February 28, 2025 • 22 mins
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Health Affairs' Jeff Byers invites Victor Dzau of the National Academy of Medicine to the program to discuss the 2025 Vital Directions paper package and what major takeaways could be found to inform the incoming administration for the future of health care.
Join a live recording of A Health Podyssey on March 12 featuring Rob Lott and Yashaswini Singh discussing her recent paper on the effect of private equity on physician turnover. Register for the live taping here.
Related Links:
- Podcast: Don Berwick on How to Fix US Health Care (A Health Podyssey)
- Vital Directions for Health & Health Care: Priorities for 2025 Webinar (National Academy of Medicine)
- Vital Directions For Health And Health Care: Priorities For 2025 (Health Affairs)
- Updating US Public Health For Healthier Communities (Health Affairs)
- Artificial Intelligence In Health And Health Care: Priorities For Action (Health Affairs)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jeff Byers (00:40):
Hello and welcome back to health fairs this week.
I am your host, Jeff Byers. Weare recording on Monday,
02/24/2025. Just to let you allknow, on March 12, we're gonna
be doing a live taping for ourother podcast, A Health
Podyssey. Rob Lott will bechatting with Yasha Sweeney
Singh on her upcoming paper inthe March issue of Health
(01:02):
Affairs, which is about privateequity's effect on the health
care workforce.
Today, to discuss the latestinstallment of the vital
directions paper package, I'mjoined by Victor Zhao from the
National Academy of Medicine.Victor, welcome back.
Victor Dzau (01:19):
Oh, thank you very much. I look forward to talking
to you.
Jeff Byers (01:22):
So Vital Directions began in 2016. In 2021, you
partnered with Health Affairsfor a set of papers, as well as
the current 2025 set of papers.Looking back at 2016 and 2021,
what would you say is the mostpressing health policy concern,
and how has that concern evolvedsince 2016, and where do you
(01:44):
expect it to land in 2029?
Victor Dzau (01:46):
Yeah. So first is what's the vital directions?
It's a series of paper that wecommissioned at every turn of
administration. So as you said,in 2016, '16, that's, during
Trump, and 2020, Biden. Youknow?
So, really, they were publishedin 2016 and 2021. And at the
time, we, of course, we look atto the administration. These are
(02:09):
the priorities that we feel thenation face in health and health
care, and we assemble groups ofexperts to write these together
around topics and provide, infact, administration and also
congress with kind of a framingand road map of what needs to be
done for the next cycle ofadministration. So that's all
(02:30):
really very exciting. That'sbeen very effective.
In fact, we've been able tospeak to leadership and congress
administration about theseissues. So if you look at them
and the issues facing the nationat that time, they were, you
know, the ones such as costfragmentation, the issue of
noncommunicable diseases andcommunicable diseases, as well
(02:53):
as many others. But I thinkwhat's really happened since
2021 is a series of things thatare almost like a substantial
threat. First of all, we didn'thave COVID nineteen, and
finally, the world woke woke upto a whole issue of pandemics.
And now more recently with fluand then pox, we know it's here
to stay.
And so that in fact is a majorchange from the first two,
(03:16):
series. Second of course isclimate change. Also in this
period, there's a recognition ofimpact on climate change and
awareness of health, less sobefore that. Third is a lot of
issues of health equity,particularly with Black Lives
Matter, many others. So I thinkthat there's a lot of changes in
the last, shall we say, fouryears that has led to really a
(03:40):
renewed look at what theemphasis are.
You know, along, of course, asyou know, with COVID nineteen
exposed the problem of publichealth, misinformation, trust in
public health, and in science.And, of course, also, we've seen
during the last few years aseries of legislative and
judicial actions that's shapinghealth activities, right, about
(04:03):
health care, reproductivehealth, you name it. So I think
this is a really particularlyimportant time for this series
of vital direction to come outto say, what do we need to look
at immediately? And I think, andI will say that there, in fact,
there are we're organizedaround, five areas. Right?
One is US health care system hasto be transformed better, less
(04:26):
fragmented, low cost, andimprove outcomes. Secondly, we
need to modernize public health.And given all the concerns of
public health, how do you makepublic health more effective?
And how do you make publichealth connected with social
care, health care delivery, youname it? Third is, of course,
the whole research enterprise.
What does The US biomedicalresearch enterprise look like?
(04:49):
Fourth is artificialintelligence, a huge area that's
coming in that we're looking atnow and the future. Then, of
course, we all start aboutwomen's health and, of course,
climate change. So those are themajor pieces of this time, this
vital directions, very timely,and many common themes emerge in
our work for actionablestrategies for progress, for new
(05:13):
administration and congress. Weneed more leadership, more
strategy, reduce fragmentation,looking at misaligned economic
incentive, investment inworkforce, and, of course,
prioritizing equity.
So that's the whole idea of thiswhole series. I think you're
looking at a blueprint, if youwill, to inform the priorities
(05:34):
of this administration.
Jeff Byers (05:36):
Yeah. So, you know, the articles were written before
the inauguration of DonaldTrump's second term, and, you
know, we're still very, veryearly on in that second
administration, but theadministration is already
creating a lot of news. So whenyou look back at the 2025
priorities and reflect on the,federal actions that have
currently taken place in thehealth care space, So, like, I I
(05:57):
ask you, like, one, what's beenyour reaction? And two, has any
recommendations changed fromthe, you know, writing to the
publication?
Victor Dzau (06:06):
Jeff, you're right. We started this before the
election, but we always have todo that in anticipation of
election. Otherwise, we won'thave the things ready. Right? We
just published in January.
But I think the areas weidentified is really remain true
irrespective of whatadministration did this. Who
would disagree that we need muchbetter health care system that's
(06:28):
not fragmented, that'saffordable, and that is in fact
transformed? Who would disagreethat public health needs to be
doing better? Who would disagreewith the fact that we need a
much better research strategy?And, of course, think about AI
and climate change.
These are things that'shappening and going in the
future. So I don't think itchanges anything, except when
(06:50):
Trump comes in, as you know, thelast thirty days, this executive
order and the push she had incertain direction, I think, took
most people by surprise, andmost people are reacting to it.
I would argue that our errorsremain true because these are
the priorities. These are thelong term immediate long term
issues. What What Trump has comein to say would be, oh, I wanna
(07:13):
look at Medicaid.
I'll look at this. I'll look atDEI. No. We need to figure out
how to respond to them, but Idon't think anything's changed
because what we need isaffordable, accessible,
equitable care what improvehealth outcomes, will reduce
health care spending, and wereally want to have much better
integration of public health,social care so that people can
(07:36):
get to it, and all the things wehad talked about earlier. So I
think it doesn't change muchexcept we need to look at
specific actions and how to besure that not only we advise his
administration, but we alsoprotect the country from things
which are under intendedconsequences.
Jeff Byers (07:55):
Yeah. And so kinda looking back at those
recommendations that you broughtup earlier, and that's in the
package of the paper. And Ireally encourage listeners to
check out all the papers in thepackage. We published them as an
ahead of print in January oftwenty twenty five, and they are
currently published in theFebruary 2025 issue of Health
Affairs. You can find them allthere, so check that out.
(08:17):
And in those papers, you touchedon investing in the health care
workforce, which we know is abig issue around the country. So
it was written that building anAI competent health care
workforce, is mentioned as isbuilding a, ready workforce in
public health. So in thebiomedical section, you write
career pathways are unclear, anda lack of workforce diversity
(08:40):
stifles both innovation andequitable health outcomes. So I,
you know, am, like, looking atthis and wondering if I'm a
hospital operator or businessowner or an administrator or a
policy officials, how might Iactually, be looking into a vest
into the new generation ofhealth care workers? I know I'm
gonna throw a bunch ofquestions, but, like Yeah.
What struggles might they have,you know, that their previous
(09:04):
generation did not? Whatadvantages? So what can you tell
us about that section?
Victor Dzau (09:08):
Well, I mean, after all, you know, the only way to
go forward do thing is throughpeople and through the
workforce, and that's why it'sso important to invest in the
workforce. If you look at wherewe are today, let's say, in
health care, even in publichealth, we're having a
tremendous shortage, ofworkforce, and we also have
(09:28):
unequal distribution ofproviders. And that's because,
first of all, we have an agingworkforce population. Second,
there's burnout and, tremendousproblem with retention. Third is
the demand for care isincreasing.
So we need effective workforce.This is a question. We know, for
(09:49):
example, if you look at thedata, primary health care
professional shortage areas,which are designated, that
affects about 75,000,000 people,20% of the population. There's
at least about 7,000 areas whichare short in primary care and
workforce. We also know that theburnout issue is high.
(10:11):
During COVID nineteen, itactually goes up to as high as
seventy, eighty percent ofdoctors and nurses. It might
have settled a little bit, butthe retention, people are
saying, I'm not coming back. Orwhen I I'm gonna early retire.
Right? And then by 2030, a thirdof physician will be over 65,
and 500,000 nurses expect toretire by 2025.
(10:34):
So we have tremendous shortage.Demand is rising because by
2030, '1 in '5 Americans will be65 and older. That's the issue.
So we need to invest not only incurrent workforce, but the
future generation workforce. Inthe research arena, same problem
because fewer and fewerAmericans are going to research.
(10:54):
The STEM education, as you know,needs to be greatly improved.
Science is no longer seen as adesirable, you know, area of
profession. And then we're alsoa highly dependent both health
care and research andinternational students. If
particularly, if you look at inareas of physics and others, I
(11:16):
mean, most of the majority ofleaders are from international
training. I myself am immigrantcoming from a different
background, and we need that.
And, of course, as you know,these days, immigration policy,
etcetera, makes it reallydifficult. We also need to pay
our workforce better and toretain them. So there are many
issues. I believe the highlightis let's start planning how to
(11:40):
create, retain, and enable thegeneration of health care
workforce researchers to makesure we can carry out the work
for the nation. So we also needto train the workforce for the
future.
And in health care, digitaltechnology, AI is really, really
important. So we need to trainthem, include, in fact,
(12:00):
requirement for training so thatthey can use manage information,
digital innovation for caredelivery. Right? I think that's
really so important. And we alsoneed to be sure that workforce
begin to work across, as youtalk about fragmentation, the
different sectors in publichealth, health care, social
(12:21):
sectors, etcetera.
So that's another important areaof workforce, readiness for the
future.
Jeff Byers (12:27):
Maybe we can touch on this, maybe not, but I am
curious about, like, when youmentioned AI and paying the
workforce better, which I thinkis desperately needed, Like, how
might those hospital operatorsor practice managers think about
those investments into theirworkforce, especially when they
think about what their you know,since they they are businesses?
Victor Dzau (12:49):
Yeah. You know, my feeling is investing in those
areas is only gonna there's agood business case because,
first of all, you'll be moreefficient. Secondly, in the
workforce shortage that in factthe use of digital technology,
AI, may allow you to actuallywork with, fewer people,
(13:11):
increasing efficiency. AI, ifdone right, can help you look at
good clinical decisions. So Ithink there's a lot of reason to
invest in it because long runand I know health systems are
investing in it.
No question. Not only workforce,but using AI to manage workflow,
possible beds. Right? Predictwho's likely to get sepsis,
(13:35):
who's likely to end up, youknow, crashing or not, and
therefore being able to managethe patient much better. That's
certainly an efficiency issue aswell as, of course, better
health care altogether.
Jeff Byers (13:49):
So another theme, in the papers was reducing
fragmentations. So fragmentationand working in silos has been a
topic of concern for as long asI can remember. Have we made any
concrete movement on this? Isthere any optimism to share on
this front?
Victor Dzau (14:04):
Yeah. Well, not enough to be sure. Right? When
you're think aboutfragmentation, we have
fragmentation within the healthcare itself, fragmentation
across the health carestakeholders and related areas,
and with fragmentation withregards to strategy, policy, and
funding. So all those threeareas.
(14:25):
Let begin with the first one.When you think about health
care, we think about primarycare, specialty care, long term
care, rehab, community care. Andas you know, these are highly
fragmented, and, more and moresystems are looking at how to
actually make them much betterseamless in a continuum of care.
(14:45):
Right? A patient frequently haveto go from one to the other,
separate appointments, gettingdifferent messages.
So one, of course, major area isusing electronic health record.
But as you all know, we havetrouble with interoperability
and making sure that we have thesame platform, particularly
records from community health,social services, and others. So
(15:09):
I think this is a bigfragmentation. Such an issue
needs to be integrated seamlessfor patient care and, hopefully,
also with financial incentiveand measurements of outcome that
can enable us to do a muchbetter integration. That's one
point.
Second, beyond health care, wehave fragmentation with public
(15:31):
health, with social care, withpayers, and others, community
organization. Right? We learn,for example, from COVID
nineteen, the issue of socialdeterminants that if we can
integrate all of these things,then you provide your patient
much better social care and,therefore, maybe less need for
(15:52):
medical care. So these thingsneed to be happening. And,
certainly, I would say duringthe, as you see a paper from
Mark McClellan about reformingpublic health needing much
better coordination acrosssectors using samples by state
and local governancecollaborating to look at how to
(16:13):
enable, a much betterintegration or coordination
across different sectors.
And third is policy and funding.And that's another problem.
Right? As I mentioned, state,federal government, even
counties are all makingdifferent decisions, and, also,
(16:33):
they all have somewhat differentfinancing needs and pressures,
and they need to come togetherto be a lot more integrated
thinking about those things. Andresearch and our research paper
by Luis talk about thedifficulty in looking at
fragmentation of funding betweenphilanthropy, foundations, NIH,
(16:56):
NSF, and rarely do we look athow to integrate and align this
funding in order to get theright outcome, particularly in
research areas.
So there's a lot of work need tobe done. Are we making any
progress? Well, certainly, Ithink there's a lot more
recognition now and willingnessto do this. So, for example, we
have seen that in the placeslike North Carolina where I
(17:20):
live, that in fact, there areefforts to look at how to use
Medicaid dollars, look at socialdeterminants, pay for housing
and others in order to integratethe social and the medical care
aspect of things. So I thinkthat the McClellan paper and the
Don Berwick paper really addressmany of these issues.
Jeff Byers (17:42):
My colleague, Rob Lott, spoke with Don Berwick
about his paper in the vitaldirection series, on the health
policy podcast. So I don't wannaretread what they discussed too
much, but I will ask as we wrapup, especially in looking at the
recommendations for publichealth, is there any small
actionable items that can helppush health care into more of a
(18:05):
team sport?
Victor Dzau (18:06):
Yeah. Thank you for using those words because Mark
McClellan's paper and hiscolleague says, we need a team
spot approach. What does thatmean? You know, at the end of
the day, population health iseverybody's responsibility.
Right?
So those who run hospitals arethinking about how do I take
care of patients that come intomy door, but they also need to
(18:26):
think about what happens afterthey leave my door, and how do I
keep them healthy, you know,within where they live,
etcetera. And we all know aboutsocial terms of health. Public
health, we will think about howdo we keep the public healthy
and particularly communityhealth. And there are, of
course, more and moreorganizations working on
community health, communityhealth workers, and others. So I
(18:49):
think the whole idea in socialcare I mentioned is a is a team
spot.
How do you actually collaborate,align, and share accountability
across different programs at theend to improve population
health? That's the key issue.And to do that, as you said, you
have to start changingincentives and integrate the
data, which is so important, andcreate partnership. So there are
(19:12):
indeed efforts now to bringtogether health care delivery,
public health, social caretogether to create ways to
align, to create teamwork, andalso to share data. So to get
beyond the silo to be able tolook at things together and
measure things together.
So there's enough severalinitiative that's going right
(19:34):
now that is in fact discussingthis. I do think that federal
legislation and administrativeaction can be helpful because
they can incentivize, you know,the, coming together, if you
will. They can enable more datasharing, etcetera. And, of
course, all that along workingalong, as I said earlier about,
(19:57):
was a state like in Indiana,where in fact they have a
multisectoral statewidecommission to form to bring
together everybody, includingbusiness, to look at how to
promote health care priorities.And the federal level, you can
look at a federal plan forequitable long term recovery
resilience and to look atchanges need in federal
(20:18):
government.
So during the lastadministration, certainly, there
was effort to bring together allrelevant federal government
departments and agencies to lookat how do we look at working
together, how to fostercommunity center collaboration
and investment to strengthenthese systems, and, ultimately,
a whole government approach onresource on communities. So lots
(20:41):
of things going on. I think ifyou read those papers, it's all
in there.
Jeff Byers (20:45):
Victor Zhao, thanks again for joining the program.
Before we head out, is thereanything you wanna highlight
regarding vital directions thatwe haven't touched on?
Victor Dzau (20:54):
Jeff, one thing I want your audience to know is
that we're actually releasingthis the the series as a webinar
on Thursday, the twenty seventh.And, of course, you are
publishing this on Friday. Sowhen people hear this podcast,
they can go to the NAM websiteand log in to listen to the
(21:15):
webinar. We'll have MarkMcClellan, Don Berwick, Sandra
Bill Frist, Al Reese, PaulaJohnson, and Michael Finney all
reviewing what their findings ofeach one of those chapters. So
please log in our website and,hear it, when you hear this
podcast.
Jeff Byers (21:35):
Again, Victor's out. Thank you for taking the time,
and speaking with us today onHealth Affairs This Week. To
you, the listener, if youenjoyed this episode, Please
send it to the futurist in yourlife, and make sure you leave a
review, give a comment onSpotify, give a rating, all that
(21:55):
good stuff. It really, reallyhelps people find the show, and
we want to continue making itfor you. So please share it far
and wide.
And with that, I hope you have agreat rest of the week, and
we'll see you next time onHealth First This Week.
Hello and welcome back to health fairs this week.
I am your host, Jeff Byers. Weare recording on Monday,
02/24/2025. Just to let you allknow, on March 12, we're gonna
be doing a live taping for ourother podcast, A Health
Podyssey. Rob Lott will bechatting with Yasha Sweeney
Singh on her upcoming paper inthe March issue of Health
(01:02):
Affairs, which is about privateequity's effect on the health
care workforce.
Today, to discuss the latestinstallment of the vital
directions paper package, I'mjoined by Victor Zhao from the
National Academy of Medicine.Victor, welcome back.
Victor Dzau (01:19):
Oh, thank you very much. I look forward to talking
to you.
Jeff Byers (01:22):
So Vital Directions began in 2016. In 2021, you
partnered with Health Affairsfor a set of papers, as well as
the current 2025 set of papers.Looking back at 2016 and 2021,
what would you say is the mostpressing health policy concern,
and how has that concern evolvedsince 2016, and where do you
(01:44):
expect it to land in 2029?
Victor Dzau (01:46):
Yeah. So first is what's the vital directions?
It's a series of paper that wecommissioned at every turn of
administration. So as you said,in 2016, '16, that's, during
Trump, and 2020, Biden. Youknow?
So, really, they were publishedin 2016 and 2021. And at the
time, we, of course, we look atto the administration. These are
(02:09):
the priorities that we feel thenation face in health and health
care, and we assemble groups ofexperts to write these together
around topics and provide, infact, administration and also
congress with kind of a framingand road map of what needs to be
done for the next cycle ofadministration. So that's all
(02:30):
really very exciting. That'sbeen very effective.
In fact, we've been able tospeak to leadership and congress
administration about theseissues. So if you look at them
and the issues facing the nationat that time, they were, you
know, the ones such as costfragmentation, the issue of
noncommunicable diseases andcommunicable diseases, as well
(02:53):
as many others. But I thinkwhat's really happened since
2021 is a series of things thatare almost like a substantial
threat. First of all, we didn'thave COVID nineteen, and
finally, the world woke woke upto a whole issue of pandemics.
And now more recently with fluand then pox, we know it's here
to stay.
And so that in fact is a majorchange from the first two,
(03:16):
series. Second of course isclimate change. Also in this
period, there's a recognition ofimpact on climate change and
awareness of health, less sobefore that. Third is a lot of
issues of health equity,particularly with Black Lives
Matter, many others. So I thinkthat there's a lot of changes in
the last, shall we say, fouryears that has led to really a
(03:40):
renewed look at what theemphasis are.
You know, along, of course, asyou know, with COVID nineteen
exposed the problem of publichealth, misinformation, trust in
public health, and in science.And, of course, also, we've seen
during the last few years aseries of legislative and
judicial actions that's shapinghealth activities, right, about
(04:03):
health care, reproductivehealth, you name it. So I think
this is a really particularlyimportant time for this series
of vital direction to come outto say, what do we need to look
at immediately? And I think, andI will say that there, in fact,
there are we're organizedaround, five areas. Right?
One is US health care system hasto be transformed better, less
(04:26):
fragmented, low cost, andimprove outcomes. Secondly, we
need to modernize public health.And given all the concerns of
public health, how do you makepublic health more effective?
And how do you make publichealth connected with social
care, health care delivery, youname it? Third is, of course,
the whole research enterprise.
What does The US biomedicalresearch enterprise look like?
(04:49):
Fourth is artificialintelligence, a huge area that's
coming in that we're looking atnow and the future. Then, of
course, we all start aboutwomen's health and, of course,
climate change. So those are themajor pieces of this time, this
vital directions, very timely,and many common themes emerge in
our work for actionablestrategies for progress, for new
(05:13):
administration and congress. Weneed more leadership, more
strategy, reduce fragmentation,looking at misaligned economic
incentive, investment inworkforce, and, of course,
prioritizing equity.
So that's the whole idea of thiswhole series. I think you're
looking at a blueprint, if youwill, to inform the priorities
(05:34):
of this administration.
Jeff Byers (05:36):
Yeah. So, you know, the articles were written before
the inauguration of DonaldTrump's second term, and, you
know, we're still very, veryearly on in that second
administration, but theadministration is already
creating a lot of news. So whenyou look back at the 2025
priorities and reflect on the,federal actions that have
currently taken place in thehealth care space, So, like, I I
(05:57):
ask you, like, one, what's beenyour reaction? And two, has any
recommendations changed fromthe, you know, writing to the
publication?
Victor Dzau (06:06):
Jeff, you're right. We started this before the
election, but we always have todo that in anticipation of
election. Otherwise, we won'thave the things ready. Right? We
just published in January.
But I think the areas weidentified is really remain true
irrespective of whatadministration did this. Who
would disagree that we need muchbetter health care system that's
(06:28):
not fragmented, that'saffordable, and that is in fact
transformed? Who would disagreethat public health needs to be
doing better? Who would disagreewith the fact that we need a
much better research strategy?And, of course, think about AI
and climate change.
These are things that'shappening and going in the
future. So I don't think itchanges anything, except when
(06:50):
Trump comes in, as you know, thelast thirty days, this executive
order and the push she had incertain direction, I think, took
most people by surprise, andmost people are reacting to it.
I would argue that our errorsremain true because these are
the priorities. These are thelong term immediate long term
issues. What What Trump has comein to say would be, oh, I wanna
(07:13):
look at Medicaid.
I'll look at this. I'll look atDEI. No. We need to figure out
how to respond to them, but Idon't think anything's changed
because what we need isaffordable, accessible,
equitable care what improvehealth outcomes, will reduce
health care spending, and wereally want to have much better
integration of public health,social care so that people can
(07:36):
get to it, and all the things wehad talked about earlier. So I
think it doesn't change muchexcept we need to look at
specific actions and how to besure that not only we advise his
administration, but we alsoprotect the country from things
which are under intendedconsequences.
Jeff Byers (07:55):
Yeah. And so kinda looking back at those
recommendations that you broughtup earlier, and that's in the
package of the paper. And Ireally encourage listeners to
check out all the papers in thepackage. We published them as an
ahead of print in January oftwenty twenty five, and they are
currently published in theFebruary 2025 issue of Health
Affairs. You can find them allthere, so check that out.
(08:17):
And in those papers, you touchedon investing in the health care
workforce, which we know is abig issue around the country. So
it was written that building anAI competent health care
workforce, is mentioned as isbuilding a, ready workforce in
public health. So in thebiomedical section, you write
career pathways are unclear, anda lack of workforce diversity
(08:40):
stifles both innovation andequitable health outcomes. So I,
you know, am, like, looking atthis and wondering if I'm a
hospital operator or businessowner or an administrator or a
policy officials, how might Iactually, be looking into a vest
into the new generation ofhealth care workers? I know I'm
gonna throw a bunch ofquestions, but, like Yeah.
What struggles might they have,you know, that their previous
(09:04):
generation did not? Whatadvantages? So what can you tell
us about that section?
Victor Dzau (09:08):
Well, I mean, after all, you know, the only way to
go forward do thing is throughpeople and through the
workforce, and that's why it'sso important to invest in the
workforce. If you look at wherewe are today, let's say, in
health care, even in publichealth, we're having a
tremendous shortage, ofworkforce, and we also have
(09:28):
unequal distribution ofproviders. And that's because,
first of all, we have an agingworkforce population. Second,
there's burnout and, tremendousproblem with retention. Third is
the demand for care isincreasing.
So we need effective workforce.This is a question. We know, for
(09:49):
example, if you look at thedata, primary health care
professional shortage areas,which are designated, that
affects about 75,000,000 people,20% of the population. There's
at least about 7,000 areas whichare short in primary care and
workforce. We also know that theburnout issue is high.
(10:11):
During COVID nineteen, itactually goes up to as high as
seventy, eighty percent ofdoctors and nurses. It might
have settled a little bit, butthe retention, people are
saying, I'm not coming back. Orwhen I I'm gonna early retire.
Right? And then by 2030, a thirdof physician will be over 65,
and 500,000 nurses expect toretire by 2025.
(10:34):
So we have tremendous shortage.Demand is rising because by
2030, '1 in '5 Americans will be65 and older. That's the issue.
So we need to invest not only incurrent workforce, but the
future generation workforce. Inthe research arena, same problem
because fewer and fewerAmericans are going to research.
(10:54):
The STEM education, as you know,needs to be greatly improved.
Science is no longer seen as adesirable, you know, area of
profession. And then we're alsoa highly dependent both health
care and research andinternational students. If
particularly, if you look at inareas of physics and others, I
(11:16):
mean, most of the majority ofleaders are from international
training. I myself am immigrantcoming from a different
background, and we need that.
And, of course, as you know,these days, immigration policy,
etcetera, makes it reallydifficult. We also need to pay
our workforce better and toretain them. So there are many
issues. I believe the highlightis let's start planning how to
(11:40):
create, retain, and enable thegeneration of health care
workforce researchers to makesure we can carry out the work
for the nation. So we also needto train the workforce for the
future.
And in health care, digitaltechnology, AI is really, really
important. So we need to trainthem, include, in fact,
(12:00):
requirement for training so thatthey can use manage information,
digital innovation for caredelivery. Right? I think that's
really so important. And we alsoneed to be sure that workforce
begin to work across, as youtalk about fragmentation, the
different sectors in publichealth, health care, social
(12:21):
sectors, etcetera.
So that's another important areaof workforce, readiness for the
future.
Jeff Byers (12:27):
Maybe we can touch on this, maybe not, but I am
curious about, like, when youmentioned AI and paying the
workforce better, which I thinkis desperately needed, Like, how
might those hospital operatorsor practice managers think about
those investments into theirworkforce, especially when they
think about what their you know,since they they are businesses?
Victor Dzau (12:49):
Yeah. You know, my feeling is investing in those
areas is only gonna there's agood business case because,
first of all, you'll be moreefficient. Secondly, in the
workforce shortage that in factthe use of digital technology,
AI, may allow you to actuallywork with, fewer people,
(13:11):
increasing efficiency. AI, ifdone right, can help you look at
good clinical decisions. So Ithink there's a lot of reason to
invest in it because long runand I know health systems are
investing in it.
No question. Not only workforce,but using AI to manage workflow,
possible beds. Right? Predictwho's likely to get sepsis,
(13:35):
who's likely to end up, youknow, crashing or not, and
therefore being able to managethe patient much better. That's
certainly an efficiency issue aswell as, of course, better
health care altogether.
Jeff Byers (13:49):
So another theme, in the papers was reducing
fragmentations. So fragmentationand working in silos has been a
topic of concern for as long asI can remember. Have we made any
concrete movement on this? Isthere any optimism to share on
this front?
Victor Dzau (14:04):
Yeah. Well, not enough to be sure. Right? When
you're think aboutfragmentation, we have
fragmentation within the healthcare itself, fragmentation
across the health carestakeholders and related areas,
and with fragmentation withregards to strategy, policy, and
funding. So all those threeareas.
(14:25):
Let begin with the first one.When you think about health
care, we think about primarycare, specialty care, long term
care, rehab, community care. Andas you know, these are highly
fragmented, and, more and moresystems are looking at how to
actually make them much betterseamless in a continuum of care.
(14:45):
Right? A patient frequently haveto go from one to the other,
separate appointments, gettingdifferent messages.
So one, of course, major area isusing electronic health record.
But as you all know, we havetrouble with interoperability
and making sure that we have thesame platform, particularly
records from community health,social services, and others. So
(15:09):
I think this is a bigfragmentation. Such an issue
needs to be integrated seamlessfor patient care and, hopefully,
also with financial incentiveand measurements of outcome that
can enable us to do a muchbetter integration. That's one
point.
Second, beyond health care, wehave fragmentation with public
(15:31):
health, with social care, withpayers, and others, community
organization. Right? We learn,for example, from COVID
nineteen, the issue of socialdeterminants that if we can
integrate all of these things,then you provide your patient
much better social care and,therefore, maybe less need for
(15:52):
medical care. So these thingsneed to be happening. And,
certainly, I would say duringthe, as you see a paper from
Mark McClellan about reformingpublic health needing much
better coordination acrosssectors using samples by state
and local governancecollaborating to look at how to
(16:13):
enable, a much betterintegration or coordination
across different sectors.
And third is policy and funding.And that's another problem.
Right? As I mentioned, state,federal government, even
counties are all makingdifferent decisions, and, also,
(16:33):
they all have somewhat differentfinancing needs and pressures,
and they need to come togetherto be a lot more integrated
thinking about those things. Andresearch and our research paper
by Luis talk about thedifficulty in looking at
fragmentation of funding betweenphilanthropy, foundations, NIH,
(16:56):
NSF, and rarely do we look athow to integrate and align this
funding in order to get theright outcome, particularly in
research areas.
So there's a lot of work need tobe done. Are we making any
progress? Well, certainly, Ithink there's a lot more
recognition now and willingnessto do this. So, for example, we
have seen that in the placeslike North Carolina where I
(17:20):
live, that in fact, there areefforts to look at how to use
Medicaid dollars, look at socialdeterminants, pay for housing
and others in order to integratethe social and the medical care
aspect of things. So I thinkthat the McClellan paper and the
Don Berwick paper really addressmany of these issues.
Jeff Byers (17:42):
My colleague, Rob Lott, spoke with Don Berwick
about his paper in the vitaldirection series, on the health
policy podcast. So I don't wannaretread what they discussed too
much, but I will ask as we wrapup, especially in looking at the
recommendations for publichealth, is there any small
actionable items that can helppush health care into more of a
(18:05):
team sport?
Victor Dzau (18:06):
Yeah. Thank you for using those words because Mark
McClellan's paper and hiscolleague says, we need a team
spot approach. What does thatmean? You know, at the end of
the day, population health iseverybody's responsibility.
Right?
So those who run hospitals arethinking about how do I take
care of patients that come intomy door, but they also need to
(18:26):
think about what happens afterthey leave my door, and how do I
keep them healthy, you know,within where they live,
etcetera. And we all know aboutsocial terms of health. Public
health, we will think about howdo we keep the public healthy
and particularly communityhealth. And there are, of
course, more and moreorganizations working on
community health, communityhealth workers, and others. So I
(18:49):
think the whole idea in socialcare I mentioned is a is a team
spot.
How do you actually collaborate,align, and share accountability
across different programs at theend to improve population
health? That's the key issue.And to do that, as you said, you
have to start changingincentives and integrate the
data, which is so important, andcreate partnership. So there are
(19:12):
indeed efforts now to bringtogether health care delivery,
public health, social caretogether to create ways to
align, to create teamwork, andalso to share data. So to get
beyond the silo to be able tolook at things together and
measure things together.
So there's enough severalinitiative that's going right
(19:34):
now that is in fact discussingthis. I do think that federal
legislation and administrativeaction can be helpful because
they can incentivize, you know,the, coming together, if you
will. They can enable more datasharing, etcetera. And, of
course, all that along workingalong, as I said earlier about,
(19:57):
was a state like in Indiana,where in fact they have a
multisectoral statewidecommission to form to bring
together everybody, includingbusiness, to look at how to
promote health care priorities.And the federal level, you can
look at a federal plan forequitable long term recovery
resilience and to look atchanges need in federal
(20:18):
government.
So during the lastadministration, certainly, there
was effort to bring together allrelevant federal government
departments and agencies to lookat how do we look at working
together, how to fostercommunity center collaboration
and investment to strengthenthese systems, and, ultimately,
a whole government approach onresource on communities. So lots
(20:41):
of things going on. I think ifyou read those papers, it's all
in there.
Jeff Byers (20:45):
Victor Zhao, thanks again for joining the program.
Before we head out, is thereanything you wanna highlight
regarding vital directions thatwe haven't touched on?
Victor Dzau (20:54):
Jeff, one thing I want your audience to know is
that we're actually releasingthis the the series as a webinar
on Thursday, the twenty seventh.And, of course, you are
publishing this on Friday. Sowhen people hear this podcast,
they can go to the NAM websiteand log in to listen to the
(21:15):
webinar. We'll have MarkMcClellan, Don Berwick, Sandra
Bill Frist, Al Reese, PaulaJohnson, and Michael Finney all
reviewing what their findings ofeach one of those chapters. So
please log in our website and,hear it, when you hear this
podcast.
Jeff Byers (21:35):
Again, Victor's out. Thank you for taking the time,
and speaking with us today onHealth Affairs This Week. To
you, the listener, if youenjoyed this episode, Please
send it to the futurist in yourlife, and make sure you leave a
review, give a comment onSpotify, give a rating, all that
(21:55):
good stuff. It really, reallyhelps people find the show, and
we want to continue making itfor you. So please share it far
and wide.
And with that, I hope you have agreat rest of the week, and
we'll see you next time onHealth First This Week.
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