Policy in Plainer English

You will find important context and links at the first half of this 2-part episode on Lifestyle Medicine, so if you haven't checked that out, there's no time like the present.

This episode features a conversation with the Lifestyle Medicine team at Springfield Medical Care Systems - Laura Jensen, Adam Ameele, Scott Durgin.

It also mentions RiseVT, which funds part of Laura's position and helped with some elements of starting the SMCS program (which began with a HRSA supplemental grant for FQHCs).

Another item mentioned in this episode is what determines the flavors we enjoy. Did you know I wrote a book on that? Seriously, I did, that's not a joke. I'm not saying it sold well or that it's still in print, I'm just saying I wrote one - go ahead and message me if you want a copy. OR you could read a book on this topic that sold quite well, Bee Wilson's First Bite. 

In the first of two episodes on Lifestyle Medicine, we interview Dr. Elisabeth Fontaine and Dr. Scott Durgin. They provide background on the Lifestyle Medicine framework, which will set us up to talk to more members of the Lifestyle Medicine team at Springfield Medical Care Systems about how they're implementing support of a plant-based, whole food centered diet with their patients. That's Part 2 and it will be great, so be prepared by listening to this one first.

Links mentioned in this episode include:

• American College of Lifestyle Medicine - Which includes the diagram of the six areas of focus.
• While you can find resources at the general link above, Dr. Fontaine also recommends The Plantrician Project,  Lifestyle Medicine Economic Research Consortium, Nutritional Update for Physicians: Plant-Based Diets, The Power of Plants.
• We also referenced Michael Pollan's In Defense of Food. 
• The two websites for Dr. Fontaine's current work: Let's Lead and Plant Based Telehealth.
• If you want the details on those primary care spending percentages cited in the show, rest assured we had a work group on that. Here is the report (Feb, 2020). 

Ready for Part 2 of this episode? It's posted here.

This episode we welcome David Waters, CEO of Community Servings, to our show. Community Servings is a Massachusetts-based Medically Tailored Meals (MTM) program that is also a leader in the national Food is Medicine Coalition.

Community Servings was founded in 1990 to serve local Dorchester and Roxbury residents struggling with HIV / AIDS. It is now a regional organization serving 15 different meal plans to 2,300 patients at a time. You may have heard them mentioned in previous discussions not only for their role in MTMs, but also the Massachusetts State Food Plan.  You can access that plan from the Food is Medicine Massachusetts coalition. 

As referenced in this episode, there are a lot of resources out there on Medically Tailored Meals. Here are some highlights:

• Definition of "Medically Tailored Meals" and guidelines.
• FiMC Accelerator Program - a 12 month intensive program for creating and scaling new MTM projects.
• Research on MTM impacts - examples from the FiMC research library, note that many programs are also doing intensive program evaluations with partners (for example, insurance payers) that aren't necessarily published. This may merit another episode for the data lovers in the crowd.
• California Food is Medicine Coalition - Notable among the different MTM programs because California has a lot of projects going within a single state and they are working together to develop funding models and study impact. 
• Examples of Nutrition Information - God's Love We Deliver, the NYC-based MTM program, has some great nutrition resources and fact sheets that show how they tailor meals for different medical conditions and food preferences. 
• Where to find out about MTM work in Vermont - part of Bi-State's current Food in Health Care grant involves a consultant-led planning process to develop next steps for exploring MTMs in Vermont, look at this page for background information and look for new updates in late spring, 2021 when the project will be wrapping up its first stage.

Special thanks to Marydale DeBor of Fresh Advantage LLC who is working with Bi-State on our MTM project and helped arrange this interview.

[Update to this episode: You can read the July, 2021, rule on audio-only telehealth reimbursement from the Dept. of Financial Regulation here]

The Policy in Plainer English podcast had been taking a break between seasons, but we return now briefly to bring you this bonus episode on the future of using the telephone in health care. It is a summary of the report from the working group on audio-only telemedicine reimbursement in Vermont.

But also we tell you the future of telehealth.

Because we dream big in health care policy in Vermont.

If you would like access to the original report, with details and a reliable narrator (aka the Department of Financial Regulation), you can find it online here.

This would also be a good opportunity to go back and review Season 2 of Policy in Plainer English, which was devoted to telehealth during COVID-19. You can find all the episodes linked from the Season Finale here.  You can also review the Telehealth in Vermont Resource Guide for many, many links to learn more. 

Also, a tip from the audio editing, I did not slow down my natural speech patterns on this one - this is how fast I talk. I had 6 months of difficult work and 114 pages of final report to get through in approximately 15 minutes of podcast, that's a lot! If you don't like the information reviewed this quickly, your podcast player should have an option to play back more slowly. 

Not to be confused with our episode on Telehealth and Transportation, this episode is on Food and Transportation. .  . perhaps we're adding up to a season on transportation. In this episode Faye Mack, of Hunger Free Vermont, and Maureen Boardman, of Little Rivers Health Care, join us to talk about how to tackle the related problems of barriers to transportation and barriers to food access.

We mention a few additional tools and examples in the episode:

• Farm-to-Plate: Local Planning for Food Access
• Farm-to-Plate: Resources for Retailers
• Geisinger Fresh Food Farmacy Presentation - From Bi-State's 2019 Clinical Quality Symposium

And with that, we're taking an end of year break - look for new episodes in January!

On November 19th, Bi-State Primary Care Association hosted a discussion with a large panel of organizations that help health care practices and their patients (and others, but we're health care focused) connect with food resources. They discussed how they have adjusted their programs in response to COVID-19.  

Much as the amount of audio to be edited for this episode exceeded my patience, so too did the amount of text for linking resources exceed the word limit on this podcast posting platform. You can access the full show notes at VTFoodInHealth.net. 

This episode features Janet Kilburn and Elizabeth Gilman discussing Help Me Grow, and the role this program's coordinative services play in helping families with young children connect to food resources.

As noted in the podcast, connecting for food access is just one piece of what Help Me Grow does and if you want to learn more about all their programs please visit their website: helpmegrowvt.org. You may also want to explore a bit at Vermont 2-1-1, which is mentioned in the episode.

This episode builds from the ones that went before it, and in particular our earlier episode on care coordination at health care practices. If you haven't listened to that episode yet, maybe start there and then tune in here. 

We continue our discussion of care coordination with Jodi Frei, of OneCare Vermont, and Patrick Clark, of Gifford Medical Center, and take a deep dive on a particular platform: Care Navigator.

Care Navigator is part of a larger approach to Care Coordination at OneCare, and there's a lot of information if you want to learn more about it.

The patient programs section of the OneCare website provides an overview of their care coordination work, including a chart showing what constitutes high / very high risk medically complex patients.

The 2019 Annual Report explains how care coordination fits into the overall OneCare goals and provides some data on how it is working in Vermont.

And, of course, there's always this podcast's Season One: Welcome to Payment Reform if you want to learn more about the overall ACO model (not specific to OneCare Vermont).

If you listen to this episode and come away wondering "what are the legal obligations around HIPAA and patient privacy related to online platforms for sharing health information?" then may we suggest a recent National Consortium of Telehealth Resource Centers webinar on this topic? This webinar is part of a telehealth series, but it's illuminating and will renew your appreciation for the complexities of building workable tech tools in health care. 

If you want to join the line of people who have stepped forward to inform me that 10 is an arbitrary number of people to play backyard football and that a real football match requires 11 on a side, then fine - this is why Patrick didn't want to say sport analogies on tape. As a former rugby player, I feel that the ideal number of players to field on a team is 15.

The last several episodes went over the process of screening for food insecurity among patients at a health care practice. This episode gets into what happens next - and what happens next usually involves a care coordinator (or similar position). 

We have Kaylana Blindow (Bi-State Primary Care Association) and Laurie Somers (Northern Counties Health Care) guiding us through this episode.  

Before moving on to Care Coordination as part of our series on accessing food resources, we're pausing for a quick look at using predictive analytics to assess which patients might be at risk of food insecurity and how to best reach them with resources they can use.   

This episode references several resources on this topic for learning more, so go check these out:

• The Weitzman Institute webinar series on using technology to address social determinants of health. The entire series is here. The two sessions referenced in this episode were an Introduction to Predictive Analytics and the panel on Food Insecurity.
• At least one of the Weitzman Predictive Analytics panel organizations has its own podcast, The Carrot Schtick.
• I referenced the famous pasta story, told here by Malcolm Gladwell for TED.  In this telling it's a parable about happiness. And if you believe that happiness is understanding market segmentation then he is right. 

Also, I told a very simplified version of my graduate thesis - I feel that to defend the honor of my department chair (who may very well be listening) I should add that I did have a more useful theory I was testing. My theory was that traditional customer surveys were over-weighting the opinions of activist consumers, people who felt very strongly that local foods (for example) were important to serve. I came up with this theory while being an activist consumer trying to manipulate surveys. But you could redesign surveys to better pull out the preferences of consumers who, yes, would prefer to eat local foods, but that had other priorities they weren't going to sacrifice along the way. That would allow for offering menu options with broader appeal and pulling products like local foods further into the mainstream. This, by the way, tells you how long ago I was in grad school because at the time eating local was still considered a bit fringe. 

The most interesting thing I learned from that experiment? When you redesign customer surveys so that activist students can't game the system, many of them get into a huff, refuse to complete the survey, and send you nasty emails.  

And in case you're wondering why the local vegetarian option in that example was so expensive, it's not just that the ingredients were pricey - building an organic local vegetarian entree meant a lot of hand processing of whole ingredients in a kitchen where that was not the norm for other dishes, which utilized pre-sliced, pre-cubed, and otherwise lightly processed ingredients from national suppliers. This time cost will become important in other episodes, so go ahead and keep it in mind.