First Mile Care Appoints Healthcare Veteran Salvatore Boscarino Chief Commercial Officer

Boscarino brings 20-plus years of health plan provider network and payer strategy experience at Aetna, Anthem, Yale New Haven Health, and Maxim Healthcare

MENLO PARK, Calif., March 14, 2022  First Mile Care (, a preventative chronic care company whose mission is to halve the number of Americans with type 2 diabetes by 2028, has expanded its executive team to include Salvatore Boscarino in the new role of Chief Commercial Officer (CCO). 

“We are delighted to welcome an executive of Sal’s caliber to First Mile Care as Chief Commercial Officer,” said founder and CEO Karl Ronn. “He is a seasoned healthcare executive with a proven track record of working successfully with national payers, integrated health systems, and third-party administrators. He’s passionate about developing and executing innovative commercialization strategies that will serve First Mile Care well as we expand rapidly into additional US markets.”

Boscarino’s deep healthcare expertise includes previous leadership positions at Anthem, Aetna, Yale New Haven Health, Community Health Network of Connecticut, and Maxim Healthcare Services. Most recently, he served as vice president of national contracting for Beacon Health Options. Boscarino has decades of experience managing contractual relationships between providers and national payers and has worked through the transition of health plan/provider arrangements from fee-for-service to fee-for-value.

“As the record number of Americans with prediabetes continues to increase, First Mile Care must accelerate the reach of its type 2 diabetes prevention program (DPP),” said Boscarino. “From billing and health policies to credentialing, contracting, and regulatory compliance, healthcare is a complicated industry.  I’m honored to join First Mile Care’s leadership team to continue building on the sustainable offering that provides patients with the interventions they need, all while addressing quality outcomes, physician integration, cost containment, and social determinants of health.” 

Prediabetes, which affects 96 million adult Americans —more than one in three adults— is reversible if caught before it turns into type 2 diabetes. By creating a national network of DPP certified coaches who help people with prediabetes develop small, sustainable habit changes, First Mile Care is taking the Center for Disease Control’s (CDC) Diabetes Prevention Program to the next level and democratizing program access to underserved populations. DPP is clinically proven to reduce the risk of developing type 2 diabetes by 58% (71% for those over age 60).

About First Mile Care

First Mile Care is a preventative chronic care company developing affordable, scalable, and sustainable solutions to reverse health conditions like prediabetes. The First Mile Care Diabetes Prevention Program enables personalized support and guidance at the community level, giving people access to the hyper-local coaching, tools, and resources they need to live better, healthier lives. First Mile Care is a spinout of Health2047, the Silicon Valley-based innovation subsidiary of the American Medical Association. For more information, please visit

Food for Thought in National Nutrition Month

By Karalyn Cass, First Mile Care DPP Coach and program coordinator

Stress and stressful events are part of modern life. We acknowledge it, and sometimes even equate it with success: Ever bragged about working 60+ hours a week just to get that project completed? Stress has its purpose — like when you have to slam on the brakes to avoid a collision or whip your hand from a hot stove to avoid a burn. But what happens when there is too much stress in your life?

Since March is National Nutrition Month, it’s a good time to revisit some useful resources about nutrition and healthy eating from First Mile Care Diabetes Prevention Program (DPP) coaches and other expert voices.  

Healthy living has never been more important. The Centers for Disease Control and Prevention (CDC) now estimates there are 96 million American adults living with prediabetes in 2022 — that’s 38% of people over age 18, or more than 1 in 3 — yet nearly 90% don’t even know they have it.

First Mile Care-certified DPP coaches help participants develop strategies for making more informed choices to eat healthily at home and away, along with being more physically active, managing stress, and coping with their other challenges in making healthy choices that can last a lifetime. One goal of the DPP is to create realistic eating habits that you can stick with for the long-term without having to give up things you love.

For example, Roberta Varnado completed the First Mile Care Diabetes Prevention Program last October. She says, “Coach Robert McNeill taught me how to pay attention to food labels and about learning to make substitutions. I eat smaller portions and choose something filling and satisfying. For example, I used to eat pastries with my morning coffee, but now I find that I’m happy with something that has protein, like a whole egg or scrambled eggs, or avocado toast. I don’t miss my doughnuts.“

Check out some articles linked below that appear on the First Mile Care blog, from our webinar series on Diabetes Prevention in Action, and on general media and government websites. You’ll find even more recommended resources in an article that we published last year for National Nutrition Month.

1. Coach Kathy Gregory offered tricks for shopping for healthier items in the grocery store to make sure you get a “rainbow of produce” in your diet.

2. The non-profit Environmental Working Group (EWG) website publishes useful information for consumers about pesticide levels on fruits and vegetables, so you can adjust your choices when shopping for fresh produce. It’s known for its Dirty DozenTM and Clean 15TM lists.

3. There isn’t one magic food for good nutrition, said Coach Jenny Fowler in an Incredible Edibles article on the world’s healthiest foods, so she recommends eating a variety of cruciferous vegetables, berries, and wild fish.

4. The DPP emphasizes learning to make healthy food choices as part of a sustainable healthy lifestyle, rather than focusing on short-term weight loss. Coach Kathy Gregory looked at the pros and cons of some current popular diets in a webinar.

5. Confused about food groups? The National Institute on Aging (NIA), part of the Department of Health and Human Services (HHS), has an informative website and free brochures.

6. Getting adequate hydration is not limited to water. Coach Sandra Huskey offered an instructive webinar on jazzing up your water intake and making healthy smoothies. 

7. Coach Jenny Fowler discussed with the Badass Body Project why we crave junk food high in fats and sugars when we’re feeling stressed.

8. One of the most comprehensive government websites for nutrition information is the Department of Agriculture (USDA)’s It updates its dietary guidelines for Americans every five years.

9. Several First Mile Care coaches shared their tips on diet and nutrition, fitness, and self-care with Everyday Health’s TIPPI online database. 

10. The Houston Chronicle talked with Al Cisneros about how he learned to make smart choices to lose weight and lower his A1c by working with Coach Sandra Huskey and First Mile Care.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!

What's the Difference Between Crude and Dietary Fiber?

First Mile Care Diabetes Prevention Program (DPP) Coach Taylor Winkel, RD explains the difference between crude and dietary fiber for Livestrong.

Read full article >

Exercising in Inclement Winter Weather

By Sandra Huskey, First Mile Care DPP Coach

No matter where you live and no matter the time of year, the weather can always provide an excuse to avoid exercise. It will be too hot, too cold, too windy, too rainy, or too humid. (Check out my article on Exercising in the Summer Heat and Humidity.) But you’ve got to get out there and do it as part of a healthy lifestyle. Regular exercise will contribute to reversing prediabetes and lowering your blood pressure to keep your heart healthy. (Did you know that February is American Heart Month?)

Preparing for outside exercise requires mental preparation as well as physical. You can warm up inside by doing dynamic movement exercises to get your heart rate up and your muscles ready. However, the mental part is just as important as getting the right nutrition, hydration, and sleep because you need to set yourself a workout routine and keep yourself accountable to it, good weather or bad.

Dressing appropriately

Preparing what to wear is just as important as preparing your mindset. Checking the forecast helps you plan not only the time of day to exercise, but how to dress appropriately. In the winter, be prepared to be a little cold when you walk out the door, as your body will warm up quickly once you start moving.

  • Dressing in layers will not only trap heat between the layers but will also help allow you to shed clothing as you heat up. I recommend starting with a higher necked, extra-long athletic shirt, as you can tuck the shirt into your running tights for an added layer of protection and warmth around your middle and backside. You can add more layers depending on the weather and wind or rain.
  • Regardless of the season, choose moisture-wicking clothing. Cold weather doesn’t prevent you from sweating so it’s important that clothing not become saturated in perspiration or weather-related moisture.
  • Running tights and tops are manufactured for various temperatures. In chillier climes, look for clothing designed to provide extra warmth, usually labeled as cold weather apparel.
  • A hat and gloves are essential as well, and not only for warmth. Even in cold winter conditions, the sun can be bright, so guard your eyes and face with sunscreen, sunglasses, and a multipurpose hat.

With the appropriate clothing, you should be able to continue to exercise outside even in generally inclement weather. However, we all have our own personal thresholds of what we consider too hot, cold, windy, or rainy.

Moving your outdoor exercise inside

If weather conditions are too uncomfortable or even hazardous for outdoor exercise — icy sidewalks, bitter temperatures, flying debris in high winds, etc. — avoid risking your safety and instead, move your workout indoors. The obvious solution is to go to a gym, but if you don’t have access to a gym, you can always make-do by working out at home.

If you have a staircase, you can do intervals of running or walking up and down the stairs.  If you have an open floor plan, you can do brisk walks within your home. You can do a variety of stretching and resistance training exercises using household items. You can get ideas from the multitude of exercise videos and suggestions on YouTube and other internet sites. 

Learning to appreciate the gym

Not everyone loves exercising in the gym, whether in an informal home setting or a professional fitness center. But sometimes all it takes is a few tweaks to your routine to learn to enjoy your gym time more.

Having a clear goal and plan for when you visit the gym will help speed up the workout and keep you focused. Knowing what you’re going to do before you do it helps take the dread out of the workout. Avoid aimlessly wandering from machine to machine. Instead, focus on training a different body area each session, such as upper body one time and the lower body the next, or concentrate on stretching and core, or choose a machine that is specifically for cardio.

If you really dislike going to public fitness centers and prefer perspiring in private, you could look into purchasing in-home pieces of gym equipment, from cardio machines to hand-held weights, balls, or bands.

Making the treadmill interesting

If you normally run outside and are stimulated by the change in scenery, taking your run indoors to the treadmill may seem boring. The goal of treadmill running should be to emulate your outdoor running experience as nearly as possible. Outdoors, there are natural speed and elevation changes based on the terrain and weather conditions. Staying at the same elevation and same pace on the treadmill will exhaust your mind and body. Creating a workout plan on the machine to add variety in speed, elevation, duration, and pace will break the monotony and make more closely approximate your typical outdoor run.

As with any run, you can listen to music or a podcast. An advantage of a treadmill is that you can also watch a movie or television program. However, be mindful of your neck alignment and keep the screen at eye level.  If you are looking up or down, you will strain your neck and your body will be out of running alignment. Your body should remain in as close to your normal running position as possible.

Biking indoors

If you are trying to translate your outdoor run to an indoor spin bike, the main goal should be to target the same heart rate zone as your run. You can achieve this by cadence (spinning quickly) or by varying the resistance levels on the bike.

An advantage of an indoor stationary spin bike is that you can stand up out of the seat for movement that more closely relates to a running motion. The standing position can be added into your overall workout to create variety or intervals, but avoid standing up for your entire workout.

Enjoying whatever exercise that you do

There is no right or wrong or best exercise routine. The single most important thing is that you find a movement that you enjoy, as then you’re more likely to do it on a regular basis. Regardless of weather, some people will always prefer exercising outdoors to benefit from fresh air, daytime sunshine, evening anonymity, and the opportunity to appreciate changing scenery in nature.

 Whatever type of exercise you do, indoors or out, or the exercise substitutions you make, your goal should be to get your heart rate into the moderate active zone at the least — the equivalent of a brisk walk. First Mile Care recommends a minimum of 150 minutes of moderate exercise per week, as per the CDC guidelines for the National Diabetes Prevention Program.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!

Building a Super Bowl-worthy Offense Against Diabetes

By Karl Ronn, First Mile Care CEO and Founder

The upcoming Super Bowl® this Sunday got me thinking how, in the war against diabetes, a good defense alone is not enough to win battles.  We need to go on the offensive against diabetes to stop it before it happens. It’s within our power.

The updated National Diabetes Statistics Report says that more than one in ten adults in the U.S. has diabetes, putting them at increased risk of heart disease, stroke, kidney damage, blindness, dementia, and even COVID-19. About 96 million adults, or 38% of the adult population, have prediabetes. What’s worse, more than eight out of ten people with prediabetes don’t even know they have it. That means they may not make easy adjustments in diet and exercise to prevent developing type 2. New data from a CDC health study reveals only about 10% of American adults eat the recommended amounts of fruit and vegetables, and a good 25% don’t do any physical activity outside of work, according to another recent CDC survey

Once people know their condition, they go on the defensive to address it with medication. But that alone isn’t stopping the spread of diabetes. We need a strong offense, not just defense. This is where the National Diabetes Prevention Program (DPP) comes into play. It is clinically proven that DPP participants who lose 5-7% of their body weight and add 150 minutes of moderate exercise per week cut their risk of developing type 2 diabetes by up to 58% — and 71% for people over age 60. 

At First Mile Care, we are partnering with physicians — including those at Federally Qualified Health Centers (FQHCs) —  to go on the offensive against diabetes at a hyper-localized level. Through our diabetes prevention program — fully recognized by the CDC for its effectiveness — we are building physician capability to help their patients address diabetes before it develops into type 2.  By educating program participants on how to make small, incremental, sustainable lifestyle changes, we help them to reverse their prediabetes status.

First Mile Care acts as a complementary extension of the physician’s practice to offer diabetes prevention classes with a limited touch. We analyze practice data so we can enroll qualified participants by ZIP codes and arrange neighborhood-based classes with local coaches we certify in the DPP. We work to retain participants, track their progress, and report data back to physicians in the way they want, when they want it — usually on a quarterly basis — and manage administrative details to ensure coverage by Medicare, Medicaid, and major health systems and insurers.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!

Two Tomball residents take one step at a time toward diabetes prevention

Al Cisneros Jr. joined the First Mile Care program after his doctor recommended it, and began making smart choices to get healthy and stave off his pre-diabetes diagnosis.

Read the full article via the Houston Chronicle >

Q&A with DPP Participant: Kicking My Sugar Addiction to Reduce My A1C

By Juliana Ronn, First Mile Care Director of Operations

Roberta Varnado is a 64-year-old retired purchasing administrator who lives with her husband in Cypress, Texas, just northwest of Houston. She completed the year-long First Mile Care Diabetes Prevention Program (DPP) in October 2021.

  1. Roberta, were you surprised when your doctor invited you to join the First Mile Care DPP?

No, I wasn’t really surprised when I got the letter from my doctor — Lesly Dessiuex of Bridge Creek Family Medicine in Cypress — suggesting that I join the First Mile Care program. I was already aware that I had prediabetes. A few years ago, before moving to Texas, my doctor in Colorado told me that my A1C level was too high — it was 6.0. I was shocked and a little angry when I first got the diagnosis, as I wasn’t overweight and I have always exercised regularly. High blood pressure and thyroid imbalance both run in my family and I know I’ll probably never stop medication for those conditions, but I really don’t want to take drugs to address prediabetes as well.

My doctor started me on medication and I attended a one-day class to learn more about living with prediabetes. I was determined that I would get off the medication and thought I could address it on my own. We moved to Texas and I retired, so my lifestyle changed, but my A1C kept going up. At one point, it hit 6.5. I finally realized my problem wasn’t weight or lack of exercise, it was my diet. I was addicted to sugar, and I just couldn’t change my eating habits to address it. So when my doctor suggested I join the First Mile Care DPP, I immediately signed up. I thought their coaching might help me to make lasting changes.

  1. First Mile Care encourages participants to determine their own individual goals for the program.  What was your goal?

As I said, weight has never been an issue for me, so losing weight wasn’t really a goal. If it happened, great, but it wasn’t my problem. My reason for joining the program was to control the sugar in my blood and reduce my A1C by natural methods. I do not want to develop diabetes, but I also don’t want to be on medication for it the rest of my life. I needed to address my sugar cravings and learn portion control.


  1. The program offers 22 sessions over the course of a year. What results have you seen?

When I started the First Mile Care program in October 2020, my A1C was at 6.2.  By the time I finished the program a year later, it was down to 5.8. Doctor Dessiuex has told me that I can move off the medication when it hits 5.7 or below, so I’m aiming for that.

I also lost 10 pounds while in the program, and have kept that off. I was glad to lose it, even though I wasn’t really overweight. I’m sure it helps with my blood pressure, though.


  1. Has changing your diet been hard for you?

In the beginning, I struggled a bit with sugar cravings. I just l-o-v-e my sweets. The First Mile Care program has been really helpful in teaching me how to adjust my diet and portions. I needed guidance as to what foods and drinks are high in sugar and carbohydrates and what can serve as satisfying substitutes. My coach, Robert McNeill, taught me how to pay attention to food labels to notice the grams and ounces of sugar, salts, carbs, and fats, and also servings and portion sizes. And other people in my class suggested things I could try in place of the baked goods and high-sugar juices I normally consumed. I used a food diary for a couple of weeks, as required in the class. It was interesting to see patterns, although I have since given it up as I have become more mindful of my eating habits. 

  1. How have you dealt with your sugar addiction? What kind of changes have you made to your food intake?

Now that I’m retired, I don’t have to eat to suit my work schedule, but have found that I am perfectly satisfied eating a late breakfast and early dinner. I eat smaller portions and choose something filling and satisfying. I used to eat pastries with my morning coffee, but now I find that I’m happy with something that has protein, like a whole egg or scrambled eggs, or avocado toast. I don’t miss my doughnuts. I usually don’t need a snack between meals, but if I do, I might make a fruit smoothie.

For me, success has really all been about learning to make substitutions. If I can find a good substitute for something I used to eat that was high in sugar, I’m happy. For example, I love to drink juice and eat fruit and used to assume that it had a lot less sugar than a pastry. I learned through First Mile Care to check the labels on juices for added sugars, and that not all fruit is equal. I’ve cut back on grapes and bananas and eat more strawberries, raspberries, blueberries, watermelon, and cantaloupe.

While I’ve never eaten a lot of chips and pretzels, one of my favorite snacks has always been popcorn. Now, instead of buying the prepared packets with their additives, I get plain popcorn to cook in a brown bag in the microwave and add a little real butter for flavor. I’ve also started to eat nuts more often now, as they are satisfying when I do have a craving for a snack.


  1. What did you discover in your First Mile Care class that surprised you?

In addition to paying attention to nutrition labels in the market, I learned a trick for when I go out to eat. Coach Robert explained that most restaurants will have their menus posted to their websites with information on calories, carbs, sugar, sodium, etc. I didn’t realize that it was possible to find that information so easily, so you can plan your meal in advance and be sure to choose the healthier options. Some of the people in my class dined out a lot, so we did an experiment in class one day and researched the online menus of a lot of local restaurants, and were able to find the nutritional information on most of the menus. 

  1. First Mile Care emphasizes hyperlocal classes with participants from the same ZIP code, moderated by a coach with knowledge of the neighborhood. Did you find this helpful?

Oh yes, of course. It’s very motivating to hear other people share their struggles and successes. You want to have something to report in your class to earn encouragement from the other people. You don’t want to be the only one to say, “Oh, no, I didn’t work out this week.”  You want to have some progress to discuss.  We even had a challenge at one point to see who drank the most water in two weeks. 

Coach Robert was very helpful and empathetic with our struggles. He offered suggestions from his own experience with healthy lifestyle change. He likes to eat out, as did most of the other people in the group, so they shared a lot of tips on getting healthy food at local restaurants and markets.

  1. You finished the First Mile Care program three months ago. How are you maintaining the progress you made in changing your lifestyle?

It’s been 15 months since I started the program, so the changes I’ve made do seem permanent. I don’t have the sugar cravings I used to have. If I need to, I’ll do a 28-day challenge or fast to break the cravings. I’m more mindful now of what I eat, how much, and when. 

I continue my fitness routine of at least 30 minutes a day of exercise, which is more than the First Mile Care DPP minimum of 150 minutes a week. Walking has always been my exercise of choice. I like to walk outdoors, and of course I have to walk my dog daily. It can get so hot and humid in Texas in the summer that I started using a walking program video for exercising at home, and I also have an exercise bicycle in my home, too. 

I know I have to be diligent to keep my A1C down. It’s very easy to slip up and have it start to increase. Now that I’m no longer in the First Mile Care class, I get support from my sister. We motivate each other. Thanks to what I learned in the First Mile Care program,  I’m hoping that I will soon be able to stop the medication — and stay off it for good.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!

The 5 Best Lifestyle Habits That Will Keep You Feeling Young, Science Says

“…it’s critical to stretch your brain as well your heart, legs, and other muscles,” explains Karalyn Cass, a Diabetes Prevention Program (DPP) coach and program coordinator with First Mile Care.

> Read the full article on Eat This Not That!

Healthy Tips to Live by in 2022

First Mile Care DPP Coach Kathy Gregory shares her tip for healthy living in the new year:

“Make movement a priority multiple time a day. The Centers for Disease Control recommends at least 150 minutes of moderate movement a week to reverse prediabetes and prevent type 2 diabetes.”

View the full eBook here

A New Year's Resolution to Create Healthy Habits That Stick

By Karl Ronn, First Mile Care CEO and Founder

An ounce of prevention, as the saying goes, is worth a pound of cure. Last year, 48% of people who made New Year’s resolutions wanted to lose weight. But a study found that two-thirds tend to make the same resolutions year after year and abandon them within a month. The key to making healthy habits stick is understanding that being healthy is not just about losing weight, it’s about sustainable lifestyle changes that prevent disease — like prediabetes. 

One in three American adults — over 88 million—are living with prediabetes, but 84% are unaware of their condition. Yet prediabetes is proven to be reversible if you follow the National Diabetes Prevention Program (DPP) established by the Centers for Disease Control (CDC).

It’s never too late to improve your health and change your future. You can start by taking the free prediabetes risk test on the CDC website. 

Here are some additional tips for managing nutrition, exercise, sleep, mindfulness, and goal setting to successfully live a healthier life. 

  1. Shift your mindset. Being healthier does not mean a new diet. It means a lifestyle change.
  2. Focus on nutrition by eating a varied diet of whole, unprocessed foods and creating realistic eating habits that you can stick with for the long-term, not just short-term meal plans. 
  3. Listen to your body’s hunger signals by eating mindfully instead of emotionally. Logging your daily intake in a food journal can help. 
  4. Make movement a priority multiple times a day. The CDC recommends at least 150 minutes of moderate movement a week.
  5. Find a movement you enjoy to break the link between stress and unhealthy eating. Try bowling, gardening, volleyball, basketball, walking, or swimming – whatever gets you off the couch and moving.
  6. Quality sleep is essential for optimal mental health, energy to exercise, and managing sugar cravings. Seven hours is the recommended minimum for adults over age 18.
  7. Set personal goals to hold yourself accountable and track your progress. Hitting those milestones week after week will have positive effects on your psyche.
  8. Create an action plan to understand the specifics of how you will achieve each goal. 
  9. Don’t be afraid to iterate! The road to success is paved with challenges. Adapt your plans as you learn what works (or doesn’t) for you. 
  10. Be patient and don’t give up. Sustainable lifestyle change will start small and grow incrementally as habits form over time. 

Ask your doctor if you qualify for a Diabetes Prevention Program with certified DPP coaches in your ZIP code. When you’re trying to build healthy habits, qualified guidance and peer support from neighbors facing the same challenges are invaluable to maintaining your motivation to reach your goals.

To learn more about how you can benefit from the First Mile Care Diabetes Prevention Program, take the prediabetes risk test and get started today!