Policy in Plainer English

Dr. Ana Poblacion and Richard Sheward discuss recent research related to measuring food insecurity, and how ongoing research supports better strategies to reduce food insecurity & its associated health risks. This episode features development & validation of a scale measuring changing levels of food security in households with young children. The work was funded with a small USDA research grant and presented as part of marking 25 years of household food security measurement.  Research presentations from all projects supported as part of this 25th anniversary are found at: https://sites.tufts.edu/foodsec25/ For the full Hunger Vital Sign explainer series, visit our website: https://www.vtfoodinhealth.net/hunger-vital-sign-toolkit To learn more about the Hunger Vital Sign National Community of Practice, visit the Children's HealthWatch HVS special projects page: https://childrenshealthwatch.org/public-policy/hunger-vital-sign/

Find all supporting materials at the Hunger Vital Sign explainer series website.This episode features an interview with Katherine Verlander, Deputy Division Director at the Centers for Medicare & Medicaid Services (CMS)Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.Part Two of this series featured Hunger Free Vermont and their work implementing Hunger Vital Sign in Vermont.Part Three of the series introduces the screening, referral, and navigation services evaluated as part of the Accountable Health Communities Model at the CMS Innovation Center.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website.This episode features an interview with Katherine Verlander, Deputy Division Director at the Centers for Medicare & Medicaid Services (CMS)Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.Part Two of this series featured Hunger Free Vermont and their work implementing Hunger Vital Sign in Vermont.Part Three of the series introduces the screening, referral, and navigation services evaluated as part of the Accountable Health Communities Model at the CMS Innovation Center.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website.This episode features an interview with Katherine Verlander, Deputy Division Director at the Centers for Medicare & Medicaid Services (CMS)Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.Part Two of this series featured Hunger Free Vermont and their work implementing Hunger Vital Sign in Vermont.Part Three of the series introduces the screening, referral, and navigation services evaluated as part of the Accountable Health Communities Model at the CMS Innovation Center.Audio Editing and Post-Production Provided By Evergreen Audio

The Hunger Vital Sign explainer series continues with an introduction to the Accountable Health Communities (AHC) Model at the CMS Innovation Center. This model is testing the results of screening for health-related social needs and offering referral and navigation services to community resources in a health care setting. The Hunger Vital Sign questions make up the food security portion of the AHC screening tool, and food insecurity has been the most common identified need. The guest expert for this section is Katherine Verlander, Deputy Division Director at the Centers for Medicare and Medicaid Services (CMS).Please visit our Hunger Vital Sign explainer series website for reference materials and resources connected to these interviews. 

Find all supporting materials at the Hunger Vital Sign explainer series website.This episode features an interview with Katy Davis, Community Health Initiatives Director at Hunger Free Vermont.Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website.This episode features an interview with Katy Davis, Community Health Initiatives Director at Hunger Free Vermont.Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Katy Davis, Community Health Initiatives Director at Hunger Free Vermont. Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here. Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.  Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.  Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.  Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.  Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.  Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

Find all supporting materials at the Hunger Vital Sign explainer series website. This episode features an interview with Richard Sheward, Director of Innovative Partnerships at Children's HealthWatch.   Citation for the Hunger Vital Sign tool and link to the original research:Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.Audio Editing and Post-Production Provided By Evergreen Audio

We're doing something a little different - this series of podcast episodes are a set of conversations explaining the Hunger Vital Sign risk screening tool. They're designed as part of a larger resource with reference materials, key point summaries, and implementation toolkits:https://www.vtfoodinhealth.net/hunger-vital-sign-toolkitIf you aren't interested in Hunger Vital Sign, we promised playlists for other entertainment. Here are two:Season Four Extended Playlist - Food & HealthStatistics, Data, Health

A season finale. . . with special guests! Edward Phillips, MD, and Juna Gjata, creators of the podcast Food, We Need to Talk, join us to comment on common themes between the two series, and suggest what should be next in your food & health podcast listening line up. The  first season of Food, We Need to Talk is available online. Two episodes cited specifically in this conversation were: This Is Your Brain on Cheesecake and Disordered Eating and Eating Disorders. We also talked about what makes a "fad" diet and common characteristics of popular diets that don't support sustainable healthy eating strategies, covered in Doomed If You Diet, Doomed If You Don't. The problems with the good food / bad food mindset are explored in Good Food, Bad Food and also What the Heck Should We Eat? In this first season they do not go deep into diets tailored for treating or managing specific health conditions. But what will happen in the next season? We'll have to tune in March 21st to find out. . .  The podcast mentioned when I steal Steven Levitt's interview structure is People I Mostly Admire from Freakonomics Radio, which also has a health care podcast in its portfolio, Freakonomics, MD (Steve interviews the host on this 2021 episode).   You were promised links to microbiome-focused podcast episodes. There are a lot. It is literally a category of podcast unto itself.  A few options that are clear about both the interesting questions before us & the limits of the current science:BBC Good Food Health Podcast - Dr. Megan RossiStuff You Should Know - Your Gut Is Also a BrainWhat Went Wrong at uBiome Part 1 and Part 2 - The Journal (also a cautionary tale in what fraudulent medical billing looks like) Find easy links to this season's episodes in order here. And an extended playlist here. This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.This podcast is part of the Food Access in Health Care program at Bi-State Primary Care Association.

This episode brings back previous guests and features a new interview with Christine Hamann, Director of the Teaching Kitchen Collaborative, to talk about cross training and collaboration. It continues our series of episodes that consider how to effectively introduce the food knowledge outlined in the first half of the season into a health care context. Christine references two conferences in this episode:Healthy Kitchens, Healthy Lives (next event is in February 2023)Teaching Kitchen Research Conference (next event is in October 2022)We feature clips from these previous episodes:Telehealth and Provider Consultations (Season Two)Food Access and Health Care Season Finale (Season Three)How to Cook (Season Four)Bonus Intro: Designing Better Health Systems (Season Four)Putting Appreciation Into Practice (Season Four)The podcast narrative also draws on background conversations I had with:The Maven Project (see also the VPQHC telehealth office hours they participated in last year for discussion of their work)Cara Feldman-Hunt - Integrative Health and Wellness Coaching CertificateStephanie Gall -  Vermont Academy of Nutrition and Dietetics and UVM HN clinical nutritionFinally, if you want to learn more about the questions around nutrition education as part of medical training, the Center for Health Law and Policy Innovation published a report in 2019, Doctoring Our Diet, and the proposed resolution referenced from Rep. McGovern is found here. Full season archive here. This podcast is part of the Food Access in Health Care program at Bi-State Primary Care Association.  This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

We talk with Chris Moldovan, RD, CD, FAND, and Director of Nutrition and Wellness at Age Well, an Area Agency on Aging in northwestern Vermont. Chris is also part of the Older Vermonters Nutrition Coalition. She provides examples of how our relationship with food and diet shifts with age, and explains how organizations like hers help people navigate changing requirements for nutrition.Some of the resources referenced in this episode:Medically Tailored Meals (episode from Season 3)National Meals on Wheels Organization - Health Care ConnectionsFood Is Medicine for Older Adults - December, 2021, Symposium SessionProfile of Hospital / Meals on Wheels Partnership for MTMsNutrition Requirements of Older Americans ActMore Details on Requirements of Older Americans Act2020 Report on Funding Adequacy for Older Americans Act Meals in Vermont Plus two book references:Ministry for the Future - and a New Yorker podcast interview with the authorThe Pleasures of Cooking for One by Judith JonesFull season archive here. This podcast is part of the Food Access in Health Care program at Bi-State Primary Care Association.  This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. 

Professor Amy Trubek, and instructors John Corliss and Emily Barbour, join us to talk about core principles of the courses they are developing in the Department of Nutrition and Food Sciences at the University of Vermont. Their curriculum combines sensory analysis with basic cooking skills to increase food agency. Some resources referenced in this episode:Food Agency Website - including a course in Culinary Nutrition that is offered to interested health professionals through UVM Continuing Education. The Google project on learning to make vegetables delicious. See also the Plant Forward Kitchen from the Culinary Institute of America. Careful listeners may have noticed that the oven frying Amy references sounds a lot like what an air fryer does. Episode Three of the last season of Nice Try, which explores the history of the crock-pot, is an interesting take on kitchen appliances that fits in well with our food agency conversation.  Salt, Fat, Acid, Heat by Samin Nosrat Children and Health Eating from Season Three. See also Vermont Food Education Every Day (VT FEED). Full season archive here. This podcast is part of the Food Access in Health Care program at Bi-State Primary Care Association.  This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

In this season of Policy in Plainer English we're looking at skills food professionals use to understand how people experience flavor and what influences food choices - and what implications that might have for health professionals working with patients on diet change. The episodes build from each other, so if you haven't started at the beginning, consider pausing here and going back to "How We Experience Flavor".   Writer Alexandra Johnson helps us get the new year off to a strong start. Among the things she writes about is the practice of journaling to support creativity. You know what we'll all need to put into practice food appreciation as a tool to become adaptable in our diets? Creativity. It's time to redefine how we think about food journals - these aren't the standard food logs of calories and serving sizes,  Alex is helping us define a different tool entirely.  No surprise, we referenced a lot of writing over the course of this conversation. Here are some links for additional reading:The Hidden Writer, Alexandra JohnsonLeaving a Trace, Alexandra JohnsonOn Keeping a Notebook by Joan Didion appears in Slouching Towards Bethlehem. Here is an article about the essay, with excerpts, from The Marginalian. 2022 Food Trends - with the coffee & climate change reference (see also a longer piece from October, here)Why I Switched to Eating Grandma's Food, Geeta Pandey in BBC NewsMelissa Clark on Wine-Braised Chicken in the New York TimesFor examples of prompting questions for finding flavor details, peruse this handout from my "Describing Flavor" craft seminar. It's from the Lesley University MFA program that I mentioned at the top of the episode. Sadly, the food samples that went with it were only available in-person. Do look for Alex's other work - we focused on only one aspect of it in this episode. Her essays, reviews, and travel pieces appear in national publications and anthologies, and her book in progress set in southern Italy is The Saint's Laundry.  Chicory will surely make an appearance.This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.This podcast does not cost $189,892.00 to produce. No, there is a much larger Food Access in Health Care program of which this is one small element (the most fun element, but still small). Find out more at VTFoodInHealth.net.

In a special year-end episode, we reverse directions. This season is about bringing skills from food professionals to bear on how we shape our individual diet, but what about moving the other way - from individuals to commercial scale production? The main lesson from this episode is to listen to the Mission ImPASTAble podcast series (thank you to the Sporkful for permission to use the clips we play).  You can find the series online.We also reference several previous Policy in Plainer English episodes, including Medically Tailored Meals and the Health Care Systems introduction to season four. For some of the reports also referenced in this episode:CDC statistics on eating patterns can be found in their Behavioral Risk Factor Surveillance System surveys. The GAO report on federal efforts to address diet-related chronic health conditions. Editorial on the structure for supporting nutrition incentive programs. USDA overview of federal nutrition programs.We'll be back at the start of 2022 to finish up our regular season.

We interview two chefs, Dale Conoscenti and Leah Pryor, about how to take all the food appreciation skills we've covered in the last episodes, and apply them to shaping what goes on our dinner plates. This episode mentions the 'sounds of water pouring' experiment, which NPR reported on in 2014, and then sound engineers got geeky about deconstructing.  A more famous experiment is the effect of sound on how we perceive chips as stale or fresh. . . less interesting audio for a podcast since that experiment focused on not hearing the crunch. The impact of sound on food design is not a fleeting concern. For example, this article from Atlas Obscura describes efforts to make airplane food taste "right" with the loud background noise of the jet engines. In this episode I also note that we're skipping over a lot of information on scaling up flavor for commercial applications. For example, ice cream inclusions don't need to only work at 10-degrees Farenheit, they also have to withstand processing at -20-degrees because to get them to combine with the ice cream both the ice cream base and the inclusions need to be the same temperature and the ice cream is processed at -20.  If you want an amusing account of going from home kitchen experiment to commercial food production, Dan Pashman from The Sporkful has you covered with his Mission ImPASTAble series. If you want to learn more about the Comprehensive Pain Program that Leah discusses, check out this link to the program - including its own short podcast episode "Can Food Fight Pain?". 

Okay, it's all you need to know to follow along the rest of this season. Nonetheless. We're bringing it all together in an interview with David Keck, Master Sommelier and wine grower at Stella14, who promises us that there's nothing to be intimidated by in the world of elite wine tasting. Or words to that effect. This episode highlights key take aways from the previous two interviews. If you haven't listened to those, pause and listen to those first. It will be helpful for understanding this one.    How We Experience Flavor  What Makes a Food Popular  This episode references The Essential Scratch & Sniff Guide to Becoming a Wine Expert, by Richard Betts and you can hear Betts talk about it on this video from a bookstore event. He appears at 14:00.This episode also mentions the Vermont wine pairing project, which was part of market development work by the Vermont Fresh Network in 2017 - 2019. Resources from the program are linked here. They include a guide to Vermont wine tasting, written with help from Rowan Jacobsen of Episode 1 fame. Learn about current Vermont activities from the Vermont Grape and Wine Council. 

Sensory professional Roy Desrochers joins us this episode to talk about how food producers can use flavor profiling methods to understand why consumers respond the way they do to products and how to make their food more appealing. Roy has had a long career in food, flavor, and smell  – he is currently running a grass fed milk project with University of Vermont Extension. We also get a few truffle reminders from last episode's guest, Rowan Jacobsen. If you haven't heard that episode yet, it's best to start there.  This episode mentions the spaghetti sauce TED Talk by Malcolm Gladwell (about Howard Moskowitz), which is found here.  One thing listeners may note about this conversation is that we're highlighting principles used to increase consumption of items where there's a health-based reason to eat more of them. For other food products, the goal is to eat less. This earlier update post provides examples of conversations about that issue.If you want a few more podcast episodes about sensory analysis and the food business:Plant- and Fungus-Based Meats - Gastropod, includes details on attempting to make non-animal "meats" that taste like their animal-based equivalents.  Mission Impastable - The Sporkful, a quest for the perfect pasta shape, in which the host offers his own "flavor leader" criteria.If you want more about truffles, now that we're past that part of this season, there's Rowan's book Truffle Hound and also these links:Planet Money podcast on truffle trading (where I got the name of the sweat molecule, if I pronounced it wrong blame NPR)Truffles and Truffle Dogs VideoVPR Vermont Edition - Local Foods Call-In + Truffles InterviewThis season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.This podcast does not cost $189,892.00 to produce. No, there is a much larger Food Access in Health Care program of which this is one small element (the most fun element, but still small). Find out more at VTFoodInHealth.net.

Author Rowan Jacobsen is the guest on this introduction to how we experience flavor, and the implications when something changes that experience - for example, if we lose our sense of smell.  Rowan's most recent book is Truffle Hound. If you want a primer in describing flavors, try his Apples of Uncommon Character as a study guide - it would be a nice companion to the apple chapter of Michael Pollan's Botany of Desire, which provided the passage on sweetness read during this episode. If you want to learn more about Thanksgiving Dinner Candy Corn, the original Twitter thread was posted here.  I fact checked the review against a bag of said candy corn for accuracy. It's accurate.   Before English Majors (or French Majors for that matter) complain about Proust, I realize that the novels have since had an updated translation and the new title is In Search of Lost Time and the quote we read was re-translated differently as well . . . really I just care about the madeleine. Which some scholars claim was actually toast.      We mentioned sommeliers and their vocabulary of scent. If you want to read more about that, and what happened when COVID-19 arrived in wine and perfume country in France, the New York Times covered the topic in this September, 2021, article.   This season of Policy in Plainer English is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $189,892.00 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.This podcast does not cost $189,892.00 to produce - if it did, I wouldn't be using my husband as the "voice actor" reading book passages. No, there is a much larger Food Access in Health Care program of which this is one small element (the most fun element, but still small). Find out more at VTFoodInHealth.net.

With some commentator's license, this episode uses a presentation by Dr. Shantanu Nundy to set the stage for a new season of discussing food and health care. It reviews key concepts from previous podcast seasons and considers changes to the systems for primary care that we might see in the near future.   Thank you to the Northeast Telehealth Resource Center and Dr. Nundy for permission to use this audio, which is taken from the closing presentation at the 7th Annual NETRC conference. Commentary added by the Policy in Plainer English podcast is our own and does not necessarily reflect the opinions of the original presenter. Links referenced in this episode:Dr. Nundy's new book: Care After COVIDNETRC's Telehealth Resource Library - also check out their new Telehealth Classroom project! Audio-Only Telehealth ServicesLifestyle MedicineCDC - Obesity & COVID-19 Hospitalization RisksJournal of the American Heart Association - COVID-19 Hospitalizations Attributable to Cardiometabolic Conditions 

The Policy in Plainer English podcast is returning this fall! And it's going deeper on the food access and health care topic. Want to catch up ahead of the next season? Here are some concepts from Season Three that will be important:Lifestyle Medicine Part 1Lifestyle Medicine Part 2Children and Healthy EatingMedically Tailored MealsAnd you can find many more resources (in written format) at the site VTFoodInHealth.net.

We're wrapping up our series on food and health care with a conversation with Georgia Maheras of Bi-State Primary Care Association. If you'd like to browse all the episodes in this series, we've linked them below in order. This season the episodes built on each other more than in our previous series, so we  recommend taking it from the top and working your way through: Food & Health - An IntroductionHunger Screening - Part 1Hunger Screening - Part 2Predicting Food InsecurityCare CoordinationCare Navigator Help Me GrowBonus: Panel on Connecting to Food ResourcesFood and TransportationMedically Tailored MealsLifestyle Medicine - Part 1Lifestyle Medicine - Part 2Children & Healthy EatingFood Prescription Pilot Program As mentioned on this episode, Bi-State Primary Care Association recently received a grant to continue work on food in health. Keep an eye on the site VTFoodInHealth.Net for more details.This season was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $99,960 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. (The podcast was a very small percent of the award).

In our final example of a food in health care project, we welcome guests Chelsey Canavan and Natalie Romano from Dartmouth-Hitchcock and Jennifer Fontaine from the Upper Valley Haven to discuss a new Food Prescription pilot.You may have also heard of Produce Prescriptions, which are a way for health care practices to help patients increase their fruit and vegetable consumption. Produce Prescriptions have a variety of sources for support, including from the USDA, and you can read examples of different forms these programs take here. This Food Prescription project includes plenty of produce, but provides a more full diet with whole grains, dairy, and lean protein as well.One thing mentioned in this episode is waivers and forms that allow organizations to share patient information. The Harvard Center for Health Law and Policy Innovation published a guide in 2020 on navigating HIPAA in food and health care partnerships. Also, here is the article on which I based my comment that we don't produce enough fruits and vegetables to meet basic dietary recommendations.This episode covered a lot of territory and pulled together many themes from the season. Join us next episode for the season finale. 

This episode we talk with two people leading programs that engage with children around topics in healthy eating: Koi Boynton, from Healthy Roots Collaborative, and Emmy Wollenburg, from RiseVT speaking about Dinner Together. If you're interested in programs designed to help children access healthy food, our earlier episode on Help Me Grow also touched on this topic. In this episode, Koi mentions that Farm-to-School is a long-established approach in Vermont - which is true, we are one of the leading states in the country in farm-to-school programming. To learn more about Farm-to-School resources, check out the Vermont FEED (Food Education Every Day) website.We did not talk a whole lot about the idea of making healthy choices convenient choices, but that, too, is an established approach. For an example of programs designed with the idea of making healthy food choices the default, check these resources from the Vermont Foodbank. 

You will find important context and links at the first half of this 2-part episode on Lifestyle Medicine, so if you haven't checked that out, there's no time like the present. This episode features a conversation with the Lifestyle Medicine team at Springfield Medical Care Systems - Laura Jensen, Adam Ameele, Scott Durgin. It also mentions RiseVT, which funds part of Laura's position and helped with some elements of starting the SMCS program (which began with a HRSA supplemental grant for FQHCs). Another item mentioned in this episode is what determines the flavors we enjoy. Did you know I wrote a book on that? Seriously, I did, that's not a joke. I'm not saying it sold well or that it's still in print, I'm just saying I wrote one - go ahead and message me if you want a copy. OR you could read a book on this topic that sold quite well, Bee Wilson's First Bite. 

In the first of two episodes on Lifestyle Medicine, we interview Dr. Elisabeth Fontaine and Dr. Scott Durgin. They provide background on the Lifestyle Medicine framework, which will set us up to talk to more members of the Lifestyle Medicine team at Springfield Medical Care Systems about how they're implementing support of a plant-based, whole food centered diet with their patients. That's Part 2 and it will be great, so be prepared by listening to this one first.Links mentioned in this episode include:American College of Lifestyle Medicine - Which includes the diagram of the six areas of focus.While you can find resources at the general link above, Dr. Fontaine also recommends The Plantrician Project,  Lifestyle Medicine Economic Research Consortium, Nutritional Update for Physicians: Plant-Based Diets, The Power of Plants.We also referenced Michael Pollan's In Defense of Food. The two websites for Dr. Fontaine's current work: Let's Lead and Plant Based Telehealth.If you want the details on those primary care spending percentages cited in the show, rest assured we had a work group on that. Here is the report (Feb, 2020). Ready for Part 2 of this episode? It's posted here.

This episode we welcome David Waters, CEO of Community Servings, to our show. Community Servings is a Massachusetts-based Medically Tailored Meals (MTM) program that is also a leader in the national Food is Medicine Coalition. Community Servings was founded in 1990 to serve local Dorchester and Roxbury residents struggling with HIV / AIDS. It is now a regional organization serving 15 different meal plans to 2,300 patients at a time. You may have heard them mentioned in previous discussions not only for their role in MTMs, but also the Massachusetts State Food Plan.  You can access that plan from the Food is Medicine Massachusetts coalition. As referenced in this episode, there are a lot of resources out there on Medically Tailored Meals. Here are some highlights:Definition of "Medically Tailored Meals" and guidelines.FiMC Accelerator Program - a 12 month intensive program for creating and scaling new MTM projects.Research on MTM impacts - examples from the FiMC research library, note that many programs are also doing intensive program evaluations with partners (for example, insurance payers) that aren't necessarily published. This may merit another episode for the data lovers in the crowd.California Food is Medicine Coalition - Notable among the different MTM programs because California has a lot of projects going within a single state and they are working together to develop funding models and study impact. Examples of Nutrition Information - God's Love We Deliver, the NYC-based MTM program, has some great nutrition resources and fact sheets that show how they tailor meals for different medical conditions and food preferences. Where to find out about MTM work in Vermont - part of Bi-State's current Food in Health Care grant involves a consultant-led planning process to develop next steps for exploring MTMs in Vermont, look at this page for background information and look for new updates in late spring, 2021 when the project will be wrapping up its first stage.Special thanks to Marydale DeBor of Fresh Advantage LLC who is working with Bi-State on our MTM project and helped arrange this interview.

The Policy in Plainer English podcast had been taking a break between seasons, but we return now briefly to bring you this bonus episode on the future of using the telephone in health care. It is a summary of the report from the working group on audio-only telemedicine reimbursement in Vermont. But also we tell you the future of telehealth.Because we dream big in health care policy in Vermont. If you would like access to the original report, with details and a reliable narrator (aka the Department of Financial Regulation), you can find it online here. This would also be a good opportunity to go back and review Season 2 of Policy in Plainer English, which was devoted to telehealth during COVID-19. You can find all the episodes linked from the Season Finale here.  You can also review the Telehealth in Vermont Resource Guide for many, many links to learn more. Also, a tip from the audio editing, I did not slow down my natural speech patterns on this one - this is how fast I talk. I had 6 months of difficult work and 114 pages of final report to get through in approximately 15 minutes of podcast, that's a lot! If you don't like the information reviewed this quickly, your podcast player should have an option to play back more slowly. 

Not to be confused with our episode on Telehealth and Transportation, this episode is on Food and Transportation. .  . perhaps we're adding up to a season on transportation. In this episode Faye Mack, of Hunger Free Vermont, and Maureen Boardman, of Little Rivers Health Care, join us to talk about how to tackle the related problems of barriers to transportation and barriers to food access.We mention a few additional tools and examples in the episode:Farm-to-Plate: Local Planning for Food AccessFarm-to-Plate: Resources for RetailersGeisinger Fresh Food Farmacy Presentation - From Bi-State's 2019 Clinical Quality SymposiumAnd with that, we're taking an end of year break - look for new episodes in January!

On November 19th, Bi-State Primary Care Association hosted a discussion with a large panel of organizations that help health care practices and their patients (and others, but we're health care focused) connect with food resources. They discussed how they have adjusted their programs in response to COVID-19.  Much as the amount of audio to be edited for this episode exceeded my patience, so too did the amount of text for linking resources exceed the word limit on this podcast posting platform. You can access the full show notes at VTFoodInHealth.net. 

This episode features Janet Kilburn and Elizabeth Gilman discussing Help Me Grow, and the role this program's coordinative services play in helping families with young children connect to food resources.As noted in the podcast, connecting for food access is just one piece of what Help Me Grow does and if you want to learn more about all their programs please visit their website: helpmegrowvt.org. You may also want to explore a bit at Vermont 2-1-1, which is mentioned in the episode. This episode builds from the ones that went before it, and in particular our earlier episode on care coordination at health care practices. If you haven't listened to that episode yet, maybe start there and then tune in here. 

We continue our discussion of care coordination with Jodi Frei, of OneCare Vermont, and Patrick Clark, of Gifford Medical Center, and take a deep dive on a particular platform: Care Navigator. Care Navigator is part of a larger approach to Care Coordination at OneCare, and there's a lot of information if you want to learn more about it. The patient programs section of the OneCare website provides an overview of their care coordination work, including a chart showing what constitutes high / very high risk medically complex patients.The 2019 Annual Report explains how care coordination fits into the overall OneCare goals and provides some data on how it is working in Vermont. And, of course, there's always this podcast's Season One: Welcome to Payment Reform if you want to learn more about the overall ACO model (not specific to OneCare Vermont). If you listen to this episode and come away wondering "what are the legal obligations around HIPAA and patient privacy related to online platforms for sharing health information?" then may we suggest a recent National Consortium of Telehealth Resource Centers webinar on this topic? This webinar is part of a telehealth series, but it's illuminating and will renew your appreciation for the complexities of building workable tech tools in health care. If you want to join the line of people who have stepped forward to inform me that 10 is an arbitrary number of people to play backyard football and that a real football match requires 11 on a side, then fine - this is why Patrick didn't want to say sport analogies on tape. As a former rugby player, I feel that the ideal number of players to field on a team is 15.

The last several episodes went over the process of screening for food insecurity among patients at a health care practice. This episode gets into what happens next - and what happens next usually involves a care coordinator (or similar position). We have Kaylana Blindow (Bi-State Primary Care Association) and Laurie Somers (Northern Counties Health Care) guiding us through this episode.  

Before moving on to Care Coordination as part of our series on accessing food resources, we're pausing for a quick look at using predictive analytics to assess which patients might be at risk of food insecurity and how to best reach them with resources they can use.   This episode references several resources on this topic for learning more, so go check these out:The Weitzman Institute webinar series on using technology to address social determinants of health. The entire series is here. The two sessions referenced in this episode were an Introduction to Predictive Analytics and the panel on Food Insecurity.At least one of the Weitzman Predictive Analytics panel organizations has its own podcast, The Carrot Schtick.I referenced the famous pasta story, told here by Malcolm Gladwell for TED.  In this telling it's a parable about happiness. And if you believe that happiness is understanding market segmentation then he is right. Also, I told a very simplified version of my graduate thesis - I feel that to defend the honor of my department chair (who may very well be listening) I should add that I did have a more useful theory I was testing. My theory was that traditional customer surveys were over-weighting the opinions of activist consumers, people who felt very strongly that local foods (for example) were important to serve. I came up with this theory while being an activist consumer trying to manipulate surveys. But you could redesign surveys to better pull out the preferences of consumers who, yes, would prefer to eat local foods, but that had other priorities they weren't going to sacrifice along the way. That would allow for offering menu options with broader appeal and pulling products like local foods further into the mainstream. This, by the way, tells you how long ago I was in grad school because at the time eating local was still considered a bit fringe. The most interesting thing I learned from that experiment? When you redesign customer surveys so that activist students can't game the system, many of them get into a huff, refuse to complete the survey, and send you nasty emails.  And in case you're wondering why the local vegetarian option in that example was so expensive, it's not just that the ingredients were pricey - building an organic local vegetarian entree meant a lot of hand processing of whole ingredients in a kitchen where that was not the norm for other dishes, which utilized pre-sliced, pre-cubed, and otherwise lightly processed ingredients from national suppliers. This time cost will become important in other episodes, so go ahead and keep it in mind. 

The second half our of episode on screening for hunger and food insecurity. . . and you can probably guess what these show notes are going to say: start with the first half!  In this episode, our original guests (Kristen Bigelow-Talbert and Katy Davis) are joined by Christina Quinlan from Islands Community Medical Services, Inc. in Maine. The subtitle of this episode may be "in which Helen learns that three guest interviews is one guest too many for amateur podcasting." On the plus side, there's a lot of good information here about implementing hunger screening.  Maybe be prepared to take notes.  . .and definitely peruse what was covered in the first half of this two-parter before diving into the action-packed second half. 

Kristen Bigelow-Talbert, from Bi-State Primary Care Association, and Katy Davis, from Hunger Free Vermont, discuss screening for hunger and food insecurity. If poor diet leads to poor health, and health care providers want their patients to stay well, then it makes sense that we would screen for poor diet just like we screen for high blood pressure, cholesterol, BMI, etc. - simple, right? Clearly not simple or we wouldn't be podcasting about it. This episode provides background on the interest in screening for hunger / other social factors in our overall health, and some considerations for selecting screening tools. The second installment will look at implementation, including lessons we might learn from trying new models during COVID-19. Some references from this episode:Community Health Needs Assessments - Definitely helpful as a prelude to this episode, in fact if you have a moment, start here.EHRs - This will be more important in Part 2, but you might as well get ahead.Hunger Vital Sign - One thing that didn't make it into the finished episode was Katy praising Children's HealthWatch on their work with this screening tool. Children's HealthWatch has a lot of excellent resources.PRAPARE - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences. The Community Health Centers screening tool.  SBINS from Blueprint for Health - Screening, Brief Intervention, and Navigation to Services (acronym or to-do list? This sent me down a rabbit hole of looking up the precise definition of 'mnemonic' and I'm no closer to knowing what to call SBINS)Examples of other screening tools can be found in this toolkit from the Rural Health Information Hub. This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

This episode gives a short introduction to our topic for Season Three. If you want more background information on food access in general here are some good starting places:Feeding America - includes Hunger and Health exploring health connections and the Map the Gap site for statisticsFood Research and Action Center USDA Food Security - includes definitions of commonly used terms like "food insecurity"Food is Medicine Coalition - this is for a very specific area of food work, but it's useful to know as an example of food prescribed to treat particular diseasesNFACT - A UVM led project that uses survey data to capture food insecurity and concerns during COVID-19 response, including stay at home ordersAnd a few other items of interest referenced in the episode:If We All Ate Enough Fruit and Vegetables, There'd Be Big Shortages - NPR, 2019The Great Nutrient Collapse - Politico, 2017Behind Belle Gibson's Cancer Con - The Guardian, 2017 - I keep reading these stories because what I really want to know is, are the recipes any good? They didn't cure cancer, but how did they taste? It's not easy to write a cookbook you know. Columbia and the Problem of Dr. Oz - The New Yorker, 2015One topic we won't cover, but one where Vermont is particularly awesome, is food literally in health care - what food we serve at our hospitals. There's a whole movement around that (Healthy Food in Health Care) and a Vermont network. "Healthy" food in this context includes environmental health along with nutrition. It's a great set of initiatives, but beyond the scope of this series, so we're mentioning it now and for more details you'll have to follow the links above to learn more. This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

Update: The program described in this podcast is now live and accepting applications from Vermont practices until Oct 5: www.vpqhc.org/ccptelehealthvtIn a follow up to our telehealth series from this spring, we check in with Hillary Wolfley, Associate Director at the Vermont Program for Quality in Health Care on a new program designed to help patients cross the digital divide and access telehealth.Some additional links referenced in this episode:Our earlier episode on Broadband for Telehealth (May 14, 2020).Bi-State's Vermont Telehealth Resources Guide, which we update regularly. Recordings of (most of) the VPQHC telehealth office hours. At the beginning of the public health emergency the rules were changing so quickly that we didn't want to record and post things that were no longer true (that was also the time when we were not just date stamping the resource guide, we were hour stamping it). Hillary references Telehealth Access for Seniors as a program VPQHC is working with, you might recognize some of their materials from the Telehealth Resources Guide in the section on patient communications. 

We're leaving telehealth and entering the world of food . . . food and health care (although, as former director of a restaurant and farmer association, I'm happy to talk about any element of food that might be of interest). Before we completely exit the telehealth realm, I'm doing a few more quick updates and also reminding everyone that Bi-State Primary Care Association does track telehealth developments in a non-podcast format. Just hop over to our telehealth resource guide for all the updates and details you might ever want.https://televermont.atavist.com/telehealth-in-vermont

We're wrapping up our special series on telehealth with a conversation with Georgia Maheras of Bi-State Primary Care Association, where we hit on some of the highlights of what we discussed over the season.A few items referenced in this conversation that we have not previously linked are: VPQHC Twice-Weekly Telehealth Office Hours, I reference some early data which we discussed in a 2-part webinar series with VPQHC that will be posted here (June 11 & June 18), and we refer to the Milbank study on eConsults. For current federal guidelines, we recommend the Center for Connected Health Policy.About the same time we recorded this episode, the Freakonomics podcast came out with their summary of telehealth and the economics of telehealth. That would be a nice geeky prelude to browsing our full series:Telehealth Special Series - IntroTelemedicine vs. Telehealth (previously recorded)Telehealth Reimbursement & COVID-19 (note that specific rules change frequently, and for the most up to date version check this update page). Telehealth and the TelephoneTelehealth and the Telephone - Chronic Care Management (not everything fit in the first episode)Broadband for TelehealthTelehealth Reimbursement & COVID-19 Part Two (same caveat as above, check our update page if you want specific guidance)TeledentistryTelehealth and Provider ConsultationsTelehealth and Global Budgets (can't get enough of this topic? We recommend our Season One: Welcome to Payment Reform)Transportation and Telehealth Final Episode Bonus: VPQHC Connectivity Care Packages PilotFor more telehealth information, check out our resource guide. 

This episode starts where we probably would have started a telehealth series in normal, non-COVID-19 times . . . looking at telehealth as one of the tools available to help overcome transportation-based barriers to accessing health care. Chris Towne, of Northern Counties Health Care*, and Dr. Brian Bates, of Mountain Health Center, join us to discuss this issue.If you want to read more about options for public transit, including the state's plan for connecting patients to medical appointments, the Vermont Agency of Transportation released their Public Transit Policy Plan earlier this year. Slide 9 in this presentation shows travel hours and miles saved in a telehealth pilot at UVMMC.  If you want to read more about MAT programs in Vermont and their COVID-19 adjustments, UVMMC has this April 17 blog post. Also, the Rural Health Information Hub has this toolkit on using telehealth as part of MAT programs (in non-COVID-19 times). *Northern Counties Health Care was an original sponsor of this series - and if you feel it's totally unfair that a sponsor got a coveted interview spot then please, by all means, contact us and volunteer to be interviewed to even things out, we would love that. 

Here we check back in on a topic from Season One - global budgets. You may remember this as the final phase of our journey into value-based payment reform. But if this is the first time you've heard that phrase, never fear - we give a quick recap at the beginning. And an even shorter one here: A global budget means that instead of getting a fee for every service performed, health care providers or a network of health care providers (aka an Accountable Care Organization or ACO) get an annual budget designed to cover the costs of keeping all their patients well. Obviously it gets more complicated than that, hence Season One, but that's all you need to know to understand this discussion with Lawrence Miller of Five Vine Consulting. 

In this episode we're joined by Katie Marvin, MD, from Community Health Services of Lamoille Valley (CHSLV) and Jennifer Fenn, NP, from Northern Tier Center for Health (NOTCH) to talk about provider-to-provider connections through telehealth.One thing this episode doesn't touch on is what is reimbursable in these systems, which use specialist input to keep treatment in primary care. There's a mixture of reimbursable and non-reimbursable items in this conversation.eConsults are one form of "store and forward" telehealth - asynchronous connections that happen not in real time. In Vermont these were previously only reimbursable for dermatology and ophthalmology but recent legislation is opening them up to a range of specialties. As this episode describes, the hope is that this gets us to the much-sought-after health care moment of both improving access to care and saving significant money within the system. It also makes programs like the one at NOTCH (currently funded through a grant) sustainable and replicable. A very exciting telehealth moment. And, in full disclosure, one that Bi-State lobbied for - you can read our testimony on this topic here.Thank you to Northern Counties Health Care for making this series possible.

At the end of last week, Governor Scott and the Vermont Department of Health authorized dental practices to start accepting non-emergency patients for the first time since the COVID-19 emergency began. Because of its aerosol generating procedures and the creation of droplets when performing work in mouths, dentistry has been particularly hard hit by this pandemic. Here we discuss some of the options available for remote work.This episode features Dr. Rachel Rivard, Dental Director at Community Health in Rutland, and Dr. Joe Errante, Vice President for Network and Clinical Strategies at Northeast Delta Dental. Thank you to Northern Counties Health Care for sponsoring this special series on telehealth.A few additional resources on this topic, taken from the Bi-State guide to telehealth implementation during COVID-19: DentaQuest Partnership COVID-19 ResponseTeledentistry in COVID-19 Webinar (April 6)“Fast Track to Teledentistry” White PaperMouthwatch COVID-19 Resource HubMouthwatch - Adapting Teledentistry for COVID-19 with Dr. Paul GlassmanNNOHA Collection of COVID-19 ResourcesNNOHA Implementing Teldentistry During COVID-19 Webinar & Resources links (May 12)ADA Billing & Coding During COVID-19 Sheet (regularly updated)Includes lists of policies by payerMemo from Northeast Delta Dental on Teledentistry & COVID-19Northeast Delta Dental Teledentistry Presentation (4/30)Vermont Medicaid Teledentistry Reimbursement Memo

Our second episode on Telehealth Reimbursement during COVID-19 looks at the systems used to set payment for telemedicine services. If you want more details on evolving Medicare telehealth billing guidance in response to COVID-19, see this video from CMS, updated on May 8th If you want lots of details on Medicare billing as it relates to FQHCs, visit the Bi-State Medicare Guidance page, which is regularly updated and contains links to key CMS documents. If you want to fact check the claim that this is the worst public health disaster since the advent of the modern telephone system, check out this Fast Company article on the telephone system that was in place during the 1918 Spanish flu and which, unfortunately, relied on an army of operators to manually make phone connections. Thank you to Northern Counties Health Care for their sponsorship of this special series on telehealth and COVID-19.