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Stay Mindful

Posted by communitymanager Jan 29, 2019

Living a healthy lifestyle is about consciously making healthy choices each day. This involves being intentional – or remaining aware of each choice – throughout the day. 

Building your awareness can seem challenging, but creating certain mindful habits sets the stage for feeling healthy and fulfilled. Check out the options below to see which you’d like to incorporate into your healthy lifestyle.

  • Mindful eating: This means slowing down and being aware of the sensations of eating – really tasting, smelling, and enjoying the food as you eat it. It also means listening to your body and knowing what it feels like when you’re hungry or full, and acting in accordance with those feelings.
  • Awareness of beliefs: We are all raised with certain beliefs about the world, whether it’s being part of the “clean plate club,” using food as comfort, or the need to always say “yes” to others’ demands. Becoming aware of your own personal set of beliefs, viewing them without judgment, and then choosing how you want to respond in the future are at the heart of conscious living.
  • Mindful movement:  Building conscious awareness of how you feel during or after physical activity provides a much-needed opportunity to reconnect with your body. Love the way you feel on a favorite walk or when salsa dancing? Do more of that. And while feeling your muscles fatigue during a workout may not be enjoyable, noticing the feelings and recognizing your muscles’ newfound strength can be empowering. 
  • Self-acceptance:  This is about accepting your current weight and body as it is, even while having goals to improve your health and your lifestyle. It also means letting go of guilt and shame about minor lapses, which can lead to self-defeating or self-sabotaging choices.  Although it may seem contradictory, when you accept where you are at the moment without judgment, you’re better able to get back on track and make the next choice a healthy one.

Living mindfully is about making conscious choices throughout the day, each day. It is a commitment to consistently practice self-awareness and self-acceptance. And it’s the foundation to your new, healthy lifestyle. 

Not sure how to stay mindful?  Talk to your coach!



At some point, most of us have at least thought about keeping a diary or journal. It’s a great way to stay in touch with your thoughts and feelings, as well as to better remember events, people, and other details from our lives.

But did you know that the act of journaling can enhance your mental and emotional well-being? These are just a few benefits discovered from research:

  • It helps you process and communicate your emotions. Putting your feelings into words can be hard, but taking up the task with a journal can serve as a good first step towards shaping your thoughts about a situation. In doing so, you may be able to dig a little deeper and figure out why you feel a certain way, and what you should do with this information.
  • It can improve your mood or even your general outlook. If you’re in need of a mental boost, writing about the things that are bothering you can instantly lift your mood. And in the long run, it gives you a tool to examine uncomfortable or unpleasant situations or thoughts, but at a safe distance because you’re analyzing how you’re feeling at the same time.
  • Some studies suggest journaling make you physically healthier. In fact, one such study found that people who journaled actually recovered faster from a medical procedure compared with those who didn’t keep a journal. It shouldn’t come as a big surprise, considering the deep link between our physical and mental well-being.

Tips for journalingTwo of the biggest barriers to successful journaling are 1) being unable to keep up the habit and 2) writing in a way that helps you gain insight and solve problems. Here are some tips to help with both challenges.How to keep up the habit

  • Create a routine around journaling that’s pleasant or rewarding. For example, make journal time the time you drink your cup of tea or coffee in the morning, or the time when you’re in pajamas and getting ready to wind down for the night.
  • Choose a medium that suits your lifestyle and preferences. You may want to go down the old-fashioned pen-and-paper route if you want to spend less time looking at screens, or because you simply enjoy the physical sensation of writing on paper. Or you may want to use a computer, tablet, or smartphone since you find handwriting too slow or laborious, or because you already spend much of your time typing on a device anyway.
  • Micro-journaling may help! Apps like Five Minute Journal (App Store, Google Play, $4.99) are set up to get you to jot down your thoughts once or twice a day in just a matter of minutes. Plus, you can connect the Five Minute Journal app to your Go365 app and set up a mindfulness log under “Activities.” From there, you could earn 10 Points for completing three or more journal entries a week.

How to write in order to gain insight and solve problems

  • Set up goals – but don’t be too restrictive. Do you want to recall situations or details better? Are you attempting to manage your anger? Want to motivate yourself to do something specific? Think of what you want to accomplish to come up with journal entries. But don’t feel like you have to stick with the same topic or format all the time. You can talk about your feelings one day and then come up with a to-do list the next. The journal is there to help you at any given time.
  • Express yourself, but also analyze the situation a little bit. One study found that those who only wrote about their feelings didn’t improve their mental well-being, but those who also analyze the why and how behind their feelings fared better. “Venting” can help, but only to a certain extent. Problem solving takes your journaling to the next level and that starts with reviewing and questioning feelings, motives, reactions, and the situations themselves.
  • When reflecting on challenges or struggles, think about the things you learned. Use phrases like “I have learned” or “I now realize” or “The reason that…” Even with situations where you may not do anything differently in hindsight, you could develop some insights that could make you feel better. After all, a conflict, struggle, challenge, or obstacle is always worthwhile if you can learn something from it.



Frittata Primavera

Posted by communitymanager Jan 23, 2019


Spring isn’t too far off, but that doesn’t mean you can’t yet enjoy a dish with ingredients straight from the garden. Enjoy an omelet with yummy greens and a little yogurt and cheese to start the day off right. It’s proof that a hearty breakfast doesn’t need meat!


3 eggs or ¾ cup egg substitute

1 tbsp. plain yogurt, low-fat

1 tbsp. Parmesan cheese, grated

3 tsp. olive oil

¼ cup onion, chopped

1 clove garlic, finely chopped

½ cup fresh asparagus pieces

½ cup canned or frozen artichoke hearts, chopped

½ cup sugar snap peas, strings pulled and cut in ½-inch pieces

¼ tsp. dried basil

Salt and pepper to taste


1. On the stove, heat 1 teaspoon of the oil in a skillet and cook the onion for 2-3 minutes or until soft.

2. Add the garlic and cook 1 minute more.

3. Stir in the asparagus, artichoke hearts, peas, basil, and pepper, and cook, stirring occasionally until tender but still slightly crisp, 3-5 minutes. Set aside.

4. Preheat the broiler.

5. Beat the egg substitute or eggs with the yogurt and another pinch of pepper.

6. Heat the rest of the oil in a heavy-bottom skillet. Pour in the egg mixture and cook until just set on the bottom but still wet on the top, 1 minute.

7. Scatter the vegetables over the top and set into the oven to finish cooking, 2 minutes.

8. Dust the top with the Parmesan cheese, cut into wedges, and serve.


The turkey and almonds in this pasta recipe are just two of the best sleep-promoting foods, according to a list by Healthline. The poppy seed dressing is also a lighter alternative to creamy dressings like ranch.


1 pound farfalle (bowtie) pasta*


1 pound turkey, cubed (bite-sized)


½ cup red onion, diced


½ cup celery, diced


1 cup whole almonds, toasted


1 cup dried cherries


1 cup gorgonzola cheese, cubed (or a similar cheese like feta or goat cheese)


4 large fresh basil leaves, finely chopped


1 ½ jars (12 oz.) poppy-seed dressing


Seasoned salt and pepper to taste

* If you want alternatives, fusilli (corkscrew) or conchiglie (seashell) pasta could also work.

1. Cook pasta according to package directions. After draining and rinsing with cold water to cool the pasta, set it aside.


2. In a large bowl, add turkey, onion, celery, almonds, dried cherries, cheese and basil. Toss to mix.


3. Add pasta. Gently toss to distribute all ingredients.


4. Add seasoned salt and pepper to taste.


5. Add poppy seed dressing and mix gently to coat all. Add more dressing if needed.


6. Transfer to serving bowl. Cover and refrigerated up to an hour before serving.


Avocado toast with poached eggs can be a great post-workout meal. The combination of protein from the eggs, the healthy fats from the avocado, and the carbohydrates from the bread can help you better recover from an intense workout. And the shredded cheese, cherry tomatoes, and chili flakes make this healthy meal more fun!


2 large eggs
1 avocado
2 slices of flatbread, whole wheat, or sourdough
2 tbsp. white wine vinegar
Juice from one half of a lemon
Salt and pepper to taste
4-6 cherry tomatoes cut in quarters
Shredded white cheddar or feta cheese to your liking
(Optional for spice lovers) 1 tsp. chili flakes


1. Fill a large saucepan with water, add the vinegar and bring to a hard boil over high heat. Once boiling, reduce the heat so the water is simmering, then use a spoon to swirl the water into a whirlpool. Crack in both eggs and cook for about 2 minutes and 30 seconds.

2. In a small bowl, mash and mix the avocado, lemon juice, salt, and pepper with a fork.

3. Toast the bread. Spread the avocado over the toast, then top off with the cheese, cherry tomatoes, poached egg, and the optional chili flakes, in that order.


It’s that time of year again to enjoy all the perks of camping: hikes during the day, sing-a-longs by the campfire, and of course, waking up to some breakfast burritos before starting a new day out in the wilderness. The best part about this recipe – other than the fact it’s full of healthy ingredients – is that you can make it ahead of time, wrap it in foil and keep it in the cooler, and then throw them next to the fire when it’s breakfast time. Serves four burritos.


  • 2 tsp canola oil
  • ½ small white or yellow onion, diced
  • 1 red bell pepper, seeded and diced
  • 1 cup drained, rinsed canned low-sodium black beans
  • ¼ tsp chili flakes
  • 4 eggs and 4 egg whites
  • 1/3 cup shredded pepper Jack cheese
  • Nonstick cooking spray
  • 4 10-inch whole wheat tortillas



1. Over medium-high heat, warm up canola oil in a large nonstick skillet. Cook the onions and peppers for about a minute (remember all these ingredients will cook again later on the campfire).

2. Add black beans and red pepper flakes for 1 minute. Season with salt and pepper and transfer the bean mixture to a dish.

3. In a bowl, whisk the eggs and egg whites, then stir in the cheese and salsa. Spray the skillet with cooking spray and reheat the skillet over medium heat. Reduce heat to low and add eggs, scrambling until cooked through. Spread each tortilla with the egg and bean mixtures. Roll up burrito style and wrap in heavy-duty aluminum foil, preferably twice.

4. Store burritos in refrigerator then in a re-sealable plastic bag in a cooler with ice when traveling to the campsite. When ready to eat, place foil-wrapped burritos in hot coals next to fire. Cook until burritos are thoroughly heated, roughly 10-12 minutes depending on how hot the fire is.


Tabbouleh with Quinoa

Posted by communitymanager Jan 23, 2019


Tabbouleh is a traditional Mediterranean salad, usually served cold, with finely chopped ingredients like mint, tomato, onion, and usually lightly seasoned with a dressing made with olive oil. Usually, bulgur or couscous is added to tabbouleh but this version uses quinoa, which is a generous source of fiber and protein. This easy dish can be served as a light meal or on the side.


½ cup quinoa

2 tablespoons lemon juice

2 tablespoons olive oil

1 bunch flat leaf parsley

3 green onions (scallions), finely sliced

½ cup almonds


  1. Bring a saucepan of salted water to a boil. Cook the quinoa for about 9 minutes or to your liking. Drain.
  2. While the quinoa cooks, combine the lemon juice and olive oil in a separate bowl. Season this dressing however you like; salt and pepper would be common choices.
  3. To prep the parsley, chop the stalks finely and the leaves coarsely.
  4. Once the quinoa is cooled, toss it with the dressing, parsley, green onion, and almonds. Feel free to season further to your taste.

Try these tips to make physical activity more satisfying.

But what about those times when all intrinsic motivation seems to wane?  We’ve got solutions to that too. Here are some things to try when your motivation needs a little extra boost.

  • Use cues or prompts. A cue gets you ready to start by providing a clear reminder that you intend to get active. To cue yourself, you might lay out your workout clothes next to your bed before going to sleep at night, packing your gym bag and leaving it next to the door, or prepping exercise equipment in your workout space at home.
  • Set the bar low.  Not up for an hour of hard work at the gym or a long trail hike? Tell yourself you can keep your activity to just 10 minutes. After 10 minutes, ask yourself how your body feels and whether you’re up for more time or ready to stop. Chances are you’ll keep going!
  • Create a contract. Tell a family member or friend (or your coach!) your plan for being physically active in the coming week. Ask them to check in with you about how you did. Knowing you’ll be telling them what you accomplished makes it more likely you’ll get it done.
  • Reward yourself. Decide how you’ll reward yourself for hitting your activity goal. Maybe new workout clothes? Some favorite music? A quick massage? Be sure your reward is something you’ll really enjoy, and reward yourself soon after accomplishing your goal! Oh, and avoid using food as your reward to keep your weight management plan on track.


Still thinking about how to give your motivation a boost?  Talk to your coach and brainstorm some ideas together! 



Stress is a reality of life for both introverts and extroverts. Regardless of which camp best characterizes you, it’s not a question of whether you experience stress, but rather how you manage it. And introverts and extroverts tend to manage their stress differently.

What’s most important in sorting out these differences is to understand the core distinction between introverts and extroverts. Contrary to what most think, introverts typically like people. But, they have a need to pull back after awhile and recharge by reflecting and resting. In contrast, being with people energizes extroverts. They need less reflection time and seem to recharge by being active and engaged. Neither personality type is better than the other. Each simply handles stress differently.

Introverts – healthy ways to manage stress by:

  • Recognizing your limits and giving yourself permission to pull back from contact with others when you feel a need to do so
  • Journaling your thoughts and feelings to help make sense of what’s going on inside
  • Meditating on a regular basis to find that inner peace and calm
  • Practicing spiritual disciplines, such as reading sacred texts or prayer

Extroverts – healthy ways to manage stress by:

  • Enjoying an outing with family or friends
  • Participating in games or group activities such as volleyball, bowling, etc.
  • Doing something novel such as trying new ethnic foods
  • Giving yourself permission to stop, unwind, and do nothing for awhile


Stress can have a detrimental effect on both introverts and extroverts. It’s really a question of whether both personality types pay attention to their own needs and choose to manage their stress in ways that coincide with those needs.


Gary Gilles, Licensed Clinical Professional Counselor


Nothing is more classic than a salad during the summer. Watermelon is the star of the show in this recipe, which is rich in water (remember to drink plenty while you sweat!) and nutrients that help protect the skin from sunburn.


  • 1-2 lbs. watermelon
  • 2 cups seedless grapes
  • 6 oz. crumbled feta cheese
  • 1 bunch fresh mint
  • 1 tbsp. extra virgin olive oil
  • (Optional) ½ small red onion, thinly sliced


  1. 1. Cut the watermelon into bite-sized pieces. Slice the grapes into halves. Chop the mint finely.
  2. Combine the watermelon, grapes, crumbled feta, mint leaves, and if you’re adding it, the onion slices in a large bowl. Toss all ingredients gently.
  3. Drizzle with olive oil, toss again, and serve.


It’s after the holidays and, in many part of the country, it’s cold outside. But you can make the most of the season by making sure the weather doesn’t disrupt your journey to better well-being. Here are just a few reminders on how you can keep up with your health and wellness goals for a healthier, happier winter.


Even if it’s cold outside, you can still keep moving! Whether you exercise indoors or outside, make sure you get the minimum recommended amount of exercise per week:

  • 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or a combination of both. “Moderate” is defined as being not quite out of breath and developing a sweat after 10 minutes, as you would with a brisk walk. “Vigorous” activity would make you develop quick, deep breathing and you would sweat after a few minutes, as you would with running.
  • Strength training for all major muscle groups at least twice. With weights or some type of resistance equipment, you should do at least a single set of 12 to 15 repetitions. It should be hard enough to make your muscles tired after three sets at most.

You can earn up to 25 Points a month by setting a fitness habit through Go365. On the Go365 mobile app (Apple; Android), you can choose the type, frequency, and duration of the fitness habit and then submit photo proof that you kept up the good work. These habits can range from taking the stairs to parking further away or walking your dog.

Take a vacation

During the winter, taking a trip can get you away from your usual routines and environments, especially when people feel extra temptation to stay inside. You can get away to warmer climates with a getaway, or you can travel to a cold location where there may be fewer people and lower costs.

Behavior change experts believe that people can start a new habit when they’re away from their usual routines, like during the weekend, a holiday, or on a vacation. So, taking a trip may also be good timing for turning a new leaf, like quitting smoking or eating healthier. The Five Minute Journal app (Apple; Android; $4.99) is designed to help you create and maintain positive thinking patterns. You only need to check in twice a day to record your thoughts. If you connect Five Minute Journal to your Go365 app (Apple; Android), you can keep a weekly mindfulness log and earn up to 10 Points a week.

Recognize Seasonal Affective Disorder (SAD)

SAD is a type of depression that occurs in 1 to 2 percent of the population when they have less exposure to sunlight, so it happens most frequently in winter. However, some believe that as many as 10 to 20 percent of people may experience less severe symptoms of depression during this season. Common symptoms of SAD include loss of interest in activities that usually bring pleasure or joy, troubles with mental concentration, loss of appetite, and changes in sleeping habits.

Some people can cope with less sunlight by making sure to take walks outdoors. Others may use full-spectrum light bulbs that can mimic daylight, or change their wall coverings or window curtains to maximize incoming light during the day.

Regardless of the time of year, if you believe you may be experiencing any type of depression, see a qualified health professional for guidance and advice.

Eat well

Winter may not be thought of as a time of year with the best fruits and vegetables, but some produce does peak in colder temperatures. Always be sure to look up what’s seasonal and local when looking for the best produce. However, as a general rule, foods like clementines, kale, cabbage, beets, Brussels sprouts, and sweet potatoes are great during the winter. Plus, you can track your food intake all year by keeping a food diary with your Go365 mobile app (Apple; Android), earning up to 10 Points a week.




You’ve been running. You know your legs are getting stronger. You may have even learned names of leg muscles you didn’t know before. The fronts of your thighs (quadriceps), backs of your thighs (hamstrings), and bottom backs of your legs (calves), all contribute to your running success. Optimally, your quads and hamstrings will both be equally strong, but this isn’t actually what running emphasizes. Your quads usually bear more of the load. To shrink the gap in their strength differences, you may need to perform hamstring strength training.


Studies have shown that high performing runners may actually be weaker than recreational runners. Despite this fact, those who are highly trained use less oxygen at a given pace because their muscle strength in their quads and hamstrings are more balanced. So even though recreational runners may be stronger, the fact that their quads are dominant over their hamstrings actually makes them have to work harder to run at a given pace than highly trained runners.


Here’s an exercise you can perform to strengthen your hamstrings:


Ball hamstring curl

  • Lie on your back and place your heels on a stability/exercise ball with your arms pressing firmly into the floor by your sides.
  • Lift your hips off the floor so that your body is in one straight diagonal line from your heels to your shoulders.
  • Bend the knees in to bring the ball in toward your bottom.
  • Return to start.
  • You can do 3 sets of 8-10 repetitions. Rest in between each set.
  • To make this move more difficult, try to keep your hips high and extended versus letting them flex as you bring the ball in closer to you.


Perform this exercise as part of your cross training routine and perform quadriceps stretches to help equalize the imbalance between these muscles. Running will get easier as your muscles become more equally strong and you’ll be better prepared to avoid injury like a torn hamstring. Keep this move in your repertoire to be faster, stronger and healthier!







Sarah Scholl, “Owner’s Manual: Strong Hamstrings,” Runner’s World, accessed November 2016.

The Runner’s World Editors, “Winter Weekly Workout – Week 5,” Runner’s World, accessed November 2016.

1,2,3 Amby Burfoot, “Study: Strengthen Hamstrings To Improve Your Running Economy,” Runner’s World, accessed November 2016.

“Stability Ball Hamstring Curl,” ACE, accessed November 2016.

Richelle Wescott, NASM CPT, M.S. Exercise Science and Health Promotion, Balanced Body Comprehensive Pilates Instructor, accessed January 2018 at

New research from Humana found that nearly one-third of beneficiaries over the age of 65 experience social isolation, which increases their likelihood of other health risks.

One-third of beneficiaries over 65 experience social isolation and increased health risks.

Source: Thinkstock



By Thomas Beaton

September 25, 2018 - A new survey of Humana’s commercial population has found that almost one-third of members over 65 years old experience social isolation. The survey reveals that payers could benefit by addressing social isolation among their elderly members because reducing loneliness enhances member satisfaction as well as overall health.

Seniors recognize the importance of creating strong social bonds, but often struggle to find opportunities to develop friendships and spend time in social settings.

Eighty-five percent of survey respondents said it is important to establish friendships and 61 percent said establishing companionships was also important. In addition, 22 percent of respondents said that building romantic relationships with others was important as well.

Humana suggested that combining physical activity with opportunities for social engagement could improve both physical and emotional health.

“Healthy aging is a group activity,” said Dr. Meredith Williams, Lead Medical Director at Humana. “Social isolation and loneliness can often impact health as much as physical attributes, which is why we want to inspire seniors to focus on whole-person health. Going to the gym is great but going with a friend can have even larger health benefits, given the social impact.”

Twenty-two percent of survey respondents currently go to the gym for physical activity, the survey found. Only 13 percent of senior members going to the gym use their time as an opportunity to meet new people, but 54 percent of single beneficiaries expressed interest in building social connections at the gym.

The interest among senior citizens in expanding their social relationships reiterates the importance of social engagement as a means to improve health.

Humana’s previous research in the Bold Goal Progress Report found that Humana Medicare members living in social isolation had a 22 percent higher chance of dying prematurely than members who had adequate social support. Additionally, socially isolated Medicare beneficiaries have a two times greater risk of developing Alzheimer's disease than members with healthy social relationships.

Humana announced plans to launch public events for their senior beneficiaries and partnered with SilverSneakers, a wellness vendor, in order to address social isolation and beneficiary well-being.

The events include outdoor social events, fitness classes, cooking classes, and other lifestyle improvement activities. Humana will offer these events to beneficiaries across the US during Active Aging Week, a week-long campaign that promotes an active lifestyle.

“Social isolation has a measurable impact on physical and mental health, and older adults are often uniquely affected due to the loss of a spouse, adult children moving away, lack of transportation and a host of other reasons,” said Steve Janicak, Chief Growth Officer at Tivity Health.

“Our SilverSneakers members thrive on the social connections they make through the program. We’re excited to partner with Humana during Active Aging Week to promote the social and physical benefits of exercise to more seniors.”


by Shannon Spence

A diet rich in fruits and vegetables offers more health benefits than you can count on both hands, including lower blood pressure, reduced risk of heart disease and stroke, cancer prevention, lower risk of obesity and digestive problems, and improved blood sugar levels. Even more, eating the daily recommended doses of fruits and veggies will help you feel full longer and keep your appetite in check.

“There are so many people who rely on supplements and vitamins when we should be able to get most of what we need from our food,” says registered nurse and nutrition advocate Kristin Woodruff. “Make sure you’re getting as many colors on your plate as possible. That is the original multivitamin.”
While the research surrounding the effects of color on health is ongoing, here’s a look at the potential health benefits of tasting the rainbow with some help from Dr. David Heber, author of What Color is your Diet?

Red foods

Health benefits - Contain lycopene , a powerful antioxidant associated with reduced risk of some cancers and protection against heart attacks

Sources - Tomatoes and tomato-based products; watermelon, pink grapefruit, guava, cranberries

Fun fact - Cooked tomato sauces may offer the most health benefits. The heating process allows the body to more readily absorb carotenoids, including lycopene.

Blue/purple foods

Health benefits - Rich in anthocyanin, antioxidants that support a healthy heart and regulate blood pressure

Sources - Eggplant (especially the skin), blueberries, blackberries, prunes, plums, pomegranates

Fun fact - The richer the color, the riper the fruit/veggie. Blueberries have the highest antioxidant activity of all.

Green foods

Health benefits - Contain lots of isothiocyanates, which live in the liver and help the body remove carcinogenic compounds; good source of vitamin K (essential for blood clot formation), folic acid, and potassium (helps lower blood pressure)

Sources - Broccoli, cabbage, bok choy, brussels sprouts

Fun fact - The isothiocyanates found in cruciferous vegetables may have cancer-fighting properties, particularly against colon and bladder cancers.

Yellow/green foods

Health benefits - Rich in lutein, which is especially good for eye health; good source of vitamin C

Sources - Avocado, kiwi, spinach and other leafy greens, pistachios

Fun fact - Pistachios contain lutein in the green skin that surrounds the nut.

Orange/yellow foods

Health benefits - High in vitamin C and beta-carotene (good sources of antioxidants), which convert to vitamin A, a vital nutrient for vision and immune function as well as skin and bone health

Sources - Carrots, mangos, cantaloupe, winter squash, sweet potatoes, pumpkins, apricots

Fun fact - Beta-carotenes may also help prevent some cancers, particularly lung, esophagus and stomach.

White/green foods

Health benefits - Rich in flavonoids, powerful antioxidants that help the body combat free radicals

Sources - Garlic, onions, endives, chives, celery, pears

Fun fact - A recent study found that increasing your intake of white fruits (those with white flesh) may lower your risk of stroke.

As a Go365 member, you can earn up to 10 Points per week for tracking your fruit and veggie intake when you set a weekly food log in the Go365 App.

For more nutritional facts and information on how to select and store specific fruits and veggies, visit

Reducing the impact of chronic diseases will require payers and providers to get to the root causes of long-term illness, many of which are attributable to the social determinants of health.

Source: Thinkstock


Healthcare providers do their very best to understand everything they need to know about their patients during the few scant minutes they are able to spend with each individual.

Once or twice a year, or maybe when a sore throat strikes, providers collect data on current medications, chat about new problems, and order a prescription or two before sending the individual on his way.

For many patients, these self-contained interactions are perfectly adequate to address low-level concerns or maintain good health.

But for many more, especially those at elevated risk of developing chronic disease, episodic care that begins and ends inside the clinic is simply insufficient to meet their needs.

Chronic disease doesn’t occur in isolation. Conditions such as diabetes, asthma, heart disease, and obesity are all tied very closely to the environments, cultures, and behaviors that surround individuals.

Food insecurity, lack of housing or transportation, low educational attainment, the threat of interpersonal violence, and social isolation create a complex web of challenges that can contribute to deteriorating health, limited functionality, and unnecessarily high spending.

As a whole, these factors are known as the social determinants of health.

Defined by the World Health Organization as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life,” social determinants may be responsible for up to 90 percent of an individual’s long-term health and outcomes.

Commonly cited statistics pin the impact of purely clinical care at between ten and twenty percent, while physical environments, socioeconomic conditions, behaviors, and genetic predisposition account for the vast majority of factors influencing outcomes.

As a result, healthcare organizations are feeling the pressure to extend their reach beyond the confines of the hospital campus and connect with patients where they live: in their communities, at their work places, in their grocery stores, and at their schools.

From sponsoring community wellness programs to delivering targeted, clinically validated patient education, healthcare providers are increasingly leveraging their leadership positions to help local residents control their chronic diseases and utilize healthcare resources more appropriately.

They are not undertaking these efforts alone. As financial imperatives continue to shift towards rewarding proactive approaches to care, payers are playing their part in trimming costs and reducing the need for expensive acute services.

Both entities are actively seeking out community-based partnerships and closer relationships with public health officials, first responders, non-profits, social work agencies, and other non-clinical organizations.

At the 2018 Value-Based Care Summit hosted by Xtelligent Healthcare Media, panelists and presenters shared insights and experiences about how to make this multi-pronged approach to population health management work for some of the most underserved populations in the country.

By combining the use of data analytics to guide the allocation of scarce resources with some old-fashioned, low-tech approaches to outreach and collaboration, healthcare providers and payers are successfully combatting rising risks in vulnerable communities by addressing the social determinants of health.


Every facet of an individual’s life contributes towards his or her ability to successfully manage health.

The luxury of taking paid time off work for doctor’s appointments, affording child care, and hopping in a working car to drive down to the clinic; the ability to understand and act upon instructions from a clinician; the spare cash to pay for a prescription, an MRI, or a follow up – all these factors depend on a person’s personal behaviors, economic status, education, employment, family history, and cultural expectations.

These challenges impact rural populations just as much as inner city communities. In fact, rural patients are more likely to face shortages of physicians, a dearth of high-paying jobs with robust insurance benefits, and difficulties accessing specialty care.

Non-metro communities see higher rates of suicide, heart disease, respiratory disease and stroke – and public health crises like the opioid epidemic are hitting rural areas particularly hard.

At Atrium Health, a large health system serving patients in North and South Carolina, providers see just as many socioeconomic challenges in rural counties as in the urban areas of the state, said Alisahah Cole, MD, Chief Community Impact Officer.

“When we map social and economic factors like income levels and educational levels, and match that data with the rates of chronic diseases, we can see that every county we serve has at least one dark red area – a pocket of real vulnerability with huge disparities,” she explained, showing a map of Atrium’s service area.

“People in urban Mecklenburg are facing very similar issues to people in rural Cleveland County, so that increases the complexity of the challenges we’re facing, as the healthcare system, to address the social determinants leading to those disparities.”

Socioeconomic disparities in North Carolina communities

Socioeconomic disparities in North Carolina communities

Source: Atrium Health

Healthcare systems are using increasingly sophisticated data analytics strategies to identify the specific challenges in each community, and to monitor the effectiveness of interventions designed to get upstream of unplanned admissions and ED use.

Rising risk individuals, or those on track to become high-spending, complex patients, are a key focus for Atlanta’s Grady Health System, said Leslie Marshburn, Director of Population Health.

“We know that psychosocial needs are going to impact the speed at which someone hits the markers of being a high-risk individual,” she said.

“As a safety net hospital, we're really looking at those individuals who have the chronic illnesses in conjunction with all the social, economic, behavioral, and psychological factors that can contribute to poor health.”

“At Grady, we’re using artificial intelligence to help us build out how we can identify patients in the rising risk, moderate risk, and high risk categories. The challenge is operationalizing that information and using those insights to allow the care team to focus their resources appropriately.”

Hospital readmissions are a popular place to start, she said, due to the potential return on investment for avoiding admissions.

“We know that psychosocial needs are going to impact the speed at which someone hits the markers of being a high-risk individual”

“We look at everyone who is at risk of an avoidable readmission within 90 days,” said Marshburn. “Our tool looks at everyone who has touched our system in the last 12 months or has an upcoming appointment in the next six months – that’s around 160,000 people in any given time period.”

“That might seem like a lot, but it does actually allow our care teams to get a handle on the scope of the problem so they can prioritize and triage their outreach.”

Narrowing the field to target interventions is essential, but it isn’t easy, added John Supra, VP of Solutions and Services at the Care Coordination Institute in South Carolina.

John Supra, Tina Brown-Stevenson, Leslie Marshburn, and Caroline Berchuck present at the Value-Based Care Summit

John Supra, Tina Brown-Stevenson, Leslie Marshburn, and Caroline Berchuck present at the Value-Based Care Summit

Source: Xtelligent Media

Understanding patterns of utilization and getting ahead of costs is especially difficult in communities where individuals may only access care in a life-threatening emergency.

“We tend to have at least marginally workable data on people who are traditional seekers of care, and that can help with risk stratification and prediction. But what about the people who aren’t in the system?” he asked.

About half of the members of a given population do not seek care in a given year, he explained. Yet at least some percentage will incur high costs in the near future when they experience an exacerbation of chronic disease or another type of acute event.

“Where are these people when they aren’t touching the healthcare system? Are they employed? Do they have contact with faith-based organizations and schools? Are they taking advantage of social services that we don’t know about?”

Marshburn agreed that even the best population health analytics tools can’t be effective without any data to use.

“We struggle a lot at Grady with patients who aren’t represented in traditional data sets, especially in data from payers,” she said.

“They’re uninsured. They live in a cash world, and they don’t engage with the financial system in ways that would create a consumer history. They might have clinical records, but they’re often fragmented. They don’t have regular sources of care that create the patterns we rely on for risk stratification and case management, so we can’t track them in the way that we would like.”

Most healthcare organizations have not yet developed strategies to fill in those blanks and reach the individuals who currently reside outside of the digital environment – they still struggle to identify and care for patients who have electronic health records.

“It’s difficult enough to do any kind of analytics – I know that from experience. But the people in the ether are the ones we need to get to, because the goal of predictive analytics in the context of population health is to understand those people before they end up in the ED or the hospital,” Supra stressed.

“And that will require getting more insight into their communities and finding new connection points to deliver education and preventive care.”

Hospitals, health systems, and physicians are pillars of their communities, and quality healthcare providers tend to enjoy a unique position of trust and influence that can be invaluable for enacting change.

“The people in the ether are the ones we need to get to, because the goal…is to understand those people before they end up in the ED.”

In fact, few other entities have such a powerful and wide-ranging impact on the very components of health that may appear outside their direct control.

Healthcare systems must take the lead when it comes to addressing fundamental challenges of vulnerable communities, said Cole.

“We have found that every community needs a convener,” she said. “As a healthcare system, a lot of that burden is going to fall onto us. Atrium gives about $5 million a day in uncompensated care and other community benefits across our region, and plenty of other health systems do comparable work. But we can't do it alone. We can’t solve for all the problems, no matter how much we want to.”

“What we can do is pull everyone together and oversee the development of a cohesive, intentional approach to addressing the social determinants of health. Someone has to be responsible for coordinating those efforts, but we all need to be holding each other accountable to really move the needle on population health.”


While advanced risk stratification and data analytics techniques play an important role, many of their suggestions about how to address socioeconomic disparities revolved around fundamental changes that don’t require hiring a team of analysts or signing complicated vendor contracts.

“We talk so much about changing patient behaviors to improve chronic disease management and educating them about how to work within the healthcare system, but we don’t always focus enough on how we, as providers, need to change our attitudes towards our patients,” asserted Caroline Morgan Berchuck, MD, Complex Care Fellow at the Boston University Institute for Health Systems Innovation and Policy.

“Value-based care isn’t just a financial initiative. It requires culture change. Being a good provider is about communication and working with patients on a level that they understand. It’s about relationships, trust, and respect.”

Source: Kaiser Family Foundation

The absence of trust and respect from providers can have long-lasting impacts on how individuals interact – or fail to interact – with the healthcare system, Berchuck continued.

“I actually rotated through Grady during medical school,” she said. “One of my first patients as a medical student was in the A Tower at Grady – there are A, B, C, and D towers.”

The patient, a life-long Atlanta resident who was around 90 years old, told Berchuck that he couldn’t believe he was being treated in the A Tower.

“Value-based care isn’t just a financial initiative. It requires culture change.”

“When I asked why not, he said that 60 years ago, the last time he needed the hospital, black people weren’t allowed in the A Tower,” she recalled.

“His experiences at that time had left him so averse to the healthcare system that he barely interacted with it for sixty years. He had miraculously made it to 90 in great health – but it just goes to show how some things that have nothing to do with the clinical care he might have received can really affect personal decision-making.”

Offering a positive, respectful patient experience is vital for success with value-based care, especially when attempting to discuss sensitive SDOH topics such as economic security, education, or interpersonal relationships.

“We need to be more cognizant of those things, and we need to be more thoughtful and compassionate with our patients,” urged Berchuck. “There is so much judgement around diabetes, obesity, health literacy – even the inability to pay for certain services. A lot of that comes from the clinicians themselves.”

“We need to be careful that our patients don’t feel repulsed by their interactions with the healthcare system if we’re going to truly support patients as they make lifestyle changes and navigate their challenging circumstances. That doesn’t cost a thing, but the ROI is huge.”

Extending relationships outside of the traditional confines of the clinic and offering services that meet patients where they are can be a powerful way to make accessing care less daunting or uninviting, agreed Supra.

“The more we can do locally, the better we’ll be at overcoming some of the cultural disconnect between patients and providers,” he said. “We talk about hot spotting and targeting interventions from a data perspective, but we can actually do that from a physical standpoint, too, by bringing mobile clinics into areas that we know are underserved or high-cost and rehabilitating empty storefronts or grocery stores.”

“And when you staff these clinics with people who are culturally competent, speak the same languages, and have ties to the community themselves, you can create connections that are very hard to replicate if you expect everyone to converge on some centralized location away from where they live and work.

“The more we can do locally, the better we’ll be at overcoming some of the cultural disconnect between patients and providers.”

Going the extra mile to create a welcoming, understanding, socioeconomically sensitive patient environment has already paid off for Atrium Health, added Dr. Cole.

After using data analytics to identify patients at high risk of readmission, Atrium looked closer at socioeconomic factors that could contribute to those risks.

“We found that about 70 percent of our high-risk patients were food insecure,” Cole explained. “Of that 70 percent, more than half were eligible for SNAP benefits but didn’t realize that they qualified for assistance.”

In North Carolina, the 13-page application for nutrition assistance is “extremely difficult” to complete, she said. “I consider myself pretty well educated, and even I struggled with it,” she admitted. “Talk about barriers to people achieving good health, right?”

Atrium tasked one of its community health workers with walking applicants through the document to ensure they received the benefits they were eligible for, she explained.

“On average, these people received $200 a month in assistance,” Cole said. “Can you imagine what a help that is to an elderly patient with diabetes, hypertension, and high cholesterol living on a fixed income?”

Dr. Alisahah Cole presents at the Value-Based Care Summit

Dr. Alisahah Cole presents at the Value-Based Care Summit

Source: Xtelligent Media

Providers at Atrium didn’t have to imagine the results. The impact was clear. The readmission rate for the high-risk patients who received extra help with their applications and subsequently utilized SNAP benefits plummeted by 67 percent.

“That doesn’t just pack a punch financially – although the savings are certainly there. It also positions the community health worker as a valuable resource and an ally, and it makes sure that these individuals know Atrium is there to support them. That’s an attitude shift within the community that goes beyond dollars and cents.”

Atrium has also seen success with its Community Resource Hub, an online compendium of community services, such as housing options, legal aid, transportation, and financial assistance for food, utilities, and education.

The website catalogues services nationwide, and is freely available to the public as well as to healthcare providers.

“This is the answer to the question we get very often, which is ‘what do I do next when a patient screens positive for a social need?’” said Cole.

“Now, a community member can self-refer to services, or a member of our care team can do it. And the service agency can talk back to us. It used to be that I never knew what happened after I referred a patient to a community service unless the patient came back and told me that she got what she needed.”

“With the hub, we now have digital communication between these entities that enables us to take action if we need to close that loop.”


Payers, too, are offering more options for engagement, education, and access to care.

“Value-based care is encouraging a lot more innovation on the payer side,” said Tina Brown-Stevenson, Senior Vice President of Advanced Network Analytics at UnitedHealthcare.

“One of the studies we did with the United Health Foundation Board was around group prenatal visits. They have proven to be unbelievably popular and successful, especially among low-income women. They really enjoy and value the chance to meet other mothers-to-be, share experiences, and spend some time in an environment that supports them.”

“They have a group session, step out for their individual exams with a nurse practitioner, then come back together and have amazing experiences. That’s a lot more attractive as an incentive to seek care than being told that they need to come to the clinic for an appointment. They get their prenatal care, which is good for everyone, and they get social interacts that they value on top of it. It’s been so successful that we’ve been rolling it out all around the country.”

At Humana, similar community-based initiatives are designed to have net-positive impacts for all parties involved, said Worthe Holt, MD, Vice President in the Office of the CMO at Humana.

“This is the answer to the question we get very often, which is ‘what do I do next when a patient screens positive for a social need?’”

The social determinants of health are a core component of the company’s Bold Goal program, which aims to improve community health by 20 percent by the year 2020.

In San Antonio, one of seven original communities serving as anchors for Bold Goal initiative, diabetes is a major concern.

“The dinner table is a central part of the Hispanic culture, where much of the diabetes challenge lies,” Holt explained. “Sharing a meal while recounting the news of the day, telling stories, and spending time with family is very important, but that can make it difficult to make consistently healthy choices about what foods to eat and how to engage in portion control.”

“Until you can help people make better decisions about nutrition and diet without negatively impacting a tradition that is so important to their social lives and family structure, you aren’t going to make a real impact on the development of chronic disease.”

Humana collaborated with grocery stores, the YMCA, and food banks in the San Antonio area to deliver education, ensure food security, and share resources related to managing diabetes effectively.

Results from the San Antonio Bold Goal community

Results from the San Antonio Bold Goal community

Source: Humana

“So instead of just treating diabetes reactively, we worked with the community to offer more advantageous placement of healthy food alternatives, cooking classes and other education for individuals so they could add some new, lighter meals to their repertoires without feeling like they are making some kind of unsustainable lifestyle change,” said Holt.

By early 2018, the results included a 5.1 percent improvement on the CDC-validated Healthy Days measure for seniors living with diabetes, as well as 5 percent increases in biannual hemoglobin A1C testing and the use of diabetes statin therapies.

While health systems like Grady and Atrium tend to view their coverage areas in terms of entire geographic regions, payers like Humana and UnitedHealthcare are in the slightly different position of being financially responsible for only a portion of individuals in any given community.

Yet Bold Goal projects are open to non-Humana members as well as the company’s health plan beneficiaries, says Holt.

“The Bold Goal and our other work around social determinants is really aligned with the ethos of value-based care,” he said. “We’re going to work with underserved populations, and we’re going to work with people experiencing socioeconomic hardships. It’s going to improve the health of the community – and by the way, it’ll benefit some Humana members, too.”

“Even the tools we’re developing are intended to be payer agnostic. Most physicians work with multiple payers, so it doesn’t make much sense to add to their existing burdens by restricting tools and resources to just our members. If we can produce tools and strategies that can bring value to the entire patient panel, then Humana benefits as much as the physician and all those patients.”


An open mindset and a non-traditional view of responsibility are vital for creating the transparency and collaboration that will start to make a dent in the nation’s socioeconomic disparities.

As value-based care takes hold across more and more payer-provider relationships, both parties will need to make adjustments to the way they view historical competitive differentiators, such as data assets and the volume of patients served.

“If we can produce tools and strategies that can bring value to the entire patient panel, then Humana benefits as much as the physician and all those patients.”

“Collaboration is truly the name of the game, and that will definitely include collaboration between payers,” said Holt. “For our part, we are working with CMMI and CMS to improve the data assets we can use to make valid inferences and conduct meaningful analytics. We need more than just the population of one payment model from one payer to get a true sense of the patterns and trends that impact health.”

“Aggregated data is essential. We’re talking to other payers at the CMO and CEO level to try to get a group of individuals together who are willing to share de-identified information and create more actionable insights for everyone.”

Payers have a unique level of visibility into those patients who do leave a digital audit trail, but they need clinical data from providers to maximize their analytics capabilities, said Brown-Stevenson from UnitedHealthcare.

“Increasingly, we’re getting data from providers who have electronic health records,” she said. “And we’re working through some of the trust issues that surround data sharing. But a lot of us are still stuck in the fee-for-service mindset, where we have these parameters around who’s staying in our network, who’s using our formulary, and who’s outside of our zone of caring, more or less.”

Community Resource Hub from Atrium Health

Community Resource Hub from Atrium Health

Source: Atrium Health

“Those distinctions aren’t going to help in the value-based care world,” said Brown-Stevenson. “Integration of data will help. Delivering better evidence-based care will help. Data is extremely important to our ability to manage individuals, but we can’t do it all by ourselves. No one can.”

For providers, getting access to the results of those analytics, as well as accessing care coordination data such as admission, discharge, and transfer (ADT) notifications, will significantly boost their ability to be proactive and reduce costs, says Berchuck.

“The integration of the payers with the provider delivery system is really critical,” she said. “In most primary care practices, you don’t have any way of finding out if your patient is in the hospital. The hospital is on a different EHR, or they didn’t call the PCP when they were supposed to – now you’re left with a patient who has had 18 medication changes and a surgery, and you can’t do the follow up that you would do if you knew about it.”

“Data is extremely important to our ability to manage individuals, but we can’t do it all by ourselves. No one can.”

“Payers have such broad visibility into the pharmacy, the hospital, the specialists, and pretty much everything else that is happening to a patient. We need to keep working on integrating that data more effectively into the clinical delivery system.”

Creating alignment between payers and providers will support the ongoing shifting of incentives towards care that takes the social determinants of health into account.

Continuing to reward healthcare providers for approaching healthcare in a person-centered, holistic manner will produce exponential gains in financial and clinical outcomes.

“When the right incentives are in place, we see that people are excited about this and looking forward to engaging,” said Holt.

“We see consumers recognizing that they are getting a more satisfactory experience, and we’re pleased to see that they are pushing for even more change. Employers clearly are, as well. As we demonstrate that value-based care improves quality and reduces expenses across the board, it’s going to have a snowball effect.”

“It’s not going to happen tomorrow, but I am convinced it will happen much more quickly than we might have thought just a few years ago. We’re making excellent progress, and it isn’t going to slow down any time soon.”

The results of investing in communities and addressing social determinants can manifest in a variety of ways, said Dr. Cole, and can truly change lives for the better.

“I'm a kid from one of those dark red areas,” she said. “Statistically, I should not be standing up here on this stage today. There are people like you who invested in me, so never underestimate the power you have as an individual to impact someone's life.”

“If we all committed to work on social health and wellness together, just think about how much more of an impact we can have. We want our communities to be better for us being there. That’s our vision at Atrium Health: that the communities we serve are the first and best choices to live in.”

This article was originally published on October 31, 2018.