Spring is in the air, which means it’s time to start embracing change and renewal in some areas of your life. If one of the things that you want to change is the food that you consume on a daily basis. You will need to start thinking about ways to eat healthier, even if you have a busy schedule to contend with. Here are 6 tips that will help you do just that

Shop locally and think about different types of produce

With spring almost upon us, the types of produce now available is changing. What’s on offer will vary depending on where you live, so be on the lookout for fruit and vegetables that are in-season. Not only are they cheaper, they can also add a new splash of flavor to your meals

Have a plan at the farmer’s market

If you have a farmer’s market close by, you can save some real money when shopping for produce. If you also want to save time, find out which days and times are the quietest, as this will allow you to get in and out quickly. Take other members of the family with you and split up in the store, with each person taking a list of things to get

If you go nearer to closing time, you might actually be able to grab a discount or two. The problem is that you also run the risk of having fewer items to choose from

In order to get the most out of the produce that you buy, take the time to properly prep it, which means washing it once you get it home from the store

Be on the lookout for organic store brands

If you don’t have a farmer’s market nearby, or just prefer the convenience of shopping at your local supermarket, there are still healthy options available to you. Some stores now team up with local farmers to deliver an organic store brand that can help you save some money

Pack a healthy snack when traveling

Eating properly when you have to travel for work regularly can be tough. Eating often gets put on the back burner when rushing to catch flights and make connections, so make sure to pack a healthy snack in your carry-on bag. A healthy granola bar or a pack of nuts is a much better option than a candy bar snagged while in a hurry

Keep track of your snacks in a digital food diary

Keeping detailed info on all that you eat can help you eat and spend more wisely. It will also help you understand what portion sizes actually look like. There are a number of great apps available, with MyFitnessPal and Lose It! among the best

The Lose It! app lets you scan bar codes on products to find smarter options. You will also get a better idea of the foods that help you stay fuller for a longer period of time. This is information that can be invaluable when traveling, especially if you know you are not going to have an opportunity to eat during the course of the day. It’ll also help you keep track of the calories you consume on a daily basis

Keep it simple

Choose a breakfast item that is quick and easy to prepare. Oatmeal fits that bill perfectly, and is also a very cheap option. Oatmeal is easy to make, as well as being very healthy. The high fiber content will make you feel fuller longer, and the soluble fiber content is good for your cholesterol levels. The steel cut version of oatmeal is healthier still, but it does take a little longer to prepare

As you can see, eating healthier does not have to be a massive chore. The above tips will help you to start eating healthier without having to break the bank

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The Health Benefits of Jogging

There are many health benefits of jogging. For starters, it’s a great cardiovascular exercise which increases your heart rate slightly. This is exactly the type of exercise you should be doing if you are looking to lose weight and improve your overall fitness. Jogging is also reasonably easy to do, costs you almost nothing, and you don’t need any equipment other than a comfortable pair of shoes. You can take up jogging by yourself, or get your friends together and go jogging as a group. Some areas even have organized jogging groups for all fitness levels that you can join, if you feel you need the encouragement

Weight Loss

One of the most obvious health benefits of jogging is weight-loss, and many people take up jogging for this reason. The reason jogging, or any other cardiovascular exercise, helps with weight loss is simple. Jogging uses energy (calories), and if you use up more energy than you take in the effect is weight-loss. Jogging is also very good for improving muscle tone which can aid weight loss and help with creating a slimmer, more defined figure. You should aim to increase your heart rate slightly for around thirty minutes each day for maximum effect. Of course you don’t want your heart rate increasing too much and you shouldn’t be too out of breath. If you find that you are so out of breath or become unable to speak, you should take a break until your breathing returns to normal

Better Mood

Research has shown that cardiovascular exercise, such as jogging, can help relieve depression and make you feel generally happier. This is because endorphins and ‘feel good’ hormones are released during exercise which have been shown to improve mood. This improved mood even continues after exercise stops. With regular exercise, mood can be significantly improved over the long term

Reduces Stress

Another one of the great health benefits of jogging is that as a cardiovascular exercise, jogging can reduce stress levels. Exercise such as jogging reduces short-term stress due to endorphin release, and reducing short-term stress will help to relieve longer-term stress over time. Jogging is a particularly good stress relieving exercise because you can simply pop in some headphones and jog away – there is nothing to focus on other than your music and where you are going

Also, people who undertake regular exercise, such as jogging tend to sleep better at night. There are many reasons for this including the reduction in stress levels brought about by regular exercise. There is also thought to be a hormonal reason for sleeping better after exercise, and some people think that simply burning off extra energy by exercising can contribute to a better night’s sleep. Whatever the reason, getting a better night’s sleep has all sorts of benefits; including less stress, better concentration and less irritability during the day

Reduce Cholesterol and Blood Pressure

High cholesterol is a growing problem in our modern society, caused in part due to a diet which is too high in fat, which can build up in the arteries. High cholesterol has many associated problems, including high blood pressure and heart disease, and it is a known risk factor for heart attacks. Undertaking simple, regular exercise such as jogging has been shown to reduce cholesterol levels over time, which in turn reduces the risk of developing 

any of the associated complications

Jogging is also a great way to reduce blood pressure, in part because it helps reduce cholesterol, but also because of the way your body responds to exercise. Your blood pressure is higher during the time you are working out, but due to exercising it will be lower than it would normally be when you are not working out. It is a complicated process, but it does work and studies show that cardiovascular exercise can significantly lower blood pressure over the long term

Cardiovascular exercise such as jogging helps your muscles to use oxygen more effectively, which benefits the muscles and your overall health. Every cell in the human body needs oxygen to survive, if your body can use that oxygen more effectively then you may find that you don’t get out of breath as easily. For example you may find just now that climbing a few flights of stairs leaves you feeling a little breathless for a few minutes; this is because your cells need oxygen and because you have increased the workload of your cells by climbing the stairs, they now need more of it. This causes your body to increase the rate you are breathing in order to pull in more oxygen. However, if your cells can use the oxygen you already have more effectively, then you will not need to breathe faster to accommodate the extra oxygen demands

Great Way to Start Exercising

Finally, jogging is a great exercise to take up if you are just starting out with regular exercise because you control the intensity. You decide how fast to go and how far; you can even use the popular technique of jogging for a set amount of time then walking for the same amount before going back to jogging again, and continue repeating this process until you reach your destination. As your fitness improves, you can increase the jogging time and decrease the walking time, or increase the distance of your jog. This allows your work out to grow with you as your level of fitness improves and ensures that you don’t tire yourself out too much when you’re first starting out

The health benefits of jogging are numerous; it costs very little to take up and you don’t need a costly gym membership to do it. You can jog wherever and whenever suits you, as long as it is safe to do so, and it is something you can do yourself or in a group. Jogging will improve many aspects of your health, particularly your cardiovascular health, as well as improving your general fitness

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Exercise While You Work At Your Desk

In a perfect world, we would all be able to make time in our busy work schedules so that we could exercise and get in shape. The reality is that many people spend a large portion of their day tied to a desk, but that doesn’t mean that exercise is out of the question. There are a number of exercises that can be performed while sitting in a chair, all of which are also good for seniors or people with limited mobility. You can even get a bit of a workout in while you sit and watch your favorite shows on TV.

If you have back issues, pelvic tilts are an excellent way to combat the problem. To perform this exercise, simply use your pelvic area to press backwards towards the chair back. Once your lower back is in contact with the rear of the chair, let go of the pressure and return to your normal sitting position. Repeat those movement 10 or 20 times each session. It’s a great way to build lower back strength without putting a lot of strain on the area

You can also work the upper part of your body while sitting in your chair. Shoulder shrugs involve nothing more than simply raising and lowering your shoulders. You can also move your shoulders in circles to work other areas of the upper body. Give you neck muscles a work by rolling your head in a circle, followed by tilting it from side to side. Sitting in a chair all day can be uncomfortable, and these simple movements can help prevent you from feeling stiff and achy at the end of the work day

If you spend a lot of time working on a computer, your hands and fingers can quickly get tired and achy. Regularly stretching and flexing your fingers will help relieve some of that stress, as can moving your wrists in a circular motion. You can also get a bit of a chest workout by locking your hands behind your back and performing and upward pushing motion. These are not exercises designed to make you look buff, but rather simple movements to get the blood flowing again after hours of sitting and barely moving

It’s also a good idea to invest in some smaller weights that you can keep in your office. Ankle weight are great if you want to work your legs while sitting at your desk. Once that weights are on, lift and stretch out your legs, holding that pose for a couple of seconds before putting your feet back to their normal position. When you get a coffee or lunch break, use that time to get some work in with your weights. If doing that, make sure to stretch first so that you don’t tweak a muscle

Finally, you might even consider ditching the chair altogether in favor of an exercise ball. It may feel a little awkward at first, but it really does help with your posture. You can also use the exercise ball to do some mile exercise routines when you get a break from work

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How To Make Your Workouts Fun

There are no two ways about it, getting healthy and in shape usually starts to feel like hard work after a pretty short period of time. It’s one of the main reason why people end up slipping into the bad habits that made them unhealthy in the first place, and it’s also why you have to find ways to spice up your workouts and make them a little more fun. It’s actually not as hard as you might imagine, and there are a few simple changes you can make that will help you stay the course with your health and fitness goals

One of the easiest ways to make exercising fun is to do it with a friend. If you know someone who is also interested in getting in shape, try to organize your schedules so that you can both hit the gym at the same time. Besides having a friendly face with you when you exercise, a workout partner is also a good idea, as they will help you stay motivated and on course for all your goals. It’s also a whole lot more difficult to simply skip a workout session when you know that doing so would mean letting down your friend

If you don’t know of anyone that is looking to get in shape, you can still find exercise buddies by enlisting in one of the many classes that they will have at your local gym. There are all sorts of different classes available, including yoga, spinning, and a host of others that are performed in a group setting. Choose the classes that are best suited to your specific fitness goals, and then try to make some new friends when you attend. There is very much a social element to these classes, and the focus is always on fun as well as fitness

Another good way to spice things up and have a little fun when you exercise is to go for a change of scenery. Modern gyms are very well equipped with all the latest equipment, but there is still nothing that beats the feeling of working out in the great outdoors. Think about changing things up once or twice a week, and maybe heading to your local park to work out instead of heading to the gym. Many parks have jogging paths and exercise stations set up in them, so do a little research and see if there is something like that in your city

Even if you do just stick to the gym every single time you work out, you can still have a little fun by mixing things up. Try out new exercise machines that you haven’t tried before, or perhaps think about getting involved in organized sports. Modern gyms often have basketball courts, and some even have rock climbing walls in there. Step outside of your comfort zone and try new things. You will still be getting a great workout, and you may even discover a new hobby along the way

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Reasons Why You Shouldn’t Quit Exercising

Have you ever looked at people exercising and wonder why they continue to do so when they are obviously in really good shape? Sure, there is a need to exercise in order to maintain the body you have built, but there are also the changes to your body that happen the moment you decide that you no longer need to hit the gym. What may come as a surprise is that many of these changes start to happen very quickly, and the effects that they deliver can be felt in no time at all. Let’s look at some of the reasons why you should not stop exercising

When you commit to exercising regularly, one of the first things that you notice is that it becomes easier to breathe after a pretty short period of time. This is because of the flow of oxygen in your body and improvements to your cardiovascular health. This is one of the first things affected when you hit the couch instead of the gym, with a decrease in cardiovascular performance happening within a week. The longer you go without working out, the more it will decrease

You also get pretty strong when you exercise regularly, as you start to build and develop muscles all over your body. When you stop challenging those muscles, you start to lose muscle protein, which eventually results in you losing some of the strength that you have built up. The muscle protein loss can begin as quickly as 72 hours after you quite exercising, but you won’t really start noticing the reduction in strength for about 2 weeks. Again, the longer you go without exercise, the more your strength will diminish

There are sometimes legitimate reasons for not being able to exercise, with age, injury, and illness high on the list of viable excuses. It becomes much harder to recover from exercise as you age, generally because of the decrease in hormone levels in the body. There are natural decreases in strength and fitness levels that come with aging, but those can be somewhat slowed down by continuing to exercise. Interestingly enough, you lose strength and cardiovascular health faster when you are sick or injured than you would when you just simply quit exercising. It can take as long as a year to get back to pre-injury levels if you are forced to take a few weeks off because of an injury

It is believed that you need about 3 weeks off exercise to recover for every week that you take off. That is a lot of work to put in for a short break, so it’s always a good idea to maintain some level of exercise as opposed to just stopping altogether for an extended period of time. If you need to take a break from the gym, consider taking a half hour per day to go for a brisk walk or a jog. That small time commitment can save you a ton of work in the future

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Are Provider-Led Health Care Networks Too Big To Fail

1. Are provider-led health care networks equipped to function like insurance companies? Do they have the expertise and experience to assess population health risks and costs and to accurately price health insurance products? The answer is no, and the current effort to consolidate providers and make them into ersatz insurers is a prescription for disaster

   The Affordable Care Act (ACA) is driving health care providers to combine into large health systems and to take on risk — i.e., to provide care for a specific problem or comprehensive care for a period of time, with the proviso that if costs exceed predetermined payment amounts, providers will bear the losses, and if costs are less, providers will keep the profits. Three ACA architects wrote in a 2010 Annals of Internal Medicine article that the legislation was intended to “lead to vertical integration of providers and accelerate physician employment by hospitals and aggregation into large physician groups” on the theory that consolidation, coupled with assumption of financial risk, will incentivize providers to decrease unnecessary services, cut costs, and improve outcomes.

   Affordable Care Act cuts to hospital payments and new regulatory burdens make it difficult for smaller, weaker institutions to go it alone. And solo physicians and small groups cannot afford to purchase and maintain electronic records and comply with government reporting requirements. As a result, hospital mergers are booming, and large hospitals are buying up beleaguered physician practices and outpatient service providers to form health care networks—only about a third of physicians remain independent—with many offering insurance plans directly to patients

   In essence, providers are being encouraged to function as insurance companies. As Peter Orszag, President Obama’s former director of the Office of Management and Budget and an ACA advisor,acknowledged last year, “If you’re a provider and you are taking on capitated payments you are effectively becoming an insurance company without all the protections surrounding insurance companies”

   This didn’t work in the 1990’s failed, managed care experiment, when providers consolidated to gain negotiating leverage with health maintenance organizations (HMOs). Many groups took on risk by participating in capitation arrangements to treat patients over a period of time for a predetermined sum. Nearly all the capitation arrangements lost money and folded.

   Affordable Care Act initiatives aren’t working either. The ACA’s Medicare Shared Savings programestablishes provider-led Accountable Care Organizations (ACOs) to coordinate care for Medicare patients. These ACOs share savings over projected costs and will eventually share losses. Over 400 ACOs care for over seven million elderly Americans. But only 26 percent of ACOs generated enough savings to qualify for shared savings payments. Nearly half spent above benchmarks. The ACA’sPioneer ACOs, for providers with previous experience coordinating patient care, share both savings and losses. Sixteen of 32 Pioneer ACOs have dropped out. Overall, ACO savings have been modest, approximating 0.1 percent of Medicare spending.

   The ACA also created Consumer Operated and Oriented Plans (CO-OPs)—private, state licensed, non-profit health insurance companies—to provide low-cost, consumer friendly coverage to individuals and small businesses. Twenty-three plans were funded with $2.4 billion in government loans. Thirteen have failed, leaving more than 800,000 people in 14 states scrambling for coverage and $1.3 billion in delinquent loans. Only one had a positive margin. Remaining CO-OPs may close, leaving thousands more patients without insurance. This result is hardly surprising. The people running the CO-OPs had no experience running an insurance company — CO-OPs were forbidden to have anyone affiliated with insurers on their boards

   Even experienced health insurers have trouble providing ACA-compliant insurance. United Healthcare, the country’s largest health insurer, recently announced it is losing money on ACA plans and may exit the exchanges in 2017

   Earlier hospital consolidation led to higher inpatient prices. New studies show that vertically integrated networks raise outpatient care prices, too. But decreased competition and higher prices may be the least of the problems

   Government promoted consolidation creates large entities that, like their financial counterparts in the 2007-2008 meltdown, will be “too big to fail” and will need government rescue. Health care markets are becoming so concentrated that some areas will have only one or two provider networks. Inevitably, large, risk-bearing networks will fail — most hospitals barely break even and are ill-equipped to take on insurance-like functions. Local, state, and federal governments cannot and will not allow important providers to go belly up. Too many people will be left without medical care, and too many health care workers will lose their jobs

   The moral hazard will be immense. Networks, knowing that they will not bear the costs of taking risks, will over-expand, underprice their products, and overspend in the pursuit of market dominance. In 2014, the American Hospital Association urged, “CMS not to require that Pioneer ACOs establish significant financial reserves.” Unlike the financial institutions bailed out in 2008, undercapitalized provider networks will be unable to repay the government. Taxpayers will be left holding the bag. As Peter Orszag admitted

   There are going to be a bunch of hospitals that blow up…because they take on too much risk that they don’t have the analytical tools to handle…too big to fail, which is a phenomenon that is associated with the financial sector, is also a kind of clear and present danger for the hospital sector over the next decade….

   Perhaps, the ACA’s architects intended this too big to fail scenario to extract concessions from health care providers or prompt a government takeover of health care. But the clear and present danger of multiple major health care network failures could trigger an economic crisis. Government policies that encourage provider consolidation and risk-bearing have not delivered their promised benefits and should end before the inevitable network failures occur

   tags: acos, physician perspective, physicians
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Oral Health, Mental Health, Opioid Addiction, & More: Foundation Blogs Round-Up

“Mission Possible: Using HIT to Integrate Dental and Medical Care,” by Colin Reusch of Children’s Dental Health Project, December 16, on the Connecticut Health Foundation’s blog. Reusch comments that electronic health records systems that integrate both dental and medical information “are rarely present.” I had never really thought about this important point. He also mentions the challenges of “lack of common coding systems, software, and interoperability.” Reusch suggests that this health information technology integration should emphasize the patient health viewpoint. And, for those asking why integration is even needed, he has some good answers. Also, Reusch reminds us in this important post that “oral health is an essential component of overall health”

Mental Health

“Can Philanthropy and Government Work Together?” by Jo Carcedo of the Episcopal Health Foundation(Houston, Texas), December 3, on the foundation’s V1sion Blog. If the answer to this question is “yes,” Carcedo, who is the foundation’s vice president for grants, addresses the next question: How can philanthropy effectively “support government without supplanting its responsibility to fund the public interest”? Philanthropy can’t do it all, I have heard foundations say over the years! Carcedo’s post describes lessons learned when the foundation funded an initiative of the Houston Police Department and the Harris Center for Mental Health and IDD. (IDD stands for Intellectual and Developmental Disabilities.) The initiative concerns “non-criminal, non-imminent risk mental health calls,” through the 911 phone system, that law enforcement personnel deal with each day

HIV/AIDS

“2015 AIDS Philanthropy Summit Opening Address,” by John Barnes of Funders Concerned About AIDS (FCAA), December 16, on FCAA Blog. Barnes, FCAA executive director, gave this speech at thisDecember 2015 summit, which had the theme of “restoring urgency and renewing commitments.” It is now the fourth decade of the HIV/AIDS struggle. And Barnes says we already have “identified the tools” to end the AIDS epidemic, but we need to fight the complacency that is seen “in finding the resources to implement” those tools. “’Isn’t AIDS over?’” some folks ask. The blogger says that is not the case

“Advocacy has driven every step of progress” made against HIV. However, Barnes notes, only 11 percent of philanthropic dollars in the HIV/AIDs area was spent on advocacy in 2014. That statistic is from a newly released FCAA report, which is chockfull of details on what foundations and others are funding, how much they are funding, and more. It is a useful publication for grant seekers and “philanthropoids” alike

Smoking Prevention

“A Look Back at 2015: Tobacco21/KC a Win for Public Health,” by Jessica Hembree of the Health Care Foundation of Greater Kansas City, December 17, on the foundation’s Local Health Buzz Blog. Hembree, the foundation’s policy officer, reports that in November, both Kansas City, Missouri, and Kansas City, Kansas (including Wyandotte County) passed ordinances that will increase the age at which one can purchase tobacco products from age eighteen to age twenty-one. She explains why she thinks the Tobacco21/KC collaborative effort has been successful thus far. Factors include use of an alternative approach (for example, an earlier effort to raise the tobacco tax in Missouri had been unsuccessful) and the business community’s speaking out in favor of the Tobacco21 effort, which “made an incredible difference”

In response to a follow-up question, Hembree said in an e-mail that since her blog post was published, Independence, Missouri, has also passed a Tobacco21 policy. “This issue has very much snowballed in the metro area, and we now understand that as many as a dozen more communities plan to consider Tobacco21 policies in the coming months,” she said. “We are in the process of creating a web-based toolkit to aid local communities that are working on this issue”

Opioid Addiction

“Let’s Reclaim Obituary Page for Long, Full Lives, Instead of Tragedies of Addiction,” by Wendy Wolf of the Maine Health Access Foundation (MeHAF), December 15, on the foundation’s blog. (This was originally published in the Bangor Daily News on December 13.) Wolf, who is MeHAF’s president, says that when reading newspapers’ obituary pages, she has noticed “young faces increasingly interspersed” with those of deceased older folks. She later states that “Maine’s growing heroin—and fentanyl—epidemic is quickly gaining traction as a contributor to the number of young adults dying unexpectedly.” And many people’s increasing dependence on prescribed opioid medications to treat pain is fueling this epidemic, Wolf, a physician, says. She describes a recently announced Anti-Opiate/Heroin Initiative in the Pine Tree State

tags: health it, health philanthropy, health promotion and disease preventiongw, hiv/aids, maine, mental health,opioid addiction, oral health, police, policy, public health, smoking prevention, tobacco

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Study On Highest-Markup Hospitals Leads The Pack OfHealth Affairs 2015 Top-Ten List

As 2016 begins, Health Affairs has tallied its ten most-read articles for 2015, an annual tradition

The most-read article, by Ge Bai of Washington and Lee University and Gerard Anderson of the Johns Hopkins Bloomberg School of Public Health, contains a list of its own: the 50 US hospitals with the highest markup relative to Medicare-allowable costs. To celebrate the New Year, Health Affairs is making this piece and all the articles on the journal’s 2015 top-ten list freely available to all readers for one week

Health Affairs’ 2015 list also includes: reports about US health spending for both 2013 and 2014 and projections for the decade ahead; life expectancy disparities as a result of hazardous workplace practices; and how different US hospital rating systems could generate consumer confusion. Two Narrative Matters essays, one about giving birth and the other addressing octogenarians’ desire to maintain independent living, round out the list

Join in the conversation on twitter with the hashtag #HA_Top10

The full top-ten list is below

1. Extreme Markup: The Fifty US Hospitals With The Highest Charge-To-Cost Ratios, by Ge Bai and Gerard F. Anderson, June 2015

2. National Health Expenditure Projections, 2014–24: Spending Growth Faster Than Recent Trends, by Sean Keehan and coauthors, WEB FIRST July 2015/August 2015

3. National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity, J. Matthew Austin and coauthors, March 2015

4. National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending, by Anne Martin and coauthors, WEB FIRST December2015/January 2016

5. Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups, by Joel Goh and coauthors, October 2015

6. Trends In Health Insurance Enrollment, 2013–15, by Katherine Carman and coauthors; DATAWATCH and WEB FIRST May 2015/June 2015

7. For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary, by Tracy Johnson and coauthors, August 2015

8. Necessary Steps: How Health Care Fails Older Patients, And How It Can Be Done Better, by Louise Aronson, NARRATIVE MATTERS March 2015

9. Watching The Clock: A Mother’s Hope For A Natural Birth In A Cesarean Culture, by Carla Keirns, NARRATIVE MATTERS January 2015

10. National Health Spending In 2013: Growth Slows, Remains In Step With The Overall Economy, by Micah Hartman and coauthors, WEB FIRST December 2014/January 2015

tags: health affairs journal, most read articles

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Paying For Value In Cancer Care

Everyone wants to pay for value (and certainly not just for volume) and the value imperative is nowhere greater than in cancer care. Cancer care cost the US health care system $125 billion in 2010, accounting for 5 percent of total health care spending. Before Sovaldi hit the front pages for offering a breakthrough treatment for Hepatitis C at a cost of $84,000, and Turing Pharmaceuticals pushed Sovaldi out of the headlines for increasing the price of an HIV drug 50 fold, most of the attention to drug pricing was focused on cancer

With average yearly treatment costs exceeding $100,000, cancer drugs in the US cost nearly twice as much as anywhere else in the world. Drug pricing is driven by state and federal policies, as well as clinical advances that allow the development of specific treatments for targeted populations. It can be difficult to find any correlation between a drug’s price and the social value or efficacy of the drug. We recently published a case study comparing three cancer treatments, one for colorectal cancer and two for multiple myeloma, illustrating how the net health benefits versus costs for new treatments can vary widely

Medicare has a great deal at stake in the pursuit of value in cancer care because cancer incidence is highly correlated with age. The Center for Medicare and Medicaid Innovation (CMMI) has announced theOncology Care Model (OCM) for physician practices that administer chemotherapy to Medicare patients. Its key features are a monthly care management payment for each patient throughout the six-month episode as well as performance-based payments. If practices are able to spend less than their target amount for the care episode, they will receive a portion of the savings in a performance payment, with the exact amount determined by their scores on quality measures

Bundles have a natural logic as a means for promoting lower cost for a given episode of care. With a fixed sum of money available, those responsible for organizing and providing care have strong incentives to eliminate unnecessary care and find the most efficient care partners

The challenges associated with turning this logical case into a practical application are well known. Bundles need a clear beginning and ending point. They need to adjust for underlying patient risk and potentially exclude high-cost/low-frequency elements of treatment where the cost saving imperative of the bundle could yield under-provision of high-value care. Controlling the cost of each bundle does nothing to reduce the number of bundles provided — in fact it creates incentives to increase them

Even with strong incentives to control the cost of the bundle, providers may lack the information they need to pursue the highest value care for their patients. As policymakers focus on the question of how much bundled payments can save, clinicians see a treasure trove of clinical data on a large number of patients with the same diagnosis. How can we harness those data across the health care system to learn which treatments work best for which patients

The cancer bundle is, for obvious reasons, focused on oncologists. Yet, care for cancer patients is spread across hospitals, payments for drugs, and a broad range of health professionals. Bundles paid after a diagnosis of cancer fail to engage possibilities for cancer prevention and do little to alter patterns of cancer detection. While the oncologist may lead the care team at certain points, most patients ultimately return to their primary care clinician for ongoing care. How does a shift to bundles for a portion of the continuum of care affect care outside the bundle

These are great questions to ponder, and I will have the pleasure of posing them to panelists in a session I will moderate at ECRI Institute’s 22nd Annual Conference to be held November 17-18, 2015 at the Omni Shoreham Hotel in Washington, DC. Health Affairs is pleased to once again be a sponsor of this free event. My panelists will be Patrick Conway, Chief Medical Officer of CMS, Lee Newcomer, Senior Vice President at UnitedHealthcare, and Richard Roberts, Professor of Family Medicine at the University of Wisconsin. It is sure to be an interesting conversation

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The Battle Plan To Fight Diabetes And Obesity

From time to time, most strategic grant-making organizations review their programmatic priorities, assessing the needs and opportunities in a given area and figuring out what role a foundation could play in it. When the New York State Health Foundation’s (NYSHealth’s) board and staff began reviewing its strategic priorities in 2014, we grappled with how we could have the most impact given our modest resources. (Our annual grants and operations budget is approximately $15 million—a modest sum in a state expected, by 2020, to spend more than $300 billion annually on health care!)

One question for us was how best to tackle challenges outside of the medical care delivery system that have an impact on New Yorkers’ health. Doing so meant taking a hard look at our work to address the diabetes epidemic to see whether we were targeting the right populations to achieve the most impact

An important priority for NYSHealth since our inception in 2006 had been reducing the toll of Type 2 diabetes in New York State. We singled out this type of diabetes (which primarily affects adults) for two key reasons: (1) its incidence and prevalence were increasing (while for some other chronic conditions, like asthma, rates were actually declining) and (2) it could be both prevented and managed, so we could use both community-based and clinical interventions

Initially, we focused most of our attention on improving primary care and outcomes for patients with diabetes. By the end of 2013, we had helped more than 3,000 health care providers achieve National Committee for Quality Assurance (NCQA) recognition for excellent diabetes care and outcomes; these providers care for approximately 600,000 of the 1.8 million New Yorkers with diabetes

We felt good about our clinical work, but we also saw needs and opportunities for the prevention—not just treatment—of diabetes. The need is great: more than 4 million New Yorkers have prediabetes, a condition that puts them at high risk for developing diabetes and its complications (including cardiovascular disease, kidney disease, nerve damage, and complications with their eyes and feet). And a key opportunity is to ensure that more New Yorkers with prediabetes have access to the National Diabetes Prevention Program (NDPP), a lifestyle modification program that has been shown to help participants lose 5–7 percent of their body weight and reduce their risk of developing diabetes by 50 percent

In 2010, NYSHealth supported YMCAs in ten regions across New York State to deliver the NDPP, and in 2013 the foundation provided grants and technical assistance to twenty-five other community-based organizations to implement, expand, and secure the sustainability of the NDPP

But we grew concerned that our investment would not be sufficient to reach a substantial number of New Yorkers with prediabetes. In addition, we wondered whether our approach was too narrow: by targeting those adults at highest risk for developing diabetes, were we missing an opportunity that could help a wider swath of New Yorkers of all ages to lead healthy lives and maintain a healthy weight

Should we be thinking beyond diabetes, and beyond just those at highest risk

As we often do, we looked to other leading health foundations to inform our thinking. Some of our peer foundations were focused more broadly on “healthy communities” (for example, the California Wellness Foundation’s Promoting Healthy and Safe Neighborhoods efforts include attention to environmental justice and violence prevention)

Other funders had chosen to focus at least some of their efforts on childhood obesity (for example, the Colorado Health Foundation’s Healthy Living priority area addresses opportunities for young people to eat healthy foods and engage in physical activity, and the Missouri Foundation for Health focuses primarily on childhood obesity in its Healthy Schools Healthy Communities initiative). And, of course, the Robert Wood Johnson Foundation has committed $1 billion in the area of childhood obesity as a key element of creating a “culture of health”

It seemed logical that an exclusive focus on children could lead to enduring success. From a classic prevention perspective, if we can ensure healthy patterns of eating and exercise among children and keep them fit and healthy, it may be the best path to avoiding diseases like diabetes that are related to what we eat and how much physical activity we get every day of our lives

But what about those adults at high risk of developing diabetes and other obesity-related conditions? Would we be swinging the pendulum too far if we focused only on kids

A recent New York Times op-ed by Tom Farley, the former health commissioner of New York City, reminded me of the debates NYSHealth had internally as we grappled with these questions. Farley posits that investing in children alone is actually a risky bet in the battle against obesity and related conditions, because “[w]hile obese children tend to become obese adults, about 80 percent of obese adults were not obese as children, and more than half were not even overweight”

These numbers suggest that investing in children very well could be worthwhile and should be part of the battle plan when it comes to tackling obesity and conditions like diabetes. But, addressing the problem only for children cannot be the entire battle plan

A holistic approach that creates community environments encouraging healthy living for everyone, regardless of age, makes sense to me

Ultimately, this is where NYSHealth has decided to focus its efforts. The main part of our battle plan, which we call Building Healthy Communities, is focused on changing community environments in six neighborhoods throughout New York State so that healthy foods and physical activity become easy choices for residents. We aim to improve the availability of affordable healthy foods, increase access to safe places to exercise, and encourage physical activity throughout every resident’s normal day. And, if these interventions lead to good outcomes, we hope other funders in our state step in to help us spread the idea to more communities

This approach is not without its challenges—it will require years to achieve our ultimate goal: a meaningful impact on rates of physical activity and consumption of healthy foods in these communities. Although it is encouraging to see important progress (for example, the addition of farmers markets or improvements to local parks) being made more immediately, it will require much more time for those improvements to lead to actual changes in behavior

And our support is only a small fraction of the investments happening in these areas; so, while we know we are contributing, how can we measure precisely what NYSHealth’s specific impact has been in the communities we fund? This comprehensive strategy, targeting all residents of vulnerable communities, is certainly more difficult to evaluate than our earlier work, in which we could simply count the number of health care providers delivering excellent diabetes care, was

But philanthropy is often more art than science, and we feel confident that we will see palpable change in our targeted communities in the coming months and years

Editor’s Note

Related Reading

Table of Contents for November 2015 Health Affairs thematic issue on “Food & Health”

“Project ECHO Is Awarded $6.4 Million Grant For Diabetes And Endocrinology Care To New Mexico Underserved,” by Tracy Gnadinger, GrantWatch section, Health Affairs Blog, July 23, 2014

“New York State Health Foundation’s Diabetes Campaign Is Influencing Practices to Improve Care,” by Harris Meyer, GrantWatch Profile, Health Affairs, January 2012 issue

Table of Contents for January 2012 Health Affairs thematic issue on “Confronting the Growing Diabetes Crisis”

tags: diabetes, food and health, health philanthropy, health promotion and disease preventiongw, healthy communities, new york state, physical activity, population health, prevention, public health, quality, states,vulnerable populations

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To Better Cope With Stress, Listen to Your Body

To handle stress and adversity more effectively, we should probably pay closer attention to what is happening inside our bodies, according to a fascinating new brain study of resilience and why some people seem to have more of it than others

We live in difficult times, as readers of this newspaper know well. Worries about the state of our world, our safety, our finances, health and more can lead to a variety of physiological and psychological responses

“When faced with stress, whether it’s giving a talk in front of a hundred people or feeling pressured to get a second gold medal at the Olympics, we experience changes in our body,” said Lori Haase, a clinical professor of psychiatry at the University of California in San Diego and lead author of the new study. Our heart rates rise, breathing grows shallow, and blood levels of adrenaline and other stress chemicals soar

While this stress response can have desirable results — “I need anxiety to motivate myself to write a grant,” Dr. Haase said — it can easily can get out of hand. Remaining in a state of heightened arousal undermines physical and mental performance, she explained. So while our bodies should respond to dangers and worries, our stress reactions also should dissipate as soon as possible afterward

This is where resilience comes in. In scientific terms, resilience is the ability to rapidly return to normal, both physically and emotionally, after a stressful event

Scientists and therapists long have known that some people are more resilient than others but had not known precisely why

In recent years, Dr. Haase and colleagues have begun to speculate that part of the answer might involve whether and how people listen to their bodies

To reach that conclusion, the researchers had been examining how adventure racers and elite special-operations soldiers develop resilience in the face of the frequent and often extreme physical and emotional demands of their jobs. The researchers had asked those men and women to lie in brain scanning machines while wearing face masks that, when the researchers touched a button, made it difficult to breathe, conditions that the brain and body find quite stressful

The scientists soon noticed a common pattern of brain activity among these volunteers. Portions of their brains that receive and process signals from the body, such as changes in heart rate or breathing, were very active when the volunteers thought that their masks were about to close. But despite this heightened awareness, the flow of messages from those parts of the brain to areas that intensify bodily arousal were fairly slight

In other words, the brains of these highly trained men and women closely monitored the beginnings of bodily panic but dampened the response. They experienced stress but didn’t overreact. They were resilient physically and mentally
They also, of course, were outliers; most of us are not elite athletes or soldiers

So for the new study, which was published this month in Biological Psychology, the same researchers recruited 48 healthy adults and asked them to complete a standard questionnaire about their self-perceived emotional and physical resilience. Based on their scores, the scientists assessed them as having high, average or low resilience

Then they scanned the men’s and women’s brains while the volunteers wore the same type of face masks the athletes and soldiers had and, like them, underwent periodic moments of breathlessness

The people whose scores had showed that they were highly resilient displayed brain activity very similar to that of the elite athletes and soldiers, as did, to a lesser degree, people with average resilience

But the brains of those people with low resilience scores behaved in almost the opposite way. As their face masks threatened to close, they displayed surprisingly little activity in those portions of the brain that monitor signals from the body. And then, when breathing did grow difficult, they showed high activation in parts of the brain that increase physiological arousal. In effect, they paid little attention to what was happening inside their bodies as they waited for breathing to become difficult — and then overreacted when the threat occurred

Such brain responses would undermine resilience, the scientists concluded, by making it more difficult for the body to return to a calm state

Of course, this study was based on people’s own assessments of their resilience and on a one-time snapshot of brain activity. It can’t tell us why the brains of the different groups of volunteers worked differently or whether we can change our brains’ responses to stress

But the researchers found the results compelling. “To me, this study says that resilience is largely about body awareness and not rational thinking,” said Dr. Martin Paulus, the scientific director of the Laureate Institute for Brain Research in Tulsa, Okla., and the senior author of the study. “Even smart people, if they don’t listen to their body, might not bounce back” as quickly from adversity, he said, as someone who is more attuned to his or her physiology

Improving internal communications with our bodies may be as simple as spending a few minutes each day in focused breathing, Dr. Haase said. Quietly pay attention to inhaling and exhaling without otherwise reacting, she said. Over time, this exercise should “teach you to have a change in breathing when anxious but be less attached to that reaction,” Dr. Haase said, “which may help to improve your reaction in a stressful situation”

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