Population Health vs. Public Health: Why America's Hospitals Must Invest in Prevention, Not Just Treatment

<p>what would make sense what makes us money and I think Hospital administrators Healthcare leaders Physicians certainly should be incredibly well paid from a value to society [Music] standpoint hello everyone this is Cole from the American Journal of healthc care strategy joined by a special guest uh many of you I'm sure follow are aware of him out on on the LinkedIn space um Alex can you please kind of introduce yourself your current role uh and you just a little bit about what you do that's kind I'm uh I'm going operating with the assumption that nobody knows me and so this will be the the first introduction I'm Alex meisburger I lead Global healthc care product marketing at SAS um as the the day job and then night job side hustle um all other things as a sign I'm the co-founder of the advancement League a membership Organization for those advancing health and home to the young Health leader Summit for early career ambitious Healthcare colle uh Healthcare leaders and those who support them Mentor them hire them uh headed into Year s in May in Atlanta of 2025 and and you've done you've done a lot of different things I think this is what's great about your your resume is um it you know we love talking one thing we've noticed is that even people who have very similar resumés they have such drastically different stories and then it's Amplified when you have resumés that follow a kind of a weird path then you find some really interesting insights and that's why I really wanted to talk with you you have your mha and MPH right um and you also have your Bachelor's in public health and you were an administrative fellow at one point you've worked in both health insurance uh and and you've had a lot of experience with health care I mean you've done a lot of different things then you find yourself at this really unique organization just looking at the resume here it's really impressive but you've gained a lot of popularity from one of your posts here that starts off with you know I'm embarrassed and it it's gotten about 20 reposts and 1,600 likes on LinkedIn which is a lot for LinkedIn um and you gain a lot of followers from this and so it's talking about how well explain what the post is about I'll let you explain what the post is about explain why it got so popular and then also explain how kind of your story if you don't mind has invigorated people yeah I actually am uh I didn't know you're were gonna bring up a specific post so I I could dig into this up but I think I I remember the general purpose and I um probably post similar sentiments often of just I think in the United States right now we're betting on drugs and Advanced Technologies is to really solve our health problems um we're effectively trying to out Health Care bad health and so you see this all over the world is populations are getting older and sicker almost everywhere on Earth uh and in the United States we just have that unique cultural mentality right now to it's going to be wonder drug it's going to be a health care intervention a new surgical tool a bigger brighter hospital that has more advanced technology that that's going to be the thing that's really going to drive our health outcomes and so we have this weird uh just wording even around healthc care and health they're just two very separate things even the way probably you see it in the way we structure our insurance benefits where our brains and our teeth and our eyes are very separate from our our overall health and so even the way we sort of structure the payment model around our physical versus mental health um not to mention emotional spiritual Dental Care all the things so we we just have the trouble distinguishing between health and Health Care quite a bit and so my general purpose and some of the things that I share in a lot of the conversations that I'm having with Healthcare leaders is we just need to be spending the same amount of time uh both time money Talent so same amount of resources in addressing our health issues as our health care issues and I think it's a unique aspect that Healthcare leaders can step up in in the country is a lot of times you see a healthcare leer leader and it's uh they're talking about Medicare policy and a specific payment model and a specific way we go about a reimbursement structure all of that is well and good I think equal air time and equal amount of their time should be spent saying here are the things that really Drive Health here are the things that our patients are struggling with before they come into the hospital here's some of the ways that we could fix that and and do better so some of it's simply a supply and demand issue uh in so many regions we just have endless demand and so when you look at some hospital administrator resumés uh some of the growth tactics that they've done or some of the things is just sort of right time right place of this area has exploded in population it's older and sicker and our hospitals thriving um and I don't know that that we should celebrate that probably as much as as we do currently yeah and I think that that's it's a unique perspective which is odd right because after talking with you I mean one of the things that brought to you was isn't it a good thing that we spend so much on healthc care you know wouldn't there be something better you know what's better to spend than than on Healthcare and you had some really good points I think what's interesting to me is a lot of people resonate with this messaging you know your posts get a lot of likes and a lot of Engagement and you know you're talked about as kind of a thought leader what's interesting though is it seems that we still don't really adopt a lot of the the things that you you say or in in it's interesting right because it's it's almost as if we like the post we listen to the podcast we read the articles we do a lot of these things and then we kind of go about our our daily life you know using our old models right and I'm not just talking about payment models I'm talking really about philosophical models right you know like I was you know been trying to write an article on how value-based care is really more about philosophy than it really is about actual you know changing the payment model around um and so why do you think it is that we struggle to actually make changes even when you can go to a conference and you know a thousand or 2,000 people are in a room saying this is a great you know presentation or this is a great thing that these people are saying but then we never really follow up on it why is that do you think oh it's it's so much easier to write something on the Internet than it is to do something uh and make meaningful change and so part of it is just the the inertia of the current system and the current models that we have um and part of it is not to negate and uh just talk bad about the sort of current world that we live in or the current health care System I'm just such a proponent of how amazing the American sick care and medical uh system is if you have any rare disease or any sort of interesting uh just problem that can't be solved by some ofat traditional medicine like America is by is the place you want to be we have incredible specialists across almost every type of specialty we have incredible researchers we have incredible technology and so I I don't think that there's some people who are just very like anti our current health care System we've got a it's a lot of ways framed as health and Healthcare or a lot of ways currently it's framed as like healthc care verse health I think you have to do both we have to continue to invest in technology we have to continue to invest in sick care type system we have to have the best technology the best researchers we should be coming up with Wonder drugs all of those things I don't think it's a verse conversation it's an and conversation and so part of it is just I think the the post you were talking about in question of like I'm embarrassed it is true the the basic sentiment was just I've gone through a lot of education and a lot of parts of the healthcare ecosystem and I can name uh specific parts of the Affordable Care Act or I can talk to you about specific policies that insurers are implementing right now I can talk to you about why hospitals are uh using certain Technologies or not using certain other ones but I can't name the like my senator from my current state of what they are focused on in the next round or I can't name two laws that I would change if I was given a magic wand today and it would fix our food system or I can't even like some of the very basic things uh public parks Green Space safe space uh some of the things that really we know as Healthcare leaders drive better health outcomes and just keep people out of the the current healthare system that we have uh the embarrassing fact is it's like I have so much healthare education and somehow I missed all the like Health part of it and so I think that that just gets to the question of it's really hard to make those changes though but I think some of it is we're not even having those conversations and so maybe it's a a quick sound bite on stage at a a main conference but nobody goes back and calls five of their Healthcare Friends and says hey I want to spend a Tuesday night can we talk about this and then what is the actual sort of action we would take do we write our congressmen do we write uh a policy brief and share it with 10 people and have them tweak it and have them make some changes and then do we share that with a group so some of it is just actually putting in the work there's a little bit of a nura behind the like hey I love this message it resonates with me what we're trying to do at advancement league and and throughout the groups that we lead is bring that messaging and that excitement and that passion for certain topics and putting them into practice of how do you actually go take that back to your local community and how do you start making a difference and we've seen people Implement things and go and and take it and that's what sort of keeps us going in Year s wow so many good points um I think one of the big ones is it thinks about it makes me think about the education system too right you know we complain so much about even our higher education system and how it's so expensive but yet it really is one of the best in the world I mean if not the best in the world for higher education we have some of the best institutions and um and so it's the same thing with Healthcare right I mean we have the best trained physicians in in the world here and you can if you speak to them you'll realize like these people are extremely focused on their their path and they have tremendous resources available and so sometimes they can feel like demonized or or looked down on because you know they're making you know uh and charging a lot of money for some of these extreme conditions but we don't necessarily want that to go away right because they they do deserve to get compet and some of these conditions are very hard to treat it's really more so this other end of things which is the the health side like you said can you explain real quick why they are different when you talk about health versus kind of the health care when you talk about kind of managing the population as a whole compared to those you know serious conditions that we need you know kind of Extreme Experts for in complicated treatments what's the difference between those two concepts I've been really fortunate to to host a podcast as well so I'm excited to be on the other side of a microphone today um and uh have a bunch of leading cancer experts uh on on our podcast the health pulse podcast um and one thing that has struck me is just how they speak about medicine verse lifestyle and how they speak about different countries and the way sort of you adopt Health and healthc Care strategies and so it's probably echoing what a lot of people inherently know but I think food is a a big one so food is probably the easiest and clearest example too so if you have readily made processed food and some of it's traced back to like the refrigerator and uh the ease of which so the the refrigerator pricing came down so it came out and then it was expensive and then pricing came down so people put a a freezer out in their garage or wherever and that led to just you could have more shelf stable food so essentially processed food that lasted for ever in a fridge or freezer and all these things so some of just the convenience you can trace back to historical decisions that were made and historical inventions and what that enabled and goes back to like a car you could then could have a bigger car to carry your bigger fridge and put in your house and you could stock up on more food at a single time so you didn't have to go to the grocery store because the grocery store was further so some of it is cultural some of it is historical inventions all the things uh the big challenges there are now I think just general common knowledge is probably like our food in the United States or just the general diet that most of us adhere to is fast uh just in general so like fast food or food that we get too fast uh that comes from all over the world uh maybe loses nutrients along the way or has Supply chains that we don't really understand and all the things uh and stays in our house for 30 days before we eat it or 60 days or 90 days or five years whatever containers we put them in and so it's really easy to just start thinking through and then we see the health problems that kind of Rise since the 1980s and so looking at those graphs and seeing the health challenges that we undergo now uh it's pretty easy to start thinking through like oh well maybe we eat different foods and maybe we're doing that in larger quantities and at larger times so some of that convenience and access and just culture around eating obviously drives so much of our health concerns and so once you can just pinpoint one easy example of like oh that's Health that's really affecting health care so on the population sense at an individual level if you're eating that food and then all your neighbors are eating that food and then you see it play out in like Hospital regions um it's pretty easy to make that jump and then if you just start thinking through some of the rest of the things in your life of how far is the nearest park to you do you drive to it do you walk to it is it open at available hours does it feel safe and you're like shoot now if I didn't have now if I'm eating bad food and I'm also not getting exercise or I'm not out in the sunlight I'm not in a safe space like think about that through so I think just some of the the thought process of what are the things that I'm doing in my life and how does that play out on a population level and it's pretty easy to see like we're not getting healthier from some of our cultural and historical and and just daily aspects of life and so starting to think through those too also gets back to the funding mechanism so if we do have a lot more healthy people uh whether through wonder drug or through societal investment and invention uh what does that due to the acute care hospital industry and you already see even with all the technolog technological advances now hospitals are moving into the outpatient setting or moving into Community Care or moving into home care and so you already see it shifting without the population shifting towards healthier culture um and so just what does that mean as an industry and things I think are all things we should be thinking about and uh actively working on this episode of the strategy of Health was sponsored by modality Global advisors modality Global advisors optimizes Hospital Revenue enhances patient experience and delivers proven results visit modality Global advisors.com to learn more so I like that you brought those issues up that's those are two really good ones um first let's I guess we can look at food as the first one um clearly that is not the you know I've worked with a lot of neurologists when I was a medical assistant and you know a lot of them have you know mdp phds or or at least many years of of experience focusing on the specific aspect of Neurology so like epileptologists it clearly can't be their job to fix some of these problems because they're working I mean 80 hours a week A lot of times into their into their 60s you know so um whose job is it I guess you know because that that's a lot to to take on for a lot of these these doctors who are working in Specialties even in primary care I see a lot of doctors who are pretty overworked um you know maybe they're not doing the research but they still are seeing a huge patient volume whose responsibility is this to to start implementing some of these required changes if you see the the graph and I don't know I haven't done my fact checking on on all of the graphs but I think even if some are are sensationalized a little bit it's probably not far off where you see the last 20 years the growth in Physicians and it's it's fairly flat and then you see the growth growth in administrators and administration it's just like an explosion up and right um and so I I do think number one just Physicians I think you mentioned it a little bit earlier of just Physicians are are heroes and nurses and clinical staff of we have such incredibly highly trained people that give up such an incredible portion of their lives and their talents and the other things that they could be doing in the community setting or the family setting uh to be there at 2 am when we need them uh so first off I think we we have to do something about the way we treat Physicians and the way we treat nurses um both in the inpatient type setting of physician lounges and like the way we we like literally banish them to basements with no food and we like make their lives very unhealthy uh by the work life balance uh both physician nurses clinical staff and so I think one part of the administrative work that we have to do in the future and that we have to talk about more is just how do we create a better life balance for the people that are helping us literally live um our lives and so that's probably issue number one we can shelf that and say whose issue is it I do think there is a little bit of collective responsibility and so even though even if you're busy and you're a physician and you're saying like hey I'm so busy seeing these patients they all come in because they have this food allergy if that was the case like we would go that story would be told significantly enough of like hey we shouldn't have this food that's uh that people are immediately allergic to on our shelves and there would be like collect action about it the problem is so much of the food or so much of the culture that we have makes us sick very slowly and somehow we're we're just insensi to that and so if you get sick over decades um and that compounds and you have multiple chronic conditions we are just generally more accepting of that and so those stories don't get told in a way that was like Hey this person came in they're allergic to this and the next person came in they're allergic to this like we got to do something about that right now I think we get to the point whether it's the payment model Mech uh payment model sort of forces us to uh just from unsustainable payments and we we can't pay for healthcare as a country anymore because we're not able to pay for infrastructure and Roads and airports uh so at some point we'll be forced to I hope we can collectively act before that but I would say on the on the physician side there is some responsibility to say how can I tell this story in a compelling way how do I explain what is hurting and damaging patients and then that explosion on the administrator side I do think we need to get some healthc care administrators more versed in the health world and more engaged in the policy and Community Building to be able to say here's the things that are really going on it's heartbreaking stories they're true stories here's a way to tell them um in a way that will spur action from the the collective us so there is some work then that that should fall on on the physician but also some work that needs to really get put onto the administrative side one of the issues that I see though is is that hospitals really are not originally set up from what I understand to care for public health um in in the way of you know they we can't legislate food and and things like that and so where does the line get drawn uh I guess of what a hospital system can do and then does that then fall on government is is that the next person who's responsible yeah these are these are really tough questions I appreciate being on the hot seat here yeah uh the I do have a few hospital administrator friends who are very much opposed to population Health efforts or to sort of the public health efforts of like I run an acute care hospital let me be incredible at the person who comes in the door we're going to fix them the best we can we're going to you get them in and out as fast as possible we're going to have the best technology the best people the best training like let us do that and all of the rest of it that happens outside of the hospital uh have public health agencies and have government have all the things fixed I don't know where I fall actually on that that spectrum because I definitely do think if someone comes into the hospital and there are things that you can do outside of their lives or if you have multiple chronic conditions and you can set up the structure in a way that treats a bunch of those better like there's clearly many aspects of the inpatient hospital that still deal with quite a bit of the outside life that you have um or that can deal with them in a better way so more coordinated and even from a patient scheduling type efforts uh we can improve there I also don't feel that it's government's responsibility to solve sort of all of our problems I think there's a lot of free market type Solutions um and maybe some of that is regulation that needs to be lifted instead of more regulation or we say hey the government has to step in here sometimes it might be government stepping out and so I think there's not like one single solution that it's going to be but I do think part of the solution is going to be having conversations like this and then moving it to a bigger broader group or moving it to an in-person group moving it to a couple people who are influential in their distinctive field so a current Hospital CEO that's moving up through the ranks or someone some of it's going to take a generation of leaders that are building off of the past but building into maybe a little bit different of a future so if all that we do if if you're a brand new hospital CEO if all that you do is uh continue what's been built we're going to continue to get the the results that we've always gotten and so uh if you just look at Health Care spending per outcomes and overall health and life expectancy those Trends aren't exactly the same we're spending more money and we're getting less outcomes and so it is going to take I don't think we we can pawn it all off onto the government side or we can't ask hospitals to do everything but it's going to take a whole generation of leaders to be able to say here's the type of future that we want here are the type of goals that we're working towards here's what we're doing today and here's what we're going to have to shift in the future and it may take some uncomfortable uh administrative discussions or physician discussions it's going to take a lot of uncomfortable discussions around here's maybe parts of the economy that get a little bit bigger here's parts that get smaller maybe it's inpatient care does get smaller because the outpatient world or the population Health world or public health World those budgets will get bigger and some administrative shift will go to there so it's going to take uncomfortable conversations but I think it's going to take those conversations and right now I don't think we're having enough of them I agree and I I think on the administrative side too sometimes and maybe this is a silly statement but we've gotten to the point where Physicians make for the hospital I mean usually at least four or five times more than what they're paying usually at least that a lot of times it's more um so you know you think primary care I mean they're easily bringing in uh usually well over a million dollars and they're getting paid around 220 230 um so I think at some point we're going to have to have that same conversation about administrators right like we're going to need an administrator to to manage the administrators so I think that's an interesting conversation as well is we've had this huge growth administrators to manage clinicians and it seems like it's it's done well at squeezing out efficiency but at the cost of burnout and at the cost of of really low satisfaction sometimes you know suicides and so it's very serious right um and and now we're seeing diminishing returns where you know you you can't really lower physician salaries a lot of times physician salaries or clinician salaries in general aren't getting raised a lot and then you also have some areas where nursing salaries have gotten incredibly high but satisfaction Still Remains very low um you know if you're getting you know assaulted at work by a patient I'm you know assuming that no salary is going to really be able to make up for that so these are really challenging questions how can people get involved if they really want to get involved you know whether it's your organization or another organization what what's one of the first steps you recommend people take I actually wrote a post the other day about just not enough people have opinions on things or not enough people are willing to share those opinions so I do think it it doesn't have to be social media it can be one-on-one in a phone call um there's so many it can be meeting someone at an event it can be talking to a co-worker at lunch it can be all the things but not enough people so many of us are just so busy in our day-to-day lives that it's like hey hey I'm I show up to work tomorrow I'm going to do the thing that I did yesterday and do it a little faster a little better I'm going show up the next day do those same things without sort of stopping to say I'm going to go to a lunch with a colleague and ask how they're approaching these problems I'm going to go to I'm G to call a friend on my way home from work and ask uh just Express a few opinions about what I think's going on and what would fix it I don't know that we have I think we might get to a little bit closer of a consensus of even on what you talked about the the payment model so value based care there's some really strong thoughts about does it work does it not work is there new words that it needs to include are there differences in the payment models could it be Global capitation makes more sense than value based care I think some of the projecting 20 years out of if you're a a upand cominging hospital administrator and you're saying I need to think about what a hospital I would run looks like in 2040 or whatever time frame it is uh thinking about like how would we pay for it what would make sense what makes US money and I think Hospital administrators Healthcare leaders Physicians certainly should be incredibly wellp paid from a value to society standpoint uh sometimes it Healthcare gets picked on so much and then you see all of the other ways that we spend money as a society I mean we I sometimes healthcare workers get unfairly victimized of like healthcare has all these problems and I I try to remind people that we still have a tobacco industry and we still have a tension industry that uh you're getting paid for clicks and eyeballs and excess money goes into some of the addictive type Industries uh when Healthcare you literally have a human being there at 2:30 a.m ready to give you stitches or to open your heart and keep you breathing for a few more years so you can spend some time with your family so there's some sort of unfair victimization as a a category in the healthcare world uh but I do think it it really is important to be having these conversations and that more people should be expressing their opinions of what and just just to have strong opinions in the first place and so take a little bit of time at the end of a workday and say hey it makes no sense that I'm calling this insurance company and fighting over these fees uh let me look into that a little bit and let me think about what I would do to change it and does it make sense and then you share that with two or three people and they say oh actually it's the way this is because people tried to change that and when they did this thing you're suggesting it didn't work and here's why maybe there's a different way and you get to that Third Way and you start sharing it with people and they say okay like that actually makes quite a bit of sense like two or three of us are going to be working at payers or we actually have that job right now maybe that's something we suggest for our 2025 2026 goals so I think that's the way the world really changes um and then sometimes it's not reflected there's so many people doing incredible things right now that are having those conversations making those decisions setting that strategy that never gets sort of press and publication but I do think one day we'll wake up and the the healthcare industry will be significantly different than it is now and it's because of so much incredible work and inertia that's going on behind the scenes of people that are really willing to take the time and make the effort uh to say here's what the future looks like and here's how we get there so you're hopeful overall I am I am a certified t-shirt wearing healthc care Optimist I do think uh so many of the challenges that we have are timing issues and so if you look at a lot of things I just I think the world generally obviously there's incredibly heartbreaking stories and Incredibly heartbreaking things that happen but just as a very general sense I think that up into the right progress of the world generally gets healthier wealthier safer um and better uh continues to march on and I think the healthcare industry is very much like that and so I think a lot of our current issues are current issues it's you'll look back at a point in time and be like man what were we thinking and it's just that's kind of the point that it got to and we live through a little bit of that point in time reference but there will be a time where uh you don't go to a a hospital or an Outpatient Center and check in with a clipboard there's going to be a time where it makes a lot of sense and they've got some information on you and it's easy to share and it's easily findable and you don't have to pay for it and all the things and so a lot of that groundwork is being laid right now uh and just sometimes it doesn't feel like it because you got to live through it and it takes a long time too it people people are sometimes slow to come around I know I am with with new things even new things that are good you know uh I got a new computer recently for example and it's still is oh I don't like the keyboard as much I know this is a silly example but people are that way in real life as well with things right you know like the KE the the the clipboard example there's always going to be these little hitches I think that take people a little bit longer to adapt and so I'm an optimist as well I appreciate you saying that that's awesome um so you know homework for the audience is to just call up somebody you know message message a friend email a friend talk about some of the problems maybe get on social media you know up up to you but um that is homework for the audience I think is just you know have an opinion right get your voice out there talk about the some of the problems that you're facing and find some solutions that's awesome uh really do appreciate you coming on Alex I really hope we can have you on again I you know 30 minutes uh is not not enough time to talk about all the topics so really appreciated you uh coming on oh appreciate the invite uh love your audience and for everyone listen just really rooting for you to find a career path and a community impact and a way to to be impactful to the people around you um in a way that just benefits your life and benefits those around you I think there's so many good people Healthcare truly truly does have the best people like I said that repeatedly of just the 2:30 a exists I think also for healthcare administrators of just it is such a mission aligned industry that you're going to find people that really care about you individually and your success success and your overall health and that will continue on to your family and your community and those around you so absolutely rooting for all the good things to happen uh throughout your careers and lives</p>