Nash on Health Policy

Meeting the Challenges of Transitioning to Accountable Care

noreply@blogger.com (David B. Nash, MD, MBA) — Thu, 16 May 2013 15:26:00 +0000

Accountable Care Organizations have been attracting a lot of attention lately, with the recent article in The New York Times and Don Berwick reportedly advising some Pioneer ACOs in their dispute with CMS about how to measure quality. Here on the TJU campus, Jonathan M. Niloff, MD, spoke at the JSPH Forum on ACOs and ways of achieving organizational alignment and management through healthcare transformation. Dr. Niloff, Chief Medical Officer for MedVentive, is responsible for the strategic development of population health analytics and solutions.

ACOs take up only seven pages of the new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

During his talk at the May 9 JSPH Forum, Dr. Niloff described the often difficult realities of making an ACO work. A successful ACO implies less revenue per patient – a scary proposition for any health system. In an environment of less revenue per patient, it is crucial to keep the patients that were going out of the system, within the system. Growing the network is also vital. “Ultimately, it’s about aligning more physicians, gaining the allegiance of more physicians to your program to drive better coordination of care.” A successful ACO also requires a population health approach to managing healthcare by identifying patients most at risk and putting programs in place that captures those patients and drives specific programs focused on improving quality and coordination of care.

One health provider that seems to have this figured out is Advocate Health Care, based in Oak Brook, Ill. Described in The New York Times piece as an innovator in the accountable care approach, Advocate Health Care has seen hospital admissions decline nearly 9 percent. The average length of stay has declined, and many other measures show them providing less care, too. Under Advocate’s deal with Blue Cross Blue Shield, certain patients are assigned to the accountable care framework – about 380,000 – and their health costs are projected. If Advocate achieves savings below that amount while meeting explicit quality targets, it splits the money with the insurer. If not, its revenue is at risk.

The Affordable Care Act has helped encourage a shift to Advocate’s payment model – an estimated 428 accountable-care organizations now cover four million Medicare enrollees and millions more people with private insurance.

Still, many remain skeptical that we have arrived at the right set of measures to allow us to declare one ACO a success and another a failure. Perhaps what is needed is a set of definitive measures, beyond readmission rates and average length of stay, that can tell us how a specific population is doing.

I’m sure that by now, many of you have had experience with ACOs. What are your thoughts? Are ACOs part of the answer to alleviating Washington’s long-term deficit problems? Feel free to weigh in on this issue in the comment field below.

An Insider's Look at Comparative Effectiveness Research

noreply@blogger.com (David B. Nash, MD, MBA) — Wed, 24 Apr 2013 14:26:00 +0000

Patrick Monaghan

JSPH Director of Communications

The Jefferson community was treated to true insider’s look at comparative effectiveness research last week when Robert W. Dubois, MD, PhD, visited campus to speak at the Jefferson School of Population Health Forum.

Dr. Dubois is the Chief Science Officer at the National Pharmaceutical Council, where he oversees NPC’s research on policy issues related to comparative effectiveness research, as well as how health outcomes are valued.

During his talk at Jefferson, “Applying Comparative Effectiveness Research and Evidence-Based Medicine to Everyday Decisions,” Dr. Dubois provided a simple definition for CER (“CER is what works, for whom, under what circumstances”); described the evidence needed to guide decisions; discussed concerns that evidence is not being used well, and outlined examples of policies impacting individual treatment, evolving payment environment, and use of real-world evidence.

“What I’m hoping is that I’ll open your eyes to some of these choices so that we collectively choose wisely,” Dr. Dubois said. “Once you’ve figured out what to do, you have to do it. None of this is going to work if we don’t make it embedded in how we make choices.”

CER, Dr. Dubois said, if you do it narrowly -- drug A vs. drug B, therapy A vs. therapy B, and looking at the cost of those interventions “you’re going to get it wrong more often than you’re going to get it right.” Policy implications, he noted, are extremely important in the CER world.

Following Dr. Dubois’s talk, members of the School of Population Health’s Grandon Society were invited to remain for a private question and answer session, which led to interesting discussions about bundled payments, rapid-cycle learning in healthcare systems, and the Patient-Centered Outcomes Research Institute (PCORI). Asked about the political reality of bundled payments, Dr. Dubois replied “I think it’s a reality; the American public is running with the concept,” pointing out that 10 percent of American patients are in accountable care organizations (ACOs), which reward doctors and hospitals for working together to improve quality and to control costs.

Asked about his “take” on bundled payment systems, Dr. Dubois offered, “A lot of this is religion, it’s belief. I, in my core, believe this is the right way to go.”

The audio portion of Dr. Dubois JSPH Forum presentation is available on Jefferson Digital Commons by clicking here.

Checking in on the ACA, Three Years Down the Road

noreply@blogger.com (David B. Nash, MD, MBA) — Mon, 15 Apr 2013 18:10:00 +0000

We may be a little late to the dance on this, but it needs to be acknowledged that the Affordable Care Act marked its third anniversary in March…despite 39 (unsuccessful) attempts to have it repealed.

So, three years down the road, the question, with a nod to the late Ed Koch, needs to be asked: “How’m I doin’?” Well, despite Republican leaders in Congress who regularly denounce the ACA, vow to block funding to carry it out or even repeal it, the answer is “not bad.”

Although the date for full implementation of most provisions of the law is January 1, 2014, the ACA has already had an impact on the goals of expanded coverage of the uninsured, improved access and better care delivery models, broader access to community-based long-term care, and more integrated care and financing for beneficiaries who are dually eligible for Medicare and Medicaid. While the ACA remains controversial, with many debates about its future as well as provisions already implemented, implementation is moving ahead.

Beginning in 2010, young adults up to age 26 can remain on their parents’ insurance policies even if they are no longer living with a parent, are not listed as a dependent on a parent’s tax return, or are no longer a student. According to Census data, over two million young adults have gained coverage under this provision, contributing to the decline of 1.3 million in the number of uninsured Americans in 2011.

Additional highlights include:

17 million Americans now receive some kind of free preventive service, such as flu shots, and 34 million Medicare recipients received free preventive services in 2012
17 million children with pre-existing conditions are now protected against being uninsured
More than 107,000 adults with pre-existing conditions finally have insurance under the federally run insurance program
21 million received care from expanded community health centers; 3 million more than previously served
$1.1 billion in rebates, an average of $151 per family, was paid by insurers that failed to meet the benchmark of 80 to 85 percent of premium revenues on medical claims or quality improvements
Since 2010, more than 6.3 million older or disabled people have saved more than $6.3 billion on prescription drugs.

Perhaps most importantly, there are signs that the ACA has already started to help slow the growth of health care costs and improve the quality of care through value-based purchasing programs, strengthened primary care and care coordination, and pioneering Medicare payment reforms. For each year from 2009-2011, National Health Expenditure data show the real rate of annual growth in overall health spending was between 3.0 and 3.1 percent, the lowest rates since reporting began in 1960.

Speaking of primary care, providers get increased Medicare and Medicaid payment rates under the ACA, according to a Kaiser Family Foundation report. The law provides for a 10 percent bonus payment on top of the regular Medicare fee schedule amount for many services provided by primary care physicians (and other practitioners) from 2011 through 2015. The law also requires states to raise their Medicaid payment rates in 2013 and 2014 to Medicare payment levels for many primary care physician services. As a result, Medicaid primary care fees will increase by 73 percent, on average, in 2013 although the size of the increase will vary by state.

As a recent editorial in The New York Times noted, one of the most promising aspects of the ACA is its focus on improving quality. According to the editorial, the percentage of Medicare patients requiring readmission to the hospital within 30 days of discharge dropped from an average of 19 percent over the past five years to 17.8 percent in the last half of 2012, an improvement due in large part to penalties imposed by Medicare to providers to encourage better coordination of care after a patient leaves the hospital.

It’s also worth noting that, as we here at JSPH have, the ACA supports population-based prevention activities through a new Prevention and Public Health Fund. This Fund has been used to make over $1 billion in critical investments in programs aimed at reducing the burden of chronic disease an improving overall health of communities. Funding has supported Community Transformation Grants in 36 states to reduce the incidence of heart attacks, strokes, cancer, and other diseases; rebuilding the immunization infrastructure, tobacco cessation programs; and substance abuse and suicide prevention activities.

Happy(belated) Birthday, ACA. This School of Population Health feels you’re on the right track, and we feel we are, too.

Meeting at the Crossroads of Social Work and Public Health

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 05 Apr 2013 19:49:00 +0000

Patrick Monaghan

JSPH Director of Communications

The School of Population Health acknowledged National Public Health Week (NPHW) by hosting a lunchtime symposium, “Meeting Again at the Crossroads: Social Work and Public Health.” Since 1995, the first full week of April has been a time when communities across the United States recognize the contributions of public health and highlight issues that are important to improving our nation.

This year, JSPH took a closer look at the connection between public health and social services. Although the two fields share historical roots, their paths have diverged until recently. But today’s complex health issues require the expertise of both professions and the lunchtime symposium explored the intersection of public health, social services, health care, and health policy.

Moderated by Darlyne Bailey, PhD, LISW, Dean and Professor at the Graduate School of Social Work and Social Research (GSSWSR) of Bryn Mawr College, panelists included Cindy Sousa, PhD, MSW, MPH, an Assistant Professor at GSSWSR; Jennifer Campbell, PhD, MSW, a consultant, and Lecturer at GSSWSR; JoAnne Fischer, MSS, Executive Director of the Maternity Care Coalition and Bryn Mawr alumna; and Christina Miller, MSS, Senior Program Director of the Health Promotion Council, and also a Bryn Mawr Alumna.

Each provided a vital element of the formula that fuses public health and social work, from Christina Miller’s work with the Health Promotion Council, which has programs that include chronic disease risk reduction and professional education and consulting; to Cindy Sousa’s research on investigations of violence, stress and trauma and their relationships to health and well-being; to JoAnne Fischer’s work making the needs of mothers and their families visible through policy advocacy and research as executive director of the Maternity Care Coalition; to Jennifer Campbell’s work strengthening grantmaking for an aging society.

The symposium served as a poignant reminder that many quality improvement techniques – including the promotion of evidence-based treatments and well-coordinated care – can improve health outcomes, but their influence is often limited by factors beyond clinicians’ control, such as patients’ education, employment, and social support. In order to address the social and economic factors that affect health, quality improvement initiatives must reach beyond the traditional boundaries of the health care system. The panelists gathered at JSPH this week was representative of the community-based partnerships that bring a wide range of stakeholders – health care providers, educators, business leaders, social service providers, community organizations, and clergy – together to promote healthy behavior, improve access to primary and preventive care, and reduce health disparities.

The program also further strengthened the partnership between JSPH and GSSWSR. Last fall, the schools began offering a dual degree MSS/MPH program, acknowledging the long-standing synergy between social work and public health, and also recognizing the growing interest among professionals to further their preparation by earning multiple graduate degrees.

A Civil Dialogue on a Traditionally Volatile Topic

noreply@blogger.com (David B. Nash, MD, MBA) — Sat, 30 Mar 2013 23:46:00 +0000

Patrick Monaghan
JSPH Director of Communications

If there was one thing that the inaugural Bernard Wolfman Civil Discourse Project proved, it’s that two people from differing sides of the health care debate can come together and have an intelligent conversation about this traditionally volatile topic.

Thursday evening’s public forum was conducted at Beth SholomCongregation in Elkins Park, the spectacular synagogue designed, appropriately enough, by Frank Lloyd Wright. Wright’s structures, of course, were designed to work in harmony with humanity and its environment.

The event is the brainchild of Dina Baker, a congregation member who works in the healthcare field, to honor her late father. The experts were our very own David B. Nash, and Stuart Butler, director of the Center for Policy Innovation at the Heritage Foundation in Washington. Moderating the event was Chris Satullo, vice president for news and civic dialogue at WHYY/Newsworks Philadelphia. Satullo set the mood for the evening in his opening remarks: “Tonight is not a debate. No one will win, no one will lose. Disagreements will remain.”

And that’s pretty much how the discussion unfolded. If you’re into labels, Dr. Nash’s leanings are more liberal; Dr. Butler’s, conservative. Regardless, these two health policy experts were clearly on the same page more often than not. When Dr. Nash said cutting waste, not cost, is the right tact for improved performance in our healthcare system, Dr. Butler concurred, adding that the problem is determining what, exactly, is waste. When Mr. Satullo suggested that electronic medical records have not proven to be the efficient, waste-cutting tool advertised under the Affordable Care Act, both parties agreed. The bigger problem, Dr. Nash said, is that we still fail to practice basic care coordination.

Dr. Nash did draw what was perhaps the biggest applause of the evening when he defended the ACA as an attempt by the Obama Administration to do the right thing. Perfect? Far from it. A good start? Yes. And something that previously had never been accomplished in this country.

Still, countered Dr. Butler, the federal government needs to realize its limitations when it comes to fixing our healthcare system. The U.S. healthcare spend, he noted, is equivalent to the sixth largest economy in the world.

In the end, both agreed it is important for all citizens to engage in the conversation on health care. There are steps we can all take to influence how healthcare dollars are spent, be it by exercising more, initiating important conversations with family members about end-of-life care, or, as Dr. Nash said, practicing charity.

Disagreements may have been hard to come by at the inaugural Bernard Wolfman forum. Smart, civil dialogue certainly was not.

Drs. Butler and Nash authored commentaries that ran in last Sunday's Philadelphia Inquirer. You can read Dr. Nash's commentary here, and Dr. Butler's, here.

Join Grandon Society for 'Brown Bag' Lunch with Dean

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 08 Mar 2013 17:54:00 +0000

Amanda Solis
JSPH Project Director

When you join the ranks of JSPH, you quickly learn the unintended consequences of working in an office full of faculty and staff members who are passionate about wellness, health policy, and population health. Most days, this results in a fascinating dialogue on the current state of events. On the other hand, it also forces you to be mindful of your own habits and diet.

Working at JSPH also presents opportunities to interact with thought leaders in population health and outcomes research. Naturally, we regularly have face-to-face time with Dr. Nash at brown bag lunch discussions…and I will always remember how we all sat in our conference room to await the Supreme Court’s decision on the Affordable Care Act. You also never know who is going to show up in the conference room – be it the CEO of Humana or Jeffrey Brenner (who most likely rode his bike here to discuss his latest work in Camden).

In an effort to share this sense of community with each of you, we developed the Grandon Society. Read more about this 100+ member group here, where the rates and benefits are more formally outlined. Ultimately, our goal is to invite you into our office culture and have you join our “water cooler” discussions.

To this end, we are hosting our first members-only “Brown Bag” webinar with Dr. Nash. Join us on Wednesday, April 3, 2013 at 12 pm for a one-hour chat. This unscripted, off-the-cuff session is your chance to hear about his favorite “aha!” moment from the Population Health Colloquium, learn where he traveled that week and who he met with, and witness his unbridled enthusiasm for all things related to population health. Truth be told, we can’t predict what he will say or surprise us with on any given day – and we (gulp) invite you to become part of our team.

Curious? Click here for information on joining the Grandon Society; as a member you will receive invites to discounted programs and be able to join us on April 3rd for a glimpse into Dr. Nash’s candid thoughts on all things population health.

March Madness... JSPH style!

noreply@blogger.com (David B. Nash, MD, MBA) — Tue, 05 Mar 2013 02:04:00 +0000

It's already March and I am thinking about the crazy month ahead. Not about basketball but about all of the amazing activities that await us. Starting this week I will have the distinct privilege to deliver the plenary address at the QSEA meeting in Tempe, AZ.

QSEA -- the quality and safety educator's academy! This is the premier group in the nation composed largely of medical school-based faculty who teach the tenets of quality and safety to young physicians across the training spectrum. QSEA is at the leading edge of the movement to bring these tenets into the medical education mainstream. This remains an uphill battle!

Next week the JSPH will host the 13th Annual Population Health Colloquium. We will break all of our previous attendance records and faculty from around the nation will present dozens of plenaries, workshops, and break out sessions. Headliners include Jeff Brenner, Paul Grundy, Sue Dentzer and scores more. Our Professional Development team has worked tirelessly for months to build this program.

As soon as the Colloquium ends I will be on a train to Washington, DC to deliver the Saturday plenary address at the Annual Meeting of the American Medical Student Association (AMSA). With over 1,000 students in attendance, the AMSA meeting is a "cultural happening". I intend to deliver a veritable "call to arms" to encourage students everywhere to create bottom up changes in the medical school curriculum. I hope students will petition their own faculty to include more training on the tenets of quality, safety and population health.

JSPH is on the move and this is our brand of March Madness!

Honoring a Father's Legacy Through Civil Dialogue

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 01 Mar 2013 15:00:00 +0000

Nash on Health Policy is pleased to present this guest blog by Dina Wolfman Baker.

By Dina Wolfman Baker

My father died in August 2011 after a life as a champion of civil rights and a respected scholar of legal ethics and tax law. He sought justice through lifelong learning and action and he believed that civil dialogue was key to those outcomes.

When we were young, my father exacted ten cents whenever he heard me or my brothers dismiss each other with the phrase “shut up.” That was our earliest lesson in civil discourse: We were to find respectful ways to disagree.

While reflecting on my father’s life, I thought about the state of discourse around public policy. If people with differing views could not talk among and truly hear each other, how could we learn? If we could not learn, how could we take meaningful, informed action? And if we could not take action, how could we progress?

So I decided to honor my father’s legacy by creating The Bernard Wolfman Civil Discourse Project. Its centerpiece is a forum for exploring critical policy issues while modeling civil dialogue between leading experts from differing positions and providing concrete opportunities to take action.

I’m incredibly excited that our inaugural forum on March 28^th features two nationally recognized experts to discuss the federal government’s role in health care policy. One is Dr. Nash, and I’m delighted to be his guest on this blog. The other speaker, Dr. Stuart Butler, is director of the Center for Policy Innovation at The Heritage Foundation in Washington, D.C. Dr. Butler, also an adjunct professor at Georgetown University Graduate School, has been a fellow at Harvard University's Institute of Politics, and serves in major national health policy roles.

Working with Dr. Nash and Dr. Butler has been incredibly gratifying, because they treat each other—and each other’s ideas—with genuine respect and enthusiasm. Imagine how much my father would have loved to be in their audience!

The Bernard Wolfman Civil Discourse Project will be 7:30 pm, Thursday, March 28 at Beth Sholom Congregation, 8231 Old York Road, Elkins Park, PA. Register by clicking here.

Let's not jeopardize higher education at the cost of Medicaid

noreply@blogger.com (David B. Nash, MD, MBA) — Tue, 29 Jan 2013 18:57:00 +0000

As a Dean, I am committed to higher education, both in the public and private sectors. As a parent, I have spent a small fortune on tuition to educate my three children at “elite” private universities. I understand the cost structure of higher education, both as a provider and a consumer. Perhaps this is why I find myself very concerned about the little-known connection between paying for health care for the poor (Medicaid), and the cost of higher education.

According to The Wall Street Journal (Dec 14, 2012), state subsidies for higher education fell 21% between the school years of 2001 and 2011. In that same period, tuition at four-year public universities has risen nearly 45% and now averages nearly $9,000 per year.

The WSJ story goes on to site several prominent educational policy experts who admit that states have to focus on Medicaid first, prisons second, and that universities are further down the list. Now, connect these dots with Sara Rosenbaum’s recent piece in the New England Journal of Medicine (Threading the Needle – Medicaid and the 113^th Congress; December 20, 2012), where she says essentially that Medicaid spending, under Health Reform, will continue to expand.

Rosenbaum hopes that the proposed “organizational changes” under the ACA, like Patient-Centered Medical Homes, Accountable Care Organizations, and other topics previously covered in my blog, could possibly stem the tide of red ink for health entitlements before Medicaid undergoes a severe budgetary reduction by lawmakers.

Here is my view: – we are in a total jam and most persons don’t recognize it. We have a very difficult choice ahead. Continue to pay for the care of the poor – especially poor children – or, raise public university tuition to the point that the middle class will be priced out of a college education.

I surely don’t want to pit higher education against health care! I just want to make sure that we all understand that current spending for health care is unsustainable. Higher education will become another casualty if we are not careful. What should health care deans do?

With new year, push for ACOs is in full swing

noreply@blogger.com (David B. Nash, MD, MBA) — Wed, 23 Jan 2013 20:01:00 +0000

The new year is barely weeks old and already the rush to create Accountable Care Organizations (ACOs) is in full swing. By the end of this month, the nation will be sporting upwards of 300 such organizations. Some estimates put the total number of covered lives at 30 million, split equally between Medicare and commercial insurance plans.

Hospitals are competing on this new playing field and as a result, some have called the ACO an “awesome consulting opportunity!” With all of this frenzy, I remain skeptical that we have arrived at the right set of measures to allow us declare one ACO a success and another a failure. What is truly needed is a set of definitive measures, beyond readmission rates and the like, that can tell us how a specific population is doing.

Recent reports from two sources are worth noting in this regard. Michael Stoto, a professor at Georgetown University doing a sabbatical at Academy Health in Washington, DC, is using his time there to work on a comprehensive model for population health and appropriate metrics. I look forward to seeing the finished product, as it is essential to the nation as we move forward in implementing population health initiatives.

Another great source is Matt Stiefel’s piece from a recent Institute of Medicine roundtable at Kaiser Permanente, linking the Triple Aim to Population Health and the ACO movement. Finally, my piece for The Governance Institute, entitled the Population Health Mandate, tackles some of the identical issues. The abstract is available to the general public. Members of The Governance Institute may download the complete article.

Taken together, these three pieces begin to build the platform we will need to make ACOs truly accountable for the care they provide. The secret sauce is population health and the understanding that health policy, quality and safety, and care coordination all have an impact on what we do at the bedside for every patient.

Patient Safety Lessons Forged on the Flight Deck

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 11 Jan 2013 20:52:00 +0000

Patrick Monaghan
JSPH Director of Communications

When John Nance talks about safety, people listen. An internationally recognized aviation safety expert, Nance was on the Jefferson campus this week, speaking to 3rd-year Jefferson Medical College students at the 10th Annual Interclerkship Day for Improving Patient Safety. Nance is one of the best speakers you’ll see.

He is a pioneer of Crew Resource Management, which revolutionized aviation safety, and a founding member of the National Patient Safety Foundation. Best known for his work as aviation analyst for ABC World News and Good Morning America, Nance is also a decorated Air Force officer and pilot, a lawyer, and the author of 19 books, including Why Hospitals Should Fly, which received the prestigious “Book of the Year” award for 2009 by the American College of Healthcare Executives.

His mission: to convince people that patient safety can be dramatically improved only when the hospital is run to directly support, and be extremely responsive to, the needs and limitations of the people who actually take care of the patient. It’s a message that he also brought, that same evening, to a special meeting of the JSPH Chapter of the IHI Open School.

In a small and intimate setting, Nance’s message is even more striking and clear. He spoke of the climate of fear that prevails in health care – fear of rocking the boat, fear of harming a patient – and how that climate must change. He posited that simple safety checks and checklists can reduce medical mistakes. “We make mistakes because we don’t see or hear what’s there,” he said. “We make mistakes because we’re human.”

Organizational excellence is a theory that has been wrongly built, especially in the U.S. health care system, on the notion that no one is going to make a mistake, Nance said. Medical schools and other health care training institutions must change their philosophy to prepare students to expect errors and to understand how to deal responsibly with to mitigate their impact. Physicians, Nance said, are still too often taught to be commanders rather than leaders. To put it in Star Trek terms, which Nance likes to do, physicians need to evolve from Captain Kirk – who pretended to be omnipotent and infallible – to Jean-Luc Picard – who understood the inherent fallibilities that come with being human. Interesting.

Nance applauded the bravery of institutions such as Cincinnati Children’s Hospital Medical Center for its commitment to transparency and high quality care. In December, Cincinnati Children’s was named one of just 12 children’s hospitals and 81 hospitals of any kind in the U.S. included in The Leapfrog Group’s annual class of top hospitals. There was plenty of back and forth between Nance and his IHI audience, leading to discussions on patient safety surveys, coordinated care, and applying his teachings to small practices.

Nance’s now annual visit to Jefferson never fails to shed light on our health care system’s patient safety shortcomings. He’s the first to point out that progress, system wide, is slow and results are nominal. While the culture shift required is seismic, I’m betting on the resolve of groups such as our own IHI chapter and 3rd-year medical students to help see it through.

In tragedy's wake, a call for comprehensive mental health policies

noreply@blogger.com (David B. Nash, MD, MBA) — Wed, 19 Dec 2012 21:09:00 +0000

Alexis Skoufalos

Associate Dean for Continuing Professional Education

For months now, we have heard the drumbeat of the Mayan prophecy for 2012…the apocalypse, the end of civilization as we know it. Who could have ever expected that it would arrive a week ahead of schedule, in a small, quiet Connecticut town?

To a person, we have experienced a mixture of overpowering emotions – sorrow, grief, outrage and anger – at the heart-wrenching horror that occurred at Sandy Hook Elementary School on the morning of December 14.

As a nation, we appear to have reached the limit of our ability to stomach this type of violence, now that it has been visited so cruelly upon the youngest and most innocent among us. Across the political spectrum, there is commitment to make whatever changes necessary to prevent similar incidents in the future.

The effort to enact more restrictive gun laws, or limit access to assault weapons and extended capacity ammunition, while noble, is short-sighted and will only address part of the problem.

The root cause of last week’s tragedy lies in the failure of our health system to provide proper supports and services for those who suffer from mental illness. The perpetrator of this unspeakable event was himself a victim; a victim of a broken system that does not provide proper treatment for people with mental health issues and personality disorders. Individuals with mental illness are a chronically underserved special population, even when they have plentiful financial resources and insurance coverage.

According to news accounts, Adam Lanza suffered from Asperger’s syndrome in addition to other neurological and personality disorders. Because this young man had no intellectual disabilities – in fact, he has been described as ‘brilliant’ – the supports he received to address his developmental disorder (that allowed him to function in mainstream society) ceased once he left the school system.

By itself, Asperger’s is a complex disorder, presenting a bit differently in each individual. The supports needed for a sufferer to be successful are seemingly minor –– but they can make the difference between a person who is productive and successful and one who is troubled, broken, and destructive.

Once one leaves the special education cocoon, the structured framework of mandatory counseling and behavioral support services is gone. Functional supports that help someone understand the appropriate conversational responses, how to structure one’s time and work, manage stress and engage socially with peers disappear…to say nothing of badly needed employment coaching and vocational rehabilitation.

The healthcare system does a good job in managing acute illness, a fair job in dealing with chronic conditions, and a miserable job in health promotion and wellness. Particularly for those with complex personality disorders and serious mental illness, mental health services are poorly managed and difficult to access…if they are available at all. For those without insurance coverage, all bets are off.

We must work together to develop comprehensive policies and services to address the mental health crisis that plagues this country, or the body count will continue to increase while we shake our heads, wring our hands and cry over the littlest angels.

A Presidential Address and a Fellow’s Perspective

noreply@blogger.com (David B. Nash, MD, MBA) — Thu, 13 Dec 2012 19:29:00 +0000

Dominique Comer, PharmD

Health Economics and Outcomes Research Fellow

I have just returned from the 2012 ASHP Midyear Meeting, the largest gathering of pharmacists and pharmacy students in the US. While this meeting is always popular for those in the pharmacy profession, there was extra anticipation this year when it was announced that President Bill Clinton was to be our opening keynote speaker.

Many of us waited for hours in line to enter the arena to hear him speak, and with approximately 20,000 attending the meeting, overflow rooms were utilized to handle the demand.

Even though this was a pharmacy conference, much of what President Clinton spoke about was strongly rooted in population health. The president talked about inequality in access, the unsustainability of various programs and the instability of the market and how all three points tie back to impact health care and the economy.

I enjoyed listening to one of his stories about the way that the William J. Clinton Foundation is tackling the childhood obesity epidemic. In discussions with the soft drink companies, the president said that he didn’t want the companies to stop making money…just to make their money in a different way (think diet sodas, flavored water, etc.)! He reported on the success in this area, even stating that there has been a 90% decrease seen in the caloric content of soft drinks and juice sold to schoolchildren.

At the end of his speech, the president stressed that a change in culture is needed now and that purpose-driven reform will be required for us to move forward, which is a core belief here at JSPH.

At a Q&A session after his address, President Clinton encouraged us to “step into the gap.” What needs to be done in order to improve health care? The president noted that when he left office, he made a list of what he still wanted to accomplish. After scratching off what he could no longer do out of the office as president, he discovered that he still had a long list and then set out to organize how he could make an impact for each task. This piece of advice is very pertinent to population health; how can we “step into the gap” and make an impact?

Why we cannot get there from here!!!

noreply@blogger.com (David B. Nash, MD, MBA) — Sat, 24 Nov 2012 17:23:00 +0000

Our best wishes during this season of Thanksgiving to all of our students, faculty, colleagues, and followers. I myself am in a right handed cast following wrist arthroscopy for SLAC---scaphoid lunate advanced collapse. More on SLAC at a later date. Today the urgent topic is why we cannot get there from here!!

I am speaking about the collective challenge that all health care providers face as we cope with the data requirements of health reform. By now, most providers are well versed in speaking the language of Cerner, Epic, Allscripts, and the like. Can you speak the language of reform??---this is the key question on my mind.

The language of reform says, in my view, that you will need a registry to evaluate the population of patients for whom you are responsible. A provider must be able to come into the office, switch on the computer, and nearly effortlessly assess his own performance relative to a peer group as it relates to a population of patients. For example--in my own primary care practice---I should be able to instantly get good data on the patients I care for who share a certain diagnosis. I should be able to quickly assess my performance and learn new ways how I might improve. I should be able to do this with a minium of fuss!! There is just no way in my mind's eye that I can envision the Cerners, Epics, and Allscripts of the world to be able to carry out this function.

We need a new generation of soft ware to sit on top of these classic software boxes. The current EMR is really an electronic chart, not a tool for improvement at any level. I am intrigued then by the work of Anvita, Anceta, Phytel, Sandlot, NetOrange, Quantumleap, Humedica, Vree and others.....can they get us where we really need to go??

I am interested in learning from our colleagues----will the current tools get us where we have to go?? If the answer is no, as I contend it is, then what does the road ahead really look like as we build the analytic engine necessary for reform?? DAVID NASH

JSPH named PBJ's Medical Education Innovator fo the Year

noreply@blogger.com (David B. Nash, MD, MBA) — Mon, 12 Nov 2012 18:21:00 +0000

There was a tremendous sense of pride and accomplishment coming from the Jefferson School of Population Health the morning of November 8, when the Philadelphia Business Journal named the school its Medical Education Innovator of the Year as part of its annual Health Care Innovation Awards.

In a story about the awards on the PBJ Web site, JSPH was specifically lauded for our master’s programs in Healthcare Quality and Safety, and Healthcare Quality and Safety Management. According to the article, JSPH Dean David B. Nash “has helped craft a series of new patient safety educational offerings available to students from all sides of the health profession – ranging from clinical practice to administration, to policy – and at all career stages, including doctors and executives.”

JSPH was especially honored to be recognized alongside Thomas Jefferson University Hospital President David McQuaid, who was lauded as Emerging Executive of the Year. Said the PBJ: “During five years spent as chief operating officer, David McQuaid applied his decades of health-care industry experience toward advancing two of Thomas Jefferson University Hospital’s most vital goals: service excellence and collaboration. The result has been the hospital’s continued expansion in clinical programs and market share – and McQuaid’s promotion to president on July 1.”

In a city such as Philadelphia, where health care plays such a prominent role in the economy and the day-to-day lives of its citizens, the Jefferson School of Population Health is proud to be recognized as a leader and innovator in preparing the health care leaders of tomorrow for their roles in service to the community.

A Lesson in Physician Empathy from Parma, Italy

noreply@blogger.com (David B. Nash, MD, MBA) — Wed, 10 Oct 2012 21:24:00 +0000

Patrick Monaghan

JSPH Director of Communications

This morning’s Jefferson School of Population Health Forum was notable on two fronts: a presentation on findings from a highly publicized study on empathy in patient care, and a first-ever workshop with the researchers for members of the Grandon Society.

Formed earlier this year, the Grandon Society serves as the Jefferson School of Population Health’s membership organization for leaders throughout the healthcare sector – including government, foundations and professional societies, academia, the pharmaceutical and biotech industries, and related business and corporate interests – who are dedicated to transforming the US health care system through collaboration, education and innovation.

The study, published in the September 2012 issue of Academic Medicine, shows that diabetes patients of doctors who scored lower on a test of empathy were more likely to have acute metabolic complications associated with their condition, than patients of doctors who scored higher on the test. The study included 20,961 people with diabetes in Italy, and their 242 primary care doctors. The researchers divided the doctors’ empathy scores into high, moderate and low. Then they tracked the occurrence of acute metabolic complications – hyperglycemia, radically low insulin production and diabetic coma – in patients.

The presentation featured the kind of topical, thought-provoking content typically spotlighted by the Jefferson School of Population Health Forums. But the hour-long discussion and question-and-answer session that followed, reserved especially for Grandon Society members, made the morning. It was well planned, insightful, and entertaining and a good representation of the kind of programming that is in store for Grandon Society members.

During the Grandon session, three authors of the study, Thomas Jefferson University’s Mohammadreza Hojat, PhD; Daniel Z. Louis, MS, and Vittorio Maio, PharmD, MS, MSPH, were joined, via a Skype call to Parma, Emilia-Romagna, Italy, by the study’s lead author, Stefano Del Canale, MD, PhD. Guests were even treated to – what else? – samples of Parmigiano Reggiano cheese, direct from Parma, Italy.

A nice touch, indeed.

For further information on the Grandon Society, click here.

ESCAPE FIRE---THE MOVIE

noreply@blogger.com (David B. Nash, MD, MBA) — Thu, 20 Sep 2012 03:15:00 +0000

Earlier tonight the Jefferson School of Population Health, in conjunction with our IHI Open School Chapter, sponsored a special preview of ESCAPE FIRE, the soon to be released award winning film.

Called Dinner and a Movie, we hosted nearly 100 persons from across the Jefferson campus in downtown Philadelphia. Following the screening, we had a panel discussion with myself, a physician student in our graduate program in quality and safety, and a resident physician in Physical Medicine and Rehab. The movie made me laugh and cry. I laughed at some of the absurdities of our system and the way some patients approached their interaction with us as caregivers. It made me cry with scenes from on board a military rescue plane bringing wounded soldiers directly from far away battlefields all the way to Walter Reed Army Medical Center in suburban Washington DC.

It featured in depth interviews and "on air" conversations with the CEO of the Cleveland Clinic, with Don Berwick, and with real caregivers on the frontlines of medicine as well. It had drama, pathos, irony, and the graphics were good too!! One personal highlight for me occured in the darkened auditorium. About half way through the film I thought "I have to reach out to Dr. Berwick and share the experience we were all having together." Sure enough, in less than five minutes, Don answered my quick email, all the way from his current trip to New Zealand and Singapore, applauding our efforts at educating more persons about the need for an ESCAPE FIRE, a new way of thinking about our broken system.

I hope you will all watch ESCAPE FIRE when it comes to a theater near you and I also hope you will join us in the ongoing conversation about how to fix the jam we are all in!! And be sure to visit the Escape Fire web site.

Special thanks to our IHI Open School Chapter lead by Valerie Pracilio. Once again, our team at the JSPH is at the forefront and we will ask you...."What is your ESCAPE FIRE for our system??" DAVID NASH

Improving Public Health in Colombia – Fulbright Specialist Program Experience

noreply@blogger.com (David B. Nash, MD, MBA) — Thu, 06 Sep 2012 02:53:00 +0000

Rob Simmons, DrPH, MPH, MCHES, CPH
MPH Program Director
Jefferson School of Population Health

The country of Colombia, located in the Northwest section of South America, has gone through an incredible transition over the past 15 years. Once known for international drug cartels, major political corruption, and armed revolutionary guerillas holding the country hostage, the country has been transformed into a politically stable democratic nation that has experienced incredibly strong economic growth.

Colombia is projected to surpass Argentina in the next couple of years and have the third highest Gross Domestic Product in Latin America (after Brazil and Mexico). Its recent free trade agreement with the US, coupled with its strong political ties to the U.S. and Western Europe, will only increase its stature as a Latin American leader in the future.

Serving as a Fulbright Specialist Scholar, I spent four weeks in Medellín, Colombia (the country’s second largest city) this summer working with CES University (CES stands for “City of Eternal Spring”), a private health science university, to help develop its new Doctoral Program in Public Health.

I taught a pilot five-session course that will be a precursor to a global health course for its masters and doctoral program in public health; provided faculty development education on public health policy and advocacy , chronic disease prevention, and health promotion; and developed a concept paper outlining a future collaborative research project on violence and public health to be conducted between universities in Medellín and Philadelphia. In addition, I was able to connect with the public university in the region (University of Antioquia) and its School of Public Health to discuss future collaborative opportunities.

I also had the opportunity to meet with the Health Secretary for Medellín and the Director of Health for the state of Antioquia (Medellín is the state capital) to discuss public health challenges and planned public health initiatives.

Like most developing and developed nations, Colombia faces significant challenges with growing urbanization that taxes the public health infrastructure and impacts environmental health, injury control and prevention (particularly automobile injuries), and health care services. An aging population has led to large increases in chronic diseases. There are few national policies in place to improve health, since their health care system consists mostly of private payers.

We look forward to working with CES University, University of Antioquia School of Public Health, and the city of Medellín on future collaborative opportunities to improve the health of their population.

The Eleventh National Quality Colloquium

noreply@blogger.com (David B. Nash, MD, MBA) — Mon, 20 Aug 2012 00:01:00 +0000

Just a few days ago, we completed the 11th Annual Quality Colloquium at Harvard University, co sponsored by the Jefferson School of Population Health, with support from major organizations like Oracle, the Lewin group, and others.

Faculty from our school, and from around the nation, made the three day event a veritable "feast" of new information about the growing area of quality measurement and improvement. On the heels of Health Reform, quality measures are taking on increasing importance in patient centered medical homes, Accountable Care Organizations, and other new structures.

On the day prior to the launch of the conference, our faculty supported two "Boot Camps" -- a day long session at both the basic and advanced levels that were also simultaneously broadcast on the web. The Boot Camps featured a deep dive into topics such as leadership for quality under reform, the cultural barriers to quality improvement, high reliability in health care delivery and the like.

The plenary presentations that followed the next day featured presentations by persons such as Maureen Bisognano from IHI, Mike Dowling from the North Shore Long Island Jewish Healthcare System, Mike Barry from the Informed Medical Decisions Foundation, Bill Conway from the Henry Ford Healthsystem, and finally David Blumenthal, now the incoming President of the Commonwealth Fund. Given the setting in Annenberg Hall on the Harvard Campus, there was plenty of interaction with the attendees in both formal and informal gatherings.

The JSPH is proud to be a cosponsor of this important national event. As our field grows in importance, so does our school!! To learn more about the colloquium go to www.qualitycolloquium.com and you can still purchase a CD of all the presentations and the power points as well. We would value your feedback. DAVID NASH

Student Leaders Share Quality Practices at IHI Academy

noreply@blogger.com (David B. Nash, MD, MBA) — Tue, 07 Aug 2012 16:10:00 +0000

Valerie P. Pracilio, MPH

Project Manager for Quality Improvement

Last month, nearly 120 students and health professionals gathered in Boston at the Student Quality Leadership Academy (SQLA), organized by the Institute for Healthcare Improvement (IHI). The participants entered into a network of nearly 100,000 students from around the world that are part of the IHI Open School community.

One might say they were already leaders when they arrived, since they self-selected to participate in this two-day Academy, but the IHI staff and program faculty strengthened those skills through sharing personal experiences and the fundamentals of good leadership practices.

Prominent healthcare leaders including Don Berwick, Diana Chapman Walsh and Allan Frankel were among the faculty and the interdisciplinary group of participants representing medicine, nursing, health administration and engineering – all in various stages of training.

So many discussions about leadership and teams begin by focusing on culture. The Leadership Academy was no different. Not surprisingly, the meeting kicked off in the IHI office in Cambridge where the first thing you see upon exiting the elevator is the organization’s mission.

The workspace is open to foster collaboration and the walls are adorned with charts tracking progress on key initiatives and quotes reminding the staff about the importance of their work. One particular quote that grabbed my attention was by Anne Frank, “How wonderful it is that nobody need wait a single moment before starting to improve the world.” Coincidentally it was painted on a wall in a waiting area where I did not once see anyone sitting. Needless to say, IHI is not simply teaching about good leadership, the organization is filled with live examples.

The Academy served to strengthen the community of improvement leaders through substantive discussions, networking and collaborative case reviews. Some of the nuggets that the participants left with were: never worry alone, always be honest and give/seek feedback early and often.

Some returned to their institutions with new ideas about how to be effective leaders. Others renewed their passion for improvement. All left Boston as members of a community of leaders that will truly have an impact on health care.

Follow the LEADER...the JSPH

noreply@blogger.com (David B. Nash, MD, MBA) — Wed, 01 Aug 2012 01:24:00 +0000

I sense a trend and I can't wait to point it out!! Four years ago this week the Trustees of Thomas Jefferson University voted unanimously to create the first and only school of population health in the nation, aptly named the Jefferson School of Population Health. We now have more than 320 students, taking at least one course with us, either on line or in person, across our four masters programs and our doctoral degree. Our team accomplished this feat in record time and we have exceeded all of our enrollment targets every semester since our founding. But that's not all---all around the nation others are taking our lead. Now, NYU School of Medicine and Hofstra North Shore Long Island Jewish Medical College have created Departments of Population Health. They are baking this material directly into the medical school curriculum!! Others like Arizona State University have established the "College of Health Solutions", appointing the former Dean of Mayo Medical School as the inaugural leader. Wait, there is more!! Northwestern University in Chicago is opening its "Center for Population Health Sciences with a special focus on information technology. The venerable Massachusetts Medical Society, the folks who bring us among other things the New England Journal of Medicine, labeled their Annual Meeting--"The Secret Sauce--Population Health as a Recipe for Transforming Health Care" ( and I had the privilege of delivering the plenary address). Finally, the July cover story of TRUSTEE magazine, from the American Hospital Association, is all about Population Health. Well, half a dozen or so data points may not mean much but I believe these institutions are following the leader...skating to where we all know the "puck is headed". I am incredibly proud of our team and I hope you will visit our school website to learn more about the Real Leader...JSPH. DAVID NASH.......................www.jefferson.edu/population_health

A Lesson in Civility for Inaugural Grandon Society Meeting

noreply@blogger.com (David B. Nash, MD, MBA) — Mon, 23 Jul 2012 17:19:00 +0000

This year’s Summer Seminar provided a glimpse of the kind of programming available to members of the Jefferson School of Population Health’s Grandon Society.

This year’s Seminar, the inaugural meeting of the Grandon Society, was held at WHYY’s Dorrance H. Hamilton Public Media Commons. Chris Satullo, WHYY’s Executive Director of News and Civic Dialogue, provided the morning’s keynote with his presentation, “Keeping a Civil Tongue: How to Have a Better Dialogue, Next Time.” He was followed by Tony Auth, WHYY’s Digital Artist in Residence. Auth, whose distinguished 40-year career as a political cartoonist at the Philadelphia Inquirer included a Pulitzer Prize, spoke about his new adventures and experiments in digital story-telling, using pen and ink and watercolor, as well as digital apps.

The tandem provided an engaging message about civil dialogue and the polarity of what passes for dialogue in the politically charged times in which we live. Satullo, who formerly ran the editorial page at the Inquirer, spoke of the need to establish ground rules, including: 1) Listen, just listen. 2) Tell stories, don’t trade positions. 3) Search for shared identities, values, even amid differences. 4) Find useful work to do together.

It was a perfect venue and subject for the Grandon Society’s debut. As JSPH Associate Dean for Continuing Professional Education Alexis Skoufalos told the crowd, “There is an underlying synergy between this new endeavor and public broadcasting’s mission to educate and inform the public about important topics that impact their daily lives, as individuals and as a community.”

We’d love to hear your ideas for future topics for Grandon Society events. For further information, or to join the Grandon Society, visit our Web site, here.

CONVERGING in Philadelphia

noreply@blogger.com (David B. Nash, MD, MBA) — Mon, 16 Jul 2012 00:23:00 +0000

About one week ago our School of Population Health participated in the inaugural CONVERGE program in Philadelphia. Powered by the team from Medcity.com out of Cleveland, Converge brought together all kinds of persons interested in health care innovation -- from big pharma to little pharma, from start ups with two employees to established managed care companies in our market, and everything in between.

I took the stage right after lunch for a "Fireside Chat" (on a day that was sweltering) with Karl Stark from the Philadelphia Inquirer. We "chatted" about innovation in general terms and specifically about my service on the Board of two amazing companies -- HUMANA and ENDO Health Solutions. Both of these firms are leaders in innovation as Humana is rapidly becoming the most important health and wellness company in America. ENDO is a fascinating company where drugs, devices, and information are being brought together under one roof to help physicians and others to deliver greater value in the marketplace.

I was so excited by all of the very positive feedback on our chat that we hope to help Medcity bring CONVERGE to an even larger audience, in Philadelphia, next year this time. What innovative projects are you involved in?? Finally, I hope you will all follow up with us after our upcoming launch of the GRANDON SOCIETY this coming Thursday, July 19th at 10am EST. Look for more tweets from us at that time. Thanks again for your amazing support on line, DAVID NASH

Reflections from the 5th Latin American and 4th Inter American Conference on Health Promotion and Health Education

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 22 Jun 2012 15:03:00 +0000

Rob Simmons, DrPH, MPH, MCHES, CPH

Program Director, MPH Program

Jefferson School of Population Health

Last month, I had the opportunity to participate in the 5^th Latin American Conference on Health Promotion and Health Education in Mexico City. The conference was co-sponsored by the International Union of Health Promotion and Education (IUHPE), the Pan American Health Organization (the Western Hemisphere Region of the World Health Organization), and the Ministry of Health of Mexico.

The conference brought together over 1,500 public health promotion professionals and students from the Americas for five days in professional presentations, workshops, planning sessions and of course, networking. The focus of discussion was the evolving health challenges that face the Spanish, English, Portuguese, and French-speaking countries in the Americas from Canada to Chile and from the Pacific Coast to the Caribbean nations.

A range of preventive health topics were addressed, including: social determinants of health, the growth of non-communicable diseases (NCDs) and associated lifestyle risk factors, community health planning networks and coalitions, the use of health promoters and community health workers for health education and preventive health services, and the use of mobile technology for health promotion and education.

I was invited to participate in the pre-conference General Assembly of the Consortium of Universities and Centers for Health Promotion and presented on the health education and promotion organizational and professional accreditation process in the U.S. The Assembly formed work teams to develop policy and programmatic papers over the next two years. I am looking forward to collaborating with a team of faculty colleagues from Central and South America to develop plans for regional interdisciplinary networks in health promotion and prevention.

I also conducted a pre-conference workshop on public health policy and advocacy education, modeled after our MPH course at the Jefferson School of Population Health. The workshop also draws on the national public health education advocacy summit, where we take MPH students to Washington, D.C. to learn about federal public health initiatives and advocacy strategies.

It was an incredible learning experience to conduct the two-hour workshop -- in Spanish -- with community and university participants from throughout the hemisphere. I needed to be cognizant and open to different ideas of key policy goals, such as equity and liberty in public policy and advocacy with representatives from socialist countries such as Cuba, Bolivia, and Ecuador.

Several workshop participants are based in rural areas, with limited or no health data to inform their plans for public health programs and policies. This called for some creative strategies, mostly coming from the workshop participants, such as recruiting youth volunteers to develop and conduct interviews with community members on health needs and assets, and using a “photovoice” technique to visually depict priority health areas for policy and advocacy.

Later in the conference, I was able to represent the North American Region on a panel presenting public/global health and health promotion competencies for undergraduate and graduate health education programs.

My final presentation was on our Health Care Improvement Foundation/Jefferson, Pennsylvania Department of Health grant-funded initiative on health literacy with hospitals and organizations that serve seniors. There was much interest in this relatively new topic area for Central and South America and I expect there will be an increased amount of programmatic and research work on health literacy in the decade ahead.

The conference was “infectious” with a culture of camaraderie and collaboration across the region. Mexico, through its Ministry of Health, Director General’s Office of Health Promotion, showed its “tri-colors” as excellent hosts for the conference. I look forward to hopefully participate in the next health promotion conference of the Americas, scheduled for Ecuador in 2015.

JSPH Teams Up with NBA Hall of Famer for Dribble to Stop Diabetes

noreply@blogger.com (David B. Nash, MD, MBA) — Fri, 15 Jun 2012 13:19:00 +0000

Patrick Monaghan
JSPH Director of Communications

The last time I was in the same area code as NBA Hall of Famer Bob Lanier, I was a pint-size pre-teen looking on from my seat at the old Spectrum while Lanier and his Detroit Pistons did battle with a 76ers team, who, at that time, featured a young guard out of Illinois State University named Doug Collins.

I’ve grown a bit in the 40 years since I last saw Bob Lanier on a basketball court, but still felt pretty pint-sized standing next to his 6’11” frame this past weekend when JSPH, along with Sanofi US and the American Diabetes Association, hosted a Dribble to Stop Diabetes Fit Clinic on the campus of Thomas Jefferson University.

“Those were battles back in those days,” said Lanier, after listening to me recall one of my earliest memories of attending an NBA game. “They let us play; not like today, where they blow the whistle for every little thing.”

Lanier, a six-time All-Star and 1992 Naismith Memorial Basketball Hall of Fame inductee, was diagnosed with Type 2 diabetes in 2004. The disease has been rampant throughout his family. As a Dribble to Stop Diabetes campaign ambassador, he hopes to emphasize the importance of seeing a doctor regularly and taking control of your health.

Lanier’s message was loud and clear to the 60-or-so youngsters who attended Saturday’s Dribble to Stop Diabetes event. “You have to push yourself to exercise and eat right because those are important things that you have to do with diabetes,” he said. “I’m more active now than ever.”

Getting kids and their families to live a more active lifestyle is part of what Dribble to Stop Diabetes is all about. Saturday’s clinic lasted an hour and a half or so. The kids had a blast and probably didn’t even realize that they were getting a pretty good workout while also improving their basketball skills. “Coach Donny” did an amazing job running the clinic, keeping the kids engaged while also slipping in messages about the benefits of eating right and being active.

Bob Lanier got into the act as well, participating in some of the drills, posing for photographs with seemingly anyone and everyone, and generally having a good time. It was great to see him on a basketball court again.

Afterward, he even showed a little of the competitive spirit that served him so well against the likes of Willis Reed, Kareem Abdul-Jabbar, Dave Cowens, and Wes Unseld. “That one kid made three or four shots on me. That made me a little mad.”

Diabetes, you’ve been warned.

For more photos from the Dribble to Stop Diabetes event, visit the JSPH Facebook page at http://www.facebook.com/jeffersonjsph.