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If You Build A Crew Program For Overweight Kids, They Will Row — And Get Fitter

There was no comfortable place for 17-year-old Alexus Burkett in her school’s typical sports program of soccer and lacrosse and basketball.

“They don’t let heavyset girls in,” she says.

Alexus was “bullied so bad about her weight,” says her mother, Angelica Dyer, “and there was no gym that would take her when she was 14, 15 years old. There was no outlet.”

But Alexus has found a sports home that is helping her bloom as an athlete: an innovative program called “OWL On The Water” that offers rowing on the Charles River specifically for kids with weight issues.

She has lost more than 50 pounds over half a year, but more importantly, says her mother, “They’ve given me my daughter’s smile back.”

Alexus Dwyer during warm-ups before instruction time. (Jesse Costa/WBUR)

Alexus Burkett stretches during warm-ups before “OWL On The Water” instruction time. (Jesse Costa/WBUR)

“It’s given me a lot of good strength and it’s making me more outgoing,” Alexus says. “We’re all best friends and we’re all suffering with the same problem — weight loss — so we’re more inspiring each other than we are competing against each other.”

OWL On The Water offers a small solution to a major national problem: According to the latest numbers, 23 million American kids are overweight or obese, and only about one quarter of 12-to-15-year-olds get the recommended one hour a day of moderate to vigorous physical activity. Heavier kids are even less likely to be active, and only about one-fifth of obese teens get the exercise they need, the CDC finds.

“I know I need to be active, but please don’t make me play school sports!” That’s what exercise physiologist Sarah Picard often hears from her young clients at the OWL — Optimal Weight for Life — program at Boston Children’s Hospital that sponsors OWL On The Water.

Many gym classes still involve picking teams, “and my patients are the ones that are always picked last,” she says. “You’re the biggest one, you’re the last one, you’re picked last, and you’re uncomfortable.”

They are strong, powerful people.
– Sarah Picard

School fitness testing is important, Picard says, but it, too, can be an ordeal: “I have kids who sit in my office and tell me that they didn’t go to school for a week because they wanted to miss the fitness testing,” she says.

While many a coach might see bigger bodies as poorly suited to typical team sports, Picard sees them as having different strengths. Particularly muscular strength.

“What I’ve observed is that these kids are much better at strength and power-based activities,” she says. And rowing is particularly good for them, she says, because though it is strenuous, it is not weight-bearing, and thus more comfortable for heavier bodies — yet a heavier, strong body can pull an oar much harder than a smaller person’s body. The program begins by building on that muscular strength, she says, and then works on aerobic fitness. Continue reading

Boston-Based Partners In Health Leaps Into Ebola Crisis

Members of Partners in Health work with representatives from Liberia and Sierra Leone via conference call to help combat the Ebola outbreak. (Jesse Costa/WBUR)

Members of Partners in Health work with representatives from Liberia and Sierra Leone via conference call to help combat the Ebola outbreak. (Jesse Costa/WBUR)

An advance team from Boston-based Partners In Health heads for Ebola-stricken Liberia Monday. Four doctors, including co-founder Paul Farmer, and two operations staff will lay the groundwork for an ambitious two- to three-year project that will require well over 100 volunteer doctors, nurses, lab techs and public health workers. The budget for just the first year is $35 million.

“We are at a dangerous moment with Ebola,” said Farmer as he prepared for the trip. “Even though this is a huge jump for PIH, I am confident we will succeed.”

PIH will work with two established groups, Last Mile Health in Liberia and Wellbody Alliance in Sierra Leone, to strengthen existing public health clinics and train several hundred new community health workers. In addition, PIH will open two 50-bed Ebola treatment centers in rural areas of each country.

The plan began to take shape last week, as the World Health Organization reported a near doubling of Ebola cases in Liberia and an estimate from Columbia University projects 30,000 cases by mid-October if conditions in the country deteriorate.

“There’s more doctors on a single floor of the Brigham than in the entire country of Liberia.”
– PIH's Paul Farmer

In the colorful offices of PIH, decorated with art from countries where the group works, some staffers are flashing back to 2010 and the weeks following Haiti’s earthquake. Ebola is creating another humanitarian crisis, one that is unfolding right before their eyes.

The call for volunteers went up on PIH’s website five days ago. More than 100 people responded within 24 hours, but it will take some time to determine if the skills of applicants fit the needs of these rural Ebola treatment and isolation units. PIH is trying to screen potential recruits quickly. It plans to send a first round to a training run by the Centers for Disease Control next week and open the centers by mid-October or early November.

“To do this right, we will depend on people who are willing to fight against this terrible crisis,” said Joia Mukherjee, chief medical officer at PIH. “The reason we will need a lot of non-Liberians, non-Sierra Leoneans — these countries simply do not have enough doctors and nurses.”

“There’s more doctors on a single floor of the Brigham than in the entire country of Liberia,” added Farmer, who is also chief of the Division of Global Health Equity at Brigham and Women’s Hospital.

He hopes to tap the medical wealth of Boston for the Ebola project, but the PIH board has demanded that a plan to treat and evacuate sick volunteers is in place before the operation begins. Farmer and Mukherjee are talking to the U.S. Department of Defense and other possible partners about transportation and care options.

A fourth doctor in Sierra Leone died Saturday, bringing the total number of health care worker deaths in Liberia, Sierra Leone and Guinea from Ebola to 150. Continue reading

How Mass. Plans To Re-Enroll 450,000 Residents In Health Insurance

All of the estimated 450,000 Massachusetts residents who get health insurance through the Health Connector or MassHealth — some of whom have been in a confusing phase of temporary coverage this year — will soon begin the process of applying for coverage for 2015.

If the state’s new health insurance website is up and running — which the Patrick administration promises it will be — then residents will be able to beginning applying online Nov. 15. If the website still isn’t working, or using a computer isn’t convenient, then you’ll have to fill out a paper application.

Either way, you might want to keep a copy of this timeline handy through January. There are several different deadlines that may be tricky to remember. Here’s an explanation:

(Click to enlarge)

(Click to enlarge)

The key on the bottom left of the chart describes each diamond. Pay close attention to the red diamonds — these are the working end dates for your coverage. I say “working” because these dates assume insurers and the federal government grant the state’s request for extensions.

The state is seeking the extensions so it can spread out the re-enrollment period to avoid overloading members or the system. All the plans through the Connector and MassHealth are currently set to end on Dec. 31, but your coverage may be good for a few more weeks if the extensions are approved. Make sure to look for the coverage end date on any letters you receive.

If you have a commercial health plan through the Connector, find the gray QHP (qualified health plan) box on the top left of timeline and follow the timeline across. Look for your open enrollment package in the mail in early November. Your coverage ends on Dec. 31.

If you had a Commonwealth Care plan last year that has been continued this year, then look for the gold box. The state hopes to extend your coverage through January, so you’ll have two-plus months to review your coverage options.

If you have temporary coverage through MassHealth, then you will be reminded to re-enroll in waves based on when you signed up. You’ll fall into the purple, blue or green boxes above. According to this timeline, your coverage is expected to end sometime between Jan. 15, 2015 and Feb. 15, 2015. But again, the state does not yet have approval for that extension.

The Patrick administration is also waiting to hear if the federal government will give Massachusetts another $80 million to build the new health insurance website, or the $18 million requested to fund outreach, ads and other enrollment efforts.

Related Coverage:

Surprise In Mass. Primary: 21 Percent For Single-Payer Candidate Berwick

Note to politicians: Backing “Medicare for all” is looking less and less like electoral poison. If, deep in your heart, you believe American health care would be better off with a Canadian-style, single-payer system, you might now consider coming out of the closet. (In Democratic primaries in blue states, at least.)

That’s my suggested takeaway from the striking Massachusetts Democratic primary showing of Dr. Donald Berwick, who rocketed from near-zero name recognition among general voters to 21 percent at the polls. Catch him saying forcefully in the video above: “Let’s take the step in health care that the rest of the country hasn’t had the guts to take: single payer. Medicare for all.”

Now, Vermont not only has a mainstream politician who backed a single-payer system — Gov. Peter Shumlin — it’s actually translating the idea into practice as we speak. But let’s put it this way: This seems to be the first time that a candidate in a mainstream political party in a state that is not a verdant utopian duchy has run on a single-payer platform. And though he did not defeat the longtime familiar faces, he did surprisingly well.

“The term I’ve used, and it’s a bold term, but it’s confiscation.”
– Dr. Donald Berwick

Of course, we knew that Massachusetts voters tend to like the idea of single payer. As recently as 2010, 14 fairly middle-of-the-road districts voted in favor of a non-binding ballot measure calling for “creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts.”

Analysts projected that the results meant a statewide majority in support of a single-payer system. The single-payer idea had polled well in non-binding ballot measures before, as well. But now we’ve seen that sentiment translated into support for a candidate.

Other politicians, including President Obama, have backed the general idea of a single-payer system, but they always add a “but,” said Dr. Steffi Woolhandler, who helped found Physicians for a National Health Program.

“And the ‘but’ usually has to do with the political situation,” she said. “But it’s actually important to say what’s the right thing to do and to really work toward the right solution, and that’s what Don [Berwick] has been willing to do, to say, ‘We need single payer and skip the ‘but,’ let’s just say we need single payer and that we need to start working toward it.’”

Will Berwick’s strong showing change the playing field for other candidates? Dr. Woolhandler says yes: “Politicians understand votes. Unfortunately, they also understand money. But they do understand votes, and I think other politicians will see that voters are behind the idea of single payer.”

I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, “That sounds right to me. Let me tell you my story.”

“I remember a carpenter in Hingham,” he said. “I don’t think he would have said he was a progressive — he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess — embarrassingly, to me — I was expecting some pushback. But he immediately said, ‘I’ve got to tell you a story.’ And he told me about his struggle to get health insurance.

“He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered — to his dismay — that the deductible did not apply to the year, it applied to each separate episode. So this guy, who’s working with his hands and trying to just get through and have his family’s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, ‘Enough of this!’ He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.”

Overall, Dr. Berwick said, “The response has been extremely positive beyond anything I would have anticipated. Continue reading

Mass. Study: Limited Health Insurance Networks Save Money, Cause No Harm

Jonathan Gruber of MIT (Courtesy MIT)

Jonathan Gruber of MIT (Courtesy MIT)

Most patients, myself included, do not like to be told, “You can’t see that doctor or go to that hospital.” But the message is becoming more common as we, patients, or our employers choose what are known as “limited” or “narrow” network plans (note the not-so-subtle name change).

These plans are often cheaper than other options because they cut out expensive hospitals and because insurers negotiate better prices with hospitals and doctors who are promised our business.

But there’s a backlash that’s both real and hyped. Some of the hype is refuted by a study out today.

It looks at a broad movement toward limited network plans in Massachusetts in 2011, when state employees got a three-month “premium holiday” if they switched from more traditional coverage to the lower-cost option.

State employees who chose to switch reduced their health care spending by 36 percent.

“Clearly, this was a big cost-saver for the state,” says study co-author Jon Gruber.

The savings, says Gruber, occurred because patients with limited network coverage relied more on primary care and less on specialists. There is no sign that patients received lower quality care or that their health deteriorated.

Gruber, who had a hand in creating both the Massachusetts coverage law and the Affordable Care Act, claims the political implications of this Massachusetts limited network experiment are profound.

“There’s a lot of discussion about ObamaCare leading to more ‘limited’ choices,” says Gruber, and “isn’t that a shame.” But Gruber says people in these plans “don’t appear to be suffering.” Continue reading

Mass. Doctor Working In Liberia Diagnosed With Ebola

A family physician from Massachusetts has become the third American aid worker infected with Ebola.

Dr. Rick Sacra, of Holden, was volunteering at a hospital in Liberia run by a Christian missionary group when he became infected with the virus.

An undated photo of Dr. Rick Sacra (simusa.org)

An undated photo of Dr. Rick Sacra (simusa.org)

The 51-year-old was scheduled to return to Liberia last week, but moved his trip up to the beginning of August.

“When he said he was going back early I wasn’t surprised,” said Frances Anthes, who runs the Family Health Center of Worcester where Sacra is a family physician. “We all knew it was a difficult situation. He asked for prayers and I know I promised them.”

Sacra, his wife and his three sons have spent years in the country as medical missionaries, and Sacra had been in close touch with colleagues in Liberia all summer about the unfolding health care catastrophe there.

“Dr. Sacra is probably the closest thing that a living human-being can be to being a saint,” said Dr. Gregory Culley, Sacra’s supervisor at the Worcester health center.

Culley says he received an email from Sacra last week. “It was bad news and good news. He said the epidemic is zero controlled, it’s chaos and anarchy in Monrovia, and the entire medical system has broken down.”

Continue reading

A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading

Mass. Health Wonks, Start Your Engines! Contest To Guess Rise In Costs

money

This Tuesday, Sept. 2, we will know … Did Massachusetts succeed or fail in its first year of trying to keep health care costs in line with all the other things we spend money on?

In 2013, health care costs were not supposed to grow more than 3.6 percent.

So what do you think, did Massachusetts make it?

Weigh in below in the comments section, and enter our contest.

The winner will be the person who is closest (you can go over) on both of the following questions:

First, how much did health-care spending increase in 2013? Please submit to the first decimal place (for example, 0.7 percent, 1.7 percent, 4.3 percent, 6.6 percent, etc.).

Second, what was the total amount of money spent on health care in Massachusetts last year? Think double-digit billions.

Remember, the state’s calculations for both of the above will not include out-of-pocket expenses (except those related to insurance), health-care research dollars or public health spending.

The answers will come on Tuesday from the state’s Center for Health Information and Analysis.

Your prize…lunch with CHIA director Aron Boros at the hospital or health insurance cafeteria of your choice. And I might tag along too.

Hidden Price Of That Succulent Lobster: Health Woes Of Stoic Lobstermen

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

By Richard Knox

Mainer Jon Rogers started lobstering 47 years ago at the age of 10, when he’d go out on his grandfather’s boat.

Ask him about his health and he says, “No worse than anyone else who uses his body in his work. My hips are sore, my knees are sore, my shoulders are sore, my back is sore. I get up every day and it takes me awhile to get going. I hurt every day.”

But Rogers, who lives on a skinny, south-pointing finger of land in Casco Bay called Orr’s Island, doesn’t go to the doctor much. “I never really complained about too much unless I was really hurting,” he says.

“I’d schedule a doctor’s appointment with all the intentions of going,” Rogers says. “But if there was an opportunity to haul traps for a few days, I’d set aside the doctor’s appointment and go haul traps.” This summer he’s running 800 traps, which means his days starts around 5:30 a.m.

Rogers appears to be pretty typical of Maine’s 5,000 lobstermen, and of all 9,000 people who work in the state’s fishing industry.

“They work really hard and have a lot of chronic diseases,” says Miranda Jo Rogers, Jon’s daughter. “These people have a stoic mentality — they don’t seek health [care] until they really need it. So there are no really positive role models on how to be proactive and keep healthy.”

Lobsterman Jon Rogers with med-student daughter Meredith Jo Rogers, who is studying the health of lobster harvesters. (Courtesy)

Lobsterman Jon Rogers with med-student daughter Miranda Jo Rogers. (Courtesy)

Miranda Rogers aims to do something about that. Although she’s still a Tufts Medical School student, she’s taken on a project she expects will take her to graduation and beyond — maybe decades beyond.

“I am happily indebted to the community that raised me, and I wish to make a long-lasting difference in Maine,” she wrote recently to the state’s lobster harvesters, asking them to fill out a 24-page questionnaire on their health.

It will be the most complete look ever at the health of a difficult-to-reach population with special health care needs, low rates of health insurance and high skepticism of outsiders.

“Up and down the coast, the commercial fisherman is very talkative on his own turf, but it’s a very secretive bunch and not that trusting,” Jon Rogers says. Continue reading

Democratic AG Candidates Question Whether Partners Deal Will Cut Costs

Veronica Thomas
CommonHealth Intern

The two Democratic candidates for Massachusetts attorney general are united in their skepticism: They question whether the deal forged by current AG Martha Coakley with Partners HealthCare will succeed in containing costs.

On Tuesday, The Boston Globe hosted a debate between candidates Maura Healey and Warren Tolman, who will go head-to-head for the Democratic nomination in two weeks. While the candidates diverged on a majority of issues, ranging from sexual assault to smart gun technology, they concurred (at minute 34-36 in the YouTube video above) that the controversial Coakley-Partners deal aimed at regulating the expansion of Partners, the state’s largest hospital network, may fall short.

Boston Globe columnist Joan Vennochi asked whether the proposed Coakley-Partners deal has “enough teeth for effective enforcement.” Here are the candidates’ responses:

Maura Healey, former Assistant Attorney General: There are aspects of this deal, Joan, that I am skeptical about. I actually had left the office at the time this agreement was done. But it’s true, Joan, I was in the office. I oversaw, as Public Protection Bureau Chief, the teams that prepared the reports on transparency, and trying to point to what was driving up costs. And I oversaw teams that began this investigation that resulted in this proposed agreement. What I’ve seen, what I’ve read, gives me pause.

I mean, we all know we’ve done a great job here as a state in terms of increasing accessibility to care, increasing quality of care, but costs are key. And as AG, you need to do everything you can to put a downward pressure on costs, and so I have some skepticism about the proposed agreement.

Warren Tolman, former State Senator: So the big issue here, from my perspective, is the ability of this agreement to control costs or not.

My mom spent the last five and half years of her life in a wheelchair, in and out of a nursing home, and in and out of hospitals. And I watched as my dad — my mom and dad had raised eight kids and they grappled with these ever-increasing costs that are associated with Partners and with other healthcare entities.

So I’m very, very concerned about the impact of the ever-increasing healthcare costs and whether this agreement really does what it’s intended to do in terms of curtailing those costs. That’s the number one concern. Continue reading