Kenneth L. Davis, MD, led a luncheon roundtable discussion on rising drug prices.

New models of care that keep people healthy—rather than intervening only when they are sick—were the focus of experts from the Mount Sinai Health System, which participated for the sixth time in the annual Aspen Ideas Festival. Presented by the Aspen Institute and The Atlantic magazine, the festival in Aspen, Colorado, which ran from Thursday, June 21, through Saturday, June 30, is a gathering place where thought leaders across many disciplines engage in an exchange of ideas.

“How do we keep people well? How do we keep people out of the emergency room? We think about this all the time,” Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System, said in “Health Systems of the Future,” a key panel discussion. “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.”

Next generation health care was discussed by, from left, Eric Schadt, PhD; Alan B. Copperman, MD; and Judy H. Cho, MD, in the panel “Saving Lives Through Genomics.”

Jesleen Ahluwalia, MD, Assistant Clinical Professor of Dermatology, screened festival participant Sam Abdelhamid.

Mount Sinai demonstrated its dedication to wellness and prevention by providing more than 1,300 attendees with complimentary screenings—the most ever at the festival. Dermatologists from the Kimberly and Eric J. Waldman Department of Dermatology performed 754 skin cancer screenings and identified 28 possible basal cell carcinomas, 15 possible squamous cell carcinomas, and 2 potential melanomas. Nurses from Mount Sinai Heart performed 635 blood pressure and cholesterol screenings.

The Health System also spread its message through social media, with its biggest audience ever. On Facebook, interviews with Mount Sinai experts at Aspen received more than 1 million views, compared with 92,000 in 2017, an increase that partly resulted from more precise targeting of viewers. And on Twitter, Mount Sinai was the festival’s third biggest “influencer,” with its content displayed more than 40 million times.

In a panel discussion led by Dr. Davis, experts from Mount Sinai elaborated on the promise and practice of precision medicine and genomics, especially in treating cancer. “We are able to conduct comprehensive molecular profiling of tumors to help guide treatment options,” said Eric Schadt, PhD, Dean for Precision Medicine, Icahn School of Medicine at Mount Sinai, and founder and Chief Executive Officer 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 predisposes you for certain cancers. For example, the BRCA genes for breast cancer and ovarian cancer are increasingly seen as being important for men as they could impact the treatment for prostate cancer.”

Judy H. Cho, MD, Professor of Genetics and Genomic Sciences, and Medicine (Gastroenterology), Icahn School of Medicine, and Director of the Charles Bronfman 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.” Inflammatory bowel disease and fatty liver disease also have a genetic component. “We think this understanding will allow us to diagnose patients earlier and treat more effectively, as well as identify drugs that will be most effective in patients,” Dr. Cho said.

Alan B. Copperman, MD, a leader in the treatment of infertility and Chief Medical Officer of Sema4, discussed breakthroughs in screening for couples using in vitro fertilization. Genomic sequencing is advancing so fast that over the next year or two, “We should be able to routinely test for all known diseases and even tiny rearrangements and deletions of DNA. This will move us forward in a way we could never have dreamed of in figuring out which embryo has the best chance of being a healthy baby,” Dr. Copperman said.

The microbiome—trillions of bacteria and fungi that live in the gut—was the subject of a popular talk by Ari Grinspan, MD, Assistant Professor of Medicine (Gastroenterology), Icahn School of Medicine, and Director of Gastrointestinal Microbial Therapeutics, Mount Sinai Health System. Dr. Grinspan said that for patients with persistent Clostridium difficile infections, fecal transplants are “incredibly effective,” curing 90 percent of cases. And he answered questions from a very engaged audience: Is taking probiotics good for you? It doesn’t hurt, and might help. How do you maintain a robust microbiome? “Eat fiber, fiber, fiber,” Dr. Grinspan said. “And exercise.”

Innovative models of care were outlined by, from left, Niyum Gandhi; Linda V. DeCherrie, MD; and Prabhjot Singh, MD, PhD, in the panel “Do or Die: It’s Time to Think Beyond the Hospital.”

In a second panel led by Dr. Davis, Mount Sinai experts discussed models that allow care to be delivered to its 3.8 million patients a year in more effective ways. “We must reimagine the financial model so that we can be rewarded for keeping people healthy,” said Niyum Gandhi, Executive Vice President and Chief Population Health Officer, Mount Sinai Health System.

Another innovation is Mount Sinai at Home, which encompasses programs that deliver home-based primary care, rehabilitation, hospital care, and palliative care. One of those programs, Hospitalization at Home, has resulted in shorter hospital stays and fewer readmissions and emergency department visits. “Though the model is successful, 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 Geriatrics and Palliative Medicine, Icahn School of Medicine, and Clinical Director of Mount Sinai at Home.

“Addressing the social determinants of health is critical to reducing the cost of health care and improving the lives of our patients,” said Prabhjot Singh, MD, PhD, Director of the Arnhold Institute for Global Health, and Chair of Health System Design and Global Health, Icahn School of Medicine. “We need to find smart ways to recognize the food insecurity, housing, and transportation issues that our patients face, and then incorporate the right support as a seamless part of their care.”

All of these measures help Mount Sinai to control health costs, which are rising fast across the nation. “And they allow us to maintain our core values—to take care of everybody who comes to our door and still be an Honor Roll hospital and a leader in education and in research innovation,” Dr. Davis said.

Festival participants on the grounds of the Aspen Institute. Credit: CZ Photography