Paul Koebnick has been at Singapore American School for 20 years. What began as his interest in lighting design evolved into his career in theater tech, and the opportunity to mentor hundreds of students!
from Singapore American School http://ift.tt/1UtoCgb
Tuesday, May 31, 2016
1996
1996
Paul Koebnick has been at Singapore American School for 20 years. What began as his interest in lighting design evolved into his career in theater tech, and the opportunity to mentor hundreds of students!
from Singapore American School http://ift.tt/1UtoCgb
from Singapore American School http://ift.tt/1UtoCgb
2002
As a student, Kate Ryan '02 learned to expect excellence from herself and the people she worked with. As a professional, she can trace much of her success back to the experiences she had as a student at Singapore American School.
from Singapore American School http://ift.tt/1XeEkjx
1988
For Singapore American School fitness teacher Ursula Pong, healthy living goes beyond a weekly trip to the gym. Her greatest joy comes from watching students move from the hunt for great abs to a desire to embrace a healthy lifestyle.
from Singapore American School http://ift.tt/1TWvVwN
2002
As a student, Kate Ryan '02 learned to expect excellence from herself and the people she worked with. As a professional, she can trace much of her success back to the experiences she had as a student at Singapore American School.
from Singapore American School http://ift.tt/1XeEkjx
from Singapore American School http://ift.tt/1XeEkjx
1988
For Singapore American School fitness teacher Ursula Pong, healthy living goes beyond a weekly trip to the gym. Her greatest joy comes from watching students move from the hunt for great abs to a desire to embrace a healthy lifestyle.
from Singapore American School http://ift.tt/1TWvVwN
from Singapore American School http://ift.tt/1TWvVwN
2009
For Singapore American School middle school digital media teacher Ana María Gach, fun is at the heart of learning.
from Singapore American School http://ift.tt/1O455E1
from Singapore American School http://ift.tt/1O455E1
2009
For Singapore American School middle school digital media teacher Ana María Gach, fun is at the heart of learning.
from Singapore American School http://ift.tt/1O455E1
2001
For Kyle Aldous '02, Singapore American School was an opportunity to discover his potential and use his teachers' support to lay his foundation for future success.
from Singapore American School http://ift.tt/1XetFFo
2001
For Kyle Aldous '02, Singapore American School was an opportunity to discover his potential and use his teachers' support to lay his foundation for future success.
from Singapore American School http://ift.tt/1XetFFo
from Singapore American School http://ift.tt/1XetFFo
Are our kids eating too much fast food?
Are our kids eating too much fast food? It is hard when we are so busy, so we run through and grab a bite for the kids, instead of giving them healthier options from home. This new study reveals the truth about fast food, what they are eating and what they ARE NOT eating…
Recently, Beech-Nut organized a study to see how young children were really eating. They found that 1 out of 3 children weren't eating any fruit.
"By 15 months, babies eat 6 ½ teaspoons of added sugars per day, mainly from fruit drinks, soda, cookies, sweetened yogurt and ready-eat-cereals, which are introduced into the diet as early as 9 months. To put that into perspective, an 8-ounce cup of cola has about 6 ½ teaspoons of sugar. So, babies are eating as much sugar in a day as what you'll find in an entire cup of soda!"
"Less than half of babies are consuming any vegetables by the time they are 23 months old. And, for the babies who do eat vegetables, the most common veggie is potatoes from French fries and potato chips."
- What it means: When processed options like fries and chips are the most common form of vegetable, babies are missing out on nutrient-dense choices found in green veggies. In fact, only 1 percent of babies consume green vegetables!" – See more at: Beechnut.com here.
We are living in a time when fast food is all too easy to get and home cooked meals take time. Between running to appointments and practices, it makes grabbing that on-the-go meal or snack that much more tempting.
How can you help?
1. Give your child baby food. Our kids love those baby food pouches of pureed fruits. We give them to our 3, 5, 8 & 9 year olds as 'snacks'. They think they are great. (Refrigerate them if your child doesn't like them the first time).
2. Sneak it into their food! Our kids love these Rice Balls.
3. Make them smoothies!
4. Make popsicles from fruit & vegetables.
5. Let them play with their food!
6. Offer it as the only snack when they are ready for dinner, but have to wait for it to finish cooking.
7. If you go to a park, only pack veggies and fruit (we know that grabbing a pack of crackers is way faster, but if they only have healthy options, that is what they will eat.)
8. Prep fruits and veggies every Sunday and have them ready to grab throughout the week.
9. Make homemade juice with these 10 juice recipes for beginners (our kids love to help make it… and then drink it!)
10. Try any of these 45 recipes that sneak veggies into their food!
We love to share helpful tips here at Kids Activities Blog and on our Facebook Page. Stop by to see our latest parenting conversations. In the meantime, here are some more ideas to encourage your preschooler to eat more vegetables.
The post Are our kids eating too much fast food? appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1TIBv3y
Are our kids eating too much fast food?
Are our kids eating too much fast food? It is hard when we are so busy, so we run through and grab a bite for the kids, instead of giving them healthier options from home. This new study reveals the truth about fast food, what they are eating and what they ARE NOT eating…
Recently, Beech-Nut organized a study to see how young children were really eating. They found that 1 out of 3 children weren’t eating any fruit.
“By 15 months, babies eat 6 ½ teaspoons of added sugars per day, mainly from fruit drinks, soda, cookies, sweetened yogurt and ready-eat-cereals, which are introduced into the diet as early as 9 months. To put that into perspective, an 8-ounce cup of cola has about 6 ½ teaspoons of sugar. So, babies are eating as much sugar in a day as what you’ll find in an entire cup of soda!”
“Less than half of babies are consuming any vegetables by the time they are 23 months old. And, for the babies who do eat vegetables, the most common veggie is potatoes from French fries and potato chips.”
- What it means: When processed options like fries and chips are the most common form of vegetable, babies are missing out on nutrient-dense choices found in green veggies. In fact, only 1 percent of babies consume green vegetables!” – See more at: Beechnut.com here.
We are living in a time when fast food is all too easy to get and home cooked meals take time. Between running to appointments and practices, it makes grabbing that on-the-go meal or snack that much more tempting.
How can you help?
1. Give your child baby food. Our kids love those baby food pouches of pureed fruits. We give them to our 3, 5, 8 & 9 year olds as ‘snacks’. They think they are great. (Refrigerate them if your child doesn’t like them the first time).
2. Sneak it into their food! Our kids love these Rice Balls.
3. Make them smoothies!
4. Make popsicles from fruit & vegetables.
5. Let them play with their food!
6. Offer it as the only snack when they are ready for dinner, but have to wait for it to finish cooking.
7. If you go to a park, only pack veggies and fruit (we know that grabbing a pack of crackers is way faster, but if they only have healthy options, that is what they will eat.)
8. Prep fruits and veggies every Sunday and have them ready to grab throughout the week.
9. Make homemade juice with these 10 juice recipes for beginners (our kids love to help make it… and then drink it!)
10. Try any of these 45 recipes that sneak veggies into their food!
We love to share helpful tips here at Kids Activities Blog and on our Facebook Page. Stop by to see our latest parenting conversations. In the meantime, here are some more ideas to encourage your preschooler to eat more vegetables.
The post Are our kids eating too much fast food? appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1TIBv3y
Foam Popsicles
Making Foam Popsicles is a fun summer craft for kids of all ages. They are adorable, require minimal craft supplies, and are easy for kids! This craft is suitable for home, school, or camp.
Foam Popsicle Craft
Popsicles…the first thing my kids ask for when the weather gets hot! The craft shared below is perfect for summer and popsicle-loving kids!
Materials and Directions:
- Craft foam
- Wooden popsicle sticks (standard)
- Glue Dots
- Scissors
- Adhesive back magnetic tape (optional)
- Pencil or pen
After gathering supplies, use a pencil or pen to draw the shape of a popsicle on a piece of foam. Use that shape to trace popsicles onto the rest of the foam pieces so the shapes are the same.
RELATED: Blackberry Cheesecake Pops
After tracing the shapes, cut out all of the popsicles with a pair of scissors. Use Glue Dots to attach standard sized wooden popsicle sticks to each foam popsicle. Glue Dots work better than white glue or tacky craft glue.
If desired, attach 2 strips of magnetic tape to the back of the popsicles. They look adorable on the refrigerator!
Kids will have a blast making foam popsicles in a rainbow of colors to share with neighbors and friends. This craft is perfect for welcoming summer!
If you liked this craft, you may also enjoy painting with popsicles and making some for your pup!
The post Foam Popsicles appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1WXduf3
Foam Popsicles
Making Foam Popsicles is a fun summer craft for kids of all ages. They are adorable, require minimal craft supplies, and are easy for kids! This craft is suitable for home, school, or camp.
Foam Popsicle Craft
Popsicles…the first thing my kids ask for when the weather gets hot! The craft shared below is perfect for summer and popsicle-loving kids!
Materials and Directions:
- Craft foam
- Wooden popsicle sticks (standard)
- Glue Dots
- Scissors
- Adhesive back magnetic tape (optional)
- Pencil or pen
After gathering supplies, use a pencil or pen to draw the shape of a popsicle on a piece of foam. Use that shape to trace popsicles onto the rest of the foam pieces so the shapes are the same.
RELATED: Blackberry Cheesecake Pops
After tracing the shapes, cut out all of the popsicles with a pair of scissors. Use Glue Dots to attach standard sized wooden popsicle sticks to each foam popsicle. Glue Dots work better than white glue or tacky craft glue.
If desired, attach 2 strips of magnetic tape to the back of the popsicles. They look adorable on the refrigerator!
Kids will have a blast making foam popsicles in a rainbow of colors to share with neighbors and friends. This craft is perfect for welcoming summer!
If you liked this craft, you may also enjoy painting with popsicles and making some for your pup!
The post Foam Popsicles appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1WXduf3
The State of Play in the ACA Marketplaces
Last week I was interviewed by Dmitri Sotus on WTOP's "To Your Health" about the state of competition in the ACA marketplaces.
Recent news reports have highlighted rising premiums and plan exit in the ACA marketplaces. United Healthcare has announced they will no longer offer marketplace plans in most of the 34 states where they had previously participated. Based on early insurer filings, three states may only have one insurance carrier offering marketplace plans during open enrollment this fall. Are these reports a sign that the marketplaces are unsustainable? Or are they a sign that the markets are working to make plans compete on price as intended?
Listen to find out and to get a preview of our June issue.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2812XU2
How To Make Erupting Soap
How to make Erupting Ivory Soap: If you think baking soda and vinegar eruptions are cool then you’re going to love what happens to a bar of ivory soap when you put it in the microwave!
How to Make Erupting Soap
What you need:
A bar of Ivory soap (no substitutions allowed)
A microwave safe plate
A microwave
Yep, that’s it!
I first asked my son what he thought might happen if we put a bar of soap in the microwave. He naturally said that it would melt. Most soaps will melt but Ivory soap is different because of the way it is formed. More on that later…
What to Do:
Put your bar of soap on the plate and microwave it for 2 minutes.
The action starts right away as the soap quickly starts to grow. When it stops growing you can stop the microwave although it won’t harm anything if it runs for the full 2 minutes. The soap just won’t grow any bigger at that point.
My son was absolutely giddy watching this for the first time…and every time after that. I must admit I haven’t gotten tired of watching erupting soap either!
When the soap had finished erupting, this is what we got.
What’s going on?
There is a scientific principle called Charles’ Law which states that the volume of a gas directly increases with an increase in temperature. So the hotter air gets, the more space it wants to take up and the more pressure it will produce in order to take up that space.
Ivory soap in an unusual kind of soap in that it has a lot of air pockets in it. There is also a lot of moisture in Ivory soap. When it is heated, the soap softens but before it gets close to melting, the moisture in the bar gets hot and turns to gas (steam). Add that to the already present air particles throughout the bar and you’ve got a lot of steam trying to get out. As the steam pushes its way out, it expands the soap.
Here’s a simple animation of Charles’ Law to help explain how volume and temperature are directly related.
Other soaps are not as porous as Ivory soap because they do not have air pockets throughout. Therefore, the steam isn’t able to build up inside it and instead the soap just melts.
Except for the loss of water, this is still Ivory soap. No real chemical change took place. The soap is puffed full of air so we had fun crumbling it up, and then we whisked in a bit of water and made “soap paint”.
We painted on styrofoam trays both with paintbrushes, and with our hands.
Once the “Wow Factor” died down just a little, we decided to get a little more scientific so we pulled out a scale.
We weighed a whole bar of ivory soap: 78g., and an erupted bar of Ivory soap: 69g.
The erupted bar weighed less due to moisture evaporation.
Other Observations:
1. The soap has expanded six or more times its original size but actually weighs less now because of water that has evaporated. Amazing!
2. If you microwave half a bar of Ivory soap, the cut side of the bar will expand significantly more quickly and with more force than the uncut side. In this experiment above, the force of the expansion out of the cut side was so strong that it flipped the bar from its side to an upright position so that the eruption from the cut side was then facing upward.
3. The plate was hot all over after a minute and half. However, the plate was significantly hotter directly under the expanded soap. Microwaves focus on heating water molecules so the water in the soap heated quickly and made that part of the plate hotter.
Did you know? We wrote a science book!
Our book, The 101 Coolest Simple Science Experiments, features tons of awesome activities just like this one that will keep your kids engaged while they learn. How awesome is that?!
The post How To Make Erupting Soap appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1zNxK2s
How To Make Erupting Soap
How to make Erupting Ivory Soap: If you think baking soda and vinegar eruptions are cool then you're going to love what happens to a bar of ivory soap when you put it in the microwave!
How to Make Erupting Soap
What you need:
A bar of Ivory soap (no substitutions allowed)
A microwave safe plate
A microwave
Yep, that's it!
I first asked my son what he thought might happen if we put a bar of soap in the microwave. He naturally said that it would melt. Most soaps will melt but Ivory soap is different because of the way it is formed. More on that later…
What to Do:
Put your bar of soap on the plate and microwave it for 2 minutes.
The action starts right away as the soap quickly starts to grow. When it stops growing you can stop the microwave although it won't harm anything if it runs for the full 2 minutes. The soap just won't grow any bigger at that point.
My son was absolutely giddy watching this for the first time…and every time after that. I must admit I haven't gotten tired of watching erupting soap either!
When the soap had finished erupting, this is what we got.
What's going on?
There is a scientific principle called Charles' Law which states that the volume of a gas directly increases with an increase in temperature. So the hotter air gets, the more space it wants to take up and the more pressure it will produce in order to take up that space.
Ivory soap in an unusual kind of soap in that it has a lot of air pockets in it. There is also a lot of moisture in Ivory soap. When it is heated, the soap softens but before it gets close to melting, the moisture in the bar gets hot and turns to gas (steam). Add that to the already present air particles throughout the bar and you've got a lot of steam trying to get out. As the steam pushes its way out, it expands the soap.
Here's a simple animation of Charles' Law to help explain how volume and temperature are directly related.
Other soaps are not as porous as Ivory soap because they do not have air pockets throughout. Therefore, the steam isn't able to build up inside it and instead the soap just melts.
Except for the loss of water, this is still Ivory soap. No real chemical change took place. The soap is puffed full of air so we had fun crumbling it up, and then we whisked in a bit of water and made "soap paint".
We painted on styrofoam trays both with paintbrushes, and with our hands.
Once the "Wow Factor" died down just a little, we decided to get a little more scientific so we pulled out a scale.
We weighed a whole bar of ivory soap: 78g., and an erupted bar of Ivory soap: 69g.
The erupted bar weighed less due to moisture evaporation.
Other Observations:
1. The soap has expanded six or more times its original size but actually weighs less now because of water that has evaporated. Amazing!
2. If you microwave half a bar of Ivory soap, the cut side of the bar will expand significantly more quickly and with more force than the uncut side. In this experiment above, the force of the expansion out of the cut side was so strong that it flipped the bar from its side to an upright position so that the eruption from the cut side was then facing upward.
3. The plate was hot all over after a minute and half. However, the plate was significantly hotter directly under the expanded soap. Microwaves focus on heating water molecules so the water in the soap heated quickly and made that part of the plate hotter.
Did you know? We wrote a science book!
Our book, The 101 Coolest Simple Science Experiments, features tons of awesome activities just like this one that will keep your kids engaged while they learn. How awesome is that?!
The post How To Make Erupting Soap appeared first on Kids Activities Blog.
from Kids Activities Blog http://ift.tt/1zNxK2s
CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities
The Center for Medicare and Medicaid Innovation (CMMI, or “the Innovation Center”) recently announced an initiative called Comprehensive Primary Care Plus (CPC+). It evolved from the Comprehensive Primary Care (CPC) initiative, which began in 2012 and runs through the end of this year. Both initiatives are designed to promote and support primary care physicians in organizing their practices to deliver comprehensive primary care services. Comprehensive Primary Care Plus has some very promising components, but also misses some compelling opportunities to further advance payment for primary care services.
The earlier initiative, CPC, paid qualified primary care practices a monthly fee per Medicare beneficiary to support practices in making changes in the way they deliver care, centered on five comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health. For all other care, regular fee-for-service (FFS) payment continued. The initiative was limited to seven regions where CMMI could reach agreements with key private insurers and the Medicaid program to pursue a parallel approach. The evaluation funded by CMMI found quality improvements and expenditure reductions, but savings did not cover the extra payments to practices.
Comprehensive Primary Care Plus uses the same strategy of conducting the experiment in regions where key payers are pursuing parallel efforts. In these regions, qualifying primary care practices can choose one of two tracks. Track 1 is very similar to CPC. The monthly care management fee per beneficiary remains the same, but an extra $2.50 is paid in advance, subject to refund to the government if a practice does not meet quality and utilization performance thresholds.
The Promise of CPC+
Track 2, the more interesting part of the initiative, is for practices that are already capable of carrying out the primary care functions and are ready to increase their comprehensiveness. In addition to a higher monthly care management fee ($28), practices receive Comprehensive Primary Care Payments. These include a portion of the expected reimbursements for Evaluation and Management services, paid in advance, and reduced regular fee-for-service payments. Track 2 also includes larger rewards than does Track 1 for meeting performance thresholds.
The combination of larger per beneficiary monthly payments and lower payments for services is the most important part of the initiative. By blending capitation (monthly payments not tied to service volume) and FFS, this approach might achieve the best of both worlds.
Even when FFS payment rates are calibrated correctly (discussed below), the rates are pegged to the average costs across practices. But since a large part of practice cost is fixed, it means that the marginal cost of providing additional services is lower than the average cost, leading to incentives to increase volume under FFS. The lower payments reduce or eliminate these incentives. Fixed costs, which must also be covered, are addressed through the Comprehensive Primary Care Payments. By involving multiple payers, practices are put in a better position to pursue these changes.
An advantage of any program that increases payments to primary care practices is that it can partially compensate for a flaw in the relative value scale behind the Medicare physician fee schedule. This flaw leads to underpayment for primary care services. Although the initial relative value scale implemented in 1992 led to substantial redistribution in favor of evaluation and management services and to physicians who provide the bulk of them, a flawed update process has eroded these gains over the years to a substantial degree.
In response to legislation, the Centers for Medicare and Medicaid Services are working correct these problems, but progress is likely to come slowly. Higher payments for primary care practices through the CPC+ can help slow the degree to which physicians are leaving primary care until more fundamental fixes are made to the fee schedule. Indeed, years of interviews with private insurance executives have convinced us that concern about loss of the primary care physician workforce has been a key motivation for offering higher payment to primary care physicians in practices certified as patient centered medical homes.
Two Downsides
But there are two downsides to the CPC+.
One concerns the lack of incentives for primary care physicians to take steps to reduce costs for services beyond those delivered by their practices. These include referring their patients to efficient specialists and hospitals, as well as limiting hospital admissions. There are rewards in CPC+ for lower overall utilization by attributed beneficiaries and higher quality, but they are very small.
We had hoped that CMMI might have been inspired by the promising initiatives of CareFirst Blue Cross Blue Shield and the Arkansas Health Care Improvement initiative, which includes the Arkansas Medicaid program and Arkansas Blue Cross Blue Shield. Under those programs, primary care physicians are offered substantial bonuses for keeping spending for all services under trend for their panel of patients; there is no downside risk, which is understandable given the small percentage of spending accounted for by primary care. The private and public payers also support the primary care practices with care managers and with data on all of the services used by their patients and on the efficiency of providers they might refer to. These programs appear to be popular with physicians and have had promising early results.
The second downside concerns the inability of physicians participating in CPC+ to participate in accountable care organizations (ACOs). One of CMMI’s challenges in pursuing a wide variety of payment innovations is apportioning responsibility across the programs for beneficiaries who are attributed to multiple payment reforms. As an example, if a beneficiary attributed to an ACO has a knee replacement under one of Medicare’s a bundled payment initiatives, to avoid overpayment of shared savings, gains or losses are credited to the providers involved in the bundled payment and not to the ACO. As a result, ACOs are no longer rewarded for using certain tools to address overall spending, such as steering attributed beneficiaries to efficient providers for an episode of care or encouraging primary care physicians to increase the comprehensiveness of the care they deliver.
Keeping the physician participants in CPC+ out of ACOs altogether seems to be another step to undermine the potential of ACOs in favor of other payment approaches. This is not wise. The Innovation Center has appropriately not established a priority ranking for its various initiatives, but some of its actions have implicitly put ACOs at the bottom of the rankings. Recently, Mostashari, Kocher, and McClellan proposed addressing this issue by adding a CPC+ACO option to this initiative.
The Innovation Center should be lauded for continuing to support improved payment models for primary care. Its blending of substantial monthly payments with lower payments per service is promising. But the highest potential rewards come from broadening primary care physicians’ incentives to include the cost and quality of services by other providers. CMMI should pursue this approach.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1ZayZXM
CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities
The Center for Medicare and Medicaid Innovation (CMMI, or "the Innovation Center") recently announced an initiative called Comprehensive Primary Care Plus (CPC+). It evolved from the Comprehensive Primary Care (CPC) initiative, which began in 2012 and runs through the end of this year. Both initiatives are designed to promote and support primary care physicians in organizing their practices to deliver comprehensive primary care services. Comprehensive Primary Care Plus has some very promising components, but also misses some compelling opportunities to further advance payment for primary care services.
The earlier initiative, CPC, paid qualified primary care practices a monthly fee per Medicare beneficiary to support practices in making changes in the way they deliver care, centered on five comprehensive primary care functions: (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health. For all other care, regular fee-for-service (FFS) payment continued. The initiative was limited to seven regions where CMMI could reach agreements with key private insurers and the Medicaid program to pursue a parallel approach. The evaluation funded by CMMI found quality improvements and expenditure reductions, but savings did not cover the extra payments to practices.
Comprehensive Primary Care Plus uses the same strategy of conducting the experiment in regions where key payers are pursuing parallel efforts. In these regions, qualifying primary care practices can choose one of two tracks. Track 1 is very similar to CPC. The monthly care management fee per beneficiary remains the same, but an extra $2.50 is paid in advance, subject to refund to the government if a practice does not meet quality and utilization performance thresholds.
The Promise of CPC+
Track 2, the more interesting part of the initiative, is for practices that are already capable of carrying out the primary care functions and are ready to increase their comprehensiveness. In addition to a higher monthly care management fee ($28), practices receive Comprehensive Primary Care Payments. These include a portion of the expected reimbursements for Evaluation and Management services, paid in advance, and reduced regular fee-for-service payments. Track 2 also includes larger rewards than does Track 1 for meeting performance thresholds.
The combination of larger per beneficiary monthly payments and lower payments for services is the most important part of the initiative. By blending capitation (monthly payments not tied to service volume) and FFS, this approach might achieve the best of both worlds.
Even when FFS payment rates are calibrated correctly (discussed below), the rates are pegged to the average costs across practices. But since a large part of practice cost is fixed, it means that the marginal cost of providing additional services is lower than the average cost, leading to incentives to increase volume under FFS. The lower payments reduce or eliminate these incentives. Fixed costs, which must also be covered, are addressed through the Comprehensive Primary Care Payments. By involving multiple payers, practices are put in a better position to pursue these changes.
An advantage of any program that increases payments to primary care practices is that it can partially compensate for a flaw in the relative value scale behind the Medicare physician fee schedule. This flaw leads to underpayment for primary care services. Although the initial relative value scale implemented in 1992 led to substantial redistribution in favor of evaluation and management services and to physicians who provide the bulk of them, a flawed update process has eroded these gains over the years to a substantial degree.
In response to legislation, the Centers for Medicare and Medicaid Services are working correct these problems, but progress is likely to come slowly. Higher payments for primary care practices through the CPC+ can help slow the degree to which physicians are leaving primary care until more fundamental fixes are made to the fee schedule. Indeed, years of interviews with private insurance executives have convinced us that concern about loss of the primary care physician workforce has been a key motivation for offering higher payment to primary care physicians in practices certified as patient centered medical homes.
Two Downsides
But there are two downsides to the CPC+.
One concerns the lack of incentives for primary care physicians to take steps to reduce costs for services beyond those delivered by their practices. These include referring their patients to efficient specialists and hospitals, as well as limiting hospital admissions. There are rewards in CPC+ for lower overall utilization by attributed beneficiaries and higher quality, but they are very small.
We had hoped that CMMI might have been inspired by the promising initiatives of CareFirst Blue Cross Blue Shield and the Arkansas Health Care Improvement initiative, which includes the Arkansas Medicaid program and Arkansas Blue Cross Blue Shield. Under those programs, primary care physicians are offered substantial bonuses for keeping spending for all services under trend for their panel of patients; there is no downside risk, which is understandable given the small percentage of spending accounted for by primary care. The private and public payers also support the primary care practices with care managers and with data on all of the services used by their patients and on the efficiency of providers they might refer to. These programs appear to be popular with physicians and have had promising early results.
The second downside concerns the inability of physicians participating in CPC+ to participate in accountable care organizations (ACOs). One of CMMI's challenges in pursuing a wide variety of payment innovations is apportioning responsibility across the programs for beneficiaries who are attributed to multiple payment reforms. As an example, if a beneficiary attributed to an ACO has a knee replacement under one of Medicare's a bundled payment initiatives, to avoid overpayment of shared savings, gains or losses are credited to the providers involved in the bundled payment and not to the ACO. As a result, ACOs are no longer rewarded for using certain tools to address overall spending, such as steering attributed beneficiaries to efficient providers for an episode of care or encouraging primary care physicians to increase the comprehensiveness of the care they deliver.
Keeping the physician participants in CPC+ out of ACOs altogether seems to be another step to undermine the potential of ACOs in favor of other payment approaches. This is not wise. The Innovation Center has appropriately not established a priority ranking for its various initiatives, but some of its actions have implicitly put ACOs at the bottom of the rankings. Recently, Mostashari, Kocher, and McClellan proposed addressing this issue by adding a CPC+ACO option to this initiative.
The Innovation Center should be lauded for continuing to support improved payment models for primary care. Its blending of substantial monthly payments with lower payments per service is promising. But the highest potential rewards come from broadening primary care physicians' incentives to include the cost and quality of services by other providers. CMMI should pursue this approach.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1ZayZXM
We’re Failing Adolescents And Families Coping With Behavioral Health Issues
During my twenty-five years as president and CEO of the Jewish Healthcare Foundation (JHF), I have learned how to help people navigate the health care system. But I have struck out miserably when it comes to helping people facing behavioral health issues. I've had the pleasure of watching many talented staff members start and raise families of their own. One employee of the foundation, located in Pittsburgh, Pennsylvania—let's call her Amy—is a doting single parent to Joe, a towering teenager with a wry sense of humor and dyed, technicolor hair. Images of Joe—from football games, camping trips, and long-ago school picture days—line Amy's desk. Phone check-ins between mother and son, who is now age sixteen, are a lunchtime staple.
Last fall, however, Amy became concerned about Joe. He distanced himself from friends and family, quit his part-time job, and started skipping school. One day, Amy came home and found that Joe had spent two hours breaking into a gun safe and, after contemplating suicide, put a weapon on the floor and returned to his room. Amy took Joe to a local psychiatric hospital for children and adolescents, where he was admitted for a week and discharged with a care plan, a psychiatrist and therapist, and medications for depression and attention deficit/hyperactivity disorder (ADHD). He returned to school. He seemed OK.
On a Sunday in mid-March, two of Joe's friends died—one in a motocross accident, the other in a shooting. He was inconsolable. On Monday, Joe ingested all of his pills and took off into the woods. He was eventually found by local police and friends, sick, but not seriously harmed, while Amy made frantic, unreturned calls to Joe's psychiatrist and therapist. Joe returned to school by Wednesday, but he called and asked Amy to remove all sharp objects from the house because he wasn't feeling safe. On Thursday, Amy took Joe to a nationally known center for psychiatric and addiction services.
After an eight-hour wait for intake, staff said that they wanted to admit Joe for three days—but there were no beds available. She and Joe could stay in the waiting room in hopes of there being an opening, but staff warned that it could take days, maybe longer. They gave Amy a list of other inpatient treatment facilities with available beds, most of which were in Ohio or other surrounding states. Staff eventually connected Amy with a local, intensive outpatient treatment facility that promised to evaluate Joe the next morning. When Amy called that facility back, she was told that Joe would have to wait seventeen days for intake.
Joe remained at home for seventeen days, closely cared for by family but not returning to school upon the recommendation of his psychiatrist. When staff at the facility finally did evaluate Joe, they wanted to place him in a full-day program—but there were no openings. Joe's therapist recommended a separate program that integrates educational classes and treatment for behavioral health challenges, with the goal of transitioning young adults back to their normal school and activities. But Joe's high school wouldn't provide needed approval for the program, saying that Joe hadn't attended class enough to be properly evaluated by school staff. The school staff said that he was a truant who might not graduate, but he wasn't seriously emotionally disturbed.
The system has failed both Joe and Amy. Unfortunately, as the JHF probed deeper into the issue, we found that Amy's story was not just an unfortunate anecdote. Many teens and their families are grappling with issues of mental illness, alcohol and substance use, and self-harm during this critical phase of human development. Few teens are accessing treatment, and those who do are not getting the sort of help that allows them to lead fulfilling, productive lives. We're in the midst of a public health crisis—one that the JHF, our local community, and the nation can't afford to ignore.
Chances are, you know a teen who's struggling with a behavioral health issue. Nearly half of US teens experience some sort of mental disorder over a lifetime, and about twenty percent of (all) teens experience a seriously debilitating mental disorder during their lifetime, according to research cited by the National Institute of Mental Health. About 17 percent of youth in Pennsylvania report binge drinking during the past month, and nearly 9 percent of adolescents report using illicit drugs during the past month, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Suicidal thoughts and self-harm are pervasive, too, with the Centers for Disease Control and Prevention (CDC) estimating that 17 percent of US high school students have seriously considered attempting suicide over the past year. More than a third of teens recently surveyed by the Allegheny County (Pennsylvania) Health Department (see p. 24) admitted that they hurt themselves on purpose over the past year.
We've also found that access to behavioral health treatment is limited, and frequently ineffective—particularly in our region of southwestern Pennsylvania. Among adolescents in Pennsylvania who have been diagnosed with a major depressive episode, just about 42 percent received treatment within the past year, according to SAMHSA. Among children and adolescents in Pennsylvania who did receive treatment for mental health conditions in general, in the public mental health system, about 37 percent said that their functioning has not improved. (Nationally, that percentage is about 31 percent.) Treatment rates are even bleaker in Pennsylvania for alcohol and substance use issues, SAMHSA says.
At the JHF, we have an extensive record of connecting stakeholders and implementing programs to improve the physical and behavioral health of adults (documented in the most recent edition of our ROOTS magazine). Now, we're looking to move further upstream, so that kids and teens receive the help they need to thrive in adulthood.
In May 2016, the JHF kicked off a $500,000 multiyear adolescent behavioral health initiative, which is designed to spark a community dialogue and strengthen the prevention/treatment services available to kids and teens. We're engaging fellow health care funders, families, health care providers, and community partners to create an inventory of local services, identify holes in the safety net, champion and spread best practices, discover creative technology solutions, and advocate for policy and payment changes that will support better outcomes. The JHF has formed a distinguished advisory group to accelerate achievement of these goals.
The consequences of not addressing the adolescent behavioral health crisis are severe and may span generations. Half of all mental illnesses begin by age fourteen, according to the World Health Organization. Yet, the average time between when teens presented behavioral health symptoms and when they received treatment was about a decade, according to research that was published in 2005 in the Archives of General Psychiatry and funded by the National Institute of Mental Health. When left untreated or treated ineffectively, such problems can alter the course of a young person's life—they can lead to isolation, stigma, lower educational and professional achievement, poor reproductive and sexual health, addiction, and premature death. Their loved ones suffer emotionally, physically, and financially as well.
Behavioral health challenges early on don't condemn kids and teens to a lifetime of hardship. They can recover, and even flourish. They can lead our cities, invent the next game-changing app, or cure diseases. I think of the coordinated system of care that has been created for children on the autism spectrum in Pennsylvania, thanks to parents and other advocates who destigmatized the condition and pushed for policy changes. Behavioral health demands a similar rallying cry.
Simply put, we're not doing a good enough job of getting adolescents and their families the help that they need, when they need it. Joe and Amy are still waiting, as are millions of others. Our children and teens deserve better. The JHF and the Pittsburgh Regional Health Initiative are seeking partners, best practice examples, and answers.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1TURhfr
We’re Failing Adolescents And Families Coping With Behavioral Health Issues
During my twenty-five years as president and CEO of the Jewish Healthcare Foundation (JHF), I have learned how to help people navigate the health care system. But I have struck out miserably when it comes to helping people facing behavioral health issues. I’ve had the pleasure of watching many talented staff members start and raise families of their own. One employee of the foundation, located in Pittsburgh, Pennsylvania—let’s call her Amy—is a doting single parent to Joe, a towering teenager with a wry sense of humor and dyed, technicolor hair. Images of Joe—from football games, camping trips, and long-ago school picture days—line Amy’s desk. Phone check-ins between mother and son, who is now age sixteen, are a lunchtime staple.
Last fall, however, Amy became concerned about Joe. He distanced himself from friends and family, quit his part-time job, and started skipping school. One day, Amy came home and found that Joe had spent two hours breaking into a gun safe and, after contemplating suicide, put a weapon on the floor and returned to his room. Amy took Joe to a local psychiatric hospital for children and adolescents, where he was admitted for a week and discharged with a care plan, a psychiatrist and therapist, and medications for depression and attention deficit/hyperactivity disorder (ADHD). He returned to school. He seemed OK.
On a Sunday in mid-March, two of Joe’s friends died—one in a motocross accident, the other in a shooting. He was inconsolable. On Monday, Joe ingested all of his pills and took off into the woods. He was eventually found by local police and friends, sick, but not seriously harmed, while Amy made frantic, unreturned calls to Joe’s psychiatrist and therapist. Joe returned to school by Wednesday, but he called and asked Amy to remove all sharp objects from the house because he wasn’t feeling safe. On Thursday, Amy took Joe to a nationally known center for psychiatric and addiction services.
After an eight-hour wait for intake, staff said that they wanted to admit Joe for three days—but there were no beds available. She and Joe could stay in the waiting room in hopes of there being an opening, but staff warned that it could take days, maybe longer. They gave Amy a list of other inpatient treatment facilities with available beds, most of which were in Ohio or other surrounding states. Staff eventually connected Amy with a local, intensive outpatient treatment facility that promised to evaluate Joe the next morning. When Amy called that facility back, she was told that Joe would have to wait seventeen days for intake.
Joe remained at home for seventeen days, closely cared for by family but not returning to school upon the recommendation of his psychiatrist. When staff at the facility finally did evaluate Joe, they wanted to place him in a full-day program—but there were no openings. Joe’s therapist recommended a separate program that integrates educational classes and treatment for behavioral health challenges, with the goal of transitioning young adults back to their normal school and activities. But Joe’s high school wouldn’t provide needed approval for the program, saying that Joe hadn’t attended class enough to be properly evaluated by school staff. The school staff said that he was a truant who might not graduate, but he wasn’t seriously emotionally disturbed.
The system has failed both Joe and Amy. Unfortunately, as the JHF probed deeper into the issue, we found that Amy’s story was not just an unfortunate anecdote. Many teens and their families are grappling with issues of mental illness, alcohol and substance use, and self-harm during this critical phase of human development. Few teens are accessing treatment, and those who do are not getting the sort of help that allows them to lead fulfilling, productive lives. We’re in the midst of a public health crisis—one that the JHF, our local community, and the nation can’t afford to ignore.
Chances are, you know a teen who’s struggling with a behavioral health issue. Nearly half of US teens experience some sort of mental disorder over a lifetime, and about twenty percent of (all) teens experience a seriously debilitating mental disorder during their lifetime, according to research cited by the National Institute of Mental Health. About 17 percent of youth in Pennsylvania report binge drinking during the past month, and nearly 9 percent of adolescents report using illicit drugs during the past month, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Suicidal thoughts and self-harm are pervasive, too, with the Centers for Disease Control and Prevention (CDC) estimating that 17 percent of US high school students have seriously considered attempting suicide over the past year. More than a third of teens recently surveyed by the Allegheny County (Pennsylvania) Health Department (see p. 24) admitted that they hurt themselves on purpose over the past year.
We’ve also found that access to behavioral health treatment is limited, and frequently ineffective—particularly in our region of southwestern Pennsylvania. Among adolescents in Pennsylvania who have been diagnosed with a major depressive episode, just about 42 percent received treatment within the past year, according to SAMHSA. Among children and adolescents in Pennsylvania who did receive treatment for mental health conditions in general, in the public mental health system, about 37 percent said that their functioning has not improved. (Nationally, that percentage is about 31 percent.) Treatment rates are even bleaker in Pennsylvania for alcohol and substance use issues, SAMHSA says.
At the JHF, we have an extensive record of connecting stakeholders and implementing programs to improve the physical and behavioral health of adults (documented in the most recent edition of our ROOTS magazine). Now, we’re looking to move further upstream, so that kids and teens receive the help they need to thrive in adulthood.
In May 2016, the JHF kicked off a $500,000 multiyear adolescent behavioral health initiative, which is designed to spark a community dialogue and strengthen the prevention/treatment services available to kids and teens. We’re engaging fellow health care funders, families, health care providers, and community partners to create an inventory of local services, identify holes in the safety net, champion and spread best practices, discover creative technology solutions, and advocate for policy and payment changes that will support better outcomes. The JHF has formed a distinguished advisory group to accelerate achievement of these goals.
The consequences of not addressing the adolescent behavioral health crisis are severe and may span generations. Half of all mental illnesses begin by age fourteen, according to the World Health Organization. Yet, the average time between when teens presented behavioral health symptoms and when they received treatment was about a decade, according to research that was published in 2005 in the Archives of General Psychiatry and funded by the National Institute of Mental Health. When left untreated or treated ineffectively, such problems can alter the course of a young person’s life—they can lead to isolation, stigma, lower educational and professional achievement, poor reproductive and sexual health, addiction, and premature death. Their loved ones suffer emotionally, physically, and financially as well.
Behavioral health challenges early on don’t condemn kids and teens to a lifetime of hardship. They can recover, and even flourish. They can lead our cities, invent the next game-changing app, or cure diseases. I think of the coordinated system of care that has been created for children on the autism spectrum in Pennsylvania, thanks to parents and other advocates who destigmatized the condition and pushed for policy changes. Behavioral health demands a similar rallying cry.
Simply put, we’re not doing a good enough job of getting adolescents and their families the help that they need, when they need it. Joe and Amy are still waiting, as are millions of others. Our children and teens deserve better. The JHF and the Pittsburgh Regional Health Initiative are seeking partners, best practice examples, and answers.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/1TURhfr
1983
For Dr. Vicki Rogers, Singapore American School and her family are one in the same. Dr. Rogers attended SAS as a student and now teaches at SAS. Her son is now a student at SAS as well!
from Singapore American School http://ift.tt/1OZR2dw
1983
For Dr. Vicki Rogers, Singapore American School and her family are one in the same. Dr. Rogers attended SAS as a student and now teaches at SAS. Her son is now a student at SAS as well!
from Singapore American School http://ift.tt/1OZR2dw
from Singapore American School http://ift.tt/1OZR2dw
Monday, May 30, 2016
River Park Place – Phase 2 coming to Richmond
Following the success of Intracorp's One River Park Place, we are pleased to bring you and your clients the newest addition to Richmond's riverfront Oval Village. RPP II will be Richmond's brightest new neighbourhood and will feature the most sought-after amenities within minutes, while paving the way with progressive and illuminating technological details.
RPP II will feature 127 vibrant one, two and three bedroom homes. Views of the mountains, the river or the city centre will celebrate both the natural setting to the north, and a bustling epicentre of amenities to the south. Without even leaving your front door, Intracorp's quality and industry-leading excellence is proven with state-of-the-art recording and practice rooms, a business centre, games and study rooms – all within steps – and all part of the luxury amenities at RPP II. Also enjoy a peaceful yoga room, an innovative gym space, and the ultimate car wash.
The post River Park Place – Phase 2 coming to Richmond appeared first on Vancouver New Condos.
from Buildings – Vancouver New Condos http://ift.tt/1RGUBF5
River Park Place – Phase 2 coming to Richmond
Following the success of Intracorp’s One River Park Place, we are pleased to bring you and your clients the newest addition to Richmond’s riverfront Oval Village. RPP II will be Richmond’s brightest new neighbourhood and will feature the most sought-after amenities within minutes, while paving the way with progressive and illuminating technological details.
RPP II will feature 127 vibrant one, two and three bedroom homes. Views of the mountains, the river or the city centre will celebrate both the natural setting to the north, and a bustling epicentre of amenities to the south. Without even leaving your front door, Intracorp’s quality and industry-leading excellence is proven with state-of-the-art recording and practice rooms, a business centre, games and study rooms – all within steps – and all part of the luxury amenities at RPP II. Also enjoy a peaceful yoga room, an innovative gym space, and the ultimate car wash.
The post River Park Place – Phase 2 coming to Richmond appeared first on Vancouver New Condos.
from Buildings – Vancouver New Condos http://ift.tt/1RGUBF5
Sunday, May 29, 2016
Firefly Craft
We are so excited about summer! Whether enjoying crazy cool activities or making easy crafts like this Wooden Spoon Garden Craft, we are ready to play, create, and learn with our kids in the sun.
Shared below is an easy summer firefly craft, perfect for older kids who like to keep busy. It’s adorable, requires minimal supplies, and is perfect for home, camp, or school.
Firefly Craft for Kids
This sweet summer craft is perfect for older kids who are able to use a hot glue gun. A hot glue gun isn’t necessary for this craft, but it makes it easier.
Supplies and Directions:
- Wooden craft spoons
- Black and lime green tissue paper
- Mod Podge and a brush
- Bubble wrap
- Googly eyes
- Black twine or yarn
- Black construction paper
- Hot glue and a hot glue gun
- Scissors
- Silver or white permanent marker
RELATED: Catch Fireflies for Classic Summer Fun
After gathering your supplies, use scissors to cut the green and black tissue paper into small 1 inch squares.
Use a paintbrush and Mod Podge to decoupage the squares onto the thin end of the craft spoon. When finished, attach a couple googly eyes to the wet Mod Podge and place the craft spoon into a clothespin to dry.
While the firefly is drying, use scissors to cut the shape of wings from the bubble wrap and black construction paper. Then use Mod Podge and a brush to decoupage the other end of the firefly. Allow it to dry completely propped up in a clothespin.
Fold the bubble wrap wings horizontally and secure the fold with a dot of hot glue. Attach the bubble wrap wings and the black wings to the back of the firefly with hot glue. Use the hot glue gun to secure 2 black twine antennae to the firefly.
Use a silver or white permanent marker to make a smiley face on the firefly.
Isn’t it cute! If desired, glue a loop of black twine to the back of the firefly so you can use it as a Christmas ornament this winter!
If you liked this craft, you may also enjoy:
The post Firefly Craft appeared first on Kids Activities Blog.
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