The Three Pillars of My Health Career

In the last few years, we have collectively witnessed important and monumental shifts in how we view and deliver health, both in the U.S. and globally. However, despite the ever-evolving health landscape, my 20+ years in the industry have consistently focused on three key elements to health: primary care, public health and health technology.

These core elements of our health system impact outcomes on a broader scale and have an outsized impact relative to the current level of investment in each, which is why they are critical to the future of health.?

Transdisciplinary Primary Care Teams

In the U.S., just five to seven cents of every dollar spent on healthcare is dedicated to primary care. Yet, it can have a direct impact on 50 to 60% of each dollar spent. Changing how we think about primary care and allocating more spending in this critical area, simply put, is a better investment. The proof is in the results of other industrialized nations, who spend approximately triple what the U.S. does on primary care, and all have lower per capita overall healthcare spending and better health outcomes.?

I have also personally found this to be true after witnessing first-hand how regular primary care can set the trajectory for longer, healthier lives, as well as drastically reduce costs for both patients and providers, while practicing as a frontline primary care physician as an internist and pediatrician early in my health career.

One reason primary care has such a significant impact on health outcomes is because of the whole, transdisciplinary team involved in this care. As a Chief Medical Officer, I found that there were approximately five to seven people behind every primary care doctor: nurse practitioners, pharmacists, registered nurses, social workers, psychologists, front office staff, care coordinators and medical assistants, who enable personalized, high-quality care.

To reap the full benefits of these teams’ care, we must, as a nation, shift to thinking of primary care as meeting patients where they are with the entire primary care team. At CVS Health and Aetna, we are leveraging our full suite of offerings – like MinuteClinic appointments, Caremark pharmacy consultations, pharmacist panels, key screenings at CVS HealthHUB? locations, and telehealth or virtual care visits – to maximize ease and convenience for all health consumers. For example, during the COVID-19 pandemic, this meant supporting nearly 40 million telehealth appointments, half of which were for mental health services.

The “7 Ps” of Public Health Partnerships

In the U.S., while a few pennies of every dollar spent on healthcare is spent on governmental public health, the impact of this small investment on broader health is both significant and profound.?After my time as a frontline primary care physician and Chief Medical Officer in community-based settings, I was able to witness this with my work in federal governmental public health at the Health Resources and Services Administration (HRSA) and the National Institutes of Health (NIH). I like to say that I went from caring for one patient at a time to one population at a time. The importance of public health was best summarized by former Surgeon General, C. Everett Koop, who said, “Healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time.” ?

I had a front-row seat to the passage and implementation of the landmark Affordable Care Act, which demonstrated that public health is an ecosystem of seven key stakeholders across the population: the 7 “Ps”. ?In this ecosystem, health needs, spending, data, and decisions flow from Patients to their health and healthcare Providers to the Payers (e.g., health plans), Purchasers (e.g., employers) and Policymakers (e.g., CMS) of their care. We must also not forget the Product manufacturers (e.g., pharmaceutical and medical device companies) and Pioneers (e.g., academic and research institutions, entrepreneurs) of new health discoveries and solutions, forming a diverse, but complex ecosystem back to the most important stakeholders—the Patients.

Our public health requires collaboration across each and all of these seven stakeholders. The COVID-19 pandemic taught us the importance of collaborative, “across-the-ecosystem” efforts to address health issues, demonstrating that national and global coordination was and is essential to reach the next stage of this pandemic. This shift was made possible by purchasers or employers, who moved their employees to work from home, public and private partnerships between policymakers and product manufacturers to accelerate scientific development of a vaccine (e.g., Moderna, Johnson & Johnson), and payer and provider collaboration, like that between Aetna and CVS, which provided nearly 120 million provider-facilitated COVID-19 interventions (COVID-19 tests and vaccines).

Health Technology for the “3 Ds”

Underpinning work across public health and primary care is health technology. In the U.S., health organizations are shifting their thinking about their IT investments (typically 4% of revenue) and departments from a data and cost center to an insights center that helps to reduce costs and improve health outcomes. After my public service at HHS, I served as Chief Health Officer at IBM for a decade. With a global health perspective serving clients and partners who represent each of the “7 Ps” of the health ecosystem, I saw how, like primary care and public health, spending on information technology has an outsized impact. Most organizations spend a small fraction of their IT budgets on data and insights, but if spent right, that investment can generate immensely powerful health insights and outcomes.

Data, analytics, and artificial intelligence (AI) are critical to tracking progress, measuring health issues, predicting trends and quantifying patient and population health outcomes – both positive and negative.?However, data must be refined and then translated into insights, using analytics and AI, to drive healthcare decisions. The 3D Commission embodies this ethos by working to combine the insights of social Determinants and the power of Data to make better health Decisions for populations at the right time. By taking the time to refine data and apply analytics and AI, we can generate actionable insights that lead to better decisions and better health. ??

At CVS Health and Aetna, we are putting this into practice through our Next Best Action (NBA) recommendations, which nudge our members and providers to subsequent health decisions and steps they can take based on previous health data or behaviors. For example, in 2021, Aetna directed over 300 NBAs to more than 10 million members. With better insights, the “7 Ps” of the health ecosystem can work together to better predict illness, personalize care, prevent bad outcomes and promote better health.

These three pillars – primary care, public health and health technology – have been a driving force throughout my career, and I believe they will remain vital to the future of health, healthcare, and public health.?