Dr. Michelle McMurry-Heath, President and CEO, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Senior Vice President, Enterprise Clinical Strategy and Quality, Humana
Nick Stefanizzi, Chief Executive Officer, Northwell Direct 
Moderator: Arianna Huffington, Thrive


Brainstorm Health 2022 - How Prevention Can Prevail: The First-Mile Approach 

Conferences

Dr. Michelle McMurry-Heath, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Humana
Nick Stefanizzi, Northwell Direct 



Brainstorm Health 2022 - How Prevention Can Prevail 


Dr. Michelle McMurry-Heath, President and CEO, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Senior Vice President, Enterprise Clinical Strategy and Quality, Humana
Nick Stefanizzi, Chief Executive Officer, Northwell Direct 



Brainstorm Health 2022 - How Prevention Can Prevail: The First-Mile Approach 


are you all feeling relaxed? Have you moved from the sympathetic to the parasympathetic nervous system? Our job is to get you back to the sympathetic nervous system by telling you about all the problems that we are trying to solve at the last mile of healthcare and why this amazing panel is working hard to try actually and move us upstream and address problems before they become chronic conditions. So um I'm really excited to be talking with you as you know, this is a very personal passion of mine. So I would like to start with you Michelle because when we think about health care, a couple of images that come to mind are a doctor's office or an emergency room, but that's really sick. Yeah. So why so little attention, so few resources relatively about 3% of the massive healthcare budget being spent on prevention on what we're calling the first mile? Well, as the daughter of a public health nurse who used to go door to door in the bay Area, I can tell you it's a shame that we don't spend more on preventive care and services and there's so much that needs to be done in that space. But I think it's important as we open that aperture back up again following Covid that we remember that technology can also be a very important part of that prevention, particularly as we're trying to get clean air, clean water and nutritious and vegetables to communities in need and mana having come to humana from HHS who were just joking that She is now dealing with a company that has a mere $65 billion dollar budget having come from An operation that had a $1.3 trillion dollar budget. And but in both, you know, the government and private private sector, we see again the same reluctance to address the problems and while there are still daily habits and before they become chronic conditions. No, I think it actually starts with even earlier in our medical education system. When I think back to my training and I and I went to Hopkins um you know, the focus is on just medicalization of everything. Um when I think about the second year of medical school, it's um I think in service of in many ways of the pharmaceutical industry, right, we are learning about medications and and and drugs were not learning really about the importance of food and right nutrition. We um we give lip service to it, but we don't really think about how important that is and Um the focus on both nutrition, but also all of the other things that we now call social determinants of health, which is really 80, of what impacts our health care over the course of our lives is not a part of the structure in which we, in which we operate within the health care system. For the, for the most part, right? It it is not um we don't have approaches for how we think about scaling those programs. Um so I I do think that we have to address both, how we go upstream and the education system and really think about to focus on the whole person on nutrition on communities and how we support communities, um but then also when we do have these efforts around addressing social determinants of health, how we set them up so that they are actually scalable that they're not living in pilot health forever, right, that we are doing one transportation pilot here and one food initiative here, but how are we really working across um a set of partners in the ecosystem to make sure that uh those those local uh those those local entities are really supporting um the patients in the communities in ways that are scalable, you know, let's take a specific example because Humana gave 116,000 ft bed um to Medicare advantage plan members, how did that work out? So you know, you see variable engagement um across some of these, Right, and I think it's uh these are really important initiatives because being aware of your own health is really a first step in and being able to manage your health and and being able to advocate for yourself. So I think we have to continue with those initiatives, I think we also have to help people in seeing how tracking these things are actually is actually impacting their health and and and enabling them to stick with it for a longer period of time um and not and for it to not be a size thing right for it to for for them to understand how is the information that is getting collected then feeding into their interaction with their provider, how is the provider using that to have a conversation with them and then having an intervention that is caring for both that kind of information, but also more of the clinical information and combining those. I don't think we have the infrastructure right now fully for those things to get supported in the, in the ways that I think we would want for it to scale. Um and what's unfortunate is that, you know, folks like us and looking around to see how many people here are wearing some device and you know, most of us are um but it's really the most vulnerable that I think um often don't get access and and aren't able to sustain their engagement with those and given the prevalence of employer provided health insurance coverage in the US, what role do you think businesses can play to accelerate the shift um, from providing sick care basically to prevention in the first mile. Yeah, I'm glad you asked about employers and I just want to say, I was in full agreement with what you said in the opening session earlier about how business leaders have become health leaders and I think there's another opportunity just like there was in covid for business leaders and employers to lead the way here. And if you think about it, why There are a 155 million people in this country who have access to health insurance by virtue of participating in an employer sponsored health. It's a tremendous number. Um and in my view, employers not only have an interest but an imperative to do something. You know, if you look at the last five years of trend line on the premiums for those health plans, they've increased 22% and employees on average are Paying 22% of the cost share of those premiums. And the C. H. R. O. And the Cfos know this conversation well every year, how much of that premium is going to get absorbed by the business and how much is going to get passed on to the employee. And I think that conversation has become much more difficult now with the inflationary pressures across the country, but I also think Covid has changed what's expected by employees of their employers. That's become particularly acute given the great resignation. And I think the employers of choice going forward are going to be those that are making the investments in health well being and the resiliency of their workforce. That that first mile type of mindset is going to position those employers to win, but that it also makes sound business and financial center over the long term to make that shift to make those bold choices and those investments. Yeah, that's the big mindset shift to realize that it's not just a nice to have benefits, but measurable in business metrics, tangible to the bottom line in both the short and the long term. Because if you think about what the drivers of those costs are, it's chronic conditions that aren't managed effectively that get out of control. Uh, it's unnecessary admissions into the hospital because care isn't being coordinated. Um, the investments in the short term in changing the paradigm of how health care is organized in my view will yield a lot of value in this. And Michelle we can go even further upstream. You know, Nick talked about managing chronic conditions holistically and that's of course very important. But what about preventing chronic conditions from occurring? I mean, we know for example, that diabetes and heart disease and hypertension are to a very large extent preventable. Who is the lifestyle changes stress reduction. So what can biotechnology do and to go out to help us go upstream. Yeah. And so essential that we do go upstream, you know, another quella of the covid pandemic is that we're facing a tsunami of chronic Non communicable diseases. Because the normal prevention efforts that we've relied on for the last 10 or 20 years have totally fallen off the radar in that time period. So we need to be able to engineer a healthier generation coming up and we need to use technology also to better predict and identify who is likely to become ill um, in a way that we haven't relied on before. So if you think about it, I'm I'm a pediatrician by training. If you think about how you grow a generation of healthy kids into adults, you need clean air, you need clean water, you need healthy fruits and that are also accessible, affordable and attractive to those populations. And you know, we have companies like Benson Hill that are bioengineering micro crops of fruits and vegetables that are designed to grow in hydroponic settings, meaning you can grow them in the deserted strip mall down the street from the bodega and have, you know, very affordable and accessible food that's actually engineered to taste better, have more protein, you know, apply everything that those growing bodies need to become successful healthy functioning adults. So this is something that we have to focus on. And it's it's a question of not just health, but it's also a question of just and we have a book coming out called Just Science which is about how we can use technology to equal the in just playing field to really help poor communities, you know, be freed from from illness and other things that hold them back from achieving dream. And most people think of humana as an insurer, but in fact more than half of your employees working direct clinician roles, what can they do, um, to become agents of a greater focus on prevention. Yeah, well I would just say, you know, in addition to the insurance like my for folks who don't realize that we um have a large presence of senior focus primary care clinics. We have a emphasis. We now own the largest home health company. Um We have a an enormous focus on building communities through R. S. D. O. H. Efforts um and also um an increasing focus on on behavioral halt. So yes, we have a large clinician workforce, but we also have um direct uh care that we're providing through all of these different channels. And also really trying to think about how do we move care from the traditional brick and mortar systems that we are used to which are really more about medicalization and and more into home and community based settings I think along with that and and and you know, to your your point to what I what I think sometimes we are faced in within the healthcare um conversation is we we've generally interacted with people in those brick and mortar systems like right when there's an emergency or something is needed or we're really trying to address an acute issue. Um I think the model for engagement also has to change and I don't think we fully understand what it is that we need to do to engage people at the right time. Um and how do we really uh behavioral change? We talked about a lot in healthcare is one of the hardest things to do. Where how do we begin to think about the right moments in which to engage an individual outside of those traditional settings? What are those communities, community efforts that we need to engage in to to get people to focus more on on prevention? How do we partner with with other entities in in ways that we haven't done before, you know, to our conversation um that really focused on health and wellness that that aren't focused on, what are we doing for that individual after they have an er visit or after they're getting discharged, which is really primarily where the healthcare ecosystem focuses in on um and uh you know, we haven't solved it by, by any, by any means I think is one of the hardest things to address, but and what we saw during the last two years I think is really people coming together and breaking silos across businesses to work together. Um and it wasn't this sort of competitive thing of um you know, this is, this is my lane and this is yours or we're competitors. So we're not going to partner. I think it was folks really leaning in to say, how do how do we engage in partnerships in a, in a much more meaningful way to accelerate the work that we're all trying to do. And my hope is that in, in, in this, in this evolution of so many of our companies really focusing on health and wellness that we do bridge these partnerships with people we may have never uh done work with, but who can help us in getting to the right people at the right time to really have that conversation around engagement and and behavior change and nick, you know, Mona talked about incentives to help change behavior, which as we know, is very hard, but they're also the financial incentives based on the fact that premiums keep going up. So why can't we use this financial incentives more effectively? So let's say even if people didn't care about anything else, they clearly care about saving money. So how can we appeal to that base instinct? Well, we talked about this a little bit earlier in the lunch, there are some structural challenges that we have in the system. Um we have a lot of middlemen that exists throughout the healthcare ecosystem and there's questions about whether or how they add value uh to the overall process. But I think again, just back to the fact that employers are responsible for a lot of the health care coverage in this country, there's an opportunity through things like benefit design in partnering with HR leadership in these organizations that can help to drive and incentivize the right behaviors. So we see innovative partners around the country doing things like leveraging wellness credits to try to drive the right behaviors and get the employees engaged in proactive, We see things like copays and deductibles that helped to steer people towards the right types of care at the right time and getting ahead of particular conditions. We also see people encouraging and incentivizing participation in uh, disease specific or chronic care type manage management program to try to help people more effectively take control of their care. So I think there are a lot of levers that we can pull and we ought to think about how to partner with the right folks, whether it's at the employer level or whether it's structurally and we and we can do things, you know, going direct to employers, direct to providers without middlemen sitting between us to try to start to address. Thank you nick. So I'm planning to end all the panels that are moderating by asking the panelists a personal question because ultimately health care is personal. We talk about premiums and middlemen, but ultimately healthcare is the sum total of our daily habits, 90% of the time. Sure, there's 10% that is outside our control, But 90% who can control. So I want to ask this extremely busy people in very stressful job, what are you guys doing to take care of yourself? What are you doing to prevent as the development of chronic conditions in your own lives and in your family's life, Michelle Well, with a 10 year old, I spent a lot of time running around this morning. But I think, you know, one of the things that I've tried to also leave my organization in is really opening this portal to meditation. I think that's something that we haven't talked about enough in terms of, and you heard it earlier in the previous panels, you know, really relieving stress and giving people a sense of more control over not just their time and their day, but their body and their health. Um, and so I think that's key and you do that every day. I do it three times a week. So you don't manage micro steps, we call them a drive that somewhere greater mana. So I'm a little bit of a health nut. Um, I will say I, I'm fairly regimented. I wake up really early and I get my workout in every day. I'm a big believer in physical and, and, and spiritual and um, and you know, nutrition, so I do focus on on all three. Um, I try to meditate, but I also try to um read a fair amount in this space. Um, sleep Ariana is the one thing that I continue to struggle with. It's um, it's the one thing that I, uh, you know, my, my, my tracker is not happy with me. Um, you know, so I, that's the one place where I struggle and I'm continuing to focus, but the physical, the workout and the, and the nutrition, if I feel like if I don't get that right. Um, really, I can't show up for anybody else if I can't show up from, I'm very happy to be your personal sleep coat. Actually, my first recommendation is sleep rather than set the alarm on to go exercise in the morning because if you don't get enough sleep, um your body is going to crave that throughout the day. We can talk more about that. Guys, you have complete permission for the sleep advocate here to forget the morning exercise and sleep in and get your exercising later. Even if it's less than great, I'm getting coached. So so I worship at the sleep altar of Ariana. I am, everybody that works with me knows that I am useless late at night. Uh and so I am very diligent about trying to get to bed at the same time every night to the extent possible getting a full night's sleep and rest and then getting up early because that's when I tend to to be at my best. Well thank you so much and and thank you all for listening and maybe you can think of what are your micro steps, the things you can do every day to improve our health. We cannot learn from each other. Thank you