Health for life

Vincent Scordo is the proprietor of Scordo.com, a fabulous blog about Italian American cooking. Check out his Pasta Challenge, which is more than sufficiently awesome.

As Ive said in the past, eating out/ordering in is a colossal waste of money, and beyond the occasional breakdown or special night out I tend not to reach for the Chinese take out menu or make reservations at our local restaurant. My other rationale for not eating out is that I simply will not get the same quality food at 95 percent of the restaurants in our immediate area (including New York City). Im not a trained Chef, but outside some extraordinary restaurants in New York, Ill take a simple meal prepared at home, with high quality ingredients, over a mediocre restaurant experience. Eating well at home is not rocket science, and moreover, you dont always need to purchase exotic ingredients to make tasty dishes. (The ingredients need to be high quality, but they shouldnt break the bank).

Here are 4 ingredients that can help you eat cheap and well for as long as our recession lasts:


From Flickrs Minimalist Photography


2. Tuna in Olive Oil
I always keep between 3-4 cans of Italian tuna in olive oil stocked in my kitchen. My ideal tuna sandwich consists of one can of tuna (do not discard the oil!) with salt and pepper on toasted whole wheat bread. You can also add some fresh parsley and a few slices of tomatoes if theyre in season. (Try it without the mayonnaise, I swear youll like it.)

3. Pasta and Rice
My pasta and rice arsenal includes: thin linguine, angel hair or capellini, linguine, rigatoni, penne rigate, pastine, soba noodles, arborio rice for risotto, Carolina rice, brown rice, jasmine rice, and whole wheat couscous. Having the aforementioned pasta and rice on hand at all times gives you limitless possibilities, including: linguine with olive oil, parsley, and garlic, baked rigatoni with tomato sauce, mozzarella, and Parmigiano-Reggiano, soba noodles stir fried with green peppers, chicken breast, and onion, brown rice with ginger, cilantro, and cracked black pepper, couscous with feta, red onion, cucumber, and olive oil, etc.

4. Whole Chicken
Buying a whole, free range, chicken is the equivalent to getting the deal of a lifetime. A whole chicken gets you two types of meat (dark and white) as well various parts which translate into various types of dishes. I purchase a whole, free range, chicken every other week and butcher the chicken according to my perences. If Im interested in making a whole roasted chicken, Ill simply leave the bird as is and make a rub mixture with lemon zest, salt and pepper, rosemary, and olive oil. If I have a little more time on my hands Ill butcher the bird into nine pieces and freeze the parts for various dishes throughout the week, including: braised chicken thighs with fresh mint, breaded and baked drumsticks and wings, thinly pounded chicken breast with shitake mushrooms and sherry wine, etc.

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If you like this article, check out:

• The 10 Cheapest, Healthiest Foods Money Can Buy
• 10 Ways to Eat Less Meat
• Touch of Class: 10 Thrifty, Healthy Ingredients to Improve the Quality of Your Meals

Which naturally worries the contrarian DMCB.

In Bob Woodwards tell-all book The Price of Politics, Mr. Obama reportedly  reassured a skeptical Speaker Boehner by saying  "John, Ive got great confidence in my ability to sway the American people." 

That was certainly evident today.  He really thinks speeches can win hearts and minds.

Contrast Mr. Obamas oratory self-assurance with his predecessor, Ronald Reagan.  In the book, Reagan, A Life In Letters, it seems our 40th President used the written word to not only hone his communication skills but to internally develop and ine his thinking on the great issues of the day. Armed with that kind of self-clarity, Mr. Reagan speeches were secondary to his far more important skill of compromising without giving up on his principles.

Über academic Pat Thomson says it best: "Binge writing" allows authors to become immersed in a topic "to make sense of it."  Fifty Shades of Gray author, E.L. James, may have expressed it best: “Write for yourself,” she said. "That’s it. And write every day."

The modest DMCB agrees. Its bloggery (just over 1500 posts and counting) helps it better fashion real-world business plans that involve inevitable trade-offs between what the scientific evidence says what should be with what clients have already decided what will be.

The DMCB will never give a speech on the Washington Mall, thank goodness, and its not like Presidents will ever seek its counsel.  But it knows that philosophic certitude is better tasked to navigating inevitable compromises in the real world, not convincing skeptical listeners to give in.

Let the games continue!

As the holidays descend upon us like so many hungry vultures (What? Am I the only person who feels completely blindsided?), many of us will find ourselves entertaining, either hosting parties, large dinners, or maybe even housing guests overnight(s).

From Flickrs jpovey

In the past, I’ve always looked forward with excitement to any opportunity to entertain. Due to work and distance, the mister and I rarely see some of our friends. Of course, due to work we end up running around like headless chickens, and it turns out that headless chickens do not do housework. Then, as the date looms, I begin to freak out because the house isn’t clean, food isn’t waiting in the rigerator, and I’ve realized I have multiple work or other engagements around the time of said event.

Basically, I imagine myself as a lovely hostess with trays of hors d’ouevres, flowers in the guest room, and a nicely decorated home; in reality, I shove everything under the bed, buy the $2 manager’s special florals at Kroger, and end up making the reshments after the guests have arrived.

Luckily, I’ve found some ways to allay my freakout, and I would like to share them with you.

CARE AND FEEDING OF HOUSEGUESTS

1) Chill out. Unless your guest is a complete neatnick and you know it, don’t worry so much about the state of your house. Wouldn’t you rather be somewhere that is comfortable than in a room that looks like a museum? If you’d rather be in a museum, don’t come to my house. If you’re worrying about the state of the house and running around the entire time, you won’t be spending time with your guest and said guest may feel uncomfortable.

2) Nice amenities aren’t expensive. Want a guest to feel welcome? Leave an extra blanket, pillow, towels, a notepad, a pen, a decanter of water, and a (working) flashlight near the bed. This way, everything the guest might need is close by, and should the guest need to wander around, the flashlight can help with navigating an unfamiliar house at night, saving shins, toes, and your sleep. Don’t have a decanter? Save a juice jar, clean it, fill it with water, and invert a glass on top. Viola voila!

If your guest is couchsurfing, try to give him or her some privacy. A folding screen is great if you have one around, and the above items could be left on an endtable close by.

From Flickrs Rick

3) Keep food easy and accessible. Guests breakfasting at varied times? Have some oatmeal in a slowcooker with a topping buffet. Leave bowls of fruit on the table. Apples and oranges are cheap and crowd-pleasing, and crackers are also marked down this time of year. Leave plates, glasses, and utensils out so your guest doesn’t have to rummage.

4) Plan escape time. If you live alone and haven’t hosted before, having a houseguest could be a weird experience after a couple days. Alternately, if your houseguest lives alone, it can be stressful for him to be surrounded by people all the time. You don’t have to hover (unless your houseguest is young enough to require babysitting). Go run an errand if you need to get away, or go take a nap. It’s okay!

5) Know your guest’s expectations. Does the guest just want to spend time with you? Are there other folks in town she wants to see? Does she want to hit the museum? Ask in advance to make the visit work.

THROWING A PARTY THAT FEELS LIKE ONE WITH MINIMAL MONEY AND STRESS

1) Eat your leftovers and stockpiles in the weeks leading up to the event. This strategy serves several purposes. First, you’re going to be prepping and cooking food for an event; the last thing you will feel like doing is cooking dinner for yourself during this time. Also, eating up your fridge and freezer stockpiles makes room for the food you cook in advance. Lastly, this frees up space for the glorious leftovers you are sure to have, as well as the booze you or your guests may be chilling. And while you’re at it, wipe down the fridge shelves and door pockets. You’ll be so happy every time you see it, and you won’t shriek when one of your guests opens it to slip in a bottle of bubbly.

2) Resist last-minute additions. If you have already planned, shopped, and begun prep, do NOT drop everything to make that gorgeous appetizer you saw on The Kitchn. Cool your jets. You have enough food and you are trying to be superhost. No one will give you a cape. I promise; I have tried.

3) Have a timed list. Kris has already taught us the importance of the timetable for knocking out a holiday dinner. It’s applicable for parties too, and you should include all the tasks necessary (cleaning, dishwashing, etc.). Also, make sure you work in a good 45 minutes of chill time for yourself before guests arrive so that you can be relaxed and ready to enjoy yourself.

4) Ask two people to bring ice and have a place to put it. Unless you have an industrial icemaker, you need this whether you think so or not. You will run out of ice. It is a fact of entertaining. Also, by asking two people, if one forgets -- you still have ice! Win!

5) You don’t have to be matchy-matchy. I have tons of mismatched glassware that I use for entertaining, and I picked up 18 white appetizer plates for 29 cents a pop at the grocery store last year after the holidays. I’ve used them for a baby shower, two spa parties, and a dessert buffet. Unlike the fine china, no one has to feel bad if one crashes to the floor. Look for deals like this, or thrift some cups and plates; just clean them well. Try to stick with one color to unify the look, or pick schemes that work with pieces you already have. You’ll come out close to the price of disposables and have something you can use again and again. Or, if space is a problem, donate them back.

6) Start early with cleaning and decorating. You can also get your servingware out and ready to go days in advance. It’s one less thing on the list and will help you feel collected and ahead of the game.

7) Decorate frugally and sparsely.

From Flickrs Elin B

Tealights are the best cheap decor. You can get a bag of 100 for under $5. Put them in colored glasses, ashtrays, in jellyjars on platters -- anywhere they won’t start a fire or damage what they sit on. Dim the lights, and let them flicker for ambience. Just don’t forget the matches.

Ribbon is multipurpose and thus handy for more than decor. Craft stores often have $0.99 spools of ribbon. Tie it to chandeliers and let long strands flutter. Put bows around vases and candleholders, and tie some ribbon around a mason jar to make a nice holder for a tealight..

Flowers are a nice touch, but not necessary. Shop for flowers late the night before if you’re not looking for something particular. Lots of grocery stores mark down gorgeous flowers to move them on out, and you can get great deals. Buy several bouquets and make groupings throughout the house if they are cheap enough. No vases? Pitchers, mason jars, and glass juice bottles can make great vases, or you can float the blooms in bowls of water.

Tablecloth, shmablecloth. Use an old (clean!) sheet or two to drape the table. For an upscale look, if you have some old pillowcases in a matching or complimentary color, rip the seams down the long sides and unfold them. Lay them crossways on the table for runners that double as placemats.

8) Don’t forget the music. ‘Nuff said.

9) Dress up the outside entryway with a ribbon or something to indicate to people who have never been that they are at the right place.

10. Enjoy your guests. Don’t constantly run back and forth to the kitchen or fuss too much with things. A party isn’t just for your guests; it’s for you, too.

~~~

If you enjoyed this piece, you might also quite like:

• Cheap Healthy Party Food
• Potluck Tips to Save You Time and Moolah
• Recession Chic, Party Planning, and Me

This week’s inquiry comes from reader Cam, who’s already gearing up for what my dad likes to call The Super Bowl of Eating.

Q: Ive been asked to bring a veggie dish to Thanksgiving dinner. I have to travel about 3 hrs to get there. I was going to make the Ina Garten roasted brussels sprouts of CHG fame, but I just dont know how theyll reheat/travel.

I will have some access to an oven/microwave, but I would guess that I wont get more than about 20-25 min, while dodging the rest of the last-minute prep activities. Does anyone have any suggestions for a great veggie dish that will travel and reheat well?

A: Cam, I’m traveling for Thanksgiving for the first time ever, and I totally feel your pain. In regard to the Brussels sprouts, if you can prep them beforehand, it might work. They need a little longer than 25 minutes to roast, but other dishes can be cooking while they’re in there.

Beyond that, stuffing is tricky because the meat is laying out for so long, and mashed potatoes generally require a good chunk of cooking time. With that in mind, I might try these, always taking care to assemble the ingredients before you leave your house:

• Chunky Applesauce. It’s my mom’s recipe, and can be made well ahead of time. Goes over well with the seniors and kids. Serve hot or cold.
• Sweet Potatoes with Mini Marshmallows. This needs enough time to warm through and brown the marshmallows, but that’s about it. It is absolutely my favorite thing in the world.
• Honey-Glazed Roasted Carrots. Pretty much a roast-and-leave dish, though you would need a minute or two on the stovetop for the glaze.
• Pioneer Woman’s Cranberry Sauce. I know cranberry sauce can be kind of lame sometimes, but Pioneer Woman’s will make you forget every abomination you ever slid out of a three-year-old aluminum can. It’s seriously THE BEST.

If your guests are amenable to a first-course soup, those always reheat well. This Roasted Butternut Squash Soup will knock their collective socks off.

And with that, sweet readers, I turn it over to you. What are your favorite travelin’ Thanksgiving recipes?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

The Disease Management Care Blog (DMCB) welcomes readers to this edition of the Health Wonk Review. The DMCB is a physician-writer with knowledge and experience in primary care, health insurance, population health and health information technology. Thats why its delighted to host this compendium of recent writings from the best health policy bloggers offering insights you wont find anywhere else. Read this and the DMCB assures your Huff Po addled colleagues will admire you and your USA Today reading opponents will envy you.

For example, this HWR has a conservative who actually likes health insurance exchanges and a progressive who is disappointed with a key aspect of the Affordable Care Act. Theres also a unique description of an important collaboration among competing commercial health insurers and a thoughtful discussion of the downsides of preventing HIV infection.  Youll also find a detailed report on how the evening news blew the coverage of an important cancer screening guideline update.

And dont be put off by the wide ranging number of posts.  Read what captures your interest, follow the links and come back as often as you like.   The DMCB will leave the light on for ya.

HOSPITALS

Hospital Quality

Most readers of this Health Wonk Review are undoubtedly sophisticated and dispassionate experts on hospital quality, consumerism, patient satisfaction and outcomes.  Well, Neil Versel of the Meaningful Health IT News blog shows us how that learning contrasts with watching a terminally ill loved one with Multiple System Atrophy struggle with distant physicians, medication errors, incomplete care planning, lack of basic health services, ignored advance directives and occasional Keystone Kops style encounters with health workers who should know better.  And we wonder why Americans are so fed up with the U.S. health care (non) system?  Egads, says the DMCB.

A Medicare Hospital Measure Called "MSPB"

Speaking of hospitals and quality, CMS has started to publicly report peri-hospitalization health care costs using a metric called the Medicare Spending Per Beneficiary (MSPB). According to Jason Shafrin of the Healthcare Economist Blog in this post titled "Measuring Hospital Efficiency," Medicare is now reporting a roll-up of all payments made to docs and the facility three days prior, during and 30 days after a hospital stay. Non-surprisingly, some areas of the country have much higher MSPBs than others. Yet, despite its merits, Jason reports that the measure is not without controversy because we dont know enough about the link between the MSPB and outcomes (does more spending result in high quality?) or if reported higher costs were the the result of waste (for example, unnecessary or redundant testing) versus additional necessary care (perhaps extra days in a rehab facility after discharge were worth it).   The one thing the DMCB does know is how necessary it will be to use the acronym "MSPB" the next time it steps up to a microphone at a health policy confab.  It cant wait.

"Observational Status"

When is an admission to the hospital not an admission?  Thats the conundrum tackled by Dr. Brad Flansbaum of The Hospitalist Leader blog, who helps the reader understand how hospitals use their inpatient facilities to treat outpatients. The key distinguishing factor is a limited 24-48 hour course of care that is aimed at returning the patient home.  Unfortunately, outpatient care is covered with an outpatient insurance benefit that can include significant out-of-pocket expenses.  Medicare has policies that require providers to inform beneficiaries of the financial impact of being in "observation status" but as the line that separates inpatient and outpatient care continues to be blurred, its likely well have to wait for global payments or shared risk arrangements to reconcile patient coverage expectations and billing systems.  Until that happens, Brad has quotes a Medicare official who assures us that CMS is "considering caully how to simplify the rules in a way that best meets the needs of patients and providers without increasing costs to the system."  Right.

HEALTH SYSTEMS

Accountable Care Organizations

While the mainstream focuses on Medicares ACOs (for example), Blue Shield of California, CalPERS, Hill Physicians Medical Group and Dignity Health quietly partnered back in 2007 on a shared savings program that apparently resulted in a noisy $20 million in savings.  Glenn Melnick and Lois Gree over that the Health Affairs Blog have authored an interesting interview-narrative about this initiative that is full of interesting lessons. These lessons include the importance of physician buy-in and participation, a system-wide working familiarity with old-fashioned capitation, a supportive pre-existing provider culture, an emphasis on reducing readmissions, using wellness to reduce use of pricey bariatric surgery services, data liquidity, increasing use of evidence-based guidelines at the point of care, patient "repatriation" from non-participating care settings, data dashboards and empowering non-physicians to engage patients in self-care.  The California HealthCare Foundation has committed to completing a full evaluation of the outcomes next year. The DMCB commits to using some new health policy jargon it discovered in reading this post: "actualize" and "head in a bed."

"Charismatic Leaders"

Roy Poses of Health Care Renewal continues to expose the folly running rampant in the U.S. health care system, this time by looking at the "CEO as False Messiah." Dr. Poses cautions readers to pause any time they run into local or national leaders who are uncritically hailed as "visionary."  Its far more likely that their fawning admirers have been seduced by a toxic level of charisma that often leads to catastrophe.  Get real, advises Roy, and admire such folks for being smart while keeping a skeptical eye on their ability to produce results.

PROVIDERS

The Doctor-Patient Relationship

David Williams of the Health Business Blog uses a Health Affairs article on "shared decision making" to lect on the upsides of being labelled a "difficult patient."  Researchers found that an important barrier to forming a doctor-patient relationship is the fear among health care consumers that expressing a perence will annoy their doctor.  David argues thats not such a bad thing, especially since modern consumers now have the option of seeking a second opinion, getting another doctor and ultimately using a questionable treatment. The DMCB really agrees with Davids perspective because it wants to be liked by him.

DRUGS

HIV Prevention Is Good News, Right?

 Nate Ogden of the InsureBlog walks readers through a fascinating exercise on the costs and ethics surrounding the FDAs approval of HIV-prevention drug called "Travuda." While readers may initially want to hail this medical breakthrough, Nate suggests its not so simple: 1) the retail cost of the drug is $11,000 a year, which a) contrasts with the $30 a month cost of equally effective condoms and b) would be enough to treat 20 HIV positive patients, 2) persons taking the drug may misuse their new found protection and paradoxically engage in increased risk-taking sexual behaviors and 3) coverage may be mandated as an insurance benefit, which means therell be one more driver of health care costs for all of us.  Another silk purse turned into a sows ear, says the DMCB.

Would You Like Some Drug Monitoring Along With That Refill?

Never at a loss for words, Joe Paduda of Managed Care Matters takes umbrage with Missouri State Senator Robert Schaafs opposition to the states "Prescription Drug Monitoring Program Act." Joe argues that the act would reduce the incidence of drug-drug interactions and lessen prescription drug abuse through doctor shopping.  Without passage of the bill, says Joe, kids will lose their moms, Scout troops will have to meet without their den mothers and schools will have teacherless classrooms.Dr. Schaff, who by the way is a family physician and leads a prominent physician liability insurance carrier, has a different perspective. The DMCB predicts the Senator will not find Joes disapproval very compelling.

HEALTH INFORMATION ANALYTICS

Health Insurer Data Mining

If its one thing that Medicare has done better than the commercial insurers, its making its claims data available to health services researchers.  The DMCB suspects that the commercial insurers have been reluctant to do so because of the considerable effort involved, concerns about inadvertently running afoul of HIPAAs unwieldy confidentiality provisions, giving their competition otherwise confidential information about payment rates and the lack any relevant value propositions. According to Martin Gaynor at the curiously named Wing of Zock Blog, those barriers have finally been overcome. Aetna, Human, Kaiser and United have all agreed to ship billions of lines of claims data to the not-for-profit Health Care Cost Institute which will make the deidentified data available to researchers.  The DMCB agrees that this is a significant development that will allow researchers to mine insights that, thanks to relatively low numbers of patients, non-generalizable health care settings and limited imagination, have been out of reach. The DMCB hopes the data will be made democratically available on as close to an "open source" basis as possible.

HEALTH INSURANCE

 Group and Individual Insurance Markets

Need a quick lesson on the fundamental differences between group and individual health insurance policies?  Louise over at Colorado Health Insider has a terrific "101" on health insurance guaranteed issue, mandates, underwriting, the role of high risk pools and the impact of Affordable Care Act. The DMCB recommends that everyone - except the White House - bookmark this page just in case were forced by the Supreme Court into a health insurance orm do-over. The White House is being given a pass by the DMCB because if that happens, no one will really care what they think.

Speaking of the Individual Market....

In case you think all progressives uncritically support the Affordable Care Act, Maggie Mahar at the healthinsurance blog inconveniently points out that a big part of the individual health insurance market will remain broken come 2014. Maggies post offers up some compelling statistics that demonstrate that many middle aged boomers (yikes, including the DMCB) who are between ages 50 and 64 years wont meet income thresholds for subsidies.  As a result, theyre looking at the prospect that health insurance premiums could reach an unaffordable average of $7500 a year. Combine that with a lackluster job market, declining incomes and substantial out-of-pocket costs and it is clear that health orm will remain a contentious, time-consuming and difficult work in progress for years to come. In the meantime, the DMCB will wonder about the affordability of essential benefits, the merits of value-based insurance designs, how population health-based care management can help blunt the impact of chronic illness and the wisdom of  using limits on age rating to shift costs to the DMCB spawn.

STATES

One States Perspective on Federal Health Reform

While Californias budget slides into the sea thanks to an unending budgetary earthquake, every dollar counts. Thats why Anthony Wright of the Health Access Blog points out that in addition to the patently obvious merits of assuring access, lowering costs and protecting consumers, the Affordable Care Act is also a windfall for the Golden State.  He quotes and links a California-based Bay Area Council Economic Institute report that calculates that the ACA will add close to a 100,000 new California-based jobs and $4.4 billion in additional state output.  Alas, says the DMCB, between the U.S. Supreme Court and less-than-expected taxable income from the disappointing Facebook IPO, it looks like fixing Sacramentos budget woes may need a Plan C.

How Should States Respond to Health Insurance Exchanges?

Conservatives hate those ACA-mandate insurance exchanges, while progressives love them, right?  And any Republican Governor that sets up an exchange under the terms of the ACA is a hypocritical closet-supporter of Obamacare? Is that so?  John Goodmans Health Policy Blog point-counterpoint posting teaches us that its not so simple.  It turns out that states 1) may fare better with or without the ACA if they maintain control over exchanges, 2) could use the flexibility that comes with control to make insurance exchanges more effective and fair, and 3) with that control will also have a say over the commercial insurance subsidies that will add up to gazillions of dollars.  Just in case you think Johns post is just a lot of hot air, check out this telling Pennsylvania-based Op-Ed.

WORKERS COMP

Links Between Workers Comp and Health Promotion

Many health care providers regard "workers comp" as something as a policy sideshow, but Workers Comp Insider Jon Coppelman shows us that this multi-billion dollar industry is not only a big deal but also not immune to the growing costs of our sedentary lifestyle. When a 50 year old fat ambulance workers stroke was blamed on a lower extremity paradoxical embolism resulting from hours of sitting, the lifelong care costs were ruled "compensible." Next stops are the diabetes-causing donuts on our way to work and the hypertension from those generously salted fries in the company cafeteria. Mr. Coppleman recommends early adjuster involvement in the claims adjudication. The DMCB wonders if the Workers Comp insurance industry should think about being more proactive, including using risk stratification and advocating for common sense health promotion.

WELNESS AND HEALTH PROMOTION

Wellness!  Gotta Have It!

No Health Wonk Review would be complete without one enthusiastic endorsement of all things wellness. Kat Haselkorn of Corporate Wellness Insights steps into that role with copious praise of all the benefits of health promotion, including positive culture change, huge returns on investment, enriched social networks and accelerating employee productivity.  Kat suggests that if just one person buys into wellness, the effect can ripple through the company faster than spandex-clad yuppies swarming at an after-work Zumba class.

Wellness!  Gotta Keep Funding It!

New blogger Tracey Moorhead of the Care Continuum Alliance writes in the Voice On Population Health Blog about the ill-advised willingness of the U.S. House to steal from the ACAs Prevention and Public Health Fund to extend coverage of student load interest subsidies. Tracey passionately argues the fund has already led to important behavioral health screenings, data infrastructure development and expansion of wellness services in multiple states. Whoa, says the DMCB, which isnt surprised at the Care Continuum Alliances advocacy on behalf of prevention and population health.  Good for them.

And Heres An Added Benefit of Being Fit?

Michael Gavin of the Evidence-Based blog notes that a recently published article in the medical journal Pain shows that athletes have a higher pain threshold.  From his point of view, this is why exercise should not only be promoted as an alternative to using dangerous drugs to control pain but as an added overall benefit from achieving maximum fitness.  The contrarian DMCB took a look at the abstract and wonders if persons who are naturally blessed with higher pain thresholds are attracted to exercise (or at the very least, find it less unpleasant).  While readers are figuring out which is cause and which is effect, they can also show their health knowledge chops by not only erring to exercise related "endorpins" but "endocannabinoids" as the basis for the runners "high."

SPECIAL POPULATIONS

Prisoners

Talk about a disenfranchised population. Suffering with highly prevalent rates of Hepatitis C, HIV and mental illness, huge numbers of released prisoners were being left to fend on their own. Harold Pollack, also of the healthinsurance blog describes how thanks to recently passed federal legislation, hundreds of thousands of these individuals will be able to qualify for Medicaid, obtain tax credits that can defray the cost of private insurance and access basic community-based health care services. While health orm is all about the single mom waitress with two kids, the middle America steel worker and the kid with end stage cancer, Dr. Pollack says we all benefit when ex-prisoners are also staying away from crowded emergency rooms, avoiding unnecessary hospitalizations and not burdening over-stretched safety net programs.

Geriatrics

IF you believe geriatric care is important, THEN you should read this post BECAUSE youll get to learn about the "ACOVE" framework. Thats the message the DMCB got after reading Chris Langstons post on the Quality of Geriatric Care over at the John A Hartford Foundation. It turns out that the Assessing Care of Vulnerable Elders is a handy IF-THEN-BECAUSE tool that identifies the specific health issues afflicting the elderly and targets geriatriccare planning. Chris argues wider use of ACOVE would increase quality of care in geriatrics and clarify the important differences between general medical versus geriatric conditions.

CODING

Hate ICD-10?

Heres another anti-ICD-10 rant, courtesy of a post by TBD Consultings Jonena Relth at the Healthcare Talent Transformation Blog.  She argues that veteran front-line health care workers are deeply skeptical about the ultimate value of the insurance billing systems astonishingly complicated specificity and detail. Jonena is concerned that the new coding will paradoxically lead to billing errors and enable greater health insurer mischief. Too bad there wasnt any credit given to the AMA for CMS decision to delay implementation of ICD-10 as well as the organizations continuing advocacy on the issue. As for the health insurers, the DMCB thinks that given the circumstances of a very hostile Administration and the luster of an ACA-driven enrollment windfall, they quietly came as close as they could to expressing concerns over the wisdom of ICD-10.

and last but not least.....THE NEWS DISAPPOINTS...AGAIN

Prostate Cancer Screening and the News Media

As risks, benefits and alternatives to cancer screening move into the public square, Gary Schwitzers HealthNewsReview blog offers up this balanced scientific review on the merits of prostate cancer screening by Richard Hoffman and this insightful description on how the mainstream news media made a mess of things. It turns out that the U.S. Preventive Task Forces recommendations werent really all that new, that a substantial number of physicians have been PSA skeptics for years and that early detection of prostate cancer - whatever its merits - is hugely remunerative to providers. As testimony to the news elites  selective inattention, ask yourself if you should thank Diane Sawyer et al for avoiding this new wrinkle on the topic of lung cancer screening.

Image from Wikipedia

There comes a time – or several times – in the course of things when eating healthfully and inexpensively goes right out the window. Maybe you’re working on a major project. Maybe you’re having a baby. Maybe you’re quitting your job, finding a new one, marrying, moving, or trying to get over the passing of a loved one. Rightfully, you have other concerns.

And you know what? That’s okay.

The Artist Formerly Known as Husband-Elect and I just wrapped up the busiest and most joyous month of our lives, during which we ate approximately two vegetables. (Wait. Is frosting a vegetable?) Preparing nutritious meals was next-to-dead-last on our list of priorities, just above keeping up with the Mets. (*grumble*) Instead, we were penning vows, seeing to the happiness of 140 loved ones, and entering a state of marital bliss unrivaled, even by a really good pot of macaroni and cheese.

Now, we’re home. The wedding festivities and pasta-packed honeymoon are over. We knew it would happen eventually. And with it done, it’s time to resume dietary normality. And once this time – this busy, emotionally haywire time – passes, you will, too.

Meanwhile, here are a few tips to get you through the rough parts.

Take it easy on yourself.
Order takeout. Choke down your five-minute hospital cafeteria lunch. Scarf that three-year-old bag of Sun Chips from HR’s vending machine. Because right now? At this very second? Keeping a budget and a strict calorie count doesn’t matter. What does matter: getting enough in your body to keep going. Forget the rest.

Remember, it’s only temporary.
Of course this doesn’t go for every situation. Kids are pretty permanent, and there are some jobs in which 70-hour weeks are the norm. But once you complete your task and/or get the hang of your new situation, everyday existence will become easier. I promise. Same goes for that interminable project, your inaugural home ownership, or even the tragedy that might consume your world right now. Time will pass, and there will be a dazzling light and pot of delicious turkey chili at the end of your seemingly endless tunnel.

Don’t be afraid to ask for help.
There are people who love you, and in pressured times, they will trip over themselves to feed, cook, or otherwise shove food into your mouth. If no one volunteers, go ahead and ask. Whether it’s a friend, a family member, or a benevolent government agency, somebody is going to step up. Never forget that, and try to do the same for others when you can.

Work good food in where you can.
Sporadically, in the midst of chaos, a cheap salad will present itself to you. (I think Confucius said that.) Eat it. A simple, occasional nod to nutrition will fuel you just as well as half a pizza. And if you can easily find a convenient provider of healthy, low-cost meals? Bonus. Food fuels mood, and keeping your spirits up is vital right now.

Do the best you can with what you have.
Forget keeping up with the Joneses. This ain’t the time. Use your available resources as best you can. If that means three weeks of pantry meals, so be it.

Pick a date to get back on the horse.
I don’t know about you, sweet readers, but I would do bupkis without deadlines. During nerve-racking periods, having that red-letter date provides a definitive end point for stress habits (ex: eating fast food), as well as a psychological starting point for new behaviors (ex: eating home-cooked meals). Plus, on a simpler emotional level, it’s just something to look forward to. Real world example: When projects devolved into anarchy at my old job, we repeated this like a mantra: “Think of it. Next Wednesday this will all be over.”

Help others in the same situation.
What goes around comes around. The love you take is equal to the love you make. Quid pro quo, Clarice. In other words: Pitch in, dearies. Somebody out there could use the assistance.

Readers, how do you eat during difficult or stressful periods? Do you agree or disagree with any of this advice? What practices make life easier? How can we best help others? The comment section is way open. Let’s help some brothers and sisters out.
_http://cheaphealthygood.blogspot.com/2010/10/when-not-to-eat-cheaply-healthy-and.html

Care management in action?

What is "care management?"

As discussed and quoted by the Disease Management Care Blog, heres one useful definition courtesy of the New England Journal:

"A set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aims of improving patients’ functional health status, enhancing the coordination of care, eliminating the duplication of services, and reducing the need for expensive medical services."

Now another one has emerged, thanks to this article by Lawrence Casalino and colleagues that appeared in the August issue of Health Affairs. The authors were interested in comparing the use of "care management processes" in small to medium sized physician-own practices that were either in or outside of an Independent Practice Association ("IPA") or Physician Hospital Organization ("PHO").

For this article, Casalino et al developed a "care management index" that reconciled five care management "processes" (1. use of a registry, 2. access to nurse care managers, 3. reliance on guideline-based reminders at the point of care, 4. sending care/health maintenance reminders to patients and 5. reporting outcomes)against the four chronic conditions asthma, heart failure, diabetes and depression. Having all 5 processes available for all four chronic conditions resulted in a top score of 4 x 5 or 20. The score therefore ranged from a high of 20 down to zero.

So, as ACO wannabes, hospital administrators, health system entrepreneurs, policymakers and regulators assess their care management landscape, they now, thanks to Health Affairs, have this handy zero to twenty scale.

To perform the study, a sample of physician-owned practices were asked to participate in a telephone survey in which the lead physician or administrator was asked about the 5 processes for each of the four conditions.

The results resembled the DMCB spouses scoring of her husbands clean-up-after-himself processes.  There were some points, but theres plenty of room for improvement against the measured baseline. 

Small to medium-sized practices with "significant" participation in an IPA or a PHO had a average care management process score of "10.4" vs. a score of "3.8" in the unaffiliated practices.  When the care management processes were provided by the IPA or PHO to the practices, the average score was 5.4. 

The value proposition for IPAs and PHOs includes care management, but they have a ways to go.