Reed Tuckson, MD, is the Executive Vice President and Chief of Medical Affairs at the UnitedHealth Group and was a keynote speaker during the opening session of this year’s annual meeting of the American Public Health Association meeting, taking place this week in San Francisco. As part of a thought leader Q&A series around APHA, we sat down with Tuckson to discuss the potential for better integration of public health and health care.
We’re spending a lot on health care yet not getting the best health. What can public health do to partner more closely with health care to get us to a better health destination?
One of the really exciting movements that is now gaining momentum and energy is this realization that we’ve got to stitch together the preventive and population health movement with the medical care delivery movement. These are two worlds that have unfortunately operated in silos. And so now we’re beginning to have a shared realization that we have to be able to address the needs of each individual across the continuum of their needs, from prevention, early identification of disease, all the way through to management of disease and the restoration of function. It’s putting the pieces of the puzzle together, which is very exciting and this is an interesting moment when the incentives to encourage that are beginning to become aligned.
We talk a lot about return on investment. The word “value” is something that is really important to employers. What can public health do to partner with health care and with business, and to communicate the value?
Let’s say you’re operating in a state that has high costs for Medicaid coverage for children with asthma. The delivery system can work very hard, and has to work even better and harder, at making sure the medical management of a child with asthma is appropriate—that they’re using the right inhaler the right way, that they can catch a child before they’re in crisis and keep them outside of the emergency room. All those things will be very powerful for decreasing the costs that a state has to pay for children with asthma. On the public health side, we can have a real partnership where the public health team itself, or through partners, can go into the homes of kids with asthma and make sure that we root out possible causes, such as mold and mildew in the heating and the electrical and the air conditioning systems. We need to look at those precipitants of an asthmatic crisis. We need to stitch [the medical and public health fields] together in a more clear, transparent and accountable way so that each side understands the expectations of the other. Then we can say, look at what we have done together to reduce the cost of Medicaid to asthmatic children in the state, but also look what we’ve done for the overall health and wellbeing of that wonderful child.
How important are factors such as housing, education and transportation when we think about better health as a destination?
When we look at health care holistically and we look at trying to manage in this new era of patient-centered care then it means that we have to understand not only the natural history of disease, but we also have to address the social determinants of illness. We know, for example, that the largest cost-driver in our Medicare budgets is readmission back to the hospital after thirty days for people with congestive heart failure. Well if you discharge a woman who lives alone and who’s vulnerable and fragile into a community and there’s no Meals on Wheels program, there’s no home health care aid program—people to engage that person once they’re discharged—then it is inevitable that [they may have to be readmitted to the hospital]. So we have to understand now that the genius of the American medical and health system has to be an integration that looks not only at clinical medicine, but also at such things as housing, food, nutrition, and home health care aides. It is a holistic approach and we are beginning now to understand better than we’ve ever understood that it is the non-medical social support services which can be equally important as the medical care services.
What kind of data don’t we have? What do we need to make this case better to providers, payers, and employers?
One of the most exciting things about the health industry—and I use that as a generic term—is that we’re beginning to mirror other consumer-centric industries in our access to big data and the analytics that are necessary to understand the meaning of big data sets. We’ve got now, thankfully, the ability to understand a plethora of new kinds of knowledge—knowledge that comes from how people engage with their smartphones, their social networks, how they engage in biometry and other sensor-based technologies, how they engage in consumer gaming technologies. We’ve got a lot of information that we’ve never had before. Our challenge going forward will be how do we integrate that and aggregate it in a way that makes sense. How do we make sure that the holistic health care team has appropriate access to it? And then we will have to make sure that there is a fundamental level of trust by the American people that their data can be used by the comprehensive holistic health team in a way that will help them, and not harm them. Those are the requirements going forward, and this is an exciting moment when we have lots of information. We just have to make sure we have the intelligence to organize it, analyze it and then disseminate it and provide access at the point of care when people have to make choices, whether that point of care is at the grocery aisle, picking the right foods for my situation, whether that point of access is in the clinical arena when the patient must make very important personal health choices.
What do you want to get out of APHA this year?
APHA is a fantastic way of engaging this army of public health and their stakeholders in a continuous conversation about the important issues. What I want to get out of the APHA convention is being not only able to surface ideas, but to continue to refine and deepen the partnerships that turn ideas into action. We’re going to certainly be using things like social network and social media to solidify our relationship with stakeholders. We’ll be looking for opportunities to dive deeper beyond that in the days to come to shore up and build up those infrastructures. The biggest challenge that we have when we come to APHA meetings is to take the enthusiasm and the excitement we have for ideas and turn those into tangible actions that can be operated at scale and that can be sustained by financial infrastructures that are already weak and challenged. The return on investment has to be very, very clear and so turning ideas into meaningful and sustainable actions is really what we’re ultimately all about.