Tucked away in an office on the campus of the Icahn School of Medicine at Mount Sinai is a futuristic medical clinic—Lab 100—that provides patients with a 90-minute comprehensive health checkup using the latest technology to measure their vital signs, their strength, cognition, balance, and dexterity. Designed as a complement to a primary care visit, Lab 100, which opened to the public in October 2018, provides patients with information that can help them lead a healthier lifestyle. It serves as a digital biometric health screening that alerts patients and practitioners to areas of their health they need to improve, such as poor sleep habits or a stronger core that can be achieved through yoga or a different exercise routine.
“Our goal is to empower patients by rapidly and transparently providing them with their own personalized health data,” says Marina Gazayeva, NP, Lab 100.
Lab 100 patients fill out an online questionnaire in advance of their appointments. When they arrive at the clinic, they visit eight health stations, including one that measures their body fat ratio and skeletal muscle mass. At the conclusion of the visit, their health results are posted on a large digital screen that serves as a point of discussion between the patient and a Lab 100 nurse practitioner. Within 24 hours after their visit, patients receive a health report card of their results, with recommendations for improving their health.
The cost of a visit, which is not covered by medical insurance but may be covered through a health spending account, is $199 for Mount Sinai Health System employees and $399 for nonemployees.
Donald Mashni, PharmD, right, with David L. Reich, MD, center, and José Almonte, Director, Specialty Pharmacy Call Center.
A new option is now available for Mount Sinai Health System patients and employees who have rare or chronic disorders that require complex medications such as immunotherapy or chemotherapy—the Mount Sinai Specialty Pharmacy. The facility, which opened in June at The Mount Sinai Hospital, helps patients seek insurance approval and financial assistance, and relieves the administrative burden of physicians, with the ultimate goal of improving patient outcomes.
“The Mount Sinai Specialty Pharmacy will offer patient-focused, convenient, and affordable services for all our patients,” says Donald Mashni, PharmD, Director, Specialty and Outpatient Pharmacy, Mount Sinai Health System. Specialty pharmacies dispense complex medications that require special storage and handling and ongoing clinical support and monitoring by specially trained pharmacists.
When patients and doctors present specialty prescriptions to the Mount Sinai Specialty Pharmacy, the pharmacy staff can assume the important tasks of securing insurance approval, financial assistance, and clinical counseling. Pharmacy staff also coordinate delivery to the patient’s home or to the physician’s office. “Our facility will tie everything together,” Mr. Mashni says. “The goal is to keep all patient care inhouse, from diagnosis through post-treatment follow-up. This approach provides thorough and immediate communication among pharmacists and specialists. It also improves the efficiency and accuracy of the medications.”
For example, one commonly prescribed specialty drug is adalimumab, or Humira, an advanced biologic medication for severe Crohn’s disease and rheumatoid arthritis. Patients inject a pre-filled syringe every other week. The drug must be refrigerated, and each syringe must be used in full and injected in the thigh or stomach, in a different spot each time. The patient should not skip a dose or stop taking the medication without consulting a physician or pharmacist. “Adherence to the treatment schedule is critically important,” Mr. Mashni says. “It maximizes the benefit patients get from the medication and improves outcomes.”
Specialty medications once were a niche market. But advances in drug research mean they are available for many more conditions. The U.S. Food and Drug Administration approved 39 new specialty medications in 2018, according to Specialty Pharmacy Times, and because they can be so costly, specialty drugs are expected to account for almost 50 percent of drug spending by 2020, although they represent only about 2 percent of the total prescriptions filled.
The Mount Sinai Specialty Pharmacy is launching services in therapeutic categories that include HIV, hepatitis C, inflammatory bowel disease, rheumatology, dermatology, and oncology. It shares space with the Mount Sinai employee pharmacy in the Annenberg Building and functions like a traditional specialty pharmacy but with the advantage of full integration with Mount Sinai’s hospitals and physicians. The Health System also operates two other specialty pharmacies, which are part of the Institute for Advanced Medicine and specialize in treating patients with HIV. They are the West Village Pharmacy, at the Center for Transgender Medicine and Surgery, and the St. Luke’s-Roosevelt Outpatient Pharmacy in the Samuels Clinic at Mount Sinai West.
A new Call Center, adjacent to the Mount Sinai Specialty Pharmacy at The Mount Sinai Hospital, is centralizing all of the Health System’s specialty pharmacy services and fulfillment, with Call Center staff coordinating prior authorization, financial assistance, and delivery of medications. These services are essential as the Mount Sinai Specialty Pharmacy is seeking accreditation from URAC, the gold-standard accrediting body for specialty pharmacies. URAC accreditation will allow the pharmacy to gain access to more limited-distribution drugs and get contracts with more insurance plans.
“The Specialty Pharmacy is enabling Mount Sinai to provide seamless service for patients with complex and chronic illnesses, from diagnosis through treatment and long-term aftercare,” says David L. Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, and President of Mount Sinai Queens.
Faculty and staff of the Department of Medicine (Cardiology) took part in International Yoga Day. Front row, from right: Annapoorna S. Kini, MD; Lori B. Croft, MD, Associate Professor; and Joseph M. Sweeny, MD, Assistant Professor.
Mount Sinai Heart faculty and staff recently participated in International Yoga Day at Guggenheim Pavilion, with multiple sessions starting at 7:30 am. However, the enthusiasm for the practice goes well beyond a one-day event. The organizer, Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory at The Mount Sinai Hospital, and the Zena and Michael A. Wiener Professor of Medicine, Icahn School of Medicine at Mount Sinai, practices yoga herself and recently published a list of recommended yoga and meditation techniques in the CRT Times, including a 10-minute sequence specifically for physicians in the Cardiac Catheterization Laboratory.
Dr. Kini says, “At Mount Sinai, we strongly advocate yoga and meditation to counter musculoskeletal discomfort, to relieve stress, and to maintain focus and concentration.”
From left: panelists David Muller, MD, FACP; Erica Rubinstein, LCSW; and Chaplain Rocky Walker, MDiv; keynote speaker Mary-Frances Winters; Pamela Y. Abner, MPA; panel moderator Maxine Legall, MBA, MSW; and Gary C. Butts, MD, Dean for Diversity Programs, Policy and Community Affairs, Icahn School of Medicine at Mount Sinai.
Participants received information on efforts throughout the Mount Sinai Health System.
At a networking and informational session, Nolan Kagetsu, MD, FACR, left, Vice Chair Quality, Associate Professor of Clinical Radiology, Department of Radiology, Mount Sinai West, talks with Mari Umpierre, PhD, LCSW, Director, Mount Sinai Calm, right, and Shehan Chin, LMSW.
From left: Edgar Vargas, MPH, LMSW, LGBT Program Manager; Leona Hess, PhD, Director of Strategy and Equity Education Programs; and Bee Jaworski, Education Program Assistant in Medical Education
At the start of a meeting, give participants a few moments to reflect quietly on the subject at hand, then call on each person for their thoughts. When people do speak, “listen to understand, and not to reply.”
These were some of the specific and achievable strategies discussed in the inaugural Health Care Inclusion Summit, which was in June at the Corporate Services Center and sponsored by leadership in Service Excellence and Patient Experience.
The keynote speaker of the event was Mary-Frances Winters, founder and Chief Executive Officer of the Winters Group, a consulting firm that has been working with top leaders of the Mount Sinai Health System on inclusion strategies for more than a year. “It is important to recognize that inclusion is a developmental process,” Ms. Winters said. “We must address changes in attitudes one stage at a time.”
Ms. Winters used an interactive tool to ask the 150 attendees how they defined themselves. The anonymous answers appeared on a screen at the front of the room: A daughter, a Buddhist, an African American mom, a gay man, a husband, a millennial, a person with ADHD. These “identity markers”—some visible and some not visible—influence how each person sees and reacts to the world, Ms. Winters said, and understanding this is the beginning of understanding and accepting others.
Panelists during the half-day summit were David Muller, MD, FACP, Dean for Medical Education, Icahn School of Medicine at Mount Sinai; Chaplain Rocky Walker, MDiv, Center for Spirituality and Health, Mount Sinai Health System; and Erica Rubinstein, LCSW, CPXP, Vice President, Service Excellence and Patient Experience, Mount Sinai Health System. Maxine Legall, MBA, MSW, Assistant Director, Patient Experience, Mount Sinai St. Luke’s, served as the moderator.
The panelists said that both staff and patients were benefiting from inclusion efforts—which have the overarching goal of making every person feel heard, understood, and respected. Among other measures, the Health System has revamped a panel that addresses patient complaints and created the Strategic Leadership Collaborative to improve equity in medical education. In addition, ODI has expanded its portfolio of education and training on unconscious bias, LGBTQ health care and workplace equity, and cultural and disability awareness.
Leona Hess, PhD, Director of Strategy and Equity Education Programs for Medical Education led a discussion on the mindsets of the inclusive change-maker with Ann-Gel Palermo, DrPH, MPH, and Chief Program Officer. Attendees were advised to focus on how their mindset as a leader was created and how it informs their interactions with staff and patients. “Understanding your own personal and social identity is critical for the development of the skills and behaviors needed to understand, work with, and integrate the perspectives of staff and patients with a diversity of identities.” Dr. Hess said.
Planning is already underway for a summit next year, said Pamela Y. Abner, MPA, CPXP, Vice President and Chief Administrative Officer. “The response has been overwhelmingly positive,” she said after the event. “We see an opportunity to make inclusion and equity even more integral to patient care, medical education, and every other facet of the Health System.”
Takeaway thoughts
“I have grown into the understanding that others face challenges that I’m not aware of. When I went to seminary for four years, one of my biggest takeaway lessons was what women go through in this world.”
Chaplain Rocky Walker, MDiv
“You have to stay open to different perspectives and different mindsets. Be open to other voices that might challenge you.”
Erica Rubinstein, LCSW, CPXP
“Inclusion begins with I and happens with us.”
Mary-Frances Winters, Founder and Chief Executive Officer of the Winters Group
“I have learned that you have to have humility—professionally and personally. Just take a step back and listen to people.”
Charlotte Vrod, left, an aspiring tennis player, at the US Open with Alexis Chiang Colvin, MD, an orthopedic surgeon at Mount Sinai who helped Charlotte get back on the court after tearing her ACL.
It’s one of those diagnoses every young athlete, and their parents, fear: A torn ACL—the anterior cruciate ligament, one of the major ligaments in the knee.
The injury can happen to young athletes who play sports that involve twisting, turning, jumping, and rapid changes in direction, such as soccer, basketball, football, and tennis.
“We are seeing a trend with so many more kids playing sports these days,” said Alexis Chiang Colvin, MD, Associate Professor of Sports Medicine in the Leni and Peter W. May Department of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai. Dr. Colvin is also the Chief Medical Officer of the US Open and team physician for the US Fed Cup team. Mount Sinai is the official medical services provider of the USTA Eastern Section and the US Open.
Charlotte Vrod had a classic case of an ACL tear. An advanced junior tennis player, 14-year-old Charlotte was doing some intensive conditioning work at the John McEnroe Tennis Academy in New York where she was training. During a drill, she sprinted and then stopped suddenly. That’s when she heard and felt a pop, and felt her left knee cave in. She could barely walk. Her trainer could immediately see something was wrong.
Charlotte and her mother chose to return to Mount Sinai for her knee injury where she had had previous orthopedic care. She saw Dr. Colvin, who discussed treatment options with her and her mother. Ultimately, they decided to proceed with ACL reconstruction in order to allow her to pursue her dream of playing college tennis. Without surgery, Charlotte would have trouble even playing tennis for fun, according to Dr. Colvin.
A week later, she had the surgery to reconstruct the ACL—a ligament which provides stability in the knee—and to repair the meniscus, a pad that forms a cushion between the bones of the knee. One reason she and her family picked Dr. Colvin was knowing that she had worked with some of the world’s top tennis players at the US Open.
After eight months of rehabilitation, Charlotte, now 15, has resumed playing tennis. She’s optimistic about the future, and so is Dr. Colvin, who visited with her at the US Open this year.
“The amazing thing about Charlotte is her attitude. From day one, she’s been so positive,” said Dr. Colvin, who specializes in the surgical treatment of knee, shoulder, and hip disorders and has extensive experience in treating athletes. “It has been a long road for her. But she has always rolled with the punches. Now I am seeing her on the US Open grounds as a spectator. I hope to see her in a couple of years playing on the courts.”
For Charlotte, who began playing tennis when she was five years old, the recovery period has been an opportunity to appreciate how much she enjoys tennis and how fortunate she is that she can expect to return to the game. But the recovery has required a commitment to physical therapy and a change in attitude.
“One thing I learned is that it’s okay to take a minute and stop playing because you need to take care of yourself,” she said. “Even though I was really into tennis, I had to stop. I will get back to it.”
In fact, she came to enjoy the physical therapy and working with a personal trainer on targeted strength and conditioning for tennis.
“It was hard, but surprisingly it was actually a lot of fun,” she said. “PT was always something I looked forward to. I went three times a week before school.”
Now she’s looking forward to returning in the fall to playing varsity tennis at Trevor Day School in New York City. Then she hopes to resume training at the John McEnroe Tennis Academy and playing in some USTA tournaments in New York and New Jersey. She says she’s a bit emotional about it.
“I am not going to lie. Recovery was hard both mentally and physically, but it was all worth it because I learned so much from this journey,” she said. “It was hard in the beginning because the courts felt so far away, but I got my head into the game and just put everything I had into recovery and self-care. As I was working harder and passing milestones, like starting to walk again without crutches or even when I was able to bend my leg an extra five degrees, it made recovery so much easier and made the courts seem closer than ever.”
Jeannie Gaffigan, left, and, at right, Ms. Gaffigan with her family.
Five kids. Four Grammy nominations. One pear-shaped brain tumor. When a life-threatening diagnosis turns comedy writer, producer and director Jeannie Gaffigan’s life upside-down, she and her husband, comedian Jim Gaffigan, turn to faith, family, and of course—humor.
Ms. Gaffigan was successfully treated for a large and rare brain tumor by Joshua Bederson, MD, Chair of the Department of Neurosurgery at the Mount Sinai Health System. In the operating room, Dr. Bederson used virtual reality technology that he pioneered to help surgeons operate more safely and precisely.
Ms. Gaffigan talks about her terrifying health crisis and how it’s served as a source of renewed purpose for both her and her family. Her new memoir, “When Life Gives You Pears,” will be published October 1.
Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families and communities, the podcast explores what’s possible when science meets the human spirit. To listen, visit Apple Podcasts, Spotify, Stitcher, Google Play, or the Road to Resilience website.
