Health for life

The great Wayne Gretzky once famously observed that he achieved ice hockey prowess because he made a habit of skating to where the puck was going, not where it is.  That important lesson may have been lost on countless health care executives who, now that the Department of Health and Human Services has told us what an "Accountable Care Organization" (ACO) is, are furiously skating to fill out this application.

The Disease Management Care Blog suggests they also think about where this ACO puck could go.  Listen to the ACO zealots and its easy to believe that the triple aim will become manifest and providers will rolling in shared savings moolah in less than 18 months.

Regular DMCB readers know better.  They know that Medicares ACOs have no track record and that the ACO-like models have had a checkered experience.  As data on the Medicares ACOs come in, it is quite possible that we may discover a penalty box where a) shared risk translates to shared losses, b) the Feds are fickle partners, c) the correlation between cost inflation and quality is implacably positive and d) only a few hospital-physician alliances have the kind of non-generalizable culture necessary to make ACOs financially viable.

In other words, this is not going to be a preordained power play. By the time they get there, ACOs could find the puck went somewhere else. 

The DMCB humbly suggests that that somewhere else could be a post-ACO world.  That’s why the DMCB suggests that no organization’s long-term ACO strategic planning is complete without serious contemplation of why they should not follow the herd and plan on a 3rd quarter where:

The Bubble Bursts?  The hangover of lost millions in misallocated capital and human resource investments could preoccupy key partners and hobble lead competitors for years to come.  This has important implications for future business relationships, mergers and acquisitions and growing market share.

The Ascendancy of Physician Groups.  As hospital-physician arrangements unravel, the larger  independent physician-owned practices left behind could fill the vacuum with an array of contained, discreet and non-global commercial insurer payment arrangements that are based on 1) a level playing field and 2) what both sides value.  That is, of course, assuming these practices dont run afoul of any market dominance scrutiny by the FTC.

Federal Retrenchment:  Despite any prior deals on the SGR, a perfect storm of entitlement non-orm, rebounding cost inflation and the lack of any new innovative ideas forces CM to cut rates. The impact on physician participation in Medicare is anyone’s guess, but the new urgency to control costs means physicians will 1) have one more business reason to seek the efficiencies of larger groups and 2) be even less willing to take on additional practice costs that ranges from hiring to technology.

Should provider organizations skate toward this post-ACO world?  The DMCB suggests its not unreasonable.  Time will tell if they win this game.

For years, I have been brown-bagging my lunch, cooking most meals at home, and living what I thought was a fairly frugal existence, especially when it comes to food. But I’ve been living a lie.

Okay. Maybe “lie” is too strong a word. I’ve been living a fib, though. My big weaknesses are the inability to get a handle on weekly meal planning, reign in my impulsive food shopping, and stop eating cookies for dinner when I’m too tired to cook.

I’ve read and reread Kris’s article on meal planning, but to no effect. I wander aimlessly through the grocery store trying to remember what’s in my kitchen and then buy what I already have. I waste food—particularly produce—because I buy what looks good instead of what I need and often can’t use it before it goes bad. And when I’m tired, I stare into the abyss of my fridge, then eat cookies instead of cooking something.

Well, a few weeks ago, a delightful convergence occurred. I woke one morning with the compulsion to clean all the clutter off my fridge: sticky old magnets, food-stained recipe clippings, out-dated coupons.

I took a quick scan of the cupboards, looking for oatmeal, and realized I had two huge containers of kasha. I’ve never used kasha before, and I’m not quite sure what to do with it. Direct evidence of shopping without a list.

So I went online to look up a kasha recipe. But first I checked my Google Reader. There I saw an online posting (by Kris’ Husband-Elect—cue Twilight Zone music) of this totally rad magnetic clipboard and pencil cup at Design Sponge via LifeHacker.

The Hypothesis
I was in love with the jazzed-up office supplies and clean, visually compelling, downloadable menu and shopping list templates. Kate from Design Sponge stole my heart.

This is the kind of thing I need to get me to plan my meals: it’s simple, allows my list-making flag to fly, and it’s pretty. I really just needed someone to SHOW me what to do. With pictures. And a craft project. Because I’m 4.

Overcome with enthusiasm, I decided to plan my meals for the week and set several goals for the project.

1. Weeklong success
2. Less food waste
3. Savings on the grocery bill
4. Lower rate of cookies-for-dinner consumption

The Preparation
With orange and red paper and recycled magnets, I had tricked out my old, graffitied, high school clipboard and converted an old Tootsie Roll bank into a pencil cup. Pretty!

Then, I got (really) busy: I pulled down a few of my favorite cookbooks for perusal, scoured my cabinets and fridge for main ingredients, and started list making. It only took about an hour to come up with a viable menu. I was stoked!

And I couldn’t believe how many groceries I Didn’t Need to Buy. My pantry was so well stocked, my weeklong grocery list only had about 10 items, including produce and fresh herbs for four recipes and several miscellaneous items like seltzer, dog treats, and, yes, cookies.

The Results
1. Weeklong success—achieved. To my great surprise, I stuck to the menu all week. I loved looking at my pretty clipboard and checking off the days when I ate the meals. Some of the leftovers from scheduled meals out pushed back a couple of recipes into the next week, but …

2. Less food waste—achieved. Nothing spoiled in my fridge! Nothing! I only bought what I needed (sorry beautiful cabbage…maybe next week), so nothing went to waste. I really turned a corner.

3. Savings on the grocery bill—achieved. My total food bill for the week was $23.57, a savings of at least $15.00. I’m such an impulse food shopper, having a list was a godsend. Plus, I finally started making a dent in my overflowing pantry.

4. Lower rate of cookies-for-dinner consumption—achieved. I ate a grand total of 0 cookies for dinner. Don’t get me wrong, I ate cookies, but at more appropriate between and after meal times. And they were so much better that way.

Bonus result: Conversion—achieved. I am a meal-planning convert. I haven’t been to the store without a plan or a list (except for seltzer) since. I’ve saved a considerable amount of cash and tossed out much less food. And this week, I haven’t even bought cookies.

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If you dig this article, you might also like:

• The Hour: How 60 Minutes a Week Can Save Hundreds of Dollars on Food
• Recession-proofing Your Diet: Food Strategies for a New Economy
• Weekly Menu Planning for Singles, Couples, and Working People

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Photo from Design Sponge.

Written by the fabulous Leigh, Veggie Might is a weekly Thursday column about all things Vegetarian.

Meal planning is a hot topic ‘round these parts; you’d think we’d covered it all. But what if you’re a mostly vegetarian, or a family of omnis trying to work in a few vegetarian meals a week? A reader wrote in asking specifically how to plan for vegetarian meals that don’t involve tapas.

This Veg is here to help. Here are some tips and tricks to help you plan weekly meals that will improve your health, reduce your budget, and satisfy everyone at the table.

Decide How Many Vegetarian Meals/Week
Decide how many times a week you want to eat vegetarian meals and to what degree. Will you eschew all animal products (like dairy and eggs) or just meat?

Mark Bittman endorses a “vegan before dinnertime” lifestyle, only eating meat for his evening meals. The Johns Hopkins Bloomberg School of Public Heath suggests giving Meatless Mondays a try. Take a poll of your household (or rule like the theistic monarch you were born to be) and decide what works best for you and yours.


Take a Look at Your Pantry
All those staple items are about to come in very handy. Grains, beans, and pastas are your friends when you go veg. If you’re not already stocked, don’t worry: dried beans and rice are about as inexpensive as foodstuffs come.

Compare what you have to the recipes you want to make, and then supplement with fresh or frozen vegetables. You’ll be amazed at how far your food budget goes.

• Lentil, Spinach, and Bulgur Stew
• Quinoa with Mustard Greens and Mushrooms
• Kasha with Root Veg and Dill

Tweak Your Favorite Recipes
There are probably dozens of meals you love that are already vegetarian or can easily become so: spaghetti with marinara sauce, macaroni and cheese, peanut butter and jelly sandwiches…and those are just the beginning.

With minimal effort, you can convert your and your family’s favorite meals into vegetarian delights. Swap meat with spinach or zucchini, and you’ll have a killer veggie lasagna. Chili sin carne is just as delicious as con; and don’t forget, every kid’s favorite: pizza. Just load up the pie with cheese and veggies, like mushrooms, peppers, and spinach.

• Camp Stove Veggie Chili
• Meatless Shepherd’s Pie
• Fresh Tomato Lasagna

Try Something New
A common myth about vegetarians is that our diets are very limited. “What can you eat?” I’m often asked. “EVERYTHING!” I say, “except four things: beef, poultry, pork, and seafood. All the other food in the word is available to me.”

Eliminating one type of food forces creativity in other areas. I’ve tried things I never would have otherwise, just to keep things interesting. Explore foods of other cultures or experiment with spices. Vegetable curries, beans and rice, and stir fries are among the most versatile and delicious dishes in my repertoire. Try adding them to yours.

• Pindi Chana
• Smokin’ Summer Stir Fry
• Summertime Gazpacho

Forget the Food Myths
Worried about carbs? Fear not: complex carbohydrates are energy. Stick with whole grains and you’re golden. “But what about protein?” you ask. “What about it?” I answer. Allow me to put to rest another myth: that of the anemic, peaked vegetarian/vegan. Protein is available in variety of plant-based sources, the key being variety. Ingest a combination of grains, legumes, and nuts throughout the day, and you’ll be mighty and strong.

• Vegetable Lo Mein
• Nuyorican Beans and Rice
• Collard Greens and Black-eyed Peas

Know Your Audience
Some meat eaters want a meat replacement with their veggie meals. Some don’t. If you decide to go the meat analog route, please head this warning: Fake meat does not taste like real meat. If you can appreciate the fake meat on its own, you’ll be a much happier omni on the vege path.

That said, don’t fear the bean curd. It’s a beautiful, misunderstood food, and, in the right hands, can make your vegetarian day. Other meat subs, like tempeh or seitan, can add protein and B vitamins, not to mention texture and pizzazz, to your playlist.

• Mighty Good Veggie Burgers
• Seitan O’Greatness
• Falafel in Love

Save Money, Eat Well, and Be Healthy
Planning ahead saves time in the long run and money at the market. It curbs impulse buying and keeps you on budget. Decide what you’ll make before you head to the store. Armed with your shopping list and empowered with a plan, you’ll be ready to make healthy, delicious vegetarian meals as often as you like...and hopefully more and more.

Did I leave any unanswered questions? Would you do anything differently? Do you need a recipe for something amazingly veg you’d like to see here? Let us know in the comments.

Happy Earth Day!

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If you like this piece, you might also enjoy:

• 20 Cheap, Healthy Dishes Made From 10 Pantry Staples
• Cheap, Healthy Zucchini and Eggplant: 134 Recipes
• Reaching Into the Mailbag - Mom Seeks Help with Teen Veg

(Photos courtesy of Flickr members Steeena [peanut butter],  DodogoeSLR [pasta], Ze Eduardo [veggies].)