Category Archives: Well-Being – PersonaL

Well-Being, Personal Well-Being, Health, Obesity, Chronic Disease, Healthy eating, healthy drinking, healthy cooking, physical exercise, Prevention, Predictive Medicine, Genomics, Personalization, Forecasting, Public Policy, Assessment, Diagnostics, Adaptive Health Systems Design, Medicare, Obamacare, Active, Healthy Living

Senior concierge services

“Elder concierge”, or senior concierge services, are blossoming as baby boomers age:

CREDIT: New York Times Article on Senior Concierge Services

https://www.forbes.com/sites/robertpearl/2017/06/22/concierge-medicine/amp/

The concierges help their customers complete the relatively mundane activities of everyday life, a way for the semi- and fully retired to continue to work.

Facts of note:
“Around 10,000 people turn 65 every day in the United States, and by 2030, there will be 72 million people over 65 nationwide.
Some 43 million people already provide care to family members — either their own parents or children — according to AARP, and half of them are “sandwich generation” women, ages 40 to 60. All told, they contribute an estimated $470 billion a year in unpaid assistance.”
“elder concierges charge by the hour, anywhere from $30 to $70, or in blocks of time, according to Katharine Giovanni, the director of the International Concierge & Lifestyle Management Network”

Organizations of note:

“One start-up, AgeWell, employs able-bodied older people to assist less able people of the same age, figuring the two will find a social connection that benefits overall health.
The company was founded by Mitch Besser, a doctor whose previous work involved putting H.I.V.-positive women together in mentoring relationships. AgeWell employees come from the same communities as their clients, some of whom are out of reach of medical professionals
until an emergency.”

The National Aging in Place Council, a trade group, is developing a social worker training program with Stony Brook University. It wants to have a dedicated set of social workers at the council, funded by donations, who are able to field calls from seniors and their caretakers, and make referrals to local service providers.
The council already works with volunteers and small businesses in 25 cities to make referrals for things like home repair and remodeling, daily money management and legal issues.”

Village to Village Network, has small businesses and volunteers working on a similar idea: providing older residents and their family or caretakers with referrals to vetted local services.
In the Village to Village Network model, residents pay an annual fee, from about $400 to $700 for individuals and more for households. The organization so far has 25,000 members in 190 member-run communities across the United States, and is forming similar groups overseas as well.”

=========== ARTICLE IS BELOW ============

Baby Boomers Look to Senior Concierge Services to Raise Income
Retiring
By LIZ MOYER MAY 19, 2017

In her 40 years as a photographer in the Denver area, Jill Kaplan did not think she would need her social work degree.
But when it became harder to make a living as a professional photographer, she joined a growing army of part-time workers across the country who help older people living independently, completing household tasks and providing companionship.
Elder concierge, as the industry is known, is a way for the semi- and fully retired to continue to work, and, from a business standpoint, the opportunities look as if they will keep growing. Around 10,000 people turn 65 every day in the United States, and by 2030, there will be 72 million people over 65 nationwide.
Some 43 million people already provide care to family members — either their own parents or children — according to AARP, and half of them are “sandwich generation” women, ages 40 to 60. All told, they contribute an estimated $470 billion a year in unpaid assistance.

Seven years ago, Ms. Kaplan, 63, made the leap, signing up with Denver-based Elder Concierge Services. She makes $25 to $40 an hour for a few days a week of work. She could be driving older clients to doctor’s appointments, playing cards or just acting as an extra set of eyes and ears for family members who aren’t able to be around but worry about their older relatives being isolated and alone. Many baby boomers themselves are attracted to the work because they feel an affinity for the client base.
“It’s very satisfying,” she said of the work, which supplements her photography income. Like others in search of additional money, she could have become an Uber driver but said this offered her a chance to do something “more meaningful.”
“We see a lot of women,” Ms. Kaplan said, “who had raised their families and cared for their parents out there looking for a purpose.”

Concierges are not necessarily social workers by background, and there isn’t a formal licensing program. They carry out tasks or help their customers complete the relatively mundane activities of everyday life, and just need to be able to handle the sometimes physical aspects of the job, like pushing a wheelchair.
Medical care is left to medical professionals. Instead, concierges help out around the house, get their client to appointments, join them for recreation, and run small errands.
While precise statistics are not available for the elder concierge industry, other on-demand industries have flourished, and baby boomers are a fast-growing worker population.
Nancy LeaMond, the AARP’s executive vice president and chief advocacy officer, said: “Everyone assumed the on-demand economy was a millennial thing. But it is really a boomer thing.”
Ms. LeaMond noted that while people like the extra cash, they also appreciate the “extra engagement.”
A variety of companies has sprung up, each fulfilling a different niche in the elder concierge economy.
In some areas, elder concierges charge by the hour, anywhere from $30 to $70, or in blocks of time, according to Katharine Giovanni, the director of the International Concierge & Lifestyle Management Network. Those considering going into the business should have liability insurance, Ms. Giovanni said.

One start-up, AgeWell, employs able-bodied older people to assist less able people of the same age, figuring the two will find a social connection that benefits overall health.
The company was founded by Mitch Besser, a doctor whose previous work involved putting H.I.V.-positive women together in mentoring relationships. AgeWell employees come from the same communities as their clients, some of whom are out of reach of medical professionals until an emergency.
The goal is to provide consistent monitoring to reduce or eliminate full-blown crises. AgeWell began in South Africa but recently got a grant to start a peer-to-peer companionship and wellness program in New York.
Elsewhere, in San Francisco, Justin Lin operates Envoy, a network of stay-at-home parents and part-time workers who accept jobs like grocery delivery, light housework and other tasks that don’t require medical training. Each Envoy employee is matched to a customer, who pays $18 to $20 an hour for the service, on top of a $19 monthly fee.
The inspiration for the company came from Mr. Lin’s work on a start-up called Mamapedia, an online parental wisdom-sharing forum, where he noticed a lot of people talking about the need for family care workers. He decided to start Envoy two years ago, after his own mother died of cancer, leaving him and his father to care for a disabled brother.
The typical Envoy employee works a few hours a week, so it won’t replace the earnings from a full-time job. But it nevertheless involves more interpersonal contact than simply standing behind a store counter.
“It’s not going to pay the rent,” Mr. Lin said. “They want to be flexible but also make a difference.”

Katleen Bouchard, 69, signed up with Envoy three years ago, after retiring from an advertising career. She gets $20 an hour working a handful of hours a week with older clients in her rural community in Sonoma County, Calif. She sees it as a chance to be civic-minded. “It’s very easy to help and be of service,” Ms. Bouchard said.
Companies like AgeWell and Envoy are part of the growing on-demand economy, where flexibility and entrepreneurship have combined to create a new class of workers, said Mary Furlong, a Silicon Valley consultant who specializes in the job market for baby boomers. At the same time, many retirees — as well as those on the cusp of retirement — worry that market volatility may hit their savings.
The extra income from the job, Ms. Furlong said, could help cover unexpected expenses. “You don’t know what the shocks are going to be that interrupt your plan,” she added.
Other organizations are looking to help direct older residents to vetted local service providers.
The National Aging in Place Council, a trade group, is developing a social worker training program with Stony Brook University. It wants to have a dedicated set of social workers at the council, funded by donations, who are able to field calls from seniors and their caretakers, and make referrals to local service providers.
The council already works with volunteers and small businesses in 25 cities to make referrals for things like home repair and remodeling, daily money management and legal issues.
Another group, the Village to Village Network, has small businesses and volunteers working on a similar idea: providing older residents and their family or caretakers with referrals to vetted local services.
In the Village to Village Network model, residents pay an annual fee, from about $400 to $700 for individuals and more for households. The organization so far has 25,000 members in 190 member-run communities across the United States, and is forming similar groups overseas as well.
“We feel like we are creating a new occupation,” said Marty Bell, the National Aging in Place Council’s executive director. “It’s really needed.”
Twitter: @LizMoyer

Four Daily Well-Being Workouts

Marty Seligman is a renowned well-being researcher, and writes in today’s NYT about four practices for flourishing:

Identify Signature Strengths: Focus every day on personal strengths exhibited when you were at your best.

Find the Good: Focus every day on “why did this good thing happen”?

Make a Gratitude Visit: Visit a person you feel gratitude toward.

Respond Constructively: Practice active, constructive responses.

===================

CREDIT: Article Below Can Be Found at This Link

Get Happy: Four Well-Being Workouts

By JULIE SCELFO
APRIL 5, 2017
Relieving stress and anxiety might help you feel better — for a bit. Martin E.P. Seligman, a professor of psychology at the University of Pennsylvania and a pioneer in the field of positive psychology, does not see alleviating negative emotions as a path to happiness.
“Psychology is generally focused on how to relieve depression, anger and worry,” he said. “Freud and Schopenhauer said the most you can ever hope for in life is not to suffer, not to be miserable, and I think that view is empirically false, morally insidious, and a political and educational dead-end.”
“What makes life worth living,” he said, “is much more than the absence of the negative.”

To Dr. Seligman, the most effective long-term strategy for happiness is to actively cultivate well-being.

In his 2012 book, “Flourish: A Visionary New Understanding of Happiness and Well-Being,” he explored how well-being consists not merely of feeling happy (an emotion that can be fleeting) but of experiencing a sense of contentment in the knowledge that your life is flourishing and has meaning beyond your own pleasure.

To cultivate the components of well-being, which include engagement, good relationships, accomplishment and purpose, Dr. Seligman suggests these four exercises based on research at the Penn Positive Psychology Center, which he directs, and at other universities.

Identify Signature Strengths
Write down a story about a time when you were at your best. It doesn’t need to be a life-changing event but should have a clear beginning, middle and end. Reread it every day for a week, and each time ask yourself: “What personal strengths did I display when I was at my best?” Did you show a lot of creativity? Good judgment? Were you kind to other people? Loyal? Brave? Passionate? Forgiving? Honest?

Writing down your answers “puts you in touch with what you’re good at,” Dr. Seligman explained. The next step is to contemplate how to use these strengths to your advantage, intentionally organizing and structuring your life around them.

In a study by Dr. Seligman and colleagues published in American Psychologist, participants looked for an opportunity to deploy one of their signature strengths “in a new and different way” every day for one week.

“A week later, a month later, six months later, people had on average lower rates of depression and higher life satisfaction,” Dr. Seligman said. “Possible mechanisms could be more positive emotions. People like you more, relationships go better, life goes better.”

Find the Good
Set aside 10 minutes before you go to bed each night to write down three things that went really well that day. Next to each event answer the question, “Why did this good thing happen?”
Instead of focusing on life’s lows, which can increase the likelihood of depression, the exercise “turns your attention to the good things in life, so it changes what you attend to,” Dr. Seligman said. “Consciousness is like your tongue: It swirls around in the mouth looking for a cavity, and when it finds it, you focus on it. Imagine if your tongue went looking for a beautiful, healthy tooth.” Polish it.

Make a Gratitude Visit
Think of someone who has been especially kind to you but you have not properly thanked. Write a letter describing what he or she did and how it affected your life, and how you often remember the effort. Then arrange a meeting and read the letter aloud, in person.

“It’s common that when people do the gratitude visit both people weep out of joy,” Dr. Seligman said. Why is the experience so powerful? “It puts you in better touch with other people, with your place in the world.”

Respond Constructively
This exercise was inspired by the work of Shelly Gable, a social psychologist at the University of California, Santa Barbara, who has extensively studied marriages and other close relationships. The next time someone you care about shares good news, give what Dr. Gable calls an “active constructive response.”

That is, instead of saying something passive like, “Oh, that’s nice” or being dismissive, express genuine excitement. Prolong the discussion by, say, encouraging them to tell others or suggest a celebratory activity.

“Love goes better, commitment increases, and from the literature, even sex gets better after that.”

Julie Scelfo is a former staff writer for The Times who writes often about human behavior.

High costs of health care

I found this NYT story to be scary and illuminating. God save this country. Frankenstein lives….they are called CPT codes … And CPT consultants and CPT courses and CPT mavens and AMA licensing of CPT (biggest source of revenue).

New York Times Article on High Costs of Health Care

Hospitals have learned to manipulate medical codes — often resulting in mind-boggling bills.

Microbiome Update

CREDIT: https://www.wsj.com/articles/how-disrupting-your-guts-rhythm-affects-your-health-1488164400?mod=e2tw

A healthy community of microbes in the gut maintains regular daily cycles of activities.
A healthy community of microbes in the gut maintains regular daily cycles of activities.PHOTO: WEIZMANN INSTITUTE
By LARRY M. GREENBERG
Updated Feb. 27, 2017 3:33 p.m. ET
4 COMMENTS
New research is helping to unravel the mystery of how disruptions to the bacteria in our gut, caused by an unhealthy diet or irregular sleep, can lead to a number of diseases.

Such research could someday result in new treatments for obesity, diabetes and other metabolic conditions by restoring the health of the gut-microbe community, known as the microbiota. Researchers are exploring how to do this through individualized diets and mealtimes or other interventions.

When gut microbiota are healthy, they maintain regular daily cycles of activities such as congregating in different parts of the intestine and producing metabolites, molecules that help the body function properly. A disruption of the gut’s circadian rhythms is communicated through the bloodstream and upsets many of the body’s other circadian clocks, especially in the liver, one of the main metabolic organs, according to a studyby Israel’s Weizmann Institute of Science published in the journal Cell in December.

The gut’s circadian rhythms and those in other organs “dance together in a very profound way and go up and down in coordination with each other,” says Eran Elinav, a physician and immunologist at the Weizmann Institute and one of the study’s lead investigators. “By controlling the gut microbiota, you can modify many physiological capabilities” throughout the body, he says.

DeathEd

I recently did a post on “elderhood” ( http://johncreid.com/2017/02/elderhood/ This post is a follow-up to that.

CREDIT:
https://www.nytimes.com/2017/02/18/opinion/sunday/first-sex-ed-then-death-ed.html?emc=edit_th_20170219&nl=todaysheadlines&nlid=44049881

First, Sex Ed. Then Death Ed.

By JESSICA NUTIK ZITTER•FEB. 18, 2017

FIVE years ago, I taught sex education to my daughter Tessa’s class. Last week, I taught death education to my daughter Sasha’s class. In both cases, I didn’t really want to delegate the task. I wanted my daughters and the other children in the class to know about all of the tricky situations that might await them. I didn’t want anyone mincing words or using euphemisms. Also, there was no one else to do it. And in the case of death ed, no curriculum to do it with.

When Tessa heard I’d be teaching sex ed to her fellow seventh graders, she was mortified. My husband suggested she wear a paper bag over her head, whereupon she rolled her eyes and walked away. When the day arrived, she slunk to the back of the room, sat down at a desk and lowered her head behind her backpack.

As I started in, 13 girls watched me with trepidation. I knew I needed to bring in the words they were dreading right away, so that we could move on to the important stuff. “Penis and vagina,” I said, and there were nervous giggles. A pencil dropped to the floor. With the pressure released, I moved on to talking about contraception, saying no, saying yes, pregnancy, sexually transmitted diseases, even roofies. By the end of the hour, hands were held urgently in the air, and my daughter’s head had emerged from behind her backpack.

Sexual education programming was promoted by the National Education Association as far back as 1892 as a necessary part of a national education curriculum. As information spread and birth control became increasingly available, unwanted pregnancies dropped, and rates of S.T.D.s plummeted. In this case, knowledge really is power.

I believe that this is true of death, too.

I am a doctor who practices both critical and palliative care medicine at a hospital in Oakland, Calif. I love to use my high-tech tools to save lives in the intensive-care unit. But I am also witness to the profound suffering those very same tools can inflict on patients who are approaching the end of life. Too many of our patients die in overmedicalized conditions, where treatments and technologies are used by default, even when they are unlikely to help. Many patients have I.C.U. stays in the days before death that often involve breathing machines, feeding tubes and liquid calories running through those tubes into the stomach. The use of arm restraints to prevent accidental dislodgment of the various tubes and catheters is common.

Many of the patients I have cared for at the end of their lives had no idea they were dying, despite raging illness and repeated hospital admissions. The reasons for this are complex and varied — among them poor physician training in breaking bad news and a collective hope that our technologies will somehow ultimately triumph against death. By the time patients are approaching the end, they are often too weak or disabled to express their preferences, if those preferences were ever considered at all. Patients aren’t getting what they say they want. For example, 80 percent of Americans would prefer to die at home, but only 20 percent achieve that wish.

Many of us would choose to die in a planned, comfortable way, surrounded by those we love. But you can’t plan for a good death if you don’t know you’re dying. We need to learn how to make a place for death in our lives and we also need to learn how to plan for it. In most cases, the suffering could have been avoided, or at least mitigated, by some education on death and our medical system. The fact is that when patients are prepared, they die better. When they have done the work of considering their own goals and values, and have documented those preferences, they make different choices. What people want when it comes to end-of-life care is almost never as much as what we give them.

I am a passionate advocate for educating teenagers to be responsible about their sexuality. And I believe it is past time for us to educate them also about death, an equally important stage of life, and one for which the consequences of poor preparedness are as bad, arguably worse. Ideally this education would come early, well before it’s likely to be needed.

I propose that we teach death ed in all of our high schools. I see this curriculum as a civic responsibility. I understand that might sound radical, but bear with me. Why should death be considered more taboo than sex? Both are a natural part of life. We may think death is too scary for kids to talk about, but I believe the consequences of a bad death are far scarier. A death ed program would aim to normalize this passage of life and encourage students to prepare for it, whenever it might come — for them, or for their families.

Every year in my I.C.U. I see dozens of young people at the bedsides of dying relatives. If we started to teach death ed in high school, a student visiting a dying grandparent might draw from the curriculum to ask a question that could shift the entire conversation. She might ask about a palliative care consultation, for example, or share important information about the patient’s preferences that she elicited during her course. High school, when students are getting their drivers’ licenses and considering organ donation, is the perfect time for this. Where else do we have the attention of our entire society?

Last week, my colleague Dawn Gross and I taught our first death ed program in my daughter’s ninth-grade class at the Head-Royce School, a private, progressive (and brave) school in Oakland. In the classroom, we had some uncomfortable terms to get out of the way early on, just as I did in sex ed — death, cancer, dementia. We showed the teenagers clips of unrealistic rescues on the TV show “Grey’s Anatomy,” and then we debunked them. We described the realities of life in the I.C.U. without mincing words — the effects of a life prolonged on machines, the arm restraints, the isolation. Everyone was with us, a little tentative, but rapt.

And then we presented the material another way. We taught them how to play “Go Wish,” a card game designed to ease families into these difficult conversations in an entertaining way. We asked students to identify their most important preferences and values, both in life and as death might approach. We discussed strategies for communicating these preferences to a health care team and to their own families.

We were delighted by their response. It didn’t take them long to jump in. They talked openly about their own preferences around death. One teenager told another that she wanted to make sure she wasn’t a burden to her family. A third said he was looking forward to playing “Go Wish” with his grandfather, who recently had a health scare.

Dawn and I walked out with huge smiles on our faces. No one had fainted. No one had run out of the class screaming. The health teacher told us she was amazed by their level of engagement. It is my hope that this is only the first step toward generating wide public literacy about this phase of life, which will eventually affect us all. The sooner we start talking about it, the better.

8 Health Habits

CREDIT: NEW YORK TIMES ARTICLE POSTED BELOW
===============SUMMARY=============

Weigh yourself often.
Learn to cook
Cut back on sugar.
Live an active life. 

Eat your veggies.
Practice portion control.

Adopt a post-party exercise routine. 
 

Find a job you love.

============ JCR NOTES ==========

As we enter 2017, I am in the mood for simplifying well-being, which is why I like this list above. But I want to cross-check it against what I know.

For example, I long have asserted that “MARVELS” are critical to well-being. MARVELS stands for MEDS (M), ACTIVITY (A), RESILIENCE (R), VITALS (V), EATING (E), LABS (L), AND SLEEP (S).

I still believe this. But it is complicated – can it be simpler?

The article suggests – correctly – that in your 20’s, “what’s important now” is developing and maintaining an active, healthy lifestyle. It emphasizes E (a healthy diet, moderate alcohol consumption and no smoking), and A (regular physical activity).

Just for fun, what if the most simplistic acronym was “EAT”, which stands for:

E – eating, drinking, smoking ………….(what you put into your body)
“be mindful about what you put in your body, by tracking it, and enjoy taking increasing control over this by developing related habits such as learning to cook or juicing”
A – activity, including rest and sleep ….(what you do with your body)
“Be mindful about what you do with your body by staying active and getting plenty of rest”
T – track E and A ….
“Develop quantified self habits that track E and A and regularly verify that your body is operating normally”

So I might restate “what is important now” for people in their 20’s:

You want to fully enjoy your life in your 20’s – without putting your 30’s,, 40’s and beyond at risk – develop AHL (active, healthy living) habits that you enjoy, so that they have a good chance of being with you the rest of your life. stay lean and well-rested during your 20’s. To get that way, eat and drink well, don’t smoke,

Tracking:

Daily (get a routine, like taking a shower): M, A, E, and M. (Track what you put in your body (E) and what you do with your body (A and S) daily.

Simple checklist is this. Today, did you:
“Take MEDS as prescribed” (were you in compliance?)?
“Smoke?”
“Eat your veggies?”
“use sugar, especially alcohol, in moderation?”
“stay active with activities that can be life habits?”

Monthly: V (Track your vital signs, including body weight and body mass monthly.)

Annually: L (Track your lab results annually, and more frequently if results are out of normal range). L includes genomes – so do them once, and annually if V or L is out of normal range.

==============KEY STUDY===========

Staying healthy in your 20s is strongly associated with a lower risk for heart disease in middle age, according to research from Northwestern University. That study showed that most people who adopted five healthy habits in their 20s – a lean body mass index, moderate alcohol consumption, no smoking, a healthy diet and regular physical activity – stayed healthy well into middle age.

===============ARTICLE=============
The 8 Health Habits Experts Say You Need in Your 20s
By TARA PARKER-POPE OCT. 17, 2016
If you had just one piece of health advice for people in their 20s, what would it be?
That’s the question we posed to a number of experts in nutrition, obesity, cardiology and other health disciplines. While most 20-year-olds don’t worry much about their health, studies show the lifestyle and health decisions we make during our third decade of life have a dramatic effect on how well we age.
Staying healthy in your 20s is strongly associated with a lower risk for heart disease in middle age, according to research from Northwestern University. That study showed that most people who adopted five healthy habits in their 20s – a lean body mass index, moderate alcohol consumption, no smoking, a healthy diet and regular physical activity – stayed healthy well into middle age.
And a disproportionate amount of the weight we gain in life is accumulated in our 20s, according to data from the Centers for Disease Control and Prevention. The average woman in the United States weighs about 150 when she’s 19, but by the time she’s 29, she weighs 162 pounds – that’s a gain of 12 pounds. An average 19-year-old man weighs 175 pounds, but by the time he hits 29 he is nine pounds heavier, weighing in at 184 pounds.
But it can be especially difficult for a young adult to focus on health. Young people often spend long hours at work, which can make it tough to exercise and eat well. They face job pressure, romantic challenges, money problems and family stress. Who has time to think about long-term health?
To make it easier, we asked our panel of experts for just one simple piece of health advice. We skipped the obvious choices like no smoking or illegal drug use – you know that already. Instead we asked them for simple strategies to help a 20-something get on the path to better health. Here’s what they had to say.

Weigh yourself often. 
- Susan Roberts, professor of nutrition at Tufts University and co-founder of the iDiet weight management program 
Buy a bathroom scale or use one at the gym and weigh yourself regularly. There is nothing more harmful to long-term health than carrying excess pounds, and weight tends to creep up starting in the 20s. It is pretty easy for most people to get rid of three to five pounds and much harder to get rid of 20. If you keep an eye on your weight you can catch it quickly.

Learn to cook. 
- Barbara J. Rolls, professor and Guthrie Chair of Nutritional Sciences at Penn State 
Learning to cook will save you money and help you to eat healthy. Your focus should be on tasty ways to add variety to your diet and to boost intake of veggies and fruits and other nutrient-rich ingredients. As you experiment with herbs and spices and new cooking techniques, you will find that you can cut down on the unhealthy fats, sugar and salt, as well as the excess calories found in many prepared convenience foods. Your goal should be to develop a nutritious and enjoyable eating pattern that is sustainable and that will help you not only to be well, but also to manage your weight. 
(Related: The foods you should stop buying and start making yourself) 


Cut back on sugar. 
- Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic Foundation 
I suggest that young people try to avoid excessive simple sugar by eliminating the most common sources of consumption: 1) sugared soft drinks 2) breakfast cereals with added sugar and 3) adding table sugar to foods. Excessive sugar intake has been linked to obesity and diabetes, both of which contribute to heart disease. Sugar represents “empty calories” with none of the important nutrients needed in a balanced diet. Conversely, the traditional dietary villains, fat, particularly saturated fat, and salt, have undergone re-examination by many thoughtful nutrition experts. In both cases, the available scientific evidence does not clearly show a link to heart disease. 

Live an active life. 
- Walter Willett, chairman of the nutrition department at the Harvard School for Public Health 
While many people can’t find time for a scheduled exercise routine, that doesn’t mean you can’t find time to be active. Build physical activity into your daily life. Find a way to get 20 or 30 minutes of activity each day, including riding a bike or briskly walking to work. 
(Related: Learn how to run like a pro.) 


Eat your veggies. 
- Marion Nestle, professor of nutrition, food studies and public health at New York University 
Nutrition science is complicated and debated endlessly, but the basics are well established: Eat plenty of plant foods, go easy on junk foods, and stay active. The trick is to enjoy your meals, but not to eat too much or too often. 

Practice portion control. 
- Lisa R. Young, adjunct professor of nutrition at New York University 
My tip would be to not to ban entire food groups but to practice portion control. Portion control doesn’t mean tiny portions of all foods – quite the opposite. It’s okay to eat larger portions of healthy foods like vegetables and fruit. No one got fat from eating carrots or bananas. Choose smaller portions of unhealthy foods such as sweets, alcohol and processed foods. When eating out, let your hand be your guide. A serving of protein like chicken or fish should be the size of your palm. (Think 1-2 palms of protein.) A serving of starch, preferably a whole grain such as brown rice or quinoa should be the size of your fist. Limit high-fat condiments like salad dressing to a few tablespoons – a tablespoon is about the size of your thumb tip. 

Adopt a post-party exercise routine. 
- Barry Popkin, professor of global nutrition at the University of North Carolina at Chapel Hill 
If you engage in a lot of drinking and snacking, ensure you exercise a lot to offset all those extra calories from Friday to Sunday that come with extra drinking and eating. We found in a study that on Friday through Sunday young adults consumed about 115 more calories than on other days, mainly from fat and alcohol. 


Find a job you love. 
- Hui Zheng, associate sociology professor, population health, Ohio State University 
Ohio State University research found that work life in your 20s can affect your midlife mental health. People who are less happy in their jobs are more likely to report depression, stress and sleep problems and have lower overall mental health scores. If I can give just one piece of health advice for 20-year-olds, I would suggest finding a job they feel passionate about. This passion can keep them motivated, help them find meaning in life, and increase expectations about their future. That in turn will make them more engaged in life and healthier behaviors, which will have long term benefits for their well-being.

MDVIP

MDVIP

MDVIP is a “Boca Raton, Fla.–based concierge care company, with 565 affiliated physician practices in 40 states. MDVIP’s 200,000 patients each pay between $1,500 and $1,800 annually—a lower price than many concierge competitors.

Summit Partners is the driving force behind the company. It invested in the early 2000’s and then sold the company to P&G in 2009. It then bought the company back from P&G in 2014.

They say they partner with Mayo, Cleveland Clinic, and Johns Hopkins, among other partners.

CREDIT: http://www.mdvip.com
CREDIT: http://www.mdvip.com/what-is-mdvip/our-model
CREDIT: http://www.mdvip.com/member-benefits
CREDIT: http://www.dpcare.org
CREDIT: http://www.kiplinger.com/article/retirement/T037-C000-S004-pay-flat-fees-to-doctors-with-direct-primary-care.html
CREDIT: http://johncreid.com/2016/09/direct-primary-care/
CREDIT: http://medicaleconomics.modernmedicine.com/medical-economics/news/bill-could-allow-health-saving-account-use-dpc
CREDIT: http://www.kevinmd.com/blog/2014/08/direct-primary-care-concierge-medicine-theyre.html

============Notes from credited sources ============
LIVE HEALTHY WITH A PRIVATE DOCTOR FOCUSED ON YOU
Long Live Healthy with Personalized Healthcare

PRIMARY CARE BUILT JUST FOR YOU
At MDVIP, we know that a lifetime of good health cannot be achieved through a one-size-fits-all approach to medicine. That’s why MDVIP is different. From the first day of your membership with MDVIP, its affiliated physicians across the country focus on delivering an experience that rivals ordinary primary care practices. Working as partners, you and your personal doctor will develop a tailored, comprehensive wellness plan that delivers in-depth knowledge and one-on-one support all year long. With the added benefit of minimal wait time, extended appointments and partnerships with some of the top specialized medical centers in the nation, you can rest assured that maximizing your health, no matter your current health status, is our number one priority.
TOP DOCTORS: 
Selected from among the best in the nation, MDVIP affiliated doctors hold accomplishments and honors such as Best Doctor mentions and Castle Connolly Top Doctor Awards.
SAME-DAY APPOINTMENTS:
MDVIP affiliated doctors are dedicated to providing convenient same-day or next-day appointments.
TAILORED CARE:
Whether you have a chronic condition or a clean bill of health, MDVIP’s Wellness Program provides tailored wellness plans with guidance in weight management, sleep, exercise and much more.
SPECIALIST CARE:
For advanced care needs, MDVIP helps manage direct referrals to top medical centers, including Cleveland Clinic, Mayo Clinic, Johns Hopkins and more.

==========
MDVIP is a personalized healthcare program that empowers people to reach their health and wellness goals through in-depth knowledge, expertise and one-on-one coaching with some of the finest primary care doctors in America. With memberships that average $1,800 per year (prices vary based on location), you become one of a few exclusive patients who receive the highest levels of personalized care to help transform your life into a healthier one.
Our unique approach to healthcare is proactive, instead of reactive. Unlike a traditional primary care practice, your MDVIP-affiliated doctor will take the extra time to get to know you, your lifestyle and your current health through consultations, comprehensive screenings and advanced testing.
He or she can then offer you a carefully thought out wellness plan tailored to meet your unique needs, while also helping you manage acute or chronic medical needs as they arise. Your MDVIP-affiliated doctor will get to know you as a whole person, rather than as a faceless name on a chart.

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Select Your Physician
Experience personalized, primary care from a dedicated MDVIP-affiliated doctor who understands you and your health needs. Beginning with your first office visit, your doctor will go above and beyond to provide care that knows no limitations. To start your MDVIP membership and find the perfect doctor, search by doctor’s name or geographical area in the form fields below.
Insurance and Medicare
To suit the unique needs of each MDVIP member, our program is compatible with Medicare and most insurance plans. An MDVIP membership supplements traditional insurance by emphasizing preventive measures and proactive care to keep you healthy and happy. Our customer service experts will help answer any questions you may have regarding your insurance or membership cost. Call 1-844-205-4940 to learn more.
Wellness Program
You and your MDVIP-affiliated doctor will form a partnership focused on better health and overall well-being that starts at day one. Working side-by-side, you will develop a comprehensive Wellness Plan made just for you. Taking key health factors and lifestyle habits into consideration, your personal Wellness Plan will help accomplish specific goals and live your best and healthiest life every day.

MDVIP Connect
Our goal is to provide convenience so that you can go about your life as planned. Using the latest technology, MDVIP Connect brings expert advice, round the clock secure messaging, medical records, customized nutrition plans and Health Assessments together in one personalized site. This intuitive platform makes managing your health simple and empowering, letting you focus on living a vibrant life.

===============================OTHER BENEFITS ========
MDVIP Travel Advantages
We want our MDVIP members to travel with peace of mind. Your doctor will connect you with other affiliated doctors across the country if an urgent need arises, provide care to out-of-town guests and inform you of necessary vaccinations before traveling abroad.
Online Personal Health Record
Every MDVIP member will receive online access to his or her Personal Health Record that includes a summary of the annual MDVIP wellness exam, lab results, EKG and other important medical information.
MDVIP Connect
After becoming a member, you have access to MDVIP Connect, an innovative personalized website designed to bring convenience and peace of mind to your life. Build a strong partnership with your MDVIP-affiliated physician and manage your health with 24/7 secure messages, medical records, meal plans and more available in one location.
Medical Centers of Excellence
We have partnered with nationally renowned medical institutions to create the Medical Centers of Excellence program. Through this program, your doctor can connect with the experts at these institutions to help you get a second opinion, consultation or specialized treatment if needed.

We strive to provide our members with more than just healthcare. We go above and beyond what the traditional primary care practice offers. Our holistic, proactive approach to healthcare addresses your physical, mental and emotional well-being through one-on-one counseling and comprehensive diagnostic testing. Unlike traditional practices of 2,000 patients or more, we ensure each MDVIP-affiliated doctor cares for 600 patients or fewer, so you receive the extra time and attention you deserve. Additionally, we provide you with convenient appointments and the benefits of our Travel Advantages program, Medical Centers of Excellence program and online access to your Personal Health Record.

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http://www.kiplinger.com/article/retirement/T037-C000-S004-pay-flat-fees-to-doctors-with-direct-primary-care.html

The trend has had an impact on concierge care. “We’ve seen more and more demand,” says Dan Hecht, chief executive officer of MDVIP, a Boca Raton, Fla.–based concierge care company, with 565 affiliated physician practices in 40 states. MDVIP’s 200,000 patients each pay between $1,500 and $1,800 annually—a lower price than many concierge competitors.

Pay Flat Fees to Doctors With Direct Primary Care
By CHRISTOPHER J. GEARON, Contributing Editor
From Kiplinger’s Retirement Report, March 2013
Ever need to wait a week or more to see your primary care doctor? Perhaps you should follow the lead of Debra Sallee, 58, a Seattle hair salon owner. For a flat fee of $79 a month, she can see her family physician as often as she wants—with no co-payments or health insurance

For several years, Sallee has been a member of Qliance, a primary care provider with four locations in and near Seattle. Her fee pays for round-the-clock e-mail or Skype access to the medical staff as well as same- or next-day (or evening) appointments for non-emergency medical care.
Sallee and Qliance are part of a growing movement known as direct primary care. For a set monthly fee, patients receive a full range of preventive services, such as wellness examinations, screenings and basic mental health care. Qliance also provides urgent care, including treatments for respiratory infections. Monthly fees are based on age, ranging from $54 to $89.
Direct primary care is an outgrowth of a concept known as concierge care, which provides unlimited access to physicians for hefty premiums ranging from $2,000 to $5,000 a year. Direct primary care provides many of the same services at a much lower price, eliminating the administrative costs and hassles of insurance. “It’s concierge care for the masses,” says Dr. Erika Bliss, a family physician and chief executive officer of Qliance. More than 80 medical practices nationwide belong to the Direct Primary Care Coalition. (Some members offer higher-priced concierge services.)

The trend has had an impact on concierge care. “We’ve seen more and more demand,” says Dan Hecht, chief executive officer of MDVIP, a Boca Raton, Fla.–based concierge care company, with 565 affiliated physician practices in 40 states. MDVIP’s 200,000 patients each pay between $1,500 and $1,800 annually—a lower price than many concierge competitors.
Primary care providers typically provide most of a patient’s care, including coordinating the oversight of patients with diabetes, asthma, heart ailments and other chronic conditions. Providers such as Qliance and Cambridge, Mass.–based Iora Health also coordinate all specialist and hospital care.

When Your Insurance Falls Short
Direct primary care may be a good option for those without insurance or who have high-deductible policies, such as Sallee. She pays a health insurer $311 a month for a policy with a deductible of $2,750, which she considers “catastrophic” insurance for high-cost hospital services. She pays Qliance separately.
Many employers who offer high-deductible plans are paying the fees for direct primary care. In these cases, the employer-based insurance covers the costs of specialists, hospital care and major tests once the patient meets the deductible.








Employers and unions pay Iora Health $50 a month to cover each worker and retiree in the Boston area; Dartmouth, N.H.; Las Vegas; and Brooklyn, N.Y. “Our practices aren’t designed for rich people to have conveniences,” says Dr. Rushika Fernandopulle, chief executive officer of Iora Health.
Direct primary care could get a big boost next year. Under the federal health care law, these practices will be able to operate in state-based health insurance exchanges. However, insurers on exchanges must offer a basic benefits package that includes hospital, drug and other coverage, so direct primary care practices will likely team up with other health plans.
If you’re considering a direct primary care practice, get a list of provided services and talk with a physician in the practice. Also, some practices that are similar to concierge care may accept insurance but charge a monthly fee for extra services. For options in your area, visit the Web site of the Direct Primary Care Coalition (www.dpcare.org).

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CREDIT: http://johncreid.com/2016/09/direct-primary-care/

Its pretty clear that a coalition of “direct primary care” providers is pushing Congress to recognize subscription services a service reimbursable under Medicare.

I believe they are differentiating themselves from “concierge” care, for political reasons. The coalition says concierge care is $2000-$5000, instead of under $2000.

“The Primary Care Enhancement Act of 2016” has been brought to the Ways and Means Committee, where is was referred in September, 2016 to the Health Sub-Committee.

Sponsor: Rep. Paulsen, Erik [R-MN-3] (Introduced 09/13/2016)
Committees: House – Ways and Means
Latest Action: 09/19/2016 Referred to the Subcommittee on Health. (All Actions)

===============
Direct primary care could get a big boost next year. Under the federal health care law, these practices will be able to operate in state-based health insurance exchanges. However, insurers on exchanges must offer a basic benefits package that includes hospital, drug and other coverage, so direct primary care practices will likely team up with other health plans.
If you’re considering a direct primary care practice, get a list of provided services and talk with a physician in the practice. Also, some practices that are similar to concierge care may accept insurance but charge a monthly fee for extra services. For options in your area, visit the Web site of the Direct Primary Care Coalition (www.dpcare.org).

======================
The Primary Care Enhancement Act of 2016  proposes to amend the tax code so consumers can use their health savings accounts (HSAs) to pay physicians in direct primary care (DPC), bypassing insurance. H.R. 6015 would also enable Medicare enrollees to pay for direct primary care using Medicare funds, rather than pay out of pocket.

======================
http://www.dpcare.org

Senators Bill Cassidy, MD (R-LA) and Maria Cantwell (D-WA) have introduced bipartisan legislation which clarifies that DPC is a medical service for the purposes of the tax code regarding Health Savings Accounts. The bill also creates a new payment pathway for DPC as an alternative payment model (APM) in Medicare. “Co-sponsors are important. They show Senate leaders that there is widespread support for the legislation,” said Sen. Cassidy when he addressed the DPCC Fly-in Sept. 24. We need your help today to ensure that S.1989 moves forward.  Please contact your Senators and urge them to co-sponsor the Primary Care Enhancement Act today.

On the Move in the States with DPC
16 States Move to Clear Regulatory Hurdles for DPC 
Legislation  defines DPC outside of Insurance.
 
As of June, 2016, 16 states have adopted Direct Primary Care legislation which defines DPC as a medical service outside the scope of state insurance regulation. 
 
The DPCC has developed model legislation to help guide legislators and their staffs on the best way to accomplish  this important reform. Click here to see the model bill.
States With DPC Laws:

• Washington – 48-150 RCW
• Utah – UT 31A-4-106.5
• Oregon – ORS 735.500
• West Virginia – WV-16-2J-1
• Arizona – AZ 20-123
• Louisiana – LA Act 867
• Michigan – PA-0522-14
• Mississippi – SB 2687
• Idaho – SB 1062
• Oklahoma – SB 560
• Missouri – HB 769
• Kansas – HB 2225
• Texas – HB 1945
• Nebraska – Leg. Bill 817
• Tennessee – SB 2443
• Wyoming – SF0049

Current as of June, 2016

=============
Direct Primary Care is an innovative alternative payment model in primary care model embraced by patients, physicians, employers, payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. In DPC unwanted fee-for-service incentives are replaced with a simple flat monthly fee. This empowers the doctor-patient relationship and is the key to achieving superior health outcomes, lower costs and an enhanced patient experience.
=============
http://medicaleconomics.modernmedicine.com/medical-economics/news/bill-could-allow-health-saving-account-use-dpc

Direct primary care physicians charge patients a monthly fee for care and access to a package of services rather than by fee-for-service or insurance. The subscription model can grant patients increased access to doctors, discounted drugs and laboratory services. 
According to Meigs, the proposed law will allow people with high deductible plans to use their HSA to pay for primary care, given that people with high deductible insurance plans can use their insurance for catastrophic coverage and hospitalizations, and cost-effectively tap their HSAs for primary care.  

============

Direct primary care and concierge medicine: They’re not the same

Direct primary care and concierge medicine: They’re not the same
SAMIR QAMAR, MD | PHYSICIAN | AUGUST 24, 2014
Samir Qamar
Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct primary care companies, I have attempted to differentiate the two based on extensive personal knowledge and experience.

First, concierge medicine. Born in the mid 1990s, this practice design was first created by wealthy individuals who were willing to “bypass” the woes of the current fee-for-service system by paying a subscription to access select primary care physicians. This access consists of same-day appointments, round-the-clock cell phone coverage, email and telemedicine service, and sometimes, as in my previous practice, house calls. Although some high-end practices charge as much as $30,000 a month, most charge an average monthly fee of $200.
In return, to allow such unrestricted access, physicians limit their patient panels to several hundred patients at most, a significant drop from the typical 2,500-plus panel size most doctors are used to. Many concierge doctors also bill insurance or Medicare for actual medical visits, as the monthly “access fee” is only for “non-covered” services. This results in two subscriptions paid by patients — the concierge medicine fee, and the insurance premium. Importantly, a few concierge practices do not bill insurance for medical visits, as the monthly fees cover both access and primary care visits.
Direct primary care started in the mid 2000s, and was created as an insurance-free model to serve a new patient population: the uninsured. In DPC, patients, and now their employers, are also charged a monthly fee, but the fee can be as low as $50 per month and there is typically no third-party payer involvement. Consumers pay physician entities directly (hence, direct primary care), and because the insurance “middle man” is removed from the equation, all the overhead associated with claims, coding, claim refiling, write-offs, billing staff, and claims-centric EMR systems disappears.

Patient panels can be as high as 1,500 patients per doctor, and there is typically no physician cell phone access or house call service. Similar to higher-priced concierge practices, DPC practices also allow for longer patient visits and telemedicine. The most important characteristic of DPC practices, however, is that insurance claims are not filed for medical visits.

Direct primary care’s definition, therefore, is any primary care practice model that is directly reimbursed by the consumer for both access and primary medical care, and which does not accept or bill third party payers.
Confusion arises from similarities that exist in both models, such as decreased patient panels, monthly subscriptions, and longer visits. There is added confusion when a DPC physician offers house calls or email access, typical of concierge practices. Confusion is maximized when a physician is by definition practicing direct primary care, yet calls the practice a “concierge practice.” Similarly, a concierge practice may decide to abstain from participating in third party payer systems, and thus would also be a DPC practice.
The distinction is important because direct primary care is explicitly mentioned in the Affordable Care Act, while concierge medicine is not. Several state laws have also recognized direct primary care as medical practice models, and non-insurance entities. In addition, the term “concierge medicine” causes visceral reactions in select social and medical circles, drawing criticism such as elitism and exacerbation of physician shortage.
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In summary, not all direct primary care practices are concierge practices, and not all concierge practices are direct primary care practices. The terms are not synonymous, and even the basic fundamentals of either model do not overlap. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or direct primary care model, no matter what the fees.
Samir Qamar is CEO, MedLion and president, MedWand. He can be reached on Twitter @Samir_Qamar.

Helix.com takes genomics commercial

I believe that genomics just advanced …. headed to commercialization. Read on.

I received this as a gift, and just registered my saliva sample. “Geno 2.0”. As with ancestry.com, the “hook” is they promise a profile of your ancestry. Clever – does not over-promise.

Cost …. $149?

Took 10 minutes. Very cool box, like something from Apple. Inside was an equally cool, self-addressed, stamped box. Fancy test tube inside. Coded carefully – right on the sample tube. Protected for shipment … Nice. Netflix started with a kit like this.

They have 800,000 samples so far. Partnered with National Geographic, Duke, bunch of others. I registered separately – online. Great privacy policy.

This is only the beginning….like the Internet when AOL was the only game in town, and Amazon only sold books.

Go to Helix

Helix seems to be a venture-backed company – Kleiner, Warburg Pincus, and Mayo are shown as investors.

The essence of their value proposition seems to be “products that will be offered by our partners in the future.” These products will obviously draw upon the database that is being accumulated.

Solid Scientific Advisory Board.

Duke shown as partner. National Geographic as well.

Genography.com seems to be another of their sites? Partner.

Human connection lies at the heart of human well-being.

See NYT article below: if these facts are anywhere close to right, a community-based BeWell Center has an opportunity to do a whole lot of good by simply being an organizer of volunteer outreach. Low or no cost, big impact, great from a philanthropy POV. Meals on Wheels, elderly check-ins, classes, etc. “Research confirms our deepest intuition: Human connection lies at the heart of human well-being.”

“Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences. Since the 1980s, the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent.

About one-third of Americans older than 65 now live alone, and half of those over 85 do. People in poorer health — especially those with mood disorders like anxiety and depression — are more likely to feel lonely. Those without a college education are the least likely to have someone they can talk to about important personal matters.
A wave of new research suggests social separation is bad for us. Individuals with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones. One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.
Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 percent higher risk of dying in the next seven years, and that this effect was largest in middle age.”

Research confirms our deepest intuition: Human connection lies at the heart of human well-being.