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Chronic Care Management

An estimated 117 million adults have at least one chronic health condition, and an estimated one in every four adults have two or more chronic health conditions. In a questionable healthcare system, mostly focused on treatment instead of prevention, it is not a wonder. Medical providers actually profit short-term by sick patients visiting often. But, frankly, medical providers are also strained with high-demand patient loads, and time and resources do not allow easy tracking. So care has not been very outcomes based – communication post treatment, assessment of disease reversal, etc.

The Centers for Medicare and Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. Since 2015, Medicare has been reimbursing medical providers for CCM services. Eligible patients are those with two or more chronic conditions expected to last at least 12 months or until death, and that place the patient at significant risk of death, acute decompensation or functional decline.

Examples of chronic conditions include, but are not limited to:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS

Wow! Now that I’ve caught you up on the background…

I had the pleasure of helping Doctor for Life launch their Chronic Care Management program, enabling us to create individualized, comprehensive care plans including special education, motivation and follow-up efforts to better patient health outcomes. Medicare covered non face-to-face encounters such as the following, with patients only responsible for a small monthly co-pay:

  • At least 20 minutes per month of chronic care management services
  • Personalized help from a health care professional to create a care plan based on your needs and goals
  • Care coordinated between your doctor, pharmacy, specialists, testing centers, hospitals, and other services
  • Phone check-ins between visits to keep you on track
  • Emergency access to a health care professional, 24 hours a day, 7 days a week
  • Expert help with setting and meeting your health goals
  • Review of medical records and test results
  • Medication refills and management
  • Scheduling same-day appointments

Doctor for Life also decided to offer free group education classes each month – one in Fitness and one in Nutrition. (Yes, you guessed it, I was leading the classes on Fitness. 😉 ) My lessons included:

  • Exercise for the Prevention of Falls / Balance Testing
  • Exercise for Independence / Activities of Daily Living
  • Habits to Improve Health / Lifestyle & Techniques

Participants definitely learned and laughed. (I mean, making them laugh is like my number one goal.) I enjoyed the process too, getting to dig deeper into the perspective of others. I do not have a chronic disease, but I need to understand as much as possible about what that’s like in order to help people.

Health pros must be knowledgeable and empathize. I’m grateful for this opportunity at DFL, and feel the need to share with everyone what some medical providers are doing to improve care and, working together, get patients to their desired health goals.

The outcomes really are positively improving. Recent statistics show that it is worth CMS paying providers because they are saving by lowering benefit payouts to individuals, meaning patients’ care is being routinely controlled instead of having more emergency and extra inpatient or outpatient needs.

If you or someone you know is interested and eligible, please ask your providers accepting Medicare about this level of concierge care.

Resources:

CMS website >

CMS handout >

Medicare website >

Modern Healthcare article >

AarikaChronic Care Management
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First Week

Like many people, I took advantage of a lot of opportunities to indulge over the holidays. Nearly every event was centered around food. The wine, beer and cocktails runneth over. My rambunctious brother was visiting and stayed at our house for a week. So yeah.

I think we all “give ourselves a break” during the holidays. Normal lives may be filled with order, boundaries, regime. Especially if your routine changes, like you are off work for a week, you are kind of vacationing from reality. You feel entitled to freedom, freedom from standard “proper” actions and freedom from guilt in your own mind. Like I said, I did it. Celebratorily. Gladly.

For the first week in January though, I came up with some “get back on track” rules for myself. (I know this could sound silly to some, but creating these rules on a weekly or monthly basis have been truly crucial to my personal health and fitness, the key to goal-setting.)

The rules for January 1-7 were simple:

  • No candy
  • No soda
  • No fried foods
  • No alcohol

One could certainly set stricter rules, and in the past I have. But in this case, I only wanted a solid week off from the top four offenders in my diet. These were the specific foods and drinks I noted I was consuming too much of in weeks prior. I had to cleanse!

Tuesday, January 2, I came home from work after a hazardous day. Here was my thought process…

  • Gosh, today was tough, and I’m exhausted.
  • I wish I could treat myself, to feel better, as consolation.
  • I really want two mini Milky Way bars that I got in my stocking.
  • I had a good day by the rules, did not have soda, fried food or alcohol.
  • Maybe that’s what I should do instead – just allow myself one thing from the No list each day.
  • Cool! I will have the candies.
  • Chomp. Chomp.

A minute later, I felt terrible. I had just set these rules for my First Week, and I broke one immediately. I thought, what the heck is wrong with me? I realized I wanted to write a blog post about this experience right then. I wanted to document my own journey and failure. If this happens to a health and fitness expert, then it most definitely happens to those unpracticed and unaware. My problem was talking myself into that candy. I rationalized why I could have it, why I deserved it. This thinking was not in line with my goal. The person who lost here was me.

This is what my clients go through every day when trying to be active and eat healthy. They set goals. They make themselves promises. They welch on the deal. Because behavior change is not instant. It takes having “I want the candy” moments followed by “I ate the candy,” “I know eating the candy does not get me to my goal,” and “I resolve to not do that next time” moments.

We are all learning more, all the time. The better we recognize and analyze our behavior, the more likely we will change it and make positive, healthy lifestyle decisions.

< As written for Doctor for Life >
AarikaFirst Week
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Resolve to Succeed

It’s that time again. We can’t believe it’s December. Christmas is almost here. We recap our year, taking stock of the best times and worst times. We evaluate, how did 2017 go? We think about a new year and a new beginning. It means something to us, somehow.

Self-improvement is a shared hobby. It is estimated that greater than 40% of Americans make New Year’s Resolutions. But only about 8% achieve them.

People have good intentions. The problem lies in goal-setting. Say the first thought is “I want to lose weight.” A person may decide on a goal of losing 30 pounds.

“Losing 30 pounds” is an Outcome Goal. It’s what you accomplish after a series of steps. You have to work to get there. Instead, a person should focus on Behavior Goals – what, when and how you are going to do something in order to lose that 30 pounds.

I found a Forbes article that breaks down how to be successful with New Year’s Resolutions nicely, that is worth re-reading every year. Borrowing the sections…

Keep It Simple

We tend to set a huge goal or create a long list for ourselves. We are daunted from the start, which can lead to failing to launch at all or getting overwhelmed early. Instead, set small, attainable goals… “I am going to walk in my neighborhood.”

Make It Tangible

The more vague your resolution, the more vague your results. We have to be specific with our goals, and we have to measure the method. “I am going to walk in my neighborhood every Sunday for 30 minutes.”

Make It Obvious

Track, track, track! The pure idea that you have to document what you do (and don’t do) will affect your choices. It becomes real then. You have to admit it. Another great tactic is sharing your goals with other people – family, friends, social media. You are then accountable to more than just yourself.

Keep Believing You Can Do It

Simply setting a goal increases your chances of actually achieving something by 10 times (according to Statistic Brain). Yet average people get discouraged easily after a couple weeks or months. They feel defeated and at fault. Yet confidence is key. You have as much willpower as you think you have. So boost that willpower supply with some self-love and positive influences.

< As written for Doctor for Life >
AarikaResolve to Succeed
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Meet Me at the Bar

Closing out the year strong, and having a little flexibility of schedule, I decided to take on a new fitness venture. My office life kept me in Greenville, so what better time to explore that area. I had two friends petition me to come to their group exercise classes. They didn’t have to try hard at all to get me to CycleBar.

Sells Itself

CycleBar started in 2004 in Boston and is now a well-recognized cycle studio brand with franchise opportunities. The founding principles for a rockin’ experience still stand: great instructors, great music, great environment. The CycleTheatre is most impressive – tiered bikes, data monitoring and state-of-the-art audio, video and lighting.

Goal Setting

As a first-timer, I got to participate in a 30-minute Intro Ride for free. Unfortunately, I was late to that class due to Woodruff Road traffic. Fortunately, they were so nice to let me just hang for another 20 minutes and join the next full-length class (for all levels). I absolutely loved it! Clearly high from endorphins, I purchased a New Riders Special – 5 rides for $39. Since the rides expired after 1 month, it perfectly fit my timeline for a “December of devotion,” and I opted for 1 ride per week.

CycleBar

Some details about this experience that can’t be overlooked… CycleBar was incredibly thoughtful. They gave me promo items upon signing up – water bottle, lip balm, magnet. They supplied water, snacks and all kinds of products in the bathroom including hair ties. They provided cycling shoes and sweat towels for each ride. CycleBar also had their tech covered. You register online for classes, then arrive in-person to simply check-in on a tablet.

CycleStars

My secondary goal was to try all different instructors. I thought, I might as well maximize this situation for variety of class types and personalities. I took my friend Simone’s class. She is a powerhouse, and for this particular sesh she was 8 months pregnant. She said, “If I can do it, you can.” :0 I took my friend Emily’s class. She used music videos, which totally had me tranced and ignoring the pain. We blasted our “glutes and guns.” Also, shout outs to Lisl, Greta, Vilora and Demar. They were all high-energy, motivational and caring. CycleBar has to be proud!

CycleBar = Focused indoor cycling. Moving and grooving relentlessly but not even noticing. Concierge and clean.

 

AarikaMeet Me at the Bar
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Diabetes Prevention Program

I took this picture the last day of class. I paused on my way out the door, letting the impact of the empty room and happy memories linger for a moment more…

I became a YMCA Diabetes Prevention Program Lifestyle Coach in 2016. Aside from my general agenda for healthy and fit living and my grandfather recently being diagnosed with type 2 diabetes, I was shocked by the staggering statistics of this disease plaguing America.

  • 29.1 million people suffer from diabetes (27% don’t know it)
  • Another 86 million people have prediabetes (90% don’t know it)
  • Without weight loss and moderate physical activity, 15-30% of those with prediabetes will develop type 2 diabetes within 5 years
  • Risk of death for adults with diabetes is 50% higher than for adults without diabetes
  • In 2012, reported total medical costs and lost work and wages for people diagnosed with diabetes was $245 billion
  • Type 2 diabetes is a “lifestyle disease” – which is preventable and should be fought

The YMCA’s program helps adults reduce their risk for developing diabetes by taking steps that will improve their overall health and well-being. Participants qualify for the program by being 18 years of age or older, overweight (BMI of 25 or greater), and diagnosed with prediabetes via a blood test or gestational diabetes. The program is a one-year commitment – meeting as a group weekly for the first 16 sessions, meeting every other week for the next 3 sessions, and meeting monthly for the final 6 sessions. The YDPP emphasizes two primary goals: reducing body weight by 7% and increasing physical activity to 150 minutes per week.

Thanks to the company AFL and their wellness initiatives, I was able to start facilitating a class at their Duncan, SC, campus in December 2016. Some might have questioned beginning our program near the end of the calendar year, but – lemons to lemonade – I was convinced that my participants could learn a tremendous amount in 3 weeks and go into the holidays more prepared than ever.

Day One, we were all a little nervous, I think. But our small group of 4 bonded quickly and proved to be a candid and effective setting.

We powered through Y curriculum. We shared our triumphs and struggles and made action plans. We practiced fitness and nutrition challenges like a week without fried food, pizza or chocolate; cooking a new recipe, buying a piece of gear; and working out with a buddy.

We had “lapse” but not “relapse.” We had birthdays, weddings, travel, bad weather, office deadlines and so many other life events – that, under other circumstances, may have held us back. But we learned.

We actually looked forward to seeing each other. The “power of the group” was valued and motivational. They definitely had a coach who cared. And I had participants who would get REAL. That’s how we managed our year together.

I would be remiss to not say that as of December 2017, all 4 people did prevent diabetes!

So, to Angie, the HR lead who championed YDPP, and to John, Rich, Candice and Tammy, the hard-working, fun-loving folks I am grateful to know…

“Go forth and be successful!”

 

AarikaDiabetes Prevention Program
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Low-Fat Foods Making You Fatter

What? Fat is not the Devil? Sugar is the leading cause of weight gain? Check out this video from the host of TruTV’s Adam Ruins Everything, as posted by CollegeHumor. Very insightful and entertaining presentation about a huge myth – that eating fat makes you fat. Instead, hear how bad science and the sugar industry worked together to dupe Americans, or at least not tell the whole story for many decades.

< As written for Doctor for Life >
AarikaLow-Fat Foods Making You Fatter
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Behavior Change Revolution

I was listening to a podcast from Freakonomics Radio entitled “How to Launch a Behavior-Change Revolution.” It relates entirely to my everyday struggle as a health and fitness professional, and covers an underlying issue for client success in Healthy Weight Lifestyle Programs at Doctor for Life.

Behavior change is a big ask. Experts understanding thinking and decision-making is tough. The average person understanding his or her own influences and patterns is tougher. And that person actively choosing to change and diligently fulfilling that path is the toughest of all. I say to clients all the time, “Knowing what to do and actually doing it are two different things.”

The podcast representatives state that human nature is to “repeatedly make decisions that undermine their own wellbeing” and that “people rarely behave as rationally as economic models predict.” They believe that studying and trying to implement behavior change is the most worthwhile pursuit for any scientist, that it is wise to help people make better decisions for themselves and for society. I agree.

With the staggering and growing statistics in obesity and chronic disease, particularly a lifestyle-related disease like Type II Diabetes, I do not doubt that the general public is ignorant to the fact that all these per-day and per-meal unhealthy decisions add up. Of course, it is much more convenient to eat a fast food cheeseburger today than to worry about how that affects many tomorrows and premature death.

This podcast focuses on a group of researchers, a dream team, coming together to work on the Behavior Change for Good Initiative. Their mission is to determine best practices in three realms – number one being Health (smoking cessation, healthy eating, increasing exercise, reducing alcohol consumption). They are partnering with large organizations for participation and funding of real-world experiments, helping scientists discover insights that could address the pressing social problem of self-destructive humans and establish long-lasting behavior change.

The Behavior Change Revolution has been happening for decades – in academia for a while, and creeping into government policy shops and commercial firms more recently. But it is hardly mainstream yet. Institutional and societal change, when it happens at all, usually happens slowly and with a lot of pushback. So this team’s ambition is quite lofty (and time-consuming, and expensive).

Will it take a nudge? Will it take expanding or shrinking choice sets? Will it take redesigning how incentives in given situations are set up, via smart algorithms or old-fashioned human touch? The ultimate goal is to help people get satisfaction they’ll need in the short-term and outcomes they’ll want in the long-term.

< As written for Doctor for Life >
AarikaBehavior Change Revolution
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Cancer & Excess Weight

A recent Internal Medicine News article covered an October report from the Centers for Disease Control and Prevention citing that “being overweight or obese significantly increased the risk of developing at least 13 types of cancer.”

The study compared statistics between 2005 and 2014, showing that obesity-related cancers* increased by 7%. They found that 40% of nearly 1.6 million of all cancer diagnoses were people with overweight- or obesity-related cancers. The rates were more pronounced in older people (50-74 years of age) and women (possibly because of female-specific cancers). Although, during that same time period, incidences of cancers unrelated to body weight decreased by 13%. [*Excluding colorectal cancer.]

CDC Director Brenda Fitzgerald, MD…

“A majority of American adults weigh more than recommended – and being overweight or obese puts people at higher risk for a number of cancers – so these findings are a cause for concern. By getting to and keeping a healthy weight, we all can play a role in cancer prevention.”

Doctor for Life bridges the gap to fight overweight and obesity and chronic disease. Our Healthy Weight Lifestyle approach helps mitigate these negative statistics with screening and prevention. Our lead physician is board certified in both Internal Medicine and Obesity Medicine.

Dr. Cheryl Sarmiento…

“Even though the effects of unhealthy weight on diabetes, cardiovascular disease, mortality and other health outcomes are widely known, there is less awareness that unhealthy weight gain is associated with increased risk of certain cancers. There are opportunities for Clinical Intervention, and at DFL, we have all the available tools with services and programs to fight these dreadful diseases.”

< As written for Doctor for Life >
AarikaCancer & Excess Weight
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Atlanta MANIA

MANIA is an annual fitness convention offered in multiple states by SCW Fitness Education, where professionals go to earn credits, get certifications, network with peers, learn new material and be utterly inspired. This year’s Atlanta conference was held July 28-30, and our Fitness department was in attendance.

One Doctor for Life priority is enlisting the most qualified employees. We take pride in investing in staff, providing Certified Personal Trainers and others with continuing education opportunities. The goal was to have trainers and group exercise instructors return from this conference enthusiastic, knowledgeable and better able to serve clients. Here’s what the team had to say…

AARIKA

“What a fantastic experience to reinvigorate the spirit! I loved going with colleagues because we got to know one another better, shared a lot of laughs and commiserated over being exhausted after multiple hours of exercise. I felt lucky to have picked such a thought-provoking two-day lineup. My favorite session was Barre Trilogy with Leslee Bender. She was charismatic and wise. The class was part lecture and part activity. We covered warm-ups and cool-downs with myofascial release. I was fascinated by the impact these can have on performance and recovery.”   

CHRIS

“MANIA was an overall awesome opportunity. It was a great chance to catch up on what is going on in the fitness industry, what the latest trends are and the current research and application. My favorite class was definitely a tie between Stress and Chronic Disease by Kimberly Garcia and Everything Resistance Training by Dr. Len Kravitz. Both of these lectures were super informative, […] explaining the physiology behind everything we discussed. Dr. Kravitz challenged you to […] take a more scientific approach to training clients. Kimberly Garcia encouraged us to look outside the box at how different factors are stressing the body, and how these stressors may be affecting our clients’ overall health and well-being.”

ANNA

“This past weekend in Atlanta for the SCW Fitness Conference was a wonderful experience, and I certainly think my time was well spent in the classes. Some of the sessions incorporated lectures to refresh already acquired knowledge, and then brought attention to additional information that can be used to further health and fitness for clients and myself. My favorite class was a very challenging workout with SGT Ken, which was as physically taxing as it was mentally exhausting. SGT Ken’s class sparked some ideas of how to workout more efficiently, so that each exercise session presents the rewarding feeling that only comes from the combination of motivation and hard work.”

< As written for Doctor for Life >
AarikaAtlanta MANIA
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HIIT Me

After leaving my job at the YMCA, I found myself right back in the Group Exercise classroom regularly. But this time, I was not teaching; I was participating.

For one, my Wellness Department successor Wendy Jo was leading a new Small Group Training, and I wanted to support her and this effort to bring specialty, pay-for programming to Y members. For two, the class type was High Intensity Interval Training (HIIT), and I had never focused on that very intentionally. For three, the commitment was six weeks, and I could really use that as a condensed period for reboot and body change. Wahoo!!!

HIIT Explained

High Intensity Interval Training describes any workout that alternates between intense bursts of activity and fixed periods of less-intense activity or even complete rest. For example, a good starter workout is running as fast as you can for one minute and then walking for two minutes. This Shape Magazine article lists 8 benefits of HIIT…

  1. Efficient
  2. Burn fat
  3. Maintain muscle
  4. Healthier heart
  5. No equipment necessary
  6. Do anywhere
  7. Increase metabolism
  8. Seriously challenging

HIIT Experience

I was right that I was not at my preferred level of fitness. I found that out on Day One of class. Granted, HIIT is not supposed to be easy. But, I really thought I would fair better. So, this revelation made me work even harder over the six weeks. I only missed one session – because of a travel conflict. I even worked out on my birthday – really proud of that choice. Wendy Jo and Jana were the instructors. And, man, did they make us all sweat. I did see improvements in endurance and body fat. Don’t worry about my red face in the photo above. I was just pushing it to the max!

I loved this new experience. It is me upholding an objective for the year – “engaging in new physical challenges to keep my own activity fresh and interesting.” To make twice a week workouts for six weeks took prioritization, and was not without me rescheduling a date night or two. Setting goals is incredibly important for me. I really enjoy executing a plan.

YMCA

I am a member of the YMCA of Greater Spartanburg. I mostly frequent their Thomas E. Hannah branch located in downtown Spartanburg. This facility is pretty amazing. It is only about 6 years old, which means state-of-the-art design and clean. They offer plentiful amenities for exercise – courts, pools, classrooms, Schwinn cycles, machines, free weights, functional tools and adjacency to the city’s Rail Trail. The Y is also well known for Group Exercise, offering 65 classes per week, last time I counted. Some instructors have been staples in the community for decades. And that doesn’t mean they are stale; they are the most energetic, caring people you’ll ever meet. Extra nice – Standard GX is included with your monthly membership fee.

YMCA Small Group HIIT = Great variety. Heart pumping. Falling in the floor but smiling. High fives!

 

AarikaHIIT Me
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