Health for life

Every Saturday, we post a piece from the CHG archives. This one comes from June 2009.

Though it might seem intuitive, determining a recipe’s cost and nutritional value can get pretty complicated, pretty quickly. Ingredient prices can add up before you know it, and a combination of fats, meats, and cheeses will take a toll on your calorie count without even registering on your radar. And sometimes, even the most harmless-looking dishes, like All Recipes’ Greek Pasta Salad with Shrimp, Tomatoes, Zucchini, Peppers, and Feta, can run you $2 and 42 grams of fat per serving.

So, how can you tell if a dish is good for you, just by looking at it? How can you avoid the pitfalls of secretly fatty and financially unsound food? How can you err on the side of caution when it comes to cooking?

Look no further, sweet readers. We’ve got you covered. If your recipe source doesn’t give a nutritional breakdown and you’re unsure of the potential cost, these tips will help you decide whether the money/waistline expenditures are worth the trouble. If you have any suggestions, be sure to include them in the comment section.

DO choose your source wisely. Man, I love Paula Deen. Her food looks stupendous and she’s endlessly entertaining – like Yo Gabba Gabba if it was a charmingly cackley southern woman. That said, her concoctions might not be the best choice for those concerned about weight. If you know you’re looking for healthier recipes, sources like Everyday Food, Cooking Light, and Eating Well will generally be more helpful than the Neelys or the Two Fat Ladies. Likewise, reproducing a dish from Grant Achatz’s Alinea cookbook will probably run you a pretty penny compared to the average Cook’s Illustrated meal. Starting your search with a website, cookbook, or blog aimed at your requirements is half the battle.

DO check the number of servings. Once you have a recipe in mind, before you do anything else, check how many people it’s supposed to sate. Fourteen ounces of flank steak does little damage split among eight eaters, but can destroy diets if it’s meant only for two.

DO read the ingredient list caully. After the serving size, the ingredients are the most important determinant of the cost and nutritional value of a recipe. Scan the rundown, look for a few keywords (many of which are listed below), and be extra aware of extravagant or difficult-to-find foods for your area, which will drive up the price.

DO consider recipes with one or two out-of-the-box ingredients. In small doses, odds are it/they won’t break the bank, and you can incorporate new flavors into your repertoire. Lemongrass? Meyer lemons? Lemon basil? Sure, why not?

DON’T dismiss a long list of ingredients outright. Lighter foods like Bon Appetit’s Turkey Chili with Beans frequently require multiple, inexpensive spices and flavorings to make up for the absence of fat. While their sheer number can seem pretty intimidating, don’t fret. Oftentimes, these foods can be found right in your pantry for minimal cost.

DO count the number of ingredients already in-house. Speaking about that pantry, recipes based on dry goods will usually be cheaper than ones requiring a trip to the supermarket. Look for meals that use rice, beans, pasta, and other staples as jump off points, and go from there.

DO opt for whole food ingredients. If it can be found in the outer aisles of your supermarket, it’s probably a good start to a meal. Fresh fruits, veggies, and lean meats give recipes more bang for the buck, and almost guarantee a healthier overall experience. Fewer preservatives and extra-excellent flavor are just bonuses.

DON’T choose recipes made from processed food. The less ingredients are handled by humans, the better. Why? Well, in general, heavily processed and pre-cut edibles are more expensive and worse for you than the aforementioned whole foods. Semi Homemade-style meals may be convenient, but when you’re sacrificing money, nutrition, and taste, is it worth it?

DO watch out for lots of meat and cheese. In moderation, neither of these is anything to fear. But prices and calories rise when a meal centers on multiple cups of frommage or large cuts of beef or pork. Instead, search for recipes where meat and cheese are add-ons instead of the main event. You’ll save all around.

DO calculate about 12 or 13 grams of fat per tablespoon of butter or oil. When doing a cursory scan of any recipe, I take extra care to check the total cooking fat. If there’s a lot, but it can be easily reduced (like in sautés), I keep going. If there’s a lot, but the amount is set in stone (as in some baking), I move along to the next dish.

DON’T rule out all fatty ingredients. Nuts, olives, avocados and certain oils aren’t low-fat foods, but they’re healthy ones because of the vitamins and minerals they offer. Relatively inexpensive and often pivotal to a dish’s overall flavor, they should be incorporated into any diet in moderation.

DO look for words like: baked, roasted, steamed, grilled, or sautéed. These cooking techniques tend to use less fat than others while still producing flavorful foods. Steaming and boiling are good keywords as well.

DON’T choose recipes with the words: fried, au gratin, cream sauce, bisque, bacon-wrapped, or lard. Each of these terms implies one thing: fat. If you’re serious about watching your weight, there are lighter recipes for certain dishes (Spaghetti Carbonara, etc.), but straight-up lobster bisque will do a number on your numbers.

Confusing? Maybe. Do-able? Definitely. With some practice, these rules will get easier to use. And in the end, you’ll have no problem telling the difference between the recipe you really want and the recipe you thought you wanted.

Readers, fire away in the comment section.

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The Disease Management Care Blog feels your pain. 

You help lead a unique and innovative care coordination initiative.  Your program has some preliminary data that strongly suggests quality has increased while costs have remained neutral or gone down.  Patients are satisfied.  Docs are happy.  You even have a patient anecdote or two.

But somethings missing.

While your institutions marketing department has been supportive, you believe that the customers you want to serve are tired of glossy brochures, breathless press releases and chatty sales reps.  Your customer meetings are fun, but you cant tell if the positive feedback is the result of real insight or that second glass of wine. 

On the other hand, the prospect of publishing your findings in some scientific journal is too dreary to contemplate. 

You know some more meaningful is at stake.  You want to share your good news and get some feedback.

Heres your solution: the Care Continuum Alliance Annual Conference.  Hundreds of individuals just like you - individuals who give a damn about patients, are excited about making a difference and want to make a living doing it - will be available to give feedback.  Who knows, some of them may talk partnerships.  Others will resent your competition, confirming that you are on the right track.

The CCA Call for Proposals can be found here.  You have until March 6 to submit.

Disease Management Care Blog regulars are fully aware of the rich variety of care coordination approaches that exist outside of the patient centered medical home (PCMH).

They also know that the mainstream health policy dons have it wrong and that care coordination doesn’t come down to choosing between a Medicare PCMH and an ACO PCMH.  Other options are in or outsourcing a cohort of generalist, credentialed, dedicated and fulltime nurse-coaches on a shared service basis.  When done right, there is little physician disruption and a high degree of patient acceptance.

Prevailing common wisdom is wrong: primary care sites dont always need to individually hire, train and pay for a full-time nurse-coach when this human resource can be centrally managed by smart provider organizations, commercial insurers or self-insured employers using economies of scale.

In prior posts, the DMCB has repeatedly linked peer-reviewed literature describing successful "turnkey" approaches to care coordination and management.  Knowing, however, that published evidence is necessary but not sufficient for changing policy, the DMCB has also been keeping its eyes peeled for real world examples of outsourced care management.
  
It found one during the last Care Continuum Alliance webcast.

Webcast listeners got to hear from another company that has successfully commercialized outsourced care management.  MedAssurant does business with hundreds of provider organizations that ultimately touch 118 million persons. While MedAssurant is perfectly capable of providing modern remote telephonic disease management, it also offers a care management "solution" that relies on nurses who are embedded in physician offices and clinics.  Their value proposition is to complement the physicians care with additional face-to-face coaching that helps patients engage in greater levels of self-care. The nurses are backed up by predictive modeling that identifies the patients at greatest risk, a telephonic coaching program when appropriate and access to other community based services including social workers. 

While MedAssurants outcomes data havent been formally published anywhere, it has some compelling data in the graphic above as well as information here describing increases in HEDIS and CMS Stars Ratings as well as drops in condition-related inpatient and emergency room visits.  The DMCB also knows that the health insurers, employers and provider organizations that are buying or using MedAssurants offerings are skeptical, sophisticated and demanding. 

MedAssurant is doing something right.