#lbp create into reality

[bciphergrl]

Create Into Reality Doodle Dump #1 (All The Blue Titan)

It sooooo floofy as a child XD

[mcflurry-of-dancing-flames]

just learned of this and am actually inconsolable about it. legitimately this is mountains of brilliant, beautifully designed, and fun digital pieces lost forever. i know there are legitimate technical achievements that people poured hundreds upon hundreds of hours into that are just. gone.

[esa-marie]

I like making spotify playlists so heres a masterlist.

I'm still updating a ton of these and if you have any suggestions for characters/ prompts i would love to hear it

Fandom:

Shirt music with success of upon people || Flesh Cousin || Regretevator

Mostly compiled of songs that are utter nonsense, or fit the idea of a disconnect between your mind and your body.

Toxic construction Yaoi || Mannequin mark and Wallter || Regretevator

Songs that are pining, but also sad. bc divorce.

I just love to dance || Big Mama || ROTTMNT

Big Mama talks about dancing a lot in rottmnt. I threw in lots of girl disco and some more evil-vibed songs, ofc. (I love her sm im a #1 big mama defender)

FUCK YES! || Karlach || BG3

Karlach's story means so much to me. lots of songs to do with fire/ inevitability/ general badassery.

Fate spins along as it should || Withers || BG3

This one is the most WIP bc im sourcing a lot of the songs from old 13th century manuscripts, which is harder than it sounds.

Various White Knight Chronicles Playlists ( Cisna , Ceasar , Eldore , Yulie , Leonard , Kara , Setti/Grazel ). Since the fandom is actually incredibly small I might make a separate post for their playlists.

OC and others under cut!

OC

'What is it?' 'Home.' || Zael Stormveil || BG3 tav

Zael is my first tav when I started playing BG3. Im developing her more as I play, and started a tag for her on this blog

Was I sweet once? || Anatasios || BG3 Durge

Even though I havent finished my Zael run, I started a Durge run. Still more WIP than other playlists, and is about resist!Durge

Comin' atcha live from Avalonia! :3 || Elliot || LBP OC

Elliot, also known as console kitty, is a tv celebrity in avalonia! Ill spare you the rest of their lore for now, but their playlist is full of silly goofy songs, and songs about not feeling good enough, for whatever reason :)

Spidersona [Spider: Null] || Eve || Project Eden

My spidersona universe (Project:Eden) uses a different titling scheme than my other playlists. Anyway, Eve was a computer program who was ejected into reality. She now has to figure out how to be a human, and what being a human really is.

The Lizard || Lilith || Project Eden

Eve's best friend, who knew her when she was just a program on a laboratory computer. She has a corruption arc :3 (dw she gets better. Kinda.) gentle songs, and some not-so gentle songs

Doc Ock || 'Ock || Project Eden

A scientist who was employed at the same facility Eve was created. calculating, colhearted, cynical. at least for now (enemies to lovers??? P). Science songs and love songs, ofc

The Goblin || Goby || Project Eden

His tagline is "Imitations Limitations"-- a fish man cyborg amalgamation that was trying desperately to mimic the structures of pre-awakened Eve. But, that didn't go well, for him or the scientists. Not nonsense, but definitely songs that teeter on insane.

You said you know a guy? || Vance || Rottmnt OC

Vance is a scavenger, they go above the hidden city and 'scavenge' for things to sell below. Energy is his name, an he lives up to it.

You dont know me. || The Ghosts Official Playlist

I have several WIP projects, and Pastries and a Poltergeist is one of them. The ghost inhabits this old, run down, 70s house and is trying to get Maya to move out. but she wont. Melancholy 70s

I need this. || Maya Dufour's Official Playlist

Recent college graduate, she's about to find out why this house was insanely cheap. Stubborn. WIP.

This is a story about beginnings || The Librarian's Official playlist.

Ill spare the story for The Dead World for now, but The librarians playlist is a lot of epic orchestral and some medival songs sprinkled in.

Squash and Stretch || Cross || AVA/AVM OC

Living in-between a sketched figure and a stick figure, Cross is ever stuck in limbo. lots of video game songs/ songs to pick them up.

GameDev!Donnie || TMNT SONA Official Playlist

Gamedev is stuck in the world of video games for now. He doesnt mind a ton, although he misses his brothers sometimes. Filled with upbeat/happy video game songs

Monsters? That's Outrageous! || Gwen || Doors OC

WIP, but songs relating to the timeloop shes stuck in or the game itself.

Got it!! || Tracey || White Knight Chronicles OC

Songs for when your not the main character but still trying to be useful.

Technically I have more OC playlists but I think that's good for now ahjhkdbSAhkadk

Other

GET SHIT DONE (via killer video game soundtracks)

Over 40 hours of video game music (as soon as i finish a game it gets shoved into this playlist. I might reduce it in the future but I like the absurdity of how big it is)

She blinded me... WITH SCIENCE!!! || Silly songs about science

Specifically songs referring to science. This started as a Donatello playlist but then i fully committed to the bit. This is also technically my most popular playlist for some reason lmao.

A New Ghost Town

WIP playlist for a fanfic I may never make (each song is supposed to be representative of a chapter/ the chapter titles) (if you wanna know its dp and Gravity falls crossover)

Again, you'll see more playlists than this on my account (shared) But heres the tip of the iceberg :)

[drpaulmacdonaldrnma]

WOE to those who decree unrighteous decrees, and who write unjust decrees; To turn aside the needy from justice and to take away the right from the poor of my people, that they may plunder the widows and that they may rob the fatherless! And what will you do on the day of recompense and in the storm which shall come from afar? To whom will you flee for help? And where will you leave your glory? Isaiah 10:1-3 LBP

So you dishonor the word of God for the sake of the tradition which you have established; and you do a great many like these. Mark 7:13 LBP

Organized To Do Jehovah’s Will

Jehovah’s Witnesses believe they are organized to do Jehovah’s will and they are the only ones who are ‘in the truth’. Everyone else has ‘false’ beliefs and they are ‘out of the truth’ This is the unique language Jehovah’s Witnesses use.

Pay Attention To Yourselves And All The Flock 

That which which they deem as true doctrine of the cult, is not for public viewing. What do they really have to hide? Once again the Watchtower has deceived it’s flock of hell-bound sheep.

“Shepherd the Flock of God” is probably one of the most controversial books to date that has been published by the infamously notorious Watchtower Bible and Tract Cult that is based in New York.

The book is an update of “Pay Attention To Yourselves And All The Flock“. Both of these publications are secret publications. These are publications which are not for the eyes of the public, nor for the eyes of those who are just ordinary run of the mill members of this notoriously dangerous Cult. 

A World Dominated By Use of Fear 

This book gives insight into a world that is motivated by the use and abuse of “fear“, “abuse“, “false beliefs“, “stripping of personality“, “abuse of the civil rights”, and “denial of the freedom of speech“.

These are but a few of the burning issues in question, but serious ones at that. This is a World which is not filled with “joy”, “love”, “peace”, “hope” and “happiness”, but one of” abject misery”. Its a world where the adherents are “held hostage” to the “fears”, ”paranoia”, “ideas” and “concepts” belonging to a group of men based in New York. It is a world in which “9000″ people die each year due to lack of proper medical attention. Again, these are deaths that occur due to faulty reasoning and false interpretation, and interpretations that have changed like the wind since 1945.

Divide and Conquer Strategies

This is a World that makes the World of Stephen King look like Disneyland, but unlike King, this is a World of reality, and a world in which millions are held captive against their will by means of man made rules. These rules are not found in God’s word the Bible, but are rules which are contrivances and ideas belonging to men, rules that send 9000 people on average to needless deaths each year. Rules that also create family division, and rules that create a climate of fear and terror.

Man Made Rules

Thus, by the rules and traditions that have been created by Richard D. Moake and his legal team at the Watchtower, (just like the Pharisees of old), they have rendered the word of God to become “powerless”, “numb”, and “void”, and all in favor of their own “traditions”, “practices” and “interpretations” that have no biblical basis whatsoever.

Legalistic Man Made Jargon

The man made rules of the Watchtower that are found in these secret publications, these not only take the word of God out of context, but these publications are a Masterpiece of Satan, and Masterpieces which set out to “bastardize” and “mock” the power of the word of God. And, these publications have been written, created and devised by someone, or some group with knowledge of legalistic jargon and terminology. These are publications which do not reflect that of the mind of God, but that of Satan, as the Kingdom of Satan, and his thought, is one upon which the notion of “divide and rule” stands or falls.

The Watchtower As Only True Religion?

This Cult claims to be the one and only true religion, and they have made no bones about this claim. It is a claim they never fail to let their members, nor indeed the public forget, and this is despite continuous ”hardcore scandal”, and a very “long history” of “false prophecy”. Now the never ending array of abuses and scandals are coming to light. This is a Cult which by means of their works, and words, expose Christ to public shame on a continual basis, and this can be readily seen when these publications are viewed.

The Secret Elders Handbook

You will not find this book on any bookshelves, and nor is it available for sale, nor is it available by means of any JW coming to your door, in fact, it is a publication the Watchtower will deny exists. But, this publication does exist, and it’s a publication which is now in the hands of Federal Marshall’s and the Authorities they represent.

With regards to the secretiveness of these publications, publications which the Watchtower deny exist, but publications which have been proven to exist, what is it the Watchtower don’t want anyone to know?

Insight Into The Real World of the Watchtower

Begin your journey into a world that you never thought could exist. You have heard all the horror stories, now read the truth. You could never know of the pain and suffering that exists within the walls of this group unless you make that personal journey. This book provides all the insight one needs into a World that is motivated by fear, mind control, and as well as an extremely well documented catalogue of other Human and Civil Rights Abuses.

These secret publications are now available for you now. Please click on the links to download at your own leisure. Please download, view and share with others.

Dr Paul MacDonald RN RMN MA (Hons) Dipl

[praneethgannoji]

Annotated Bibliography

1. Porter, G. and Starcevic, V. (2007). Are Violent Video Games Harmful? Australasian Psychiatry, 15(5), pp.422–426.

The content of this source is about the relationship between violent video games and aggression, It argues that even though there is a link between violent videogames and aggressive behavior, it can be because of hostile traits. It takes experimental, correlation, and longitudinal study designs with 32 students to find the link, using parameters like heart rate. During experimental studies, the participants blasted their opponents with strong noise 0.16 seconds longer and rated themselves higher on the hostility scale after playing a violent video game compared to a non-violent one, remaining studies also found the link between violent video games and aggressive behavior. This source very useful because it addresses the debate that has been going on since the creation of video-games. More research has to be done as there is minimal data to prove and the link between them and as an aspiring game designer it made me more cautious about the kind of games I create.

2. Ventura, M., Shute, V. and Kim, Y.J. (2012). Video gameplay, personality and academic performance. Computers & Education, 58(4), pp.1260–1266.

The purpose of this Journal is to find the relationship between video games, personality and academic performance. this journal states selective video games can actually improve GPA, social skills, visual-spatial skills and attention. Diverse playstyle is linked to openness but habitual playing can reduce a person’s Conscientiousness. I found this journal very insightful because video games are usually linked with violence, bad GPAs, social skills, this journal argues the contrary. One of the strengths of this experiment is it actually contradicts a common notion that Video games have a negative effect on a person’s academic performance. its weaknesses are the small sample size, genre diverseness, gender. This source though not perfect shapes my way of understanding as playing video games with moderation can have a positive impact on social and academic skills.

3. Dubey, R., Agrawal, P., Pathak, D., Griffiths, T.L. and Efros, Alexei A (2018). Investigating Human Priors for Playing Video Games. [online] arXiv.org. Available at: https://arxiv.org/abs/1802.10217.

This paper deals with the difference between human beings and computer learning when it comes to video gameplay and how human beings can solve a complex video game that they have never seen before by bringing prior knowledge, unlike AI. This paper covers how vital are these priors and the ways to measure them. Its main arguments are, unlike machines, human beings bring a great amount of prior knowledge to solve a problem and the removal of it can cause a drastic difference in speed. To prove this the researchers recruited 40 subjects and made them play an unfamiliar game. They completed the task very quickly, for the next test they adjusted object semantic, hidden object locations, removed affordance and found a drastic difference in-game time, with this experiment the researchers found how important each prior is to complete the given task and it will be very useful to me as an aspiring game developer.

4. Michailidis, L., Balaguer-Ballester, E. and He, X. (2018). Flow and Immersion in Video Games: The Aftermath of a Conceptual Challenge. Frontiers in Psychology, 9.

This article looks at the differences between flow and immersion, these two terms are often used in the video game literature interchangeably, this paper critically analyses both of the concepts and argues flow is more descriptive not definitive in nature as it varies from person to person, it is labeled as an intense experience. while an average immersive experience can be defined as engagement and engrossment which is not much different from the flow and concludes that the word flow and immersion can be used interchangeably until further behavioral and neurophysiological evidence is provided. I found this source very useful as it looks at the subtle nuances between flow, immersion, presence which can be very useful in video game design as games are all about immersing a player in the world developers created.

5. Pallavicini, F. and Pepe, A. (2019). Virtual Reality Games to Enhance Positive Emotions and Decrease Anxiety: A Pilot Study on the Role of Body Involvement (Preprint). JMIR Serious Games.

This paper is an experiment conducted on how Virtual reality can increase positive emotions of the player, decrease anxiety and negative emotions by looking at the level of body involvement requested by the game. the subjects were 36 young adults who were made to play a low body involvement and a high body involvement game, fruit ninja and  Audioshield respectively, using The Visual Analogue Scale and State-Trait Anxiety Inventory. They concluded VR does improve positive emotions and reduce anxiety especially during playing high body involvement games. I found this article very useful as games cannot only be for mindless fun but can also have some positive effect on your mental health, few downsides are that the games did not have a control group, small sample size, no physiological measure, short game time periods.

6. de Las Heras, B., Li, O., Rodrigues, L., Nepveu, J.-F. and Roig, M. (2020). Exercise Improves Video Game Performance. Medicine & Science in Sports & Exercise, p.1.

This source is about finding how physical exercise can help gamers to improve their performance in-game thus promoting physical activity, by investigating how a short session of cardiovascular exercise has an effect on performance in League of Legends. Researchers investigated short term effects on twenty individuals. They were told to do high-intensity interval training (HIIT), during rest they were told to sit on a cycle ergometer for 15 minutes without pedaling after that they were told to read a book for 20 minutes to eliminate any external stimulation, after that they were told to fill out a self-reported questionnaire(PANAS). They were tasked to play a customized LoL match for 20 minutes and eliminate targets with a single attack and performance was accessed along with enjoyment and concluded even short-term exercises can improve game performance. I found this source very novel as the results are very clear without any assessor bias.

7. King, D.L. and Delfabbro, P.H. (2018). Predatory monetization schemes in video games (e.g. ‘loot boxes’) and internet gaming disorder. Addiction, 113(11), pp.1967–1969.

This article is about monetization schemes like ‘Lootboxes’ that can influence players to spend real-world money to buy virtual items. It states how predatory these schemes are and how Videogame companies take advantage of loopholes in the law and also about teenagers who spent thousands of dollars, some of them undergoing treatment for internet gaming disorder(IGD). It also states the countermeasures taken by different governments to tackle this issue, like China which passed legislation for game developers to reveal the chances of getting their desired item in the loot box, and Belgium declaring they are in violation of Gaming legislation. This source is very useful to me because as a  gamer who never had any sort of addiction problems, always thought the government should never involve in markets but looking at the problem I think some form of government regulation is necessary to stop videogame companies to take advantage of gullible people.

8. Zadro, J.R., Shirley, D., Simic, M., Mousavi, S.J., Ceprnja, D., Maka, K., Sung, J. and Ferreira, P. (2018). Video-Game–Based Exercises for Older People With Chronic Low Back Pain: A Randomized Controlled table Trial (GAMEBACK). Physical Therapy, 99(1), pp.14–27.

This study is about an experiment conducted on older individuals(>55 years) with chronic LBP randomized 1:1 to continue usual physical activities or to play Wii Fit U exercises to test pain self-efficacy and care-seeking, it revealed people playing Wii Fit U had more pain self-efficacy at 6 months compared to people with the control group. Thus proving Wii Fit U exercises improve pain self-efficacy, pain, and function in older people, The interesting part of this experiment is that it proves video games actually improve pain resistance which is the core part of continuing any physical activity, unlike other experiments, it expresses adherence in different ways by showing how compliant a participant is, few limitations of this experiment are the exercises done on Wii Fit U are unsupervised, using a paper exercise diary to track adherence, possible differences between Therapist and participant interaction.

9. Formosa, P., Ryan, M. and Staines, D. (2016). Papers, Please and the systemic approach to engaging ethical expertise in videogames. Ethics and Information Technology, 18(3), pp.211–225.

This paper is about exploring the themes of a video game called Papers please (2013) to demonstrate the systemic approach in video games for moral engagement and showing the difference between strengths and weaknesses between systemic approach and scripted approach in video game design by using Four Component model of moral expertise(moral motivation, moral sensitivity, moral judgment, and moral action) which can help to design games that are morally engaging. This paper is very useful to game designers as it shows the advantages and disadvantages between scripted and system approach in games, This source shapes my understanding as to how a simple gameplay mechanic like checking papers can give rise to such complex themes such as dehumanization, loyalty, etc., but it lacks the strong characterization provided my more scripted games.

10. Gros, L., Debue, N., Lete, J. and van de Leemput, C. (2020). Video Game Addiction and Emotional States: Possible Confusion Between Pleasure and Happiness? Frontiers in Psychology, 10.

This study is about differentiating pleasure and happiness within the addiction sphere, an experiment was conducted between game addicts and nonaddicts with video game-related activities and neutral activities between the subjects and emotional reactions were taken by self-reported scales and psychological data through relaxation and heart rate. Out of 105, 61 video game players were made to complete three questionnaires anonymously, after that they were welcomed to a testing room that made them choose their favorite video game and the examiner observed them. 6 types of experimental phases determined their emotional state through self-report questionnaires or through physiological measures and the result is game addicts show high craving and low relaxation level which is in contrast to associating video games with happiness. I found this study very insightful because generally, people associate happiness and craving as positive emotions it's actually a negative one this made me research more on the nuances between pleasure and happiness.

[bciphergrl]

The story of Create Into Reality AU takes place many years after Marlon destroyed the Imaginsphere in the movie, "Out Walking the Dog 2". However, a new universe was created in it's place. In the new world of Scribbleton, Alina moves into a town with her family. She's an extremely very creative sackperson in terms of making drawing and writing stories. But then, she slowly discovers that she can create anything that she can think of into reality. This brings her alot of attention. Both the good and the bad. With the new friends that she'll make, she'll need to keep this kind of power from falling into the wrong hands. She'll also find things underneath the town they were supposed to be long erased. Things from the old world.

(I highly recommend watching the video for this to make any sense)

[acehotel]

Little Black Pearl believes in radical possibility. A thriving cultural arts center and high school serving kids in the Kenwood/Oakland, Woodlawn and Bronzeville neighborhoods on Chicago’s South Side, LBP has helped empower young people to envision and achieve their own singular potentials through art and entrepreneurship. They believe that true change begins when young people are given the platform to tell their own stories. 

The “I AM” project is an extension of that philosophy, helmed by Little Black Pearl’s executive director Monica Haslip. The concept for the project came to her in her sleep. In her own words, 

There is no one coming to save us. This is an opportunity to reflect on who we are as a people, and how we begin to save ourselves. The reality is — “I AM” the solution. You are the solution. We are the solution. There’s no superman. It’s us. 

“I AM” began to take on a life for me that was about creating a new narrative. In deep darkness, there’s always an opportunity for light to shine through. “I AM” is our opportunity to demonstrate to people that the children who we are often hearing about that are living in darkness and doing things that none of us believe in, or condone — we have to find ways to love them even though we don’t like what they are doing. We have to help them understand that they, too, are the solution.

...This is about common humanity. What happens to me happens to everyone. What my children live through, I live through. Whether or not it’s my own personal experience is not really relevant. “I AM” is the opportunity for us all to be the example of what’s possible. It creates the opportunity for our young people to tell their own stories. For them to understand that you are not your circumstance, that you have the power and the possibility to live a very full and beautiful life. But we all have to contribute, to this being better. It’s not going to happen on its own. 

I believe that in the darkest hour, we can emerge with great light. Each of us, as we tell our own stories, we begin to reshape how people think of us. If every story that we hear is about the negativity that’s happening in our communities, if every story about black children is about dark things and negativity and guns and violence, that’s who we believe we are. So until we start to tell different stories — until we create platforms to create and tell different stories — then we will always stay in the same circumstance. 

“I AM” is the opportunity for them to tell their own stories, for us to tell our own stories. We spend our time creating opportunities and platforms for them to be heard so people can understand that we are a beautiful community of people. Our assets are valuable to the entire world.

We are part of a global community. The more we understand that, the more we are able to help people see the value we bring. We bring great value. We are great musicians, we are great artists, we are great scientists, we are great inventors. We are great people. But we have to believe that. And we have to tell that story. 

We will continue, at Little Black Pearl, to be a place of human potential where young people can come into a space and they can reclaim their greatness. They get a chance to not be who they used to be. They get a chance to be who they dream of being. And that’s what “I AM” is about.

We’re lucky to call Little Black Pearl one of our community partners at Ace Hotel Chicago. When you book a room there this summer, a portion of your reservation will go to LBP, along with Young Chicago Authors and 826CHI, with the hope of reaching a goal of $25,000. Keep your ear to the ground for events with Little Black Pearl, as well as interviews with some of their students. 

[kristinsimmons]

Overprescribing Is a Key Component of the Opioid Crisis — Here’s How to Stop It

By DAVE CHASE 

Today’s opioid crisis is one of the most dire side effects driven by our dysfunctional U.S. healthcare system. A recent JAMA Surgery report found that many surgeons prescribe four times more opioids than their patients use. This opens the door for misuse and abuse later on. In fact, the total combined cost of misuse, abuse, dependence and overdose is about $78.5 billion.

Unfortunately, there’s a direct connection between the low-quality care many patients receive, and the astounding rates of opioid addiction. Often, insurance plans offer access to high-cost, volume-centric physicians and include high deductibles — creating an expensive cycle that doesn’t focus on patient outcomes. Instead of taking the time to figure out what is actually ailing a patient, these overworked and nearly burnt-out doctors get them in and out the door with a referral and a prescription for more pills than they could ever need.

What may surprise you is that employers play a large part in setting the stage for addiction. Millions of Americans get their health insurance from their employer, and a majority of those plans are fully-insured. To determine what insurance plan they offer, employers work with a benefits broker to purchase one from a carrier like Aetna or Cigna. Each year, employers and their broker join together for an annual dance — the broker tells them that healthcare costs are rising so their insurance rates have gone up, usually by 5-20 percent. The employers don’t know better than to accept these increases, filtering them down to employees in the form of higher premiums. Despite costs constantly going up, the quality of care does not follow.

The reality is, cash prices for healthcare services haven’t actually gone up by much. Employers have been asleep at the wheel — but they can begin to enact change immediately. By working with a transparent benefits advisor, employers can design health insurance plans that incentivize their employees to visit high-quality, value-based primary care providers and Centers of Excellence: organizations with proven records of positive patient outcomes that are less likely to overprescribe unnecessary, addictive drugs.

Most employers trust that their broker has done their research, shopping around for the most affordable and effective health plans. Unfortunately, some benefits brokers don’t have their clients’ best interests at heart. They may be following hidden financial incentives to keep employers on expensive plans with poor offerings because they receive commissions and bonuses from certain carriers. Employers should ask their brokers to disclose this information (it should include whatever bonuses their office receives from carriers, which heavily influences what they present to clients), and also see how quickly they are willing to meet. The sooner they are able to, the more time they can go through the pros and cons of multiple plans before making a final decision.

When comparing plans, it’s important to keep in mind that high cost does not mean high quality. And further, most status quo plans cover the same low-quality care that has largely led to the opioid epidemic. Poor primary care is a product of the fee-for-service model under which most primary care practices operate. In this system, the more tests, procedures, scans, and other services a physician orders, the more money their organization makes — and employers and patients pay for. Many of these are unnecessary and often require follow-up or referral appointments. More people needing to see a doctor means it takes longer to make an appointment, waiting rooms are crowded, and the appointments themselves are usually ten minutes or less.

Short appointments prevent physicians from having enough time to get to the root cause of a patient’s problem. And because lower back pain (LBP) is a common issue, especially among older and working adults, physicians hoping to satisfy patients quickly prescribe them painkillers like hydrocodone, oxycodone, morphine or benzodiazepines. This, despite the fact that we know these drugs aren’t effective in treating pain, only masking its symptoms.

By comparison, in a value-based primary care setting, doctors are incentivized to spend more time with patients because they are rewarded for positive outcomes. These physicians have a better chance of getting it right the first time – reducing the need for follow-ups, unnecessary tests, and patient costs. For a patient with LBP, a value-based primary care physician may find out that the patient is sitting too much or isn’t educated on the proper exercises to prevent or relieve back pain. Rather than write an opioid prescription (likely including too many pills), a physician focused on value may show the patient how to change their technique to prevent further damage, plus recommend a physical therapy or stretching program. In my book on the employer role in the opioid crisis, nothing created more fertile ground for the opioid crisis than an undermined primary care model. It’s just one of the twelve major drivers of the opioid crisis, but it’s a particularly critical element to preventing addiction upstream.

This kind of care better employees’ health and for employers’ bottom lines because in order to provide access to value-based primary care, employers can cut ties with their old fully-insured health plans and instead work under a self-funded health plan. This type of plan is one in which an employer pays for their employees’ healthcare using their own money. This may sound risky, but that’s why such employers purchase stop-loss insurance – coverage that kicks in after certain claims thresholds. And for those employers concerned about this being too much work, a third-party administrator (TPA) will process claims and provide administrative support for a monthly fee.

Under a self-funded plan, employers will no longer have to budget for those annual 5-20 percent premium increases. Plus, employers can have more control over the quality of care their employees receive. In addition to encouraging their employees to visit the value-based primary care providers they’ve identified, they could also send their employees who need high-cost, high-risk surgeries to Centers of Excellence, which are often recognized for their high success rates for certain procedures. Employees who go there are likely to save money in the form of fewer complications, readmissions and prescriptions. Boeing did this for its employees, sending those in need of cardiac or spine care and hip or knee replacements to Mayo Clinic in Phoenix and Scottsdale, Arizona.

The health plans employers offer, and the low-quality, status quo care that they provide, have all contributed to today’s opioid crisis, including rampant overprescribing. Fortunately, a solution exists: health plans that provide access to value-based primary care. All employers have to do is put it in motion.

Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our health care system, and the author of “The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back.” 

Overprescribing Is a Key Component of the Opioid Crisis — Here’s How to Stop It published first on https://wittooth.tumblr.com/

[isaacscrawford]

Overprescribing Is a Key Component of the Opioid Crisis — Here’s How to Stop It

By DAVE CHASE 

Today’s opioid crisis is one of the most dire side effects driven by our dysfunctional U.S. healthcare system. A recent JAMA Surgery report found that many surgeons prescribe four times more opioids than their patients use. This opens the door for misuse and abuse later on. In fact, the total combined cost of misuse, abuse, dependence and overdose is about $78.5 billion.

Unfortunately, there’s a direct connection between the low-quality care many patients receive, and the astounding rates of opioid addiction. Often, insurance plans offer access to high-cost, volume-centric physicians and include high deductibles — creating an expensive cycle that doesn’t focus on patient outcomes. Instead of taking the time to figure out what is actually ailing a patient, these overworked and nearly burnt-out doctors get them in and out the door with a referral and a prescription for more pills than they could ever need.

What may surprise you is that employers play a large part in setting the stage for addiction. Millions of Americans get their health insurance from their employer, and a majority of those plans are fully-insured. To determine what insurance plan they offer, employers work with a benefits broker to purchase one from a carrier like Aetna or Cigna. Each year, employers and their broker join together for an annual dance — the broker tells them that healthcare costs are rising so their insurance rates have gone up, usually by 5-20 percent. The employers don’t know better than to accept these increases, filtering them down to employees in the form of higher premiums. Despite costs constantly going up, the quality of care does not follow.

The reality is, cash prices for healthcare services haven’t actually gone up by much. Employers have been asleep at the wheel — but they can begin to enact change immediately. By working with a transparent benefits advisor, employers can design health insurance plans that incentivize their employees to visit high-quality, value-based primary care providers and Centers of Excellence: organizations with proven records of positive patient outcomes that are less likely to overprescribe unnecessary, addictive drugs.

Most employers trust that their broker has done their research, shopping around for the most affordable and effective health plans. Unfortunately, some benefits brokers don’t have their clients’ best interests at heart. They may be following hidden financial incentives to keep employers on expensive plans with poor offerings because they receive commissions and bonuses from certain carriers. Employers should ask their brokers to disclose this information (it should include whatever bonuses their office receives from carriers, which heavily influences what they present to clients), and also see how quickly they are willing to meet. The sooner they are able to, the more time they can go through the pros and cons of multiple plans before making a final decision.

When comparing plans, it’s important to keep in mind that high cost does not mean high quality. And further, most status quo plans cover the same low-quality care that has largely led to the opioid epidemic. Poor primary care is a product of the fee-for-service model under which most primary care practices operate. In this system, the more tests, procedures, scans, and other services a physician orders, the more money their organization makes — and employers and patients pay for. Many of these are unnecessary and often require follow-up or referral appointments. More people needing to see a doctor means it takes longer to make an appointment, waiting rooms are crowded, and the appointments themselves are usually ten minutes or less.

Short appointments prevent physicians from having enough time to get to the root cause of a patient’s problem. And because lower back pain (LBP) is a common issue, especially among older and working adults, physicians hoping to satisfy patients quickly prescribe them painkillers like hydrocodone, oxycodone, morphine or benzodiazepines. This, despite the fact that we know these drugs aren’t effective in treating pain, only masking its symptoms.

By comparison, in a value-based primary care setting, doctors are incentivized to spend more time with patients because they are rewarded for positive outcomes. These physicians have a better chance of getting it right the first time – reducing the need for follow-ups, unnecessary tests, and patient costs. For a patient with LBP, a value-based primary care physician may find out that the patient is sitting too much or isn’t educated on the proper exercises to prevent or relieve back pain. Rather than write an opioid prescription (likely including too many pills), a physician focused on value may show the patient how to change their technique to prevent further damage, plus recommend a physical therapy or stretching program. In my book on the employer role in the opioid crisis, nothing created more fertile ground for the opioid crisis than an undermined primary care model. It’s just one of the twelve major drivers of the opioid crisis, but it’s a particularly critical element to preventing addiction upstream.

This kind of care better employees’ health and for employers’ bottom lines because in order to provide access to value-based primary care, employers can cut ties with their old fully-insured health plans and instead work under a self-funded health plan. This type of plan is one in which an employer pays for their employees’ healthcare using their own money. This may sound risky, but that’s why such employers purchase stop-loss insurance – coverage that kicks in after certain claims thresholds. And for those employers concerned about this being too much work, a third-party administrator (TPA) will process claims and provide administrative support for a monthly fee.

Under a self-funded plan, employers will no longer have to budget for those annual 5-20 percent premium increases. Plus, employers can have more control over the quality of care their employees receive. In addition to encouraging their employees to visit the value-based primary care providers they’ve identified, they could also send their employees who need high-cost, high-risk surgeries to Centers of Excellence, which are often recognized for their high success rates for certain procedures. Employees who go there are likely to save money in the form of fewer complications, readmissions and prescriptions. Boeing did this for its employees, sending those in need of cardiac or spine care and hip or knee replacements to Mayo Clinic in Phoenix and Scottsdale, Arizona.

The health plans employers offer, and the low-quality, status quo care that they provide, have all contributed to today’s opioid crisis, including rampant overprescribing. Fortunately, a solution exists: health plans that provide access to value-based primary care. All employers have to do is put it in motion.

Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our health care system, and the author of “The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back.” 

Article source:The Health Care Blog

[fitnesstwister-blog]

New Post has been published on http://www.fitnesstwist.org/lower-back-spasm-followed-by-left-leg/

Lower Back Spasm Followed by Left Leg

Do you have reduced neck and back pain? Otherwise, you most likely will, and also quicker compared to you assume. It’s one of one of the most typical ailments in the United States, with about 85 percent of the populace dealing with pain in the back at some time in their lives. Neck and back pain is likewise the 2nd most typical factor for seeing a physician in the United States, adhering to coughings and also various other breathing infections.

These stats are comparable in various other nations. 95 percent of pain in the back situations (such as muscular tissue convulsions or a plain pain in the reduced back)are exactly what professionals call non-specific. That indicates that the precise reason is normally evasive as well as could not be attributable to a recognizable problem (such as infection, growth, joint inflammation, or swelling, which specify situations, as well as the minority). With non-specific reduced neck and back pain (LBP) being so typical therefore evasive, it has actually ended up being an industry with Americans investing a minimum of $50 billion every year on prospective therapy and also avoidance techniques.

That could be an issue. Anytime you speak about a quantity of cash that huge, you’re bound to bring in professionals – both reputable and also those that are, well, packed with it – that declare they a) recognize the precise root cause of your reduced pain in the back, as well as b) have the remedy for it.

You should not think them – at the very least, wrong away.

Concern the Answers

Consider this: Back discomfort is most typically criticized on points like herniated (slid) back discs, inadequate postural positioning, absence of core stamina, limited hamstrings or hip flexors, and also being obese. And also it’s these aspects that several preferred therapy as well as avoidance approaches assert to boost (or treatment).

These “realities” are held as undeniable to the specialists that advertise them. They base their competence on individual experience and also unscientific outcomes. It’s humanity: If a person you recognize gained from seeing a chiropractic physician, they will certainly constantly (noisally) announce their chiropractic specialist a wizard. Exact same for your pals that obtained favorable arise from a medical professional, physiotherapist, acupuncturist, massage therapy specialist, or individual instructor.

So just what’s the trouble? When you take a look at the research study with a cool eye, the clinical legitimacy for a lot of the usual cases of reduced neck and back pain triggers and also therapies is doubtful. To claim the least.

Exactly what does that mean for you – particularly if your back harms? It indicates that even if a specific specialist declares a specific reason is your issue, and also they have the ideal therapy, their reason could not be the actual reason. Their remedy could not be exactly what eventually makes your discomfort vanish. Sometimes, paying a great deal of cash for these therapies might not be the most effective alternative.

Right here are several of the usual sources of reduced pain in the back, study that resolves several misconceptions bordering them, and also “the takeaway” – exactly what you must do therefore.

Misconception # 1: Bulging discs, vertebrae crack as well as constriction create pain in the back.

BULGING DISCS: A spots 1994 research study in the New England Journal of Medicine located that 82 percent of research study individuals that were pain-free had favorable MRI results for a back disc lump, outcropping, or extrusion. 38 percent of them had these problems at numerous lumbar degrees.

A 2001 research study in the Journal of Bone and also Joint Surgery revealed that MRI scans were not anticipating of the advancement or period of LBP which people with the lengthiest period of low-back discomfort did not have the best level of physiological irregularity.

Just what does that suggest? You could have disc problems and also have no discomfort. As well as if you have a protruding disc and also neck and back pain? The disc might not be the reason.

BROKEN VERTEBRA: Two 2009 researches in the New England Journal of Medicine discovered that vertebroplasty, a dangerous treatment that infuses an acrylic concrete right into bones in the spine to support cracks triggered by weakening of bones, to be no much better at developing discomfort alleviation compared to a sugar pill.

BACK STENOSIS: While this problem has actually traditionally been believed to be an inescapable root cause of LBP, a 2006 research study in the Archives of Physical Medicine and also Rehabilitation located that a tightened spine canal does not (alone) trigger pain in the back.

THE TAKEAWAY: You are not doomed by your MRI. Many individuals with irregular outcomes are discomfort cost-free. Inning accordance with a 2009 study evaluation released in The Lancet, medical professionals need to avoid regular, instant back imaging in individuals with LBP without functions recommending a significant underlying problem. For you, that suggests asking your medical professional regarding exactly what various other analysis methods they will certainly utilize besides an MRI. Specifically if you’re becoming aware of your MRI outcomes as well as words “surgical procedure” turns up.

Misconception # 2: Spinal curvatures, pelvic turns or leg size crookedness reason LBP.

SPINAL CURVES: A 2008 testimonial in the Journal of Manipulative as well as Physiological Therapeutics considered greater than 50 researches and also located no organization in between dimensions of back contours and also discomfort.

Inning accordance with Eyal Lederman, Ph.D., an osteopath and also writer of numerous hands-on treatment books as well as study documents, “There is no relationship in between pelvic obliquity/asymmetry as well as the side sacral base angle and also LBP. However there could be an organization in between serious scoliosis and also pain in the back.”

PELVIC TILT: Many health and wellness experts think that former pelvic tilt and also raised back lordosis suggest stomach weak point and also extremely solid (or limited) hip flexors. Yet, inning accordance with a 2004 research in the Internet Journal of Allied Health Science and also Practice, there is no connection in between back lordosis and also isometric stamina of the trunk flexors, trunk extensors, and also hip flexors as well as extensors. Numerous various other researches have additionally had comparable searchings for.

LEG LENGTH ASYMMETRY: According to Dr. Lederman, “Although some earlier research studies recommend a relationship, even more appropriate are potential research studies where no connection was located in between leg size inequality and also LBP. Also individuals that have actually obtained their leg size distinctions later on in life as effect of condition or surgical procedure had an inadequate connection in between leg-length inequality, back scoliosis as well as low-back problems a number of years after the beginning of the problem.”

THE TAKEAWAY: Many individuals with inadequate postural positioning or crookedness have no discomfort while others with much better placement deal with persistent discomfort. So, immediately condemning these elements is misdirected because physical blemishes appear to be typical variants, not pathology. As Mark Comerford, writer of Kinetic Control: The Management of Uncontrolled Movement places it, “There’s a huge distinction in between disorder and also just a variant on typical.”

It’s even more precise to discover the details body settings (if any type of) that create pain in the back, like standing or resting slumped over compeling your back muscle mass to stay gotten. Additionally, discomfort or no discomfort, all of us have the tendency to rest way too much. Enhancing glute toughness as well as in our mid-back muscular tissues, which are extended when we rest, could assist us to eliminate the unfavorable impacts of resting as well as slumping over.

An useful preventative approach: Adding weights and also pinhead rowing variants to your routine exercise, in addition to squats as well as deadlifts, as long as you could do them pain-free.

Misconception # 3: Lack of core security or inadequate core toughness triggers LBP.

CORE STABILITY: According to Comerford,” The Transverse Abdominis( TvA) has actually never ever been revealed to be off or weak, also in individuals with LBP. It’s just been revealed to trigger 50-90 nanoseconds late just in individuals with LBP. We understand with the study that the TvA timing hold-up is NOT the reason for the discomfort,

however a signs and symptom of it.”In addition, Stuart McGill, Ph.D. and also teacher of spinal column biomechanics at the University of Waterloo, claims; “True back security is accomplished with a well balanced stiffening (co-contraction) of the whole trunk musculature, consisting of the abdominals, the latissimus dorsi as well as the back extensors. Concentrating on a solitary muscular tissue usually leads to much less security.”

CORE STRENGTH: According to Dr. McGill, “The distinctions in between those with persistent, persisting back concerns and also matched asymptomatic controls,” or, individuals in the researches that have no discomfort, “have actually been revealed to be variables besides stamina or wheelchair.” Simply puts, in this research study, core stamina was not the reason for the victims’ discomfort.

THE TAKEAWAY: There’s no demand, neither is it suggested to “attract” your tummy switch throughout workout or showing off tasks. Core fortifying might or could not assist you alleviate or stop LBP. As Comerford states, “If all pain in the back resulted from weak point, compared to the toughest professional athletes worldwide would certainly never ever have discomfort, yet they do.”

It never ever injures to reinforce your core muscle mass together with the remainder of your muscular tissues just for much better wellness and also efficiency of day-to-day tasks. Yet if you have reduced pain in the back, getting rid of particular core-centric workouts might speed your healing.

Dr. McGill states, “The very first step in any type of workout development is to get rid of the reason for the discomfort. For instance, flexion-intolerant backs are typical. Getting rid of spine flexion workouts (like sit-ups, grinds, as well as burpees), specifically in the early morning when the disks are inflamed after bed remainder, has actually verified extremely efficient with this sort of problem.”

Additionally, boosting the high quality and also effectiveness of just how you relocate versus simply boosting stamina could assist you to prevent overusing your back. To puts it simply, workout method as well as kind issues, particularly if you have LBP.

Misconception # 4: Tight hip flexors (psoas) as well as limited hamstrings draw on the spinal column and also trigger LBP.

PSOAS: Scientific literary works exposes that psoas significant is a really misinterpreted muscular tissue. In his “Myths and also Misconceptions concerning Psoas Major: Where is the Evidence?”Comerford states,”There is practically no proof for psoas being brief; it does not create considerable motion in the back; it has a substantial security duty for the back spinal column, the sacroiliac joint, and also the hip; as well as, like the TvA, the psoas has actually been revealed to have actually postponed activation in the visibility of LBP.”So once more, hold-up in psoas activation is a signs and symptom of neck and back pain, not a reason.

HAMSTRINGS: A 2012 research in the Journal of Electromyography as well as Kinesiology wrapped up there is no proof to suggest easy hamstring extending as a way of decreasing LBP throughout long term standing. Lots of researches have actually revealed hamstring rigidity to be associated with LBP as a signs and symptom, not the reason. Inning accordance with Carl DeRosa, Ph.D. as well as writer of Mechanical Low Back Pain, “Many individuals show up to have limited hamstrings. Yet, their hamstrings are not limited, their CNS(main nerve system)is creating them to get their hamstrings to reduce undesirable anxiety as well as to secure their back. You might make somebody extra symptomatic by extending their hamstrings.”In addition, inning accordance with Dr. McGill, “The finest entertainers in sports have tighter hamstrings after that their affordable equivalents. The common rigidity individuals really feel in their hamstrings is in fact a neural rigidity, not a totally soft-tissue sensation.”

THE TAKEAWAY: Attempts to”launch” or hinder the Psoas with hand-operated strategies is misdirected. Extending your hip flexors (illiacus, rectus femoris) is alright, yet doing so isn’t really extending your psoas. Additionally, bear in mind that limited hip flexors have actually not been revealed to be related to too much back lordosis, former pelvic tilt, or as a reason for LBP.

Dr.McGill suggests” reinforcing the core muscle mass in charge of safeguarding the back rather than extending our hamstrings.

This does not imply doing numerous repeatings of problems or various other spine-bending workouts given that those with back problems have the tendency to have even more activity in their backs and also much less movement as well as lots in their hips.”

Dr. DeRosa advises reinforcing your glutes,(which could enhance hip movement) and also your lats, as those muscle mass could raise back security.

Misconception # 5: Being old or obese reasons LBP.

OVERWEIGHT: While it appears instinctive that LBP as well as excessweight might be associated, a 2007 paper in the Journal of Rehabilitation Research and also Development states the scientific research could not figure out whether they remain in truth straight associated, under exactly what situations they relate, exactly how they come to be relevant, the stamina of partnership(if one performs in truth exist ), as well as the effect of a modification in one problem on the various other. Simply puts, we do not know without a doubt.

An unexpected 2012 research in The Spine Journal discovered that advancing or repeated filling with higher-than-normal body mass(almost 30 extra pounds typically )was not unsafe to the topics ‘back discs. Actually, a minor hold-up in L1-L4 disc deterioration was observed in the larger guys, as compared to their slimmer equivalents.

SENIORITY: In a 2009 population-based research of 34,902 Danish doubles 20-71 years . old, there were no significant distinctions in the regularity in LBP in between more youthful as well as older people Although disc deterioration is anticipated from around age 30 years forward, genetics plays even more of a function in disc deterioration. Inning accordance with, Dr. Lederman,” Research has actually shown in doubles that as long as 47 – 66 percent of back deterioration results from genetics. ”

THE TAKEAWAY: Age or being obese isn’t really an ensured neck and back pain sentence. As well as, neck and back pain should not be blown off as just a negative effects of these concerns. Shedding excess weight is constantly a great idea for total wellness, however having LBP while obese does not indicate you will not have future rounds of pain in the back after shedding the weight.

Something that is particular? A horrible great deal of individuals put on weight as they age. Smart consuming integrated with routine workout will certainly aid maintain you fit and also energised.

It simply might not avoid reduced neck and back pain if you take place to be susceptible to it.

Just what to Do When Lower Back Pain Strikes

Possibilities are, your back will certainly harm at some time. However it’s a huge error for wellness experts to try to avoid or deal with LBP based upon covering presumptions connected to position, toughness, or versatility. Rather, every neck and back pain instance ought to be dealt with as well as evaluated separately by eliminating details excruciating placements and also motions while highlighting pain-free workouts as well as tasks.

The reality is, data reveal that a lot of severe LBP starts to enhance after 2 to 5 days as well as generally fixes itself in much less compared to 1 month with non-steroidal anti-inflammatories(NSAIDs)as well as (bearable) tasks. Does that imply you should not look for therapy when your back secures? Certainly not. Feel in one’s bones that it’s impractical to attribute any type of one certain therapy or unique workout approach as the magic remedy for intense pain in the back.

When a neck and back pain specialist states,”I understand just what your issue is and also I understand ways to heal it,”pay attention, however be cynical. He or she might have the ability to aid you. However when you think about the moment and also monetary investment entailed, bear in mind the clinical realities. No person could forecast just how one person will certainly react to one sort of pain in the back therapy.

[bciphergrl]

Alina does tell Sam about the baby titan that she found and how she basically adopted it. However, her friend couldn't help but think about the history of the old worlds that had titans.

(Yes I made the baby titan floofy and nobody can stop me from doing that! >:3)

[bciphergrl]

As you already know, there was only three titans, before Marlon destroyed the Imaginsphere. However, this isn't the first time that a universe got destroyed. It has happened two other times. Each time the universe gets destroyed, a new titan will eventually come into existence in a new universe. There was originally only one titan in the first universe. But, because it got destroyed three times, a fourth titan will eventually appear in the newest universe. It's unknown when it'll show up. It just suddenly happens without warning.

Alina found a baby blue titan during her afternoon walk, which it was about a month after moving into her new home.

[bciphergrl]

I got a few sketches of Little Big Planet ocs that will show up in an upcoming au called 'Create Into Reality.'

Alina is a short bean of a protagonist who loves drawing and writing stories in a form of scripts. She'll slowly discover that she has the power to create anything she can think of. Her creativity goes as far as her imagination takes her.

Elizabeth (Also most likely know as Ellie by her friends) is a manipulate girl who is pretty good at convincing people with whatever she says is true, due to her good reputation at the town. But she isn't who everyone think she is. She'll be antagonistic towards Alina and her friends in this story.

Alex is the baker in Alina's friend group who tries her best to stay out of trouble, even though she always ends up in Alina's situation with the Titans.

Ryan is an graffiti artist who will vandalize on abandon buildings and steal paint cans to show his art to the world. He's an older sibling of Alina.

Samantha (Also known as Sam in Alina's friend group) is the most loyal sackperson in Alina's friend group. She has a strong interest in the history of the old world.

Issac (Also sometimes called Azi by his closest friends) is an intelligent man who strangely sometimes remember some memories that aren't his own. Memories from someone in the old world.

More about Create Into Reality AU will be revealed soon! Keep an eye out for more updates on it!

[kristinsimmons]

Overprescribing Is a Key Component of the Opioid Crisis — Here’s How to Stop It

By DAVE CHASE 

Today’s opioid crisis is one of the most dire side effects driven by our dysfunctional U.S. healthcare system. A recent JAMA Surgery report found that many surgeons prescribe four times more opioids than their patients use. This opens the door for misuse and abuse later on. In fact, the total combined cost of misuse, abuse, dependence and overdose is about $78.5 billion.

Unfortunately, there’s a direct connection between the low-quality care many patients receive, and the astounding rates of opioid addiction. Often, insurance plans offer access to high-cost, volume-centric physicians and include high deductibles — creating an expensive cycle that doesn’t focus on patient outcomes. Instead of taking the time to figure out what is actually ailing a patient, these overworked and nearly burnt-out doctors get them in and out the door with a referral and a prescription for more pills than they could ever need.

What may surprise you is that employers play a large part in setting the stage for addiction. Millions of Americans get their health insurance from their employer, and a majority of those plans are fully-insured. To determine what insurance plan they offer, employers work with a benefits broker to purchase one from a carrier like Aetna or Cigna. Each year, employers and their broker join together for an annual dance — the broker tells them that healthcare costs are rising so their insurance rates have gone up, usually by 5-20 percent. The employers don’t know better than to accept these increases, filtering them down to employees in the form of higher premiums. Despite costs constantly going up, the quality of care does not follow.

The reality is, cash prices for healthcare services haven’t actually gone up by much. Employers have been asleep at the wheel — but they can begin to enact change immediately. By working with a transparent benefits advisor, employers can design health insurance plans that incentivize their employees to visit high-quality, value-based primary care providers and Centers of Excellence: organizations with proven records of positive patient outcomes that are less likely to overprescribe unnecessary, addictive drugs.

Most employers trust that their broker has done their research, shopping around for the most affordable and effective health plans. Unfortunately, some benefits brokers don’t have their clients’ best interests at heart. They may be following hidden financial incentives to keep employers on expensive plans with poor offerings because they receive commissions and bonuses from certain carriers. Employers should ask their brokers to disclose this information (it should include whatever bonuses their office receives from carriers, which heavily influences what they present to clients), and also see how quickly they are willing to meet. The sooner they are able to, the more time they can go through the pros and cons of multiple plans before making a final decision.

When comparing plans, it’s important to keep in mind that high cost does not mean high quality. And further, most status quo plans cover the same low-quality care that has largely led to the opioid epidemic. Poor primary care is a product of the fee-for-service model under which most primary care practices operate. In this system, the more tests, procedures, scans, and other services a physician orders, the more money their organization makes — and employers and patients pay for. Many of these are unnecessary and often require follow-up or referral appointments. More people needing to see a doctor means it takes longer to make an appointment, waiting rooms are crowded, and the appointments themselves are usually ten minutes or less.

Short appointments prevent physicians from having enough time to get to the root cause of a patient’s problem. And because lower back pain (LBP) is a common issue, especially among older and working adults, physicians hoping to satisfy patients quickly prescribe them painkillers like hydrocodone, oxycodone, morphine or benzodiazepines. This, despite the fact that we know these drugs aren’t effective in treating pain, only masking its symptoms.

By comparison, in a value-based primary care setting, doctors are incentivized to spend more time with patients because they are rewarded for positive outcomes. These physicians have a better chance of getting it right the first time – reducing the need for follow-ups, unnecessary tests, and patient costs. For a patient with LBP, a value-based primary care physician may find out that the patient is sitting too much or isn’t educated on the proper exercises to prevent or relieve back pain. Rather than write an opioid prescription (likely including too many pills), a physician focused on value may show the patient how to change their technique to prevent further damage, plus recommend a physical therapy or stretching program. In my book on the employer role in the opioid crisis, nothing created more fertile ground for the opioid crisis than an undermined primary care model. It’s just one of the twelve major drivers of the opioid crisis, but it’s a particularly critical element to preventing addiction upstream.

This kind of care better employees’ health and for employers’ bottom lines because in order to provide access to value-based primary care, employers can cut ties with their old fully-insured health plans and instead work under a self-funded health plan. This type of plan is one in which an employer pays for their employees’ healthcare using their own money. This may sound risky, but that’s why such employers purchase stop-loss insurance – coverage that kicks in after certain claims thresholds. And for those employers concerned about this being too much work, a third-party administrator (TPA) will process claims and provide administrative support for a monthly fee.

Under a self-funded plan, employers will no longer have to budget for those annual 5-20 percent premium increases. Plus, employers can have more control over the quality of care their employees receive. In addition to encouraging their employees to visit the value-based primary care providers they’ve identified, they could also send their employees who need high-cost, high-risk surgeries to Centers of Excellence, which are often recognized for their high success rates for certain procedures. Employees who go there are likely to save money in the form of fewer complications, readmissions and prescriptions. Boeing did this for its employees, sending those in need of cardiac or spine care and hip or knee replacements to Mayo Clinic in Phoenix and Scottsdale, Arizona.

The health plans employers offer, and the low-quality, status quo care that they provide, have all contributed to today’s opioid crisis, including rampant overprescribing. Fortunately, a solution exists: health plans that provide access to value-based primary care. All employers have to do is put it in motion.

Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our health care system, and the author of “The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back.” 

Overprescribing Is a Key Component of the Opioid Crisis — Here’s How to Stop It published first on https://wittooth.tumblr.com/