In light of this active role in policy, what is your perspective on the direction of US health reform in advancing medical
innovation? Where are the real pockets of progress taking place?
Nash: The US is a very heterogeneous society. There is no one single source of insight or innovation. Hence I would disagree that
government – or the Obama Administration – is in the driver's seat where system change is concerned. One example I would cite
of a creative response to health care challenges are multi-specialty physician practices like the Everett Clinic in Seattle,
where the physicians work together as employees and have a laser focus on producing value for every treatment dollar spent.
Another is the proliferation of interest among academics, providers and payers in supporting dozens of peer-reviewed journals
publishing good research on quality and safety.
Likewise, there is no doubt that the US leads the world in generating good data on disease interventions; what used to be
unfathomable questions are now being answered. The problem is in executing on the basis of this data to measurably improve
outcomes that lead to advances in the standard of care. Even here, however, we can point to significant gains – there are
hospitals that go a year without a single case of ventilator-induced pneumonia or an i.v. line infection of the blood stream.
Just five years ago, these assaults on patient safety used to be frequent, repeatable incidents in most every facility.
The states are incubators of innovation, especially Oregon and Arkansas, who are using federal waivers under Medicaid to initiate
novel ways to cover patients with chronic disease.
Finally, consumer engagement in health care is an exploding reality – a source of" creative destruction" as Professor Eric
Topol contends in his book. The evidence is clear: if consumers see a positive economic incentive, they will act to change
their behavior. When obese people find their insurance rates go up, more will opt for diet and exercise. Wellness programs
among employers do appear to lower the absentee rate.
What binds all this is the capacity to forge consensus out of our diversity. That consensus is simple: every major player
in the US system acknowledges there is a better way to treat and pay for the health services our society expects. I believe
this consensus is due to the practical intellectual approach initiated through our work in population health
It is interesting that none of the innovations you cite involve the use of biopharmaceuticals. Do you support the premise
that the industry's expressed support for outcomes – services "beyond the pill" – is more rhetorical than real?
Nash: I have been a member of the Board of Directors of Endo Health Solutions, so I am familiar with the industry business model.
In reference to your question on the industry commitment to delivering outcomes, I would say its half real – and half rhetoric.
For many years, drug companies had a winning formula built on the blockbuster product. Sales of these billion dollar medicines
helped boost research pipelines along with a commitment of resources unmatched by any other country.
But the blockbuster model has run its course; the science of drug discovery is harder and the growth of generic rivals means
society has less need for a tenth in class beta-blocker or the 12th consecutive version of a drug for erectile dysfunction.
What we do need today is the ability to demonstrate, with evidence, that appropriate use of the pharma armamentarium will
produce a good outcome, for payers as well as patients. For 20 years, I have advocated precisely this approach, asking companies
to work with us on the delivery side to demonstrate value in the products that come from their labs. In fact, I believe this
is now one of the key battlegrounds of 21st century health policy: to get big Pharma to move beyond rhetoric to register the
true value of their products in the competitive marketplace.
Some companies are already there. J&J has been engaged with Jefferson for five years on a partnership called Health Policy
Excellence, where our faculty conducts regular interchanges with company managers on health economics and other relevant topics.
Clearly, however, industry has the capacity to do more. These actions must become institutionalized for the industry to show
it has moved from rhetoric to reality in demonstrating value. Failure to turn this impression around will prevent a more important
industry objective, which is to establish itself as a full partner in the health care delivery system. For years, medicines
have been treated as a commodity purchase, separated from the continuum of patient care. Until recently, therefore, it has
not been possible to show how use of a drug influences the other services patients receive, often eliminating the necessity
for surgeries or other high-cost interventions. Unfortunately, this separation is now being compounded by the increasing scrutiny
of drug promotion, in which physicians are barred from seeing field force representatives or participating in company educational
campaigns to encourage the uptake of a new medicine.
Taken together, these trends effectively give the industry no choice but to pursue answers to the following question: how
do we get from a business model centered on the volume of pills we sell to the value our customers derive from each purchase?
If you don't have a strategy focused on this central point, you are missing the future.