Tag Archives: Diabetes

Humana Bold Goal Launched in Jacksonville, Florida – a Call to Action

This is the longer original piece with all the links and images that  was the genesis for the Florida Times Union commentary.

This past month I had the opportunity to participate during Humana’s  half-day Bold Goal launch conference in Jacksonville, Florida (the county seat is Jacksonville and there has been a consolidated government of Duval County since 1968, so some refer to the broader county).  The conference had excellent presentations and I was honored to be included with a distinguished group of panelists from the Health Department, hospitals, providers of care and the Duval County Medical Society. It was nice to be involved in an event and try to play a role in improving the health in the community in which I live.

There are other efforts ongoing to improve community health in Jacksonville, including the Clinton Health Matters Initiative, which has focused on solving the hunger issues and a number of hospitals have launched their own efforts as part of the Community Health Assessment and Improvement Plan. While these programs and others in the community may have made some progress, Jacksonville still faces major health issues and our quality measures are poor:

Some of the major barriers we face include:

  • we tend to say we need more data or another study,
  • we have not been very innovative, and
  • we have little accountability.

As far as data goes, there are plenty of studies available in addition to those cited above. Here are just a few more interesting ones: Continue reading

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PopHealth Week Explores Full Risk Medicare Advantage with Roy Hinman, MD, Founder of Island Doctors, a Pioneering Primary Care Physician

Island Doctors Capture_03B_CleanPopHealth Week’s guest on July 1 at 12 pm ET is Roy Hinman, MD the founder and CEO of Island Doctors which employs more than 50 people within 14 offices in Florida stretching from Jacksonville to Interlachen and New Smyrna Beach. He opened his first family practice office in 1991 on Anastasia Island in St. Augustine, Florida.

Dr. Hinman is a pioneer and began to take full risk Medicare Advantage in 1998. Since then, Dr. Hinman’s practice has grown to approximately 16,000 capitated Medicare Advantage patients in Florida. He anticipates having 20 offices by the end of 2015 to meet the demand. In addition to his owned offices, he also manages a network of 32 affiliated providers.

With innovative programs targeting diabetes, COPD, cholesterol, smoking and weight loss, he understands keeping patients healthy and how to manage capitated contracts. His comments may surprise you.

Here’s some of Dr. Hinman’s bio:

Dr. Hinman was raised in Tulsa, Oklahoma. He is a graduate of Oklahoma Military Academy, received his Bachelor’s Degree in Psychology from Tulsa University, and his Master’s Degree in Human Resource Management from Pepperdine University in Malibu, California. He completed medical school at Universidad Technologica de Santiago in Santo Domingo, The Dominican Republic. He served his family practice residency with the University of Florida Medical Program at the University Medical Center in Jacksonville, Florida and worked as an emergency room physician at Bradford County Hospital in Starke, Florida and at Ed Fraser Memorial Hospital in Macclenny, Florida.

Commissioned as a Second Lieutenant in the U.S. Armored Cavalry in 1975 at Oklahoma State University, Colonel Hinman ultimately retired from the U.S. Army Reserve in 2014 as a Medical Corps officer, after 37 years of military duty in the United States, Germany, Korea, Kuwait, Nicaragua, Panama, Saudi Arabia, Ecuador, the Dominican Republic, and Iraq where he served three combat tours. He recently served as the Territorial Surgeon of the U.S. Virgin Islands.

Dr. Hinman is Board-Certified in Family Practice and is a member of the Florida Medical Association, the American Association of Family Practitioners, the Florida Association of Family Practitioners, the St. Johns County Medical Society and the American Academy of Anti-Aging, and has full Family Practice admitting privileges at Flagler Hospital in St. Augustine, Florida where he has been an active staff member since 1991.

So join PopHealth Week’s guest, Dr. Roy Hinman and gain valuable insights into how he has been doing what many have, and or will be trying in the not to distant future, full risk capitation.

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Medicaid – a Community Based Approach to Fixing the Issue

Medicaid, a program for low-income Americans, is one of the largest health programs in the country and is  jointly administered by the Federal Government and the States.  With passage of the Affordable Care Act, Medicaid in many states will be adding millions of new beneficiaries to a program that is typically the first or second largest line item in the State’s budget.

It’s well-known that Medicaid has always struggled with poor payment and provider networks, managed care plans that sometimes work, and  ever-increasing  expenditures.  A recent study released by Gallup points to another problem known for years by those involved with Medicaid but which the current Medicaid system has little or no ability to address; the ever-increasing rate of preventable chronic diseases.

The Gallup Wellbeing Survey documents  the issue clearly if you look at the data for Diabetes, Obesity, High Blood Pressure or High Cholesterol. The reported rates of  these conditions are higher than just about any other group surveyed and the rate of Obesity is the highest of any group.   Medicaid beneficiaries  also report very high rates of smoking, exercise less often and are less likely to eat fruits and vegetables. As the article points out, there is a link between poor health and poverty. We have heard of the issues of “food deserts” and  getting exercise or feeling safe doing outdoor activities is not always possible in certain neighborhoods. Furthermore, access to physicians and other health services are a problem that has been well documented in many Medicaid programs.

To begin to solve this issue we must make a concerted effort to integrate Prevention into the Medicaid programs and expand our thinking about what it takes to “create health” versus what we do to “treat illness.” Medicaid today is structured to treat illness; you get sick, you go the doctor, you get treated, the doctor gets paid, and as is often the case in Medicaid, this does not occur well at any point in the process for a myriad of reasons.    But more importantly why should we be accepting of a higher rate of preventable chronic diseases, the costs of which will continue to grow and impact state budgets, while we narrowly focus on improving Medicaid’s “care system?”

The time is now, before we add millions of new beneficiaries, to revamp Medicaid to create a  comprehensive program targeting the lifestyle issues that create these higher rates of preventable chronic diseases while continuing efforts to improve the sick care system.  The way to do this is not to start by adding more funding to Medicaid but to lead by having Medicaid convene a community in which it operates, invite the beneficiaries, not for profit organizations, schools, religious institutions, providers,  government agencies and employers and develop a broad-based plan to address the issues impacting these lifestyle related diseases.

There are a myriad of disparate resources available throughout these communities that if harnessed, focused and integrated could create the synergies needed to improve upon the communities health and reverse these trends. These groups need to be brought together,  held accountable for their results and incentivized by offering a percentage of the savings. This type of Accountable Health system would create a healthier community.

To learn more or set up this process in your state or local community, contact me.

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Sitting Less Reduces One’s Risk for Type 2 Diabetes, Really?

Sitting less reduces one’s risk for developing Type 2 Diabetes.  Well, is that really much of a shocker? Sure its a bit of a variant from telling someone that they need to exercise 150 minutes per week, but is it really that much?  Have we become so jaded that we need to publish what should be obvious. Like others, I have worked on exercise and eating to cut some excess weight and become healthier. A few years ago, after seeing those around me get up from their desk , I decided to remove the chair and began using a standing desk. It’s an easy thing to do and only takes a few days to become acclimated to it. It’s certainly worth a try…

Or perhaps you can get up and walk around more often;

And then we have the study about woman and less house work where it looks like time sitting at home went from about 8 hours in 1965 to 16.5 hours in 2010. Perhaps remove the couch in front of the TV??

I guess you coud try either one…….. until you can’t stand it anymore..

So there you have it, one more Accountable Activity to improve your health brought to you by…

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