Bill Frist Answers Questions Around Health
Just I’ll circle back. You did mention population health and actually that’s part of my question. So, we’re seeing a lot of interest on the part of hospitals and hospital systems on reducing care variation. That kind of fits into the value care in the bundling, but it’s very hard of course to get surgeons and physicians to change behavior. I think it’s also very hard to get patients to change behavior. You want to comment about mechanisms or how we can do that to improve healthcare and to provide better value.
Yeah. So, we got health. We got healthcare. We’re all part of healthcare. It’s what Nashville is all about, what you’re all about. It’s what the surgeons are all about and the healthcare is our delivery of our services. We’re a service industry and that’s good. The biggest wake up call to me in the 1990s was that, because I thought the world centered around what we did, but in truth, the outcome of the health of a patient, that’s only about 10%. The health of all of you, the health of your parents, the health of your kids, the health of your family is only about 10% dependent if you put all the studies together in the country in these meta analyses. It’s only about 10, maybe 12% that we can affect outcome in terms of overall survival, overall infant mortality, overall obesity, overall the other measures of health, stroke that we have.
Focusing on Health
Then you go back and say, “Well, if that’s the case, we really are focused on health.” That’s your driver. Which I’ve tried to do it in politics and in business and all so I’m thinking about that all the time. What are they? It ends up being about only about 5 to 10% are environment in the broadest sense. Probably more like 5 than 10. Then about 30% is genetics. I was talking to Sam [Rody 00:02:05] over there. There’s a great book out about genetics. Ancient DNA by a guy David Wright that I’m reading now and it talks about ancient DNA and who we are as a people. It’s just out in the last three weeks.
But it also talks about the determination of our genetics and who we are and our health. So, 10% say 5% environment and then about 30% genetics and then about 10 to 15% of what we do and then about 15% is socioeconomics. Just how rich you are, where you live. But then 40% is behavior and that’s where we need to focus on. Wear seatbelts, do you smoke? The obesity, nutrition, exercise and all of that 40%. So, any sort of outcome that you use that’s going to be on health, you do gotta measure our 10% of what we do, but you have to come into the 40% of the behavior. Not just on the outcome but if you want to change what that health is and therefore you have to look at what are called the social determinants.
Again, I hate those words, but for those of us in the policy world, it means everything from our transit system here. A huge debate. We have a terrible transit system in Nashville, but if you can’t get to a doctor or you can’t get to a job, that affects your overall well being. So, it means transportation, it means housing, it means food. It means attention to those bigger determinants. From an investing standpoint, since I know that, I go out and buy and develop the largest delivery of food to the Medicaid population because right now if they don’t get good food after a hospitalization, they’re not going to do well.
Developing a Culture of Health
So, it’s this much broader picture developing a culture of health and back again to the culture, but a culture of health and expectation beyond just the delivery of very good acute services which is what we do.
This is somewhat of a personal question, but you said earlier you went through a phase where you thought you lost your mind. You made the decision-
I knew I lost my mind, but after the fact.
But you went to Washington, D.C. with the intention that you were only going to serve two terms. Why was that? Why did you make that decision up front, knowing that you had ascended fairly quickly within the ranks but then to quickly or at a certain point say, “That’s it and I want to do something else?”
Personally, that’s a great question. The question is because everybody is so down on politics and public policy and the service end of what I did of politics, remember I’m a doctor. I’m just part of what all of you are and that’s just sort of caring and the mission of making lives better for other people. So, I went saying that that is a vehicle beyond the operating room or teaching or an innovative field that I might be able to have an impact. I didn’t know HIV AIDS would come up. I didn’t know the impact. That wasn’t just me, but being the only doctor in the senate, I pushed it hard or part D of prescription drugs. So, I didn’t know all of that, but I knew that it was a potential vehicle and it might be and I say I lost my mind because why would anybody leave from medicine to politics?
Government, Politics & Health
But I did go in as you said … Highest trusted to the least trusted in the world. So, that’s one reason. I didn’t want to stay in the least trusted forever, but no. I did go and before going I served 12 years. I knew that I was not going to be, I didn’t want to be a career politician. There’s nothing appealing to me about it. I knew how long it took me to become a cardiac surgeon. It was about 12 years from the day I really started after medical school or you can say halfway through medical school to the time I really was on my own doing heart transplants about 12 years. So, in my mind, 10 years gives you time to spend a few years learning and a few years applying with still a freshness. That was it.
So, it ends up being 10 years is about two terms. So, I went in and said I’m a citizen legislature. I want to go to that body with the real life experiences that I’ve picked up being a southerner or little town in Nashville, Tennessee and I want to give as much as I can and then not be absorbed by the system and if I’ve given everything in truth, other people can come in and do the same thing. It needs regular people, citizen legislators. So, even when I was sort of kept being elevated through the system it was never really tempting for me to stay. Then the good news from that is that I left and then I had to start all over.
So, starting all over is not a bad thing. I started all over in politics. I’ve never done it before and then in the business world, the last 12 years again started over, but things like Aspire Health and Devoted Health and the Medicare advantage world and this whole world of artificial intelligence and medicine and stuff that I didn’t really know 10 years ago, 12 years ago. The citizen legislature may not be for everybody but again, having a government, a democracy where you’re taking regular people with being fallible, having weaknesses but also strengths just creates a richer, more robust, more real, more humble government and more representative of the American people.