Food Reward Friday

This week's lucky "winner"... the Reese's PBC Burger!!

Image credit: The Works

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Why Become a Doctor?

Talk about good timing.

This just-broadcast NPR Morning Edition segment spoke to the importance of "STEM" (i.e., Science, Technology, Engineering and Math) high school education. When the network's framing began (Mr. Obama's "stargazing" vs. "hard-line" House Republicans), the otherwise agreeable Population Health Blog began to tune out.

Its attention snapped back when it heard this....

.... combination of budget cuts and policy decisions has left many local, state and federal bodies short on funds to robustly back science education. To help fill the gaps, a national patchwork of corporations, non-profits, foundations, and volunteers have stepped in to help. Volunteer and corporate-backed STEM networks "can help schools bridge those gaps and make those connections".....

Indeed. 

The PHB spent the prior day - October 27 - participating in a Junior Achievement-sponsored "STEM Summit" at a local Harrisburg PA high school. Groups of 9th graders rotated through a number of stations (fun experiments in physics, food science, electrical engineering and math) and panels (presentations about careers in geology, food science, finance and health care). 

The loquacious PHB was naturally assigned to a panel, and its job was to prompt the rotating groups of participants to think about becoming doctors:

After you graduate from high school, go to college, and continue your studies in science. But remember the goal is a broad education that will help you become a better and informed global citizen. Then you go to medical school.  That involves four years of both lectures and exposure to real patients across a range of disciplines.  By the time that is over, you have a doctor degree, but you're not ready for independent medical practice. For that, you have to pick a specialty career path with an additional 3 to 5 years (or more) in an apprenticeship called a internship/residency.

Medical school can result in more than $100,000 in debt. That sounds like a lot, and it is. But during your residency, an income of more than $50,000 is likely. Once you are in independent practice, your income can exceed $200,0000 a year. 

Your debt will be serviceable.  Being a doctor is in your reach.

Remember that 1 out of very 5 dollars (the PHB held up a $5 bill) in the U.S. will be going to healthcare - 20% of your and everybody's income will be going to people like me.  This is a growth area in the U.S. economy.  As a doctor, you will always have a job and be able to put a roof over your head and put food on your table.

If you like science and people, medicine is a good place to be, and we need talented people like you in there.

Do Processed and Red Meat Cause Cancer?

Today, the World Health Organization's International Agency for Research on Cancer published a statement in The Lancet detailing its position on the carcinogenicity of processed and red meat (1).  The statement, resulting from a meeting of 22 scientists from 10 countries, concluded that processed meat is a group 1 carcinogen, meaning that it is "definitely carcinogenic to humans".  They also judged that red meat is a group 2A carcinogen, meaning that it probably causes cancer but the evidence isn't as strong.  They're mostly referring to the links between processed and red meat and digestive tract cancer, particularly cancers of the colon and rectum.

These statements were met with a media frenzy, and the expected furor from the meat industry.  The most surprising thing, for me, is that anyone would be surprised by the IARC's statement.

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It's Time to Break The Cycle of Bad Habits

Henry Ford said it best, "If you always do what you've always done, you'll get what you've always got." 

Bad habits need to be broken which means hard choices are often required to create health and happiness in our life.  What we think in our heads as the way things should be or how we want them to be doesn't magically happen because the thought is there.  Bad habits are ugly and keep us trapped in a life of emotional stress, depression, repeating unhealthy behaviors, and unable to move forward into the life we are supposed to live.  We are not loving ourselves when we are repeating bad habits.  In order to create good habits, ending the cycle of what you have always done will be the start of great things for you.

Bad habit cycles can include turning to unhealthy ways of dealing with stress, enabling a loved one, or simply not accepting it is happening at all.  Turning to alcohol, drugs, smoking, binge eating or not eating are examples of unhealthy stress relief habits.  Making accommodations for a person's harmful conduct and dysfunctional behavior believing it is a help actually makes the problem worse and is an example of enabling.  Being in denial about bad habit cycles is another way of not facing what needs to be changed.

The cycle of bad habits feels horrible in life and many of us are running around living this as our "norm" daily walk.  Many times we are fat, sick and angry and not looking at ourselves as the cause of what is happening.  Instead we choose to repeat what is not working for us to get healthy and "get what we have always gotten".  It is time for us to take our heads out of the sand and begin finding our mental strong to make the tough choices that will open doors to good health.  It is time to stop doing what we have always done.

Health and fitness are about physical and emotional health and it does take making changes, removing bad habits, and remaining true to the choices that will keep us heading in the direction of our goals.  The journey will not be easy and life is not about that, but it is always about progressing and becoming better than we were yesterday.  If you really want a better, healthy life it will be up to you to break the cycle of bad habits.  Your life, your body and your choice.

Head on over to my site on the about.com network and enjoy some great reads! Did you know warnings have been strengthened for Ibuprofen causing heart attack and stroke?  Check out the FDA safety communication and my article on the subject. You will also be happy to read about the health benefits of Full Fat Foods instead of the crappy alternatives being pushed on consumers today.

Linked to Heart Attack...Read on!

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Break the Cycle of Bad Habits for Health
Darla Leal, Fit-Over-50

Value Creation for Healthcare Apps - or - Avoiding the Mistakes of "Meaningful Use"

Meaningful Use is debated

Any health care provider who hasn't been sealed in a Faraday cage for the last five years is likely aware of "Meaningful Use 3" or "MU3." Briefly, thanks to the American Recovery and Reinvestment Act (ARRA) of 2009, CMS can impose incentive payments to promote the adoption and "meaningful use" of electronic health records (EHRs).  Meaningful Use or MU has since become its own government program.  MU1 and MU2 are well underway, and CMS is preparing for the third phase, or MU3.
 
But a phunny thing happened on the way to this phase phorum. While insiders have saluted the good intentions behind the latest requirements, there's a lot of bad and even more ugly. It's telling when even the prestigious New England Journal publishes a highly critical perspective like this. It seems that skepticism over the fit of MU with the realities of clinical practices is being misinterpreted in some quarters as technophobic non-cooperation.

And so it goes.

Fortunately, for the Population Health Blog, its psychological EHR scars have long healed.  It, like a lot of other colleagues, has moved to a market of (for example) electronic care solutions that are not local and PC-based,  but are mobile and cloud-based.  And the good news is that - so far - there is no ARRA statute intended to enable a well-intentioned lawyer from uttering those Nine Most Terrifying Words just when the health app ecosystem is reaching critical mass.

But that doesn't mean that we can't learn from the EHR-MU Wars.  To wit:
 
1) Learn from mistakes; for example, better, not more, information technology begets more patient safety.

2) It's ultimately all about user value creation: for example, resist linking the technology to billings/revenue and link it to care/satisfaction.

3) Design with the end-user in mind: for example, release no product unless the intended user has shown that it can fit in their (provider) work flows or their (patient) home setting

4) Align the time frames: keep in mind that the short-term time technology horizon of 2-3 years to may not align with the 5 or more years it takes to "bend the curve" for a insurance risk-bearing organization

5) Resist the allure of government help: while incumbent companies may believe federal legislation may turbocharge their business models, the MU suggests that the downsides are considerable.

Why Do Girls and Boys Reach Puberty Younger Than They Used To?

Girls, and probably boys, are reaching puberty years younger than they did in our great-grandparents' generation.  Why?  There's no shortage of explanations, but the primary reason is probably quite simple.

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Be a Leader not a Follower with Your Fitness

My daughter's 1st grade teacher let me know she would always be a leader and not a follower and this still holds true 24-years later.  I have also remained great friends with the awesome lady providing this advice, and I think about it often and how it applies to health and fitness. We all need to be leaders and not followers when it comes to our nutrition, exercise, sleep and everything related to improving the quality of our health.

I am a  skeptic when it comes to the "too good to be true" fitness miracles regardless of who is sharing the information.  I refuse to follow into the beliefs of others just because they heard it was the next best thing to sliced bread and how they have lost 20lbs in 5 days, or some crazy thing like that.  I feel the same way about exercise programs and will not trend in with the crowd because it has been advertised as the coolest "big hit" workout ever.  What does impress me is solid research and leading myself with what works best for me nutritionally and physically.  Everything else is just fluff until proven quality.  Sure it takes work when you are a leader, but it is worth the time and effort to ensure sound principles are being applied to your health.  There is so much crap out there that can actually hurt you and to not be aware of this fact is negligent.

Leaders also do not feel the need to compare and are confident moving forward, regardless of how slow, with a tried and true fitness program.  Followers are more apt to give up and jump to the next new fitness "thing" in hopes of achieving something from empty promises.  Leaders stand firm with dedication while followers get lost in the shuffle.  Leaders will get lifelong results and followers will yo-yo through and typically end up right where they started or worse.  Science has already proven consistent healthy eating and regular exercise is the answer to good health and leaders understand and accept this fact. Followers continue to struggle because they want fast and easy and typically the results worn by the leaders.

It is so important to understand being a leader will be the success of your overall health and fitness.  We all have differing things going on genetically, medically, and even emotionally worthy of our time and attention so an accurate fitness program specific to each of us can be applied.  It is time to stop jumping through someone else's hoop and think that is going to work and start being a leader with your fitness.

My current article on the About network covers science-backed nutrition recommendations for contest preparation and natural bodybuilding.  This is a great read and right on track with being a leader!

Science Steps Up with Nutrition Recommendations
Read the Article!

 

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Of Rising Risk and ACO Success in the Medicare Shared Savings Program: Community Health Network and Pharos Innovations

To each according to their need, from each according to their ability.

While that famous (and paraphrased) adage was originally used to attack capitalism, it's also not a bad way to think about effective care management programs.  Ill persons have varying needs, and care providers have varying resources.  In a resource-constrained environment, the health system that matches the right needs with the right resources will win.

A case in point may be one of the few Medicare Shared Savings Program (MSSP) ACOs that met CMS' savings threshold.

"Community Health Network" is a joint venture between HealthEast Care System and Entira Family Clinics that serves Medicare beneficiaries in Minnesota's Twin Cities.  According to this Pharos Innovations case study (which can be found here), the organization analyzed their population's past utilization and future risk and realized that a relatively small group of beneficiaries were high need.

High need was defined as those individuals with "rising risk" or what the Population Health Blog has termed the "sweet middle." These are individuals who are not only burdened by chronic medical conditions (such as heart failure), but have a constellation of issues (such as a recent discharge from a hospital) that also can be mitigated or impacted.

Once these patients were identified, Pharos Innovations provided the "transition coaches" and "engagement specialists" for the high need/rising risk/sweet middle patients who were most likely to have an admission and/or readmission.

By pinpointing state-of-the-art heart failure treatment protocols, care management, self-care coaching and discharge-care interventions, avoidable admissions and avoidable readmissions - compared to a control group of patients - dropped in significant manner. That was enough to skew the ACO's overall admission and readmission costs downward and reach CMS' savings threshold.

Population Health Blog lessons:

1) If a healthcare organization is willing to take on the financial consequences of health insurance risk, it will have to array its covered population's risks from high to low, and deploy interventions that can address the needs of patients at high - yet modifiable - risk.

In other words, within any high risk subpopulation are sub-populations with specific health care needs that can be addressed with smart population-based care management interventions. 

2) The PHB looks forward to these data appearing in the peer-reviewed literature.  In the meantime, kudos to Pharos Innovations for achieving credible outcomes based on a comparison to a valid control group.

3) Patients who don't have to go into a hospital are better off for it.  Despite Karl Marx's antipathy, aligned economic incentives can be win-win for everyone.  Community Health Network deserves to be financially rewarded by CMS.

4) There is a good reason to believe that Community Health was destined to do well versus the other MSSP participants. As pointed out here, physician leadership may be one ingredient to the MSSP ACO secret sauce. According to the case study linked above, Community Health Network expended considerable resources to convince their physicians that this approach was a good idea.  What's more, their board is majority physician controlled.  In addition, Pharos Innovations was started by a doc and they have additional physician representation on their board.

The PHA Forum 2015. the Premier Population Health Meeting

If you have any interest in medical costs, outcomes and consumerism, you really should think about attending the Population Health Alliance Forum November 2-4 in Washington DC.

Why?

The PHA is an advocacy and education association dedicated to advancing population health as a component of health reform.  The Population Health Blog likes the PHA because its membership is made up of a wide range of experts who have worked to translate the theoretical and fiduciary interests of insurers, payers, government and other stakeholders into real-world and sustainable programs. 

After rubbing elbows with these guys in meetings, hallways and over beverages, the PHB always walks away a little bit smarter.  If you go, you will too.

Highlights:

Great keynotes that connect policy, theory and reality;

A debate between wellness skeptic Al Lewis and widely published Ron Goetzel.

Instructive case studies that you won't hear about anywhere else;

Insights about monitoring and communication technologies;

Continuing education credits;

You'll get to meet PHA CEO Fred Goldstein and the other outstanding PHA team members;

The PHB will be there!

Registration information here.

The Latest Health Wonk Review Is Up!

Revolving doors at the FDA, anti-Obamacare lawsuits, meaningful use, shared savings, alleged corporate malfeasance, health insurer interest in your Fitbit data and the prognosis of private practice.

Where else can you find linked insights on these topics and more, but at the latest Health Wonk Review hosted by the brainy Joe Paduda? 

Enjoy!

Will You Fill Out This Paleo Diet Survey?

This week, I received an e-mail from a graduate student at Humboldt State University named May Patiño.  She asked me to share her online research survey targeted to Paleo dieters.  Here are the goals of her research, in her words:

The main objective of my study is exploring how the Paleo diet is being implemented in practice.  I would like to assess the health outcomes of these practices, as well evaluate how closely they conform to, or deviate from ways this diet is being described in theoretical literature, and implemented in controlled diet trials. I also want to be able to use the data collected to help explain what is driving the popularity of the ancestral health movement. Ultimately, I would like this information to be used to better inform protocols for controlled diet trails.

The survey took me about 40 minutes to complete.  You're welcome to participate whether or not you're on the Paleo diet.  Please consider taking the survey, for the love of science!

Research Survey: The Paleo Diet in the US

More is Not Better for My Fitness Life

When it comes to fitness, I am not a believer of the "more is better" philosophy. Sometimes doing more exercise, juicing more, supplementing more, and eating more protein for example can come back to bite you in the butt.  When will people realize getting fit and maintaining a healthy body is a simple process and does not require all the "more" believed to be better?  Focused hour workouts that include a variety of cardio, weight training, and flexibility at least 4-times per week are sufficient.  Throwing in active rest days and having fun are also part of the exercise week and by all means should be enjoyed.  Nutrition is about eating a healthy and wide variety of all the macronutrients: lean proteins, good carbs, and fats.  Food is our fuel, but our body only requires a certain amount and over-consumption of one can actually have adverse health effects, just as eliminating healthy foods can cause nutrient deficiencies.

If I was conducting a consult with a potential new client who currently spent hours per day in the gym to get lean and buffed, my question would be why? This is a perfect example of the "more is better" thinking when it comes to workouts and no wonder burn-out is happening.  Over-use of joints and even muscle breakdown can occur when the body is over-trained.  Over-training syndrome is actually a thing and breaks down our immunities, prevents muscle growth, and puts unwanted stress on our body.  Also, a cycle of exercise addiction may also be at play for those who are caught up in guilt for eating a certain way and psychologically beating themselves up in the gym.

   Food is our medicine and fuel.  The "more is better" mindset rears it's ugly head here as well with people over-juicing to the point of death and permanent kidney damage.  This is no joke and if you have not read my current article on "Juicing Can Be Deadly", take a few minutes for a jaw-dropping read.  Eating healthy is important and essential for a healthy body but when it is taken to extreme is when problems can happen.  Eating too much protein can have negative health effects and put our body into ketosis which means the body does not have sufficient access to its main fuel source, glucose. This can also swing the other direction where too much food is eliminated from daily intake leading to illness due to nutrients the body is lacking.  Take a look at my article on "Orthorexia" and learn about clean eating gone wrong.  DIY fitness diets can pose a problem because of the "more is better" being applied in so many wrong directions and beautiful bodies end up over-supplemented and under-nourished. I put together a recent article on "Self-Made Fitness Diets Can Come with Health Risks" and advisable to check out to ensure you are eating right for your fitness goals.

   

What it comes down to is being healthy but smart about it and stop believing all the "more is better" crap.  I enjoy down to basics, fun and simple workouts maintaining my body without over-working it to the point of burn-out or injury.  I do not fall for exercise gimmicks or workouts fads and I feel the same way about nutrition myths.  If it is too good to be true...guess what? I am a creature of habit so many days I will enjoy similar meals but they include all the macronutrients and I enjoy my treats on occasion.  I am not a girl sitting around eating boiled fish and broccoli all day.  This simply is not living or being realistic.  Sometimes I believe "less is more" and probably live that more true than the other way around, but overall I believe "balance is more" and definitely hold firm to that daily.  

   If you have not read my articles on the about network, you are missing some great stuff.  Check out my landing page to see what is currently trending!

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That Time I Ate Most of a Large Pizza in One Sitting

Two weeks ago, I had a brush with Extreme Eating.  My experience illustrates some important principles of how the brain regulates appetite and body fatness-- and how it reacts to calorie-dense, highly rewarding foods.


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Physician Owned Private Practice Is Still Alive and Well: Here's Why

A death greatly exaggerated...

The Population Health Blog recently broke bread with a Director at the Tucker Advisory Group.  TAG provides professional services to a host of health care entities, including physician-owned provider groups.

The PHB has been skeptical about the death of private practice, and the breakfast did little to change its mind.

What it learned is that there is no shortage of business for outfits like TAG.  A typical private practice client is a group of ten or more physicians with multiple clinics in a multi-county area serving thousands of patients.  These groups range from primary care to pain management to women's service to cardiology.  While their revenues and expenses cannot be taken for granted and payer hassles abound, it's not impossible for a nimble and hard-working group of private practice docs to serve their patient population and still end the year in the black.

In addition, it hasn't been that unusual for individual physicians who are in salaried positions in large hospital-dominated provider organizations to contact TAG to explore the options for going into "private practice."

Anecdotal you say?

Despite the narrative that the death of private practice is "unstoppable," there are plenty of reasons to be contrarian:

1) The latest good information (like this) on physician employment that supports the narrative that private practice is dead is from the AMA's 2012 data base.  While newer data from 2014 indicate that independent primary care practice is dwindling, there are pockets of specialty physician private practice that are remaining strong. In other words, one reason for the growth of salaried physicians is their flight from continuing struggles of primary care, not toward the advantages of employment.

2) Whether they're in a salaried position or in private practice, today's physicians are still demanding autonomy, adequate resources, input and to be rewarded.  Given reports like this and this on getting docs to do what they're told cooperate, is it any wonder that physician entrepreneurship is still alive?

3) And speaking of being rewarded, physician compensation in ACOs don't appear to provide any particular advantages.

4) What about the patients, you ask?  Good question, and you can be sure that the docs are asking it too.

The point?  Large hospital-provider systems relying on salaried physicians are an important option in health care reform.  The PHB suggests that reports of the death of private practice have been exaggerated and it will also remain an important option. 

Stay tuned!