Monday, November 17, 2014

In the News: a new heart health calculator and a study on the value of cooking at home

Just a quick post to share two newsworthy items. First, the Harvard School for Public Health released a new online calculator to estimate your risk of cardiovascular disease. I like that it focuses on lifestyle choices and modifiable risks. It's easy to complete and you don't need to know your blood pressure or cholesterol to get your results. 

Despite being one of the leading causes of mortality and morbidity in the U.S. and worldwide, people seem to be less fearful of cardiovascular disease than cancer or Ebola. And, unlike some diseases almost all cardiovascular disease is preventable. The recommendations you receive after completing the survey include practical tips for improving your health. It's been so popular that the site sometimes gets overwhelmed (an encouraging sign), but keep trying. It's worth doing! 

Second, a new study from Johns Hopkins University Bloomberg School of Public Health revealed that:

"People who frequently cook meals at home eat healthier and consume fewer calories than those who cook less, according to new research. The findings also suggest that those who frequently cooked at home -- six-to-seven nights a week -- also consumed fewer calories on the occasions when they ate out."
Certainly, not surprising, but it does confirm again that we're on the right track in planning a series of cooking classes for ASHA staff.

Friday, November 14, 2014

Mediterranean Diet and Workplace Health -- The Evidence Behind the Recommendations

One final post about the the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. The conference organizers prepared the review paper below. It clearly indicates the health benefits of following a Mediterranean diet and the evidence that supports the recommendation. I particularly like this chart at the top of page three that provides clear instruction for following a Mediterranean diet. Please take a few minutes to peruse the paper. 

Thursday, November 13, 2014

Health Plan Changes for 2015

When I announced that ASHA will be self-insuring the medical coverage for staff next year, I mentioned that one of the advantages is that we have more flexibility in the plan design. This has allowed us to enhance benefits in a number of areas. Below is a summary of the changes our plan participants should expect for 2015.

1. You’ll receive a new card. Our administrator will be listed as UMR, but we’ll be using the same Choice networks through UnitedHealthcare that we have now. Your id number, the mailing addresses, phone numbers, and the website will all be new. We’re doing everything we can to assure you will have your new cards in hand before January 1, 2015. And, we will make sure you have all the up-to-date contact information for the 2015 calendar year.

2. To get a 90 day supply of a prescription medication, you will have to use mail order. Through mail order, you will receive 90 days of medication for two copays. (The cost of procuring the medication through mail order is less, so we’re passing along some of that cost savings to you if you chose this option.) If you chose to have your prescriptions filled at your local pharmacy, you will get a 30 day supply for one copay. Our copays will continue to be $10 for a generic (Level 1), $35 for a preferred brand name (Level 2) and $60 for a non-preferred brand name (Level 3.) If you are in the Choice Plus with HSA plan, you will continue to pay the cost of the medication until you hit your deductible. Then, the copays will apply.

All mail order prescriptions will be transferred from 2014. You will have to call OptumRX the first time you need a refill in 2015. After a prescription has been filled once, you’ll be able to order refills online at the UMR site. Your prescription number will stay the same. At a local pharmacy, you’ll just need to present your new insurance card. If you have a specialty medication, call and talk with your advocate. You’ll just need to provide your new id number and your prescription will be transferred.

Some of the tiers that drugs are in may change. The 2015 prescription drug list has been posted on the Healthcare Savvy ASHAnet site for you. Diabetic supplies will now be covered at the generic copay level of $10.

Learn more about prescription drug pricing and safety by reading the summary of the session we hosted here in July.

3. Out-of-network services will be reimbursed at 90% of UCR (usual customary and reasonable) in 2015 instead of 80% as they are now. This enhances the benefit for staff that seek services outside the network.

4. The in and out-of-network deductibles in the Choice Plus with HSA will now cross accumulate. This means that whatever you spend out-of-pocket for in-network services will also count towards your deductible for out-of-network services. This softens the hit of the out-of-network deductible.

5. Your pre-colonoscopy doctor’s visit and the “prep” kit will now be covered as preventive services if they’re billed as preventive. (They are currently subject to the deductible and copays, so this is an enhancement.)

6. Chiropractic services will no longer be limited to 30 visits per calendar year. They will be reviewed for medical necessity after 25 visits and an unlimited number of visits may be approved if they’re medically necessary.

7. Replacement batteries on durable medical equipment will be covered in 2015 enhancing your coverage.

8. A number of exclusions for mental health disorders have been eliminated for 2015 enhancing your coverage.

We will talk about these changes during our open enrollment meetings. The HR team will also be happy to answer your questions.

Sunday, October 19, 2014

Mediterranean Diet and Workplace Health -- Best Practices from the Field

2014 Initiative for Productivity and Health Management Conference at the Harvard School of Public Health

I came back from the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health with so many notes, I decided to break them up into two posts. You can read my earlier post about Day 1 where they defined a Mediterranean diet and shared the scientific evidence about the health benefits. Day 2 focused on effective real world initiatives to help people eat a Mediterranean diet. Here’s some of what stood out to me…

Chef Psilakis is a big proponent of teaching kids to cook. That was actually a theme that was thread throughout the two days. Dr. Gianluca Tognon talked about how they improved the diet of school children in Sweden. They empowered children by involving students in the meal planning and offering them choices. They exchanged information by inviting school chefs into the classrooms. And, they evaluated the effects of what they were doing by keeping track of foods that were not well accepted and collecting feedback from students and teachers. He suggested food tastings, having specially themed food days, creating "smarter lunchrooms" by carefully considering food placement and having school gardens as ways to improve dietary habits of children. Dr. Tognon has a free e-book that I look forward to reading. 

UMass shared what they did at the university level and it really didn't sound all that different. Ken Toong the Executive Director did add a mention of "stealth health" for example making sliders with a meat blend that's 30% mushrooms. At UMass they've found a way to make healthy affordable. They have 12% waste and the US average is 40%. He also reported that they consumed 22% less soda from 2013 to 2014. They encourage students to drink water by offering sparkling water and water infused with fruit. (I'm already requesting that we do that in our office.) I loved the UMass tagline -- Come for the food, stay for the education. I sure didn't have lobster when I was in college. 

In general it sounds like it is much easier to get children and college students to make healthy choices than adults. Although the effective strategies for adults were much the same as those used for young people -- samplings, tasting tables, talking with chefs -- with the addition of distributing recipe cards. A few other poignant points:
  • Many people know they should change what they eat and move more, but feel "stuck" and lack the skills to change.
  • Nutritional knowledge is not enough. Culinary literacy is at an all time low. Hands-on training is essential. 
  • Each 30 minute reduction in time spent cooking in the US has been associated with an increase in BMI of 0.5.
This made me recall reading, Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies which concluded,
"Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking."
I had a chance to observe this first hand when we did our Mediterranean Challenge. Many people really struggled with the cooking. Grocery shopping took a long time because they were looking for items that were unfamiliar to them. The kitchen prep work took a long time because they weren't set up for it and their knife skills weren't good. And, they often picked meals that were too ambitious for a week night because they didn't have enough experience judging what could be prepared quickly. I've been planning to organize a knife skills class and a series of cooking classes at ASHA since I learned this. From what I learned at the conference, I'm on the right track with this idea. 

The experience of Todd LeDuc at the Boston Fire Service affirmed something I believe, money is not the best motivator for improving healthy. They started out with some incentive programs that they later eliminated. He shared an example of a communication that I liked, if you eat x you'll have to run x miles to work it off. How much more useful would that kind of message be than our current food labels?

One of the most exciting presentations was David Eisenberg, MD, he hit on many things that I'd been discussing during the breaks with other attendees. He has a program that teaches physicians too cook -- Health Kitchen, Healthy Lives. You can read about it in this New York Times article. I'm wondering how many of the program objectives we could incorporate in our workplace wellness program. Dr. Eisenberg was the first to mention mindfulness. I emailed him and asked if he'd share his slides. I'll definitely be spending some more time reflecting on what he shared. 

As a Blue Zones fan, I enjoyed hearing from Diane Kochilas. I especially liked her take on seasonal foods, 

"Eating foods in their season, when nature intended, brings anticipation, which in turn teaches us to savor and enjoy the moment, a notion obscured by the 24/7 availability of almost everything in American supermarkets and the erroneous -- and, ultimately, unsustainable -- belief that it's our right to have it all in endless choice."
Chef Michael Psilakis described the Mediterranean as the “have your cake and eat it to diet” and they practiced what they preached.  Breakfast was served both days of the conference – Fage plain greek yogurt, fruit, honey, pistachios and veggie filled filo pastries. Lunch was 90 minutes long. It included chicken, farrow, eggplant, salad and wine (no dessert.) Snacks and appetizers were fruits, roasted vegetables, hummus and more filo pastries. I’ve never eaten so well at a conference and all in the name of health. What’s not to love? They also closed the conference with a Greek Food Expo that gave us a chance to try wines, olive oils and other treats imported from Greece. 

With the focus on diet, I don't want to neglect the fact that activity and sleep were mentioned. I sat next to Voula Manousos, a registered dietitian, and she described our need for sleep in an enlightening way. She suggested you imagine your bedroom with everything pulled out of the closet and drawers heaped in the middle of the floor. While you sleep, everything is neatly put away where you can find it the next day. That's why sleep is such a critical component of memory and recall. On that note, I think I'll say good night. 

I recommend trying the oils from Flying Olive Farms. They're available in Whole Foods in the Raleigh, NC area and I'm begging the Wine Cabinet in Reston, VA to carry them. I loved their balsamic too. 

I recommend the series of Huffington Post articles written by the conference organizers and faculty. 

Friday, October 17, 2014

From Passive Patient to Savvy Healthcare Consumer: How to Seek and Find the Best Care

Dr. Gourdine met with us yesterday to teach us how to seek and find the best medical care. This was Dr. Gourdine's second visit to ASHA. I shared a little about her impressive background when I summarized her last presentation How to Be the CEO of Your Health

Yesterday, we walked away away better equipped to:
  • Distinguish among an empowered patient, an engaged patient, and a savvy healthcare consumer.
  • Define quality healthcare.
  • Identify and use reliable sources for choosing the best doctor.
  • Talk to our providers about safe care.
  • Identify and use reliable sources for choosing a safe hospital.
  • Define the role of a hospitalist.

An empowered patient is informed, speaks up, asks questions, and makes sure he/she fully understands all aspects of his/her care. To be empowered, you must first be an engaged patient and have the knowledge, skills and tools to take charge of your health. Engaged patients have fewer hospital admissions, fewer ER visits, better preventive care and lower medical costs. But, what does it mean to be a savvy healthcare consumer? Savvy consumers:

  1. Select quality providers
  2. Seek care from the highest quality hospitals and facilities when they need it.
  3. Are educated about procedures and alternatives.
  4. Estimate the total cost and out-of-pocket costs of their care.

So, what is quality healthcare? There are two main types of quality measures -- consumer ratings that tell you what people think about the care they received and performance measure that evaluate how well a doctor, health plan or hospital prevents and treats illness. Many of the resources we first think of like publications that list top doctors are more popularity contest or paid advertising than an indication of quality. Dr. Gourdine provided us a number of reliable resources to help us select top quality doctors and hospitals. 

So, how do you chose a doctor? 

  • First, identify your own health priorities. AHRQ has a nice tool
  • Look at the Unitedhealthcare website to find providers that are in-network. Look for providers that are designated as Tier 1 which indicates that they have received a premium designation for quality and cost efficiency.
  • Review information on the AMA website. Many doctors are not AMA members. You can still find them in the directory, but there is limited information about them available.
  • Check out the doctor on Health Grades to learn more about their background and read reviews from patients. 
  • You can also look at the Medicare physician compare website
  • And, Rate MDs

What reliable resources are available for choosing a hospital?

Dr. Gourdine has compiled a more comprehensive list of resources in the last few slides of her presentation. I encourage you to take a few minutes to view it. 

We look forward to having her back at ASHA next year. If there is a particular topic you'd like to have her speak about, please let me know. We feel very fortunate to have someone with her expertise available to help us.