Associated Press | HealthyCal - Part 5
 

Associated Press

  

Incentives paying off for non-profit practices

Published: April 18, 2013 | No Comments

Leslie Conner, executive director of the Santa Cruz Women's Health Center, said the physician incentive program through the Central California Alliance for Health benefits her clinic both financially and clinically through data and assistance the Alliance is providing and collaboration with other providers. Photo: Lynn Graebner/California Health Report

By Lynn Graebner
California Health Report

Just a few years ago, pay-for-performance incentives for doctors were promoted as the next new solution to rising health care costs. Today, it’s clear they aren’t living up to expectations. For the most part, in the U.S. and in other countries, they’re not saving much money or significantly improving care. But one program serving three California counties might have found a way to make pay-for-performance pay off.

Many doctors contracting with non-profit health plan Central California Alliance for Health, with members in Santa Cruz, Merced and Monterey counties, suggest that the program is working.

The health plan’s pay for performance program offers significant financial incentives to practices, many of which are non-profit community clinics or county clinics. And the patient data and support Alliance is giving doctors helps them make changes in their practices.

Alliance’s program, called the Care Based Incentive, distributes bonuses based on a comparison among primary care practices. Practices serving Alliance’s members get quarterly profiles that show how well they are doing compared to each other and they are rewarded accordingly.

“It’s intelligently designed,” said Caroline Kennedy, Medical Director for the Monterey County Health Department Clinic Services Bureau. “You have to be better than everyone else.”

Physicians get more money for efforts such as minimizing preventable hospital and emergency room admissions, submitting claims electronically, and extending office hours. Alliance also gives financial bonuses to both physician practices and patients for steps they take to maintain health, such as creating asthma, weight and medication management plans and for getting more patients to do routine screenings for diseases like cervical cancer and diabetes.

Meeting measures like reducing ER visits is important to Alliance, since 85 percent of its 210,000 members in Santa Cruz, Monterey and Merced counties receive Medi-Cal. And it’s often lower income residents who end up in emergency rooms for basic medical care.

Because many Alliance providers are non-profit community clinics and county clinics, the bonuses have a big impact on them, sometimes totaling 10 to 15 percent of Alliance’s payments to them, said Dr. Richard Helmer, Alliance’s chief medical officer. Alliance allocated $8.4 million for the program in 2012.

“It’s not insignificant,” said Leslie Conner, Executive Director of the Santa Cruz Women’s Health Center, a nonprofit community-based clinic. Doctors there aren’t earning incentives individually, but some of the money is rolling into staff salaries and has helped fund two additional case managers and improvements to the electronic health records system, Conner said.

Some clinics are receiving $200,000 annually, Kennedy said. The incentives have become an important part of her department’s budget.

While the money is helpful, some clinics say the data generated is just as valuable. Conner’s and other safety net clinics meet quarterly to analyze the report cards they get to see who is doing well and why. One clinic, for instance, had good scores for immunizations. The reason: they take walk-ins, Conner said.

The incentives include a number of strategies for reducing preventable emergency room visits such as an asthma action plan drafted by the physician and patient. Patients track their asthma with a breathing device at home and the plan helps them dose their medication according to their lung capacity and directs them when to call the doctor to prevent an emergency.

From 2011 to 2012 asthma-related emergency department visits for Alliance patients dropped almost six percent, Helmer said.

Diabetes is another area of concentration. If a diabetic patient gets four screenings annually for hemoglobin, cholesterol, eye health, and nephropathy, the patient receives $50 and the physician gets $100.

Dr. David Simenson, a family practice doctor with Golden Valley Health Centers in Merced, said he personally and his organization are very much in favor of Alliance’s incentive program. However, he sees very few of his diabetic patients taking advantage of the incentives. He would love to see them used more.

Still, some physicians take issue with being penalized for patient behavior they feel they have little control over.

Dr. Donaldo Hernandez, a hospitalist for Palo Alto Medical Foundation, doesn’t receive Alliance’s Care Based Incentives because he’s not a primary care physician, but he takes care of Alliance members in the hospital.

Alliance has the challenge of a patient population with a lack of resources, and sometimes a lack of a support system, he said. If they get in trouble healthwise and there’s no one at home to look out for them, they end up in the ER and the doctor gets blamed, Hernandez said. It’s difficult to measure and incentivize the effort a doctor puts into those cases, he said.

One Santa Cruz County primary care physician contracting with Alliance says diabetes, high blood pressure, high cholesterol and obesity are illnesses that need to be addressed on a national public health level directed at dietary and lifestyle changes.

“A lot of this is beyond the control of the doctors on the front line,” he said, asking not to be named while criticizing the health care plan that pays him.

Because doctors in his office take care of their patients in the hospital if needed, they tend to have some of the sicker Alliance patients, he said. Other offices depend on hospitalists to do that. But there are no incentives in the program to take on those sicker patients, he said.

Dr. Robert Berenson, a fellow with the Urban Institute, a Washington D.C.-based non-profit policy research organization, agrees that many of these incentive programs don’t encourage doctors to take chances with sicker patients or to report adverse effects in medicine.

“Internationally, pay for performance hasn’t proved to be a terribly successful approach,” he said. But he likes the idea of strategies like Alliance’s asthma action plans and other preventative measures. And he said the success of an incentive program depends heavily on doctor buy-in.

Despite the growing number of pay-for-performance programs for primary care physicians in a number of countries, there is “little rigorous evidence” of their success in increasing health-care quality and decreasing health-care expense and more research needs to be done, the Cochrane Collaboration reported in 2011.

But hope is still alive that rewarding performance rather than volume of care can improve care and reduce costs. Even the Centers for Medicare & Medicaid Services rolled out its version of a pay-for-performance program planning to allocate $850 million in 2013 to hospitals if they can improve clinical processes and patient satisfaction.

If those programs are similar to the one Alliance has put in place, they might succeed. The health plan routinely wins first and second place in the California Department of Health Care Services Medi-Cal Managed Care Quality Awards. Last year it received the silver award out of a pool of more than two dozen health plans.

But the quest for quality is a journey, not a destination, Helmer said.

“The really great organizations like Southwest Airlines and Toyota are always saying we can do a better job. That’s the way the health-care industry should be.”

 

Faith-based organizations help step up ACA enrollment efforts

Published: April 17, 2013 | No Comments

Adelaida Macias signs her Medi-Cal insurance application as OneLA volunteer Marissa Gallegos looks on at a recent church-based enrollment fair. Photo: Chris Richard/California Health Report

By Chris Richard
California Health Report

By the time national health-care reform takes effect next year, Los Angeles County health officials expect to enroll 300,000 people in an expanded Medi-Cal program.

But some estimates put the number of people eligible for the low-income insurance coverage countywide at more than half a million.

To help make up the difference, a coalition of churches, synagogues and nonprofits has launched an enrollment drive that invites people to sign up at the neighborhood church.

“Depending on the policy decision at the state and county level, [health-care reform] can merely be an exchange that provides more insurance and still leaves a million or so people out, or there can really be an aim to provide health-care coverage for everybody in LA county,” said Tom Holler, executive director and lead organizer at OneLA.

“And that was the decision the OneLA leaders made, to make sure the enrollment is done in a way that eventually provides insurance for everybody.”

Los Angeles County’s Medi-Cal expansion, Healthy Way LA, provides free primary and specialty care, mental health services, chronic disease management, medication and emergency treatment.

Enrollment is open to citizens or permanent legal residents between the ages of 19 and 64 who earn less than 133 percent of the federal poverty benchmark. That’s about $14,500 for an individual and $29,700 for a family of four.

Lambreni Waddell, who organizes OneLA’s church recruitment events, said working through relationships in a congregation makes it easier to correct widespread ignorance about the program.

“Our strategy is actually going to the people who are not yet at the point of needing health-care coverage,” she said.

“It’s meeting them when they’re healthy, when they’re bringing their kids to confirmation class, and saying, ‘Hey, why not begin now learning what your options are? Let’s get you connected now.’”

At an enrollment fair Sunday at St. Agnes Church south of downtown Los Angeles, Adelaida Macias, 59, brought a thick sheaf of documents, including her United States citizenship naturalization certificate. A volunteer from OneLa took about half an hour to help her complete her Medi-Cal enrollment forms.

“I’ve been worrying a lot,” Macias said, explaining that she suffers from severe bronchitis and arthritic knees. “So when I heard at Mass about this event, I signed up right away.”

Until now, only Los Angeles County health department employees or professional enrollment agents employed by county-authorized community clinics could enter new people into the county’s Healthy Way LA database, said Katie Murphy, supervising attorney at Neighborhood Legal Services of Los Angeles County.

“This project is the first time that community leaders are being trained to help people in their own communities,” Murphy said. “So it’s really about building capacity.”

Waddell said some 15 churches and other organizations will hold enrollment events in coming months, hoping to begin the insurance qualification process for several thousand people.

Amy Luftig-Viste, director of the county health services department’s community partner program, noted that one problem with enrolling people exclusively within the clinic setting is that by definition, that means signing people up once they are already sick.

“Part of what we are trying to do here is help people get their health coverage (and understand it) well before they need it,” Luftig-Viste wrote in an email.

Neighborhood Legal Services already trains county and community clinic staff to help people with the insurance signup process. OneLA’s enroller training is based upon the same instruction, Murphy said. Volunteers learn the range of public insurance programs, what documentation is required for each program and how to enter applicants into the county’s online enrollment system. They also sign the same confidentiality agreements required of professional staff.

Brother Lucio Cruz, whose Mary Immaculate Catholic Church in Pacoima hosted the first enrollment event in early March, said parishioners clearly are more comfortable completing the insurance documents with the help of OneLA volunteers they already know in his congregation.

“When it comes to a church where they go for Mass, people come because they trust,” he said. “They come because they know this is a safe place. And it’s the same for this program.”

Ellen Israel, who chairs the social justice committee at Temple Judea, a Tarzana synagogue and OneLA member, thinks the local effort could offer a broader model.

“We really look at Los Angeles as being ground zero for all of this health care reform,” she said. “We have such a big population and so many uninsured individuals that this is a good place to do a pilot. We’ll see. We’ll see. But it looks to me like it’s going to be successful.”

Luftig-Viste, the county health official, said county officials plan their own variation on the OneLA model, training about 200 certified application assisters to help people complete applications at centers of community throughout the county. These agents are more familiar with the application procedures than is the typical volunteer and should be able to complete application materials more easily, Luftig-Viste said.

Even as OneLA presses for broader enrollment, Holler said, the organization’s leaders are concerned that Gov. Jerry Brown has yet to sign state legislation enabling the full Medi-Cal expansion once national healthcare reform takes effect.

At first, the federal government will cover nearly the entire program cost as part of the Affordable Care Act. Starting in 2017, California would be required to pay a maximum 10 percent of care costs, as well as half the program’s administrative expenses. By 2020, the state would pay about $600 million in exchange for a health care package valued at $6 billion.

Holler said he’s confident Brown will eventually come to an agreement with local officials throughout the state on paying California’s share. But if discussions extend into May, that could cause interruptions in health coverage for people already enrolled in Medi-Cal transitional programs, he said.

“For the bureaucrats, that may be OK,” Holler said. “But if you’ve got a disease and you’ve got to go to the hospital, that’s not OK.”

He said OneLA leaders are discussing a coordinated series of sermons this month on the need for a speedy resolution to the impasse.

 

Special court helps veterans with addictions

Published: April 15, 2013 | No Comments

San Mateo County Superior Court Judge John Grandsaert started Northern California’s newest veteran’s treatment court last July. Photo: Callie Shanafelt/California Health Report

By Callie Shanafelt
California Health Report

San Mateo County’s Veteran’s Treatment Court looks like a typical criminal courtroom on a recent morning. Three men in orange jumpsuits sit in a holding area in the front near two bailiffs as the session begins. A row of lawyers and court staff, all wearing business suits, has case files at the ready. At the back of the room, social workers and defendants sit in army green and gray theater-style seats.

But what happens at Veteran’s Treatment Court is anything but typical. Modeled on drug treatment courts, this court provides extra support and treatment opportunities for military veterans.

San Mateo Judge John Grandsaert started Northern California’s newest veteran’s treatment court last July.
First, he had to convince the county that the court would not mean an additional hit to the county budget. In the past five years, California trial courts have lost nearly one billion dollars to budget cuts – an unprecedented amount. San Mateo Court has cut its total staff by 30 percent, even as caseloads increased after reforms to the state prison system.

“It’s not a good environment for starting new courts in light of the terrible budget squeeze that we’re under,” Grandsaert said.

But he was able to create the Veteran’s Treatment Court by limiting admission to the program and tapping into the resources of veteran support networks.

Judge Grandsaert sits behind a raised corner desk framed by the U.S. and California flags when court is in session. The state seal hangs above his head. He speaks in a soothing and encouraging tone to each veteran that comes before him—reminiscent of how a supportive father would speak to his son.

In fact, Grandsaert has a particular passion for veterans because his own son is in the Air Force and he spent 17 years in the Army reserve. He thinks vets deserve special treatment in the criminal justice system.

“Veterans have already sacrificed part of their life in service to their country,” Grandsaert said.

There are more than 23 million vets in the United States, according to the Veteran’s Administration. The VA also estimates that one third of the homeless population has served in the military. Vets aren’t more likely to be arrested, but those who are in the criminal justice system are more likely to have problems with addiction.

Vets in the San Mateo Court have already been convicted of a crime. They usually end up on Grandsaert’s radar because of a probation violation or referral. Defendants agree to be closely monitored during probation. In exchange, they get extra support and opportunities through the court. If they successfully complete the program, Grandsaert expunges their record and forgives their fines.

He estimates it will take vets 18 months to three years to go through the program. If they don’t progress with their treatment, they can be removed.

Halfway through the April proceedings, Clarence Young is called before Judge Grandsaert. He is a stout man with silver highlights in his beard, with his t-shirt tucked neatly into navy blue work-pants.

Grandsaert announces that he’s heard Young is a star at the shelter where he lives.

“I’m doing well, keeping busy,” Young tells Grandsaert.

“You’re being modest,” replies Grandsaert.

Young approaches the bench with a folder of paperwork. He shows Grandsaert a to-do list with twenty items, all of which have been checked off.

Grandsaert gives Young a Target gift card to reward his progress, and says he has advanced to the stage where he only has to report in every couple months.

Other courtroom participants applaud and smile.

About twenty vets, all men, are currently on the vet court docket. Most of them come before Judge Grandsaert once a month to report their progress. About half of the people who came before him in April were petitioning to be included in the court.

Grandsaert asks them each if they feel confident that they could complete the program.

Grandsaert has limited participation to San Mateo vets who can show that their substance abuse or mental health issues are related to their service. They also have to qualify for Veteran’s Administration benefits.

Grandsaert estimates that about half of the vets in his court are from the Vietnam era and half are from the Gulf wars. Combat service is not required to be eligible for vet court.

Grandsaert also created a volunteer mentor program where each defendant is paired with a mentor to keep tabs on them to better provide intensive support to the vets in his court and to keep the court sustainable.

He asked Derrick Felton, a team leader at the Peninsula Vet Center, to set up the program.

“It’s unpaid, it’s gonna be terribly annoying for these guys, they’re gonna be called at all hours of the day or night,” Grandsaert remembers saying.

But Felton jumped at the chance to organize it.

Tim Healy, a mentor at the nearby Veteran’s Treatment Court in Santa Clara County, has been one of three San Mateo mentors since the court started.

Healy understands what these guys are going through. “I am a two-strike convict,” he explained.

He was an air crewman in the Navy from 1986 to 1990. He developed a meth habit after his discharge, which led to his criminal offenses.

He was facing his third strike in Fresno County when he came before a sympathetic judge. He decided to have Healy evaluated for the Homeless Vet Rehab Program in Menlo Park.

“The judge told me out loud in court, ‘Mr. Healy, I’m going to do everything in my power to send you to this program’,” Healy said. “At that time I’d kind of given up.”

Healy was released from jail for 12 hours to go to Menlo Park for evaluation. Afterwards, he had to turn himself in.

“It was probably one of the hardest things I’ve ever done,” Healy said.

But he was approved to go into the treatment program instead of prison and began his road to recovery. He’s been sober for four years and works as a case manager with homeless veterans, most of who have criminal backgrounds.

“If I didn’t get a deferment, I would still be in prison,” Healy said.

He wanted to volunteer for the Veteran’s Treatment Court because he knew what a difference it can make when someone believes in you.

“I’ll tell my clients they may not believe they can change but lean on me cause I believe they can,” Healy said.

Healy points out that by joining the Veteran’s Treatment Court, vets are actually consenting to more restrictions.

“The majority of my clients are very compliant—they have that military background,” Healy said.

He checks in with everyone at least once a week but sometimes he gets a call at odd hours from someone in crisis.

Healy is also going to school to get his drug and alcohol counselor certification. He said it takes those skills as well as his personal experience with addiction to get through to these guys.

“If guys look like they’re slipping, I’ll call them on their garbage,” Healy said.

He feels proud when his mentees succeed and blames himself when someone ends up back in custody. He’s developed lasting friendships with some of them.

Judge Grandsaert was surprised at how grateful the vets who come through the court are for this opportunity.

“I think they’re surprised that their service has entitled them to this kind of support, attention and treatment,” Grandsaert said. “They are proud once again of their military service, because of what it is doing for them in this court.”

 

The Vibrant Brain: A User’s Guide

Published: April 14, 2013 | 1 Comment

By Matt Perry
California Health Report

Three recent stories about brain health and dementia spotlight a frequent conundrum in the world of health: sometimes pills just don’t have the answers.

In an eye-opening March report, the Alzheimer’s Association claimed that one in three adults over 65 will die while suffering from dementia – Alzheimer’s Disease in its most pernicious form. (The report does not say older adults will die from the effects of dementia – only that they will have some form of dementia when they die.)

Another study, by the RAND Corporation, tallied the annual costs of dementia at between $157 billion and $215 billion – more than heart disease or cancer.

The FDA also recently announced it wanted to simplify approvals for drugs that attack the earliest stages of Alzheimer’s, hoping to slow progression of the insidious disease that affects mental clarity and physical agility.

So it’s no wonder that the burning question for Americans in middle age and older is this: How do I avoid Alzheimer’s and other forms of dementia?

I recently asked several aging experts what they recommend to others – and what they do themselves – to mitigate the possible effects of dementia.

While the answer doesn’t come in a pill, it’s still quite simple.

Keep moving.

Not just physically, but in every part of your life: socially, intellectually, and emotionally. Study French. Take a yoga class. Read a self-improvement book. Spend time with your friends. Learn an instrument. Push yourself. Change directions. Grow.

As a single unit, the body and brain function together, so keeping the body in tiptop condition is crucial to brain health, experts say.

Fine-tuning the blood vessels to minimize disorders related to vascular health – diabetes, high cholesterol, and high blood pressure – is critical to brain health, says Margaret Gatz, who chairs USC’s department of psychology.

Injuries due to falls – especially head trauma – should particularly be avoided, says Dr. George Martin, former head of the University of Washington Alzheimer’s Disease Research Center.

Exercise

“Physical exercise is by far the most important risk-lowering activity, for many reasons” says Judith Horstman, author of last year’s “The Scientific American Healthy Aging Brain.” Chief among these reasons, she says, is that heart health is “tightly connected to brain health. What’s good for the heart is good for the brain.

Others agree that exercise can slow the progression of dementia – some citing in particular long-time runners.

“They seem to remember that they were faster than they actually were,” jokes Adam Chase, trail and gear editor for Running Times magazine. “But otherwise I’d say no, I can’t think of any cases of dementia or Alzheimer’s in my older running friends.”

The modern enemy of exercise? The computer screen.

Michael Merzenich, a pioneer in brain plasticity research, says not only should we be exercising, but avoiding the computer screen or anything else that keeps us physically inert.

“Avoid technology that does your thinking for you.”

Diet

Experts also recommend eating a healthy diet: hearty portions of fruits and vegetables, increasing healthy fats – fish, avocados, and nuts – while reducing animal fats and salt.

Like many, Michelle Johnston, regional director of the Alzheimer’s Association
northern California and northern Nevada chapters, follow the Mediterranean diet, which emphasizes plant-based meals flavored by herbs instead of salt, olive oil over butter, and red meat eaten only sparingly.

In “The Alzheimer’s Prevention Cookbook” – a heady mix of colorful recipes and easily-digested science – Dr. Marwan Sabbagh cites the critical role of diet in India’s surprisingly low rates of Alzheimer’s.

The secret ingredient: curcumin, found in the spice turmeric, which gives Indian curry its yellow tinge.

“Eating spicy Indian curry once or twice a week could help prevent the onset of Alzheimer’s disease and dementia,” states Sabbagh.

Socialization

Scientific studies have shown that loneliness and social isolation can increase the risk of physical and mental illness ranging from depression to hypertension and diabetes.

“I like to say that ‘the brain loves company,’ and that (people) who stay socially- engaged may get Alzheimer’s later in life,” says David Troxel, pioneer of the Best Friends Approach to Alzheimer’s.

Brain Fitness

Equally important as good company is exercising the brain itself.

But how?

“Some skeptics would argue that doing crossword puzzles will make you good at doing crossword puzzles, but will not guarantee advances in other cognitive domains,” says Martin.

Merzenich, founder of San Francisco-based brain fitness giant PositScience, says the difference between games and exercises is simple.

True exercises “drive brains in corrective directions,” says Merzenich, while simple brain games don’t.

Natural Approaches

“Medicine Hunter” Chris Kilham, who has studied traditional medicines in over 30 countries, takes a strictly natural approach.

“To reduce risk of dementia, I drink plenty of clean organic coffee, which demonstrates very high activity in reducing risk of all forms of dementia, Alzheimer’s and Parkinson’s,” says Kilham, a frequent guest on the Dr. Oz show.

Besides meditation and yoga, Kilham also takes a variety of what he calls “brain-active herbs” including Rhodiola rosea, curcurmin, schisandra berry, eleuthero and panax ginseng.

Engaged

In summary, Merzenich says that the brain flourishes the same way as any person.

“Because of the way that it is – or is not – engaged in life.”

 

Food trucks keep it local and healthy in Fresno

Published: April 11, 2013 | No Comments

By Diana Hallare
California Health Report

By the historical Water Tower in downtown Fresno, four colorful food trucks lined up along with two netted food booths to sell fresh gourmet food, from fruit cobbler to tamales. Unlike Los Angeles or San Francisco, Fresno isn’t known as a foodie haven, but that may be changing. Hundreds of people flock to the Friday food truck event, called CArt Hop because art is on display too. And that’s just one way that a new generation of food trucks are emphasizing fresh, local and health foods in the Central Valley city.

A nonprofit organization, Creative Fresno, is in charge of CArt Hop, which started last year with a focus on using food local to the San Joaquin Valley. The project coordinator, H. Steele, says that among the criteria for all food vendors at the event is to use locally grown ingredients and innovativeness.

Dustin Stewart, co-owner and chef of Dusty Buns Bistro, thought up the idea – a Central Valley version of Matt Cohen’s Off the Grid in San Francisco.

“There is a capacity to have just as many types or ethnicities of food trucks as any other city because of what the Valley grows and produces locally,” Stewart said.

Launched in 2010, Dusty Buns Bistro earned a reputation as Fresno’s first gourmet food truck, serving and advocating for dishes made from scratch with fresh, organic products. Their business won the tenth place in a national food truck contest in 2011. Today, they also have a restaurant downtown.

The Stewarts are known regulars of farmers’ markets, including the Vineyard Farmers Market in Fresno. Local sources of their ingredients include Green Jeans Ranch, which raises free-range chickens, and Marian Farms, a Community Supported Agriculture Biodynamic farm and distillery with practices such as composting, soils restoration via cover or seasonal cropping, and seed saving. The Dusty Buns website lists several other local organic farms from where their food is derived.

Community Supported Agriculture is a movement that has become popular throughout California and had gained a following in the San Joaquin Valley over the last decade.

When locals turn to of Community Supported Agriculture, people grow better relationships with food producers and widen the variety of their diets, said Tom Willey, owner of T&D Willey Farms in Madera, which began in the 1980s.

In this system, members subscribe for boxes of produce to be delivered to them at fixed monthly or yearly price rates. So far, T&D Willey Farms has more than 800 members. The CSA also helps to support the farm’s 62 employees and their families.

According to Dr. Sajeemas Pasakdee, the adviser of California State University Fresno’s Student Operated Organic Farm, eating local and organic is beneficial to community health. Not only are health and environmental risks reduced due to the avoidance of pesticides, for instance, but it also provides awareness to consumers about the origins of their food and a sense of unity.

The university’s organic farm used to supply goods to the university dining services, which now has an extension, a kitchen-on-wheels called Bulldog Bites.

“We are the second campus in the CSU to have branded its own mobile food truck,” said Megan Sarantos, the food truck’s manager.

Healthy food may be a growing trend, but all mobile vendors aren’t on board with the change yet – and neither are all consumers. For example, healthy choices are on the Bulldog Bites menu, but are often not as popular as the others, Sarantos said.

Genoveva Islas-Hooker, Regional Program Director of the Central California Regional Obesity Prevention Program, still lauds the efforts of CArt Hop, particularly in their use of local produce and support of local enterprise.

Yet Islas-Hooker also hopes for more healthy food at affordable prices and increased food access in “areas with limited food options.”

A solution, in the form of a mobile teaching kitchen, may arrive soon. Clarene White, a personal chef, entrepreneur, and certified instructor, is the organizer of this new venture called Cook’n Up Mobile Teaching Kitchen and Theater, part of her Food for Your Soul Ministries. One of the main services of this social enterprise would be not only to sell nutritious food but also to teach others about healthy cooking and eating within a small budget. In this way, White aims to join the fight against issues such as diabetes and hunger. For this cause, she has recently partnered with the Central California Regional Obesity Prevention Program.

She is excited about another feature of the kitchen too: a teppanyaki grill, often found at Japanese restaurants. Diverse meals would be created with fresh, local ingredients. The mobile kitchen route would include Central and South Fresno, which, she says is abundant in fast food, but limited in access to fresh products.

Among her target population are seniors, veterans, children and the homeless.

Innovation has played a major role in the growing popularity of food trucks and the eat-local trend. James Caples, the Benaddiction food truck owner at CArt Hop, accepts text messages for orders, and his menu items boast musically inspired names, such as the Clapton and Mr. Jones sandwiches. Dusty Buns Bistro makes lunch box deliveries to offices. White plans to add an entertainment component to her social enterprise.

A common goal for local food entrepreneurs is the exposure to more opportunities for themselves and others, from the food producers to the food truck customers. This may mean creating an environment friendly to health, economic sustainability, and collaboration.

“Food trucks may be in our future as a staple in the Central Valley, to represent our wealth and harvest,” Stewart said.

 

Futures At Risk: Preventing Children’s Exposure to Violence

Published: April 9, 2013 | No Comments

By Dr. Nadine Burke Harris and Esta Soler

Picture yourself walking through a forest. Now, imagine that you’ve come face to face with a large bear. Instantly, your emergency response system kicks into gear, flooding your body with stress hormones. Your pupils dilate, your heart starts beating fast, and your skin becomes cold and clammy. The executive, cognitive portion of your brain shuts off so you can focus only on two options—-fight or flight.

Your body’s emergency response system could save your life—-if a bear in the forest really is confronting you. But, what happens if that big bear is waiting for you when you get home every day? Or follows you as you walk down the street to the local store? Or threatens you in the schoolyard? In the face of such extreme and repeated danger, your emergency response can go from saving your life to damaging your health and well-being.

Around the country, this scenario is similar to the reality faced by millions of children who experience violence and trauma at home, in their schools, and in their communities. According to a report by the U.S. Attorney General’s Defending Childhood task force, our children are experiencing and witnessing violence on an alarming scale. The numbers are staggering. Approximately two out of every three children in the U.S. are exposed to violence.

The good news is that we now know a great deal about how to change the odds for children exposed to violence and trauma. But, to protect children across our country, we need to galvanize a broad, national movement to call for the solutions we know can work. In the absence of such an effort, many of our children will experience lifelong consequences from exposure to violence and the toxic stress it causes. With their brains and bodies still being formed, children are uniquely vulnerable to the impact of toxic stress on their physical, mental, and emotional health.

A major study by the Center for Disease Control found that childhood exposure to abuse and other traumatic stressors, termed Adverse Childhood Experiences (ACEs), led to a multitude of social and health problems. For example, adults who had been exposed to four or more categories of Adverse Childhood Experiences were more than twice as likely to develop chronic lung disease and more than four times as likely to develop depression. Subsequent research has shown that children with four or more categories of ACEs are 32 times more likely to have learning or behavioral problems in school than those who had none.

Violence can happen in any community and can take on many forms, from sexual and physical abuse to violence in homes or neighborhoods, including violence against friends, family members, trusted adults, or bystanders. Some children—-as many as one in ten-—may experience multiple layers of violence at the same time. These children in particular are at high risk of never developing the basic capacities they need to function normally and lead productive and successful lives as adults.

When the futures of millions of children are jeopardized, we all suffer. Our health care, social services, law enforcement, education, and other public systems bear the brunt of our failure to prevent this epidemic; and the costs are astronomical. A 2012 study by the CDC found that total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse, or neglect) is approximately $124 billion.

If we don’t intervene, it’s clear that we all pay the price when children are not successful in school, enter the juvenile justice system, or grow up to become perpetrators of violence themselves. Less recognized is the price we pay for the healthcare of millions of Americans whose heart disease, chronic lung disease, obesity or depression may have been prevented with early and effective care.

We have learned a great deal about how to prevent violence, and how to help children exposed to violence and trauma heal and thrive. The next step is to launch a state and national agenda to make homes, schools, and communities safer, more supportive, and healthier places for all of our children. We must not allow violence to deny any child the right to grow up safe and secure. Here’s what we can do:

- Start early by identifying kids who are exposed to violence through routine screenings, and establish prevention programs within the health care system, schools, and youth organizations to protect children from future violence.

- Focus our efforts on early childhood and early adolescence, critical stages when it comes to preventing violence. We can intervene then with those who already have experienced extensive and multiple traumas when there is the greatest opportunity for healing and positive development.

- Change public policies to support prevention and healing for children and families, using key policy shifts such as health care reform and laws designed to prevent violence against women and to help children who are victims of violence and abuse.

- Don’t spend money on things that don’t work—-such as punitive juvenile justice facilities—-and re-invest in programs that can help children heal and thrive. Instead of supporting zero-tolerance policies that drive troubled kids out of schools and away from safety, let’s keep kids in school and connected to safe and stable adults.

- Make violence a public issue, and educate all Americans about this problem and the role each of us can play to ensure that our children are safe.

Too often, the youngest victims go unseen and unheard. It is up to all of us—-from teachers to clergy, to coaches, to doctors, to parents—-to take the steps needed to effectively protect and heal children exposed to violence, giving them the web of support they need to grow up healthy, happy, and secure.

Dr. Nadine Burke Harris is the founding physician and former medical director of the CPMC Bayview Child Health Center, and CEO of the Center for Youth Wellness. Esta Soler is president of Futures Without Violence. They originally wrote this piece for the Rosenberg Foundation’s Justice in California publication.

 

Mothers battling insurers for breast pumps, despite new law

Published: April 9, 2013 | No Comments

Photo: Flickr/planet_oleary

By Hannah Guzik
California Health Report

When Adriana Stovall heard that the Affordable Care Act would require health insurance companies to provide nursing mothers with a breast pump beginning Jan. 1, she was elated.

Finally, the working mother would have access to an efficient pump, enabling her to provide more milk for her 11-month-old son.

Or so she thought.

Stovall is among a number of California nursing mothers who have had their requests for a breast pump denied by their insurance companies this year, despite the new law.

“They said that I wasn’t eligible for a pump because my son was almost 1 and he didn’t have a medical ailment, so it wasn’t necessary for him to receive breast milk, when formula was available,” the Ventura resident said. “That was very alarming to me.

“Breast milk has so many benefits to mother and child, and they’re just hindering the whole reason this act was put into place.”

The Affordable Care Act requires insurers to provide new mothers with a breast pump, but it doesn’t specify what kind of pump or how long after giving birth women can qualify. So, in the last three months, insurance companies have begun creating their own policies, with some providing high-end electric pumps to all women who ask and others offering only manual pumps to women in the first 30 days postpartum on a rental basis.

Stovall’s insurance provider, Kaiser Permanente, offers manual pumps only to women who have given birth in the last six months, and rents hospital-grade pumps to those with a medical need, the company said in a statement.

Peggy Hinz, spokeswoman for Kaiser’s Southern California region, declined to comment on specifics of Stovall’s request or the company’s policy.

“While we are prohibited from discussing the details of a specific patient, Kaiser Permanente follows all aspects of the Affordable Care Act including those pertaining to the coverage of preventative services,” she said in an email message. “This includes support for breast feeding equipment to our members.”

“Should a specific member have any concerns we encourage them to reach out to their OB/GYN or to member services at any time,” Hinz said.

The federal law is intended in part to expand health-care services for women and provide them with more preventative care and access to lactation support and supplies.

“Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children,” reads a fact sheet on the coverage from the federal Department of Health and Human Services. “One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.”

Difficulties obtaining a pump could cause some mothers to stop breastfeeding, especially if they need to return to work and aren’t able to afford a pump out-of-pocket, said Paris Maloof-Bury, a lactation consultant and registered nurse who runs a support group for breastfeeding mothers in Ventura.

“My feeling is that without being able to maintain their (breast-milk) supply with a good pump while at work, they may not be able to have enough milk at home either for their baby,” she said.

Manual pumps cost about $30, but the more efficient electric pumps — which Maloof-Bury recommends for nursing mothers who work full-time — typically cost between $150 and $400.

Stovall, who works full-time as an administrative assistant, said she couldn’t afford to buy a new pump when hers began malfunctioning during her son’s first year, and she suffered health problems as a result, including plugged milk ducts and mastitis, a breast infection.

In mid-January, her doctor wrote her a prescription for a pump, and put in a request to her insurance company, under the new law. Nearly a month went by, and she heard nothing from Kaiser, Stovall said.

“I had to call them to find out I’d been denied,” she said. “The fact that they just didn’t get back to me and explain to me from the very beginning their policy just seemed shady. It seemed like they didn’t care and it wasn’t a priority for them.”

Stovall was eventually able to get her malfunctioning pump replaced through the manufacturer, but if that hadn’t been an option, she might have thrown in the towel, she said. She now intends to breastfeed her son until he is at least 2, as per the World Health Organization’s recommendations.

“It don’t think it’s fair for insurance companies to say, ‘You’re away from your son for 10 hours a day, but we can’t give you a pump because of his age,’” she said. “That was almost like a slap in the face for me. I wanted to ask them, ‘Do you have any children and did you formula feed them?’”

Some mothers of newborns have also reported difficulties obtaining breast pumps through the health care law.

Weshoyot Alvitre, also of Ventura, got a prescription for a pump in late January, when her daughter was 2 months old. But when she tried to fill it at medical supply stores in the area that contract with her insurance company, Anthem Blue Cross, they told her they didn’t have pumps in stock or had just created new guidelines that required mothers to be less than 30-days postpartum to receive one, she said.

“It’s frustrating, because there are boxes and boxes of these things on store shelves, so I really don’t believe them when they say they have a ‘shortage,’” Alvitre said in an email message.

Alvitre, who works as a store artist for Trader Joe’s, eventually decided to buy a manual pump herself, spending about $40. She added her name to a waiting list for a pump from a medical supply company, but has yet to hear back, she said.

Darrel Ng, spokesman for Anthem Blue Cross, said he couldn’t comment on Alvitre’s case or the company’s policy regarding issuing breast pumps, because the person who handles those issues was out of the office.

Ng did say that health insurance companies have reported “a nationwide shortage on these, just because when the benefit came out they weren’t ready for the demand.

“I don’t know that we have a warehouse full of breast pumps,” he added. “We process claims, we’re not like Amazon and we just have these things in a warehouse somewhere.”

Other new mothers, including Oxnard resident Valerie Lopez, have had success obtaining pumps after initially being denied by their insurers.

“A couple days after being denied over the phone, I got a letter saying I was approved,” she said. “I said, ‘You’re kidding me, but I’ll take it.’ I drove on my lunch break that day to pick it up.”

Insurance companies are still establishing their policies and weighing whether they meet the requirements of the new law, Maloof-Bury said.

“Gaining compliance, with any big change, requires time and emotional buy-ins,” she said. “As insurance companies learn more about the long-term cost-benefits to them if a baby is breastfed, I think getting pumps will be easier.

“All that mothers want to do is feed their babies. They’re not asking for anything extreme. It’s a very basic human right.”

 

Published: April 3, 2013 | No Comments

By Robert K. Ross and Linda P.B. Katehi

Preventive measures and an active, healthy lifestyle are without question the best way to maintain good health and keep down health care costs for everyone, and the California Endowment and UC Davis want to spread that message far and wide.

The Endowment’s Health Happens Here campaign promotes the idea that people live longer, healthier lives when communities have access to healthy and affordable choices where they live, work, play and learn.

UC Davis is following the Health Happens Here model to help its students achieve healthy, vibrant lifestyles in an integrative wellness campaign that can be replicated at college campuses everywhere.

In support of this goal, UC Davis students will hold the first ever “5K Stride for Aggie Pride” on campus Sunday, April 7. In addition to raising money for scholarships and emergency funds for students in need, the event will formally launch the partnership between the Health Happens Here campaign and the UC Davis Division of Student Affairs.

We all know that staying healthy requires more than doctors and dieting. Every moment of our day, our surroundings and the decisions we make affect how well, and how long, we live.

A healthy life is directly connected to the streets in the neighborhoods we live in, the classrooms where our students spend half their waking day and our ongoing access to preventive health care.

The days of approaching health care as something we use only when we get sick must end. We all have a responsibility to promote healthy lifestyles and choices that keep us out of the doctor’s office and hospitals in the first place. It’s the best way to reach our full potential and to control runaway health care spending.

At UC Davis, the Division of Student Affairs has been following the Endowment’s Health Happens Here campaign to promote total wellness among its 34,000 graduate and undergraduate students.

The idea behind the UC Davis effort for school-based wellness is to provide what students need to live healthy lives so the right choice for them also becomes the easy choice.

From UC Davis’ dining services that are focused on sound and affordable nutrition to nurture the mind and body, to educational programs in affordable cooking and diet, the university is providing students with desirable and safe environments in which to develop both their enthusiasm and skills for preparing healthy meals. UC Davis students also have an opportunity to promote the health benefits of organic produce, running a 5-acre organic garden that is part of the university’s Student Farm Market Garden. The garden provides organic produce year-round to the dining services and to a seasonally operated campus farmer’s market.

Just as the Endowment promotes the availability of affordable and safe options for physical activities in neighborhoods throughout California, the campus at UC Davis offers students an abundance of opportunities for healthy exercise and exertion.

The university and the city of Davis have one of the most comprehensive networks of greenbelts and bike paths that enable and encourage students to move safely on and off-campus. With more registered bicycles than motor vehicles, Davis is a model of self-locomotion that provides physical and mental well-being as the same time it contributes to a cleaner and healthier environment.

UC Davis also offers a variety of recreational and athletic programming that promotes the idea that a good mind-body balance is critical to the success of any individual. We know that people who work hard are more successful when they’re active. There are few places where we see that reality played out on a daily basis more than a bustling and vibrant college campus.

Another important piece of the puzzle at UC Davis is the effort already underway to develop a strategic plan to guide transition to a tobacco-free campus by 2014. Eliminating smoking is essential to good health, and everything we do to help college students avoid tobacco will pay dividends for them – and for society – now and in the future.

Social, cultural and emotional health are also taken into consideration. The campus opened a new Student Community Center last year that helps promote social and emotional wellness through a variety of student services and programs that honor diversity, offer students of all backgrounds and interests places to gather, interact and to raise political and cultural awareness throughout the student population.

There is no doubt that everyone’s quality of health care can be better, more affordable and accessible if we focus more on preventing illnesses and disease rather than simply treating a patient when he or she is already very sick.

The California Endowment’s Health Happens Here is promoting that message throughout California. We are happy to report that UC Davis has embraced it and is working hard to integrate its principles fully on campus. That will help make for a healthier university, healthier students and a healthier California.

Robert K. Ross, M.D., is president and chief executive officer for The California Endowment, a health foundation established in 1996 to address the health needs of Californians. Linda P.B. Katehi is chancellor of the University of California, Davis.

Note: The California Endowment is a financial sponsor of HealthyCal.org.

 
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