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Leading the Nation’s First Lifestyle Medicine Program for Alzheimer’s at EmblemHealth
00:23:03
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- [00:00]
Jacob Emerson
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 emblem Health, and Dr. Dan Necht is the Chief Medical officer also at emblem health. Karen. Dr. Necht, thank you both so much for taking the time to be with me here on the podcast.
- [00:22]
Karen Ignani
Thank you, Jacob.
- [00:23]
Dr. Dan Necht
Our pleasure.
- [00:25]
Jacob Emerson
And before we dive into what we want to talk with you both about, can you each tell us a little bit more about yourselves, your backgrounds and healthcare and what it is that you're doing today at Emblem Health? Karen, why don't you start us off?
- [00:37]
Karen Ignani
I'd be happy to. I'm the executive chair at Emblem Health, which means that I chair the board and have management responsibilities. And prior to that, I was the CEO here at Emblem Health for about 10 years. And prior to that, I was in D.C. for a significant part of my career at AHIP, which is familiar to all of your listeners.
- [01:01]
Jacob Emerson
Thank you, Karen. Glad to have you with us. Dan, how about you?
- [01:06]
Dr. Dan Necht
Hi. So I am Emblem Health'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 Emblem Health, 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 Emblem Health, I am a hospitalist at Mount Sinai Hospital, where I take care of patients on the weekends. Prior to joining Emblem Health, I've worked at a number of payers, and I am a lifelong New Yorker.
- [01:39]
Jacob Emerson
Wonderful. Well, we're really excited to dive into what sounds like is going to be a very impactful program for your patients and your members. And to our listeners, Emblem Health 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 other cognitive impairments?
- [02:13]
Karen Ignani
I appreciate your 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.
- [02:46]
Jacob Emerson
Absolutely. Please, Dan, take it away.
- [02:48]
Dr. Dan Necht
Yeah. Thank you, Karen. I appreciate the kind words. So it's increasingly clear that lifestyle choice 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 Emblem Health. In fact, it's now estimated that about 40% 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, Dr. Dean Ornish, who revealed that positive lifestyle changes can impact the trajectory of patients living with either mild cognitive impairment or which is the predecessor state to Alzheimer's as well as early stage Alzheimer's. That was one groundbreaking study. The other is the US Poynter trial, which looked at prevention of cognitive impairment for a healthy but at risk population for dementia. 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 at 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. We could bring this program to our population and those who need it most.
- [05:02]
Karen Ignani
And I want to 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 healthcare 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 what Dan described is our neighborhood care centers in the most underserved areas of the 5 Boroughs of New York will be the opportunity for people to not only to do. And Dan will talk about the online support, the coaching we're going to be doing, the food we're going to 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 healthy 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, of the people that we serve in New York.
- [07:46]
Jacob Emerson
Absolutely. And it really is incredible what you both are describing that your members are going to 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 want to touch on the neighborhood care centers a bit more as we go. But before that, Dan, I want to come back to you and ask a bit more about Dr. Ornish's, his proven success with lifestyle medicine in reversing chronic conditions like heart disease. What are some of the results that you're anticipating on the ground for the participants in this program? And ultimately, how are you going to be measuring that success over time?
- [08:29]
Dr. Dan Necht
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 to 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 going to 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.
- [09:43]
Karen Ignani
And I think just what you said there is really important in terms of wanting you're going to 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 Dr. 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 going to 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.
- [11:31]
Dr. Dan Necht
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 building off the trust we have 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 Dr. Ornish, but also in person with our Neighborhood Care centers. And so participants will be engaged up to 40 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 will actually be designing the food. So as we know, food is a very personal, on an important element to most people's lives. And so we really want to make sure their experience in this program is joyful and it really will, we believe, encourage them to stay adherent to the program. Right.
- [13:20]
Karen Ignani
And culturally sensitive too. You've spent a lot of time thinking about that with your chefs.
- [13:26]
Dr. Dan Necht
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, also teaching the participants techniques designed to promote relaxation and stress. That's available online. It's also available at our Neighborhood Care centers across all five boroughs. Participants can engage in group exercise, yoga, tai chi, learn mindfulness and stress management at Neighborhood Care, as well as 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 healthful lifestyle.
- [14:43]
Karen Ignani
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 be learning that Jacob, as we go. And I know Dan's going to be very acutely aware and very, very focused on what are the things we're learning, what works the best, etc. 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 going to be so important, important for these individuals to have a chance when heretofore with early stage dementia, Alzheimer's, etc. There hasn't been many chances. And so that's part of the excitement for us too, 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've been watching this program that Dan has begun. Just get from the beginning thought stages to now actually rolling out for particular people.
- [16:12]
Jacob Emerson
Certainly this is clearly so groundbreaking. What you both are describing and the passion that you both have for this is really coming through. I can't imagine a better place to launch something like this than what you both have described 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 in other communities around the country. So I wonder if you could speak to that, Karen, in terms of how do you foresee this partnership in this program? What could this mean for the wider insurance industry in terms of incorporating more lifestyle interventions into conventional treatment plans for diseases like Alzheimer's?
- [17:01]
Karen Ignani
I'm happy to have an opportunity and I know Dan's going to want to have some very thoughtful things to say about this as well. First, 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 come to people's minds, without a doubt. But if you step back and think we are the only entity within the healthcare 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 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 in 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 motivate marshal in terms of resources, support the comprehensiveness of it, the ability to monitor, etc. 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 see more innovations, as we see more pilots, as we see more discussions about value based care, etc. 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 healthcare 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.
- [19:39]
Dr. Dan Necht
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, yeah. I mean, I think we're flipping the script here at Emblem Health by bringing brain health into the community, into primary care, into the neighborhoods 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, 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.
- [20:31]
Jacob Emerson
That's just incredible. Before we go, anything else either of you want to add? I know, Dan, you mentioned that with some of your closing thoughts. Is there anything else, Karen, you want to share with our listeners?
- [20:42]
Karen Ignani
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 Emblem Health 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 Emblem Health 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 Emblem Health. But this is a proof positive of, you know, just making a difference in a community. I think that's what we're going to find here, and that excites me.
- [22:37]
Jacob Emerson
It's wonderful. Well, Karen, Dr. Knecht, I want to thank you both for taking the time out of your days to sit down with us and for sharing about the impactful work that's going on under your leadership at Emblem Health. We really appreciate it.
- [22:52]
Karen Ignani
Thank you.
- [22:53]
Jacob Emerson
And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Becker's Hospital review.
- [23:00]
Dr. Dan Necht
Com.