Tips from gaining health

Looking through the MRI

In a prior posting, the Disease Management Care Blog was reminded that the U.S. health care system  is exceptionally complex and non-linear. Thanks to its many overlapping, contradictory, shifting and often non-medical inputs, it defies the simple logic of a single-cause-leading-to-a-single-effect. If economics is the dismal science, health care economics is its dubious spawn.

However, that doesnt mean that multiple coordinated inputs combined with some good luck wont push the health care weather vane in the right direction. For the latest example of this fundamental truism, check out David Lee and Frank Levys Health Affairs article The Sharp Slowdown In Growth Of Medical Imaging: An Early Analysis Suggests Combination Of Policies Was The Cause.

By way of background, medical imaging has been a high profile issue for policy makers and a headache for insurers because, until recently, the rate of costly "high dollar" imaging studies has been growing much faster than other medical costs.  It has been blamed as one technology-laden driver of health care inflation.  In the meantime, physicians have pointed to a variety of causes (and, by the way, left others unmentioned).  

In this study, the authors examined 10 years worth of insurance claims for advanced imaging MRI and CAT scans from two multi-state commercial insurance plans and another smaller single state plan.  These data were then pooled with a 5% national random sample of imaging claims from Medicare beneficiaries.  The authors also interviewed radiologists, health administrators, radiology benefit managers and physician recruiters.

The results?  From 2000 through 2005, CT scans grew at a whopping rate of 14.3% but then slowed to 1.4%. MRI slowed in the same periods from 14% to 2.6%. At the same time, starting salaries for radiology specialist physicians significantly declined.
 
What happened?  According to the authors:

1. An industry sprung up.  In another example of the adage that "need is the mother of invention," companies that prior authorize imaging studies for medical necessity (for example) were hired by many commercial insurers.  They had an impact.

2. Skin in the game. Deductibles, co-insurance and co-pays made consumers think twice about agreeing to a study that was going to result in some out-of-pocket spending.

3. Unilaterally imposed fee reductions. Medicare cut the amount it paid for CAT and MRI studies performed in freestanding centers and physicians offices. Hospitals were left untouched.

4. Glow in the dark.  Media reports on the amount of radiation prompted patients to worry about the long term impact of all those x-rays.

In other words, there was no single lever. Instead, the reduction of high utilization of pricey imaging was due to the confluence of at least four mutually reinforcing trends.

As further evidence of the overlapping trends that extended beyond simple cause-and-effect, Medicare never relied on prior authorization, didnt alter the out of pocket testing expenses for beneficiaries and left the payments for hospital-based imaging untouched. Yet Medicare saw an across-the-board reduction. MRIs dont involve ionizing radiation (they use relatively harmless magnets), but their overall rate went down in concert with CAT scans..

This has important implications for other laudable policy targets.  Based on this experience, waiving out of pocket costs alone are unlikely to increase the use of preventive health care services. Simply paying for the medical home may not make that big a difference.  Quoting the DMCB may not be enough to convince your skeptical friends.  So on and so on.

The obvious implication for the population health management service companies is that if theyre going to have a significant impact, the likelihood of a successful outcome is far greater if it is implemented concurrently with other supportive interventions.

A few months ago, our own Jaime posted a piece called Little Meals for One. It was a brief, well thought-out article all about simple, small-scale home cooking. I loved it, as did many readers who were looking for both inspiration and validation. (A spoonful of peanut butter IS TOO a meal, dangit.)

Because sometimes? You just want food in your mouthhole. You want it in a single portion, and you want it a.s.a.p. Why? Well, maybe you’re late coming home from the office. Maybe it’s a lazy Sunday afternoon in August, and you have no great urge to further heat your already-sweltering apartment with a 450ºF oven. Maybe you’re just really hungry, and whipping up a whole lasagna for one person seems totally freaking insane.

Unfortunately, quick, single-portion recipes are hard to come by, probably because it’s difficult to prepare most gourmet meals in smaller serving sizes. So, how do you do it? How do you make a convenient, speedy meal without resorting to A) expensive and unhealthy processed food, B) takeout, or C) licking crumbs off your kitchen floor?

Well, first, it’s good to keep tricks these in mind:

1. Keep your rigerator, pantry, and freezer stocked with food easily portioned into small servings: eggs, cheese, pasta, etc.
2. When you buy bigger packages of food (meat, veggies, etc.), portion them off in smaller grab-and-go bags as soon as you arrive home from the supermarket.
3. Look for recipes where you broil, grill, steam, sauté, boil, and microwave. Avoid recipes where you roast, braise, soak, brine, or marinate.
4. Keep low-cost, high-impact condiments and ingredients handy. Stuff like soy sauce, capers, olives, roasted red peppers, parmesan, curry powder/sauce, Dijon mustard, and horseradish can lend big flavor to tiny dishes in a hurry.
5. Don’t limit yourself to traditional dinner cuisine. Breakfast and lunch foods taste just as good at 7pm.
6. Don’t limit yourself to traditional American cuisine. Soups, curries, and stir fries are healthier and just as fast as burgers and hot dogs.
7. Consider raw fruits and vegetables for side dishes. They’re healthy as all get out, and take zero time to prepare.
8. Load up your freezer to your heart’s content. Frozen meats and produce can be defrosted quickly and cooked even faster. Consider canned versions of certain foods, as well, but be discerning when it comes to both sodium content and taste.
   
9. Before you do anything, scan your fridge for ideas and ingredients. Bits and pieces can become ingredients in larger, more delicious meals.
10. Speaking of bits and pieces, consider using many smaller foods to create one large meal. Eggs, a piece of fruit, and a side of ried beans never killed anyone.
11. Most of all, K.I.S.S. (Keep it Simple, Sistah)
    

After that, it’s always a good idea to er to the basics: a.k.a. Dinners You Learned to Make When You Were 12. Often, these are the easiest options because you already have the ingredients on hand AND youre familiar with the foods. Like:

• Bagels (with low-fat cream cheese, lox, butter, PB&J, etc.)
• Baked potatoes
• Breads (with dips, cheese, veggies, or quick soups)
• Chicken or turkey sausages
  
• Cottage cheese
• Couscous mixed with anything (chopped vegetables, beans, etc.)
• Crackers with toppings of your choice
• Eggs (omelets, scrambled, sandwiches, baked, etc.)
• Fruit
• Grilled or broiled chicken or pork tenders
• Mashed black, pinto, or cannellini beans
• Oatmeal (sweet or savory, a la Mark Bittman)
• Pasta (with sauce, vegetables, cheese, etc.)
• Pierogies (boiled/steamed)
• Pizza bagels/English Muffin pizzas
• Portobello mushrooms
  
• Raw vegetables with simple dips (hummus, baba ghanouj, etc.)
• Rice mixed with vegetables and/or salsa
• Salads (vegetables, fruit, bean, or otherwise)
• Sandwiches (hummus, PB&J, grilled cheese)
• Shish kabobs (meat, veggies, or fruit broiled on a stick)
• Smoothies
• Steamed or sautéed veggies
• Stir fry
• Turkey burgers
• Wraps and/or soft tacos
  
• Yogurt
  

If those fail to float your boat, you might want to do a quick search for some recipes around the web, using the terms "Meals for one," "single serving," or "15 minutes or less." Here are some fast, simple, cheap, healthy suggestions from CHG. All of them can easily be rescaled to feed one person.

• Autumn Apple Salad
• Baked Eggs
• Black-Eyed Pea Salad
• Bodega Beans
• Broiled Eggplant Japonaise
• Creamy Parmesan Orzo
• Egg Drop Soup
• Egg McMuffins
• Eggplant Mini Pizzas
• Garlicky Broccoli Rabe
• Grape and Feta Salad with Rosemary
• Hummus
• Light Chinese Chicken and Broccoli
• Light Garlic Bread
• Miso Soup
• Moroccan Beet Green Omelet
• North African Style Chickpea Salad
• Pancakes (Buttermilkand Whole Wheat Buttermilk)
• Parmesan-crusted Portobello Mushrooms
• Pea Soup
• Polenta
• Refried Beans
• Roasted Asparagus with Poached Egg and Parmesan
• Shaksouka (Eggs Poached in Tomato Sauce)
• Stuffed Peppers

Sweet readers, how about you? What do you eat when you need something small, fast, and nutritionally sound? Do tell. Lets make this the biggest single meal list, ever.

Today on Serious Eats: White Bean and Mushroom Ragout. Plus, a new cookbook find. Rawk.

Masterpiece Blog Theater proudly presents another installation of CHGs ongoing one-act plays.

CHARACTERS
KRIS: an alarmingly freckled 32-year-old food and frugality blogger.
MOTHER NATURE: a faceless, otherworldly entity with omnipotent control over the weather.

SCENE
The back deck of a 110-year-old Brooklyn brownstone that, by all rights, should have been condemned 109 years ago. Kris alofts, and turns her attention toward the sky.

KRIS: Mother Nature! Hi there! It’s Kris!

MOTHER NATURE: Who?

KRIS: Kris? Kinda tall. A little busty. Very near sighted.

MOTHER NATURE: Oh! You! The one with no sense of direction. What up, girl?

KRIS: We have 12 people coming for a potluck dinner today!

MOTHER NATURE: Oooo. Potlucks are the proverbial bomb. What are you making?

KRIS: Italian Turkey Sliders and Potato Salad with Green & White Beans.

MOTHER NATURE: Sweet. Mama likes. What about everybody else?

KRIS: Well, as far as I know:

• R & J: Banana Lemonade and Kettle Corn
• S: Black Bean Dip and Fresh Salsa
• A & A: Berry Trifle and Veggie Skewers
• M & S: Barbecue Pulled Chicken
• L: Hummus
• Leigh & B: Recipe(s) coming Thursday

MOTHER NATURE: Excellent. Send some my way, will you?

KRIS: Uh … but you don’t … have a mouth. Or organs. You’re a foodie?

MOTHER NATURE: Foodie, shmoodie. I’m gonna drop this stuff on washed cars.

KRIS: Oh.

MOTHER NATURE: That Black Bean Dip has a date with my neighbor’s Humvee. Steal MY lawnmower, will you, bud?

KRIS: Makes sense. I guess. But Ma Nature, I have a favor to ask.

MOTHER NATURE: They always do. *sigh* What is it, Magoo?

KRIS: Well here’s the thing: if it rains, we can’t use the backyard. And consequently, we have to stuff everybody – including two toddlers - into an apartment living room the size of a cookie sheet. So, um, can you hold the storms off for like, two or three hours?

MOTHER NATURE: Sure thing!

KRIS: Really?

MOTHER NATURE: No.

KRIS: Oh.

MOTHER NATURE: Ha! Father Time always falls for that, too. Don’t worry kid.

KRIS: So you will stop it from raining?

MOTHER NATURE: No.

KRIS: Um.

MOTHER NATURE: But I’ll tell you what I’ll do: If you give me the recipe for those Italian Turkey Sliders, I’ll make it rain just enough so that you THINK you can stay outside, but after ten minutes, you have to haul everyone and all their food upstairs.

KRIS: That doesn’t sound like a very good deal.

MOTHER NATURE: Wait – I’m not done. Then, I’ll cut it down to a misty drizzle, so everyone moves back outside again.

KRIS: And then you’ll stop the rain altogether?

MOTHER NATURE: Sure.

KRIS: Really?

MOTHER NATURE: No.

KRIS: I don’t like you.

MOTHER NATURE: Then itll rain for the rest of the afternoon. But you know what they say: False hope is better than no hope at all.

KRIS: I don’t think anyone says that.

MOTHER NATURE: I’m sure someone said it. Anyway, that recipe?

KRIS: Uh. Okay. Here you go.

MOTHER NATURE: Excellent. Hey, hold this lightning for me, will ya?

KRIS: Sure th******** (Kris is electrocuted.)

MOTHER NATURE: Heh. Father Time fell for that one, too.

~~~

If you like this recipe, you might also be stoked by:

• Maque Choux with Chicken and Turkey Sausage
• Turkey Breakfast Sausauge
• Turkey Burgers

~~~

Italian Turkey Sliders
Makes 24 mini-burgers.


1 20-ounce package sweet Italian turkey sausage links (I use Shady Brook. – Kris)
1 20-ounce package 93/7 ground turkey (Shady Brook again. – Kris)
24 slider rolls/mini-hamburger rolls (I use Martin’s Party Potato Rolls. – Kris)
24 small slices part-skim mozzarella cheese (optional)
1/2 cup your favorite tomato sauce (optional)

1) Preheat your grill.

2) Using a knife, make a long slit along each link of the turkey sausage. Remove sausage from casings. Discard casings.

3) Combine turkey sausage in a large bowl with ground turkey. Using your hands, mix/squish until meats are thoroughly combined.

4) Make your slider patties. They should each be approximately 2 to 3 inches across and 3/4-inch thick, with a light thumb indentation in the middle. Store on wax paper until ready to cook. (Note: If you’re refrigerating the patties for later, bring them down to near-room temperature before you slap them on a grill.)

5) Place patties over direct heat and grill 4-6 minutes on each side, until outside is a bit browned and inside is cooked through. When finished, let sit for a few minutes.

6) Place patties on buns. Add mozzarella if you like (you can also do this on the grill), along with a few dabs of your favorite spaghetti sauce. Enjoy.

Approximate Calories, Fat, Fiber, Protein, and Price Per Serving
Due warning: I tried to use pretty generic calculations, but these numbers may differ slightly based on the brands you use.
Patty only: 73 calories, 3.9 g fat, 0 g fiber, 8.8 g protein, $0.29
Patty and bun: 117 calories, 4.4 g fat, 1 g fiber, 9.1 g protein, $0.42
Patty, bun, cheese, and sauce: 139 calories, 5.7 g fat, 1 g fiber, 10.9 g protein $0.52

Calculations
1 20-ounce package sweet Italian turkey sausage links: 960 calories, 54 g fat, 0 g fiber, 102 g protein, $2.99:
1 20-ounce package 93/7 ground turkey: 800 calories, 40 g fat, 0 g fiber, 110 g protein, $3.99
24 slider rolls/mini-hamburger rolls: 1040 calories, 12 g fat, 24 g fiber, 6 g protein, $3.19
24 small slices part-skim mozzarella cheese: 432 calories, 27 g fat, 0 g fiber, 41.3 g protein, $1.86
1/2 cup your favorite tomato sauce: 93 calories, 3 g fat, 0.5 g fiber, 2.4 g protein, $0.33
TOTALS: 3325 calories, 136 g fat, 24.5 g fiber, 261.7 g protein, $12.36
PER SERVING (no cheese, sauce, or bun): 73 calories, 3.9 g fat, 0 g fiber, 8.8 g protein, $0.29
PER SERVING (with bun, no cheese or sauce): 117 calories, 4.4 g fat, 1 g fiber, 9.1 g protein, $0.42
PER SERVING (with 1/4 oz cheese and ½ teaspoon tomato sauce): 139 calories, 5.7 g fat,1 g fiber, 10.9 g protein $0.52

One More Proof, Sleep Deprivation Trigger Diabetes? | A recent research suggesting a link between lack of sleep and the risk of diabetes. In their research, scientists from the Brigham and Womens Hospital in Boston found, inconsistent sleep schedule or sleep deprivation can increase the risk of obesity and type 2 diabetes.

In his study, researchers monitored 21 healthy people, who all live in a sleep laboratory for nearly six weeks, in which the cycles of sleep, diet and activity are all controlled by researcher.

The findings showed that participants who are only allowed to sleep about six hours a night and experienced a shift in the cycle sleep/wake has a blood sugar level is higher and tends to slow down the metabolic process.

"The level of glucose that higher for long periods of time on some of the participants could be increased to pre-diabetes," said the researcher. These findings were published on 11 April 2012 in the journal Science Translational Medicine.

Sleep and blood sugar

In the study, researchers conducted blood tests to measure levels of several hormones, including insulin, cortisol (stress related), and leptin and ghrelin (which relate to regulate appetite).

They found that disrupted sleep schedules cause a decrease in 32 percent of the amount of insulin released in the body after eating. Insulin is a key hormone in the regulation of blood sugar.

"The decline in insulin levels is one explanation of how the disruption or lack of sleep can cause diabetes," said Lisa Rafalson, a professor of pediatrics and family medicine at the University at Buffalo.

Rafalson revealed an increase in stress hormones that kept awake the body can cause hormonal imbalances. "Insulin can not perform their duties efficiently, so you end up getting the remaining excess glucose in the bloodstream," he said.

While the latest findings, the researchers did not notice any changes in hormone levels gheriln (which increases appetite) on the sleep-deprived participants. Whereas some previous studies showed that sleep deprivation can lead to higher levels of the hormone ghrelin and leptin are lower.

Related to these findings, Fonseca said, researchers need to find out if there is a solution to prevent the increased risk of diabetes in addition to sleep more.

"The reality is that many people who sleep less because they work. We need to identify if there is anything else they can do to fix it," he said.