By Arnold Saperstein, MD, Chief Medical Officer at Cecelia Health
I’ve spent nearly 30 years as a physician in managed care organizations, yet only recently have I witnessed the true potential of remote chronic care management programs.
A few years ago, I made the decision to leave my leadership position as President and CEO of a large health plan based in New York City where I had been for 25 years. At that organization, and in previous roles as Chief Medical Officer (CMO) of two leading health plans, we consistently attempted to measure the clinical and financial impact of our chronic care management programs. However, we were unable to find the right formula to deliver positive results at scale while also validating their efficacy. This led to frustration and skepticism of the effectiveness of remote chronic care programs. As I transitioned out of the health plan, I stepped into my new role as CMO at Cecelia Health, a growing virtual care company, with optimism that they had found the solution to this pressing challenge facing health plans and providers in America.
Why Cecelia Health?
What initially piqued my interest in joining an early-stage virtual care company in Cecelia was their impressive engagement and clinical outcomes data. As a virtual-first provider organization, Cecelia Health has been a pioneer in delivering whole person virtual care for people with chronic conditions through a mix of personalized clinical interventions combined with a comprehensive digital engagement & monitoring platform. On the surface, it appeared that remote care management, if done with the right focus and appropriate clinical staff, could be impactful in improving health outcomes at scale.
At the beginning, plans relied on Cecelia Health to assist exclusively in driving results for populations living with diabetes, given that many of their members were experiencing poor HgbA1c control, struggling with medication compliance, and engaging with their care teams sub optimally. When I joined in 2019, I was certainly familiar with the goals that we sought to accomplish, but I hadn’t yet discovered the formula that made Cecelia Health’s approach special.
I engaged regularly with the clinical leadership team and had the pleasure of listening to weekly calls of our expert clinicians in action to gain a better understanding of their approach to positively impact people living with chronic illness virtually. It was evident that the one-on-one relationships aspect of Cecelia’s model fostered a desire for members to please their dedicated clinician companion and reach their goals. Members were thrilled to report on medication compliance, keeping preventive health visits, and lifestyle changes in diet and exercise. I began to understand that our deep clinical expertise combined with the empathy our clinicians display during these remote care visits was making all the difference in driving behavior change.
A Proven Approach to Chronic Care Management
What started in diabetes has since expanded to other chronic conditions such as hypertension, congestive heart failure, and obesity with additional programs on the horizon to address high-cost high-risk conditions such as chronic kidney disease. It’s because the model of providing disease state specific experts with the appropriate tools and insights works independent of the chronic disease—human connection is essential at a time where patient confusion has reached all-time highs. During my time as CMO I’m proud that we’ve been able to prove our approach can drive significant improvements in medication adherence, close HEDIS gaps, and deliver better HgbA1c results to ensure members are in optimal range across a range of customers and disease states. With these outcomes we’ve also had the pleasure of supporting our partners in realizing positive financial results with reduced total cost of care.
In retrospect, it was clear that one of my motivations for joining Cecelia Health was to try and pinpoint and advance the recipe for a highly successful chronic care management approach. Chronic care management programs need to be frictionless and easy for members to engage, or plans shouldn’t expect to realize meaningful success. And when they do, they need to be met with highly experienced, knowledgeable clinicians that are dedicated to the needs of the individual that they are engaging with. This is critical because it allows for the empathy and understanding that is needed to establish trust and build relationships.
I am passionate about the possibilities and look forward to applying this approach across more health plans and members that can benefit from the additional support of a warm, dedicated clinician who cares.
About the Author
Dr. Saperstein began his career in managed care in 1992 and joined MetroPlus Health Plan in 1995 initially as Chief Medical Officer and then as President and CEO from 2006 until 2019. MetroPlus Health Plan is a managed care organization that, under Saperstein’s leadership grew from 40,000 members to over 500,000 members with an estimated 32,000 participating providers. Saperstein has spent the majority of his career developing programs that ensure the highest quality of care. During his tenure at MetroPlus, it ranked as one of the highest scoring plans for quality of care as measured by the New York State Department of Health Medicaid Incentive Program and by the Medicaid Consumer Guide for New York City. Under his leadership, MetroPlus rose to the forefront of Value Based Purchasing. Programs he developed included groundbreaking quality incentive pay for performance programs across the entire MetroPlus network.