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How Shifting Mindsets Can Help Cut The Costs Of Scaling Mental Health

Mental health is finally getting the headspace it deserves, right? After decades of hushed conversation and perceived inconvenience – for friends, family and work colleagues alike – around challenges as commonplace as depression and anxiety, the societal penny has seemingly dropped.

Lonely CityPhoto by Marcus Castro on Unsplash

No wonder. According to Mind, the UK’s foremost charity in the sector, one in four people will experience a mental health problem in any given year.

With depression one of the most common ailments – 300 million people experiencing the issue worldwide (accounting for 4% of the global population) – acceptance and understanding that a healthy mind is as important as a healthy body is making headway.

Though mental well-being is still posited as a personal issue, the public and economic cost mean collective ignorance is no longer an option. The systemic consequences add up to a £10 billion bill in the NHS – with spending up 3.9% in 2016-17 – for an already challenged UK health service.

With businesses losing £2.4 billion annually – stress and mental health accounting for 70 million lost work days each year – the social impact is both considerable and consequential.

No more so than to the individual, though. It’s easy to forget human beings sit at the centre of the issue when bottom-lines are being impacted, so whilst conversation around mental health is increasing, that doesn’t always translate to more help for the people suffering personally.

So, why do issues still remain, despite being recognised as a disabling experience by the World Health Organisation (WHO) – and being one of the largest contributors to disease globally? Mainly because of our collective misunderstanding of the nature of mental health concerns.

Mental Health MedicationPhoto by on Unsplash

With poor mental health often still posited as a weakness and medication being seen as a personal failing, we may not be committing people to asylums anymore, but the shame cast and expectation that those suffering just “buck up” adds further injury to well, injury. Far worse, it means people remain silent too.

No wonder people are finding it hard to cope with their diagnoses, should they seek one. Self-harm and suicidal thoughts have increased of late, with notable consequences.

Whilst women always have and still are most likely to suffer mental health challenges, the press coverage around male suicide and the rise in issues amongst children means keeping the subject a taboo is costing lives.

So, support is needed. With suicide the biggest killer of males under the age of 45 – 84 men on average taking their lives each week – and one in ten children having been diagnosed with mental health disorder (though one in four show some evidence of personal challenge) according to charity Young Minds, taking action is no longer an option.

Whether its consideration in the workplace, healthcare provision or understanding from family, friends and co-workers, culturally we need an attitude shift towards mental health.

Fortunately, there are a few organisations leading the way, prescribing a more mindful approach for us all to follow suit.

External Advocacy and Campaigning

Help SignPhoto by Fernando Venzano on Unsplash

Raising awareness about the many types of mental health issue can be challenging – our limited understanding doesn’t look much further than depression and anxiety – and societally, we adopt a one size fits all approach.

Yet, the many illnesses under the mental health banner – bipolar disorders, depression, psychosis and eating disorders to name a few – effect different, ages, genders, races and sexualities in many different ways.

That’s what makes one children’s magazine’s approach so refreshing. Through its appeal to children and their parents, the Beano recognised the responsibility it had to use its platform to address a growing youth problem.

Working with Young Minds and YouGov, the brand commissioned research into the safety of children online, and use their website and app as a way to tell stories normalising mental health issues for little ones.

For women, Dove’s (sometimes polarising) efforts to promote real beauty have manifested in the self-esteem project. With 61% of 11 to 17-year-old girls lacking confidence and positive body image – both related to poor mental health – the brand have pushed to have “normal” people spearhead campaigns, and provided online tools, intervention activities and workshops to help shift the dial on a deeply gendered issue.

Strategic Partnerships and Collaborating

Male EmotionPhoto by Ricardo Rocha on Unsplash

The topic of men’s mental health has seen increasing coverage of late, and not before time. Top and tailing with the broader conversation around the negative impact of toxic masculinity on all genders, one organisation doing stellar work to promote better understanding is CALM.

The Campaign Against Living Miserably, despite being a small suicide prevention organisation, are working strategically to encourage men to talk about their mental health.

Partnering with the LadBible on the ground-breaking UOKM8 campaign – gathering much-needed data on the state of play for young men today – and advertising with Topshop to encourage men to express their emotions, they punch well above their weight in contributing to the conversation.

Whilst driving for acceptance is essential, so too is funding those organisations which provide the much-needed support on the ground. Lloyd’s Bank in the UK has raised £4.8m for Mental Health UK since 2016.

Putting their money where their mouth is also, in 2017 they won the Channel 4 “Diversity in Advertising” award for their mass-media campaign engaging employees and celebrities in discussing different conditions to help #gettheinside out.

Internal Action and Employee Wellbeing

Connection and SupportPhoto by Clint Adair on Unsplash

Speaking of employees, nothing speaks more loudly than living and breathing the issues you support externally, and for Lloyds Bank, that has materialised in direct action.

As well as funding a pioneering money advice service through Mental Health UK, the bank has also invested in training for 30,000 of its staff, all to help them better understand mental health issues.

That, and sharing personal stories to remove the stigma, openly sharing tips for improving wellbeing across the organisation and equipping leaders to respond as compassionately and supportively as when someone might have broken their leg.

It all adds up to culturally normalising, effectively treating and radically reducing the impact on performance from poor mental health. Sexy it is not, but an honest, direct and practical approach is what’s needed, and see Lloyd’s trailblazing where many others are lagging behind.


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Ex-Health Secretary Tom Price Wasted $341000 on Improper Travel, Inquiry Finds

For many of the trips, there was no evidence that Mr. Price and his team “considered the availability of commercial flights,” the report said. Aides to Mr. Price said he was sometimes concerned about his safety and security on commercial flights, but the inspector general said that members of his security detail could have been seated near him.

Even when using chartered aircraft, the report said, Mr. Price and his team did not always choose the least expensive options. They could have, for example, obtained a charter flight from Seattle to Washington, D.C., for $75,800, instead of the $121,500 that the government paid. Mr. Price’s wife, Betty, accompanied him on that flight, and he reimbursed the government for the cost of his seat, but not for hers, the report said.

The office of the health secretary said the less expensive charter planes were not selected because they were “not deemed to be an efficient safe option for the mission.”

For one international trip, Mr. Price and his aides “used military aircraft but also paid for one commercial flight for the same trip,” the report said. The government paid $11,584 for unused tickets on the commercial flight and obtained a refund only after investigators discovered the mix-up, the report said.

As an example of waste, Mr. Levinson pointed to $36,300 spent on a three-day trip to San Diego; Aspen, Colo.; and Salt Lake City that included “only 3.5 hours of official engagements.” He said the government should try to recoup the funds, as well as $12,300 spent on a charter flight that took Mr. Price from Raleigh, N.C., to Brunswick, Ga., so he could “attend an event in a personal capacity.”

Trump administration officials said they had taken steps to improve compliance with federal travel rules.

Before taking trips, political appointees at the Department of Health and Human Services must fill out a questionnaire to be reviewed by ethics officers. Travelers must provide a “detailed justification” for the use of military or chartered aircraft and must explain how the trip will advance the government’s mission.

On the day of Mr. Price’s resignation, Mr. Trump’s budget director, Mick Mulvaney, sent a memorandum to the heads of federal agencies stating that “with few exceptions, the commercial air system used by millions of Americans every day is appropriate, even for very senior officials.”

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Bucking Trump, Health Insurers Expand Obamacare Footprints

Donald Trump along with heads of state hosted by the NATO Secretary General on 11 July 2018. (Photo: Sadak souici / Barcroft Media via Getty Images)

Undaunted by the latest attacks on Obamacare – both verbal and financial from the Trump administration – health insurance companies are forging ahead with expansion plans in the business of providing individual health coverage to Americans under the Affordable Care Act.

Take Bright Health, a startup, that said it would launch an array of new health insurance products in the government health insurance business, including new markets for individual plans under the ACA. Other insurers yet to announce Obamacare expansions are expected to do so in the next month when they report their second-quarter earnings.

“We think the basic policy issue is that, while there will be debate on aspects of how health coverage is provided to individuals at both federal and state levels, families need affordable health coverage,” Bright Health CEO Bob Sheehy said. “Healthcare is always evolving; we have navigated a multitude of changes and have always adapted to them with success.”

Bright, a privately held startup, is among several health insurance companies including various Blue Cross and Blue Shield plans and publicly traded insurers like
that are looking into new markets in the ACA’s individual health insurance business. Meanwhile, other health insurers like Wellmark Blue Cross and Blue Shield of Iowa are returning to the individual insurance business under the ACA for 2019, the insurer has said.

Bright Health will enter Arizona and Tennessee with individual plans in 2019 on the ACA’s public exchanges after already selling ACA-compliant policies in Colorado and Alabama this year.

For some of these expanding plans, they are forming closer ties with locally-based medical care providers rather than launching broad networks of doctors and hospitals that doomed some of the earlier efforts to offer individual coverage on the ACA’s public exchanges.

Plans like Oscar Health, Bright Health and Centene are expanding at a time larger players like
UnitedHealth Group
have moved on from Obamacare and related individual health insurance businesses. The larger players are scaling back or leaving the individual business after being unable to successfully manage the costs of sick patients signing up for coverage.

Those expanding say they have a different strategy. “In our discussions with potential care partners, we’ve found they are eager to engage with us to ensure access to affordable care for their patients so we see a lot of opportunity out there despite an uncertainty that might exist,” Sheehy said of the doctors and hospitals Bright Health works with in the locales where they sell health insurance. “Our Care Partner Health Plan model is such that it’s flexible enough to adapt to the shifting regulatory environment at both the federal and state levels.”

Privately held startup Oscar has established some notable relationships with medical care providers in the Obamacare markets it has entered. This year, for example, Oscar began to offer co-branded individual insurance in Ohio with the
Cleveland Clinic
in five northeastern counties in that state.  Oscar Health has said it will sell health insurance in six new markets, an aggressive expansion for 2019 despite continued regulatory changes by the Trump administration and the almost constant threats by the Republican-led Congress to repeal the ACA. “Oscar remains committed and excited to bring Oscar to six new markets in 2019,” Oscar spokeswoman Emma Riccardi said.

The latest regulatory change came last weekend when Seema Verma, the Trump-appointed head of the Centers for Medicare Medicaid Services decided to suspend the risk adjustment program, citing a New Mexico federal court ruling that said a formula used to calculate the risk adjustment payments was flawed.

The individual market has also been hit by verbal political attacks from President Trump who boasted at one of his political rallies last month that Obamacare was “essentially gutted.”

Trump, Verma and the Republican-led Congress have certainly made changes that have unsettled the individual insurance market, adding uncertainty to rules and regulations. They’ve also opening the door to skimpier health plans that don’t cover as much and could draw healthy patients away from ACA-compliant plans with richer benefit packages.

But the moves by the Trump administration and Verma have contributed to higher cost health plans that, in turn, made health insurers more profitable while jacking up premiums for taxpayers and Americans who don’t qualify for the ACA’s subsidies. “The announcement is likely to drive a meaningful increase in premiums given the repeal of the Individual mandate compounds the uncertainty,” Ana Gupte, healthcare analyst for Leerink Partners said in a report this week referring to Verma’s decision to suspend risk adjustment payments.

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‘Concerns,’ but no consequences, after suicides in mental health system

The 16-year-old drew pictures that scared her mother. Angels crying tears of blood. Devils. People hanging from trees.

Then the girl attempted suicide, and her mother sought help from Georgia’s community-based mental health system. But therapists never flagged the girl’s risk for suicide, even after she inflicted what they recorded as another “self-injury.” When she skipped several appointments, a counselor left only a single voice mail for her mother, who speaks no English.

Three days before Christmas of 2016, the girl’s family found her in the back yard. She had hanged herself on her swing set.

State regulators cited the mental health agency that handled the girl’s care, the Clayton Center Community Service Board in Jonesboro, for five “deficient practices.” They also listed five “concerns.”

But the regulators imposed no fines or other sanctions. They required only that the agency draft what they call a corrective action plan – in essence, a promise to do better.

The state took the same approach to the 34 other suicides during a recent 12-month period by people under the care of community health providers, an investigation by The Atlanta Journal-Constitution found. Officials penalized none of the publicly funded agencies, even when serious errors apparently contributed to the deaths.

The suicides, as well as the state’s muted response, illustrate how Georgia continues to fall short of its promised overhaul of a mental health system long plagued by substandard care, abuse, neglect and unnecessary deaths.

The state not only does not punish mental health care providers, it lets the agencies choose their own remedies for breakdowns in treatment. In cases reviewed by the Journal-Constitution, this often involved little more than additional training for the agencies’ staffs. In a single instance, a community service board fired two employees after a patient’s suicide.

In an interview, officials with the state Department of Behavioral Health and Developmental Disabilities said they have established procedures for screening patients for suicide risk that all mental health care providers must follow. When suicides occur, said Monica Johnson, the director of the department’s mental health division, officials want to know “if something could have been done differently.”

“There is not one consistent answer to that,” she said.

 Judy Fitzgerald, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, says that when suicides and other unexpected deaths photo
The Atlanta Journal-Constitution

The Atlanta Journal-Constitution

Judy Fitzgerald, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, says that when suicides and other unexpected deaths … read more

The department’s commissioner, Judy Fitzgerald, said particularly egregious errors – “a persistent pattern of practice” – could jeopardize a provider’s state funding. But mental health care providers are in short supply, Fitzgerald said, and her department’s first response to a patient’s unexpected death is not to hand out punishment but to “always make sure other individuals are not at risk.”

Devon Orland, litigation director for the Georgia Advocacy Office, which represents people with mental illness and other disabilities, put it a different way.

“The state has to gamble,” she said. “Is it better to have a bad provider or no provider at all?”


One woman hallucinated about seeing relatives who had been dead for years. Another believed her husband and his girlfriend used satellites to implant thoughts into her mind. One paced relentlessly, mourning her late husband. At least two struggled to reconcile their sexual identities.

“Please forgive me,” another man wrote to his family. “I hurt so bad. I smell like death.”

All killed themselves while under the care of one of Georgia’s 23 community service boards. These agencies have existed for years but have become more fundamental than ever in the mental health system. During the past decade, with the system operating under the supervision of a federal judge, the state closed two public psychiatric hospitals and reduced the number of beds in other facilities. The idea was to divert as many patients as possible from monolithic institutions to more personalized treatment in their communities.

Those providers face a “capacity issue” — more patients and not enough treatment professionals — that may undermine suicide prevention efforts, said Robyn Garrett, executive director of the Georgia Association of Community Service Boards.

“Let’s look at that,” Garrett said, “at the workforce development side of this.”

The state has only recently begun tracking suicides in community care. But the 35 deaths between July 2016 and June 2017 seem to indicate a steep increase from past years. Between 2002 and 2007, for example, just 11 patients killed themselves in the state hospitals or within a few weeks of being discharged, a fraction of the latest-available annual total.

The behavioral health department does not release the names of patients who kill themselves and redacts many details from its investigative reports. The Journal-Constitution identified about half of the recent suicides from public records and other sources, but is not naming them to protect the privacy of their families.

Among the 35, three were teenagers, as young as 16. The oldest was 71. Women outnumbered men, 19 to 16.

Regardless of age or gender, a patient’s suicide is considered the ultimate failure for any mental health program. But the people who run the community service boards say some deaths may be inevitable.

“It would be nice if they could be watched 24 hours a day, seven days a week,” said Cindy Levi, chief executive of Avita Community Partners in Flowery Branch, which reported five suicides from 2016 to 2017. “Unfortunately, that’s not going to happen anywhere unless they are in an institution.

“There is not a 100 percent foolproof.”

But state investigative reports and other public records detail serious errors in about two-thirds of the 35 suicides. Therapists, psychiatrists and other staff members frequently failed to assess patients’ suicide risk, as state regulations require; did not always flag warning signs of suicide in patients’ records; and allowed suicidal patients to repeatedly miss appointments – a sign of a deteriorating mental state – without checking on their wellbeing.

One of the 35 never met his therapist and spoke to his psychiatrist just once, and then only through a video link. Another missed three counseling appointments in September, three in October, two in November and three again in both December and January, with little or no intervention by therapists or physicians. When he finally returned in March, he said he had used “positive self-talk” to control his thoughts of suicide.

He killed himself six days later.

Details about the 35 patients who killed themselves while under the care of Georgia’s community-based mental health system between July 2016 and June 2017.

Number of women: 19
Number of men: 16

Source: Georgia Department of Behavioral Health and Developmental Disabilities

‘I am worth living’

At an Avita Community Partners clinic in Toccoa, a 40-year-old man described his suicide plan in excruciating detail.

“I wish that I would cease to exist sometimes,” the man told his therapist, according to state records. “I’m tired of dealing with this pain, the self-inflicted emotional pain that I’m always in.”

He had bought a rope, he said, and intended to attach it to a rafter that supported his punching bag. “I told my mom I love her and bye,” he said.

The therapist made notes on the man’s threats, along with other circumstances that elevated his risk for suicide: He had recently spent time in both a psychiatric hospital and jail and was due back in court soon. He had tried to kill himself at least three times. And he said he contemplated suicide as much as eight hours a day, every day.

The following week, though, the therapist wrote that the man had not identified “extraordinary events/stressors” that indicated he would kill himself, according to state records. The therapist “facilitated deep breathing exercise saying goodbye to old self,” the records said, and she urged him to recite a mantra: “I am worth living.”

The therapist passed the man’s file, including the suicide threat, to a psychiatrist on Avita’s staff. But the doctor never read it. He was booked with “back-to-back appointments,” state records say, and had no time to study the man’s history or his current symptoms. Such a review might have prompted the man’s admission to a crisis stabilization unit or other inpatient facility.

A little after 1:30 p.m. on Dec. 7, 2016, the man’s mother carried clean laundry to the outbuilding on her property where her son was staying, according to a coroner’s report. She found her son with a rope around his neck, hanging from the rafter that supported his punching bag.

State investigators documented a long list of problems with how Avita handled the case. The man had gone as long as five months between appointments with a therapist or his psychiatrist, and a therapist didn’t grasp the significance of the man’s planning his suicide so meticulously.

But the state made just one recommendation:

“The Avita medical director should review the management of this case with the patient’s physician.”

‘Corrective actions’

When patients take their own lives, therapists and psychiatrists go through a process of rigorous reflection, said Levi, Avita’s chief executive.

“What can we change? What happened? What improvements can be made?

“We learn from what’s happened and take action to do better next time,” Levi said. “We’re always trying to glean something.”

Still, these examinations sometimes leave unanswered questions.

On July 28, 2016, a patient told her therapist at Georgia Rehabilitation Outreach in Atlanta that she thought about suicide every day.

“I hate my life,” the woman said.

But the therapist let the woman go home alone. The woman killed herself five days later.

The therapist later told reviewers that the patient “always said she hated her life,” hoping the threat would enable her to move in with her mother. But the therapist couldn’t explain why a patient who expressed active suicidal thoughts wasn’t admitted for emergency psychiatric treatment.

“An oversight,” she suggested.

The agency’s chief executive did not respond to requests for an interview. State records show the agency fired the therapist and another employee.

Georgia Rehabilitation told state officials it would train all employees in “emergency intervention,” time management and other matters. The state responded that the agency should “identify the basic cause(s) of cited deficiencies and take corrective actions to prevent recurrence.”

In Jonesboro, the 16-year-old girl who hanged herself had been under the care of the Clayton Center for six months when she died on Dec. 22, 2016. A month later, the agency told state regulators it was researching suicide-risk training for all employees.

Two more months went by. Minutes of a board meeting in March 2017 show that the agency’s chief executive, Aundria Cheever, announced: “Regretfully, a youth … committed suicide.”

Then she told the board that the agency planned to train all employees on evaluating suicide risk among adolescents.

State officials had already completed their investigation of the agency’s role in the girl’s death. They concluded by saying they had “no additional recommendations.”

Georgia’s 2019 budget for behavioral health

Since federal oversight of Georgia’s mental health system began in 2010, the state has steadily increased spending, especially on community-based care. Here is a breakdown of the fiscal year 2019 budget for the Department of Behavioral Health and Developmental Disabilities:

Source: Governor’s Office of Planning and Budget

» MORE: The Invisible Epidemic: Poor and mentally ill in Georgia

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Spring Health raises $6M to help employees get access to personalized mental health treatment

In recent months, we’ve seen more and more funding flowing into tools for mental wellness — whether that’s AI-driven tools to help patients find help to meditation apps — and it seems like that trend is starting to pick up even more steam as smaller companies are grabbing the attention of investors.

There’s another one picking up funding today in Spring Health, a platform for smaller companies to help their employees get more access to mental health treatment. The startup looks to give employers get access to a simple, effective way to start offering that treatment for their employees in the form of personalized mental wellness plans. The employees get access to confidential plans in addition to access to a network and ways to get in touch with a therapist or psychiatrist as quickly as possible. The company said it has raised an additional $6 million in funding led by Rethink Impact, with Work-Bench, BBG Ventures, and The Partnership Fund for New York City joining the round. RRE Ventures and the William K. Warren Foundation also participated.

“…I realized that mental health care is largely a guessing game: you use trial-and-error to find a compatible therapist, and you use trial-and-error to find the right treatment regimen, whether that’s a specific cocktail of medications or a specific type of psychotherapy,” CEO and co-founder April Koh said. “Everything around us is personalized these days – like shopping on Amazon, search results on Google, and restaurant recommendations on Yelp – but you can’t get personalized recommendations for your mental health care. I wanted to build a platform that connects you with the right care for you from the very beginning. So I partnered with leading expert on personalized psychiatry, Dr. Adam Chekroud our Chief Scientist, and my friend Abhishek Chandra, our CTO, to start Spring Health.”

The startup bills itself as an online mental health clinic that offers recommendations for employees, such as treatment options or tweaks to their daily routines (like exercise regimens). Like other machine learning-driven platforms, Spring Health puts a questionnaire in front of the end employee that adapts to the responses they are giving and then generates a wellness plan for that specific individual. As more and more patients get on the service, it gets more data, and can improve those recommendations over time. Those patients are then matched with clinicians and licensed medical health professionals from the company’s network.

“We found that employers were asking for it,” Koh said. “As a company we started off by selling an AI-enabled clinical decision support tool to health systems to empower their doctors to make data-driven decisions. While selling that tool to one big health system, word reached their benefits department, and they reached out to us and told us they need something in benefits to deal with mental health needs of their employee base. When that happened, we decided to completely focus on selling a “full-stack” mental health solution to employers for their employees. Instead of selling a tool to doctors, we decided we would create our own network of best-in-class mental health providers who would use our tools to deliver the best mental health care possible.”

However, Spring Health isn’t the only startup looking to create an intelligent matching system for employees seeking mental health. Lyra Health, another tool to help employees securely and confidentially begin the process of getting mental health treatment, raised $45 million in May this year. But Spring Health and Lyra Health are both part of a wave of startups looking to create ways for employees to more efficiently seek care powered by machine learning and capitalizing on the cost and difficulty of those tools dropping dramatically.

And it’s not the only service in the mental wellness category also picking up traction, with meditation app Calm raising $27 million at a $250 million valuation. Employers naturally have a stake in the health of their employees, and as all these apps look to make getting mental health treatment or improving mental wellness easier — and less of a taboo — the hope is they’ll continue to lower the barrier to entry, both from the actual product inertia and getting people comfortable with seeking help in the first place.

“I think VC’s are realizing there’s a huge opportunity to disrupt mental health care and make it accessible, convenient and affordable. But from our perspective, the problem with the space is that there is a lot of unvetted, non-evidence-based technology. There’s a ton of vaporware surrounding AI, big data, and machine-learning, especially in mental health care. We want to set a higher standard in mental healthcare that is based on evidence and clinical validation. Unlike most mental health care solutions on the market, we have multiple peer-reviewed publications in top medical journals like JAMA, describing and substantiating our technology. We know that our personalized recommendations and our Care Navigation approach are evidence-based and proven to work.

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Spectrum, Lakeland Health consider merger

Grand Rapids-based Spectrum Health, one of Michigan’s largest nonprofit health systems, and Lakeland Health, a three-hospital system based in St. Joseph, have signed a letter of intent and expect to merge by Oct. 1, officials said Wednesday.

“We have a long-standing relationship with Lakeland Health and admire their excellent clinical care, strong leadership team and commitment to the community,” Richard Breon, Spectrum’s CEO, said in a statement.

“Our board has spent the past year diligently focused on our growth and partnership strategy in the context of current and anticipated future trends in the industry, such as consumer-centric care and precision medicine,” Breon said. “This integration brings benefits to both organizations in terms of improving affordability, quality and access.”

Some in the Michigan health care industry believe that Spectrum, which includes 12 hospitals, 180 ambulatory care sites, an employed medical group and the Priority Health insurance company, has had similar discussions with other smaller hospital systems.

Under the proposal, Lakeland would become a division of Spectrum and retain a local board and charitable foundation. Lakeland’s three hospitals and outpatient facilities employ more than 4,000 workers and 450 doctors, nurses and other providers.

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Happily married couple considers divorce to pay for daughter’s …

The Greys got married nine years ago on a Florida beach. They have since become the proud parents of two daughters, 2-year-old Fairen and 6-year-old Brighton, who was born with a rare genetic disorder, Wolf-Hirschhorn syndrome. Developmentally still a newborn, Brighton requires around-the-clock attention.

“She will not be able to be on her own ever and requires 24/7 care,” Maria Grey said.

The couple has tried to get Medicaid to help with spiraling medical costs but Jake earns too much — $40,000 — for the family to qualify. The Greys applied for state assistance but don’t expect to get it because of where they fall on the list.

“We’re No. 60,000,” Maria said.

Maria and Jake Grey are considering a divorce to qualify for Medicaid health care for daughter.
“You try anything when it comes to your child,” says Maria Grey, with daughter Brighton.


That’s why the couple is contemplating divorce. It would allow Maria to become a single, unemployed mother and qualify her for Medicaid. The couple said it may be the only way the family could get the help they need to care for Brighton.

“We shouldn’t have to make that sacrifice to get our child Medicaid,” Maria Grey said.

Jake Grey, an Army veteran, said the family has private health insurance but they still spend about $15,000 every year out of pocket.

“It’s drowning us to try to keep up with her medical expenses,” he said. “We’ve done everything we can do to try to keep her afloat, and we’re going to reach a point where we can’t do it and we won’t have another option. We don’t know what to do.”

Jake and Maria Grey are considering a divorce to get their daughter on Medicaid.
Jake and Maria Grey got married nine years ago.TODAY

The couple said they have heard of other families in the same heartbreaking dilemma.

“We are not looking for charity, we’re not looking for money or donations. We don’t want a GoFundMe — we don’t want any of that,” Maria said. “I need the state to step up and give us the benefits that we need.

The Greys say they’re going public with their struggle to help raise awareness about their predicament and encourage others in a similar situation to speak up. They say they’ll do whatever necessary to help their daughter.

“She is a pure and beautiful soul,” Maria said. “We’re lucky to have that and I wouldn’t change that for anything.”

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Alan introduces Alan Blue, a high-end health insurance product

French startup Alan has been mostly focused on its main health insurance product — a standard package for companies of all sizes and shapes. The company is launching a second offering on this market with Alan Blue.

Companies can now choose between two levels of insurance — Alan Green and Alan Blue. Alan Green is the existing health insurance product with a new name. It still costs the same and offers the same level of coverage. Alan Blue is a higher-end product with better coverage for companies who want to retain talent using better benefits.

French employees automatically get basic coverage from the national healthcare system. But companies also need to provide a health insurance from a private company to pay for part of the health expenses. It’s a hybrid system with a strong legal framework.

This is where Alan comes along as your employer signs a deal with an insurance company to cover all their employees. Usually, insurance companies provide multiple offerings. But Alan has historically focused on a single plan.

With Alan Green, you get good coverage starting at $59 (€50) per month per employee if you’re under 36 years old. It gets more expensive if you’re over 36, and then over 45, and then over 56 years old. Plans for employees over 56 cost $100 per month (€85).

Companies have to pay at least 50 percent of those plans. The rest is deducted from your pay. Some companies also choose to pay 100 percent of everyone’s health insurance to show that they really care about their employees.

Employees can also choose to cover their spouse and kids with Alan. Plans for a second adult cost the same as plans for employees. And you can cover all your kids for a $47 flat monthly fee (€40).

While you won’t pay anything if you see a normal medial practitioner, Alan Green couldn’t necessarily cover an expensive pair of glasses or extensive dental work.

Alan Blue is a second option for companies looking for a premium health insurance product. Companies now have to decide between the two plans for the entire staff. You can’t let employees decide between one plan or the other.

Alan Blue starts at $82 per month (€70) for young employees and also gets more expensive depending on the age of the employee. While there’s only a €20 difference between the two offerings for employees under 36 years old, the price difference is higher the older you get. Similarly, you can cover all your kids for a slightly more expensive $64 flat monthly fee (€55).

For companies that choose to fully pay for health insurance, it depends if you’re willing to spend more to provide better insurance. But some companies only pay part of the health insurance package. Employees will end up paying more if their companies switch from Alan Green to Alan Blue.

“Overall, companies that are growing rapidly tend to invest a lot for their employees and switch to Alan Blue,” co-founder and CEO Jean-Charles Samuelian told me. “We already noticed that with companies in our existing clients. Some companies are also switching to Alan because they wanted something very high end before switching.”

Alan still plans to target small companies. The startup thinks that small companies are underserved by big insurance companies and tend to pay more for health insurance.

Alan Green is not going away anytime soon. Samuelian thinks you can combine Alan Green with Alan Map to find the perfect doctor around you and get fully reimbursed.

Alan Blue is already available to selected Alan customers. All companies will be able to sign up in September. You can already view all pricing and insurance details on Alan’s website.

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‘Forest Bathing’ Really May Be Good For Health, Study Finds


‘Forest bathing’ or shinrin yokuspending time in a forest or other green space to reap the health benefitshas become an increasingly popular activity in recent years, especially in some countries, like Japan, which take it pretty seriously. And with good reason—the practice isn’t some new-age form of woo-woo healing; it’s an increasingly well-evidenced health habit that’s garnered a lot of popular and scientific interest in the last few years.

A new meta-analysis in the journal Environmental Research finds that people who spend more time in green spaces have significantly reduced risks for a number of chronic illnesses. There are probably several mechanisms behind the connection, but one of the more fascinating ones likely has something to do with phytochemicals that trees emit, and humans breathe in. 

The researchers, from the University of East Anglia, looked back at data from a slew of earlier studies—103 observational studies and 40 interventional studies. In the latter, different types of interventions were carried out, like assigning people to engage in shinrin yoku (forest bathing) or the equivalent in an urban space. Others looked at post-operative recovery time of people who could see greenery out their hospital window compared to those who could only see a wall; another compared spending time near greenery vs. water.

All told, the research tracked a whopping 290 million participants, from 20 different countries. Participants were 50% of which were in Europe, but many studies (24) were from Japan, where forest bathing is popular. The team correlated the amount of time people spent in green spaces with 100 health outcomes over time, and found a number of relationships.

Spending more time in green spaces was linked to reduced levels of the stress hormone cortisol, lower heart rate, reduced risk of coronary heart disease, lower blood pressure, lower cholesterol, reduced risk of type II diabetes, reduced all-cause mortality and death from heart disease. For women who were pregnant, more time spent in greenery was linked to reduced risk of “small size for gestational age” in the baby as well as preterm birth. Among all the participants, on average, there was an increased likelihood of self-reporting one’s health as “good.”

Some studies also suggested a possible link between green spaces and cancer outcomes, neurological outcomes, sleep duration, and certain biomarkers. The authors do note that some of the studies included weren’t of the highest quality, and further research is certainly warranted.

A number of plausible mechanisms exist, including the obvious—green spaces promote physical activity, social interaction, exposure to sunlight, and reduced pollution, which all boost health in various ways. The less obvious explanations include the “old friends” hypothesis, which suggests that the increased exposure to microorganisms can bolster the immune system, which in turn leads to reduced risk of chronic disease and early death.

But there’s also another possibility—chemicals emitted by the trees themselves, which may affect our immune systems in various ways. “Much of the literature on forest bathing suggests that phytoncides (volatile organic compounds with antibacterial properties) released by trees may explain the salutogenic properties of shinrin yoku [forest bathing],” the authors write. Some studies have also shown that the compounds may increase the activity of the immune system’s natural killer cells themselves.  

According to the paper, people have been aware of the connection between greenery and health since the 19th century, which may be part of why city parks and green spaces were developed so thoroughly in that period. The authors suggest that “green prescriptions,” especially for those who lack everyday access to green spaces, may be a valuable addition to medicine, as they could have measurable health benefits over the years. And, as those who spend regular time in nature know, the mental health benefits of forest bathing may be just as strong. 

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Dairy Industry Trumps Infant Health With US Rejection Of Breastfeeding Resolution

Women breastfeed their babies during a public event to promote the benefits of breastfeeding, at a park in Bogota on November 3, 2017. Hundreds of mothers simultaneously breastfed their babies during a gathering held to promote breastfeeding as part of infants’ right to a healthy diet.  (RAUL ARBOLEDA/AFP/Getty Images)

When the U.S. pushed to weaken language supporting breastfeeding in a WHO resolution at the World Health Assembly recently, the Trump administration prioritized the U.S. dairy industry and the $70 billion baby food industry over babies’ health, according to Alison Stuebe, M.D., M.Sc.f, a maternal-fetal medicine physician and president-elect of the Academy of Breastfeeding Medicine.

“What the WHO is trying to do is help women achieve their own breastfeeding goals, and unfortunately those goals conflict with goals of the dairy industry,” Stuebe said. “The U.S. decided that the dairy industry is more important than moms and babies.”

The resolution Stuebe is referring to should have been noncontroversial, as journalist Amruta Byatnal first reported in News Deeply last month. It updated the evidence on supporting breastfeeding, which is particularly useful for low-income nations without the resources to conduct their own research on breastfeeding support. The resolution included guidance on the WHO’s International Code of Marketing of Breast-milk Substitutes, which outlines what kind of marketing is and is not acceptable from formula companies.

And that’s what the U.S.—home to most of those companies—had a problem with. The U.S. first tried to block the resolution and then pushed hard for an alternative that removed language related to restricting aggressive marketing by formula companies. In fact, as Vox reported, the U.S. threatened Ecuador, one of the resolution’s sponsors, with trade retaliation and withdrawal of military aid if Ecuador didn’t backtrack.

The resolution eventually passed, but only after substantial changes diluting the language about formula marketing (and after Russia supported it). (Here’s the original draft, the U.S. proposed alternative wording, and the final resolution that passed.)

The reason for U.S. opposition, according to the Department of Health and Human Services in the New York Times, was that “The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children.”*

When I reached out to the department, HHS spokesperson Caitlin Oakley told me the following:

Recent reporting attempts to portray the U.S. position at the recent World Health Assembly as ‘anti-breastfeeding’ are patently false. The United States has a long history of supporting mothers and breastfeeding around the world and is the largest bilateral donor of such foreign assistance programs. The issues being debated were not about whether one supports breastfeeding. The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies. Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies.

But the issue being debated was about support of breastfeeding — that, and allowing women “to make the best choices for the nutrition of their babies” is what the entire resolution focused on. The resolution also in no way stigmatized women who might choose–or need–to use formula. In reality, it’s the U.S. placing unnecessary hurdles for mothers who want to choose how to feed their babies, including in this country with policies that make it more difficult for women to establish and maintain breastfeeding.

The benefits of breastfeeding are well established, and while formula is a lifesaver for women who do not breastfeed or children who cannot take breast milk, it cannot offer the benefits for an overall population of children that breast milk does. At the population level, Stuebe said, evidence shows that higher breastfeeding rates translate to better health of moms and babies.

“This isn’t about forcing women to do things—this is about letting women who wish to breastfeed having the support and resources to do so,” Stuebe said. Research shows that globally, most women want to breastfeed, but many face structural barriers, said Stuebe, who wrote the updated opinion on breastfeeding for the American College of Obstetricians and Gynecologists, emphasizing the need to support all women in their feeding choices.

“If breast milk is unavailable because mom is separated from her baby, cannot make milk, is experiencing excruciating pain, or doesn’t want to do it and hates it, which is a legitimate concern, then formula is a better choice than cow’s milk because an infant cannot digest regular cow’s milk and will become ill,” Stuebe said. “It’s incumbent on health professionals to support women in making decisions that are right for their lives.”

But that also means supporting women who want to breastfeed, and “aggressive marketing of formulas in developing countries contributed to a global decline in breastfeeding,” according to a 2009 article in The Journal of Perinatal Education.

Formula companies heavily pushed formula to mothers who lived in poverty across the world, undermining their confidence in breastfeeding. Formula similarly overtook breastfeeding in the U.S., to the detriment of infants’ health, the New York Times reported in 1981.

While most women in developing countries continued to breastfeed, many also supplemented with formula—which must be mixed with water. Since local water was often contaminated, babies frequently developed and even died of diarrhea, Stuebe said.

“It became clear that aggressive marketing of formula globally was killing babies,” she said. That led the WHO to develop the Code on marketing formula, restricting companies from marketing directly to families. When it was voted on in 1981, the U.S. was the only country to vote against the Code.

“We have a lengthy history of getting in the way of maternal and child health and putting the interest of the dairy industry and formula companies ahead of the interests of health and well-being of moms and babies,” Stuebe said. That has continued with Trump administration’s bullying over the WHO resolution, almost certainly driven by support for the dairy industry, whose latest attempt to unload their surplus of milk is the rapidly growing “toddler milk” market, she wrote in a blog post. “Protecting toddler milk as a dumping ground for excess milk was likely a primary motivation for the U.S. take-no-prisoners attack on global breastfeeding,” she wrote.

This latest move from the Trump administration is part of a pattern in attacking the rights of children, women and families, said Kristen Rowe-Finkbeiner, author and executive director of the large nonprofit organization Moms Rising.

“We are seeing an attack on women’s rights to simply have information about breastfeeding as well as to have what little rights we have in the workplace be protected,” she said. “There are so many barriers in our workplaces to have the time and place to pump and to have the chance to establish breastfeeding in the first place with paid family leave.”

In his tweet attempting to defend U.S. actions, Trump claims the U.S. “strongly supports breastfeeding” but does not believe “women should be denied access to formula”—except the WHO resolution did not restrict access to formula in any way. Trump goes on to say, “Many women need this option because of malnutrition and poverty.”

But as Stuebe points out, this statement doesn’t make any sense. “Poverty and malnutrition don’t prevent breastfeeding. Women make adequate milk except in cases of extreme starvation,” she said. “What prevents breastfeeding is inadequate support, such as total absence of paid parental leave, absence of lactation support, and policies that have work requirements for Medicaid,” which can prevent women from establishing a breastfeeding relationship if they need to work.

Plus, when those structural barriers are removed, breastfeeding is free, points out Rowe-Finkbeiner.

“That isn’t to say that everyone should breastfeed,” she said. “It’s to say that everyone should have the choice and not be forced to support the $70 billion infant formula industry when breastfeeding is free.”

She said actions speak louder than Trump’s words on Twitter, and U.S. actions have shown where the administration’s priorities lay.

“People need to be able to choose what’s right for them and their baby, and right now the barriers to being able to decide whether or not to breastfeed are ridiculously high. It’s time to break down the barriers, not put more up,” Rowe-Finkbeiner said. “To have the Trump admin to push against that is shameful, it’s an insult to parents and to our country and the rest of the world.”

*This post has been updated with the response from HHS.

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