Experts

How are your kids handling the stress of heading back to school?

Understanding our kids’ physical health is one thing. Tuning in to their emotions can be quite another.

According to the National Institute of Mental Health, the number of children with a diagnosable anxiety disorder is now up to a staggering 25 percent. As we’re now a few weeks into a brand new school year, this might be a good time to pause and check in on the anxiety levels of the kids in our lives.

In this episode of Total Health Radio, we explore key questions around anxiety in children. In what way do symptoms of anxiety look different in a child than in an adult? How do we differentiate between a high level of stress and something more serious? How do we help our kids identify triggers? And importantly, we look at how we can best help our kids by becoming aware of – and getting a handle on – our own anxieties.

What Does Environmentally Sustainable Health Care Look Like?

It’s all you’ve ever wanted to know about the greening of health care!  In our earlier post, we told you about the recent publication of the book, Greening Health Care, by Kaiser Permanente’s Kathy Gerwig.  Today, we begin a series of excerpts from the book — and we start with an introduction and overview from the preface.

The very nature of health care is changing. Health care reform, clinical innovations, electronic medical records, social connectivity, technological advances, baby boomers’ expectations about quality of life, demands for price to align with value, and ways the environment contributes to disease are some of the factors behind the changes. These changes offer profound, new opportunities to address environmental issues across the health care sector and beyond.image

In this changing landscape, what does environmentally sustainable health care look like? Let’s take an imaginary visit to a hospital for a routine doctor visit. Approaching the medical facility, the first thing we notice is that the building is smaller than we expected. There is a convenient transit stop at the front entrance. And the parking lot pavement allows rainwater to filter through to be cleaned and returned to the aquifer. We notice that instead of lawns there are native plantings that minimize water and pesticide use.

There is a garden path that takes us by a stream that was brought back to life from where it was hidden in a concrete culvert decades ago. We enjoy the birds that have rediscovered this tranquil place. You notice a labyrinth and take a meditative respite.

Once inside, we’re walking on nonvinyl, nonpolluting material on the carpets and floors, and we notice how much natural light floods into the lobby and hallways from specially designed window glass, shades, and blinds that allow sunlight in while minimizing afternoon heat. The walls are painted in soothing colors and patterns that mimic the adjoining landscape. The energy efficient lighting fixtures glow with a pleasing hue. You see a plaque on the wall indicating that the building is carbon-neutral.

In the bathroom, the toilets and sinks are water-conserving, and the soap does not contain harmful anti-bacterial agents. The paper towels are made from 100 percent recycled, post- consumer waste, and the used towels go into a compost container. In the waiting room, the fabric on the chairs was selected to avoid harmful chemicals that can cause adverse health effects.

In the exam room, your temperature and blood pressure are taken with mercury-free devices. You notice the purple exam gloves used by the clinical staff. These are latex-safe for worker and patient safety, and they are environmentally preferable.

If you are here for a biopsy, your doctor will use a rigid endoscope (for minimally invasive surgery) which is steam sterilized to avoid the use of chemicals that are hazardous to the environment and to staff. Read More

Caffeine and Kids: What’s the Buzz?

As your kids head back to school, you may notice that they — and many of their friends — seem to be weighed down with nearly as many commitments as adults. How they manage that level of responsibility is worth considering. With the rise of coffee house culture, the popularity of soda, and the explosion of energy drinks on the market, the amount of caffeine consumed by teens and even younger children is on the rise.

If you are concerned about the caffeine habits of a child in your life, this episode of Total Health Radio can help. In it, Kaiser Permanente’s Michael Nelson, MD, shares the symptoms that signal your child might have a problem, as well as how to broach the topic — and what you can do to protect your child’s health.

Six Burning Questions Health Care Leaders Have about ACOs

ACO imageIf you ask health care leaders what they think about Accountable Care Organizations (ACOs), you won’t be short on answers, writes Samantha DuPont of the Kaiser Permanente Institute for Health Policy, in a recent article and video on the Institute website.

According to the Centers for Medicare and Medicaid Services, ACOs are formed by groups of doctors, hospitals, and other health care providers, coming together to provide coordinated high quality care to their patients.

Early ACOs have had mixed success, and in light of emerging research questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

DuPont chronicles the six themes that emerged from the Institute’s work in asking leaders from across the nation their burning questions about ACOs:

1. What do ACOs look like today?

2. What factors will lead to ACO success?

2. Are current financial incentives strong enough to change provider behavior?

4. Will ACOs integrate with other types of caregivers?

5. Will ACOs successfully engage their patients?

6. What metrics will effectively measure quality?

Informing the Next Generation of Accountable Care Organizations

Some of the biggest buzz in health reform lies in the potential that Accountable Care Organizations (ACOs) have to help to reduce costs, improve care, and move away from fee-for-service to population-based payment.   But questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

Joy Lewis, MSW, MPH, of the Kaiser Permanente Institute for Health Policy, attended a July 13th convening in Washington D.C., hosted by the National Health Policy Forum, that highlighted some of the successes and challenges of early ACOs.

Kaiser Permanente has been supportive of this movement since the concept was first introduced in 2009.  While not technically an ACO, many elements of our care system – such as use of electronic health records, team-based care, and population management tools – ideally will be a part of ACOs.

Read the Kaiser Permanente Institute for Health Policy Observation describing Lewis’ highlights of the meeting, which include tactics for improving quality, increasing savings and overcoming the fee-for-service chassis.

Advice for New Moms’ First Hours, Days and Weeks Following Childbirth

After the BirthTotal Health Radio has had straight talk about pregnancy and truth telling about childbirth.  But what about those first days and weeks after giving birth?  In this episode, we focus less on the baby and more on the changes you are going through during that time – what’s normal, what’s not, and what may surprise you.  Packed with tips for making new moms more comfortable and advice on how spouses and partners can best provide support, this show is valuable listening for expectant parents – and the people who love them.

For more information on this episode and for links to additional resources every new mom should have at her fingertips, check out the Total Health Radio website.

Walking the Talk: Despite Challenges of Implementation, Exercise as a Vital Sign Initiative is Thriving

EVS_Blog2_doc_patientIt is well known that 30 minutes of moderate physical activity, five days a week, can over the long haul minimize the effects of many chronic diseases. Kaiser Permanente has made it a goal to ask all patients their exercise information – How many minutes per day? How many days per week? – in an effort to help them become more active and therefore more healthy.

This initiative is called Exercise as a Vital Sign, and while it may seem simple for all medical assistants and primary care providers to ask their patients those two questions and record the data in the electronic health record, it is more complex than that. Even now, five years since the first members were being questioned, EVS continues to be a work in progress

Read Dr. Latifat Apatira’s article, the second of a seven-part series, about how enthusiasm for the project remains high, despite the challenges. Learn from experts why Exercise as a Vital Sign is at the heart of Kaiser Permanente’s Total Health strategic vision, where Total Health is defined as a state of physical, mental, and social well being.

Gluten and You

Have you made the change to gluten-free eating? If so, you are not alone. The topic seems to be everywhere these days. And yet amid all of the press coverage and chatter around gluten, recent surveys indicate that many people aren’t sure what gluten actually is.

To help people understand what it is as well as the effect it can have on some — but not all — people’s bodies, ABC News Chief Health/Medical Editor, Dr. Richard Besser, dedicated his Tweetchat last week entirely to gluten. Kaiser Permanente registered dietician Kimi McAdam, RD, was one of the experts available to answer questions during the chat. We’ve included highlights from the conversation in the Storify below.

Weighing in on the Impact of Obesity Interventions

Measuring obesity in an individual person is relatively simple: get out the tape measure, step on the scale, calculate body mass index.

Measuring the impact of interventions that aim to reduce rates of obesity? Not so easy.

For all the attention directed toward combating the obesity epidemic in the United States, policymakers, researchers, advocates, and public health practitioners struggle to develop and agree upon measures that indicate whether a particular intervention is working, and even more, whether it is scalable and generalizable.

Compounding this issue is that different stakeholders have different evidence needs. Some are not convinced that an intervention is working unless they see rigorous data collected from a randomized controlled trial – considered to be the “gold standard.” Others may set the bar lower, knowing that we may never get perfect evidence, because obesity prevention involves a complex web of social, economic, environmental and behavioral factors.

These were some of the issues raised in a session at AcademyHealth’s 2014 National Health Policy Conference titled, “Obesity Prevention: How Much Evidence Do We Need to Act?”

In this session, a diverse set of stakeholders – Jeff Levi, Executive Director, Trust for America’s Health; Bill Hoagland, Senior Vice President, Bipartisan Policy Center; Linda Belheimer, Assistant Director of Health and Human Resources, Congressional Budget Office; and Shiriki Kumanyika, Professor, University of Pennsylvania Perelman School of Medicine –– discussed the myriad of issues surrounding obesity prevention measurement, and offered some clear steps for moving forward.

“There was strong agreement that the obesity epidemic is real and that we need to be thinking about how to address it,” said panel moderator Murray Ross, vice president, Kaiser Permanente, and director, Institute for Health Policy. “”It will have–and is already having–major implications for Americans’ health and America’s health care spending.”

In this short clip, Ross gives us the highlights of this important and timely conversation.

Note: Panelist Linda Bilheimer’s comments are not included in this video, but you can view her full presentation slides online.

How Community-Clinic Integration is Boosting Population Health — Part 2

When community organizations collaborate, change happens. Earmarked as one of the next frontiers in public health, community-clinic integration strengthens the health of populations through inclusion, collaboration, and commitment.

Earlier this week, we brought you the first installment of a two-part interview between Kaiser Permanente leaders about the need for community-clinic integration. In this post, Holly Potter, vice president of Brand Communication for Kaiser Permanente, continues her conversation with Loel Solomon, vice president of Community Health for  and Jandel Allen-Davis, MD, vice president of Government and External Relations for Kaiser Permanente Colorado about the creation – and the successes – of community initiative-turned-nonprofit, LiveWell Colorado.

HP: In Colorado, LiveWell has been very successful. Can you talk about that work and what has been achieved?

Jandel: Our work with LiveWell Colorado often makes me think of that Margaret Mead quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” This is a program that was started in Kaiser Permanente and in order to scale it, we invited other funders to work with us to take this program to the entire community. The Colorado Health Foundation and The Colorado Department of Public Health and Environment and Kaiser Permanente are the founding funders of the organization.

One essential element of LiveWell programming is that we work with a diverse group of community members to decide on approaches to address the issue of obesity through deployment of healthy eating and active living assets. The outcome of using community based assets to eliminate or reduce obesity is that the community is deeply invested in the results, and we build tremendous capacity in its members.

Loel: A relevant proverb in this case says, “If you want to go fast, go alone. If you want to go far, go together.” In Colorado, Kaiser Permanente wanted to do a place-based initiative. The Colorado Health Foundation wanted to do something similar, and we realized that by combining our forces, we could create much more impact. Now, LiveWell has gone from three communities to 23 communities, some of which have been doing this change work for nearly eight years.

There’s an infrastructure for technical assistance and evaluation that serve all these communities, and there are these state-level policy changes that we’ve been able to generate because all of these communities are creating the public will to have healthy school breakfasts, active transportation, and other things. It’s been powerful.

HP: When you spoke of lowering barriers to food assistance and now with the work with LiveWell, you are addressing policy and systems change that address health behaviors. Why is that so important?

Loel: Policy has a huge influence on the choices people have. It influences their opportunities, and the biggest way we can impact people’s health right now is to create a policy and environmental changes that help make the healthy choice the easy choice. Whether we’re talking about policies and practices about smoking in the workplace, or we’re talking about school lunches and access to PE, or people’s ability to access food stamps, the decisions that elected officials make and the private policies that organizations adopt have such a huge impact on health.

Jandel: We need to recognize that there are no silver bullets available to solve these deeply rooted health and social issues. Addressing these will require multi-pronged approaches. Simply providing food for those who are food insecure may not solve the long-term problem, which is the reason that people don’t have food in the first place. It’s a really interesting choreography of many actions that hopefully begin to affect change on a large scale.

HP: This is the Center for Total Health blog and I know Total Health is central to what drives each of you. How does the concept of Total Health influence your work?

Loel: The way I often think about Total Health is that it requires us to identify and act on the levers of health that exist both inside and outside the walls of Kaiser Permanente. We are focusing on not only what we do as a delivery system, but also what we can influence outside our clinic walls – where our members spend most of their time. To the extent that we can, we work with community partners to address violence and access to healthy food; leverage our workforce to volunteer in schools; and our clinicians to advocate for healthy school lunches. That’s seizing the levers of health. Doing that is necessary to improve the health of the populations we serve.

Jandel: Total Health embraces the notion that Kaiser Permanente plays many of the positions that are important in addressing health. In addition to the care delivery system, we influence many of the upstream inputs related to health and wellness that solve longer-term problems. It differentiates us. If we continue this work, I think we’re unstoppable.

HP: Thank you both for your time.

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