The Truth About Menopause

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Randi Protter, MD, FACP, NCMP

Menopause is natural and normal.  And sometimes so, so unpleasant. For many women, it’s also a bonding time – we wink when a colleague in a meeting deftly converts her handout to a make-shift fan, or when she peels off her cardigan to reveal a sleeveless top, regardless of the season.  The sisterhood unites when we glisten (we don’t sweat…)

Some women sail through, other women suffer.  There’s folklore and wives’ tales.  But what do we really know?  Lots!  And here is some info to help keep it real:

The average age of menopause in our country is 52.  Patients often ask for a hormone blood test to see if they are in perimenopause or menopause.  There is usually no need for this.  A woman’s hormonal status is determined by her monthly cycle history.  In perimenopause, women commonly notice changes in their monthly cycle years before their last and final period.  Sometimes there will be monthly skips, followed by months of regularity. Sometimes cycles will get closer together, and then further and further apart.  A woman is in the menopause when there has been no bleeding at all – not even one drop – for a full year.  If there is one drop of blood on day 364, the clock resets, and we wait for another full year.

Patients most commonly will seek treatment for the most annoying symptoms – hot flashes and night sweats.  Also top on the list – vaginal dryness, painful sex, insomnia, and weight gain.

Not every woman has symptoms associated with menopause, but for those women who do have symptoms, treatment is only indicated if the symptoms are bothersome.  Maintaining a normal weight, regular exercise, and quitting smoking (if applicable) may provide some relief of mild hot flashes.

Treatment for bothersome menopause symptoms should be customized, based on symptoms, coexisting medical conditions, and concurrent use of medications/herbs/supplements.    We have many non-hormonal and hormonal options, and many different ways to deliver the medication – oral, topical (patch, creams, gels, sprays, etc), and vaginal (creams, tablets, and rings).

The North American Menopause Society (NAMS) is a great menopause resource.

If you are having bothersome menopausal symptoms, discuss them with your R-Health doctor – some specialize in menopause medicine – they can help you through this sometimes challenging transition.

No Time, No Problem

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While we continue this month’s focus on nutrition, this week’s theme is exercise. Similarly to breakfast, one of the common associations with exercising is time…or lack thereof. Something we either hear, or even say to ourselves is, “I just don’t have the time to exercise.”

In hindsight that may seem like the case, but in reality, it’s imperative to schedule a little time for physical activity. Exercising is one of the most important things you can do to keep up your health, and today we’ll not only discuss how it’s beneficial, but also how you can engage, even with time constraints.

Our friends over at the CDC wrote an article highlighting the benefits of physical activity. Of the vast mentioned, we’re going to emphasize the following:

  • Reduces your risk of cardiovascular disease(s)
    • Cardiovascular diseases are the leading cause of death, however, moderate intense activity (less than150 minutes per week), lowers the risk drastically, while lowering your blood pressure and improving cholesterol levels.
  • Strengthens your bones and muscles
    • It’s important to protect your bones/joints/muscles, but especially as you get older. Moderate intense activity can help slow the loss of bone density as you age, and helps with arthritis and/or other major health conditions (e.g. hip fracture)
  • Controls your weight

Though these benefits may be more commonly known, we’ve entrusted U.S. News to share with us some astonishing facts about exercising that may not be privy to everyone. The few we focused on are the following:

  • Exercising can reverse the detrimental effects of stress
    • Physical activity can not only increase levels of soothing brain chemicals that relieve you of triggering stressful thoughts, but can also slow down the aging of the cells in your body
  • It lifts depression
    • Exercising can stimulate the growth of neurons in the regions of your brain affected by depression, thereby acting as a natural antidepressant.
  • Helps with learning
    • Vigorous activities aid in creating new brain cells and connections, while improving the capacity to learn and retain information – which enhances both attention and concentration skills

Aware of the benefits of exercising, yet still limited by the obstacle of time? Luckily, the American Heart Association (AHA) provides great tips on making use of your time to exercise. The AHA believes you can get heart-healthy benefits of exercise if you divide your time into two or three, 15 minute segments doing some of the following:

  1. Add more walking
    1. Walking the dog
    2. Brisk walks with your children
    3. Walks through a mall while you window-shop!
    4. Parking further away and walking towards destination
  2. Take the stairs
    1. Skip out on the elevators and power through sets of stairs
  3. TV fitness
    1. Turn TV into a mini gym session. Walk on the treadmill while streaming your favorite show, or even do quick exercises in between commercial breaks.
  4. Join a team
    1. Maybe it’s bowling, maybe it’s yoga, but find an activity you like that keeps you active and motivated!

These are just a few ways you can squeeze in some exercise even with a busy schedule. And if you are able to make it to a gym once or twice, make the most of your time. More activity, less rest. A 30 minute workout is just as good as a two hour session.

For more exercising tips that are right for you, feel free to contact your R-Health doctor, and follow us for more posts on optimum nutrition!

R-Health Supports 11 Greater Philadelphia Practices Participating in Historic Public-Private Partnership to Strengthen Primary Care

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Initiative Provides Primary Care Practices with Additional Resources to Improve Coordination of Care

R-Health, a leader in innovative healthcare solutions, today announced that 11 value-based practices supported by R-Health were accepted into the Comprehensive Primary Care Plus program (CPC+), a partnership between payer partners from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers.

R-Health, through the company’s accountable care service division, supported 11 local practices to apply for the program and all were accepted. Each of these practices are part of one of R-Health’s accountable care organizations, Care is Primary ACO or ACCO.

These local Philadelphia area practices include:

  • Founders Medical (Philadelphia, PA)
  • Greenhouse Internists, P.C. (Philadelphia, PA)
  • S. Peter Gross, DO P.C. (Philadelphia, PA)
  • LMG Family Practice, PC (Chalfont, PA)
  • Medical Group at Marple Commons (Broomall, PA)
  • Mt Airy Family Practice (Philadelphia, PA)
  • Ninth Street Internal Medicine Associates Ltd (Philadelphia, PA)
  • North Willow Grove Family Medicine, P.C. (Willow Grove, PA)
  • PIM Associates PC (Jenkintown, PA)
  • Radnor Family Practice (Radnor, PA)
  • Ritner Medical (Philadelphia, PA)

These practices join the more than 2,900 primary care practices nationwide participating in CPC+. This partnership is designed to provide improved access to quality health care at lower costs.

“A robust primary care system is essential to achieve better care, smarter spending, and healthier people,” said Acting CMS Administrator Patrick Conway. “For this reason, CMS is committed to supporting primary care clinicians to deliver the best, most comprehensive primary care possible for their patients.”

Through CPC+, CMS will pay primary care practices a care management fee, initially set at an average of $15 per beneficiary per month in Track 1 and $28 per beneficiary per month in Track 2, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices designed to support them in providing high-quality primary care on behalf of their members.

For patients, this means that physicians may offer longer and more flexible hours; use electronic health records; coordinate care with patients’ other health care providers; better engage patients and caregivers in managing their own care; and provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.

The five-year model started on January 1, 2017, with CMS soliciting a diverse pool of commercial health plans, state Medicaid agencies, and self-insured businesses to work alongside Medicare to support comprehensive primary care. Public and private health plans in 14 regions across the country signed letters of intent with CMS to participate in this model: Arkansas, Colorado, Hawaii, Kansas and Missouri’s Greater Kansas City region, Michigan, Montana, New Jersey, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, Oklahoma, Oregon, Pennsylvania’s Greater Philadelphia Region, Rhode Island, and Tennessee. The markets were selected in August 2016 based on the percentage of the total population covered by payer partners who expressed interest in joining this partnership.

Eligible primary care practices in each market were invited to apply to participate in the winter of 2016. Through a competitive application process, CMS selected primary care practices within the selected markets to participate in CPC+. Practices were chosen based on their use of health information technology; ability to demonstrate recognition of advanced primary care delivery by leading clinical societies; service to patients covered by participating payer partners; participation in practice transformation and improvement activities; and diversity of geography, practice size, and ownership structure.

CPC+ is administered by the Center for Medicare & Medicaid Innovation (CMS Innovation Center). The CMS Innovation Center was created by the Affordable Care Act to test innovative payment and service delivery models that have the potential to reduce program expenditures while preserving or enhancing the quality of care.

In addition to supporting the application process, R-Health will assist each of the practices in implementing and managing their participation in the program. This will include reporting requirements, data analytics, workflow re-design, and best practices for care management.

“The CPC+ program recognizes the importance of primary care and re-empowering primary care leads to healthier patients and better outcomes,” said Nancy Meisinger, R-Health’s Vice President of Clinical Performance. “We are proud to partner with these local practices as we help them continue their transformation to value-based care delivery.”

For more information about CPC+, visit: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/

R-Health Announces Expanded Collaboration with Aetna for Value-Based Healthcare Delivery

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R-Health, a leader in innovative healthcare solutions, today announced the company has expanded its value-based healthcare delivery collaboration with Aetna.

With a recent contract to provide Direct Primary Care services to Aetna members through the New Jersey Direct Primary Care pilot program for members enrolled in the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP), R-Health now has four agreements with Aetna, each focused on patient-centered care. The New Jersey program is an enhanced benefit for the SHBP and SEHBP that provides members free access to an R-Health Direct Primary Care physician with no co-pays or deductibles.

R-Health began working with Aetna in 2014, through the company’s accountable care organization, the Advanced Comprehensive Care Organization (ACCO). This started with a Medicare Advantage population and grew to include adult commercial and pediatric commercial populations. These programs deliver care to thousands of patients in Southeastern Pennsylvania.

These innovative collaborations are each focused on improving quality of care and reducing overall costs. This includes encouraging stronger patient engagement, sharing best practices across care teams, implementing evidence-based guidelines, and creating performance-based incentives.

“We are excited to deepen our collaboration with Aetna through the New Jersey Direct Primary Care program,” said Mason Reiner, R-Health’s CEO. “By offering their members who are enrolled in SHBP and SEHBP access to R-Health, members will experience primary care the way it should be. This builds on our existing patient-centered collaborations with Aetna.”

Through the collaborations between R-Health and Aetna, the 195 providers in ACCO have consistently surpassed clinical quality benchmarks in areas such as patient access, control of chronic conditions, preventive cancer screenings, and vaccinations. For example, during the most recent performance year, 86% of ACCO’s diabetic Medicare Advantage patients had HbA1c levels less than 9, and 96% of adolescents had proper immunizations.

R-Health’s Direct Primary Care program in New Jersey is an innovative offering focused on drastically improving the primary care experience by providing unlimited access to a personal physician with no co-pays or deductibles. It offers same-day and next-day appointments, little to no time in the waiting room, evening and weekend hours, phone consultations, and digital access to the patient’s personal doctor.

About R-Health: R-Health delivers more effective care and a better patient experience – all at a lower cost. We partner with employers, unions, insurance companies and TPAs to offer primary care that’s truly collaborative. This is accomplished through the traditional core values of convenient, personal primary care; our innovative data analytics and patient engagement platforms that streamline care, delivering better outcomes, lower costs and a refreshing patient experience; and the proactive management of chronic conditions. R-Health delivers value-based healthcare two ways, through R-Health Accountable Care, our commercial ACO, and R-Health Direct Primary Care, our innovative membership-based primary care model.  For more information, visit www.R-Health.md.

About Aetna:  Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.7 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see http://www.aetna.com/ and learn about how Aetna is helping to build a healthier world. @AetnaNews

R-Health Opens New Direct Primary Care Practice in Ewing, NJ

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New Location Part of the New Jersey State Direct Primary Care Program to Provide Free Access to Primary Care for State, Municipal, and School Employees

Yesterday, R-Health hosted a ribbon cutting and grand opening of its new location in Ewing, New Jersey. R-Health now has four primary care practices serving state, municipal, and school employees in the New Jersey Direct Primary Care (DPC) program, with additional practices launching throughout 2017.

In 2016, the State of New Jersey passed a resolution to create a Direct Primary Care Medical Home program, offering free DPC membership to more than 550,000 state, municipal, and school employees and their family members participating in the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP).

Like many states, New Jersey has been struggling with spiraling healthcare costs. DPC offers an innovative solution that is proven to lead to better care and outcomes for workers, while lowering costs for individual employees and the State.

Membership to R-Health Ewing, and other R-Health practices, is a no co-pay, no deductible, primary care option for New Jersey public sector workers and their family members. They can join an R-Health practice for free and receive a full range of services including preventive, urgent, and sick care; health and wellness coaching; chronic disease management; and care coordination.

“We are so excited that New Jersey took notice of the benefits of providing barrier-free access to primary care, recognizing the innovative solution offered by Direct Primary Care,” said Mason Reiner, R-Health CEO. “R-Health is reinventing the way primary care is delivered, offering New Jersey workers personalized, relationship-based care.”

R-Health Direct Primary Care practices offer same-day and next-day appointments, longer appointment times, little to no time in the waiting room, evening and weekend hours, and access to the doctor in the office and out of the office via phone consultations and digital messaging.

R-Health physicians care for a maximum of 1,000 patients, compared to 2,500 to 3,000 in a traditional practice, freeing R-Health doctors to spend more time with each member.

State officials and labor union leaders joined R-Health to celebrate the grand opening including State Senate President Steve Sweeney; Kevin Kelleher, Director – Research and Economic Services, New Jersey Education Association; Hetty Rosenstein, Area Director, CWA New Jersey; and other labor leaders.

Said Randi Protter, MD, FACP, NCMP, the lead physician at R-Health Ewing, “I went into medicine to take care of people, but somewhere along the way, the focus on people has been lost in our healthcare system. This approach puts the patient front and center, allowing me to dedicate 100% of my time on providing care for our members.”

This membership-based approach to primary care turns the typical volume-based, fee-for-service model on its head. with R-Health practices entirely foregoing fee-for-service insurance billing.

R-Health Ewing is now accepting enrollment of new members, with sign up available at www.r-health.md/nj.

How You Can Foster Gratitude This Holiday Season

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As we enter into the hustle and bustle of the holiday season, it’s easy to get caught up in materialism and lose sight of what this time of year is really about. Research shows that people who regularly practice gratitude experience more positive emotions, tend to be more successful, sleep better and have stronger immune systems. Sounds great, right? But starting any new practice can be difficult, especially during the holidays, so here are a few tips that may help start and maintain a gratitude practice as we enter into the season of gratitude and giving.

  1. Write it down

Putting pen to paper and actually writing out what you are grateful for is one of the best ways to reap the benefits of gratitude. When we acknowledge small fortunes each day we slowly change the way we perceive situations. For example, you may have had a great accomplishment like, “today my boss told me I was doing a good job,” something small such as “a stranger held the door for me when my hands were full,” or something like, “I am grateful to have found a doctor that takes the time to listen to me, to get to know me, and to help me become a healthier person.”  Sometimes it can be challenging to dive into the blessings beyond those that are right in front of you such as family, friends and basic needs, but once you open your eyes to the “small mercies” in your daily life you will notice a shift in your practice and general attitude.

  1. Commit to it

Making a conscious effort to write down your daily blessings and affirmations will enable you to grow and obtain the physical and mental health benefits of gratitude fostering. Writing small notes each day makes us happier, thankful and more optimistic. These positive feelings are encouraging and help us to maintain our practice, especially on those tougher days. I highly recommend using a journal of some kind to keep log of your practice. A regular ruled journal is great or you may choose a journal specific to gratitude fostering. As your practice grows you will be able to flip through pages of full of daily affirmations and positive events. It is also helpful to choose a set time of day to journal. Will you write in the morning to set intentions for the day ahead, in the evening to reflect on the day, or both?

  1. Verbalize and embody it

One of the many rewards of channeling appreciation for life’s small gifts is that you are more likely to be oriented towards being compassionate, sharing and helping. Fostering gratitude and love for your life is very important but radiating that positivity outward is equally rewarding and crucial to your practice coming full circle. Write a letter to someone who you are grateful for, share your gratitude at the dinner table every night, show someone your appreciation through a thoughtful gesture, volunteer or donate.

Manifesting your practice into your daily life will not only make you feel good for extending extra compassion into the world, but it will make others feel a little more appreciated as well. And that, is the beautiful cycle of gratitude, which can lead to a beautiful cycle of health.

Dr. Steve Horvitz is R-Health’s Medical Director and one of the physician’s part of the NJ SHBP / SEHBP program. 

Preventing Unnecessary Trips to the ER and Urgent Care

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When you have a real relationship with your doctor in a Direct Primary Care practice, this can help minimize unnecessary trips to the emergency room or urgent care center.

How?

Instead of heading straight to the ER when facing a health issue, you can instead pick up the phone and call your personal doctor. (Please note that you should head straight to the ER or call 911 for life threatening medical emergencies). Your doctor can then help guide you on the best approach to your care.

Maybe that means your doctor meets you at the office to see you for a quick appointment. Or that you just need a prescription, which your doctor can call in for you over the phone – eliminating the need for an appointment altogether. Or maybe you really do need the emergency room and your doctor can give you this advice based on the symptoms you are experiencing and his or her knowledge of your medical history.

By empowering this relationship – it eliminates many of the barriers to care that are unfortunately so prevalent in healthcare today.

And not only does this lead to better health outcomes – it also saves you money but not having to deal with the high co-pays, deductibles, and co-insurance that so often accompany a trip to the ER or urgent care center.

This is all part of the relationship we aim to empower between our members and our doctors in a Direct Primary Care setting. If you are a member of the New Jersey State Health Benefits Program(SHBP) or School Employees’ Health Benefits Program (SEHBP) you can sign up for this experience as an add-on benefit.

5 Tips for Healthy Sleep Habits

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Most of us know how important sleep is to our health and well-being, but we still have a hard time sticking to healthy sleep habits. In fact, half of Americans (48%) say they don’t get enough sleep, but less than half of us take any action to help get a better night’s sleep. These 5 simple tips will help you on the path to better sleep – and better health.

  1. Establish a bedtime. One of the most important sleep habits we can adopt is going to bed and waking around the same time every day. A consistent sleep schedule reinforces our body’s internal clock which helps optimize the quality of our sleep and reminds our brain when it’s time to release sleep and wake hormones. Establishing a relaxing bedtime routine also helps signal to the brain that is time to unwind and prepare for sleep.
  1. Turn off electronics and limit light exposure. Our sleep cycles are strongly influenced by light and dark. While any light has the ability to disrupt our circadian rhythms and suppress the secretion of melatonin, blue light from electronics is particularly disruptive and damaging. Try turning off phones, computers, TV, etc. at least 1-2 hours before bedtime. Dimming the lights in your home hours before bed can also be very effective.
  1. Exercise daily. Engaging in regular exercise each day will help you sleep better at night and stay alert during the day. The more vigorously you exercise the more powerful the sleep benefits, but even just 10 minutes of brisk walking can help. Be mindful that working out close to bedtime can interfere with sleep, however, gentle yoga and stretching in the evening can help promote better sleep.
  1. Eat and drink well. Eating a diet abundant in colorful fruits and vegetables and avoiding large, heavy meals before bed will help achieve you better sleep quality. Limiting caffeine in general or avoiding it after 3 pm will allow your body to effectively let you know when it’s ready to rest. Ideally a healthy, well-rested and active body doesn’t need stimulants to feel well and energized. If you feel dependent on caffeine to get you through your day it may be time to think about making some lifestyle changes.
  1. De-stress and de-clutter. Many people have difficulty falling asleep and staying asleep as a result of stress and worry. Exercise, yoga and deep breathing techniques are all very effective in relieving stress and anxiety. Creating new bedtime rituals can also help you feel organized and relaxed. One strategy is to check all emails and social media early in the evening and then put it away for the night – new messages can wait until tomorrow. Sometimes light cleaning and simple preparations for the next day can help ease the mind as well. And finally, carve some time out of the evening for you – read a book, listen to music, take a warm bath, do some gentle stretching anything that you enjoy and helps you relax.

Still have questions? Reach out to one of the R-Health doctors to talk about your own habits and healthy sleep.

Dr. Steve Horvitz is R-Health’s Medical Director and one of the physician’s part of the NJ SHBP / SEHBP program. 

CEO Mason Reiner Named to Who’s Who in Healthcare in Philadelphia

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Philly Biz recently named R-Health CEO Mason Reiner among the Who’s Who in Healthcare in the Philadelphia area. As Philly Biz noted, “Philadelphia has long maintained a reputation as a premier provider of top medical care. This month, we shine a spotlight on the nurses, doctors, administrators, researchers and more who are the driving force behind enhancing the scope of medicine and improving care for those who live and work here.”

And in describing Mason’s contributions to healthcare in Philly, they stated:

Mason Reiner, co-founder and CEO, R-Health
R-Health is a leader in innovative health care solutions that is dedicated to delivering more effective primary care and a better patient experience, while reducing the overall cost of health care. Reiner is a founding member of the Steering Committee of the National Direct Primary Care Coalition, the leading industry organization advancing the direct primary care model around the country, and is a sought-after speaker on various aspects of the direct primary care model.

What drew you to the health care field?
A large, fragmented industry that is going through a tremendous amount of change, and where you can make a major positive impact on people’s lives, is an entrepreneur’s dream.

R-Health Launches Medicare ACO in Southeastern Pennsylvania

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New ‘Care is Primary ACO’ is First Collaborative Medicare Accountable Care Organization of Smaller, Independent Physicians in the Philadelphia Area

R-Health, a leader in innovative healthcare solutions, today announced the company is launching a new Medicare Accountable Care Organization (ACO), Care is Primary ACO. Care is Primary ACO is the first in Southeastern Pennsylvania consisting exclusively of smaller, independent primary care physicians.

This model of care brings together a select group of high-performing, independent primary care physicians to develop an ACO – a network of physicians who collaborate to deliver coordinated care to Medicare beneficiaries. It focuses on the critical shift from fragmented, episodic care to continuous, relationship-based care that stresses prevention and management of chronic diseases.

Care is Primary ACO delivers value-based care by partnering with physicians throughout the five counties of Southeastern Pennsylvania. The value-based system rewards positive health outcomes for patients, instead of a traditional volume-based approach that rewards physicians based on the number of patients treated, not outcomes.

“R-Health believes that primary care has the ability to transform, delivering better, more personalized care to patients at lower costs,” said Nancy Meisinger, Vice President of Clinical Performance at R-Health. “The independent practitioners in this ACO have already demonstrated success through value-based contracts and we expect to achieve even greater outcomes through Care is Primary ACO.”

“High performing independent primary care practices all share the same challenges but historically we have been isolated from each other,” said Dr. Allan Crimm, Managing Partner of Ninth Street Internal Medicine. “The unique collaboration fostered by Care is Primary ACO enables us to leverage our collective expertise, share best practices, and help us all deliver superior care to our patients.”

The Care is Primary ACO currently includes nearly 100 providers, with more high-quality independent practices expected to join. The ACO anticipates serving over 11,000 Medicare beneficiaries through the Medicare Shared Savings Program.