socioeconomic and cultural factors that determine the health of populations and developing policies that address the impact of these determinants. 
  • Applying epidemiology and biostatistics in new ways to model disease states, map their incidence, and predict their impact.
  • Using data analysis to design social and community interventions and to develop new models of healthcare delivery that stress care coordination and ease of accessibility.
  • When applied to healthcare delivery, population health differs from conventional health care by emphasizing value rather than volume of services rendered.

Source: Jefferson School of Population Health