Living Well Journal

Health Care's Coming Price Revolution

An excellent Op/Ed piece in the Wall Street Journal (2/23/12) ...  "The maket is naturally creating an ObamaCare alternative, and the moment for structural reform may be riper than Washington rhetoric suggests.  'Health-care reform' is inevitable.  The only question is whether it will run in the direction of prices and choice or more government control."

Health Care's Coming Price Revolution

A Lesson in Longevity: "Ikigai," or Living with Purpose

From Dan Buettner's book, Blue Zones, on lessons learned from people living the longest, healthiest and happiest lives on the planet:

Kamada Nakazato is a centenarian living in Okinawa, one of the four Blue Zones identified by the research. Hers is just one of many fascinating stories of these amazing people.

When asked her secret to living to age 102, she said: "I used to be very beautiful... I had hair that came down to my waist.  It took me a long time to realize that beauty is within.  It comes from not worrying so much about your own problems. Sometimes you can best take care of yourself by taking care of others.  Eat your vegetables, have a positive outlook, be kind to people, and smile.

"Older Okinawans can readily attribute the reason they get up in the morning ("ikigai").  Their purpose-imbued lives gives them clear roles of responsibility and feelings of being needed well into their 100s."

" A sudden loss of a person's traditional role can have a measurable effect on mortality... Kamada remains functioning longer because she feels needed."

Researchers found a clear evidence of this purpose-driven attitude in the longevity, health and happiness of centenarians across all four Blue Zones.  One 11-year study found that "individuals who expressed a clear goal in life -- something to get up for in the morning, something that made a difference - - lived longer and were sharper than those who did not."

A Lesson in Longevity: Hara hachi bu

Taken from Dan Buettner's book, Blue Zones, on research of four areas in the world with the longest-lived individuals:

Kamada Nakazato is a 102-year old woman living on the Motobu Peninsula of Okinawa, an island archipelago 1000 miles southwest of Tokyo.  Okinawa was identified by the researchers as one of 4 "blue zones" in the world where people live the longest, healthiest and happiest lives.

During the authors' visit with Kamada, they observed a pattern of eating among people in this area:  mostly plant-based foods grown in their gardens, some fish and tofu,lots of green tea and only occasional meat.  

"Before each meal she takes a moment to say hara hachi bu, and that keeps her from eating too much... All old folks say it before they eat.  It means 'Eat until you are 80 percent full.'" 

"Okinawa may be the only human population that purposefully restricts how many calories they eat, and they do it by reminding themselves to eat until they're 80 percent full.  That's because it takes about 20 minutes for the stomach to tell the brain it is full.  Undereating, as the theory goes, slows down the body's metabolism in a way such that it produces less damaing oxidants - - agents that rust the body from within."

Low caloric intake was a practice that researchers found among centenarians in all four Blue Zones, averaging 1900- 2000 calories per day.  Compare this to one typical fast-food meal of a large hamburger, large fries and a large soft drink containing nearly 1500 calories.

Blue Zones: Lessons for Living Longer from the People Who Have Lived The Longest

OK, I want to highly recommend a wonderful book I'm reading that was shared with me by my friend, Tom Pollack, an accomplished attorney and executive coach from Santa Monica, CA.

Blue Zones is the product of years of research on the few places around the world ("Blue Zones") where people live the longest, happiest, healthiest lives.

This is one of the most winsome, encouraging and stimulating books I've read in months!  The heart-warming stories come from centenarians in many cultures around the world - - Sardinia, Okinawa, Costa Rica and even Loma Linda, California. 

"If wisdom is the sum of knowledge plus experience, then these individuals possess more wisdom than anyone else."

In the next few days, I'll be sharing some of the lessons revealed from this research that can change my life and yours for the better!

Precision Medicine

Reliance on what worked in the past will not sustain us going forward.

This is true especially in US healthcare.

A current online article in The New England Journal of Medicine is a chilling (and thrilling) preview of just how different healthcare will be in my lifetime.  

Preparing for Precision Medicine

What Has Massachusetts' Health Reform of 2006 Accomplished?

Health Affairs carried a useful article on January 25th recapping a survey of 3000 non-elderly adults on their actual experience in Massachusetts after 5 years of the program that the dederal Patient Protection and Affordable Care Act of 2010 was patterned after. Massachusetts serves as a laboratory to observe the lessons learned in a state-level experiment to improve health care access, quality and cost.

"Respondents to a 2010 survey reported fewer emergency department visits, improvements in health status and a greater likelihood of having health insurance coverage." 

Back to the Future

Sometimes I learn more about where I'm going by looking back at where I've been --- how about you?

Thanks to my friend, Mary Haley, a senior solutions consultant with IBM, for sharing this article from 2009 highlighting Dr. Paul Grudy, one of the true pioneers in finding ways BACK to the coordinated care that our family doctors (aka "primary care provider") used to provide for our moms' and dads' families.

Rediscovering Coordinated Care is one of the greatest needs/opportunities for the US health care system. 

The Family Doctor: A Remedy for Health-Care Costs?
How making primary-care physicians the center of America's health-care system could drive down costs

By Catherine Arnst with Business Week, June 25, 2009 

Living Well to the End

Stephen Covey says that highly effective people "start with the end in mind."  

A huge part of Living Well for me is learning how to invest my time intentionally.  That can mean being fully present during the day, really living, rather than rushing through life as I so often do.

Returning to my blog for the first time in 2012, I wanted to begin the New Year by sharing a beautiful yet sobering insight from one of nursing's many heroes in palliative (end of life) care.  The author shares how people at the end of this life define a Life really Well-Lived.  I hope it challenges and encourages you like it does me!  

Nurse Reveals Top 5 Regrets of Dying Patients

Make 2012 a year in a Life Well Lived!

How to make the tough decisions in Accountable Care?

The December 15 issue of Health Affairs included a policy brief on one of the most significant and controversial features of the Accountable Care Act: the creation of a new executive branch agency called IPAB (Independent Payment Advisory Board).

Independent Payment Advisory Board - Health Affairs

Why should you care?  Because the IPAB is one of the most powerful elements of the health care reform law whose decisions would affect your ability to access high quality, affordable healthcare for your family.  

The name, Independent PAYMENT Advisory Board, clearly says what the goal is:  controlling what Medicare pays for services provided to beneficiaries.  If "you get what you pay for ..." then it's hard to say the IPAB would not "ration" care indirectly by the tough recommendations it makes that affect those who provide care to patients.  

We can't continue to grow Medicare expenditures at the current rate. Politicians don't want to say No to constituents.  Enter the idea of a non-political entity to make the tough choices.  The IPAB is a centralized control approach.  Free market forces are another way, allowing Adam Smith's Invisible Hand to impassively make those choices.  This stuff isn't easy!

Here are a few excerpts from the Health Affairs brief that boil it down:

Staying Focused on The Main Thing

Our intentions don't always correspond to our actions.

Here's a link to an excellent blog post by Paul Levy, a former Boston hospital CEO, who compared what CEOs say captures most of their time and attention versus what their organizations' mission statements say they should be focused upon ... intention versus reality, and a creative way of illustrating the disconnect.  Note Paul's comment response, very insightful.

What They Say versus What They Do