Eskenazi launches $50M effort to take brain care around the world

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Eskenazi Health launched a $50 million fundraising campaign Thursday night in an audacious bid to extend its mental health services around the nation and even the globe.

The safety-net hospital system in Indianapolis will create the Center for Brain Care Innovation in the medical office building on its downtown campus.

That center will combine the staffs of Eskenazi’s existing efforts to treat dementia and psychosis, and use telemedicine and a digital avatar to reach as many as 150,000 Hoosiers and 10 million patients outside Indiana by 2030.

“I feel the vulnerable brain is the most precious organ for the human species, and it’s my responsibility. These vulnerable brains, they don’t have a geographic limitation,” said Dr. Malaz Boustani, a geriatrician at Eskenazi that will lead the Center for Brain Care Innovation. He added that “scaling is going to be our competitive advantage.”

Eskenazi already has had success in these areas. Its Healthy Aging Brain Center for dementia patients started in 2008, initially serving about 1,000 patients from the Eskenazi facilities in downtown Indianapolis.

But then the team, led by Boustani, developed a sister program called Aging Brain Care, whose central feature was a training program for non-medical staff members who would visit patients in their homes to help doctors monitor their situations and keep them compliant with medications and other regimens. That allowed it to expand the program by more than 2,000 patients.

The results have been impressive enough to be published in major medical journals.

In a study published in 2011 in the medical journal Aging & Mental Health, the Healthy Aging Brain Center showed that it reduced ER visits 47 percent and reduced hospitalizations 50 percent, when comparing the center’s patients with other similar Eskenazi Health patients served outside the center.

A 2006 randomized-controlled trial of the team-based dementia care now used at the Healthy Aging Brain Center showed patients receiving team-based care saw their scores on an evaluation of cognition decline half as fast as those receiving standard care. Those results were published in the Journal of the American Medical Association.

The Healthy Aging Brain Center, even after accounting for its higher staff costs, has saved $980 to $2,856 per patient per year, according to a 2014 study published in the journal Health Affairs.

The other half of the Center for Brain Care Innovation will come from Eskenazi’s Midtown Prevention and Recovery Center for Early Psychosis. It is led by Dr. Alan Breier, the former chief medical officer of Eli Lilly and Co.

Those two programs combined have about 100 staff members, who will move into 33,000 square feet of shell space in the Fifth Third Bank building next July. Boustani said the staff likely will grow to 150 as the Center for Brain Care Innovation gets off the ground.

Dr. Lisa Harris, Eskenazi Health’s CEO, said treating mental health is a critical part of Eskenazi’s efforts to treat all other illnesses of the patients it serves.

“We can’t manage all the other chronic illnesses patients struggle with if we have failed to identify and effectively treat mental health and brain health,” Harris said. “It enhances our ability to care for diabetes, high blood pressure, and all those other things.”

Boustani hopes patients and their caregivers and possibly even their physicians will turn to the Center for Brain Care Innovation to provide the coaching Eskenazi has used successfully to reduce hospitalizations and ER trips for dementia patients, and has used to prevent suicides among schizophrenics.

Boustani’s program for dementia patients includes regularly testing for mental acuity and depression. It encourages patients to stop taking medicines that harm brain functioning and start activities that promote it.

The avatar, which Eskenazi is calling the virtual care coordinator assistant, will interact with patients and caregivers—via Web pages and mobile apps—to answer their questions and coach them.

For about 90 percent of patients, that kind of remote counseling will be enough, Boustani estimates. But for the remaining 10 percent, whose needs will be greater, Eskenazi will direct patients to face-to-face care at specialized centers near their homes.

Even though Eskenazi’s mission, as part of the Health & Hospital Corp. of Marion County, is to serve Indianapolis residents, Harris said the hospital’s duty is to share its expertise with anyone it can.

“We’ve had a track record of developing models of care that are more efficient, more effective. That’s really been our signature,” Harris said. “It’s our responsibility to use the resources we have to help others benefit from some of the innovation that we’ve developed, and that we’re going to develop.”

The center is expected to require $40.5 million to operate over the next six years, including spending to develop technology tools to reach patients effectively, according to projections by the Eskenazi Health Foundation. The foundation assumes the center will bring in $10.5 million in revenue, leaving $30 million in uncovered expenses that need to be funded by donors.

The foundation also wants to raise $20 million to create an endowment to help support the Center for Brain Care Innovation into the future.

The fundraising campaign will be chaired by Mike Smith, the former chief financial officer of Anthem Inc., and Bob Postlethwaite, the former president of neuroscience products at Eli Lilly.

“As the campaign was winding up for the new hospital (which opened in November 2013), the foundation board began to have conversations about how can we make Indianapolis a healthier community,” said Ernie Vargo, CEO of the Eskenazi Health Foundation.

“We started focusing in on places that were already being successful and that we could expand. That kind of focused us in on the brain care Dr. Boustani is doing with dementia and Dr. Alan Breier is doing with schizophrenia. That was how we initially started to think about this.”

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