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Dear Reader,

A Positive Insight

With great pleasure we welcome you to the first edition of A Positive Insight, the brainchild of four great* friends who share similar passions and have a goal to show the positive sides of serious topics. We have been hard at work over the last few months to deliver you this magazine. Our fantastic feature stories and our interesting infographics will have something for everyone, even if you don’t know anything about our topics. The origin of our magazine can be attributed to its name, A Positive Insight. It was quickly agreed upon by our team that we had to bring positivity to our readers. We went out and contacted professionals within the fields of our topics and then we put together the very magazine you’re reading. Our Feature stories will cover a wide range of topics, including healthy habits, prosthetics, physical therapy rehab, and even insurance. We carefully considered how to make these topics have the positive take that we wanted our magazine to have. We are extremely proud of the magazine layout that we created. We adore our magazine layout because we believe the color scheme we made fits really well with our topics. We are also quite proud of our adobe illustrator graphics, as no one on our team has used it before, yet our graphics still came out looking professional. We can say with great satisfaction that everything up until this moment was worth it. We hope you enjoy reading! Remember to stay healthy and keep it positive! -Enjoy your time reading, The A Positive Insight Team

MEET THE TEAM

JACK MC KINNEY

Jack is a fre shman at L ASA that m only have 8 ay toes. His in te rests includ but are not e, limited to: P laying vide games, and o climbing ro cks. When Jack grows up he hope s to work in bio enginee a ring field or in chemistr For his ezin y . e he is talkin g about the often misun derstood su bject of insu ance. Jack b relieves he c a n share a p itive behind osthe scenes lo o k o n th is complicated topic.

Ben Ozimek, a legend in his own way, may only be a freshman attending the best high school in AISD, LASA, but whenever he isn’t at school you can find him in some of his favorite hobbies which include; gaming, fishing, biking, soccer, and he recently started curling, yes, curling. His interest in inspiring stories has led him to write about physical therapists, and their roles in rehabbing patients back to where they were, an inspiring topic.

E M I Z BEN O

ARHANT

CHOUD

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When h ig Choudh hschool freshm ar an Arha nt playing y is not shootin Mozart g hoops on his g o cool me r uitar he mber o f i sa this Ezi interest ne t i spired h n medical tech eam. His n im to w rite abo ology intechnol u t og p lives. W y and how it is rosthetic hile he c hanging may see ented a t times m work or he ha inel whe re he po s a Youtube ch comedy ansts anim videos o ation an n a vari ety of to d pics.

Sebastian Vazque z Cortes, the man , the myth, the lege nd, is a highschool freshman attendin g LASA, whose love for food from a young age of 1, inspired him to w rite about nutrition and a healthy lifestyle. As he is the team’s head gr aphic designer, it is not surprising to hear that Sebastian would like to pursue a career in graphic design on ce he graduates, dang he is getting quite old. When Se bastian isn’t busy designing the grea test ezine ever prod uced, you can find him vibing to mus ic or playing vide o games with his fr iends.

S E B A S T IA N C O R T E S 3

Table of Contents The Recovery Process .....................

Top 10 Most Common Sports Injuries .......

Prescription to Prosthesis ...........

Past and Present of Prosthetics ...............

Letter From the Editors, Table of Contents, Games & Art Page by Ben Ozimek Letter From the Editors, Front Cover, Meet the Team by Arhant Choudhary Letter From the Editors, Back Cover, Inside Covers by Sebastian Vazquez-Cortes Letter From the Editors, Games & Art Page by Jack McKinney

Harvesting Healthy Habits ...........

Fine Food Facts ...................................

Caring About Healthcare .............

American Insurance ............................

26 5

The Recovery Process

How Physical Therapists Help Steer Paitents Lives Back on Track After a Major Injury By Ben Ozimek

he star striker was running down the touchline with the soccer ball at their feet, ready to score, when all of a sudden one misstep, and they went down to the ground writhing in pain. They quickly find out that they just tore their ACL. If they do nothing about their new injury then they risk a bad healing process with possible negative effects down the road, or they can go to physical therapy, where they will have agreater chance of recovering successfully to get back to their day-to-day life. TC Hull, a former athlete who played soccer, had to ask himself if he wanted to do something about his injury or just leave it to heal by itself. This didn’t happen only once, but twice, because he tore his ACL in both his junior, and senior year. The ACL is a ligament in your knee that keeps your lower knee from sliding forward and also in keeping the knee joint stable. The choice from an outsider’s perspective was obvious, rather than possibly never playing again he decided to go to a physical therapy rehab facility to see a therapist. There he got surgery and had to relearn walking all over again, in both his junior, and senior year with the help of physical therapists.

“I actually tore my ACL

TC Hall, No. 23, playing soccer for Southern Illinois University Edwardsville. This photo shows him after he completed two stints of ACL Rehab therapy. Photo Courtesy of TC Hall

twice,’’ Hull said. ‘’My junior year of high school, there was a non-contact injury while playing soccer. I tore my right ACL, non-contact and then before even playing a game I tore it again. So, I wasn’t able to play in my senior year.” Dr. Kevin Heinrich, an at-home care physical therapist, on how someone could tear their ACL just after completing rehab therapy. “Re-injuring ACLs, the prevalence is so high,” Heinrich said. “We are basically installing intrinsic motivation into patients, and teaching them more about the rehab process and other things that they can do to reach a goal of being

on a state championship team.” Although Hull wasn’t playing for a national championship, after he recovered from his second ACL tear he played collegiate soccer for Southern Illinois University Edwardsville, a Division 1 college in the Ohio Valley Conference. “I actually went on to play college soccer,” Hull said. “I’d say it was a successful recovery. I was able to play for four years at a high level after I finished both the surgeries, [and physical therapy sessions].” Everyone’s injury recovery story is different, Dr. Heinrich’s greatest success story so far as a practitioning physical therapist came while he was working inpatient at a hospital, a care provided at medical facilities such as hospi-

tals, where you spend at least one night under the care of health professionals. “I’ve had a guy two days post stroke, and then three weeks later, he’s walking out of the hospital,” Heinrich said. This specific patient had a stroke on the left side, and the stroke was serious enough that the patient didn’t know how to operate his whole left side of the body, which doctors call left side neglect. Many impairments are then caused by this neglect, such as balance, using the lower extremities, and even grabbing objects. However, there are a few ways to help the body relearn what was lost. “Just doing small things like getting them up every day, actually manually moving his leg, manually moving his arm, standing on the left side, different interventions like that ended up helping him to recognize his left side and then start taking small steps, start actually stepping up, standing up, balance, all those things.” Heinrich said. Dr. Alison Rich, a neurological rehab therapist at Craig Hospital, which focuses on spinal cord and traumatic brain injuries, has a plethora of success stories. However, her most memorable success story happened quite recently, where she helped a patient recover from a traumatic brain injury. “I treated her for probably three to four weeks, every day,” Rich said. “From day to day, she had no idea who I was, she was unable to even stand on her own, and her balance was poor and impaired. We just discharged her recently, and she’s now walking independently. When physical therapists are helping someone learn to walk again after an injury, such as a stroke, they may use an exosuit, a robotic suit used to help a patient with neuromuscular re-education.

An Exosuit manufactured by SuitX Photo Courtesy of Soltanbekova Gulszim

“You want them to be weight bearing,” Heinrich said, “so that you pick up all kinds of different neuro receptors within their joints for

the brain to basically say that, ‘Hey! I can move my ankle this way, and I can move my knee this way, the exosuit basically helps facilitate that.’” Rich uses an exosuit from time to time, however, since she works at Craig Hospital, she also has access to other, more specialized equipment. “There’s another locomotor device, a device like the exosuit, called the Lokomat,” Rich said. “It’s this robotic assisted walking machine, it’s on a treadmill, and this robot is basically measured to your body to be able to help you to kind of relearn that pattern of walking.” Another piece of equipment that Dr. Rich uses, the C-Mill, another locomotor device, helps a patient regain their balance and cadence of walking. The C-Mill includes a video game aspect to it in order to help patients work on balance, and strength. Her favorite game on the C-Mill takes the patient to the Italian Alps. “[The game developers] put you in this setting where you’re in the Italian Alps, and you’re trying to get ingredients for pizza in a little town,” Rich said. “You literally have to walk from side to side, in order to get the tomatoes, get the other ingredients, and it’s actually really engaging, and can kind of be distracting for some patients who get tired really 8 quickly.”

A patient using a C-Mill manufactured by Motek to rehab from a injury. The C-Mill is used to help a patient relearn balance and walking. Photo Courtesy of Alison Rich While the true purpose of physical therapy is to get a patient back to where they were in the world before, physical therapy allows practitioners to develop a relationship with their patients, something a doctor in a hospital can’t entirely do so. “If you were a doctor or your PA, a physician assistant, you only really see your patients for like five minutes,’’ Heinrich said. “The best part I think about therapy is that you do work from 30 minutes to an hour to two hours with the patient.” The length of time physcial therapists see their paitents allows physical therapists to develop relationships with their patients. “I like to have those relationships, and that’s why you come to work,” Heinrich said. “You don’t come to work to type on an Excel sheet. No, I’m here to give you tools to empower you, and let’s develop a relationship together and get you back to what you want to do.” Rich agrees that this extra time allows the development of practitioner-patient relationships. “I see my patients for an hour, every day for 2-3 months,” Rich said. “One of my first main goals is gaining rapport with patients and families because I think that that therapeutic connection is really vital.”

The practitioner-patient relationship isn’t only important to the therapists, it also helps the patient during their recovery process. “I was there either two or three times a week for however long over a two year span,” Hull said. “You get to know them really well. I think the ones I had were very friendly, kind of made me feel comfortable and kind of optimistic about the recovery.” To some practitioners, the best part may be the relationships they form with the patient. However, Rich sees the best part as seeing the patient get better, and back to their own life. “The best part is getting to be a small part of somebody’s journey,” Rich said. “Just interacting with and encouraging them through this very, very difficult time is really, really rewarding.”

me through it, and were able to kind of explain how things are going just to make you feel more comfortable. They played a big role in [my] recovery, just keeping you motivated and kind of seeing the light at the end of the tunnel.” The choice on whether to go see a physical therapist to help with a person’s injury recovery is up to each person, however, Hull would recommend seeing one, if ever needed. “Absolutely.” said Hull, “I think having a physical therapist and their background and education, knowing what they’ve gone through to get to that point, you can trust them and in science and having a good feel for what you need.”

The encouragement and support that physical therapists give has been likened by some to a companion dog, and just like companion dogs are to their owners Hull believes that therapists are important to their patients too for those same reasons. “If you don’t have a therapist, or anybody to kind of give you that support, it’d be tough,” Hull said. “They made it a lot easier to push

Fun Fact The oldest document that recorded the start of modern day physical therapy can be traced back to Stockholm, Sweden. Here, Pher Hendrik Ling founded the Royal Central Institute of Gymnastics, a physical education, sports coaching, and preventative health school in the year 1813.

Shown here are the Top 10 Most Common Sports Injuries. The list is not in any particular order, and explains the injury, whilst the graphic shows where the injury occurs. Note: If the linesare on top that means the injury occurs on the front. If it isn’t, then it is either on the side or on the backside of the body.

Most Common Graphics by Ben Ozimek

Sports Injuries

1 2 3

Epicondylitis (Tennis Elbow) The slight tears of tissues within your tendons from flexing and extending your wrist too much, affecting either the inside or outside of the elbow is called Epicondylitis. Sciatica --------------->

Sciatica is an injury to the sciatic nerve, a nerve in the lower back. The main symptoms a person who has Sciatica has are pain, tingling, and numbness in the leg and lower back.

ACL Tear --------------->

The ACL is a ligament in the knee that holds the bones within the knee joint together. ACL tears are extremely painful and most ACL tears need surgery to repair the torn ligament.

Shin Splints ------------->

Shin Splints are caused by excessively increasing the intensity of your sports workout, such as running a half marathon without training. Pain will be felt up and down the inner edge of the shin.

Achilles Tendonitis ------->

The Achilles tendon, which connects the heel to the calf muscle, can tear from the overuse of the calf muscles. When it does so, it is extremely painful and it may require surgery to repaire the tendon.

Shoulder Injuries --------> The shoulder has the widest range of

motion out of all joints in the body, this leads the joint to be the most unstable, leading to a multitude of different injuries like a shoulder sprain, or a dislocation.

Groin Pull ---------------> When you strain your inner thigh from playing a sport that uses a lot of side to side motion, you are looking at a groin pull. Rest and icing the injury will help you recover, if the pull is mild, or intermediate.

Hamstring Strain -------->

When completing an activity and to complete that activity you need to kick out your leg sharply, you can strain your hamstring. Crutches for a few weeks may be needed if the strain is very severe.

Patellofemoral Syndrome ->

Patellofemoral syndrome is a likely candidate for your knee pain if you over exercise in a activity that requires a lot of running jumping, as the tissue between your thigh bone and kneecap are damaged.

Ankle Sprain ------------> An excessive twist of the ankle can cause the ligaments on the outside of your ankle to tear. A light ankle sprain the most common of ankle sprains, can be treated with just bed rest and ice. Source: foothillsrehab.com

n o i t p i r c s s e i r s P e h m t s o r o F r P To y r a h d u ho C t n a Arh By

ajor changes occur in someone’s life after losing a limb. To succeed as an amputee one needs guidance and professional help. Prosthetists not only fit patients with prosthetics but educate and counsel them to give amputees a chance at a new life. Nathan Garner, an amputee and a patient liaison (someone who helps patients during recovery) in Austin, said losing a limb is a very harsh life-changing experience. “My accident was so traumatic,” Garner said. “It was a hit and run motorcycle accident.” said Garner, “Somebody just hit me and left me on the side of the road to die.” Garner says that being an amputee is tough and getting a prosthesis isn’t easy.

“

a prosthetic. He says that the most important thing was to find a company that could listen to what he wanted. “Some of the other companies, I kind of wasn’t feeling like I was getting heard.” Garner said. “I wanted to explore and find somewhere else, where I felt like I was heard, and that I could meet my goals.” This experience showed Garner the importance of inspirational people in the prosthetic industry. It was the reason he ended up becoming a Patient Liason. “For other amputees to see another amputee succeed. I just feel like that goes a long way.” said Garner. “I wanted to be a part of that, because somebody actually talked to me whenever I was in the hospital, and made that impact on my life, and I wanted to reciprocate that” Garner said.

“Nobody prepares you… it kind of just falls into the lap and it fell into my lap” Garner said, ”In my case, I had to wait over a year and three Another individual that helps Amputees have months to even become a candidate to receive a chance at a new life is Amy Lawrence, a prosthetist orthotist (healthcare professional that a prosthetic leg.” helps fit braces and splints). She shared how After Garner became a candidate, the process of fitting a prosthesis varies a lot 12 he had to find the right place to get for each patient.

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Photo Courtesy of Tech Ridge Prosthetics

“Everybody’s gonna be so different. That’s what’s fun, it’s very unique field.” Lawrence said. “A lot of people think that we’re just

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pulling these off the shelf and giving them to people. And that’s just not the case.” Lawrence said. Lawrence described how the prosthetic goes from prescription to prosthesis. “Very generic prescription that usually comes in” Lawrence said, “For example, here this patient needs a leg.” Lawrence said that they first suck out all the excess blood and take a cast of the patient’s leg. “We make marks on the [cast] about where our bones are, and where we can take pressure and where we can’t.” Lawrence said. “Then we take our cast back to the lab, we fill it with plaster, we hand modify.” Lawrence said.

Photo Courtesy of Tech Ridge Prosthetics

Prosthetist is hand molding a positive mold

Photo Courtesy of of a Ridge patient’s cast. Tech Prosthetics

To finish off the socket the plastic is put over the mold. “We heat up a piece of plastic, we pull it over the mold under vacuum, and then we cut it out and smooth it

Photo Courtesy of Tech Ridge Prosthetics

Tony Fraello is helping an amputee and providing guidance with any issues the patient is experiencing. up.” Lawrence said. Multiple such test sockets are made until it fits the patient properly. “The process is extremely tailored to the patient.” Lawrence said. Lawrence said that the creation of a socket is only a small part of the whole operation. She said that a huge part of the prosthetic process is making sure the patients are not afraid and know what their 14 future looks like.

“We can come in and educate them on what’s to come to [remove] the fear of the unknown.” Lawrence said. “We tell the patient, ‘look, this is the process, it’s not going to take forever, you can absolutely do it, you can live whatever you want.’” Lawrence said. Along with education lots of patients require mental support Lawrence explained. “It’s a loss.” Lawrence said. “They’ll grieve, just like they’ve lost a loved one.” Lawrence said, “they just have to be, you know, really positively reinforced that it’s not the end, it’s the

beginning.” Lawrence explained mental support plays a vital role in the success of the patient’s recovery.

fresh start every time. And so, you know, you got to do a lot of experimenting with different things until you find what works for that patient.”

“A lot of counseling that comes along with this profession” Lawrence said, “You can really tell a difference when somebody’s got the right cheerleaders in their corner.”

Garner says that the strategy that works for patients is setting small goals. He said this helps them progress and have a clear mind for the future.

Garner, who is now a patient liaison, said that “So we start with small goals” Garner said, his job is to help take patients through this pro- “Let’s go, let’s walk from, your bedroom, to cess both mentally and physically. Garner said your bathroom, your bedroom to your kitchen… let’s keep those goals realistic.” “I have people look at me and say, Hey, things are gonna be okay. Because if he could do that, Garner said that these goals help motivate the I could do that” Garner said. patient and it helps them maintain a positive mindset. Listening to the patient, understanding what mental state they are in, and what they need “Starting off small with small goals that you is extremely helpful, according to Garner. He can obtain relatively easy. It gives you that said that he lets patient’s know that someone sense of accomplishment”Garner said, “I accares and is there to help. complished this today, let me see what I could do more the next day. So that’s how we keep “Just letting them know that we’re there for their morale up.” them. 100%, whether it be body or mind.” Garner said, “Even if you don’t need anything, Garner says that every time he and his colwe’re here to listen to you.” leagues are able to get the patient back to living their life it is a great feeling. Garner said that along with mental support, listening to the patient helps us understand “The best part of my job is giving somebody how to help them physically. the leg and then them taking off and doing all kinds of crazy things”,Garner said.“Seeing a 70 “The challenge is that no case is alike” “every year old lady just get up and walk out of her individual is their own person, and they have chair like nothing is super awesome to see” their own way that they walk their own way Garner said. that they can stand up.” said Garner, “really learning and listening, that’s what really matters is being that ear to take in information and then to utilize that information for the good of the patient.”

Fun Fact

An additional challenge for Garner is that there is no way set in stone for a patient to get or achieve success. He says it takes a lot of patience and experimentation. “That’s the difficult part because you can’t just go off the last patient that you dealt with.” Garner said, “You have to basically start from a

75% of all the amputations are caused by either cardiovascular diseases or type 2 diabetes. “We really don’t get that many veterans.” Lawrence said.

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U.S. Civil war caused a need for development in prothetics. A rubber hand prosthesis with movable joints was made.

1863 Peg legs and hand hooks were the vast majority of prosthesis. Made by individual tradesmen. Not very functional.

456-100 BCE 16

Courtesy of University Of Pittsburgh Medical Center

Modern prosthetisis use sensors, gears and sometimes even microproccessors to provide a great feel.

2000-2014

Advancements in tools led to better fitting. Newly discovered materials such as carbon fiber were used instead of wood.

1970-1990 17

Harvesting Healthy Habits By Sebastian Vazquez Cortes ealthy habits is something strived for. Sometimes a little help is needed or where to begin isn’t clear. It can be overwhelming, stressful, and may seem like a lot of work. Fitness instructors and Health coaches are people that help overcome that stress and help find patients that dedication needed to find a new way of life. Nick Gomez is a strength and conditioning coach in austin that decided to work to helping others after a not so healthy phase after college “I wanted to stay around athletics and went through a phase where I kind of got unhealthy after college, got kind of heavy and didn’t really work out as much as I should’ve,” Gomez said. “I realized how much it had helped me [working out] and decided that I should kind of do my best to pass that on to others and try to help other people along their fitness journeys” Gomez mentions how keeping a routine is hard, getting progressively harder the older you get. “A lot of times, especially as adults, if you’re working a regular job or you tend to travel a lot, It’s hard to stay on a consistent program.” Gomez talks about his

struggles staying on top of clients especially with the pandemic well known and loved. “It affected me a lot, especially because at the time when everything was kind of in the heat of it all, I was living in Albuquerque, New Mexico, a very mandated state. So it was pretty difficult to work consistently, it was hard to see my clients on a regular basis.” With Gyms closing down Gomez found it difficult to provide attention needed to his clientele. “A lot of every gym in New Mexico closed down multiple times due to the pandemic,” He says. “It was difficult to give my clientele the attention that they deserve”

Even when things semi-normalized and were going back to in person activities, not knowing if their clients were actually working worried Gomez. Adapting played a key role in Gomez’s career. “We were able to switch a lot of things online for the most part enough to kind of keep everybody on pace. With technology improving these days and mostly everyone having access to a device with access to the internet, Gomez decided to use that. “I would use an app that I would program to put up workouts for my clientele, my clients would be able to see their workouts there,” Gomez says “ It was definitely a challenging time to make sure that my clients are getting the work and attention that they deserve.”

“When I’m face to face with a client I can control everything within that, you know, hour, hour and a half session but I can’t the rest of the day, the other 23 hours of the day,” Gomez says. “I don’t really get to see what they’re doing as far as nutrition goes, If they’re staying active like going on walks, hiking, whatever the case may be.” Nutrition plays an important role when it comes to a healthy lifestyle, Gomez shares his knowledge about healthy dieting. “There’s so many different diets out there that it’s difficult to see which ones work for you” Gomez says “The best diets are always gonna be the one that works for that client.” Receiving a personalized diet will cost a visit to the nutritionist but Go-

mez talks about a Flexible way of dieting anyone can do.

“There are plenty of personal trainers out there that have certifications. But still, they’re not very good coaches, or they might be on “I’m a big fan of what’s called flexible dieting, their phones during sessions” which is just tracking your macros. macronutrients are fats, carbohydrates, and protein. Working on yourself can cause physical and And everyone has a certain set of macronutri- mental pain. Ericka is a health coach that ents that they should be hitting in a day, de- works with others on their journey when impending on what their goals are.” proving yourself. WIth dieting comes working out. Gomez talks about resistance training although being a good way workout, it can be a danger to untrained people.

“Workout not for the sake of burning calories but for the sake of feeling better,” Ericka says. “If you can’t do a full workout just try going for a walk outside”

“There are definitely certain dangers to any sort of resistance training, if you’re doing it either. nervously, meaning you don’t really know what you’re doing. Or if you don’t have someone watching you that has a well trained eye”

Ericka mentions how feelings can play a role in us but it shouldn’t affect your journey.

Although getting help is useful when achieving your goals, Gomez mentions how its important to find someone that will pay attention to you.

“Sometimes you tell yourself restriction is the only answer but it will lead you to another binge[Eating], it’s counterintuitive” Ericka says “No matter how you feel today, just know that you are not your feelings nor your actions.”

Fun Fact:

Walking 10,000 steps a day may be healthier and a more consistent way to do cardio than sprints or runs

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Lean Beef

= 22 grams protein per 3-ounce serving of 93%-lean ground beef

Chicken = 27 grams protein per 3-ounce serving of skinless chicken breast

= 6 grams protein per 1 large egg

Regar dle wheth ss of er a pe r is a ca rnivor son e follow ing a v or egan lifesty le

Eggs

Peanut Butter = 7 grams protein per 2 tablespoons

Salmon

= 12 grams protein per 1/2-cup serving

Lentils

= 18 grams protein per 1 cup cooked lentils

are so (or they m in betw ewhere e entire en), it is ly pos sib to get all of t le he essent ial am in acids t hat th o e body n eeds, a long a s s they ar choosi ng the e right foods.

= 19 grams protein per 3-ounce serving

Cottage Cheese

Graphics by Sebastian Vazquez

Caring about Healthcare The ACA’s Effect on Insurance By Jack Preston McKinney

alue-based care, consumerism, and social determinants of health are three of the newest models impacting healthcare. According to Brian Mathis, the former chief strategy officer for optimum care, the Affordable Care Act helped to accelerate these ideas. “The Affordable Care Act [ACA] accelerated all of those things, because it was a uniquely impactful thing to hit the healthcare industry, and the healthcare industry needed something to upend it” Mathis said Social determinants of health considers how different aspects of a person’s life affects their health. Everything from how accessible your doctor’s office is, to your work environment. Jason Helgerson, former medicare director for New York and Wisconsan, believes that Social determinants of health are strategies to get to better outcomes.

air conditioners, just a simple $300 room air conditioning unit.” Helgerson believes the reason social determinants of health works as a strategy is thanks to value-based care. “In the past hospitals would be better off financially if individuals just kept coming back over and over and over again,” Helgerson said. “They had little incentive to want to invest in things like air conditioning.” Value-based care provides incentive for keeping people out of hospittles. In a system that employs value-based care, a hospital wouldn’t get paid more for 25 hospital visits than they would one. According to Helgerson, they are financially incentivised to keep people out of hospittles, and provide better services for cheaper.

“It creates a positive incentive,” Helgerson said “If I can offer a cheaper service, and that “The example I always give is a hospital system cheaper service is a one time air conditioner in the Bronx, who realized when they looked at purchase, to prevent 24 emergency room vispatients with chronic lung disease, they were its, that becomes a very cost effective strategy.” seeing… a significant uptake in utilization of emergency rooms, when temperatures went Inorder to implement value-based care, Mathis over 80 degrees,” Helgerson said. “When they believes that the competition needs to be bedid some investigation, they found that a lot of tween doctors not hospitals. these poor seniors did not have air conditioning. And so shock of shocks, they had “The problem, in my mind, is the competition a hard time breathing. The most cost today in healthcare is between hospital syseffective strategy to prevent those tems. Hospital systems don’t provide care, doc24 emergency room visits was to buy tors do. We don’t have an environment where

HEALTH

INSURANCE

Graphic by Jack McKinney

Do You Have... Art by Jack McKinney

Your deductible is the amount you have to pay in medical fees before the insurance will step in to help cover the cost.

Even after you have payed your deductible, you still have to cover a set amount of the cost determined by your plan. That amount is your copay

Your premium is a flat amount you will pay monthly for your insurance, regardless of whether you have used your isurance or not. Medicare is free insurance provided by the US goverment to individuals who are over 65 or disabled.

Medicaid is free insurance provided by the US govermen to individuals who are considerd to be low income.

there’s competition, per se amongst the clinicians based on quality.” Said Mathis. Consumerism is a system that rewards consumers for making good choices, but at the same time, might include repercussions for ill-made ones. One method of implementing consumerism is raising deductibles, but Helgerson believes that we have gone as far as we can with that. “We’ve gone about as far as we can go with deductibles and high deductibles.” Helgerson said. “I think we need new ideas and new approaches that incentivize good behaviors.” According to Helgerson, some of these new approaches could be financial incentives, such as gift cards.

encourage value-based care, social determinants of health, and consumerism. It also created tools for innovation in the medicaid and medicare field. “I think the biggest tool that was created was the Center for Medicare and Medicaid Innovation, CMMI, which was given a lot of administrative discretion to implement new payment models” Helgerson said. CMMI is a branch of Health and Human Services that is incharge of theorizing new models for medicare and medicaid, according to Amy Basano, former deputy director of CMMI, its essentially the research and development center for medicare and medicaid.

“We were tasked with looking at different ways to pay for services, different ways to pro“There was a tried effort to do gift cards for indi- vide health care services for those who are in viduals who were HIV positive and at high risk Medicare and Medicaid.” Bassano said. “We of non compliance with treatment.” Helgerson developed what we call alternative payment said. “What this program did was it gave up models” to $250 a year for individuals in this cohort to go in on a quarterly basis. and get their blood Some of the CMMI models Bassano was perwork done. If the blood work came back with sonally involved in where bundled payment the viral load suppressed, they got a gift card. models. Helgerson believes that the ACA did more than “The ones that I was more personally involved in the development were some of the bundled payment models, where you take a hospital service and have one payment for the hospital stays, plus all the services that come for the next 90 days, and that really incentivizes much more efficient care,” Basano said. Although the ACA encouraged value-based care, social determinants of health, and consumerism, there are still a lot of other things healthcare needs. The ACA mandated more extensive health coverage, but Mathis believes that healthcare plans need to be tailored to the needs of the person. “The Affordable Care Act, well intentioned, introduced a lot of requirements on what needed to be inside of the coverage of a health plan.” Mathis said. “There was a lot more latitude previously, you could buy an insurance plan

that was bare bones, it just covered a much more convenient and more efficient” smaller universe of stuff. The Affordable Care Act said no, all health insurance needs to cover Helgerson believes that thanks to telehealth this much longer list of things.” may be more than just convenient, however, people might not need to visit their doctor Everyone has different healthcare needs, so when they’re sick, without the risk of exposing Mathis believes it is illogical to mandate the others. addition of services that not everyone needs. “I want to be able to go buy a health insur- “We have technology where we could home ance product that makes sense for me and deliver in a matter of hours a test that can conmy family, or maybe firm what it is that just me, maybe I you have.” Helwant to get a difgerson said. “You ferent plan for my can see a doctor wife and a differvia your phone or ent plan for my your computer, in kids.” Mathis said. very short order.” “It’s not obvious Ben Franklin founded the first insurthat we should Helgerson thinks ance company in the United States. It be making a colthat we might look lective decision, back one day we was oppend in 1752 abd was cakked even inside of my might view sendthe Philadelphia contribution. family.” ing sick people to in person visits Beyond tailoring might be viewed the plan to the as the modern equivperson, Helgerson believes that the user expe- alent of bloodletting rience in healthcare needs to be improved. “It will be like, wow, that was really stupid to “Ultimately we do not design the system to be send people in taxi cabs or on on subways to patient friendly, because the time and experi- go to doctor’s appointments when they had the ence of the patient is near almost zero value flu.” Helgerson said. in the system.” Helgerson said. “That’s why the user experience is so poor. The provider is at Healthcare still has a lot of work that needs to the top, we care about are they happy, are they be done in the future, with a multitude of asgetting their needs met. But the patients now pects that need to be fixed, but thats just what are at the bottom of the food chain.” Mathis likes about it.

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The terrible user experience does create openings for new models, Bassano believes that one of these openings in healthcare may be services such as telehealth. “I think from the consumer perspective, it is super convenient.” Bassano said. “The sort of telehealth zoom physicals with your doctor, coupled with remote monitoring and other types of services really make delivering services in people’s homes or elsewhere, much

“I love it, because to me, it is a puzzle.” Mathis said. “I like things that are complex and require fixing, and healthcare has an endless amount of that to be done. There’s so much that is irrational and makes no sense. You just want to tear it apart and figure out a way to rebuild it better than it exists.”

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Down: 1. An institution providing medical and surgical treatment and nursing care for sick or injured people 2. The organized provision of medical care to individuals or a communuty 4. Provides health coverage to millions of Americans 7. Engaging or ready to engage in physically energetic pursuits

Across: 3. Movement skills in which the body is moved in one direction, or a combination of directions, from one point to another 5. A practice or arrangement by which a company or government agency provides a guarantee of compensation 6. an instance of being injured 8. A person recieving or registered to recieve medical treatment

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