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Vice Chair, University of Tennessee College of Medicine
Dettwyler (1991) presents the assumptions that modern researchers harbor about disabled members of ancient populations cholesterol synthesis flow chart atorlip-10 10 mg without a prescription. A note about terminology: in a modern context cholesterol medication in canada atorlip-10 10 mg overnight delivery, we do not refer to infants as "deformed cholesterol biochemistry definition purchase 10mg atorlip-10 visa," but might say instead that they have birth defects cholesterol milk safe 10 mg atorlip-10. Although the words "deformed" and "defective" are related semantically-both referring to some sort of failure in development- "defective" sounds more negative and less appropriate than "deformed" as an adjective applied to humans. Furthermore, "deformed" fits better with ancient terminology, since much of the literature focuses on visible physical deformities-contorted feet, missing or shrunken limbs, etc. Plato and Aristotle are not only unspecific with regard to the identification of and consequences for, deformed infants, but they also present the topic of selective infanticide within proposals for abstract, idealized states, not validations of contemporary practices. Next, I introduce evidence to demonstrate that far from being pessimistic about the fate of deformed infants, some ancient authors, including and especially medical physicians, are more optimistic on the fate of deformed infants. Hippocratic physicians, for example, offer cures and treatments for congenital impairments, as well as positive comments about the economic and productive potential of deformed infants. I then discuss ancient Greek feeding bottles, found primarily in infant and child burials from the Late Bronze Age through the Roman period. These vessels, I argue, point to active assistance and accommodation given to infants who were too weak or ill or who had such severe facial deformities that they could not feed normally. Finally, I present the lack of positive bioarchaeological evidence for the killing of deformed infants. In the end, I argue that the exposure of deformed infants was not the rule in ancient Greece, even if we cannot say that it was never practiced. Competing attitudes Anthropologists have amassed ethnographic case studies that prove that reactions to , and treatments of, infants vary considerably, not only across cultures, but also within cultures (cf. These different "cultural modes of infancy" (Lancy 2014) depend on a variety of factors, some extrinsic to the birth. In a modern Western society, far removed from many of the past and present hazards of childbirth and early infancy, we are shocked by the death of an infant, but feelings of sadness and guilt cannot be generalized across all populations at all times; nor can we assume the inverse, that those in communities with high infant mortality rates were not shocked and dismayed by the death of an infant. Among the Ache, a modern foraging society in eastern Paraguay, for example, it is common to kill an infant if either of its parents is dead. No woman volunteered to cradle the baby while the mother recovered from the birth. A few minutes later the Ache packed up their belongings and Grandpa Bepurangi began to break a trail through the undergrowth with his unstrung bow. Pirajugi was tired, but she had nothing to carry, so she was able to keep up without difficulty. But even when we can identify a common practice, as here among the Ache, we cannot extrapolate from there to understand the emotions associated with it. How did Pirajugi feel about her infant being taken away from her and buried alive in a shallow hole? The mere fact that the practice is legal and/or common does not mean it was necessarily a neutral act. I use this example here to illustrate the point that a law code of a nation cannot be used to prove the attitudes of its citizens. Still, there is a wide range of reactions to the practice and an equally wide range of feelings that women who choose to have an abortion experience. Just because something is legal does not mean everyone chooses to do it, or does it for the same reasons, or thinks about it in the same way. In short, there are no relevant universal attitudes that can be attributed to the birth, life, and death of infants, and it is unproductive to make assumptions about how any culture or even any individual within a culture thinks or behaves towards infants, especially regarding a culture so far removed from our own. This is especially true when it comes to infanticide, the active or passive killing of live infants after birth. Different groups and societies make different decisions or calculations about whether to bear or rear a child and being calculating "is not synonymous with wickedness; on the contrary, it is adaptive behavior" (Lancy 2015:33). Such adaptive behavior is not specific to humans: infanticide has been tracked in several mammalian taxa, including the Indo-Pacific humpback dolphin (Zheng et al. More specifically relevant, scientists observed a chimpanzee mother, with the help of her oldest daughter, provide extensive care to a severely disabled female infant (Matsumoto et al.
An amendment to the Medicaid State Plan to update the payment methodology for hospice services cholesterol levels 30 year old male buy atorlip-10 10 mg visa. An amendment to the Medicaid State Plan regarding qualified Medicaid practitioner supplemental or enhanced payments cholesterol medication chart order atorlip-10 with amex. An amendment to the Medicaid State Plan to update the payment methodology for home health services to include Telehealth monitoring for nursing home health and the addition of a new medication administration rate cholesterol medication and muscle breakdown purchase atorlip-10 toronto. An amendment to the Medicaid State Plan to add prior authorization process for home health nursing and home health aide services cholesterol levels mmol/l conversion order atorlip-10 10 mg line. Please let me know if you have any advice, feedback, questions or concerns about these State Plan Amendments by February 5, 2016. MassHealth Update On April 21, 2016 MassHealth began the renewal process for eligible members in MassHealth only households. MassHealth will coordinate with the Health Connector on mixed households in the fall. Applications will be selected for renewal if the application date is older than twelve months. Our online system will determine which applications are eligible for MassHealth renewals and attempt to verify information based on federal and state data sources. Please visit the website below to see the Learning Series Slides for additional information on the renewal process and other information that was discussed on the call. Attached to this email is an enrollment event flyer that has additional information for these events. Attached to this e-mail is a draft list of open and closed enrollment period exceptions for enrollees, please review and let us know of any comments or questions regarding this list. Based on that number, we are interested in planning and executing some type of Outreach for these consumers and should consider what methods the group thinks might be most effective. Please review the attached draft and let us know if you think this would be helpful to Tribal members or if you have any suggested edits so that we can finalize. As discussed at the last workgroup call in January and in subsequent e-mails, the Health Connector is working with sister agencies and stakeholders to seek permission from the Department of Health and Human Services to continue its merged market structure, specifically quarterly rating and rolling enrollment for small groups within the merged market. The Health Connector will continue to provide updates to the workgroup as this process progresses. These amendments will be posted for a 30-day public comment period beginning later this month. We will send an email notifying you when the waiver amendment documents have been posted on the MassHealth website and providing details for the submission of any comments. We are just beginning to work on these amendments and will provide additional details at a later date. An amendment to the Medicaid State Plan to allow the state to receive 1% increase in federal matching funds for preventive services. The proposed amendments also include updates to the rates of payment to Transitional Living Providers. Please let me know if you have any advice, feedback, questions or concerns about any of these State Plan Amendments by May 20, 2016. Comments will be posted on the MassHealth 1115 Demonstration website: MassHealth and State Health Care Reform the public comment period is now open and will close at 5:00 p. Comments will be posted on the MassHealth 1115 Demonstration website: MassHealth and State Health Care Reform the public comment period is now open and will close on Sunday, July 17, 2016. We are fundamentally supportive of the proposed efforts to incentivize delivery system reform. We believe in the real potential for Accountable Care Organizations and the shared savings/shared risk payment structures to provide essential cost savings for the Commonwealth, to improve integrated care for consumers, and to offer quality care incentives for Massachusetts providers. That said, we do have questions and some concerns about certain aspects of the proposal as outlined below. Workforce Engagement & Training the Commonwealth has made commendable efforts to bring diverse stakeholders together through a collaborative and transparent dialogue in order to achieve the reforms necessary to ensure cost sustainability, and to deliver better integrated and higher quality healthcare. By ensuring true workforce engagement, healthcare delivery reform will benefit from listening to experienced caregiver voices. Accordingly, we greatly appreciate the inclusion of the proposed Workforce Development Grant Program (Section 5. Finally, we request that a fixed annual dollar amount be formally dedicated to the proposed Workforce Development Grant Program in the Waiver itself.
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Data show that patients who experience gaps in health insurance often lack a usual source of care or primary care provider and then are more likely to rely on emergency departments for care cholesterol check up machine discount 10mg atorlip-10 with amex. We seek more information about this part of the waiver proposal cholesterol metabolism purchase 10mg atorlip-10 with visa, including: How will risk and shared savings be distributed between different provider types? How will quality and performance metrics low cholesterol foods diet plan buy generic atorlip-10 10mg online, that determine payment bad cholesterol foods list buy atorlip-10 10 mg mastercard, be measured across these new linkages? Network Adequacy Ensuring adequate access to care and preserving care relationships are of paramount importance. Especially given provider shortages and disparities in provider density by geography, narrow networks can lead to barriers to care, missed care, and can worsen disparities. Narrow networks are more likely to lead to loss of a trusted provider in order to stay in network. Network adequacy is especially important for service types and vulnerable populations most at risk for disparities. However, many plans renew contracts or change provider networks after a member has enrolled in coverage. This can disrupt existing care relationships despite continuous insurance coverage. Specific network adequacy metrics should include: Wait times to appointment How are the collaborations facilitated? Distance to provider Travel time to provider Minimum provider/enrollee ratios Percentage enrollees who changed primary care providers in a year Percentage of change to provider network per year 6 Doctors for America is a 501(c)(3) national movement that mobilizes physicians and medical students to put patients over politics on the pressing issues of the day to improve the health of our patients, communities, and nation. At the time of enrollment in a plan type, a consumer must be empowered with accurate and easy to access information on the provider network of that plan. Member Experience and Network We have concerns about restrictions on members and providers as described in section 4. For many patients with complex health needs, their most important care relationship and their functional "medical home" may be with a specialist. This applies, for instance, to those undergoing cancer treatments with oncologists, those with multi-system diseases cared for by rheumatologists, or children with complex medical conditions like genetic syndromes. A detailed plan for educating members on this and ensuring members are making informed choices is required, especially in light of the lock in period proposed. There are many reports of "balance billing" by hospitals when patients unknowingly receive care from out-of-network providers in emergency situations, from surgeries, or during hospitalizations. Data show that over 30% of Americans have low health literacy or the inability to understand prescription instructions. Over half of Americans have low health "numeracy" or the inability to use numbers in daily life. Health and Human Services describes the following on health literacy, "The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We urge MassHealth to: ยท Commit to a specific budget and resources for member education and navigation assistance, including implementation of an enhanced community-based public education campaign for members, as well as a major expansion of in-person enrollment assistance. This would promote seamless transition from health insurance enrollment to access to healthcare services. Members should have access to individual assistance with choosing a plan and understanding the coverage and care options available. There are best practices from enrollment efforts following the 2006 reform (Chapter 58) on successful public outreach in Massachusetts. We recommend using best practices outlined in the National Action Plan to Improve Health Literacy. Member Protections While we support the shared responsibility, we express caution on the issue of cost-sharing in a program that serves low income families. We oppose new cost-sharing that is not evidence-based to add value and instead contributes to delayed or missed care. Data from Oregon and Connecticut Medicaid programs show that higher cost-sharing contributes to Medicaid disenrollment and going uninsured. Further, the introduction of copays also puts the onus on providers to collect new fees. This creates new administrative burden for providers and can promote adversarial, non-cooperative interactions between patients and providers at the time of care delivery.
I am not enough up on the financials issues from vendor perspectives to discuss the downsides natural cholesterol lowering foods or herbs atorlip-10 10 mg generic, but I will say that the conversation about created better integration and more management of care has been going on for years lowering cholesterol food to avoid buy atorlip-10 online now. I have always been in support of that definition high cholesterol levels discount atorlip-10 10 mg on-line, including more behavioral health integration since my whole career has been spent in documenting evidence based interventions for behavioral health integration in primary care cholesterol check up fasting discount atorlip-10 on line. I do hope the waiver moves forward in the direction outlined and I do believe it will result in cost savings and more efficiencies in the Medicaid program. Your input will be particularly helpful given the breadth and depth of your collective expertise and experience. If you have any questions or if you want to discuss aspects of the waiver proposal in advance of the meeting, please let us know. Following the presentation, you will be invited to comment on the waiver proposal. As this meeting is part of the public comment process for the waiver, we will not respond to any of comments during the meeting, but we will carefully consider all of the input during the public comment review process. We look forward to seeing you there and will very much appreciate your participation. If you cannot attend the meeting but would like to send written comments, please send them to us. Each of these programs is part of our larger CasaCare model that provides integrated behavioral health and primary care services across our continuum. On behalf of our clients, staff, and Board of Directors, I would like to thank the Baker Administration, the Executive Office of Health and Human Services, and MassHealth for an 1115 waiver proposal that recognizes the need for: 1) better care integration among physical health, behavioral health, and long-term services and supports; 2) services and resources that address the social determinants of health; and 3) evidence-based interventions that meet the unique needs of cultural and linguistic minorities, and other vulnerable subpopulations. We believe that this proposal provides a framework that helps the Commonwealth move toward these goals as it seeks to manage costs and improve both the quality and experience of care. We believe that setting the elimination of health disparities as a specific goal of the waiver will help to guide the development of critical components of this system that have yet to be finalized. We would also like to acknowledge the truly collaborative process that MassHealth has facilitated to ensure broad stakeholder input into this waiver proposal. We believe that active stakeholder engagement is essential to the development of a proposal that is both aspirational and achievable. We are particularly pleased to see that "MassHealth will continue to seek input from technical advisory groups on key topics. We believe that stakeholder engagement in clarifying these operational details is essential to ensure that specific mechanisms for identifying and targeting the elimination of health disparities are both required and incentivized, to promote the assertive engagement of hard-to-reach populations. Finally, we are extremely appreciative of the comprehensive way in which the waiver addresses the needs of MassHealth members living with Substance Use Disorders. Particularly in the City of Boston, affordable housing is extremely difficult to secure, while a lack of stable housing continues to be a primary catalyst of both relapse and recidivism. Given that housing stability is a "social determinant of health" that impacts such a broad array of MassHealth members, Casa recommends that MassHealth consider including a stated commitment to the development of an interagency plan to increase the availability and accessibility of affordable housing, for the express purpose of improving the health outcomes of MassHealth members affected by housing instability. If you have any questions or concerns regarding these comments and recommendations, please contact me directly. These comments are in my capacity as the mother and legal guardian of a MassHealth member. My son has severe autism, accompanied by aggression and self-injurious behavior when he is stressed. One of the things he finds most stressful is blood draws, which he must have done regularly. Having these done in his residence, before breakfast, greatly reduced his stress, and he generally had few difficulties compared to his previous experiences going to a lab. He is currently not able to get blood drawn at his residence because his need for a house call is due to behavioral reasons, not medical ones. Instead, he must go to a blood lab, where a restraint is performed by several staff members from his residence. I was actually told by Mass General that, were he to go to Mass General for labs, they could only see him in the emergency room, as that is where the security team is. This situation is not only extremely stressful for my son, it endangers other patients and medical personnel at the lab. Additionally, it incurs the cost of multiple staff having to accompany him to the blood draw.
