Wellness in the ACO Ecosystem

An ACO, or Accountable Care Organization, is a new model of coordinated healthcare allowed by the Affordable Care Act (aka health reform). In short, ACOs are one way doctors, hospitals and other healthcare providers can work together to better coordinate care for their patients. From the patient perspective, the goal of an ACO is to eliminate the frustration and hassle that comes with disconnected care. Each of us has some experience with this frustration and having a more user-friendly healthcare experience is welcome.

The goal of the ACO is to improve patient health (called "outcomes" in the healthcare system), improve the quality of care and lower costs. Impressive goals. And, in my opinion, possible if the ACO includes a comprehensive wellness solution within their program.

A comprehensive wellness solution is not to be confused with the old tems of "case management" or "care coordination" or "disease management." Each of those programs did deliver some savings and did improve some patient outcomes. They did not, however, put enough focus on the "whole person." An ACO modeled on the old ideas of disease management is less likely to succeed. Wellness is whole-person centric and is not about whichever diagnosis label appears on the medical record.

None of us are simple, one dimensional beings and our healthcare treatments cannot be one dimensional. We know lifestyle choices cause most diseases (heart disease, stroke, diabetes). When a doctor sees a diabetic patient, the doctor isn't treating "the diabetes" he is treating a person whose lab reports show a high level of sugar in the blood. The reasons for the numbers on the lab report are likely complex and a good outcome requires a whole-person strategy that combines medical, social, cultural and educational components.

Therein lies the challenge for the ACO. An ACO comprised of even the best team of clinicians will miss the opportunity for true improvement in "person health" if they treat based on historical practice and a disease-focused, patient-centric approach. "Person health" improvements demand a comprehensive wellness program focused on the whole person including exercise, nutrition and wellbeing.

A few ideas to consider:

I want to see ACOs succeed because I want people to be more healthy and happy.  Lifestyle choices are eating the healthcare system alive. An ACO lacking a lifestyle program is destined for mediocrity, at best. If you are working on an ACO design, consider comprehensive whole-life, person-centric programs in your design. It matters.

Physio-Individuality

Physio-individuality
- n
1. The unique activity requirements each of our bodies need for optimal health.

 

Physio-individuality acknowledges, while all of our bodies are made of muscle, bone, skin and tissue, the optimal exercise for each of us is different. Physio-individuality gives each person permission to exercise for their own bodies, needs and lifestyle. The types, amounts and duration of exercise our bodies will thrive on is unique and is related to a host of variables not often considered including the seasons, our daily mood, the weather, other demands on our time and our sleep patterns. Simply put the kinds of exercise each person needs is different.

Part of the challenge (and opportunity) to help Americans get more exercise is helping them understand what is best for their own body and life. A balanced exercise regime includes a combination of cardio, strength training, flexibility and core over a week's time.  How much of each, how intense or strenous, and the durations will change. There is no one-size fits all exercise program that will work for everyone.

An exercise program that embraces the concept of physio-individuality must include four things:

• Education
• Access
• Goal Setting
• Evaluation

In short, we need to teach each person about their bodies and how to exercise. We need to give them affordable and easy access to experiment with different types, intensity and durations of exercise. We need to help them set proactive and realistic goals (that go beyond their physical shape). And we need to help them learn from their experience, gather feedback, adapt their approach and evaluate their success.

Helping people get more exercise is a critical component of their improved health and longevity. And, it has the added benefit of improving our economy and saving our healthcare system.

Many thanks to Joshua Rosenthal of the Institute for Integration Nutrition who coined the term "bio-indiviudality" and was my inspiration to expand the concept to exercise and create the term "physio-individuality." Joshua - I am ever grateful for being your student.

Calories in Neon Lights

Yes, it is good news for the nation's waist line to have calorie counts listed on menus. Granted the rules will apply to less than 50% of the eating establishments across the U.S. and exempt movie theaters, hotels, airplanes and amusements parks. None the less, progress is progress. Right? Maybe....

For the record, I support the idea of listing calories on menus. Last August, I opined Every Little Bit Helps and those calorie counts have impacted my choices when in New York City. If they don't impact your choices you are either in full denial or are making a choice to indulge (the latter is good for you, in moderation... the former, please seek some help).

Here is the problem: Food manufacturers can reduce the number of calories in nearly all processed foods by manipuating the ingredients. Trust me, the manipulating is far worse for your body than the calories. The manipulating takes the form of fake, chemical additives created in a lab or taking what was a natural food and destroying its natural properties until the calories are reduced (along with all manner of nutrients and benefits).

So this new regulation while great in theory (as are many things), in practice we'll see two things:

1. More highly processed, fake foods lower in calories and devoid of any nutritional benefit (which will make our body crave more food because we aren't being fed, only stuffed, and people will actually gain more weight)
2. Smaller portion sizes

Do not think, when the burger you habitually order is suddenly 300 less calories, that the food Gods are shining down on you to make your life easier. Either the burger is even less real than it used to be, or it is several ounces smaller than it used to be. Option  #2 and some normalization of serving sizes is a good thing. Option #1 not so good.

The only way to combat such shenanigans is to stop eating processed foods. We support Real Food. Is it really too much to ask?

Holistic Wellness

What is "holistic wellness?" Let's start by looking at some definitions. From Dictionary.com:

Holistic <ho•lis•tic (hō-ˈlis-tik)>
adj
1 : of or relating to holism
2 : relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts < holistic medicine attempts to treat both the mind and the body>

Wellness <well•ness (wěl'nĭs)>
n.
The condition of good physical and mental health, esp. when maintained by proper diet, exercise, and habits.

Therefore, we'll create a working definition of "Holistic Wellness" as: your whole system being in good physical and mental condition.

To keep your whole system in good physical and mental condition, a few things are important:

 1. Exercise
Getting, at least, 30 minutes of exercise is the minimum. Optimally, you will get 60 minutes of exercise each and every day. Your best approach is a combination of cardio, flexibility, strength training and core work.
2. Heathly Eating
As Michael Pollan says, "Eat food. Not too much. Mostly plants." Following this advice is the best thing you could do for your diet. Beyond that, learning what kinds and how much food works best for your body is important. We are all different and our food choices should compliment our differences. Aim to have, at least, 80% of your meals prepared at home using whole natural ingredients (which excludes 99% of things that come in boxes). And, drink water. On average you should be drinking 1/2 of your body weight in ounces of water each and every day.
3. Rest
You've heard it before. Get 7-8 hours of sleep per night. It helps regulate your metabolism, allows your body to recharge and regenerate and you'll just feel better. Sleep is cheap. Lack of sleep is very expensive.
4. Purpose
Are you living your life's purpose? Are you pursing your dreams? Working on something you love and toward something you believe in is part of wellness. When we are spending our time doing something we love, we benefit greatly. Most of us spend the vast majority of our time working. If you're not working on something you really love, you're missing an opportunity. Sure, you might not be able to quit your job today, but you can make a step, no matter how small, toward your dream and purpose each and every day.
5. Community
Build a community around you. Friends, family and colleagues. Studies show having a community is very important for our wellness and longevity. It (almost) goes without saying your community should be a positive force in your life. If you're currently in a community with too much negativity, build another one.

Holistic Wellness. Whole You.

Stress Management

All of the healthy eating and exercise in the world won't help if you're miserable and stressed out. It has only been since 1956 that we have used the word stress to mean something affecting our bodies and feelings (you can thank Hans Hugo Bruno Selye). Stress is a very common response when you ask a person how they're doing... "I'm under a lot of stress" or "I'm stressed out."

People experience stress in different ways. Some feel flushed or hot, some feel nervous or fluttery, some feel tired and worn out. Regardless of your "experience" of stress it may be helpful to think of the experiences simply as messages from your body. Our body only has some many ways to communicate with us and the sensation of "stress" is often your body's way of getting your attention. In times of stress, your body wants you to make it stop and it will keep sending you messages until you get the message and intervene.

Stress Interventions

You have many choices to address stress and, since there is no one size fits all approach for everyone, we suggest you test a few see what works best for you. Here are some ideas:

• Deep Breathing - Often we can feel much better immediately if we take a few moments, get our bodies still and take three deep breaths.
• Nature - Getting outside and into nature is also a great way to take a stress break. Even a 10 minute walk can help separate you from your stressors and give you a new more calm perspective.
• Cardio - Getting your heart rate up and your blood pumping can help you reconnect with your body and alleviate the stress sensation.
• Meditation - A bit more involved than deep breathing, meditation is a great way to turn your thoughts onto yourself and get centered and grounded (See our Relax Breath meditation)
• Yoga - Even a few simple poses, like legs up the wall, are a great stress intervention
• Friends - Sometimes we feel better by just having a few moments to vent. Call a friend and tell them, "I need to vent. Will you listen to me for a few minutes without trying to fix my problem?" Getting it out into words helps and having someone truly listen helps even more.
• Music - Turn on your favorite song and sing along, even if you have to sing silently to yourself.
• Dance - More of your favorite music and get up and dance as boldly as you dare.
• Hot Tea - Hot tea can be a very soothing experience so brew a cup and sip slowly.

You may have other great ideas, too. The idea is for you to recognize stress as a message from your body and take a few minutes and implement the stress intervention that works best for you.

Do Something Sweet

On an airplane today, there was an older couple seated in front of me across the aisle from each other. A long flight, so I had settled in and was happily working and listening to music. The husband of the couple got up and went to the back of the plane. A few moments later he wandered back toward his seat and, having noticed his wife was reading, he reached over her head to turn on her reading light.

It wasn’t dark, she didn’t ask. He noticed. He noticed that he had an opportunity to do something sweet. Something small, something seemingly unremarkable. And yet, it was huge. The wife looked up and smiled at him. He smiled at her. No words were spoken. But the actions spoke volumes. Do something sweet. Something small and show someone you love (and anyone around who may notice) that the small things do make all of the difference. 

Broken Parts of the Whole

Let's consider a peanut butter and jelly sandwich, the staple diet of some childhood food phases. The thing that makes a peanut butter and jelly sandwich so good is the complete experience. A bit of soft white bread, crusts included. A thin and perfectly even layer of crunchy peanut butter. A huge glob of strawberry preserves (so much so that it drips out when you take a bite). Cut in half. That was my perfect peanut butter and jelly sandwich - and yours was probably slighty different.

Now, let's consider the parts on their own. Soft white bread? Not bad, though pretty boring all alone. Crunchy peanut butter? It tastes good but it makes your mouth all sticky and then you need to drink lots of milk. And strawberry preserves? Yes, yummy but go ahead and eat a big giant spoonful on its own. Blech!

The sandwich is so good because all of the parts work so well together. Same goes with much of our food. Milk is a great example. Whole, pure (and raw) milk is delicious and healthy because it has all of its parts intact. Oranges as well. A whole orange is a much better choice than many beverages contained in packages and labeled "orange juice."

Our food is grown as a whole and complete system. That whole and complete system is part mystery and part beauty. Even with our scientific acumen, we still do not understand the nature of the parts (nutrients, fiber, natural sugar, vitamins) contained in foods. It is not so much that we cannot separate and catalogue the parts; it is because we can't really tell how, or why, the parts work so well together when they are together.

Just like a peanut butter and jelly sandwich is at its best when it is all together, so is the rest of your food. Eat things as they grow in nature. Doing so simply removes a whole bunch of guess work, by you and your body.