Latest / Becker’s Payer Issues Podcast / Leading the Nation’s First Lifestyle Medicine Program for Alzheimer’s at EmblemHealth

Transcript

Leading the Nation’s First Lifestyle Medicine Program for Alzheimer’s at EmblemHealth · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
0:02
Becker's Payer Issues podcast.
0:04
Thrilled today to be joined by two special
0:07
guests. Karen Ignani serves as the executive chair
0:10
at EmblemHealth,
0:11
and doctor Dan Neckt is the chief medical
0:14
officer also at EmblemHealth.
0:16
Karen, doctor Knecht, thank you both so much
0:18
for taking the time to be be with
0:20
me here on the podcast.
0:22
Thank you, Jacob. Our pleasure.
0:24
And before we dive into what we wanna
0:26
talk with you both about, can you each
0:28
tell us a little bit more about yourselves,
0:31
your backgrounds in health care, and what it
0:32
is that you're doing today at EmblemHealth?
0:35
Karen, why don't you start us off? I'd
0:36
be happy to. I'm the executive chair at
0:39
EmblemHealth,
0:41
which means that I chair the board and
0:43
have management responsibilities.
0:46
And prior to that, I was, the CEO
0:49
here at EmblemHealth
0:51
for about ten years. And prior to that,
0:53
I was in DC,
0:55
for a significant part of my career at
0:57
AHIP, which is familiar to all of your
0:59
listeners.
1:01
Thank you, Karen. Glad to have you with
1:03
us. Dan, how about you?
1:06
Hi. So I am EmblemHealth's
1:08
chief medical officer. I've been in this role
1:10
for,
1:11
more than a half a year now. I'm
1:13
responsible for the clinical integrity of EmblemHealth,
1:16
our programs, our initiatives,
1:18
also driving clinical innovation around areas that really
1:21
matter most to our members
1:23
related to unmet health needs. In addition to
1:26
being chief medical officer at EmblemHealth, I am
1:28
a hospitalist at Mount Sinai Hospital where I
1:31
take care of patients on the weekends.
1:33
Prior to joining EmblemHealth, I've worked at a
1:35
number of payers,
1:36
and I am a lifelong New Yorker.
1:39
Wonderful. Well, we're really excited to dive into
1:41
what sounds like is going to be a
1:43
very impactful
1:45
program for for your patients and your members.
1:48
And to our listeners, EmblemHealth is going to
1:50
be the first health insurer to cover a
1:53
new lifestyle medicine program for patients who have
1:56
early stage Alzheimer's disease.
1:59
So, Karen, talk to us a little bit
2:00
about that. What inspired the organization to launch
2:03
this groundbreaking partnership?
2:05
And, ultimately, how do you envision this benefiting
2:07
your members who are living with early stage
2:10
Alzheimer's or or other cognitive impairments?
2:13
I appreciate you're coming to me first, but
2:15
this is really,
2:17
Dan's brainchild.
2:18
And I really want, Jacob, if you're okay,
2:21
to have Dan
2:22
start off this. It's so exciting.
2:25
He,
2:26
is the,
2:28
thought leader around this initiative.
2:31
He is the leader of it
2:33
in terms of,
2:34
the rollout and how it's proceeding.
2:37
So let me yield to Dan first, and
2:39
then I'll come behind to talk about some
2:41
of those other questions that you asked, which
2:43
are very important as well, if that's okay.
2:46
Absolutely. Please, Dan, take it away. Yeah. Thank
2:48
you, Karen. I appreciate the kind words.
2:50
So it's increasingly
2:52
clear
2:53
that lifestyle choices choices
2:56
drive a number of serious conditions.
2:58
So we know that lifestyle choices have impact
3:01
on cardiovascular
3:02
health and diabetes
3:04
and obesity,
3:05
but there's cutting edge research actually just released
3:08
last week that demonstrates
3:10
that
3:11
lifestyle modifications
3:12
including exercise,
3:14
diet, social connectedness,
3:16
stress management can meaningfully
3:18
impact the trajectory of dementia.
3:20
This is truly groundbreaking. When I went to
3:22
medical school not so long ago,
3:24
we really didn't focus at all on the
3:26
impact,
3:27
certain lifestyle
3:29
choices and behaviors have on this condition. And,
3:32
frankly, there were really no
3:34
options or very limited options to treat Alzheimer's
3:37
and dementia. So this is incredibly
3:39
exciting for a clinician and for the leadership
3:41
team at EmblemHealth.
3:43
In fact, it's now estimated that about forty
3:45
percent of dementia cases
3:47
are considered preventable
3:48
or delayable
3:50
by lifestyle choices as well. So this past
3:52
week, there are two
3:54
groundbreaking studies that were, announced. One was by
3:57
our partner, doctor Dean Ornish, who revealed that
4:00
positive
4:01
lifestyle changes
4:02
can impact the trajectory
4:05
of patients living with either mild cognitive impairment,
4:09
which is the predecessor state to Alzheimer's,
4:12
as well as early stage Alzheimer's.
4:14
So that was one groundbreaking
4:16
study. The other is The US POINTER trial,
4:19
which looked at prevention
4:22
of
4:22
cognitive impairment
4:24
for a healthy but at risk population for
4:26
dementia.
4:27
So we saw these exciting studies,
4:30
and we, as a health plan, saw this
4:32
was an opportunity to step in and address
4:34
this concept of an evidence practice gap. And
4:37
what's an evidence practice gap? It's effectively what
4:40
innovations have been shown to be effective, but
4:43
they really aren't adopted in a wide
4:46
scale,
4:47
widespread manner. And so we thought at Emblem,
4:50
we have clinics, we have neighborhood care centers,
4:53
we have the privilege of caring for,
4:56
our members, but we could bring this
4:58
program to our population and those who need
5:01
it most.
5:02
And I wanna come right behind where Dan
5:05
just took a breath and left off because,
5:07
Dan, I think you said something really important
5:10
that will be valuable for people listening to
5:13
know.
5:13
We approach this, Jacob, with,
5:16
unique assets.
5:18
We have an important physician group, Advantage Care
5:21
Physicians,
5:22
affiliated
5:23
as a partner within our health plan ecosystem.
5:28
We also have done something very, very unique
5:31
around the country.
5:33
We have
5:34
set we have established
5:35
invested in the establishment
5:38
of 15
5:39
offices
5:41
where anybody in the community can come in,
5:44
get help with social determinants,
5:47
help with health care issues,
5:49
help with transportation,
5:51
housing,
5:52
food insecurity.
5:53
They can take a class. They can have
5:55
a cup of coffee.
5:56
So we approach this once Dan had this
6:00
idea of doing the right thing for our
6:02
members and being on the
6:05
leading edge
6:06
of change and innovation,
6:08
we approached it with how do we partner
6:11
with physicians, primary care physicians, to do the
6:14
baseline cognitive tests. Our advantage care physician leaders
6:18
and the leader of that organization
6:20
responded
6:21
almost immediately
6:22
to this notion that we could do something
6:25
important.
6:26
So the advantage care physician
6:28
primary care team,
6:30
they're doing the assessments.
6:32
They will be the benchmarking
6:34
for us as we go through
6:36
and chronicle the results.
6:38
And then our what Dan described is our
6:40
neighborhood care centers
6:42
in the most underserved
6:44
areas
6:45
of the five boroughs of New York will
6:48
be the opportunity
6:50
for people
6:51
not only to do, and Dan will talk
6:53
about, the online support, the coaching we're gonna
6:56
be doing, the food we're gonna be giving
6:59
out,
7:00
but to make sure that everybody is able
7:02
to
7:03
meet the requirements of lifestyle medicine, and we're
7:06
doing everything we can to provide a health
7:08
in hand. But in addition,
7:11
they can go into our neighborhood care centers.
7:14
They can ask questions about the program. They
7:17
can take a class. We'll have cooking classes.
7:20
We'll have the, kind of coaching,
7:24
in the community
7:26
that you would expect for this kind of
7:28
lifestyle medicine support program.
7:30
So we come to it with it's almost
7:32
a three legged stool. The health plan, the
7:35
physician group, and neighborhood care,
7:37
all working synergistically
7:40
to help advance the health of the people
7:43
that we serve in New York.
7:45
Absolutely. And it really is incredible what you
7:47
both are describing that your members are gonna
7:50
be able to take advantage of these groundbreaking
7:52
clinical,
7:54
research. And then to your point, Karen, this
7:56
integrated care model will be able to deliver
7:58
that even more effectively,
8:00
to your population.
8:02
I do wanna touch on the neighborhood care
8:03
centers a bit more, as we go. But
8:06
before that, Dan, I wanna come back to
8:08
you and ask a bit more about
8:10
doctor Ornish's,
8:12
his his proven success with lifestyle medicine and
8:15
reversing
8:16
chronic conditions like heart disease.
8:19
What what are some of the results that
8:20
you're anticipating on the ground for the participants
8:23
in this program?
8:25
And and, ultimately, how are you gonna be
8:26
measuring that success over time?
8:28
Yeah. Great question. So I'll just start off
8:31
by saying, you know, we're doing something that
8:33
no other health plan has done. We're bringing
8:35
a clinically validated Alzheimer's lifestyle program for the
8:39
people who need it most, but we're also
8:41
measuring it in the real world. So what
8:44
we're doing is not just covering the program,
8:46
we're deploying a strategic approach.
8:49
I would compare it to coverage with evidence
8:52
development, which is a CMS
8:54
framework where we provide access to this breakthrough
8:58
approach, but we're really generating real world evidence
9:01
to determine the effectiveness
9:03
of this program in a diverse urban population
9:05
like we have at in New York City.
9:08
So what we'll be doing is, we'll be
9:11
checking in with our members who are enrolled
9:13
in the program
9:14
and ascertaining
9:16
their overall
9:17
sense of wellness and well-being here. We're gonna
9:19
be using something called the Clinical Global Impression
9:22
Scale,
9:23
which assesses
9:24
cognitive function, overall well-being,
9:27
impact of the program, sense of health and
9:30
well-being,
9:31
as well. And so this is a way
9:33
of us tracking our members through the program
9:36
longitudinally
9:37
to really ascertain if this program can be
9:40
further scaled,
9:41
nationally.
9:43
And I think just what you said there
9:45
is really important,
9:48
in terms
9:49
of wanting you're gonna be your intent is
9:51
to publish the results, to be
9:53
very transparent
9:55
about how this goes. We feel that we
9:57
have an obligation to do this, as Dan
10:00
said, for the field and for the broader
10:03
understanding
10:04
about
10:05
the importance of lifestyle medicine and what it
10:08
can actually do. And then, Dan, as you
10:10
were talking, it just occurred to me, doctor
10:12
Ornish, for decades, has issued a clarion call
10:16
about the importance of lifestyle medicine.
10:19
And I think it's exciting now the field
10:21
is generally beginning to catch up, and there's
10:25
far more
10:26
understanding
10:27
about
10:28
the role that lifestyle
10:30
plays in an individual's health.
10:33
And I think, Jacob, for us,
10:35
that's gonna be an opportunity
10:37
not only in this program for these members,
10:40
but to really take account of the effects
10:43
we're seeing so that we can determine whether,
10:47
other clinical conditions
10:48
can benefit from it. And, Dan, I know
10:50
you've been thinking
10:52
about cardiology. It's very well established, but other
10:55
conditions
10:56
that
10:57
where these interventions
10:59
could make a difference.
11:01
And the only other point to add here
11:04
is,
11:04
Dan, you might talk about how intensive
11:08
the, activity, the instruction, the support
11:12
is going to be for members and what
11:14
we're asking from them to participate
11:17
and, the time we're asking them to give
11:20
to really move the mark. So it is
11:23
very serious,
11:24
very scientific based program. But you might talk
11:27
about that because I think people would be
11:28
very interested.
11:30
Yeah. Absolutely. So, Jacob, I'll tell you a
11:32
little bit about how we're actually identifying these
11:35
folks, enrolling them, and then supporting them holistically
11:38
as Karen said. So I think first and
11:40
foremost, we're looking into our population of Emblem
11:43
members who could benefit from this program potentially,
11:46
and we're doing that by looking at claims
11:47
data and demographic data. And so we have
11:50
a nurse who calls the member directly, you
11:52
know, building off the trust we have with
11:54
the with the individual, explaining the program, and
11:57
informing them on next steps. And so the
11:59
next step is for them to have a
12:01
conversation with their primary care doctor at ACPNY,
12:05
where we're able to screen them for their
12:07
cognitive health through a validated,
12:10
clinical screener called the MoCA test.
12:12
And what we're really
12:14
benefiting from is that longitudinal relationship we already
12:17
have with the patient.
12:19
And then from then, we can enroll them
12:21
into this program. And so the program, as
12:23
Karen mentioned, is quite rigorous. So it's both
12:26
online in partnership with doctor Ornish, but also
12:30
in person with our neighborhood care centers. And
12:32
so participates will be,
12:35
engaged up to forty weeks. What we'll be
12:37
doing is,
12:39
first and foremost, giving them access to nutritious
12:42
plant based whole food meals and snacks,
12:45
all while teaching them the benefits
12:47
of preparing their own meals through cooking classes.
12:50
Right? And what's kind of, particularly exciting for
12:53
me because I'm a bit of a foodie
12:55
is we've teamed up with four
12:57
award winning chefs that are based in New
12:59
York City, and they they will actually be
13:01
designing the food.
13:02
So as we know, food is very personal
13:05
and an important element to most people's lives.
13:07
And so we really wanna make sure their
13:09
experience
13:11
within this program is joyful, and,
13:13
and it really will, we believe,
13:16
encourage them to stay adherent,
13:18
to the program. Right? And culturally culturally sensitive
13:22
too. You've spent a lot of time thinking
13:24
about that with your chefs, I know.
13:26
Absolutely. Yeah. I mean, we live in the
13:28
most culturally diverse, city in the world, I'd
13:31
say. And so we acknowledge that, you know,
13:33
food is highly culturally,
13:35
tailored to the individuals we're caring for. So
13:37
that's why we have four chefs that are
13:39
based in New York City and involved in
13:41
this program. The program will focus on,
13:44
daily moderate exercise and strength training.
13:47
I'm also teaching,
13:49
the participants techniques
13:50
designed to promote relaxation
13:52
and stress.
13:54
That's available online. It's also available at our
13:57
at our neighborhood care centers across all five
13:59
boroughs.
14:00
So and the participants can,
14:03
engage in group exercise, yoga, tai chi, learn
14:06
mindfulness, and stress management at neighborhood care as
14:08
well. We'll
14:10
we'll even be hosting cooking classes at our
14:12
neighborhood care centers.
14:13
And then finally, an important component to the
14:16
program is social connectedness. So we'll actually be
14:19
hosting
14:20
online small supportive groups where people can discuss
14:24
their journey, their transformation,
14:26
their engagement with the program.
14:28
So this is a really
14:30
robust holistic program,
14:32
that,
14:33
aims to really equip these people with the
14:36
tools and the resources to engage on this
14:38
lifelong journey of a more, helpful lifestyle.
14:42
And what you just said, I think, is
14:44
so important.
14:45
Just
14:46
it is,
14:48
when you ask people to make such significant
14:51
changes,
14:53
having the opportunity
14:54
to talk with other people who are going
14:57
through the same thing you are, there's power,
15:00
I think, in that. And I think we'll
15:01
be learning that,
15:03
Jacob, as we go. And I know Dan's
15:05
gonna be very acutely
15:07
aware and,
15:09
very, very focused on what are the things
15:12
we're learning, what works the best, etcetera.
15:15
But creating groups where people can participate together
15:19
and
15:20
commiserate
15:21
together.
15:22
I think that's really important,
15:24
to kind
15:26
of instill the changes that are gonna be
15:29
so important
15:30
for these individuals
15:32
to have a chance when heretofore
15:35
with early stage dementia, Alzheimer's, etcetera,
15:38
there hasn't been many chances.
15:41
And so that's part of the excitement for
15:44
us to,
15:45
not only to do the right thing for
15:47
our members,
15:48
but to see if we can contribute to
15:50
the broader understanding
15:52
of exactly how to do the right thing.
15:55
And that's what's exciting is I, you know,
15:57
have been watching
15:59
this program that Dan has begun
16:03
just get from, you know, the the beginnings
16:06
to thought stages to now actually
16:08
rolling out for particular people.
16:12
Certainly. This this is clearly
16:14
so groundbreaking, what you both are describing, and
16:17
the passion that you both have for this
16:19
is is really coming through. I can't imagine
16:22
a better place to launch something like this
16:24
than what you both have described in in
16:25
in the most diverse,
16:27
place on the planet. And, you know, I
16:29
think this is really going to resonate with
16:31
with the other health plan leaders listening in
16:34
right now, in terms of,
16:36
eventually, the results that you publish, how it
16:38
could impact their membership and other communities around
16:42
the country. So I wonder if you could
16:44
speak to that, Karen, in terms of how
16:46
do you foresee this partnership and this program?
16:49
What could this mean for the wider insurance
16:51
industry in terms of incorporating more lifestyle
16:55
interventions into
16:57
conventional treatment plans for for diseases like Alzheimer's?
17:01
I I'm happy to have an opportunity, and
17:03
I know Dan's gonna wanna say have some
17:05
very thoughtful things to say about this as
17:07
well.
17:08
First,
17:09
I it it is fair to say
17:11
that when we think about public health, when
17:14
we think about health improvement,
17:17
the health plan community is not the first
17:20
community that pea that come to people's minds,
17:23
without a doubt. But if you step back
17:26
and think,
17:27
we are the only entity within the health
17:30
care ecosystem
17:31
that actually touches patients in every encounter,
17:35
hospitals, physicians, nursing homes,
17:38
technology,
17:39
you name it, we touch them,
17:41
that we are uniquely
17:43
suited
17:44
not only and I think now it's become
17:46
well established that people are beginning to understand
17:49
how uniquely suit suited we are to address
17:52
social determinants.
17:54
Where uniquely because we are touching people, we
17:57
can see, and they talk to our caregivers
18:00
and our customer service agents. So to have
18:03
the opportunity to provide that help back to
18:05
them is very exciting and satisfying.
18:08
Similarly, in this regard,
18:11
I think, individuals
18:13
have not policy
18:15
leaders,
18:16
theoreticians
18:17
have not really thought of this health community
18:20
that we represent and the payer community
18:23
as a key, a secret sauce, if you
18:26
will, to health improvement.
18:28
But what Dan is describing
18:30
and what we're able to marshal
18:32
in terms of resources,
18:34
support, the comprehensiveness
18:36
of it, the ability to monitor,
18:39
etcetera,
18:40
is really a demonstration
18:42
that
18:43
we can actually
18:45
play such an important role as a health
18:47
plan
18:48
in health improvement.
18:50
And I think over time,
18:52
as
18:53
we we see more innovations,
18:56
as we see
18:57
more pilots, as we see more discussions about
19:01
value based care, etcetera,
19:04
that really moves the needle.
19:06
I think more and more individuals
19:08
will understand the role that we play and
19:12
the value of that ability to touch
19:15
individuals
19:16
in every health care context they find themselves
19:19
in. But it's our job
19:21
as health plans
19:22
to
19:23
be not only open to that, but be
19:26
very focused on that as part of our
19:28
mission.
19:29
And I think patients and members expect that,
19:32
and I think you'll see more from the
19:34
health plan community
19:35
in these kinds of efforts.
19:37
Dan, go ahead.
19:39
No. I couldn't agree with you more. I
19:41
think it was you said
19:42
so many great points, Karen. I'll just,
19:45
I guess I would just wrap by saying
19:47
that there are too many clinical innovations that
19:49
never make it in the hands of people
19:51
who need it the most. Yeah. That's right.
19:54
Yeah. I mean, I think we're flipping the
19:56
script here at EmblemHealth by bringing brain health
19:58
into the community, into primary care, into the
20:02
neighborhood hoods we're caring for, in those under
20:05
traditionally underserved,
20:08
communities. Right? So,
20:10
I think by deploying this lifestyle program and
20:13
studying it rigorously through the development of evidence
20:16
in a real world evidence study,
20:18
where we have the opportunity to pull forward
20:20
the future because the future really is a
20:22
holistic,
20:23
treatment
20:24
approach that contemplates pharmacotherapy
20:27
but also contemplates intensive lifestyle changes.
20:30
That's just incredible. Before we go,
20:33
anything else either of you wanna add? I
20:36
know, Dan, you you mentioned that with some
20:37
of your closing thoughts. Is there anything else,
20:39
Karen,
20:40
you you wanna share with our listeners?
20:42
I would just say one thing that Dan
20:44
and I have been talking about quite a
20:46
lot in
20:48
this context.
20:50
The number one
20:52
reason
20:53
that individuals
20:54
today
20:55
are coming into our neighborhood care centers,
20:59
It used to be
21:00
help with health concerns,
21:02
questions,
21:03
wanting to take a class.
21:05
All of that is still true.
21:07
The number one reason for people to enter
21:10
those doors and we serve everyone in the
21:12
community. You do not have to be a
21:14
member
21:15
of EmblemHealth,
21:16
and it's free to the community.
21:19
The number one reason people walk into the
21:21
doors today is food insecurity.
21:24
So Dan's program
21:26
to not only help people learn to eat
21:30
healthy, how to do that,
21:32
how to shop healthy in a bodega, for
21:34
example,
21:35
how to prepare healthy meals, but also to
21:38
have the ability to give them food that
21:41
demonstrates
21:42
what they're learning and being taught
21:45
and able to replicate this for their families.
21:48
I think
21:49
Jacob is really an opportunity
21:53
to make significant changes for people
21:56
who heretofore
21:58
have had
21:59
very little hope. So that's what makes me
22:01
proud about
22:02
EmblemHealth
22:03
and what we are doing
22:05
and to be,
22:07
here with Dan, our chief medical officer, who's
22:10
been so forward thinking about the opportunities here.
22:14
How do we take advantage of them? And
22:16
how do we do something
22:18
that is
22:19
really
22:20
innovative
22:21
for our members. And we're an ecosystem of
22:25
innovation
22:25
at EmblemHealth,
22:26
but this is a a proof positive of,
22:30
you know, just making a difference in a
22:32
community. I think that's what we're gonna find
22:34
here, and that excites me.
22:37
It's wonderful.
22:38
Well, Karen, doctor Nekt, I wanna thank you
22:40
both for taking the time out of your
22:42
days to to sit down with us and
22:44
for sharing about the impactful work that's going
22:48
on under your leadership at EmblemHealth.
22:50
We we really appreciate it.
22:52
Thank you. And to our listeners, if you'd
22:54
like to listen to more podcasts from Becker's
22:56
Healthcare, you can visit beckershospitalreview.com.