Mount Sinai Leaders Discuss the Future of Medicine at the 2018 Aspen Ideas Festival
Experts provide on-site complimentary skin cancer and healthy heart screenings
The future of medicine and health care delivery, the practice of precision medicine, and knowing your genome were among the topics highlighted by leaders of the Mount Sinai Health System during the 2018 Aspen Ideas Festival in Aspen, Colorado. For the sixth year, Mount Sinai participated in the ten-day festival, which is produced by The Aspen Institute and The Atlantic as a unique forum for the exchange of ideas.
During the Festival, Mount Sinai dermatologists provided complementary skin cancer screenings and clinicians from Mount Sinai Heart conducted heart health screenings to more than 1,300 participants.
"We care about your health and we take your care seriously," said Kenneth L. Davis, MD, CEO and President of the Mount Sinai Health System. "The high elevation in Aspen puts you more at risk for skin cancer. However, if skin cancer is identified early, there is a greater likelihood of treating it successfully."
Mount Sinai leaders discussed the Health System's dedication to advancing innovative models that allow care to be delivered in more effective and efficient ways. One of the largest integrated health care systems in the nation, Mount Sinai cares for more than 3.8 million patients each year.
"Currently, half a million patients at Mount Sinai are under a value or risk-based system where the insurance company pays a fixed fee to keep a certain population healthy," said Dr. Davis. "By moving away from the traditional fee-for-service model to population health care, we are better able to align incentives with clinical delivery. This result is keeping people healthy and out of the hospital."
"Part of my role at Mount Sinai is to work with health care partners on payment models that allow us to deliver care in more effective ways," said Niyum Gandhi, Executive Vice President and Chief Population Health Officer at Mount Sinai. "We must re-architect the financial model so that we can pay for keeping people healthy."
Drug prices and the social contract between drug companies, tax payers, and consumers were also a topic of discussion. "The polio vaccine was free," said Dr. Davis. "Imagine if we had priced the polio vaccine in terms of the savings in health care costs?"
"We see addressing the social determinants of health as critical to reducing the cost of health care. We need to recognize food insecurity issues as well as help patients find stable housing or transportation to and from their health care provider," said Prabhjot Singh, MD PhD, Director of the Arnhold Institute for Global Health and Chair of the Department of Health System Design and Global Health at Mount Sinai. "In addition, we need health care coaches who can be the conduit in addressing these social determinants and clinical issues together."
In an effort to better provide cost effective, compassionate care, the Health System has become a pioneer in providing services to the patient at-home, from hospitalization services to palliative care, as we as home-based primary care through the Mount Sinai Visiting Doctors program. Supported by the Centers for Medicare and Medicaid Innovation grant, the hospital-at-home program has resulted in shorter hospital stays, fewer readmissions, emergency-department visits, and transfers to nursing homes.
"Though the model is successful, and more cost efficient, we still cannot do this widely because few insurance companies have been able to develop a payment model for services," said Linda V. DeCherrie, MD, Professor of Medicine at Mount Sinai and Clinical Director of Mount Sinai at Home.
Experts from Mount Sinai also elaborated on the promise and practice of precision medicine and genomics, especially in cancer.
"We are able to conduct comprehensive molecular profiling of tumors to help guide treatment options," said Eric Schadt, PhD, the founder and CEO of Sema4, a patient-centered predictive health company spun out from Mount Sinai. "There is also the heritable side of your DNA - what you are born with and the risk that pre-disposes you for certain cancers. For example, the BRCA gene for breast cancer and ovarian cancer is increasingly seen as being important for men as it could impact their treatment for prostate cancer."
Judy Cho, MD, Director of the Institute for Personalized Medicine at Mount Sinai noted, "If you know your genome and you carry one of the high risk mutations for colon cancer, the goal is to screen early and more effectively for colon cancer. If colon cancer runs in your family, a very positive family history should also trigger a genetics test."
Knowledge of your genome can also make a difference in inflammatory bowel disease (IBD) and fatty liver disease. "We think this understanding will allow us to diagnose patients earlier and treat more effectively, as well as identify drugs that that will be most effective in patients," said Dr. Cho.
Alan B. Copperman, MD, a leader in the treatment of infertility and Chief Medical Officer of Sema4, spoke on the breakthroughs in state of the art, non-invasive testing for a pre-natal and newborn screening. "If a patient is found at risk of passing on an abnormal gene, in-vitro fertilization can be performed, and the embryo most likely to result in a healthy baby can be selected for transfer. It is a breakthrough that is beyond what we have ever imagined," said Dr. Copperman.
Health System leaders also discussed epidemics both global and national. Philip Landrigan, MD, MSc, a world leader in environmental and occupational health and Professor of Environmental Medicine and Pediatrics at Mount Sinai, discussed the immense impact pollution has on the public. Dr. Landrigan co-authored of the Lancet Commission on Pollution, which studied pollution and its impact for two years. "What we found was that pollution kills nine million people a year globally. A pollution mix of toxic chemicals can get into your body and cause asthma, heart disease, stroke and lung cancer. It is a dramatic impact on human health."
During a panel on gun violence, Dr. Davis noted that on average 92 people die every day of gun shots. "This is an epidemic. We see it in our emergency rooms. We see it in our surgical wards, and we see it in the morgues. It is time for the medical profession to be as strong as any other lobbying group as saying this is unacceptable. We have to decrease the number of deaths due to gun violence."
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.