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Co-Founder and CEO

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About <a href="https://www.greatplacetowork.com/certified-company/7011246" target="_blank">Farzad Mostashari, MD</a>:  Farzad Mostashari, MD is founder and CEO of Aledade, which partners with independent practices, health centers and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. Dr. Mostashari has spent his career at the forefront of health care policy and health information technology. He is the former National Coordinator for Health IT at the Department of Health and Human Services, and served as a distinguished expert at the Brookings Institute’s Engelberg Center for HealthCare Reform. Prior to his work at the Office of the National Coordinator, he founded the NYC Primary Care Information Project, which equipped 1,500 physicians in underserved communities with electronic health records. He has spoken and written extensively on issues affecting health IT, Accountable Care Organizations, and health care policy and delivery. He has been published in the New York Times, the Journal of American Medical Association, and Health Affairs, among others. Dr. Mostashari received his MD from Yale University School of Medicine and his Masters in Population Health from Harvard T.H. Chan School of Public Health.

COVID-19 Discussion with Farzad Mostashari, MD

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Chief Health Officer

There is a common saying that your ZIP code matters more than your genetic code. In short, where you live matters to your health risks and outcomes. But it shouldn’t. COVID-19 brought into much sharper focus the health disparities that have long existed within our communities. We better understood vaccination rates, hospitalizations and deaths based on your ZIP code. And it also further identified the gaps in care and treatments for many health conditions.  On the hopeful side, technology and data insights are being used to address health disparities, to prevent bias in care delivery and ultimately to help improve overall outcomes in all communities. Health “techquity” or the strategic design, development, and deployment of technology to advance health equity, empowers providers to look beyond clinical factors to get the whole picture of a person’s key indicators affecting health. Understanding a person’s social risk factors gives clinicians the ability to provide person-centric, equitable care and informs overall treatment planning.  Techquity helps. For example, the <a href="https://www.cerner.com/solutions/determinants-of-health" target="_blank">Cerner Determinants of Health</a> solution helps organizations advance whole person care by identifying and intervening on social risk factors through action-oriented community analytics and social determinants of health capabilities embedded within care management workflows. Lack of standardized data collection, incomplete data and limited resources and tools create barriers to adequately understanding and addressing the needs of populations. Using community social risk insights, coupled with EHR data and geospatial capabilities, it is possible to identify areas of elevated social risk, such as transportation barriers, air quality and food access, drilled down from a county to a census block group. These insights provide population health, care management and community health teams key details into social, economic and environmental risk patient populations may be experiencing in order to develop targeted interventions. These stronger connections to social needs impacting health – thanks to technology and data insights – are making a difference for the better, both to individuals and entire populations. As a global leader in healthcare technologies, Cerner has compelling examples of how data is driving more equitable healthcare in the U.S. and around the world: University of New Mexico Health Sciences Center: A screening tool allowed the hospital to get a better handle on the correlation between adverse social determinants and poor health outcomes in the diabetes population and those with other chronic conditions. The results led to a decision to hire community health workers for all primary care clinics and the emergency rooms. All patients can be screened to uncover and address important social risks. Roper St. Francis Healthcare in South Carolina: Using geospatial modeling, the system found that patients at risk for diabetes and hypertension congregated at an African American church. Partnering with church leaders – some of them nurses - the health system developed wellness programs, prevention strategies and health screenings. The result: risk levels in the population decreased 50%. NHS in the United Kingdom: Data in 2020 showed people with learning disabilities are six times more likely to be hospitalized with the flu than the general population. A solution: pop-up flu vaccination clinics tailored to people who have learning disabilities that resulted in a 92% increase in vaccinations for that population. Schools in the Middle East – A country in the Middle East is using data to make healthy decisions – for its entire citizenry! The government adapted school menus, decided where to put gyms and where not to put fast-food chains based on diabetes prevention.  These examples of techquity in healthcare are a multi-stakeholder effort. It takes all of us to create an equitable path to healing and better health for our communities. At Cerner, we created a collaborative with more than 50 organizations to focus on health equity and social determinants of health innovation. These are not just health IT leaders – these are hospital administrators, clinicians, social workers, care managers and population health leaders sharing successes and challenges in their efforts to improve the conditions in which their patients live.  Using helpful tools and data insights allow caregivers and care teams to spend more time with their patients. And techquity helps patients get access to the care they need by meeting them where they are at so they can enjoy healthy lives. Nasim Afsar, MD, MBA, is the chief health officer at Cerner.

Techquity: Using technology and data insights to deliver more equitable patient care

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President, Population Health at Providence; CEO Ayin Health Solutions

In the middle of the coronavirus pandemic, our response needs to be focused on reducing illness, providing care and saving lives. While we are doing what’s needed to reduce the spread of coronavirus, especially staying home, let’s not forget our vulnerable neighbors in our communities who also need access to information &amp; care. There are some people who are too often forgotten during national emergencies: those who are homeless, low-income families and immigrants. As most of us are sheltering in place and staying at home to prevent the spread of coronavirus, those who are homeless do not have a home to retreat to. This leaves them more exposed and at higher risk to contract the virus. Additionally, they do not have the same access to soap, water, disinfectants, etc. for basic prevention. This is where local community partnerships are immensely helpful. Partnering during public health emergencies is critically important and time sensitive. We all need to step up and offer assistance wherever we can. At Providence, we have taken the initiative to make donations to local food banks and shelters to ensure they receive the necessary supplies like soap and disinfectant. For now, while the coronavirus continues to spread, please consider donating supplies or funds to your local shelters, food banks and community organizations for the many people in need. Viruses don’t discriminate. We can’t hope to curtail the spread or reduce illness unless everyone in our communities has adequate information and the basic resources for prevention. For immigrants, I fear the U.S.&#39;s public charge rule could hamper efforts to raise awareness and control the spread of the disease. Any time there is a change in immigration policy, we see a decline in health care visits. Particularly in during a pandemic, if patients are not coming to us, that means we must go to them with proactive care. The last thing we need is for people to not renew their Medicaid, not come in and use their food assistance, or not seek our assistance for housing because they’re concerned that public charge is just another effort to put them in the process of deportation. They also may not be receiving the information necessary to keep themselves safe and minimize the spread of the virus. Those who may be fearful of facing consequences for seeking help from medical professionals or support from local officials may not be willing to come forward. One of the most important things we can do is provide immigrants with up-to-date information through a community-focused effort. Marginalized people aren&#39;t living in a box. They&#39;re part of our larger community. If we don’t include everyone in prevention, we will not be effective protecting the public’s health. When it comes to serving these vulnerable populations, the key is to deliver care locally. Some communities have been sharing information and best practices already, which is great. The best way to do it is to ensure that whoever is at the top level of the healthcare organization, system, etc. is tied to the head of the community level members. Care and the screening cannot be managed from headquarters; they must be managed locally. It is imperative to coordinate and get local partners and community members the resources they need.  Corporate and system leaders must understand the work that’s happening on the ground and the barriers frontline providers are working to overcome. At Providence, we have been communicating with the Catholic Health Association and the American Hospital Association to share best practices. We hope that this will help provide consistent messaging and a community-wide effort to mitigate the spread of the disease. These times are unsettling for all of us, but we are in it together and together we will persevere. Keep yourself safe, help those you can, consider donating locally and thank your healthcare workers.

COVID-19 Perspectives with Dr. Rhonda Medows

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Senior Principal, MercerWELL

Partner, Clinical Innovation Leader

Associate, Medical Consultant

The concept of “Food as Medicine” is simple: Food aids individuals by supporting health. It doesn’t replace medicine, but it has the potential to enhance it.  Does Food as Medicine have a role in employer health programs? Before we answer that question, let’s take a step back. It’s clear that there’s a dietary problem in the US. Only <a href="https://www.cdc.gov/nccdphp/dnpao/division-information/media-tools/adults-fruits-vegetables.html" target="_blank">1 in 10 people</a> in this country consume the recommended amounts of fruits and vegetables. Lower-income households <a href="https://www.ers.usda.gov/amber-waves/2008/november/can-low-income-americans-afford-a-healthy-diet/#:~:text=Low%2Dincome%20households%20tend%20to,nutritious%20foods%20than%20other%20households" target="_blank">consume less produce</a> and are at a higher risk for <a href="https://www.ers.usda.gov/webdocs/publications/99282/err-275.pdf?v=1931.5" target="_blank">food insecurity </a>and <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645" target="_blank">diet-related diseases</a>. Healthy eating habits can be hard to adopt or maintain for those living in food deserts or who have difficulty covering the higher costs of fresh, health-conscious foods.This is where the Food as Medicine movement comes in. Employers can potentially address food insecurity and nutrition insecurity by considering a benefit to deliver and/or subsidize healthy food.  Employers can also assist employees who are newly diagnosed with a medical condition, such as diabetes, not only by offering and/or discounting healthy food but also by providing access to a dietitian to provide culinary education and medical nutrition therapy. Specific nutrients in foods can play a pivotal role in preventing and even managing a number of health conditions. For example, the consumption of whole grains and vegetables has been associated with stopping hypertension and, similarly, eating a diet high in fresh fruits, vegetables, extra virgin olive oil, legumes, and fish has been tied to the prevention of chronic diseases. Employers can further support employees who are experiencing complex health issues by offering delivery of medically tailored meals (MTMs) once the patient returns home from the hospital. MTMs are fully prepared home-delivered meals designed by a registered dietitian to address specific medical needs. A recent study published in <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797397" target="_blank">JAMA</a> found that national implementation of MTMs for high-risk individuals could produce a net cost savings of $13.6 billion annually ($2,500 per patient year). While MTMs are not widely covered by public or private health insurance plans, pilot programs have shown significant decrease in hospitalizations and overall improvement in chronic disease management and some plans are taking steps in that direction. <a href="https://www.highmarkhealth.org/hmk/newsroom/pr/2022/2022-12-05-Medically-Tailored-Meals.shtml" target="_blank">Highmark Health</a> recently launched such a pilot for members with qualifying chronic health conditions who are at high-risk for food insecurity.  Produce prescriptions offer another more flexible Food as Medicine option that can be added to an organization’s wellness program or as part of a medical benefit for employees. For example, health plan <a href="https://www.hioscar.com/diabetes" target="_blank">Oscar</a> offers $100 per year for healthy groceries for members with type 1 or type 2 diabetes who have an annual physical or wellness visit. Generally, these “prescriptions” come in the form of a voucher for fresh fruits and vegetables. Many employers offer free wellness apps such as <a href="https://www.weightwatchers.com/us/" target="_blank">WeightWatchers</a> and <a href="https://www.noom.com/" target="_blank">Noom</a> that focus on nutrition; however, if an employee can’t afford fresh produce (over canned or processed foods) or if they live in an area where fresh produce isn’t readily available, they are less likely to see the full benefit of a wellness program.  Food as Medicine as part of the organization’s weight management strategyMany employers have programs in place to address obesity, which is associated with a number of chronic conditions and higher medical costs. The rapid increase in utilization of GLP-1 medications has raised questions about whether and how to cover these costly drugs. Food as Medicine can play a part in a comprehensive strategy to support weight management. In addition to the initiatives discussed above, employers can make it easier for employees to stick to a healthier diet with:  <ul><li>Healthy cafeteria and snack options</li><li>Onsite cooking classes and lunch and learns, offering chef-inspired and dietitian-approved recipes that are easy to recreate at home</li><li>Nutrition education sessions with registered dietitian nutritionists </li><li>Flexible work hours to support healthy lifestyle activities including time for mindful eating</li><li>Integrating nutrition support programs into existing EAP programs</li></ul> What does the future of this movement look like? As programs offered by early adopters become more mainstream, they will bring together food, healthcare and technology to support employees’ overall health and wellbeing in a more holistic, people-centric, and more effective, way. For example, if the algorithm or coach identifies financial barriers for the employee, then having the system tie in SNAP benefits information and SNAP-eligible foods into meal plans, recipes, meal delivery would be helpful.  For employers just getting started, think about which area to address first. For example, if diabetes is an issue for your population, you might choose to begin with specialized Food as Medicine support for members with this condition. You’ll also need to think about how to integrate Food as Medicine within your benefits ecosystem, what support you’ll need to administer it, and how you will define success. There are many ways to bring the Food as Medicine movement into your program. It won’t be hard to find one that is scalable for your population and helps to advance your program’s health and well-being objectives in a practical, visible, and meaningful way. This article first appeared on <a href="https://www.mercer.com/en-us/insights/us-health-news/" target="_blank">Mercer’s US Health News Blog</a>.

It’s Time to Bring “Food as Medicine” into Your Health Program

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