For the Commercial Health Insurers, Winter Is Coming

Fans of HBO's hit fantasy TV series Game of Thrones will recognize the adage. 

In the show, the continent of Westeros has had a long hot summer of breasts, butts and beheadings. Now, it's not only getting colder, but there have been sightings in the North of blue-eyed freeze-dried warrior zombies. Crops are failing, the northern tribes are fleeing and the crows are looking more sinister by the minute. The only thing that separates civilization from catastrophe is The Wall.  That's made of a lot of ice and it is guarded by the Night's Watch.  The Watch is made up of mostly unsavory criminal types who have been given the choices of decapitation or taking The Oath.  Think of them as the Fence Frozen Legion.  Cue camera, raise swords... action!

Naturally, the Population Health Blog is enjoying every minute of it, and so is, inexplicably, the PHB Spouse.  We're both gained valuable insights.  While the PHB ponders her observation that men are untrustworthy swine, it has more constructively responded that Game of Thrones has many lessons that speak to the health insurance market.

To wit:

The Night's Watch may be made up of villains, but they're our villains and they're performing a valuable function.  Commercial health insurers likewise have their knaves, but for years they have been pooling risk and paying claims. 

Unfortunately, times are changing. While we've had a lusty summer of low cost inflation and innovation, Accountable Care Organizations are not as successful as hoped, insurer networks have gone skinny, out-of-pocket expenses are climbing and tax bills are coming due.  While we thought the undead "Medicare for All" was just an unpleasant memory, there have been sightings here and here. 

Will the Night's Watch of commercial insurers hold the wall?  Cue camera, raise swords.... action!

Image from Wikipedia

New Study Strengthens the Case that LDL Causes Heart Disease

There is little remaining doubt in the scientific/medical community that high levels of LDL, so-called "bad cholesterol", cause heart disease.  Yet in some alternative health circles, the debate continues.  A new study adds substantially to the evidence that LDL plays a causal role in heart disease.

Read more »

INTENTIONS ARE GOOD, BUT THEY MUST BE LIVED OUT

I was reading my daily devotion this morning and on the subject of intentions. I was immediately drawn into the meat of the subject and felt it was talking to me personally.  Can you relate?  Isn't it so true how we have all these good intentions, dream about how we are going to carry them out and then some how along the way, they get pushed aside and forgotten some how.  Well, not really forgotten, because they are still there dancing across the pages of our thoughts now and then, at least in my case. I am sure we can all agree to being guilty of not following through on good intentions to make something happen. As I read further, I understood the importance of  writing down the intentions beginning a plan to follow through with action.

Moving from intention to action takes a plan.  This applies to all things in adopting a healthy lifestyle and staying true to taking care of the important things in life.  What has helped me is prayer and setting up challenge systems where I complete three goals of intention for that day.  Today I plan to get in a morning workout, help my ailing father to the doctor, and meet up with family later this evening.  Another goal was writing this blog and I was stumped at what to share with you at first, but enlightened after reading my devotional.  It is amazing how things happen like that.

Having good intentions are well, good, but remain thoughts until living them out takes place.  The goal of weight loss, toning, and improving overall quality of life takes action and intending to create that is wonderful, but the follow-through is what will create the health, the fit body, and overall awesome feeling of accomplishment. Those things that we think about all the time must come to the forefront of our actions.  Has a family member or friend been on your mind to call?  Pick up the phone.  Has that surprise date with your spouse been put off for months? Time to bring on the romance.  Are the intentions to workout four times a week not happening? Get your calendar, schedule your workouts and do not cancel.  Intending to eat at home more to save money and improve the quality of your food intake?  Write a healthy food list and head to the store.

Every step we make is a step closer to fulfilling our goals and taking our intentions further than our minds.  Let's not get stuck in just thinking about it and feeling good about our thoughts only to have them fizzle out and remain stuck as things we just talk about in friendly conversation.  It all sounds good but living it out by example and action will be the proof in the pudding.

Stay Healthy Happenings:  I just created a Stay Healthy Google+ account and excited to share that with you for even more MOTIVATION, support and fitness fun.  Head on over and ADD me today and Stay Healthy!

Darla Leal, Fit at 50

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Stay Healthy!

                                                

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Pasta Pea-mavera

Now this isn't what you would call a traditional Pasta Primavera. Not even close actually. To be honest I just stole the name to fit a little pun in there. Puns make for infinitely catchier titles than mere descriptions do. Yes. This doesn't mean, however, that this Pasta Pea-mavera doesn't live up to the springtime feeling of the original. The wonderful greens combined with freshly squeezed lemon juice make for a great springtime dinner or lunch, so the cheeky little name appropriation wasn't entirely uncalled for. (My sincere apologies to any offended pasta connoisseurs out there!)

This dish is also a great way to get your greens in... Because they're literally everywhere in this recipe! Wohoo! The broccoli will provide you with an abundance of vitamins (namely, vitamins A, C, K and folate) plus a great deal of your daily fibre needs, while the peas contribute with protein and a wonderful sweetness to the sauce. Go super greens!

Here's the recipe!

Serves 2

Ingredients:

- 1 heaped cup frozen peas
- 1/2 cup vegan sour cream substitute
- 2 big handfuls fresh basil leaves + more for garnish
- 2 small heads of broccoli (approximately 250 g)
- 1 tbsp + 1 tsp lemon juice
- 1 tbsp extra virgin olive oil
- Garlic powder (optional)
- Salt and pepper to taste

- Brown rice pasta or pasta of your choice, enough for two servings (approximately 150 g)

How to:

1. Bring a small pot of water to the boil and cook the pasta according to instructions on package.
2. Divide the broccoli into small, individual florets and steam until it is almost cooked through but not mushy.
3. Meanwhile the broccoli steams and the pasta cooks, place the peas in a saucepan over low heat until they have thawed completely.
4. Add in the remaining ingredients (except for the broccoli) and blend with a hand blender until fairly smooth. You can go on for longer if you want an even smoother texture but I prefer it a little chunkier. (You may also have to re-heat the sauce before putting it on the pasta.)
5. Toss the cooked pasta in the sauce and add the broccoli. Top with a few fresh basil leaves and serve immediately!

The Latest Health Wonk Review Is Up

The Health Wonk Review is a linked summary of the better insights from smart health policy bloggers.  The latest edition is hosted by Joe Paduda of Managed Care Matters.

Enjoy!

Why was NIAP so Successful?

I'm 

Key URL for documents published by NIAP:

www.niap.pk

www.iucn.org

What were the important drivers for success?

Funded posts in EPA and Planning Division at local government level to support and help coordinate the relationships and the work of the programme.

Devolution was an important driver as states had to put a policies, guidance and system in place.

Environmental, social and economic problems were also drivers.

The legal and procedures are in place but too early to say how it is working. Anecdotal evidence that yes it is being used. This is likely to be because of the way the material was developed, co-production.

A new generation of young professionals.

BUT some things didn't work e.g. establishing a professional association. 

Transboundary gas pipeline

Learned a lot more than perhaps I taught to Pakistan gas pipeline and environmental professionals. In that sense. a humbling experience.

Range of Transboundary Pipelines

Get the route right and everything else is much easier.

Some EIAs can be too early! 

Often common sense needed. For example the photo above shows a concrete barrier in the middle of a road that cuts across a tortoise migration route.

EIA Guidance for Coal Fired Power Plants

Need to understand the context of Pakistan before the guidance was developed. Portugal is 45th in GDP rankings and Pakistan is 46th but Portugal has only 10 million people compared to 190 million people.

FIRST key question that we asked was why is guidance needed.

Energy scarcity is such that focus was on distribution the limiters energy and that any thing is acceptable anywhere to bring more energy production online. This has generated concern on air pollution.

Water scarcity is also a big issues.

Three different power plant projects being  considered.

Key concern was engaging with communities and stakeholders so that there was ownership of guidance.

Very diverse culture and landscape.

Very complex and complicated country.

Lack of strategic thinking. An SEA of the energy sector or if coal fired power plants is a critical need.

In Pakistan there were 'two' governance and the governance of everything else. Environmental governance is not integrated. So people in environmental governance are strong on environmental protection but the other parts of government are not.

An IAIA Affiliate may be an important way of contouring the work that has already been undertaken.

NIAP EIA Handbook and EIA curriculum for Pakistan

EIA Curriculum challenges in Pakistan were similar to those found in other countries around the world.

National Impact Assessment Program in Pakistan: outcomes and lessons

A range of partners have been involved in supporting EIA system in Pakistan.

Curing the Healthcare Digital Divide: There's an App for That

Whither meaningful use?

For better or worse, policymakers, politicians and health leaders in the United States are committed to achieving paperless healthcare environment. Even if there is lack of high quality research and reasonable skepticism over the ultimate cost and quality merits of "e"care, there is no going back.

As a result, visitors to ehospitals and eclinics are increasingly surrounded by monitors that, in turn, are surrounded by providers. To gain their attention, patients need to have internet access to make appointments, update medications, obtain education and communicate with their doctor.

And what if they don't have that access? For the last decade, that worry has been characterized as "the healthcare digital divide. " As recently as 2014, it's been documented that the lack of computer hardware and access can have important healthcare implications for persons with low socioeconomic status.

For the doctors and nurses staring at screens all day, the millions of Americans who are living paycheck to paycheck risk being out sight and out of mind.

But it turns out that that it doesn't need to be that way.

The PHB explains.

Check out this telling report from the Federal Deposit Insurance Corporation on the "unbanked" and "underbanked."  Not having a bank account (unbanked) or using any financial services (underbanked) are linked to persons with low income, being of color, disability and being unemployed.

In other words, these are the very persons at risk of being on the losing end of the health care digital divide.

While there's interesting data on how close to 8% of U.S. households are unbanked and just over 20% were underbanked, there were also these stunning observations:

"Relative to fully banked households (86.8%), underbanked households were somewhat more likely to have had access to mobile phones (90.5%) and smartphones (64.5% of underbanked households compared with 59.0 percent of fully banked households)."

"Notably smaller, but still significant, proportions of unbanked households had access to mobile phones (68.1%) and smartphones (33.1%)" (bolding PHB).

In other words, persons of low socioeconomic status are more likely to have smart phones vs. the "banked" population. They may not have a checking account, but, compared to other segments of the population, they are also more able to use these devices to access and manage their "e"care.

The PHB's conclusions?

1. Not  explicitly fostering heandhelds as a part of the healthcare informatics "ecosystem" may be shutting out persons of low socioeconomic status from the health system. While the Washington DC's "meaningful use" (MU) criteria are not explicitly tilted toward desktop/tower computing, they seem to conspicuously silent on advocating for ease of smartphone use, for example, to manage appointments, medications, education and messaging. 

Compare MU that with Google's mobilegeddon and the unwillingness of innovative systems (like this and this) to wait for CMS to catch up.  They're loaning handhelds to patients.

What do you know: if you want to increase access to healthcare for the economically disenfranchised, there truly is an app for that.  It was there all along.

2. Yet, smartphones for the economically vulnerable and access to health information technology are not necessarily a slamdunk.  This report reminds us that smartphone contracts are vulnerable to non-payment and that it's not unusual for service to be turned off. 

Health systems that can navigate that reality that will win.

Image from Wikipedia

Towards a definition of HIA in Italy

HIA implementation at a regional level in Austria

Developed a HIA Action Plan

Then a HIA Development Unit was set up.

...

Three fold methodology

Conclusions

Leading from the front: HIA in Wales

Devolved government and a focus on health and wellbeing, inequalities, sustainable development...

High levels of poor health in Wales.

Health in All Polices and HIAS by 'stealth' where there is mix of healthy lifestyles priorities alongside HiAP and HIA.

HiAP guidance being developed to operationalise the aims of Future Generations legislation.

BUT will need to monitor and evaluate the success of the bill and guidance.