The Dell Medical School has added another department Chair: in January, Dr. William Tierney, a nationally recognized leader in medical informatics who has devoted his career to creating innovation, value and efficiency in health care delivery, will begin assembling the school’s Department of Population Health.
You can read more about Dr. Tierney here. He also answered these questions about Population Health and his vision for the department:
1. What is Population Health?
Population Health is the overall health and well-being of a defined population for which one has responsibility. The Dell Medical School’s Department of Population Health will be concerned with and accept responsibility for the health of all of the residents of Austin and Travis County. Improving population health means improving health care, access to health care, and the health of the community outside of hospitals, clinics and other health care venues in order to promote health and prevent disease. A healthy population is healthier – meaning people are better able to function and have lower risks of bad health issues and outcomes – and it has access to better care for conditions already afflicting people.
2. What is your vision for the department?
This is still under development and won’t depend only on me – there are a number of people across the community whom I’ll be talking with over the coming months about what we want and need to do. Clearly, we will want to improve objective measures of health – lower weight, fewer incident cases of diabetes, fewer asthma attacks, lower incidence of violence – as well as Austin and Travis County residents’ satisfaction with their personal health and the health of their community.
3. What are real-world examples of Population Health improving the overall health of the community?
There have been efforts to provide better alternatives for food in urban areas, so-called “urban food deserts.” There also have been efforts to provide communities with safe places to exercise. Most programs have been limited in scope – small populations within a city rather than an entire city like Austin. For example, a group of investigators affiliated with the Regenstrief Institute, the institute in Indianapolis that I have worked in for 36 years and led as President and CEO for 6, identified people at risk for getting diabetes and developed a program in partnership with the YMCA to enhance their exercise and nutrition. This program was studied in a randomized trial, and significantly fewer of the YMCA participants developed diabetes. The American Medical Association is now working with the YMCA to scale the program for a nation-wide population. Another program by one of our scientists promoted exercise by engaging African-American women, and it resulted in sustained weight loss. Investigators from the Regenstrief/Indiana University Center for Aging Research also identified almost 1,000 frail community-dwelling elders for whom a comprehensive support program increased their physical and social functioning, reduced their rate of admission to hospitals, and lowered health care costs. The Veterans Administration has adopted this program for all 150+ of its medical centers, and a 50-hospital network in California is implementing it, as are other health systems.
I’m very hopeful, based on these examples and others, that by seizing Dell Medical School’s opportunity to implement interventions like these across the community, we can improve health in Austin and Travis County effective and cost-effective ways.
4. How do you see the Population Health department interacting with the community?
Community organizations in Austin are already engaged with community members in need. Central Health supports a number of Federally Qualified Health Centers (FQHCs) that have community-engagement programs to reduce health risks and enhance access to care. I see the Department of Population Health partnering with these and other organizations to provide resources and expertise and expand both the scope of services they deliver and the number of people they serve. I also intend to reach out to leaders and participants in organizations that touch every part of our community to brainstorm and help prioritize the Department of Population Health’s goals and objectives in this regard.
5. How do you integrate Population Health into the medical school’s curriculum?
In the past, doctors and other health care providers got paid when sick patients came to them seeking help. So medical education focused on the mechanisms of disease and how to treat them. Unfortunately, this meant that all of the incentives were aligned to deliver more and more care at higher and higher costs – there weren’t incentives to reduce disease and avoid having to provide care and incur costs. This has resulted in runaway medical inflation that now consumes one of every five dollars spent in this country. We are too sick and too noncompetitive. It is bankrupting us, and people are suffering unnecessarily.
The incentives must change. We need to find ways to pay doctors and other health care providers to keep their patients healthy. The doctors and other health care providers we graduate, especially those in primary care and public health but even specialists, must be as knowledgeable about health promotion and disease prevention as they are about diagnosis and treatment. The Dell Medical School curriculum will reflect this change in emphasis from Day One, in part through Interprofessional Education, where students in medicine, nursing, pharmacy, public health, dentistry, and social work study together and learn to function as a team – just as they’ll practice in teams once they graduate – to look for more creative and efficient ways of keeping people healthy.
6. How will Population Health advancements change people’s interactions with their doctors?
It’s hard to say at this early stage. I expect that enhancing health care access will be one of the primary goals of the Department of Population Health, and I would hope that as we identify patients with health risks, those interactions will become increasingly focused on disease prevention and health promotion rather than treatment. For those receiving care in FQHCs and other health centers dedicated to treating vulnerable populations, we hope to work with Central Health to enhance the capability of these health centers to focus as much on prevention as on treatment. It all depends on the kinds of mutually beneficial partnerships we can establish with health care providers.
7. Where does the community of existing physicians fit into your vision for the department?
I don’t anticipate that the Department of Population Health will have a lot of physicians whose main purpose will be delivering care. My understanding is that, unlike most medical schools (including Indiana, by the way), the Dell Medical School will not depend heavily on clinical care revenues to subsidize its academic mission. That said, if the Dell Medical School is not going to have a big clinical footprint, then we probably will have to partner with community physicians and their practices and organizations so that our students have places to learn medicine and our faculty can work on improving health and health care. So seeking out opportunities for creating those partnerships with community health care providers will consume a lot of my time early on.
8. What kinds of data are required for effective Population Health programs, and how do you protect patient privacy?
Health is primarily an information business. To improve something, you have to measure it. So if we care about the public’s health, we have to know who is in our population area and what their health risks and needs are. We can — and will — get some of this information from existing sources, mainly electronic medical records and the county and state departments of health. But there are other relevant sources of information such as census data, locations of schools and health centers, EPA measurements … even bus routes can tell us things about health. And no doubt we’ll collect feedback about health needs directly from the people of Austin and Travis County through surveys and similar mechanisms.