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Community as a Path to Healing: a Q&A with Dr. Doug Nemecek, Chief Medical Officer for Behavioral Health at Evernorth Health Services

By Grant Stoddard

Dec 11, 20236 minute read

Exposing the pervasive issue of loneliness in America, Cigna’s Loneliness Index sheds light on how a lack of social connection can have profound effects on mental and physical health, providing poignant insights that have fueled the work of Dr. Doug Nemecek. In his role as Chief Medical Officer for Behavioral Health at Evernorth Health Services, Dr. Nemecek aims to combat loneliness, reduce the stigma associated with mental health concerns, and remove barriers to accessing evidence-based treatments for those in need.

We recently sat down with him for a compelling dialogue exploring the vital role of early identification and intervention in the treatment of OCD and other mental health conditions, how we can harness technology to combat loneliness, and approaches to reducing the stigma associated with mental health conditions like OCD in our communities and workplaces. Our Q&A provides profound insight into the evolving mental health landscape, guided by Dr. Nemecek’s expertise and commitment to advancing individuals’ vitality and well-being.

With your extensive background in both clinical practice and leadership roles, what do you consider to be the most significant breakthrough or innovation in mental health treatment during your career, and how has it influenced your approach to addressing mental health challenges at Cigna? 

Digital and virtual care has been a huge source of innovation in the healthcare space. It has allowed us to improve access to care because it removed so many barriers that existed before, such as a lack of providers in a geographical area, time and resources spent by patients traveling to an appointment, and the stigma of being seen in an office. 

In addition to making care more convenient and private, the virtual delivery of behavioral care enables greater personalization so that care is tailored to each person in need. It has also accelerated our ability to move to measurement-based care for patients, which allows us as a payer to truly work to deliver individualized specialty care to each patient to improve health outcomes. It helps us deliver high-quality, evidence-based specialty care to every individual, based on their specific condition, such as for OCD.

The Loneliness Index released by Cigna has shed light on the growing issue of loneliness in America. Could you share an example of a specific case or individual story that illustrates the profound impact that loneliness can have on a person’s mental and physical health?

Loneliness has a significant impact on a person’s overall vitality, or the ability to pursue life with health, strength, and energy. Our research shows that loneliness has the same effect on a person’s health as smoking 15 cigarettes per day. Since our first look at loneliness in 2018, we’ve experienced a pandemic, soaring inflation, climate-related natural disasters, and geo-political upheaval, and we have become even more inundated with social media platforms and 24/7 news coverage—all of which has contributed to even greater feelings of loneliness and isolation. Our most recent study this year showed that 58% of Americans feel lonely.

What we know is that social connections of all types alleviate loneliness, and one of the easiest ways to find people who have something in common with you is by engaging in person at work, such as through employee resource groups or onsite activities, as well as by engaging in the community. People who do so, and who find opportunities to learn and grow, are far more likely to have high vitality.

How can we harness the power of technology and social media to foster meaningful connections and combat loneliness, rather than contributing to it? How can building condition-focused online communities help here? 

It’s human nature to want to connect with others—to feel understood or share similar interests and experiences with another person—which is a key driver of one’s vitality. Social media can provide a forum for the connection that we all crave. 

Social media and online forums can provide entertainment and help people keep in touch with family and friends. Many Gen Z’ers specifically feel social media has helped them discover new ideas, learn skills or hobbies, and find communities with similar interests. The challenge is that Gen Z is struggling with mental health challenges to a greater extent than other generations, including feelings of loneliness and isolation, and struggles with self-esteem, which social media can exacerbate.  And we know there is a ripple effect. Their mental health impacts the mental health of their parents, which impacts how they show up at school and work. 

While each person is different, in general, the mental health of older adults isn’t as negatively impacted by social media as their younger cohorts. In fact, for older adults, social media can be a key tool they use to maintain and nurture the connections they’ve made over the course of their lifetimes. The ability of older generations to resist some of the negative impacts of social media could be attributed to the life skills or coping mechanisms they have developed, practiced, and strengthened over time.

Leveraging digital tools for mental health care also provides the opportunity for the development of communities focused on specific conditions or populations. Finding groups of people who have the same diagnosis or share a similar history can be very helpful for people who may be struggling with a particular mental health condition, and provide opportunities for people to help each other to improve their functioning at home and work.

Addressing the stigma surrounding mental health is crucial in encouraging people to seek support. What initiatives or approaches do you believe could be effective in reducing the stigma associated with OCD in communities and workplaces?

We’ve come a long way in reducing the stigma surrounding mental health over the last few years, but more work needs to be done, especially regarding OCD. Education and awareness are critical in removing stigma, as is normalizing the conversation around mental health.

One way for communities and workplaces to do this is by sharing stories of success and healing, so that others don’t hide in shame or fear. Acknowledge people who have overcome challenges and celebrate their triumphs. Implement inclusive practices so that you create a culture where differences are appreciated. In workplaces, having comprehensive mental health resources for workers and allowing flexible schedules can help people improve and maintain their mental health and manage their symptoms.

Another step forward in reducing stigma is the shift toward measurement-based care as an industry, so that we can share how to effectively treat OCD and help people manage their symptoms and improve their health. 

In your view, what are the key elements that make a treatment approach effective for individuals with OCD, and how can healthcare providers and insurance organizations work together to ensure that these evidence-based treatments are accessible to those who need them?

Early identification and intervention are critical to overall treatment so that we can get people to quality care sooner and can help optimize their outcomes. Having multiple access points to care can make it easier for patients to get connected to care, too. Using our data to identify people who have OCD or are at high risk of having OCD is also an important way to help get people to the right care quickly and simply.

Knowing which providers are providing evidence-based treatment for OCD, such as exposure and response prevention (ERP) therapy, is also key. Through measurement and demonstrated outcomes, we can help people with OCD navigate to providers who are getting the best outcomes for their patients using evidence-based care.

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