All posts tagged: disease

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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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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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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Still Alice

I recently finished a book about a woman who’s diagnosed with early-onset Alzheimer’s disease and her struggle to hang on to whatever she can of herself throughout the process, hence the title Still Alice. The novel by Lisa Genova portrays Alice Howland, a 50 year-old renowned psychology professor at Harvard University who begins to notice strange occurrences in her daily routine – not recalling words mid-thought, forgetting class times and what that day’s lecture topic should be in a series and becoming disoriented a few blocks from home and not knowing how to get back home.

Alice has always been a superior mentalist, making scientific breakthroughs and setting admirable precedents in her field. She knows this behavior is anything but normal, and after wading through a lot of denial, she final seeks help. Many tests and sleepless nights later, she discovers that she has Alzheimer’s and that her whole world is about to change drastically.

She worries about her family. How will they cope with this illness? Will her husband have to sacrifice his life-long work and passion to support her? Will she eventually not recognize her daughters and son? Was this gene abnormality passed on to her children? Will anyone have the patience?

She worries about her career. How can she possibly teach cognitive psychology and linguistics without being able to tap into those well-earned mental resources anymore? How long until her students and superiors notice? What will she be if not Alice The Brilliant Professor?

She worries about societal stigma. Why is this prognosis so difficult to bring herself to explain? Will she be able to keep up in everyday conversations and activities? Will people shy away from her with a polite nod and grin as to not offend? Will she simply be ignored because that’s easier?

Alice finds that all her worst fears are true. She grapples to preserve her memories – her mother’s Christmas bread pudding recipe, her youngest daughter’s first name – and her reasoning skills – what day is it, what is that thing called. But dementia cannot be reversed and can hardly be halted.  When her brain ceases to function naturally, when her mental synapses stop firing, the cells die, and it’s like fumbling in a maze to find ideas, knowing that the information is there yet not being able to reach it. That is the mild condition, until she loses control of motor abilities like walking or chewing.

You know this story is about a woman with a severely degenerative disease. You know you’re going to be saddened and confused as it progresses, as you see her desperate in an attempt to preserve even the little things that make Alice Alice.

I couldn’t have gotten a full breadth of Alzheimer’s from a fiction novel, but it made me thoughtfully consider the minutia that I take for granted and understand possibly the most about the mind and how it affects a soul that I ever discerned.

In a lecture to an Alzheimer’s related audience, Alice says, “There’s no peace in being unsure of everything all the time.” I dog-eared this page and took a moment. Of course, her’s has to be one of the worst fates to overcome an individual, and this puts a lot in perspective for the reader. The most triumphant ending is that Alice does find a way to accept her new reality and steer with love, letting raw emotions prevail in times of trial. And that’s a powerful message.

AarikaStill Alice
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