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