0 Medicare Accountable Care Organizations Medical Homes Experimental Potential or Essential

Time to measure some
new Medicare office drapes?

One major and longstanding criticism of CMS numerous innovation and demonstration projects is that they seldom lead to any meaningful orm of the core Medicare program.  In response, the Affordable Care Act created an "Innovation Center."  Despite legions of lobbyists, a third rail dread afflicting our political class and a powerful Medicare voting bloc, the intrepid folks in the Center promise to deliver insights that will advance quality, lower costs, increase access and spare all sacred cows.

Naturally, the thousands of health care experts who regularly read the Disease Management Care Blog have their doubts.  As a result, theyre unlikely to be moved by Karen Davis and colleagues "Medicare Essential" proposal appearing in the May issue of Health Affairs.

Assuming that the most wildly optimistic Accountable Care Organization (ACO) and medical home pilot programs projections are fulfilled, Dr. Davis et al propose the creation of a new "Medicare Essential" program that would co-exist with standard Medicare and Medicare Advantage.

"Essentials" essential purpose would be to finance ACOs and medical homes.  Given the authors enthusiasm, the DMCB is surprised that their Health Affairs paper isnt also recommending measuring drapes for the programs new offices.
 
In "Medicare Essential," Parts A (hospital), B (providers) and D (drugs) would be combined. There would be a single overall deductible, followed by low co-pays for primary care and higher co-pays for specialty and emergency room care Preventive care would have first dollar coverage. Pharmaceuticals would be governed by a single national formulary with low co-pays for generics as well as for perred brands and condition-specific/value-based drugs. Persons in the "Essential" program who are receiving care in ACOs or medical homes (financed with capitation, bonuses, gain sharing and monthly fees) would naturally have even lower co-pays.
 
Using "modeling by the Actuarial Research Corporation" and, as the DMCB understands it, transferring all savings back to the beneficiary, monthly out-of-pocket costs for the average Medicare enrollee could be reduced from the currently level of $427 to $354.  As an added bonus, if the patient used an ACO/Medical Home, the out of pocket would be further reduced to $254.

Case closed, right?

The DMCB isnt too sure.

Dont Measure Those "Essential" Medicare Program Office Drapes Quite Yet: While Davis et al should be commended for sending the savings back to the patient instead of Uncle Sam, their optimistic actuarial "research" projections cant be based on any consistent, statistically significant and real-world published proof.  Thats because there is no consistent, statistically significant and real-world published proof that ACOs and medical homes save money.  Come back, says the DMCB, when you have an analysis based on some real numbers.

Behavioral Economics: Furthermore, we dont know if monthly beneficiary savings of $73 to $173 are enough to move market share away from Medicare and Medicare Advantage to "Essential."  Thats doubly true if ACOs and medical homes, despite their quality, are viewed by patients as another way to impose a restricted network.

Disease Management Playbook: Advocates for the earliest versions of disease management likewise used official sounding projections to confidently project huge benefits for the Medicare program. When reality rudely intruded, the industrys fall was spectacular and almost fatal.  With friends like Dr. Davis similarly doubling down with huge ACO and medical home promises, who needs enemies?

Reinventing A 3rd Wheel? Many Advantage plans have similar co-pay arrangements and are already investing in ACO-like and medical home programs in their networks. They are likewise more than able to leverage out-of-pocket expenses to incent beneficiary behavior.

Suppose You Gave An ACO Party and Nobody Came? The last time the DMCB looked, many parts of the country lacked fully functional ACOs and medical homes. Dr. Davis says beneficiaries will respond by demanding local access to the Essential program and theore turbocharge additional health orm. The DMCB is unaware of any published data that supports that notion and, furthermore, wonders if the local lack of these programs will translate into even more variation in the U.S. health care system.

0 Omega 3 Fats are Essential to Prevent Nerve Damage after Traumatic Injury

People that have suffered a traumatic injury face an uphill battle as they attempt to regain their health and fight the risk of depression as a long term consequence of the event. British researchers from Queen Mary at the University of London have published the result of a studyin the Journal of Neuroscience that explains how omega-3 fatty acids play a significant role in preventing and protecting nerves from injury.

The research focused on peripheral nerve cells which transmit signals between the brain and the spinal cord to the rest of the body. Omega-3 fats from food sources including sardines, salmon, walnuts and flaxseeds provide for decreased cell death from injury and may offer significant protection against future damage.

Omega-3 Fats Help Prevent Nerve Damage and Assist the Repair Process

Current research indicates that our nerves do have a limited capacity to regenerate, but recovery is severely limited depending on the extent of the injury. Omega-3 fatty acids are essential for the bodys normal growth and development and have been well researched for their health benefits, largely focused on brain and heart health. The body is unable to manufacture its own Omega-3 fat supply, so it is necessary to obtain sufficient intake from foods such as oily fish, nuts and seeds or through supplementation.

Researchers studied the effect of Omega-3 fats on isolated mice nerve cells, known to parallel human nerve responses. They simulated nerve damage caused from an accident or injury by either stretching the cells or starving them of oxygen. Both types of damage can kill a significant portion of nerve cells, but enrichment with omega-3 fatty acids in cells gave them significant protection and decreased cell death.

EPA and DHA Fats Lower Sciatic Nerve Injury Damage and Prevent Muscle Wasting

The study also examined sciatic nerve damage in the mice. They found that a high level of omega-3 fatty acids helped mice to recover from sciatic nerve injury more quickly and more fully, and that their muscles were less likely to waste following nerve damage. The team leader, Dr. Adina Michael-Titus, Professor of Neuroscience concluded“Our previous research has shown that these fatty acids could have beneficial effects in a number of neurological conditions. This new study suggests that they could also have a role in treating peripheral nerve injuries.”

The findings from this research should come as no surprise to integrative health followers. The Omega-3 fats EPA and DHA are essential building blocks to all cellular structures in the body and are particularly dominant in the brain and nervous system. A healthy supply of Omega-3 fatty acids allows for natural cell repair and the effective chemical and electrical communications that are important to optimal nerve function. Consuming fatty fish three to four times a week or supplementingwith molecularly distilled fish oil (1 to 2.4 grams total EPA/DHA) supports the nervous system and regeneration process after injury.

0 Magnesium Essential to Heart Health Lowers Blood Sugar

(Article first published as Magnesium Slashes Heart Attack Risk, Helps Prevent Diabetes on Technorati.)

Magnesium is one of the most common elemental minerals in the human body yet experts believe that more than 90% of adults are deficient, placing them at extreme risk of sudden death from a heart attack and developing diabetes. Hundreds of biochemical functions that drive energy metabolism and DNA repair are fueled by magnesium.

We rely on eating vegetables and other natural foods grown in magnesium rich soils as our source of this vital mineral. Most people don’t eat enough fresh vegetables to supply adequate magnesium while poor farming practices have depleted the mineral from most commercially grown crops. You can ensure that you receive magnesium though diet and supplementation to stave off heart disease and metabolic dysfunction.

Magnesium Deficiency Linked with Diabetes

Magnesium is used by hundreds of enzymes in our body to regulate blood sugar metabolism. The mineral is known to dampen the flames of inflammation that interferes with healthy blood sugar and can lead to insulin resistance. The results of a study published in the journal Biologic Trace Elements Research shows that as magnesium levels in the blood increase, the risk of Type II diabetes declines in a corresponding fashion. By boosting levels of fat storage hormones such as adiponectin, magnesium plays a critical role in protecting metabolic function and lowering risk of diabetes.

Magnesium Protects Against Sudden Cardiac Death

Sudden cardiac death is a leading cause of heart-related deaths among those 40 and older. More than 250,000 people die each year for this preventable condition. Research that was part of the Atherosclerosis Risk in Communities Study demonstrates that those individuals with the highest magnesium in blood circulation had a 40% lower risk of dying from a heart attack as those with the lowest levels.

Magnesium is necessary to relax blood vessels and arteries while maintaining normal blood pressure. Further research has demonstrated the effect of magnesium on dangerous plaque formation. Low levels of magnesium are associated with the development of foamy plaque on the inner lining of the coronary arteries as well as thickening of the artery walls. High levels of magnesium were shown to decrease arterial wall thickness by 42%.

Magnesium from Diet or Supplements

The typical diet of ined foods does not supply sufficient amounts of magnesium to counteract disease. Manufacturers process out most of the nutrients necessary for health and are a poor choice to optimize health. Good sources of magnesium are nuts, seeds and beans in their natural state as well as organically grown vegetables and leafy greens. Most people will need to supplements to reach the daily intake of 400 mg recommended by experts.

Magnesium levels are grossly deficient due to mineral depletion from soils and a diet of synthetically produced foods. It`s no coincidence that humans have evolved to be reliant on a natural mineral to prevent heart disease and metabolic dysfunction. Magnesium has been plentiful in our food for generations and must be consumed as part of a natural diet or through supplementation to ensure optimal health.

0 5 Essential Steps to Weight Loss Success

(First published as Weight Loss Success: Five Essential Steps on Technorati.)

Millions of Americans are looking for a weight loss plan which is easy to follow and will deliver results. The problem with most traditional weight loss diets is that they eliminate certain important food groups or require drastic lifestyle changes which can’t be maintained long term. The only weight loss plan which can work allows for flexibility in food choices and is structured for a slow transition to a new dietary lifestyle.

Healthy weight loss occurs when calories consumed exceeds the energy burned through basic body metabolism and physical activity. The important thing to understand is that the type of food we eat and more importantly, when we eat that food has a profound effect on whether the body stores fat for future needs or burns fat for energy. For those who have tried the typical diet programs and failed, the following 5 steps will provide the necessary guidelines to achieve permanent weight loss.

Step 1: Stop Eating After 7 PM

Our body abides by a very intricate set of circadian rhythms, allowing time to carry out many necessary metabolic functions. One of those functions is fat burning and storage, which ideally occurs at night when you are asleep. When you stop eating 3 to 4 hours before going to bed, initial digestion of food in the stomach is allowed to complete and the body must turn to burning fat for its energy needs.

Try to fast for at least 12 hours each day, as the body will dip further into fat reserves for a longer period of time, and will also carry out other essential cellular maintenance functions which will slow down when food is being digested. This is not recommended for diabetics who may require small meals throughout the day.

Step 2: Eat 3 Meals: No Snacking

It’s important to eat a breakfast, lunch and dinner meal each day. The critical point is to allow sufficient time between meals with no snacking. The body closely regulates blood sugar and insulin, and eating between meals sends this delicate mechanism awry resulting in excess fat storage. The body needs three evenly spaced, moderately sized meals to fuel our energy needs, and also needs several hours after eating to process the food and return blood sugar and insulin to pre-meal levels. This will encourage fat to be used for fuel instead of being stored.

Step 3: Moderate Meal Size

Eat slowly and closely monitor the amount of calories at each meal. The body is very sensitive to caloric intake, and excessive eating at any given meal causes an overload of sugar and fat to flood the bloodstream with detrimental health implications. Women should target 400 to 600 calories each meal, and men should be in the 500 to 600 calorie range. 

Spread the meal out over at least 20 minutes to allow your body to send the full signal indicating you’re satisfied with the portion consumed. Once the body becomes conditioned to a smaller meal size, overeating will feel unpleasant and natural weight loss will be the result.

Step 4: Include Protein with Breakfast

Proteins are very complex structures which require 30% more energy and up to 12 hours for complete breakdown by the body. Eating a solid protein source with breakfast starts the energy burn cycle which continues for most of the day, as it ramps up the natural fat release mechanism in the body. It’s important to avoid quick burning carbohydrate sources such as pancakes, breads and donuts especially early in the day, as they negate the positive metabolic effects of protein digestion by disturbing insulin response.

Step 5: Reduce High Calorie Carbohydrates

Refined and processed carbohydrates cause an immediate release of sugar into the blood as they begin to break down in the mouth. This starts a vicious cycle causing insulin resistance and ultimately conversion of sugar into stored fat. Carbohydrates from vegetable sources have the opposite effect as they are bound to fiber and break down very slowly. We have evolved to eat a varied diet including lots of vegetables, lean protein sources and healthy fats. The excessive amounts of breads, pastas and sweets consumed by most people causes a sugar overload which leads directly to excess fat storage.

Permanent weight loss is an attainable goal, even for those who have tried and failed repeatedly. It’s important to be mindful of the type of foods eaten and choose wisely from all food groups. A key weight loss strategy is in the proper timing of meals with fasting, as well as intelligent macronutrient combinations. By following this 5 step plan, your healthy weight loss goal is well within reach.

0 Oral hygiene in oral health is essential

Health for human | Oral hygiene in oral health is important, several oral and dental problems occur because of our lack of oral and dental hygiene.
Awareness is necessary to maintain oral hygiene and preventive medicine is the occurrence of oral and dental problems are most efficacious. Would not it be better to prevent than to cure?

Ways that can be done alone and I think that is effective in maintaining oral hygiene such as:

a. toothbrush: everyone already knows how this one of course, may also have been done every day. So it is important here is the introduction of proper tooth brush technique, motivated to brush teeth regularly and with proper selection of toothpaste. Toothbrush technique is commonly known horizontally general, and it was a mistake because in this way can eventually lead to gingival recession and tooth abrasion. Furthermore, these diseases will be easier periondontal happen.

Selection of a soft bristle brush is also important so as not to injure the gums. Toothbrushes should be replaced at least once every month, thus the bristles are still effective in cleaning teeth. Fluoride toothpaste should be selected because of the fluoride content of the study was able to reduce the number of caries through two things: eliminate dental plaque which is the forerunner of caries as well as supplemental topical fluoride to the teeth as a mineral important protective against caries.

b. Mouthwash-antiseptic mouthwash (Oral Rinse): there are different active ingredient that is often used as a gargle, gargle. The-counter are generally derived from vegetable oils such as metal salicylates (such as Listerine products), while the necessary prescription is chlorhexidine 0.20% (as in product minosep) and H2O2 1.5% or 3.0%. -Gargle mouthwash that is cheaper and quite effective way is with warm salt water.

Actually, more is needed-gargle gargle in gum disease and periodontal while in daily use has not been proven in preventing caries, especially if its use does not begin with a toothbrush. So it is important to note that gargle-rinse is not a substitute for a toothbrush and brush your teeth still the most important prevention of dental diseases, particularly caries. Even if the mouthwash-gargle too often used to cause the normal flora of the mouth will die and stimulate the growth of candida and also make a dry mouth and burning.

c. Dental floss or dental floss: recently introduced in this way started a lot, and powerful enough to clean in between teeth. But the technique should be properly understood because if not, instead of preventing periodontal disease, which occurs even injure the gums and create inflammation.

d. Cleaning the tongue: also started a lot of use, both to clean the lingual dorsum which often escape our current clean toothbrush. Piles of debris on the dorsum of the tongue is full of germs and candida opportunists who live as normal and transient flora. Explanation of how once again required.


Maybe after making efforts to maintain oral health is good and true that we assume the control to the dentist is not important, but the controls to the dentist regularly required as one of the preventive measures, because theyre the experts, and sometimes we ourselves often escape observing changes in teeth and gums are still small.
To which does not have a mouth or dental problems should be performed every 6 months control but if have problems such as oral and dental tissue disease control should be performed 3 months.