Cheat Meals are a Part of My Healthy Lifestyle

Yes,  I am a cheater of fabulous quality splurges and I like to re-define the term as a "treat meal".  I do not believe that having a fresh baked brownie now and then is cheating on my fitness program.  I eat healthy the majority of the time and follow a 90/10 rule where I consume a wide variety of good carbs, lean proteins and healthy fats 90% of the time and allowing 10% for indulgences like a glass of wine or chocolate.

I will even apply the 80/20 rule where I eat healthy foods 80% of the time and allowing 20% to splurge on foods not on my typical menu.  This comes in handy when on vacation or during the holidays.  It is realistic to want things that are considered "bad" and I am not immune to those cravings.  I will not turn down a piece of my Mom's home baked pie or biscuits with butter and honey ... are you kidding me?

Pizza is a Coveted Cheat Meal

When I do partake in something nutritionally naughty it has to be quality.  I will not be diving into Twinkies or Ding-Dongs, or any processed junk food.  I will indulge in home baked goods, whole wheat pastas, granola, chocolate and frozen yogurt on hot days. I do eat lean burgers and home made pizza as well.  When I do cheat, I still want to be in control of the quality of the food.  I also do not believe in gorging or having a free ticket on a cheat day to binge on thousands of calories.  That is defeating the purpose of a splurge meal or day.

I do not plan a "treat day" but go by my cravings.  If I want something, I enjoy it and move on.  I work hard, eat clean 80 to 90 percent of the time and know that eating a slice of berry pie Ala mode is not going to break my fitness bank.  I will indeed savor every bite of my indulgence and eat slowly.  I do that anyway, but especially with a food I have been craving.  This works for me, but may not work for you.

Having treat meals are always a personal choice as there are physiological and psychological issues to consider.  Those suffering with emotional disorders that surround food may not be good candidates for treat meals and should be under the guidance of a physician and at the very least a support group.  Also, newbie fitness adapters may not be able to manage treat meals just yet and succumb to past triggers and old behaviors.  Medical issues like diabetes requires food monitoring and certain treats may not be in their best interest.

I utilize treat meals for a balance in life and to enjoy everything about being a fit person.  I do not teach or live eating boiled fish and broccoli all the time and think that is going to sustain me.  I am smart in my treats and know when to stop.  I enjoy one or two times per week some sort of sweet treat or fun meal and still maintain my physique.  What it comes down to is the approach to the treat meal or day and not using it as a reward for being deprived all week.  Eating healthy should not feel like a burden or deprivation where looking forward to treat day to derail efforts occurs.  If that is the case, a review of your current nutrition plan needs to happen.  An eating plan that feels like crap will not last and send anyone running back to unhealthy eating habits.  Life is too short not to eat healthy and it is also too short not to enjoy some splurges along the way.

Read my latest article on Cheat Meals: Good or Bad? on About.com and also grab some Cheat Meal Ideas of coveted comfort foods gone healthy.

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Darla Leal, Fit Over 50

Stay Healthy,
Darla

The Potential of Community Health Workers (CHWs)

He was among the highest.

Utilizers of healthcare services, that is. 

I had the pleasure of talking to a physician who is leading a group of community health workers (CHWs) assigned to taking care of dozens of patients like this.  Burdened by decades of multiple chronic conditions, patients like him are typically struggling with myriad complications of chronic illness, side effects from numerous medications, mental illness, extreme poverty and homelessness.  The result is an endless cycle of emergency room visits, admissions, discharges and more emergency room visits.

According to the physician I talked to, these highest utilizers don't need more physician care; us docs can only do so much with an office visit. They also don't need health insurance, because they already have it. 

What these patients really need are resources that can help bridge the aspirations of health reform and the reality of the street.

The Population Health Blog agrees. In its professional career, it saw plenty of insured people with access to health care who were still unable to get better.  They didn't need more of the PHB, they needed..... help, in the form of monitoring, education, coaching, encouragement and advice.

Enter this timely article by Dr. Kangovi and colleagues appearing in the June 11 issue of the New England Journal.  It's a good primer on the long history of CHWs and the work that will be necessary to mainsteam them into health reform.  
 
CHW-based programs in the U.S. have been around since the 1960s. They typically focus on the indigent, are modest in scope, and have been funded "hand-to-mouth" by community organizations.  However, they've also been used to facilitate insurance enrollment, support "Medicaid Health Homes" and provide preventive and screening services on a regional basis. 

The PHB believes, however, that their greatest value proposition may be in supporting interventions for high utilizing patients under Medicaid waiver arrangements or in managed care programs. By coordinating alternatives to the emergency room revolving doors, CHWs can save taxpayers a lot of money.

Dr. Kangovi et al describe five barriers to the widespread adoption of CHWs:

1) Insufficient integration with traditional providers - But the good news is that CHWs can now use the shared data and remote electronic communication of health information technology to extend the reach of the non-physician (e.g. nurses, social workers) members of a medical home.

2) Fragmented health care systems - But the good news is that health care organizations are slowly being forced out into the communities that surround them. CHWs are waiting.

3) Lack of treatment protocols - But the good news is that this is an emerging science. Some on-line resources already exist.

4) High worker turnover - the authors cite one Harlem program that lost a third of their workers over a matter of months.  The good news is that there are ways to identify "keepers" who will find the CHW career to be satisfying.

5) Low quality published evidence - But the good news is that the volume and the quality of published research is going up.  Even better news is that that will help inform accreditation programs.

That high utilizer mentioned above?  The PHB learned that his last encounter with the health care system was in a primary care provider's office, in the company of a CHW.

Image from Wikipedia

Apps Will Astonish

"Now this is meaningful use!"

In case you think the future for healthcare apps will be characterized by health information technology (HIT) "dead zones" of free downloads, fun gadgetry and vacuous consumerism with nothing to show for it, you should take a look at  this article appearing in the peer-reviewed journal Cell Systems. 

If authors Kenneth Mandl, Joshua Mandel and Isaac Kohane are even half right, "apps" could truly revolutionize HIT.  They argue that a superimposed "apps layer" ecosystem will demolish the "walled gardens" of EHRs and allow for true information sharing across clinics, systems and regions.

And that's just for starters.

As the Population Health Blog understands it, "Application Programming Interfaces" (or "APIs") will enable multiple third party apps to bridge to legacy EHRs.  That, in turn, will catalyze the creation of newer and better user experiences that reconcile doc and patient preferences with the current clunky one-size-fits-all EHRs. 

The result?

1. A "mash up" of "risks, trends and trajectories" with external data sources, telehealth and decision support systems. Why should a patient with cancer and his/her oncologist use the same computer operating environment as a patient and a dermatologist dealing with a rash?  Even better, apps can be easily substituted if a better one comes along.

2. Never mind ICD-9 or ICD-10, apps will be the "afferent limb" that links your unique genetic and phenotypic "diagnosis code" to the efferent limb of tailored treatment protocols.

3. Apps can collect and arrange the data from numerous devices at scale that not only allow for treatment compliance or disease management outside of the clinic, but the early identification of an emerging epidemic or medication side effects.

To achieve this, the authors recommend the EHR manufacturers not only retool, but adopt a uniform and open source approach to API development. Purchasers of EHRs consider should consider the future of APIs in their requests for proposals (RFPs).  They also recommend that research funding be directed toward apps that can operate across multiple information platforms. It would also help if there was a "seal of approval" process for app development that wasn't too closely tied to industry or too tied up in the regulatory miasma of government.

Food Reward Friday

This week's lucky winner... the Pizza Hut Hot Dog Bites pizza!!!

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It is Never Too Late to Get Fit

Getting fit and sporting a hot body is not just for the twenty-somethings.  It is never too late, things are never too bad, never too far gone, and we are definitely never too old to become our best healthy self.  Our minds can play evil tricks on us and  make us believe our goals are unattainable.  That simply is not the truth and the first step that needs to happen is to change the thoughts about our life and body and begin the process of kicking out the mental clutter.

Once we begin each day with a positive focus and have faith in what we want to accomplish, we are ready to make the goals come true.  It will be a daily choice to not give in to old patterns, old doubts and fears, and self sabotage.  This will be a time of inner strength development and facing all the crap that held you down for so long.  It will be an emptying of the old self into the trash and an awakening of the new stronger you ready to make things happen.

Each day is a new opportunity to change and make decisions that will bring us closer to reaching our fitness goals.  Start with small realistic goals like losing 10 pounds or registering to walk your first 5K.  Begin keeping a food journal to honestly see your eating habits and then get tough with yourself and start eating healthier foods.  Plan an exercise time on your calendar and do not skip out because it is important and you are worth the effort.  The simple steps of eating right, exercising 3 to 4 times per week to start, maintaining a food journal, and keeping a positive attitude will provide the results you want.

Do not think that this is a quick fix and mentally prepare for a lifestyle change. Regardless of the time, it will pass anyway so you might as well be working on health improvement.  This is not about perfection but always progress as we strive each day to be healthy.  Self pity will not be your friend and not an excuse to throw in the towel.  There will be days when it feels really hard and you may even want to give up but know that you are stronger than that.


Hot bodies are earned not given and believing this goal can happen at any age or circumstance is half the battle.  You are now armed to put in the physical work and fuel your body with the right foods to achieve your goals.

Helpful Tips:

• Eat a wide variety of healthy foods that include lean proteins, good carbohydrates and healthy fats.
• Drink plenty of water throughout the day.
• Get to bed at a decent hour and try for 7-8 hours of sleep per night.
• Exercise 3-4 times per week to start and progress as you get stronger.
• Include weight resistance training 1-2 times per week to start.
• Keep a food journal for accountability... be honest with yourself.
• Dump the junk food and replace with healthy food options.
• Pay attention to portion sizes and read food labels.
• Eat several small meals per day and do not allow yourself to feel hungry.
• Weigh in only one time per week, pay attention to how your clothes are fitting, and how you look naked. 
• Make time for prayer and positive self talk to keep up the motivation.
• Set realistic small goals to start like losing 10lbs or signing up to walk your first 5K. 
• Hire a qualified personal trainer for guidance and motivation if going it alone feels too overwhelming.

Read my article "Training for My First 5K: What Do I Eat?" on About.com for even more great information on healthy eating and reaching personal goals.

Thanks for stopping by my Blog and I look forward to reading your comments. Subscribe below and never miss a free update.

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Stay Healthy!
Darla

Are Some Physicians Stockholm Syndrome Victims?

A hostage sides with her
captors in a bank hold-up

Years ago, when the Population Health Blog was the staff physician supervising an overworked inpatient consult service, its team of residents was asked by a surgeon to evaluate abnormal kidney function tests on one of her patients. After quickly surmising that the cause was a simple case of easily-corrected dehydration, the residents complained that the surgeon should have spotted the diagnosis. As a result, they said, this was a waste of their time.

"Not so!" said the PHB. It pointed out that the resident's medical knowledge was so advanced that they could glance at some lab numbers and spot the diagnosis. It's not that the surgeon was dumb or lazy, but that they were extremely smart.

The PHB also challenged them to snap out of it. Their low self-esteem was allowing them to be held hostage by narrative that not only devalued their expertise, but put their professional well-being at risk.

Fast forward to today when it's not about troubled kidney function, but a troubled healthcare system.

As we look for solutions, physicians are being buffeted by a widespread narrative that they're largely responsible for low quality, high costs and poor patient experience.

For example, there's literature that physicians order too many or (too few) tests, that misdiagnosis is common and that their treatments warrant scrutiny.  Or, thanks to their "power of the pen," misaligned physician incentives have led to the United States' outlier status on life expectancy vs. per capita costs.

How much is truly under the physicians' control is up to debate. What's more, physicians bring tremendous value to the table of health reform.  But, public perception says otherwise, and that's likely playing a role in the declining public trust in physicians and drops in their prestige. That, in turn, is contributing to widespread professional dissatisfaction and burn-out with significant implications for patient care.

Which makes the PHB wonder if it's witnessing the consult service scenario described above, but on a national scale.  It's one thing for its physician colleagues to emotionally struggle with the tectonic challenges of health reform (and there are ways, like this and this, to deal with it), but it's entirely another thing for them to agree that their professional value has been diminished.

Which leads the PHB's to speculate about its biggest fear. In addition to the hassles of physician-owned practice, the intellectual and emotional buy-in of a narrative of incompetence may be leading many docs to willingly outsource national policy as well as local practice decisions about quality and costs to the corporation.

For some docs, this could be a professional version of the Stockholm Syndrome.

As so elegantly described by Paul Levy in his blog, the Stockholm Syndrome occurs when hostages misinterpret the near-term lack of abuse by their captors to the point of emotionally bonding with them. While he was writing about the relationship of healthcare institutions to electronic record vendors, the PHB wonders if the same could be said about the relationship of physicians to their administrators, policy makers, elected representatives, regulators and the other clerisy.

Their reward for any role they've played in marginalizing physicians is greater authority, and some docs may not only going along with it, but embracing it.

The PHB looked for physician surveys or other data to support this, and can't find it. It suspects no one has asked the question.

Until now.

Presentations from the Health in all Policies New Zealand Conference 2015

For those of us who could not make it to New Zealand below is the next best thing, pdfs of the conference programme and the main presentations.

Health in all Policies New Zealand Conference 2015 Programme

What is Health in All Policies?

Rob Quigley

Sugary Drinks and Public Policy

Dr Rob Beaglehole

Human Rights and HIA

Dr Fiona Haigh (University of New South Wales, Australia)

Health impact assessment (HIA) and human rights both contribute to the promotion of physical and mental health and wellbeing. Human rights provide an ethical and legal framework, while HIA provides evidence-based methods and tools, derived from social and natural sciences, for policy evaluation. Scholars have proposed that international human rights laws and standards provide a legally binding and morally compelling framework for

HIA. Several human rights monitoring mechanisms – including the UN Committee on the Rights of the Child, the UN Committee on Economic, Social and Cultural Rights and the UN Special Rapporteur on the right to health – have called on governments to perform human rights-based impact assessments. It has been hypothesized that HIA can provide a well established evidence based (scientific) method to systematically and transparently assess impacts on the right to health; while human rights contribute a legally binding and morally compelling framework that allows governments and governmental agencies to be held accountable drawing attention to the legal and policy context within which health interventions occur. Despite increasing attention given to human rights and health by policy makers and researchers little has been achieved to date when it comes to integrating human rights considerations into HIA work. Thus, there are few methodologies and tools developed to identify and trace the context specific pathways between a policy, human rights and health outcomes; explain why relationships between these exist or what 'mechanisms' might account for them. In the absence of such explanations it is difficult to decide 'what to do' to improve human rights and health outcomes.

This presentation explores integrating human rights into Health Impact Assessment (HIA) methodology. In particular we report on research examining the fit between HIA and human rights, how HRHIA could work and what are the implications of integrating human rights into Health Impact Assessment (HIA) methodology.

Pegasus Health the Evolution of Primary Care and Health in All Policies

Emeritus Professor Andrew Hornblow

Trading Away Health: A Health Impact Assessment of the Trans Pacific Trade Agreement

Dr Patrick Harris and Fiona Haigh

Good policy-making requires good science

Professor Sir Peter Gluckman

Relationships are the currency of the future

Ana Apatu and Henare O’Keefe

Introduction: Where to now

Mary Richardson

Mind the Gap

Associate Professor Susan Morton

A Canterbury That’s More Than Just All Right...

Dr Lucy D'Aeth

Te Ara Mua Future Streets: Engaging Communities and Challenging Polices

Dr Adrian Field and Dr Alex Macmillan

Over half of the world’s population and three quarters of OECD residents now live in cities. In the last century, New Zealand’s towns and urban areas grew seven-fold while the rural population grew very little. Cities in New Zealand and internationally are at the frontline of addressing public health and environmental sustainability. Concerted and integrated responses from planning, urban design and public health are key to securing an urban form the meets the challenges of cities in the 21st century.

Transport infrastructure poses a particular challenge, where the dominant paradigm often has the private car as is its centrepiece. Transport infrastructure investments also emphasise economic and safety gains while largely ignoring other public health, social and environmental impacts, including impacts on social and health equity. The ideas and thinking that have shaped transport infrastructure have contributed to such global health problems as obesity and social dislocation.

Interventions to re-shape or retrofit existing urban communities can have multiple co-benefits for social, physical, economic and environmental wellbeing, and increasing community resilience to expected future threats. Creating urban form for people rather than cars, improves people’s health, improves perceptions of safety, improves opportunities for physical activity and helps slow the growth of long-term conditions.

Te Ara Mua – Future Streets is a mixed methods intervention study of suburb-wide street changes aimed at making cycling and walking safer and more attractive in Mangere, Auckland.

The project, led by a consortium of universities and consultancies, in partnership with Auckland Transport and New Zealand Transport Agency, brings in leading international thinking in street design, allied with an intensive participatory design process. Te Ara Mua will offer new approaches to design, apply a participatory engagement approach in which knowledge is shared, and look to challenge the ways in which the costs and benefits of street infrastructure are measured, and how these in turn inform policy.

This pecha kucha presentation highlights the contribution that the Te Ara Mua – Future Streets project makes to applying Health In All Policies philosophy at a local level, in a way that challenges established thinking in urban form.

Economic Perspectives on Health in All Policies

Professor Paul Dalziel

The Cancer Society: Long Term Plans, Pathway to Smokefree New Zealand by 2025

Martin Witt and Amanda Dodd

Video component of the presentation by Martin Witt and Amanda Dodd

As a community based organisation, the Cancer Society has anestablished a suite of health promotion programmes designed to raise awareness of lifestyle and cancer risk. Over the last five years the organisation has placed a focus the role of public policy can play in achieving positive health outcomes for our communities. In particular our tobacco control work has placed importance on partnerships with local authorities and other key partners, to facilitate creation of smokefree community spaces. As key steps toward achieving the Smokefree Aotearoa goal by 2025 extending the scope of these policies to go beyond the “greenspace” is essential. Public support for more Smokefree community spaces is strong and there are encouraging signs that other key stakeholders such as businesses are open to further discussions but what do councils think?

With ten years to go to the goal, it is significant that councils are now developing their Long Term Plans [LTP] for the same period offering a timely opportunity for current partnerships to be strengthened. This presentation will outline how the Cancer Society is supporting a Health in All Policies approach, working in partnership to frame the need for councils to demonstrate commitment and leadership in helping ensure that New Zealand does indeed achieve its goal to be Smokefree by 2025. The presentation will address how criteria have been developed to assess the extent to which councils acknowledge their role in promoting Smokefree policy and

how this might develop over the next few years. Council responses to submissions will be evaluated against these criteria.

Although there are examples of councils already demonstrating strategies consistent with the 2025 goal, most notably Auckland and Palmerston North , there need to be much stronger signs that other councils recognise the significance of their role; a role that does not mean a large financial commitment. LTP are by their nature based on the use of limited resources, however they are also open to public consultation and intended to be an outline of all council activities that help make communities safe places to live work and play in. Failure to engage councils in the 2025 goal as part of their LTP’s in 2015 would seem to be inconsistent with that intention.

Transport and Health in All Policies

Dr Alex Macmillan

Transport policy has a strong and complex influence on population health, social and health equity, and environmental sustainability, which underpins human health. Currently in New Zealand, transport policy objectives are heavily focused on supporting economic growth through congestion reduction and freight movement, while addressing road traffic injury. Although some attempts have been made to incorporate wider public health objectives into transport planning more recently, these have been hampered by knowledge, skills, institutional and ideological barriers. Using more than a decade of experience with influencing transport policy using an arsenal of approaches, I will explore how successful this influence has been and the factors underpinning more and less successful influence. I will also draw together some insights from this experience for Health in all Policies more generally.

View the presentations from the Reflective Practice Day on 30th April 2015

Original Source: Healthy Christchurch

STARTING IS NOT THE END, MAINTAINING IS A LIFETIME

Starting to adopt a healthy lifestyle and achieve personal fitness goals can feel exciting and even easy in the beginning.  We plug into our fitness pals, fit bits, get motivated eating healthy foods, excited about the new workouts and with smiles on our faces dive head first into what is absolutely fitness euphoria.   It feels good to eat healthy, exercise and talk about it with our family and friends. Self motivation is at it's peak running on a full tank of gas and determination full throttle.  We are on top of the world and nothing will stop us from reaching our goals, right?

The struggle is usually not in the starting but in the maintaining.  We all need to start the process of getting healthy and we also need to continue creating healthy habits that eventually morph into a lifestyle.  Week three of the start may not feel as good anymore or as exciting but going out with friends downing a few drinks and sopping up some bread sounds more appealing.  Week four seems to be filled with obligations that are somehow more important than the promise we made to ourselves to get healthy.  Week five starts a two week vacation that will not include anything healthy and focused around a food frenzy that will surely expand the waistline.  In a short time, starting to eat right and get healthy has taken a back seat and old patterns have returned.  The struggle is real for many out there.

The processed food items make their way back into the pantry instead of the good carbohydrates that were there just a month ago.  Healthy fats are replaced with saturated fake food products, pizza and burgers are the staple over lean proteins and vegetables, and water intake is at an all time low.  Choices and behaviors like this happen all the time and if you are reading yourself between the lines, you are not alone.  It can cause feelings of failure, frustration and discouragement with the "give up" attitude fighting to take over the mental game. None of us are immune to falling into poor eating habits and reasons to not exercise. It can start as simply as telling yourself "just this once" that develops into a week, month and even a year.

The only choice that can be made is telling ourselves to STOP doing the things that are bringing us back into unhealthy patterns.  Somehow that motivation to START needs to come full circle again, and through whatever methods of accountability it takes.  If you are unable to do it alone, hire a qualified personal trainer or find a workout partner.  If you are sabotaged at home, start creating two separate meals to ensure that you are eating healthy.  If too busy seems to be a problem, it is time to look at your priorities.  The time is now to start achieving your fitness goals, but even more than that, learning how to maintain a healthy lifestyle.

Check out my latest article  "Ten Foods You Should Eat Every Day" for optimum fitness on About.com.  

TEN FOODS YOU SHOULD EAT EVERY DAY

Thanks for stopping by my Blog and I always appreciate your comments and look forward to responding.  Don't forget to subscribe below to receive my free updates!

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Stay Healthy!
Darla

Insulin Resistance Predicts a Variety of Age-related Diseases

In the last post, I reviewed a study by Gerald Reaven's group showing that insulin resistance strongly predicts the risk of cardiovascular disease over a 5-year period.  In 2001, Reaven's group published an even more striking follow-up result from the same cohort (1).  This study shows that not only does insulin resistance predict cardiovascular disease risk, it also predicts a variety of age-related diseases, including hypertension, coronary heart disease, stroke, cancer, type 2 diabetes, and even overall mortality risk.

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The Myriad Ways of Strategy and Population Health for Governance Boards and Health Care Leaders

What's it take to be a "luminary?"

As healthcare organization leaders grapple with health reform's uncertainties, a common refrain is importance of "strategy".

It's no longer enough to maximize revenue, increase patient throughput, lower costs, manage debt, embrace financial risk, optimize FTEs, assure compliance or strengthen the balance sheet.

While those present management and fiduciary functions are still critical, governance boards and c-suite executives in both purchaser and provider organizations also have to make bets about the future.

For example, if healthcare inflation accelerates, how will your current customers react to their future costs-sharing? How and when will today's voters reconcile the burdens from growing public debt and government-sponsorship of the insurance programs you contract with? As "the internet of things" spreads, what is tomorrow's value proposition of your healthcare "things?"  Is reading this blog today going to lead to you being smarter in tomorrow's contentious meeting?

In other words, when leaders grapple with strategy, they're really futurists. They're making bets today on how to adapt current strengths and weaknesses to myriad downstream threats and opportunities.

Uncertainty has become a new watchword. Even if an organization doesn't change and sticks with old fashioned fee-for-service, they're still making a big wager on the future of individual billing versus risk-contracting for populations.

Which is why the Population Health Blog is interested in how leaders outside of healthcare deal with uncertainty. 

Being routinely unable to resist the materialistic allure of the WSJ. Magazine fashion ads, the PHB  happily stumbled into this Soapbox column on the single topic of strategy. Six "luminaries" were asked about it.

The recording industry executive emphasized visualizing the endgame. The professional sailor trusts her gut instincts. The computer gamer is all about capitalizing on lucky breaks. The presidential historian liked ongoing experimentation. The restaurateur is constantly shaping company culture. The matchmaker likes being open to change, even if it means being vulnerable.

Lesson? The PHB has read or heard all of this and more from leaders and in boardrooms. Examples include this (the end-game), this (intuition), this (luck), this (experimentation), this (culture) and this (change management).

"Strategy" remains a highly variable work in progress.  There is no best practice.

And then there's the huge health care opportunities and risks from contracting for the care of populations. Check out this interesting post by George Washington University's Miliken Institute of Public Health that describes a survey of 37 health care luminaries on the topic of population health. As the author points out, consensus on responsibility (and, as a side note, the assets and liabilities that accompany it) is lacking.  In addition, quoting the "Triple Aim" is turning out to be less than its admirers would like.

So it turns out that this is also very much a work in progress.

The PHB's takes?

 There are two:

1) Multiply the many approaches to strategy with the multiple takes on caring for populations and the possibilities are endless. Based on the variations, no one has cracked the code applying strategy to populations and risk-contracting.

For purchaser/provider board members and C-suite leaders, the good news is that your strategic bets on the future are - for now - as good as anyone's. The bad news is that the present day fiduciary work is not lessened and you're going to have to devote more effort (and time) on developing a still unsettled strategy approach to the uncertainties surrounding health reform.

2) Regrettably, despite describing itself as a "luminary" many times to the PHB Spouse, it was not included in the WSJ. column and the Miliken Blog.  This sadly suggests that her skepticism - for now - is warranted.

Image from Wikipedia