Health for life

According to South Dakota researchers, the predator status of Tyrannosaurus rex can no longer be questioned. After finding one of its teeth embedded in the healed spine of a Hadrosaurus, paleontologists now believe T rex was a fearsome hunter, not an carrion munching opportunist. 

But, asks the Disease Management Care Blog, how do we really know that that Hadrosaurus wasnt  pretending to be dead when the T rex took its bite?  Alternatively, the Hadrosaurus could have been sleeping and only looked dead to a slow-witted and lazy T rex. 

Dino doubts, says the DMCB, remain.

Such is the level of skepticism that the DMCB is bringing to its reading of the recent CMS press release describing the initial results of the Pioneer ACO program.  CMS says "positive" and "promising." The DMCB says "problematic" wonders if, like the T rex dilemma, there isnt an alternative interpretation.

The DMCB explains.

Recall that the Pioneer ACO program is designed to test whether large integrated organizations can be successfully rewarded for reducing health care costs through a program of "shared savings."  Under the program, if the savings exceed a minimum threshold, CMS will remit a portion of the upside savings back to the participating organizations.

According to the press release, the health care costs for the 669,000 Medicare beneficiaries cared for by the 32 Pioneer ACO program providers grew only .3% versus .8% for a parallel group of "similar beneficiaries." 13 organizations exceeded the savings threshold, which will lead to Uncle Sam writing checks for $76 million in shared savings.

This front page article in The Wall Street Journal has more detail. It says 18 of the 32 reduced health care costs, which leads the DMCB to conclude that five otherwise "successful" participants did not cross the required savings threshold. Two participants lost money. That, in turn, suggests the remainder, or twelve, broke even.

Details on how each individual institution fared are not readily available.  According to WSJ, Bostons Partners Healthcare reduced Medicare claims expense by $14 million.  They will be rewarded with a shared savings check of $7 million. Wisconsins Bellin-ThedaCare will get "several million."

Good "win-win" news for the Pioneer organizations, CMS, Uncle Sam and U.S. taxpayers, right? A critical mass (40%) achieved millions in shared savings, which means proof of concept met and that a key part of Obamacare is successful, right?

"Not exactly," says the DMCB.

It figures 100% of the participating organizations had to each invest millions for personnel and other infrastructure to pursue the Medicare savings in the first place.  In other words, they were in the red before Pioneer even began.  That means that, in addition to the two participating organizations that lost money, the 12 that "broke even" as well as the 5 that did not make threshold also lost millions. 

Thats 19 losers or almost 60% of the participating organizations.

In addition, its possible that for some of the 13 "winners" that the shared savings awards wont  match their up-front multi-million dollar investment either.  Assuming thats true, its possible that as many as two thirds of the Pioneer organizations lost money. No wonder 9 of the participants have signaled a desire to exit the program.

The DMCBs dinosaur analogy may be apt.  Given a two out of three likelihood of losing millions in the first year of operations, ACOs may just be too big and complicated to survive in the current health care environment.  Nonetheless, the Pioneer program will continue and the DMCB will stay tuned for the Year 2 results.

In the meantime, the DMCB wishes CMS good luck in using these "positive" and "promising" results to expand the program anytime in the near - or distant - future.  

My daughter Evie likes pancakes. A lot. Its not really Sunday at our house if youre not in your PJs at noon eating pancakes while batter slowly drips off your daughter (and the stove, and the walls...). I cant say I blame her, theyre fun to make, theyre delicious, and theyre really not that bad for you.

(This is assuming you dont put chocolate chips inside and then slather them with whipped cream and who knows what else - I mean, you can do that, Im not judging. I wont even call the health police on you. However, if she was going to be eating pancakes that often, I figured we should at least try.)

So why are they "pioneer" pancakes? Well, anyone who has kids knows that the first component to a successful meal, especially one they dont want to eat, is marketing. (Yes, we had to sell our daughter on the idea of pancakes. Kids are funny that way. Im sure she wouldnt believe it now either.) One of the main components of the recipe is substituting molasses for sugar, since molasses is a mineral-dense sweetener, particularly for calcium and iron. My daughter and I were reading the Little House on the Prairie books, and they mentioned eating molasses as a topping for pancakes. Voilà, marketing slogan established!

Evie, helping me make pancakes: "Are we going to put that in now? The other thing?"
Me: "What thing?"
Evie: "The icky sticky goo?"

Well, apparently I cant add molasses to anything without singing, "Molasses, molasses, icky sticky goo! Molasses, molasses, itll always stick to you!" A song that fun was not going to go unnoticed.


As far as Im concerned, there arent a lot of things that cant be improved with the addition of pumpkin (and theres not a lot of other ways to sneak vegetables unnoticed into breakfast). And I throw some walnuts in there too for good measure ("Brain Food"...it looks like your brain and its good for it too! There should be a requirement that all ad execs have to have prior experience as a parent.) Use whole wheat flour and youre in business!

We usually make a triple batch and freeze them on cookie sheets, before putting them in big freezer bags. Then we can reheat one or two at a time for a quick breakfast during the week. Because, hey, if you could get away with eating pumpkin pioneer pancakes for breakfast every morning, you would too!

Pioneer Pumpkin Pancakes
Feeds 3 hungry people (12 - 14 medium-sized pancakes)

1 egg
1 1/4 cups buttermilk
1/2 tsp baking soda
1 tsp baking powder
1 tbsp black strap molasses
1 tbsp canola oil
1/2 cup pumpkin
1 tsp pumpkin pie spice
1 1/4 cups white whole wheat flour
1/4 cup walnuts

1) Beat egg in a large mixing bowl.

2) Beat in buttermilk, baking soda, baking powder, molasses, canola oil, pumpkin and pumpkin pie spice.

3) Beat in whole wheat flour. I just hand mix it (but then again Evie doesnt mind if it is a little lumpy). You might notice that the batter is pretty dark thanks to the whole wheat flour and the molasses.

4) Add water to thin batter if necessary.

5) Heat skillet. You could hypothetically do this at the same time as mixing the batter, unless you also have to manage a 3 year old.

6) Oil the skillet. I usually do this about every other batch of pancakes or so.

7) Use a large spoon to make whatever size pancakes you want.

8) Sprinkle a handful of walnuts on each pancake. You could mix it into the batter, but I like to put it into the pancakes manually so the walnuts are evenly spread. I find that if you mix them into the batter, you end up with the last few pancakes being walnut city.

9) Flip the pancakes when bubbles rise to the top and the edges look a little crispy.


NOTE: All of the following calculations come from Kris (the proprietor of CHG), instead of Shane (author of the guest post). Please e-mail her/me if there are any issues. Thanks!

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
382 calories, 15.4 g fat, 8.1 g fiber, 14.6 g protein, $0.99

Calculations
1 egg: 54 calories, 3.7 g fat, 0 g fiber, 4.7 g protein, $0.33
1 1/4 cups buttermilk: 172 calories, 6.1 g fat, 0 g fiber, 12.6 g protein, $0.62
1/2 tsp baking soda: negligible calories, fat, fiber, and protein, $0.01
1 tsp baking powder: 2 calories, 0 g fat, 0 g fiber, 0 g protein, $0.01
1 tbsp black strap molasses: 47 calories, 0 g fat, 0 g fiber, 0 g protein, $0.13
1 tbsp canola oil: 124 calories, 14 g fat, 0 g fiber, 0 g protein, $0.08
1/2 cup pumpkin: 42 calories, 0.4 g fat, 3.6 g fiber, 1.3 g protein, $0.33
1 tsp pumpkin pie spice: 6 calories, 0.2 g fat, 0.3 g fiber, 0.1 g protein, $0.70
1 1/4 cups white whole wheat flour: 509 calories, 2.8 g fat, 18.3 g fiber, 20.5 g protein, $0.27
1/4 cup walnuts: 191 calories, 19.1 g fat, 2 g fiber, 4.5 g protein, $0.50
TOTAL: 1147 calories, 46.3 g fat, 24.2 g fiber, 43.7 g protein, $2.98
PER SERVING (TOTAL/3): 382 calories, 15.4 g fat, 8.1 g fiber, 14.6 g protein, $0.99