tag:blogger.com,1999:blog-79778234853499072072024-03-19T00:17:46.447-04:00Mr. Mario's Reflectionson Faith, Culture and ReligionUnknownnoreply@blogger.comBlogger215125tag:blogger.com,1999:blog-7977823485349907207.post-15417729669696010352024-03-12T08:00:00.004-04:002024-03-12T08:00:00.129-04:00 With Francis, 11 Years “on the High Seas”<p> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNYQ3j9T4ajyv-GMYxxQnEYBO8hP7DjNpxe9c2TyTanSM9fafppCndkjCsZ30upp3F2n0Q_YCxKBT9ERIbfUb2xtNMbtPXlH1nCcrvLCQ-EJqfDDvq7aZdPUGeSHA2BtJ3i2tIf_dV3eOUyHtmeLej1EXxUh2B6fGVE-wUY35TU321Enm89H-5Seh8usM/s1118/Pope%20Francis,%2011%20years.640.jpg" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1118" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNYQ3j9T4ajyv-GMYxxQnEYBO8hP7DjNpxe9c2TyTanSM9fafppCndkjCsZ30upp3F2n0Q_YCxKBT9ERIbfUb2xtNMbtPXlH1nCcrvLCQ-EJqfDDvq7aZdPUGeSHA2BtJ3i2tIf_dV3eOUyHtmeLej1EXxUh2B6fGVE-wUY35TU321Enm89H-5Seh8usM/s16000/Pope%20Francis,%2011%20years.640.jpg" /></a></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://docs.google.com/document/d/11_aIWvvx14GQcRBC1wHg57Fio4tAIUXA/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></div><p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-47866574060331414522024-02-21T08:00:00.008-05:002024-02-21T08:00:00.150-05:00New York State launches new phase of Medicaid innovation<p><span style="font-family: helvetica;">Calling especially for awareness
of how social factors can impact health—and insisting on tackling the Social
Determinants of Health—the federal government has approved a new Medicaid 1115
Waiver for New York State, making $6B available to improve the quality of
Medicaid care in the state in a variety of ways. Officially beginning in April
2024 and concluding on March 31, 2027, the new waiver program puts a premium on
the delivery of Health-Related Social Needs (HRSN) services, which is allotted
almost half of the budget.</span></p>
<p class="MsoNormal" style="margin-left: -0.25pt;"><span style="font-family: helvetica;">The push for taking HRSN factors
into account is at the heart of the waiver's vision to promote health equity,
reduce health disparities, and sharply improve the quality of Medicaid-funded
health care across the board—putting in place mechanisms that are designed to
become a lasting part of Medicaid in New York State, including, especially, the
official inclusion in Medicaid of a budget to tackle HRSN.</span></p>
<p class="MsoNormal" style="margin-left: -0.25pt;"><span style="font-family: helvetica;">The program will provide funding
enabling primary care providers to engage Community-Based Organizations (CBOs)
to find solutions for social needs that are harming the population's health.
There will be a regional approach that will single out areas that have
historically seen health disparities and disengagement from the healthcare
system. The waiver also calls for the integration of primary care, behavioral
health, and awareness of HRSN, particularly as regards high-risk Medicaid
recipients, such as youth, pregnant women, those struggling with addiction
issues, and the chronically homeless. The waiver envisions Social Care Networks
(SCN) to oversee the HRSN programming, working with local social care
providers.</span></p>
<p class="MsoNormal" style="margin-left: -0.25pt;"><span style="font-family: helvetica;">The waiver also includes more
than $690M to be spent on New York State's healthcare workforce to stabilize
the workforce, provide training and education, and improve access to culturally
appropriate services. Training the workforce—including physician assistants,
mental health counselors, and Community Health Workers—will also feature the
introduction of Value-Based Payment models, even as the waiver calls for an
increase in fee-for-service payments. Some doctors who sign up for a multi-year
commitment to work with Medicaid patients will receive student loan repayment.</span></p>
<p class="MsoNormal" style="margin-left: -0.25pt;"><span style="font-family: helvetica;">A Health Equity Regional Organization (HERO) will use data
gathering and analytics to design formulas to reduce health disparities, as
well as support the delivery of HRSN services. This entity will also explore
different Value-Based Care models that include coverage of HRSN services. SOMOS
Community Care—a network of 2500 independent physicians, most of them primary
care providers serving the poorest Medicaid patients in New York City—applauds
the new 1115 Waiver.</span></p><p class="MsoNormal" style="margin-bottom: 56.5pt; margin-left: -.25pt; margin-right: 0in; margin-top: 0in; margin: 0in 0in 56.5pt -0.25pt;"><span style="font-family: helvetica;">
<br />
It welcomes the emphasis on integrating Health-Related Social Needs (HRSN)
services in overall healthcare as key to overcoming healthcare disparities and
creating health equity. In fact, SOMOS has pursued such a model of health care
since it got its start in 2014 as an entity mandated by the previous 1115
Waiver. As it stands, SOMOS recognizes itself in the blueprint of the new
Waiver. That is true in several key areas. <br />
<br />
Thanks to the work of CHWs who visit patients' homes, providers have
intelligence about social conditions affecting patients' lives. SOMOS doctors
have already begun reaching out to CBOs, as called for by the waiver.
Additional funding for the training of CHWs, as well as for physician staff,
among other key positions, is much needed. The waiver's workforce investment is
much needed.<br />
<br />
While Social Care Networks (SCN) are envisioned to organize HRSN programming as
delivered by local social care providers, the patients who qualify for such
care must first be identified by the family doctor who knows his and her
patients intimately. It is also conceivable that SOMOS doctors' practices in
the Bronx, Manhattan, Queens, and Brooklyn form hubs in their networks that
identify and seek help for patients needing HRSN services. It seems clear that
medical providers must—alongside social care experts—participate somehow in the
SCN networks. <br />
SOMOS has also pioneered Value-Based Payment. Its experience can be fruitful
for the specialists charged with exploring VBP models that will be key to
statewide accountability for improving health care, patients' longer-term
well-being, and health equity.<br />
<br />
The fundamental goal of the waiver is to better serve the poor, the vulnerable,
and the most disadvantaged. SOMOS doctors are community-based and accessible to
their patients, and in many cases, share a cultural identity with them, which
is most conducive to a strong relationship between doctor and patient—a bond
that plays an important role in the quality of care. SOMOS doctors have been
providing superior care—medical, behavioral, social—to their patients while
saving taxpayers money in the process.<br />
<br />
Moreover, SOMOS has operated as the only network of independent providers in
the state. It has no backing from a hospital conglomerate. Instead, it has
operated in the trenches. The new 1115 Waiver promises new growth as well as
challenges for SOMOS—and its doctors and staff will continue to give their all,
as they have done from the very start of the reinvention of Medicaid.<br /></span></p><div style="text-align: center;"><a href="https://docs.google.com/document/d/1WGP26hw7k22JOqXQmdsxQgqPK6d8kUHN/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" style="font-family: helvetica;" target="_blank">Text File</a></div><span style="font-family: helvetica;">
<br />
<br />
<i>Mario J. Paredes is CEO of SOMOS Community Care, a social care network of
over 2,500 independent providers responsible for reaching and delivering care
to over 1 million Medicaid lives across New York City.</i><i><span style="font-size: 11pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-size: 12.0pt; mso-hansi-font-family: Calibri;"><o:p></o:p></span></i></span><p></p>
<p class="MsoNormal" style="line-height: 112%; margin-bottom: 8.4pt; margin-left: -.25pt; margin-right: 0in; margin-top: 0in; margin: 0in 0in 8.4pt -0.25pt;"><o:p><span style="font-family: helvetica;"> </span></o:p></p>
<p class="MsoNormal"><o:p><span style="font-family: helvetica;"> </span></o:p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-2636587417460692842024-02-12T08:00:00.013-05:002024-02-12T08:00:00.133-05:00May No Sick Person Be Alone!<p><span style="text-align: justify;"><span style="font-family: georgia;">On May 13, 1992,
then-Pope John Paul II established February 11 as the World Day of the Sick, an
annual occasion for prayer and reflection and for promoting the assistance and
care that is needed – worldwide – for all those who do not enjoy good and
complete health.</span></span></p>
<p style="background: white; line-height: 115%; text-align: justify;"><span style="font-family: georgia;"><span style="color: black; mso-ansi-language: EN-US; mso-color-alt: windowtext;">Every year
since then, the Pope has enlivened this Day with a Message in which he
encourages us to live life adopting a compassionate and merciful gaze and
attitude – like Jesus himself – towards our brothers and sisters who suffer
from some kind of illness, towards <i>“all of you, brothers in trial, who are
visited by suffering under a thousand forms, who search in vain for the why of
human suffering and who ask anxiously when and whence will come relief.”</i>
(Closing of the Second Vatican Ecumenical Council – To the Poor, the Sick and
the Suffering – 8 December 1965).</span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">Health is a condition for
personal, family, and social life. Without health, there is no full life, there
is no “abundant life” (Jn 101:10). When we lack health, we are put in a
situation of need, fragility, and vulnerability.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">So important is health
for the human being, that – theologically speaking – God’s salvation for man is
synonymous with health. For this reason, the messianic times of the coming of
the salvation that God offers us in his Son Jesus Christ are announced, both in
the Old Testament, as times of salvation in which “the blind regain their
sight, the lame walk, lepers are cleansed, the deaf hear, the dead are raised,
and the poor have the good news proclaimed to them” (Mt 11:4-6).<o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">While health care and the
preferential attention that the sick must have in every society are important,
the institutions and people who dedicate themselves to health care through the
exercise of the medical profession are equally important.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">I am the CEO of SOMOS
Community Care, a network that coordinates more than 2,500 family physicians to
provide primary care services to New York City’s most disadvantaged. In this
medical organization, we work toward a humanistic vision and mission that views
health care from a comprehensive, preventive perspective. We are aware of the
importance of personal and collective health care, and we make our best efforts
to ensure that our medical, human, and material resources reach those who need
them most.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">For this reason, among
other expanded social welfare projects, the SOMOS Community Care Medical
Organization and the Doctor Ramon Tallaj Foundation have implemented a
scholarship system for students with academic excellence who, without this
support, would not be able to achieve their academic goals of completing their
studies in medical and paramedical programs.<o:p></o:p></span></span></p>
<p style="background: white; line-height: 115%; text-align: justify;"><span style="font-family: georgia;"><span style="color: black; mso-ansi-language: EN-US; mso-color-alt: windowtext;">For this
32nd World Day of the Sick, on February 11, 2024, Pope Francis’ Message is
inspired by the biblical quote, <i>“It is not good for the man to be alone.”</i>
(Gen 2:18). Because, says the Pope, <i>“Our lives … are meant to attain
fulfillment through a network of relationships, friendships, and love, both
given and received. We were created to be together, not alone. Precisely
because this project of communion is so deeply rooted in the human heart, we
see the experience of abandonment and solitude as something frightening,
painful, and even inhuman. This is even more the case at times of
vulnerability, uncertainty, and insecurity, caused often by the onset of a
serious illness.”</i> For this reason, the Pope summons us all to solidarity,
to a closeness with compassion and tenderness.</span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></span></p>
<p style="background: white; line-height: 115%; text-align: justify;"><span style="font-family: georgia;"><span style="color: black; mso-ansi-language: EN-US; mso-color-alt: windowtext;">A society
that abandons and forgets those who suffer is also a sick society, in need of
health and salvation. <i>“This grim reality is mainly a consequence of the
culture of individualism that exalts productivity at all costs, cultivates the
myth of efficiency, and proves indifferent, even callous, when individuals no
longer have the strength needed to keep pace. It then becomes a throwaway
culture in which “persons are no longer seen as a paramount value to be cared
for and respected, especially when they are poor or disabled…”</i> </span><span lang="ES-CO" style="color: black; mso-color-alt: windowtext;"><a href="https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20201003_enciclica-fratelli-tutti.html#18"><span lang="EN-US" style="mso-ansi-language: EN-US;">(<i>Fratelli Tutti</i></span></a></span><span style="color: black; mso-ansi-language: EN-US; mso-color-alt: windowtext;">,
18). </span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></span></p>
<p style="background: white; line-height: 115%; text-align: justify;"><span style="font-family: georgia;"><span style="color: black; mso-ansi-language: EN-US; mso-color-alt: windowtext;">Thus, we
are all called to live in the commandment of love, love that simultaneously
heals the sick, a love that heals and saves those of us who forget our brothers
and sisters in need and those who care for and soothe – from the field of
medicine – those who suffer in hospitals.</span><span style="mso-ansi-language: EN-US;"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="line-height: 107%;"><span style="font-family: georgia;">Let us ask ourselves, in
addition to praying, what we can do to ease the burdens of those who suffer
most in our society, how we can make the loneliness of the sick and elderly
more bearable, how we can lessen the pain of so many brothers and sisters who
suffer and in so many ways, because <i>“it is not good for human beings to be
alone.”</i><o:p></o:p></span></span></p><p class="MsoNormal" style="text-align: center;"><span style="line-height: 107%;"><span style="font-family: georgia;"><br /></span></span></p><p class="MsoNormal" style="text-align: center;"><span style="line-height: 107%;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1-l-RW8EgozEL9WJnmjw4taBzPUcQs_Kf/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></span></p>
<p class="MsoNormal"><span style="line-height: 107%;"><o:p><span style="font-family: georgia;"><i> </i></span></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;"><i><span style="line-height: 107%;">Mario J. Paredes </span></i><i><span style="line-height: 107%;">is a member of the Board of Directors
of the Latin American Academy of Catholic Leaders and</span></i><i><span style="line-height: 107%;"> a
Member of the Board of the American Bible Society. He is CEO of SOMOS Community
Care, </span></i><i><span style="line-height: 107%;">a social
care network of over 2,500 independent providers responsible for reaching and
delivering care to over 1 million Medicaid lives across New York City.</span><span style="color: #4472c4;"><o:p></o:p></span></i></span></p>
<p class="MsoNormal"><span style="line-height: 107%;"><o:p><span style="font-family: georgia;"> </span></o:p></span></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-87271690554022880822024-01-12T08:00:00.001-05:002024-01-12T08:00:00.141-05:00The Smart Way of Expanding Medicaid<p><span style="font-family: georgia;">A FISCAL HAWK rejects the Medicaid
expansion in 40 states, saying the now ten-year-old expansion of the program
under Obamacare has led to a growth in federal and state spending without
improving the health of beneficiaries. Writing in <i>The Wall Street Journal</i>,
Brian Blase, President of the Paragon Health Institute, praises Florida’s
decision to resist the political push for expansion, saying that that move has
already saved taxpayers almost $50B. He labels Medicaid expansion “a massive
increase in public welfare.”</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Blase notes that mortality rates in
expansion states were higher during the first four years of Medicaid expansion.
Another issue has been the payment of providers and health insurance entities,
with 20 percent of payments nationwide erroneously made for the medical care of
ineligible patients. Blase claims that research has found that, after
expansion, Medicaid enrollees were one-third less likely to be able to make
doctors’ appointments, sending program recipients to emergency rooms—and
hospital beds—for costly treatment.</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Blase charges that, at the same time,
Medicaid spending on behalf of children, as well as people with disabilities,
“stagnated.” Meanwhile, in expansion states, more was spent on “able-bodied
working-age adults.” Medicaid, the argument goes, should make “those who most
need it” a priority. As it stands, a “much bigger Medicaid program” has not
improved health.</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">There is no doubt that the Medicaid
program needs fixing. Traditional Medicaid only marginally improves the health
of beneficiaries. A famous 2010 study in Oregon found that the health of
beneficiaries showed practically no benefits compared to the health of
individuals without healthcare coverage. For example, there was no difference
in</span><span style="background: white; font-family: georgia;"> the
prevalence or diagnosis of hypertension or high cholesterol levels or in the
use of medication for this condition.</span></p>
<p class="MsoNormal"><span style="background-color: white; font-family: georgia;">Yes, traditional Medicaid makes it challenging for
beneficiaries to find doctors, from primary care physicians to specialists. In
many settings, the patient faces a labyrinthine task to build even a
rudimentary relationship with physicians. Moreover, a growing number of
Medicaid doctors are reluctant to take on new patients, given the challenges of
Medicaid payment rates, which, to begin with, are significantly lower than
payments made by Medicare and private insurers. Plus, almost 20 percent of
Medicaid payments due are not paid in full, a much higher share than the unpaid
balances under Medicare and private insurance.</span></p>
<p class="MsoNormal"><span style="background-color: white; font-family: georgia;">The payment issue needs urgent fixing. An additional
challenge is the considerable number of fraudulent claims made by physicians.</span></p>
<p class="MsoNormal"><span style="background-color: white; font-family: georgia;">These fundamental issues plaguing the Medicaid program and
that validate critics’ opposition to Medicaid expansion—above all concerning
the questionable quality of Medicaid care—are being addressed by SOMOS, a
unique network of more than 2500 independent doctors in New York City. These
physicians—most of whom are primary care providers—care for more than one
million of the city’s most vulnerable patients, many of whom are African
Americans, Asian Americans, and Hispanics.</span></p>
<p class="MsoNormal"><span style="background: white; font-family: georgia;">SOMOS got its start as a participant in an innovative
Medicaid initiative—</span><span style="font-family: georgia;"> </span><span style="background: white; font-family: georgia;">Delivery System Reform Incentive Payment (DSRIP)
Program—launched by the New York State Department of Health in 2014. The
program stipulates that payments to doctors are linked to longer-term health
outcomes for patients. The better the patients are doing, the higher the
compensation for providers. Called Value-Based Care, the formula incentivizes
providers to do their utmost in caring for their patients.</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">SOMOS enables its doctors to provide the best possible care.
A cadre of Community Health Workers are providers’ eyes and ears in the
community. They visit patients’ homes, reminding patients of their medical
regimen and assessing the family’s social circumstances. The latter are
referred to as Social Determinants of Health or Health- Related Needs,
involving, among others, such factors as housing, nutrition, and
transportation.</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Social factors affect physical and mental health and need
addressing as such, something that is only just beginning to be done in the US
healthcare universe. It is decidedly not part of the traditional Medicaid
approach. SOMOS doctors, by contrast, know their patients intimately, which
puts them in a position to provide comprehensive care, which includes engaging
Community-Based Organizations. The patient feels known and really trusts the
doctor, who plays the role of the family doctor of the old, a trusted community
leader. SOMOS doctors are supremely motivated!</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Quality Medicaid care makes for significant taxpayer
savings, which should please Mr. Blase! SOMOS saved New York State taxpayers
$330M by reducing by 25 percent both unnecessary visits to the emergency room
and hospitalizations. This was possible thanks to timely interventions and, for
example, not letting conditions like diabetes and hypertension get out of hand.</span></p>
<p class="MsoNormal"><span style="font-family: georgia;">SOMOS has demonstrated that significant Medicaid reform is
possible. A program in which superior care and cost savings go hand in hand
paves the way for a responsible expansion of Medicaid.</span></p>
<p class="MsoNormal"><i style="font-family: georgia;"><br /></i></p><p class="MsoNormal"><i style="font-family: georgia;">Mario J. Paredes is CEO of SOMOS
Community Care, a network of more than 2.500 independent physicians—most of
them primary care providers—serving more than a million of New York City’s most
vulnerable Medicaid patients.</i></p><p class="MsoNormal"><br /></p><p class="MsoNormal" style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/17qNP6whdKlov9IJmkQzGivK2ctiDBCUr/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p class="MsoNormal" style="text-align: center;"><i style="font-family: georgia;"><br /></i></p><p class="MsoNormal" style="text-align: center;"><i style="font-family: georgia;"><br /></i></p>
<p class="MsoNormal"><o:p><span style="font-family: georgia;"> </span></o:p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-28943584667632227082023-12-28T08:00:00.001-05:002023-12-28T08:00:00.155-05:00All New for a New Year<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFKyeWGqBDBh8UZ1RFFO9Jkb3S_4kKiIIZZ6gJuAIdpp1peN0k1XnJNUAgHYO6XWbla6M02bQvEoESYVH4Y2KnM1GsVURE6cWCQzGcBhPP5XUzAiN4L26-6WY1C76vKbMr1SC3pXl1LjC7VA7iKg2r1CsSJ2m2EzbOJGeq5jHpObDYQWXL9zCcxktwlm8/s1060/NYE-Eng_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1060" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFKyeWGqBDBh8UZ1RFFO9Jkb3S_4kKiIIZZ6gJuAIdpp1peN0k1XnJNUAgHYO6XWbla6M02bQvEoESYVH4Y2KnM1GsVURE6cWCQzGcBhPP5XUzAiN4L26-6WY1C76vKbMr1SC3pXl1LjC7VA7iKg2r1CsSJ2m2EzbOJGeq5jHpObDYQWXL9zCcxktwlm8/s16000/NYE-Eng_640.jpg" /></a></div>
<p></p>
<p></p>
<div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><a href="https://docs.google.com/document/d/1MfYQdScUBJqtvphPiWijFYbtZhHLxvEN/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></b></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-7977823485349907207.post-20327944320078472162023-12-21T08:00:00.003-05:002023-12-23T12:44:03.242-05:00Lessons From God at Christmas<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkjhaUWrOd6KQ-iGk8WghMkqN6ehUstBzBFMzL6Oizd9YqTiU66puAKxJOSzDQsbfu2e8E3aIc9mxakg90yzw30e-0k2J5V2UbHtsiIAXtXVjgIRKeeMORvAsj00M_fK2pplT-MzaFBI3lwlHvOQ4e2HGLJXi5um432I4AKGdKQtdo2Wm9GppaJFm67i4/s1059/Lessons%20From%20God%20at%20Christmas_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1059" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkjhaUWrOd6KQ-iGk8WghMkqN6ehUstBzBFMzL6Oizd9YqTiU66puAKxJOSzDQsbfu2e8E3aIc9mxakg90yzw30e-0k2J5V2UbHtsiIAXtXVjgIRKeeMORvAsj00M_fK2pplT-MzaFBI3lwlHvOQ4e2HGLJXi5um432I4AKGdKQtdo2Wm9GppaJFm67i4/s16000/Lessons%20From%20God%20at%20Christmas_640.jpg" /></a></div><p class="MsoNormal" style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1qfFCW7Mz_B0lITAyq5y52Uf3Mh6Dqo6K/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank"><br />TEXT FILE</a></span></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-1747148572466794522023-12-18T08:00:00.001-05:002023-12-18T08:00:00.153-05:00Excessive pharmaceutical pricing needs curbing<p><span style="font-family: georgia;">The pharmaceutical industry is out of control. That is the
conclusion of a recent article in the <i>New York Review of Books (NYRB). </i>A
case in point is Moderna, the maker of a COVID-19 vaccine. The federal
government paid the company $2.48B to develop a vaccine and bought millions of
doses at $26 each. With the end of government funding in sight, the company
announced that it would produce an updated vaccine at $130 per dose. The public
was outraged.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;"><i>NYRB</i> delivers an “indictment of American drug
companies and the federal government for all too often privileging profit over
health, and of the research universities, medical professionals and
philanthropists who have been deeply complicit with them.”</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Things started to go bad after World War II, as “the
pharmaceutical industry, aided by the federal government and philanthropic
foundations … produced an enormous arsenal of drugs against a variety of
fearful diseases and disorders,” but it “also single-mindedly profit
maximization by engaging in price gouging, blocking the availability of cheaper
generics, and exploiting the patent and regulatory systems to harass and
suppress competition.”</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Part of the problem has been the use of patents, which
“enabled huge price markups, generating corporate profit margins” … “double and
often triple those found in other manufacturing sectors.” The original intent
of granting patents was to make sure companies would make the drugs “available
to the public on ‘reasonable terms.’” Significant reforms of the patent
practices have been proposed and struck down.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">The industry managed to extend the life of patents beyond
the limit of 17 years, raising it to 20 years. And patents would be longer
still with the introduction of slightly modified versions of the medicine in
question, a “process called evergreening.” Without providing evidence,
pharmaceuticals argued that higher prices were necessary to meet “the costs of
development, including research, clinical trials and failures.”</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">A notorious case was the drug ATZ, the first treatment for
AIDS. It came to market in 1987 at a cost of $10,000 for a year’s supply.
Public pressure forced the maker, Burroughs Wellcome, to lower the price to
$8,000 per year. It did not make a dent in the company’s profit, with sales of
more than $1B by 1991.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Overall, the industry fought hard against the introduction
of much cheaper generic medicine, declaring them to be “counterfeits.” In 1970,
the pharmaceutical industry successfully lobbied for the introduction of laws
in all 50 states prohibiting pharmacists from dispensing the more affordable
medicine. (In the mid-70s, a coalition of the AARP, organized labor, and
consumer groups overturned these laws in 40 states.) Pharmaceutical companies
also successfully resist a call from poor nations to allow for the production
of life-saving generic COVID-19 vaccines.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;"><o:p> </o:p>The excessive cost of medicine is a stark reality
confronting SOMOS Community Care, a network of over 2,500 independent doctors
who serve some 1 million of New York City’s most vulnerable Medicaid patients.
Drug prices in the US are four times as high as prices in other high-income
societies. Many low-income patients—struggling to pay for the drugs they need
even on Medicaid—cut pills or forego doses altogether, putting their health at
risk. At times, there is also drug scarcity, leaving doctors and their patients
at a disadvantage. And insurance companies will not cover certain medicines.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">The monopoly enjoyed by the pharmaceutical industry—prone to
corruption—is a glaring injustice hurting people with low incomes, denying them
vital medication. It is a practice opposed to the higher calling of companies
to serve the well-being of society. The industry must reform itself and
consider its research and development slate, as there is a flipside to the high
cost of medicine—the saturation of the market that instills a need in the
public to consume ever more drugs.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">There is a glimmer of hope as the US government has set in
motion a negotiation with the pharmaceutical industry to lower the prices of 10
drugs taken by Medicare enrollees and covered under Medicare Part D. In 2022,
Medicare members paid a total of $3.4B for these drugs that are used to treat
diabetes, heart failure, blood clots, and autoimmune disorders, conditions that
disproportionately impact women, communities of color, and people in rural
areas. Some 9 million people take these drugs, which has generated $493B in
global revenue for the drug companies.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: georgia;">Now, finally, the
federal government is putting some pressure on the industry to curb its prices,
just as is standard practice in other industrialized nations. The move is part
of the Inflation Reduction Act of 2022, signed into law by President Biden. Not
surprisingly, a coalition of drug companies and industry lobbying groups have
filed lawsuits aimed at forcing the US government to halt its bid to move ahead
with the negotiations—even though 9 companies have agreed to sit down with
federal negotiators. It appears, however, that the lawsuits will have little
traction. The negotiations may mark the beginning of real change.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p><span style="font-family: georgia;"> </span></o:p></p>
<p class="MsoNormal"><i><span style="font-family: georgia;">Mario J. Paredes is CEO of SOMOS Community Care, a network of over
2,500 independent providers responsible for reaching and delivering care to
over one million Medicaid lives across New York City.</span></i></p><p class="MsoNormal"><i><span style="font-family: georgia;"><br /></span></i></p><p class="MsoNormal" style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1zWzJEq_oUK-oSaRhUMxPSQ_L9Qtbv0JM/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal"><o:p></o:p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-76087655486937254842023-12-15T08:00:00.003-05:002023-12-15T08:00:00.159-05:00City MD vs. SOMOS Community Care — A Study in Contrasts<p><span style="font-family: georgia;">A two full-page advertorial in The New York Times published on November 17, 2023 sang the praises of City MD and the host of differently named urgent care centers as a solution for people confronted with the "glacial pace of getting medical care in New York City and across the country: "It can take weeks to see a primary care doctor, and an emergency room visit can set you back many hours." </span></p><p><span style="font-family: georgia;">There is no disputing the time it takes to get treatment in an ER. Still, the SOMOS Community Care network of over 2,500 mostly primary providers is highly accessible, caring for some one million of New York City's most vulnerable Medicaid patients. City MD—not particularly present in the city's most needed neighborhoods—is an option for those with Medicare or private insurance but not for those with traditional Medicaid coverage. This reality makes SOMOS, in fact, the "City MD" for the underprivileged. </span></p><p><span style="font-family: georgia;">SOMOS offers an answer to City MD's claim that "with primary care doctors overburdened, navigating the current health care system can feel overwhelming for patients." SOMOS practices are located in the very communities that are being served, notably neighborhoods that are home to Asian Americans, Hispanics, and African Americans. These community-based practices readily welcome new patients, including those requiring urgent care. </span></p><p><span style="font-family: georgia;">The advertorial cites an example: "a kid who split his chin open at the gym. He was out of the clinic in 25 minutes. He would have waited five hours in the ER, and his primary care doctor isn't trained for that." City MD acknowledges that "primary care is super important—preventative care is huge." That, indeed, is the focus of SOMOS doctors. They are highly qualified to deal with stitches or other emergencies. If needed, those SOMOS doctors would refer a patient requiring urgent specialized care to a colleague in the community.</span></p><p><span style="font-family: georgia;">There is no disputing the need for primary care doctors. City MD argues that the model of care they provide has changed: "At one point in time, if you had a problem, you would call your primary care doctor. They would interrupt their dinner to take your call and give you advice. That model has become less prevalent." </span></p><p><span style="font-family: georgia;">This claim touches precisely on SOMOS's unique contribution to the New York State healthcare universe: the restoration of the family doctor of old as a trusted figure and community leader who has a bond with patients and is intimately familiar with patients' medical situations and overall circumstances—someone, indeed, who will take a call at dinnertime.</span></p><p><span style="font-family: georgia;">SOMOS care revolves around the patient-doctor relationship, carefully nurtured and fed with doctors' critical knowledge of their patients' lives. The provider gets vital information about his patient thanks to the work of Community Health Workers, who are doctors' eyes and ears in the community. They visit patients' homes to remind them of medical appointments, assess conditions in the home and the neighborhood, and gather pertinent information about the family as a whole.</span></p><p><span style="font-family: georgia;">Patient intelligence gathered in this fashion includes the so-called social determinants of health: social factors—poverty, subpar housing, and lack of access to healthy foods and other conditions—that can impact both mental and physical health. SOMOS doctors also engage Community-based Organizations to help address patients' social needs. The awareness of a patient's social and environmental circumstances is impossible for City MD doctors, who only get a snapshot of the overall condition of the people they see.</span></p><p><span style="font-family: georgia;">The City MD advertorial cites a finding by the American Medical Association that there is a growing shortage of doctors in the US, which is particularly true when it comes to PCPs. The AMA reports that the causes of the lack of doctors include burnout and "shrinking Medicare reimbursements." The same is true for Medicaid reimbursements, but SOMOS doctors have an edge as they have signed on to the Value-Based Payment model, which stipulates that providers' compensation is tied to the longer-term well-being of their patients. SOMOS doctors are paid extra for going the extra mile. Thus, their earnings are significantly boosted.</span></p><p><span style="font-family: georgia;">Finally, the advertorial states that, besides the shortage of PCPs, doctors "are spending their time doing administrative duties, rather than treating patients." On this score, too, SOMOS has developed a solution: training doctors' staff to take on the bulk of administrative responsibilities, such as the careful maintenance of Electronic Health Records—thus freeing doctors to focus on their patients.</span></p><p><span style="font-family: georgia;">Of course, City MD meets a need and offers convenient access to medical care. However, there is no substitute for the intimate, comprehensive, and preventative health care at the heart of SOMOS.</span></p><p><span style="font-family: georgia;"><br /></span></p><p><i><span style="font-family: georgia;">Mario J. Paredes is CEO of SOMOS Community Care, a network of over 2,500 independent providers responsible for reaching and delivering care to over one million Medicaid lives across New York City.</span></i></p><div><br /></div><div style="text-align: center;"><a href="https://docs.google.com/document/d/1qLf6vEvENb48jydzv2DAv6_9jas362Bz/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-54056625150653396982023-11-20T08:00:00.002-05:002023-11-20T08:00:00.160-05:00What Reasons Do We Have for GIVING THANKS?<p> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs724wzUnhGikJrrmQ9BwHfh_E3XR0wK3vcMWBo1cAdEAlBT44Z1VALQRnuX5bbGDI7QkXBZ0C1ycE1vX0bmT0U989BBoE7OR6s2p22UCazCbgb2IEBVg7L1CCaUJteis0wd8i6v28J26ITWW8ykUoMzCFtaPIddW7USbNvUa3CDMKw9f2ciFrhpDVteM/s1101/Thanksgiving%20Day_B.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1101" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs724wzUnhGikJrrmQ9BwHfh_E3XR0wK3vcMWBo1cAdEAlBT44Z1VALQRnuX5bbGDI7QkXBZ0C1ycE1vX0bmT0U989BBoE7OR6s2p22UCazCbgb2IEBVg7L1CCaUJteis0wd8i6v28J26ITWW8ykUoMzCFtaPIddW7USbNvUa3CDMKw9f2ciFrhpDVteM/s16000/Thanksgiving%20Day_B.jpg" /></a><br /><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><a href="https://docs.google.com/document/d/1bAZVi-eG9AcFxZIJazsYBJeWVkxKOGmY/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></b></div><p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-43734677849686461192023-10-12T08:00:00.008-04:002023-10-12T08:00:00.146-04:00SETTING OFF AGAIN ON NEW CONQUESTS<p><span style="font-family: georgia;">Every year, on October 12, we celebrate the Day of the Race and commemorate the first time Spanish navigators, led by Christopher Columbus, arrived on the American continent. Generally, and popularly, this date is also known as the discovery of America.</span></p><p><span style="font-family: georgia;">Beyond the different points of view and the many discussions that this historical event generates today, from those who see this “discovery” as very positive for the American continent and those who emphasize all the negative effects that this “meeting” wrought for the inhabitants and original cultures of these lands, I share today some reflections on the profile, lifestyle, primary convictions and desires that drive people today, especially young people: the present, hope, and future of our race, societies and all humanity.</span></p><p><span style="font-family: georgia;">We live in the historical conjuncture that anthropologists, historians, philosophers, and sociologists call the “transition from modernity to postmodernity.” Like every stage of human history, this one we live in has its lights and shadows.</span></p><p><span style="font-family: georgia;">There is consensus that the 1960s marked a rupture and novelty compared to past decades and those in which we now live. We have persevered through two world wars and many other international and local wars, failures of democracy and the capitalist economic system, the failure of science and technology to solve the great problems of human beings and all humanity, the growing situation of injustice, inequality, violence, migration and death of large masses of people in all corners of the planet, etc. These have shattered the unshakable faith of our modern ancestors in the unlimited progress of humanity through science and technology, which – at the time – once produced the Industrial Revolution.</span></p><p><span style="font-family: georgia;">For the generation of the 60s and their famous youth and student protests, their hope for a better world fell apart, and the idea of progress that their grandparents believed in became a story of history without a future or meaning, lacking direction.</span></p><p><span style="font-family: georgia;">In its totality, this formed societies that no longer produced but consumed, where everything can be negotiable, where “having” trumps being. This formed men and communities that, faced with the prospect of no future, live with no interest in work and effort, in advancing and overcoming. Instead, they seek </span><span style="font-family: georgia;">the easy and fast, the disposable and perishable, the “deconstruction,” the “light” and disengaged.</span></p><p><span style="font-family: georgia;">The rejection of everything institutional and hierarchical in all areas of life in society (political, religious, etc.), since these institutions once controlled and sustained the ideal of progress, now failed, produces a retreat to the sanctuary of the individual, the personal and private, to the detriment of the interest in everything collective and in the search for the common good. We follow characters, individualities, sects, therapies, or small groups, where individuals can feel like people and not amorphous masses.</span></p><p><span style="font-family: georgia;">We thus arrive at anarchy, a world without dogmas and lacking unique, absolute, or universal truths. We inhabit a world of subjectivism and “moral” relativism, according to which everyone elaborates “à la carte” their own truths and life projects. It is a world without certainties, a world of fragmented beings seeking what serves them, a world where “having” and pleasure form the foundation of happiness. We live in times of rapid change, uncertainty, crisis, nonsense, stories, and precarious knowledge, in which aesthetics prevail over ethics, feeling over reason, in a world of entertainment.</span></p><p><span style="font-family: georgia;">We inhabit pansexualist and hedonistic societies, living without the perspective of transcendence. We seek enjoyment in the here and now. We seek to achieve maximum luxury, comfort, and waste with the least possible sacrifice, commitment, and effort. The end justifies the means in this mad and frantic race for pleasure and happiness.</span></p><p><span style="font-family: georgia;">This all leads to sexuality, also light, in which the pleasure of physical contact prevails without fidelity. This human dimension is reduced to genitality because the authentic is forbidden.</span></p><p><span style="font-family: georgia;">In the realm of religion, the human beings of our times, our young people, inherited F. Nietzsche’s premise that “God is dead” because if we have science and technology, we can do without God. “The superman” emerges. All of this causes secularism and the decline of everything religious.</span></p><p><span style="font-family: georgia;">Postmodern man believes, but does so within a “religious market” and “à la carte.” A thousand ideas, sects, therapies, and pseudo-religious movements proliferate due to the need to find meaning in existence and a solution to the serious problems of humanity that have not yet been resolved. But this “return” or need for the religious and transcendent is also “light,” without </span><span style="font-family: georgia;">strong convictions and always utilitarian, amidst an overload of media and information in which nothing is worth and every subject is worth the same.</span></p><p><span style="font-family: georgia;">Young people today, in line with everything I have said here, believe but not in the way of institutions. They believe, but without affiliations, labels, or memberships of religious institutions. They believe but without institutional religious practices. They believe without belonging to any religious institution, rejecting imposed and traditional religious practices. They believe, but they do so heterogeneously and eclectically.</span></p><p><span style="font-family: georgia;">They are interested in ideas and movements of spirituality but reject all membership in official religions. They live and seek some kind of spiritual experience that does not have the regulation of religious institutions.</span></p><p><span style="font-family: georgia;">This brief review of the main features of the person, society, and culture of our time, even in the face of modernity, portrays ways of being and acting of today’s person amidst a human and social crisis, and at the same time, invites us to opportunities to make changes.</span></p><p><span style="font-family: georgia;">The emphases of today’s culture and man are usable and salvageable. We must applaud, for example, the achievements in respect for the rights of individuals and minority groups in the world, but without forgetting the need always to seek and find ways that ensure the good of the great majority, the common good.</span></p><p><span style="font-family: georgia;">Young people are the treasure of our race and the present and future of our hope. They are the ones who must build, with the best of the heritage of their parents and grandparents, a society that respects “the dignity, the liberty, and the rights of individuals” without being tempted to “yield to the seductions of egoistic or hedonistic philosophies or to those of despair and annihilation” affirming “faith in life and what gives meaning to it, that is to say, the certitude of the existence of a just and good God.”</span></p><p><span style="font-family: georgia;">Enlarging “hearts to the dimensions of the world, to heed the appeal of your brothers, to place your youthful energies at their service. Fight against all egoism. Refuse to give free course to the instincts of violence and hatred which beget wars and all their train of miseries.”</span></p><p><span style="font-family: georgia;">The world urgently needs young people who are “generous, pure, respectful, and sincere,” who “build in enthusiasm a better world than [their] elders had with “the ability to rejoice with what is beginning, to give oneself unreservedly, </span><span style="font-family: georgia;">to renew oneself and to set out again for new conquests.” (Phrases in quotation marks are excerpts of the MESSAGE OF THE II VATICAN COUNCIL TO YOUTH).</span></p><p><span style="font-family: georgia;"><br /></span></p><p style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1fCSiD3JgsPh8P2SntESeLcYkYz2T-Swr/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p><span style="font-family: georgia;"><i><br /></i></span></p><p><span style="font-family: georgia;"><i>Mario J. Paredes is CEO of SOMOS Community Care, a network of 2,500 independent physicians—most of them primary care providers—serving close to a million of New York City's most vulnerable Medicaid patients.</i></span></p><p><br /></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-7977823485349907207.post-68361389574135434332023-09-25T08:00:00.009-04:002023-09-25T08:00:00.142-04:00A Synod to Walk Together<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZsGUuLCp9Xi0aqXSoDiogkzzCAZrLYU3q2MJGPi3CEj8H79a9QxsBJ8tCbA5Kqtim-34Eqh9SXXs4F04T9nzhKW-uFm7wP3Jal8JEMfJpEINmQzJ-aAEldgvHViGysINZJIceXkhSyB6TkUOSSL0rEnKDRuUZ6p95sj08ZT1hOD80JBAIrPs3ABEyDuQ/s1554/SYNOD_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1554" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZsGUuLCp9Xi0aqXSoDiogkzzCAZrLYU3q2MJGPi3CEj8H79a9QxsBJ8tCbA5Kqtim-34Eqh9SXXs4F04T9nzhKW-uFm7wP3Jal8JEMfJpEINmQzJ-aAEldgvHViGysINZJIceXkhSyB6TkUOSSL0rEnKDRuUZ6p95sj08ZT1hOD80JBAIrPs3ABEyDuQ/s16000/SYNOD_640.jpg" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><span style="font-family: verdana;"><a href="https://docs.google.com/document/d/1D510ZXu9EfuZZ10op9lAZoDN773gtUWb/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-20882233118886239142023-09-20T16:18:00.000-04:002023-09-20T16:18:00.226-04:00Hispanic Heritage Month: Everyone's Responsibility<p> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSv-N84Z16wartE3hAzdX_UKwvouilZkDxvSOC_SoVuCrdLZygjMaUMA80ziPuQ4AAF3CTZDkQ9S2QpI9kQESpVVZeuQIa1uerFA9tVN2LwIj1gcNzY_PHJKBmEO9_MHjC8DDLseFSlw3FLhXId2XjwYiB0FE16dWjIwWqfEo9UUmc0pIZIdXaJWg2KU8/s1399/HISP-AM.640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="1399" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSv-N84Z16wartE3hAzdX_UKwvouilZkDxvSOC_SoVuCrdLZygjMaUMA80ziPuQ4AAF3CTZDkQ9S2QpI9kQESpVVZeuQIa1uerFA9tVN2LwIj1gcNzY_PHJKBmEO9_MHjC8DDLseFSlw3FLhXId2XjwYiB0FE16dWjIwWqfEo9UUmc0pIZIdXaJWg2KU8/s16000/HISP-AM.640.jpg" /></a></p><div style="text-align: center;"><span style="font-family: verdana;"><a href="https://docs.google.com/document/d/1DjPHSZ64gYs1Ix9MV9J02N7BeDeMJPSz/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-82916436668694349782023-09-11T18:56:00.002-04:002023-09-11T18:56:22.298-04:00The underbelly of health care in America—and an answer<p style="text-align: justify;"><span style="font-family: verdana;"><i>The New York Times’s </i>recent coverage of the
state of health care in the United States paints a very discouraging picture.
Despite all the money going to health care in the country—which outspends other
developed nations in spending on health care per capita—the US has a sorry
record. In fact, Americans rank among the least healthy compared to other rich
countries; they are also in a cohort that is most likely to die early. </span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">For example, life
expectancy in Mississippi, which stands at 71.9, has fallen below the life
expectancy in Bangladesh (72.4). An infant in the US is close to 70 percent
more likely to die in the US compared to other wealthy nations. And for the
first time in what might be a century, the likelihood that an American child
will live to age 20 has diminished. Newborns in India, Rwanda, and Venezuela
have a longer life expectancy than Native American newborns in the US. The life
expectancy of a Native American adult male, at 61.5, is below that of the life
expectancy in Haiti.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">The so-called “healthy
life expectancy—the years someone lives without suffering severe medical
problems, like amputations, dialysis, or blindness—is 66.1 in the US, which is
lower than that figure in Turkey, Sri Lanka, Peru, and Thailand, as well as other
countries, all significantly poorer than the US.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">The most gruesome
statistic shows the US to be the “global leader in avoidable amputations,”
resulting from grave shortcomings in the care and management of diabetes. These
preventable amputations writes </span><i style="font-family: verdana;">The Times, </i><span style="font-family: verdana;">“are the most heart-rending
symbol of America’s failure in health care. Patients fail to obtain blood sugar
management, which leads to diminished circulation and diabetic wounds on the
foot that can lead to amputation, first of the toes and next of the legs, both
below and above the knee.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">A patient whose leg is
amputated above the knee generally dies within five years. Some 150,000
amputations are performed each year, of a toe, foot, or leg. The neglect of
diabetes and other preventable conditions is really hurting Americans of all
ages. The hardest hit are men with little education and low incomes, especially
people of color. The poorest men in the US have life expectancies comparable to
those of men in Sudan and Pakistan.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">By contrast, the
wealthiest men in the US live longer than the average male in any country, a
Harvard study has found.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Being poor and having
little education, makes Americans very likely to suffer from multiple
conditions, in addition to diabetes, including hypertension, arthritis, and
heart disease. </span><i style="font-family: verdana;">The Times </i><span style="font-family: verdana;">pins an important part
of the blame on soda and -fast food companies, marketing their sugary and
rich-in-fat products primarily to the underserved, people who struggle to get
by, often lacking health insurance and relying on cheap fried food and sugary drinks.
As it stands, 28 million Americans lack health insurance. </span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Researchers have found
that an estimated 183,000 Americans die each year because of poverty—far more
than the number of homicides. Part of the solution must focus on overcoming
“intergenerational poverty and despair,” which cries out for improvement in education,
job training, pay, and opportunities for self-betterment. What would also hold
promise is promoting diversity among health workers. It has been shown that
Black patients do better with Black doctors.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Ethnic affinity is one
of the keys to the success of SOMOS, a network of 2,500 doctors—most of them
primary care physicians—in New York City. They provide some one million of the
poorest and most vulnerable Medicaid recipients in the inner-city with quality
care. Most patients are African American, Asian American, and Hispanic. Many of
their doctors share an ethnic and cultural background with their patients, in
whose communities they live and work. That shared identity contributes to the
bond between patient and doctor.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">That bond is also
strengthened by the fact that SOMOS doctors have comprehensive knowledge of
their patients’ needs. Community Health Workers are the doctors’ eyes and ears,
as they are kept informed about patients’ family situations. These include
awareness of social conditions, the so-called Social Determinants of health,
such as housing conditions, poverty, or educational issues. Such social
conditions can play a critical role in patients’ physical and mental health.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Patients also greatly
value the fact that the doctor has a real sense of their circumstances, which
is the foundation of a relationship of trust. This is how SOMOS delivers
superior care to a population that has traditionally suffered from poor or
mediocre care.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">SOMOS doctors adhere to
high standards in their practice. They have embraced a formula called
Value-Based Care (VBC), which stipulates that doctors are compensated in
accordance with the health of their patients. The better the patients’ health
in the longer term, the greater the financial incentive for the doctor.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">SOMOS's success was
dramatically demonstrated by SOMOS’s ability to reduce by 25 percent both
preventable visits to the ER and unnecessary hospitalizations. In the process,
SOMOS saved</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">New York State
taxpayers $330M. VBC clearly demonstrates that care for the underserved can be
both excellent and cost-effective—an antidote to poverty being an obstacle to
quality health care.</span></p><p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;"><br /></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-family: verdana;"><a href="https://docs.google.com/document/d/1KfLqtoBtLrpsgZ_vhXJzLkzyFoVkvEnu/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p class="MsoNormal" style="mso-layout-grid-align: none; text-autospace: none;"><span style="font-family: verdana;"><br /></span></p><p class="MsoNormal" style="mso-layout-grid-align: none; text-autospace: none;"><span style="font-family: verdana;"><br /></span></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-91275004401204966222023-08-12T17:35:00.001-04:002023-08-12T17:40:01.026-04:00There is a solution for Medicaid fraud—innovation<p><span style="font-family: verdana;">In 2020, Medicaid fraud was estimated to be close to $86.5M. It is a staggering figure burdening taxpayer. And clearly, more needs to be done to remedy a situation where fraud is so pervasively present in a program that cares for the most vulnerable patients.</span></p><p><span style="font-family: verdana;">The FBI lists several main types of fraud: double billing, submitting multiple claims for the same service; phantom billing, billing for a service visit or supplies that the patient never received; unbundling, submitting multiple bills for the same service, or charging more for a service that is usually part of a package; upcoding, billing for a more expensive service than the patient actually received; and over-billing, charging the government for medically unnecessary drugs, procedures, or drugs.</span></p><p><span style="font-family: verdana;">Medicaid patients are particularly vulnerable to physicians' fraudulent practices, as they have no easy access to their medical records. For example, a doctor might falsify or exaggerate a diagnosis to facilitate over-billing. The patient may be subject to unnecessary or unsafe medical procedures. </span></p><p><span style="font-family: verdana;">They are also vulnerable to individuals asking for their insurance identification number and other personal information to bill for non-rendered services. Or their identity may be stolen, and they would find themselves enrolled in a fake benefit plan. </span></p><p><span style="font-family: verdana;">To battle rampant Medicaid fraud, a new healthcare delivery model holds great promise: Value-Based Care (VBC). The VBC formula stipulates that doctors get compensated according to the longer-term well-being of their patients. The healthier the patients, the greater the compensation for the doctor. In sum, doctors are encouraged and put in a position to do their very best for the people under their care.</span></p><p><span style="font-family: verdana;">The model, as instituted by the New York Department of Health in 2014, was called Delivery System Incentive Payment Program (DSIRP). It provided for an iron-clad protocol that would make fraudulent practices pretty much impossible. Its success is exemplified by the achievements of SOMOS, a network of 2,500 inner-city physicians caring for some 1 million of New York City's most vulnerable Medicaid patients, mostly Hispanics, African Americans, and Asian Americans. </span></p><p><span style="font-family: verdana;">To make the VBC model work, doctors must carefully maintain patients' Electronic Health Records (EHR), which would periodically be sent to the Department of Health for assessment. That is when it is determined if the patient population is showing signs of enduring health, which in turn governs the doctor's compensation level. Maintaining the EHRs is a job for both doctors and their staff. Fraudulent records would be readily flagged.</span></p><p><span style="font-family: verdana;">Record-keeping also plays a role in Patient-Centered Medical Homes (PCMH). SOMOS staff works with medical practices to turn them into a one-stop portal where a patient's entire care history is recorded, allowing the doctor to keep track of which services a patient receives, be they medical, behavioral, or social. The social refers to doctors keeping track of patients' social issues that may impact their health, such as substandard housing, unemployment, and poverty. Again, a careful electronic portrait of the patient is maintained, with both doctor and staff doing the record-keeping. Fraudulent entries would quickly be spotted.</span></p><p><span style="font-family: verdana;">Now, doctors prone to committing fraud would be ill at ease being part of VBC, even though such physicians would see their income increase, a factor that prompts their criminal behavior. Ideally, VBC would make honest men and women of them. However, it is hard to picture a less-than-ethical doctor in the SOMOS VBC system, which revolves around a close patient-doctor relationship. That bond is created as physicians earn the patients' trust by getting to really know them, their families, and their circumstances. For much of that intimate detail, SOMOS doctors rely on Community Health Workers as their eyes and ears in the community. Given the stature of SOMOS doctors, it is difficult to imagine fraud-prone physicians, with far less than adequate concern for the well-being of their patients, earning such a position of trust.</span></p><p><span style="font-family: verdana;">Above and beyond traditional Medicaid's vulnerability to fraud and waste, there is a relatively poor record of delivering health care to the most vulnerable. Needy patients, people of color among them, often have a difficult time gaining access to the care they need, given the labyrinthine network of doctors to whom, on paper, they have access. A famous Oregon study (conducted in 2009/2010) found that people with Medicaid coverage showed no significant positive effect on major medical conditions—including hypertension, diabetes, and high cholesterol—compared to those without coverage.</span></p><p><span style="font-family: verdana;">SOMOS saved US taxpayers $330M by reducing by 25 percent both unnecessary visits to the emergency room and unnecessary and costly hospitalization. That is the fruit of Value-Based Care. It is high time for traditional Medicaid to be dismantled and for VBC to be rolled out system-wide. Doctors, patients, and taxpayers stand to benefit greatly.</span></p><p><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><a href="https://docs.google.com/document/d/1yTCLPr-J4oi-SHu-f8TdIoyUi2uG9WSj/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p style="text-align: center;"><br /></p><p style="text-align: center;"><br /></p><div style="text-align: center;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-15947990775561120772023-08-08T07:57:00.003-04:002023-08-08T07:57:16.180-04:00SOMOS: May we be like the sandalwood tree…<p style="text-align: justify;"><span style="font-family: verdana;">Since its very beginnings, SOMOS Community Care was founded
and has developed as an organization with the mission to create and cultivate a
collaborative network of primary care physicians and their clinics. Our goal is
to implement an innovative and revitalized model of healthcare that prioritizes
the needs of our community’s most vulnerable and underprivileged individuals,
focusing especially on migrants in New York City.</span></p><p class="MsoNormal"><span style="font-family: verdana;"><o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">The highest moral principles inspire us in our pursuit of
the common good and we dedicate ourselves to the health and well-being of those
we serve. Strong ethical values guide our healthcare organization in the
interpersonal relationships we form within the company as well as in how we
manage all economic and administrative aspects of our operations.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Our doctors focus on primary and family healthcare with a
preventive approach and aim to relieve the strain faced by hospitals. We do
this by championing a model where hospital institutions attend to patients with
the most urgent and prioritized needs.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Through the years, we can trace the success of our
healthcare services, as I have said, to the integration of hundreds of
physicians and their clinics, as well as the government funding we have secured
through the DSRIP program for state healthcare system reforms. We have been
awarded this funding based on our exceptional results and competencies, which
allows us to continue developing our mission and vision already detailed above.
These results include reductions in the statistics that track stress on
hospital emergency systems and reductions in rates of unnecessary
hospitalizations.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Our healthcare model emphasizes prevention over treatment,
and, as much as possible, healthcare is delivered in the patient’s respective
culture, customs, and language by physicians who are immigrants themselves.
This model not only enhances the MEDICAID system, but it also reveals, let’s
not forget, the difficulties that our organization’s work may face with the
traditional hospital system, because, due to a lack of prior, personalized, and
preventive care, large numbers of patients who do not need emergency services,
or even hospital services at all, attend these facilities. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">As the CEO of SOMOS, I can attest to the ethical standards,
transparency, and honesty with which we manage our financial resources, the
code of ethics that exists at the very heart of our organization, and the
desire and spirit that drives us to continually improve our service to the
health and well-being of all, particularly the most at-risk members of our
city.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><o:p><span style="font-family: verdana;"> </span></o:p><span style="font-family: verdana;">We strive to ensure that all professional services
contracted for the development or promotion of SOMOS are executed and
compensated accordingly. Likewise, we also strive to guarantee that the
healthcare services our network of affiliated physicians provides bear the
hallmark of scientific excellence, efficiency, timeliness, and solidarity that
the invaluable nature of healthcare demands.</span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">At SOMOS, we are committed to promoting the highest and
noblest values of the human spirit both within and outside our organization. We
have fostered collaborative, non-denominational partnerships with various
religious institutions, including Catholic, Muslim, Jewish, and Protestant
denominations.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Our shared pursuit of the common good and the provision of
healthcare, as integral values that support individuals, families, and society,
has brought us together with these religious organizations. We have supported
each other, especially during the pandemic, by utilizing their places of
worship to facilitate health campaigns within their communities.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">This collaborative work with religious communities has
allowed us to personally connect with and draw inspiration from spiritual leaders
such as Pope Francis, who continues to inspire us and all of humanity.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">The prestige that SOMOS has earned with the passage of time
can be traced to the vital healthcare services we have provided to our city,
particularly during the COVID-19 pandemic. Also, our humanistic vision and
solidarity with those who suffer the most have driven us to extend our
services, focused attention, and targeted assistance to communities
experiencing catastrophes and emergencies in Haiti, Cuba, the Dominican
Republic, Puerto Rico, and beyond.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">We aspire to continue to be an increasingly recognized and
sought-after healthcare organization. We aim to expand and enhance our services
over time, and to achieve this, we hope to continue relying on local, state,
and national government support that aligns with our accomplishments,
competencies, and workforce contributions.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Neither individuals nor institutions are immune to the
challenges of competition, power dynamics, economic fluctuations, and political
turbulence that are intrinsic to every society. At SOMOS, we see ourselves as a
vital and dynamic component of the social fabric, embracing the risks
associated with being an active and productive entity within society. We appeal
to the trust of all in our vision and commitment to healthcare as we continue
to grow and thrive.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;">Acknowledging the difficulties that all of us may encounter,
individuals and organizations alike, be they due to internal or external
causes, we, at SOMOS, strive to be, in the words of Nobel Laureate Rabindranath
Tagore, like the sandalwood tree that perfumes the very axe of the woodcutter
that lays it low.</span><o:p></o:p></p><p class="MsoNormal" style="text-align: justify;"><span style="font-family: verdana;"><br /></span></p><p class="MsoNormal" style="text-align: center;"><span style="font-family: verdana;"><a href="https://docs.google.com/document/d/17ev8-XBizjg84recRl3OACZpd269sATA/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">TEXT FILE</a></span></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-42052302084032460852023-07-20T20:14:00.001-04:002023-07-20T20:14:13.055-04:00A BETTER KIND OF POLITICS<p style="text-align: justify;">I appreciate this invitation to participate in this Seminar of Catholic Leaders.</p><p style="text-align: justify;">I have been asked to share with you some reflections on THE CULTURE OF ENCOUNTER AND CIVIC FRIENDSHIP from the Magisterium of Pope Francis, and what these categories and doctrines pose – as challenges – for the life and political participation of Hispanic Catholics of this Nation.</p><p style="text-align: justify;">In his Petrine Magisterium, and especially in the Encyclical Fratelli Tutti of October 3, 2020, Pope Francis invites us to build a better world through the fraternal coexistence to which Jesus of Nazareth invites us all in his Gospel. He exhorts us to make possible better relationships and communities through civic, citizen, or social friendship; friendships that make possible the “culture of encounter.” The “civic friendship” and the “culture of encounter” are two categories that are not the doctrinal or ideological property of Christianity or anyone else. Rather, they are the heritage of all humanity.</p><p style="text-align: justify;">The “culture of encounter” assumes, in individuals, “civic virtue,” which traces its roots to the philosophy and teaching of great Greek philosophers such as Plato and Aristotle (especially in his Nicomachean Ethics). It assumes civic virtue and all that it implies in terms of civic and social life, which entails a form of citizen ethics, a normativity that regulates our indispensable and necessary social coexistence. It assumes a civic virtue that, if practiced among citizens, can strengthen civic or social friendship and, with it, enable a “culture of encounter” as an ideal for human coexistence. We can achieve an understanding that civic virtue is a motivation to act as the good that society requires of us, where self-interest does not take precedence over that which is good. Thus, selfish motivation cannot be virtuous in any case https://www.scielo.org.mx/scielo).</p><p style="text-align: justify;">Civic, citizen, or social friendship does not consist of the good manners of civility that we must observe in personal and social relations. Rather, it deals with the relationships that should occur among citizens in the pursuit of the common good. This means that, regardless of our particular interests or our political, religious, etc., differences, there are – in social life – issues (education, health, etc.) where we must all put our best effort in the pursuit of the general social good.</p><p style="text-align: justify;">Therefore, civic friendship, while demanding respect for individual human rights, is located at a level of higher interests and rights, which concerns the pursuit of the well-being of all. Civic friendship thus becomes the condition we need for Aristotelian “peaceful and social concord,” because friends watch over the good of all friends.</p><p style="text-align: justify;">Pope Francis, “acknowledging the dignity of each human person,” earnestly hopes that “we can contribute to the rebirth of a universal aspiration to fraternity… as a single human family, as fellow travelers sharing the same flesh, as children of the same earth which is our common home…” (FT 8). He hopes that we can contribute to a universal fraternity that is “without borders,” which must be built – and precisely for this reason – amidst “shattered dreams,” “insufficiently universal human rights,” or “conflict and fear,” “globalization and progress without a shared roadmap,” amidst “dark clouds over a closed world,” pandemics and other scourges of history, etc.</p><p style="text-align: justify;">Universal fraternity – according to Pope Francis – opens us to the hope to “engender an open world,” having love as its only value, in societies where everyone is integrated, with a solidary and universal love, which promotes people and “rights without borders,” as long as men and women discover the concept of giving freely in everyday life, with “a heart open to the whole world,” to all humanity.</p><p style="text-align: justify;">With these assumptions, Pope Francis builds his doctrine of “a better kind of politics,” affirming that “the development of a global community of fraternity based on the practice of social friendship on the part of peoples and nations calls for a better kind of politics, one truly at the service of the common good. Sadly, politics today often takes forms that hinder progress towards a different world.” (FT 154)</p><p style="text-align: justify;">We must build this kind of politics upon the foundation of “political love,” and it must be effective, one that integrates and joins us together, through kindness and the pleasure of recognizing the “other.” It is through social dialogue, truth and consensus that we will make possible – in social friendship – the emergence of a new culture: the culture of encounter.</p><p style="text-align: justify;">We understand “culture” through Francis’ definition: “something deeply embedded within a people, its most cherished convictions, and its way of life. A people’s “culture” is more than an abstract idea. It has to do with their desires, their interests and ultimately the way they live their lives.” (FT 216)</p><p style="text-align: justify;">So, “to speak of a “culture of encounter” means that we, as a people, should be passionate about meeting others, seeking points of contact, building bridges, and planning a project that includes everyone. This becomes an aspiration and a style of life. The subject of this culture is the people, not simply one part of society that would pacify the rest with the help of professional and media resources.” (FT 216)</p><p style="text-align: justify;">“A better kind of politics,” “social friendship” and a “culture of encounter,” in the vision of Pope Francis, have as their ultimate purpose the construction of peace or the reign of God (in biblical theology) through forgiveness, as an expression of universal and evangelical love; a task that all religions in the world have to serve. (FT Ch. 8) Because “in many parts of the world, there is a need for paths of peace to heal open wounds. There is also a need for peacemakers, men and women prepared to work boldly and creatively to initiate processes of healing and renewed encounter.” (FT 225)</p><p style="text-align: justify;">This dream, this longing of Pope Francis contains many implications for our daily life as citizens and, therefore, for our life and political participation, in the broadest Greek sense of the meaning of the term “politics,” as a search for the common good of the “polis,” of the city and of all citizens in it.</p><p style="text-align: justify;">Thus, civic life as an exercise of politics or the exercise of politics as a partisan professional choice and electoral and governmental tasks is not, first of all, a matter of laws but of ethical coexistence, that is, of coexistence that seeks – through the gift of friendship among men – the good of all.</p><p style="text-align: justify;">Politics is not an exercise in publicity, untruthful speeches, or the search for privileges and particular interests. Politics is, above all, a daily exercise of shared values and common interests in the search for the common good, especially those most in need of the polis, of society.</p><p style="text-align: justify;">Every day, the news tells us that joint efforts benefit us all, but that the exercise of individualistic, selfish politics, full of ambitions for power and profit, leads also to social ruin.</p><p style="text-align: justify;">The exercise of daily politics, with our deeds, words, and citizen attitudes, or the professional exercise in socio-political leadership makes us sink or swim together, because we are deeply interconnected and share responsibility both in good and in evil.</p><p style="text-align: justify;">Today, unfortunately, especially in the professional and partisan exercise of politics, the concept of friendship is associated with that of complicity in corruption in the management and administration of public affairs.</p><p style="text-align: justify;">But selfishness and individualism in the public sphere and political corruption due to the absence of “social friendship” and fraternal and universal sense in civic life, are undermining democratic institutions and generating “social discord,” which translates into tragic forms of violence, injustice, inequality, and death.</p><p style="text-align: justify;">Ladies and Gentlemen, you are leaders in different areas of life in society. You are leaders of the Hispanic community present in this Nation. </p><p style="text-align: justify;">You are called to organize, guide, and lead people in your Hispanic professional and community environments in building social friendship for the culture of encounter, a “better kind of politics,” and social peace.</p><p style="text-align: justify;">You are charged with forming, educating, and leading our Hispanic communities for the daily exercise of citizenship for the benefit of all and for the best causes.</p><p style="text-align: justify;">You have the capacity and responsibility to “give freely what you have received freely,” to build the world of which Francis dreams and of which we all dream: a world in universal fraternity and with an abundance of life for all.</p><p style="text-align: justify;">A world in which we all respect our rights and fulfill our duties.</p><p style="text-align: justify;">A world in which we go from being anonymous individuals aggregated socially or partners and competitors to recognizing ourselves as brothers and sisters with a common destiny, in a common home.</p><p style="text-align: justify;">A world in which, as disciples of Christ, and through the commandment of love, we all live together as brothers, children of the same Father.</p><p style="text-align: justify;">We all share a responsibility in creating, for present and future generations of Hispanics in the United States, better and greater citizen and political participation and, with it, better lives and a better Nation.***</p><p>Thank you very much!</p><p><br /></p><p><i>***The words and phrases in quotation marks are from FRANCIS, in his Encyclical Fratelli Tutti.</i></p><p><i><br /></i></p><p><i>Mario J. Paredes is a member of the Board of Directors of the Latin American Academy of Catholic Leaders.</i></p><p><br /></p><p style="text-align: center;"><b><a href="https://docs.google.com/document/d/1jPWHfiLVcElsGT-adoz7PONDzKlszvSJ/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></b></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-28374995957096822502023-07-14T15:41:00.001-04:002023-07-14T15:45:11.618-04:00Value-Based Care holds promise to transform healthcare— especially for the underserved<p style="text-align: justify;"><span style="font-family: helvetica;">By 2030, the Centers for Medicare and Medicaid Services plans to see all Medicare beneficiaries and most Medicaid beneficiaries enrolled in Value-Based Payment (VBP) or Value-Based Care (VBC) programs. Simply put, VBC links the compensation of healthcare providers to patients’ health outcomes in the longer run. The formula holds doctors more accountable for improving the well-being of the people under their care and provides them with sufficient freedom and incentive to deliver the right care at the right time.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">VBC is a remedy for the pitfalls of the traditional fee-for-service system. Fee-for-service means doctors and hospitals are compensated for each service they deliver; they are rewarded for volume—they are paid more if they deliver more services, even if these do not achieve the desired result. VBC changes that dynamic by incentivizing the provision of quality care for the good of the patient—bringing costs down in the process.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">VBC also offers a solution for the troubled state of healthcare in the US. The country spends a greater percentage of its GDP on healthcare than other countries. Yet, the US sees the highest incidence of preventable deaths and has the highest infant mortality rate. What’s more, longstanding inequality of access to healthcare leaves people of color and the underserved more vulnerable to illness and disease than the rest of the population. VBC promises to revolutionize healthcare for the most vulnerable.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">VBC produced significant savings for taxpayers, as better health keeps people out of ERs and costly hospital beds, and all along, doctors are rewarded for doing a better job. The latter depends to a large degree on the coordination of a patient’s care; that means a primary care physician keeps close track of all the services a patient is getting or needs. This includes medical care as well as behavioral health services. Significantly, doctors are also encouraged and rewarded for being aware of patients’ social needs. Such needs would never be attended to in the fee-for-service model.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">Quality of care in the VBC is driven by key dimensions, including efficiency, meaning doctors only use resources that are needed; equity in care stipulates that quality of care does not vary based on race, gender, or income; care is centered on the patient and respects values, preferences, and particular needs; and timeliness means care is given without lengthy delays.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">VBC models feature different approaches to doctors’ risks. There is an upside-only risk, with doctors getting more revenue if meet or exceed standards when it comes to quality, cost, or equity. A two-sided risk means doctors also stand to lose revenue if they fail to achieve specific measurements of success. This formula is believed to discourage risk-averse doctors from joining VBC programs.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">There are also non-financial rewards for doctors who join VBC programs. The freedom to deliver the right aid at the right time can give providers a sense of purpose and mission. Participation in VBC also enhances a doctor’s reputation.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">There is growing interest in VBC models on the part of the commercial healthcare sector. It seems clear the significant growth of the model will require that VBC models become more accessible and offer greater incentives, especially for those providers serving disadvantaged populations. Overall, more research is needed to determine the impact of VBC models on patients, doctors, and the healthcare system at large.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">There is a success story in New York City, where SOMOS, a network of 2,500 doctors—most of them primary care providers—is serving some one million of the city’s most needy Medicaid patients. Caring for Hispanics, African Americans, and Asian Americans, the organization has been developing a VBC program since 2014, when it joined New York State’s Delivery System Reform Incentive Payment (DSRIP) program—one of the country’s first such programs.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">SOMOS puts its doctors in the optimal position to deliver superior care to their patients. Thanks to the work of Community Health Workers—who visit patients’ homes to remind patients to keep medical appointments—doctors learn of the social circumstances of the patients’ households. These are the Social Determinants of Health. For example, mold in subpar housing may impact physical as well as mental health, while poverty can mean that there are no means to buy fresh and healthy foods.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, a gateway to all the care needed for patients, with staff keeping close track of, for example, care given by specialists and its contribution to the patient’s overall health. SOMOS doctors bring another dimension to the job: in many cases, they share a cultural and ethnic background with their patients in whose communities they live and work. Their intimate knowledge of their patients’ health needs and their personal circumstances make doctors into trusted figures and leaders of their communities. This dimension is key to SOMOS’s VBC success. That success translated into savings of $330M through a reduction of 25 percent in the number of ER visits and the number of unnecessary hospitalizations.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;">There is no doubt that the transformation of US healthcare—especially for the neediest Americans—will require the adoption and embrace of VBC programs. Both doctors and patients are the better for it.</span></p><p style="text-align: justify;"><span style="font-family: helvetica;"><br /></span></p><p style="text-align: justify;"><span style="font-family: helvetica;"><br /></span></p><div style="text-align: justify;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-15744530440055349902023-06-15T21:40:00.004-04:002023-06-15T21:40:54.836-04:00A Medicaid Purge is Under Way<p style="text-align: justify;"><span style="font-family: georgia;">With the pandemic crisis passed, the government has ended special provisions that allowed millions to be covered by Medicaid. Until recently, 93 million people—one in four Americans—were on Medicaid or on the Children’s Health Insurance Program (CHIP). Since pandemic protections ended on April 1, more than 600,000 people have lost their Medicaid coverage. The vast majority lost their coverage because they failed to complete and submit paperwork, as required by state policy.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">For example, in Indiana, 53,000 people lost coverage during the first month after the end of pandemic provisions. Almost 90 percent were taken off Medicaid for things like failing to return renewal forms. Many forms were mailed to out-of-date addresses. Activists have urged state officials to give people more than two weeks’ notice before losing coverage. In Florida, 250,000 people lost coverage, 82 percent of them for failing to complete paperwork.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">It is clearly unfair to penalize people for failing to fill out and mail in forms. The poor, and especially vulnerable people of color among them, are not adept in dealing with often complicated forms. For those whose first language isn’t English, the process is still more difficult—most forms offer only limited foreign language options. What’s more, many people on Medicaid simply did not know they had to fill out lengthy forms to renew coverage, because during the three years of pandemic provisions renewals weren’t required.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Data from14 states that began cancellations May 1 show that 36 percent lost Medicaid upon review of their eligibility. Most people will get coverage through their jobs, or they will quality for coverage through the affordable care act. Nonetheless, millions of others, including children, will become uninsured, losing access to preventive care and basic prescriptions. The uninsured rate will rise from a historical low of 8.3 percent today to 9.3 percent next year.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Going without access to medical care for many will result in untreated chronic illnesses—diabetes, cardiovascular conditions, hypertension—spiraling out of control. These patients will eventually end up in emergency rooms and costly hospital beds, at the expense of state taxpayers. This is ironic given that states looking to purge Medicaid rolls do so to save money.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">There is an alternative. The experience of a unique network of inner-city physicians in New York City—most of them primary care providers—demonstrates that affordable, superior care for Medicaid recipients can produce significant savings. The 2,500 doctors are part of SOMOS Community Care and provide care for some 1 million of New York City’s most vulnerable and needy Medicaid recipients, mostly African Americans, Asian Americans, and Hispanic Americans. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">SOMOS doctors operate under the Value-Based Payment (VBP) system. VBP stipulates that providers are paid according to longer-term health outcomes of their patients. The healthier the patients, the greater the compensation for the doctor. SOMOS has put in place a model of healthcare that enables and encourages physicians to do their best. The key to success is doctors really knowing their patients and responding to their needs—medical, behavioral, and social. This comprehensive understanding of patients cultivates a strong doctor-patient relationship, with the doctor assuming the role of a trusted figure—not unlike the traditional role of the family doctor who was recognized and respected as a community leader.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Community Health Workers play a critical part as the eyes and ears of SOMOS doctors. They visit patients’ homes, reminding patients of doctors’ appointments and assessing their living conditions. The home may have mold issues, or money is scarce due to unemployment, and there is no access to education. These factors are known as Social Determinants of Health, which have a significant impact on medical and behavioral health.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Overall care of patients is carefully coordinated and kept track off. SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, serving as a portal for patients to access the care that they need. The primary doctor can monitor patients’ progress, for example if they must go for treatment to specialists. The patient is never left to wander alone through a labyrinth of difficult to access care, as is the case with traditional Medicaid. Finally, many SOMOS doctors share the background and culture of their patients, another element that builds trust.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Functioning as a part of an innovative health care initiative launched by the New York State Department of Health called the Delivery System Reform Incentive Payment (DSRIP), SOMOS proved superior care produces significant savings. SOMOS succeeded in reducing by 25 percent both unnecessary visits to the emergency room and costly hospitalizations. This accomplishment saved New York State taxpayers $330M. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">Reforming Medicaid—especially by introducing the Value-Based Payment system—would obviate the purging of Medicaid rolls, and instead make for healthier patients and significant saving.</span></p><div style="text-align: justify;"><br /></div><div style="text-align: center;"><b><a href="https://docs.google.com/document/d/1V652l_A0ON3S5cnCfk3e3lf6zTpNA8lF/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-7977823485349907207.post-27926136367276180432023-06-08T18:15:00.006-04:002023-06-08T18:30:49.352-04:00Immigration Reform Now!<p><span style="text-align: justify;"><span style="font-family: georgia;">We all recognize the images in
recent news. Buses transport people to discard and abandon them in some
“sanctuary” city or anywhere else, relegated to the whims of leaders, in
Florida or Texas for example, as if they are dealing with cattle, viciously,
mockingly and with contempt for the most rudimentary human rights and to
satisfy partisan whims – as if they were playing some disgusting, macabre game.
The news and the images leave us somewhere between perplexed and indignant and
show us the serious, shameful deterioration and moral and social degradation
that the political management of the immigrant situation has in this nation.</span></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">This is a nation that presents
itself to the world as a model of democracy and respect for human rights,
without considering the enormous suffering that takes place in a thousand
different ways on long journeys and that awaits all who want to achieve “the
American dream.”<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">In our world and times, human
immigration is culminating into an unsuspected drama and the human tragedies
(separation of families, diseases, violence, displacement, hunger, death, etc.)
this causes fall beyond the control of governments and nations. This results in
a Dantesque and catastrophic situation, with thousands of human lives in
subhuman conditions, and speaks very poorly of our human spirit while we boast
of our times of globalization and scientific and technological advances.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span lang="EN"><span style="font-family: georgia;">Material
progress is of little use if we do not advance or, worse, we regress in
humanization, solidarity, and justice. All this speaks ill of our degree of
civilization and the search for the common good—and not for individual and
corrupt interests—that must guide us. This also speaks ill of our leaders here
and in the countries from which these migrants come.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">Since the most recent IMMIGRATION
REFORM, we have been hearing for decades in this nation about the urgency of
this issue. Unfortunately, today’s politicians manipulate, politicize, and
exploit the issue of Immigration Reform, not for the desire to do justice and
seek humanity, but with the electoral interest of one side or the other.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span lang="EN"><span style="font-family: georgia;">Each political
party blames the other in this petty and perverse electoral game; they change
the subject; they block it indefinitely. They leave important issues
unresolved, causing suffering and uncertainty for the millions of people
who—already within our borders and residing here for many years—seek to
legalize and normalize their status as citizens in this nation, with all the
duties and rights that this entails, so they can stop living in fear,
ostracism, in the shadows and at the mercy of so many of those who abuse human
and civil rights. These abusers find in undocumented immigrants the opportunity
to pay cheaply for labor, exploit labor and persecute those who do not submit
to their violence and injustices.<o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">But there are interests that must
rank above partisan, demagogic and electoral interests that we must reclaim and
prioritize to resolve stalled and urgent immigration reform. These issues
include the recognition of human and civil rights, the recognition of the
valuable cultural contributions and work that immigrants have contributed in
the construction of the development and progress of this great nation, the
right to a dignified life and homeland and the need for the stability of this
nation to be based on respect for the human being and values such as equity,
justice, social peace and respect for life.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><o:p><span style="font-family: georgia;"> </span></o:p><span style="font-family: georgia;">Through humanitarian actions and
other contributions, social organizations and churches, among others, seek to
relieve this pain and reduce the human drama of migrants inside and, awaiting
entry, outside our borders. At SOMOS Community Care, a medical organization
where I serve as CEO, for example, we offer medical care needed by newly
arrived migrants to our city of New York.</span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">But these are all “first-aid
bandages” that do not solve the root of the problem and that—perhaps—achieve
the opposite, unwanted effect: that of prolonging the nightmare suffered by
millions of our brothers and sisters.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">The solution to this serious,
complex human problem lies with legislators. Enough of postponing a strong,
definitive legal solution for undocumented migrants in our nation! Those who
have taken up the task of legislating for the common good must find their
political will and determination! <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">We must remember that this
resolution also involves joint work with the governments of the countries from
where these migrant majorities originate. These governments—almost
always—shoulder blame for this multitudinous exodus, through administrative
corruption that impoverishes and creates all kinds of social inequalities,
injustices and violence that force so many to leave everything they have and
have earned to seek better living conditions.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">In the United States, within our
communities, our political, social and religious leaders must solve this
enormous human, social and international problem, and it occurs to me, right
now, that this includes, especially, Hispanic community leaders. IMMIGRATION
REFORM as a political and legal action requires commitment, organization, the
unification of all forces and demonstrations as an instrument of social
pressure before our lawmakers.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">Our present-day migratory
phenomenon differs from that of decades ago. Humanity and its history are
dynamic and ever-changing. Therefore, the IMMIGRATION REFORM that we need right
now must consider today’s new realities and cultural and social changes.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 115%; text-align: justify;"><span style="font-family: georgia;">When a human being suffers,
humanity suffers. So, no one is without blame or disconnected from the
phenomenon of migration and its sufferings. We all bear responsibility, and we
can and must do our best, invest our best efforts, to find a definitive legal
solution that will restore the right to a dignified life and hope for a better
tomorrow to millions of men and women who need and deserve it.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: center;"><o:p><span style="font-family: georgia;"><br /></span></o:p></p><p class="MsoNormal" style="text-align: center;"><o:p><span style="font-family: georgia;"> </span></o:p><span style="font-family: georgia; text-align: center;"><a href="https://docs.google.com/document/d/13ucFTyQHVGirflbnkhiJmFivI8M1wZvm/edit?usp=drive_link&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-34690539010190525442023-05-18T18:16:00.002-04:002023-05-18T18:16:37.875-04:00Quality Care for the Underserved: The Story of SOMOS<p style="text-align: justify;"><span style="font-family: georgia;">At the heart of the success of a unique network of 2,500
independent physicians serving one million of New York City's most vulnerable
Medicaid patients lies the conviction that medicine is more than a diagnosis,
treatment, or cure. Instead, the medical profession is called to integrate a
humanistic element that faith, life experience, or drive shapes in every
doctor, and that is decisive in how physicians ply this ancient trade of
seeking to prevent illness and heal the sick.</span></p><p class="MsoNormal"><span style="font-family: georgia;"><o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Before creating the physician's network, SOMOS Community
Care, SOMOS Chairman and Founder Dr. Ramon Tallaj, an immigrant from the
Dominican Republic, learned that independent doctors were isolated. They
occasionally crossed paths, but in their private practices, they were exposed
to a system that increasingly devoured them in every sphere: pressure from
insurance companies, competition with hospitals, and the demands of government
bureaucracy. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Dr. Tallaj set out to unite doctors, inviting them to join
the Corinthian Medical Group, a precursor of SOMOS. Working together, they were
able to benefit from respective individual experiences and unite as a
collective in negotiating with insurers and providers. Joining CMG proved to be
a significant step toward the progress and stability of doctors' practices.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">In August 2014, SOMOS began participating in the application
for the DSRIP or Delivery System Reform Incentive Payment (DSRIP) program, an
initiative launched by former New York Governor Andrew Cuomo to significantly
reduce Medicaid expenses and reform the reigning healthcare model as much as
possible. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">DSRIP embraced a noble purpose, seeking to improve medical
care for those most in need. But from its inception, the hospitals tried to set
the tone and prevent a network of independent doctors such as SOMOS – not
affiliated with a hospital system and with many of its doctors living in the
same neighborhoods as their patients – from being included among the 25 medical
service provider systems that would be approved to join the initiative. Hospital
systems were very interested in removing SOMOS from New York City's medical
landscape. Vested interests put up major roadblocks for SOMOS. But in the end,
SOMOS became a Performing Provider System under DSRIP serving African
Americans, Chinese Americans, and Hispanics, including many immigrants.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Still, SOMOS was not deemed reliable. Hence, a hospital was
imposed upon the organization as a trustee, charged with monitoring SOMOS
spending and approving organizational decisions. Happily for SOMOS, Montefiore
Hospital was eventually engaged as a SOMOS trustee, leading to the creation of
a robust and collaborative partnership.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">For decades, the US healthcare system has focused on
maintaining the status quo. Even when there were Hispanic leaders at the helm
of hospital systems, health care was always dependent solely on hospitals. The
United States has the best disease service in the world, but not the best
health service that puts a premium on prevention. The underserved, elderly,
immigrants, etc., have had to go to hospital emergency rooms even for a
headache. And then, the astronomical bills come. All this has been known for
years, but no one wanted to do anything. It was better to stay on the side of
the big powerful groups than to risk a political career to benefit the
neediest.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">It should be noted that, under DSRIP, SOMOS was paid only
for services rendered. The SOMOS Board closely managed its spending. Nothing is
approved with the mere stroke of a pen, without prior consultations,
discussion, and, above all, verification.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">SOMOS booked notable success: by keeping patients out of the
ER and hospital beds, it saved the federal government $48M a year for five
straight years; New York State taxpayers saved more than $300M due to a 25
percent reduction in visits to the ER and hospitalizations; pilot programs
enhanced the quality of the services rendered to patients; and SOMOS earned
Innovator status in New York State, in recognition of its pioneering work
featuring the Value-Based Payment formula, enhancing physicians' fees in accord
with patients' longer-term health outcomes.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Key to SOMOS' success has been the cultivation of strong
doctor-patient relationships. A major factor in this regard is the fact that
many SOMOS doctors live and work in the same neighborhoods as their patients,
with whom, in many cases, they share the same language and cultural background.
Plus, aided by Community Health Workers, doctors get a sense of the social,
family, and emotional circumstances of their patients' lives—the so-called
Social Determinants of Health. For example, poverty may prevent families from
consuming nutritious meals, which may cause obesity, or diabetes, along with
attendant stress.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Unlike hospitals and the countless Urgent Care facilities,
SOMOS doesn't wait for patients to show up at their doctor's door. Since the
beginning of DSRIP, SOMOS has been developing extensive health education
campaigns and distributing healthy eating models and plans. Working with
invited personalities from the Latino world, it developed an app with exercise
plans and nutritional suggestions. Health education is provided in medical
offices, at community gatherings, in churches, and on the street.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">SOMOS seeks out, talks to, teaches, and educates people so
that they do not come to their doctor with perfectly preventable diseases.
SOMOS sees the patient holistically, within a 360-degree viewing radius,
considering many factors that other healthcare approaches do not consider. The
highest moral principles inspire SOMOS staff and doctors in their pursuit of
the common good. They are dedicated to the health and well-being of the people
served by SOMOS.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">The SOMOS difference between hospitals and the traditional
health system lies in the formula of prevention before treatment. Our doctors are
in the neighborhoods, immersed in the same life dynamic as many of their
patients, whom they also know and have cared for generations. This intimate
familiarity with patients' lives is key to preventive care. It is ironic that
what was once traditional, the family or neighborhood doctor, is now
revolutionary. This has its explanation in the stalemate that large hospital
systems have created as the defining power of health care for years. Hospital
systems, in general, evolved from healthcare facilities to interest groups and
lobbyists that influence and determine health policies at the state and federal
levels. This makes them key factors in a disease-based health system, but not a
healthcare system that has the patient at the center of its vision and mission.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">For these large systems established on the idea that the
sicker people are, the better the economic results, it is a nuisance that a
group of 2,000 independent doctors has acquired power and reputation with their
work within the community. They are also concerned that they are losing money
on emergency room visits because SOMOS doctors are treating hundreds of
thousands of people, trying to keep them from getting chronically ill, or
having to go to emergency rooms because they have no one to treat them. In the
SOMOS vision, hospitals attend to only patients with the most urgent and
prioritized needs.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">The end of the first DSRIP mandate coincided with the onset
of the COVID-19 pandemic. On this front, too, SOMOS took a course decidedly
different than that of the healthcare establishment, which focused on
hospitalization and the purchase of costly ventilators and other medical
equipment. SOMOS focused on educating the community as to the importance of
isolating people struck by the virus and protecting family members living
together in close quarters. Here, too, the focus was on prevention rather than
treatment of the disease. SOMOS fought hard every day so that our message of
isolation and protection reached all communities. The strategy flew in the face
of large institutions seeking to maintain the status quo of a disease system.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Our doctors took to the streets. SOMOS bought and set up
tents in different neighborhoods to administer COVID-19 tests which SOMOS often
bought with its own funds. SOMOS took to the radio stations, television
stations, and the press with messages that people had to social-distance, and
that they had to isolate the sick, especially from the elderly. Messages were
delivered in English, Spanish, and Chinese. SOMOS educational campaigns were
comprehensive and efficient. Eventually, SOMOS convinced authorities of the
need for people to isolate themselves and of the importance of educational and
outreach campaigns among those most in need.<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">When, after lengthy delays, SOMOS was mandated to distribute
the COVID-19 vaccine, it did so at distribution points in the community, going
to the people and facilitating access to the vaccine for the neediest. From the
start of the pandemic, SOMOS also delivered food to the neighborhoods, working
in tandem with major charitable organizations. SOMOS is yet to be reimbursed by
the State for all its work and contributions in fighting the pandemic. <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">Dr. Tallaj, concluding a recent report on the history of
SOMOS, put it thus: "My mission, and as such the mission of the network of
doctors I lead, is to educate our community, our children, and our youth today;
and treat them preventively, if possible, to prevent avoidable chronic diseases
from conditioning their lives in the future." <o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><span style="font-family: georgia;">"This has an economic benefit for the government as a
beneficiary of health programs and for insurance companies. But the greatest
benefit is for the person, the human being, who will be able to live and
function well in our society. If we manage to see the role of the doctor like this,
if we can convince politicians of the fundamental importance of the primary
physician (general practitioner or family doctor) and of the need to allocate
funds to those doctors so that the neighborhoods, regardless of the social
class that resides in them, become conglomerates of healthy people, it will
have been worth facing so many challenges... and to have kept fighting."<o:p></o:p></span></p>
<p class="MsoNormal" style="text-align: justify;"><o:p><span style="font-family: georgia;"> </span></o:p></p><p class="MsoNormal" style="text-align: center;"><o:p><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1xPCsbz-1ja3MrPeSAgdWTYpOPy102EPJ/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></o:p></p><p class="MsoNormal" style="text-align: center;"><o:p><br /></o:p></p><p class="MsoNormal" style="text-align: center;"><o:p><br /></o:p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-73191634239511180712023-05-15T23:00:00.005-04:002023-05-15T23:00:57.545-04:00The faith, or lack of it, of US Hispanics<p style="text-align: justify;"><span style="font-family: georgia;">Though it remains the faith to which most US Hispanics belong, it also is the faith that is losing more Latinos than any other religious group, with an increasing number of Hispanics identifying as religiously unaffiliated. These were some key findings of a Pew Research Center report released April 13. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">In 2010, 67 percent of Hispanics said they were Catholics. That figure has dropped significantly to 43 percent in 2022. That figure stood at 49 percent in 2018. Almost one-in-four US Hispanics are former Catholics. Of the 65 percent of Hispanics who said they were raised Catholic, 23 percent report that they no longer identify as Catholics. Some have joined another faith, becoming mostly Protestants, while many no longer belong to a Church. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">Protestants are the second largest faith group to which Hispanics belong, accounting for 21 percent of US Hispanics. Among Hispanics, 39 percent say religion is “very important.” Of Hispanic evangelicals, 73 percent say religion is very important, with 46 percent of Catholic Hispanics saying so. Among US Hispanic Catholics, 22 percent attend Church weekly or more often. Just 1 percent of religiously unaffiliated do so.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">The share of Hispanics who identify as atheist, agnostic, or “nothing in particular” stands at 30 percent. That compares to 10 percent belonging to this category in 2010 and 18 percent in 2013. It should be noted that 29 percent of Hispanics who say they do not belong to any faith continue to pray at least weekly. Almost a quarter of all US Hispanics are former Catholics.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">The abandonment of Catholicism is most pronounced among young people ages 18-29. Of this group, 49 percent identify as religiously unaffiliated. The 50-64 and 65-plus age groups are least likely to identify as unaffiliated, with respectively 20 percent and 18 percent claiming religiously unaffiliated status. Those are still significant numbers. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">Among foreign-born immigrant Hispanics, 52 percent belong to the Catholic Church, with 21 percent identifying as religiously unaffiliated. By contrast, 36 percent of US-born Hispanics say they are Catholic, while 39 percent say they are religiously unaffiliated. Language also plays a role, with 56 percent of Spanish-dominant individuals identifying as Catholic, compared with 32 percent of English-dominant saying they are Catholic. That figure stands at 42 percent of bilingual respondents.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">The decline in the number of Hispanics embracing the Catholic faith—especially but not exclusively among young people—should give Hispanic Church leaders pause. It calls for innovative evangelization efforts that consider what is most important in people’s lives, which for many revolves around material success. Hispanics going to Mass and living a Catholic life can no longer be taken for granted.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">It seems clear that the American way of life, predicated on entertainment and the acquisition of money and material goods, numbs Hispanics with respect to their Catholic roots and values. It leaves them empty in critical ways. People are working two or three jobs to keep up, which pushes reflection and spirituality to the sidelines. There is a sharp decline in the appreciation of the faith that has shaped and sustained the cultures of Latin America. For hundreds of years, the Church has played a vital role in US Hispanics’ countries or cultures of origin, while Catholicism is also the foundation of the formation of the human person.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">For Church leaders, the task ahead is presenting Catholicism in a more dynamic form that drives home the historical and contemporary importance of the faith. Somehow, the Church must engage and convincingly challenge the dominant culture to present a viable alternative in a culture driven by materialism and the ambition to succeed. The Church can borrow a page from the evangelical playbook and its commitment to going out to the people rather than waiting for the people to come to the Church.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">There also is a political and ideological battle that must be waged. Former Catholics, the Pew survey notes, cite the Church’s lack of LGBTQ inclusivity, the clergy sex abuse scandal, and the ban on women priests as key factors that prompted them to leave the Church. On this front, too, the Church must demonstrate sensitivity and sophistication to make a compelling case for its teachings.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Failing a concerted, creative effort on the part of the Church, the loss of Hispanic Catholics will continue apace, further undermining a faith that goes to the heart of the Hispanic community.</span></p><p style="text-align: justify;"><span style="font-family: georgia;"><br /></span></p><p style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1XA4oR40tYpT1Es7PnXsdfG3nAWrZ7oeS/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></p><p style="text-align: center;"><br /></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-57175385567598622862023-04-25T18:49:00.000-04:002023-04-25T18:49:04.274-04:00 Urgently Seeking "Passage"<p style="text-align: justify;"><span style="font-family: georgia;">The Hebrew word "pesah/pesaj" and the Spanish word "pascua" both mean "passage." With these words, we commemorate the "passage" of the people of the Old Testament across the Red Sea and their resulting liberation from slavery in Egypt as well as the "passage" of the first Christians to their "new" life, i.e., the transformation of their lives following the death of Jesus of Nazareth. This is a transformation and new life that they attribute to the Crucified One, to whom they now confess as the "Risen One," because this transformed their lives.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">During these weeks, Catholics find ourselves celebrating the Easter season when we commemorate the Resurrection of Christ and our resurrection through Him, a resurrection that embodied, among the first disciples and must embody today in us—as I said—a "passage" to a different, transformed, and new life that seeks the construction of better existences, societies, histories and a better humanity. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">This inspires in me some reflections that I will share with you within these lines, through which I intend to compare the men, women, lifestyles, and society of our historical conjuncture against the "new man," as St. Paul calls him, stemming from his own conversion experience and detailed in his theological explanation of the paschal event.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">I do not shrink from my position as a believer in Christ, but I understand that the truths and criteria of the Gospel have universal validity insofar as they coincide with the deepest and most genuine values engraved in the heart and human nature of every man and woman, believer, or non-believer. These are values that every human being expresses as tendencies. They are: life, goodness, truth, love, solidarity, justice, peace, etc.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Jesus of Nazareth lived and taught these values, which constitute the criteria and logic of the Gospel and contrast against the logic of our world. These are the values that are constituted in the "renewed mentality" of the "new" man and that we see in the ways that those who are new and good live and work. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">It falls to us to live in this global culture and time, in this transition from modernity to postmodernity, characterized by principles and values that contradict the human and universal values mentioned above.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Ours is a historical juncture characterized—following two world wars and countless failures—by the meaninglessness of history, a history with no future, a funeral of hope. We live immersed in a consumerist culture and society where everything can be negotiable, fashion determines moral behavior, and the abundance of material things is the reason for living. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">This generates materialistic societies and standards of living where "having" prevails over "being," in an immanentism and reluctance to place oneself higher, to transcend. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">Apathy for the greater good and our society as a whole characterizes this "light" man, culture, and society because it is within this individual, personal and private "sanctuary" that happiness occurs. This leads—where universal truths and certainties are lacking—to a "moral relativism," subjectivism, sentimentality, moral permissiveness, and laxity. </span></p><p style="text-align: justify;"><span style="font-family: georgia;">In a world where each person constructs "à la carte" their own half-truths of consumption through mediocre life projects, where "truth is defined by what is convenient for each individual person" and in which the happiness, enjoyment, and pleasure of the immediate, here and now, are imposed as the norm and measure of life.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Our societies are naïve. They are lacking in hard work and sacrifices. They are lightweight, with lifestyles imbued with facilitation, and surrounded by the disposable, superficial, and banal, by façades and appearances, exteriority, and the disengaged.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Confronted by this panorama, our society and world urgently need models of humanity who pursue well-being and happiness by following the principles of the Beatitudes, taught by the master of Nazareth, and eschewing our culture's siren songs that have been built upon the shifting sands of worldly vanities.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">We have grown tired of clay-footed models elevated by "light" advertising. We need men and women who are role models, witnesses and examples of authority and truth, who model coherence in life, their words and deeds, and their professional titles and lifestyles.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Today's world urgently needs rulers, religious leaders, parents, teachers, and professionals in all fields who have moral authority and live lives worthy of being followed and replicated.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">We are fed up with social leaders in all fields, who do not "lead by example." We have grown tired of social authorities and dishonest professionals who live public and private lifestyles that disregard the noblest values that should guide every human being and moderately healthy society.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Our society and all humanity urgently need "new" women and men, authentic and capable of building, through their deeds, words, and attitudes, new paths that enable "new" societies, i.e., just, solidary, fraternal societies, in which we can hope for better times.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">Those who—foolishly, ostentatiously, and boastfully—dedicate themselves to "losing themselves" in the "craziness of life," in the traffic of this frivolous, superficial and materialistic world, the banal and light world of brands and labels, the hedonistic and pansexualist world, a world of comforts, luxuries, waste and bacchanals, proceed through life confusing immediate success with happiness. They attack fundamental human values, but they—also—insensibly turn their lifestyles into an impudence, a shame, and an affront to a world plagued by needs and the needy, by hunger, inequities, fratricidal wars, violence, injustices that cry out to heaven, etc.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">"To whom more is given, more is demanded." Our society urgently needs leaders in all fields and professionals in all branches of knowledge who lead consistent, adequate lives and conform to the exercise of our social roles. They must lead exemplary and integral lives and not the double lives and double standards that today, in this world of moral relativism, are so celebrated and applauded.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">I invite us all to ask ourselves about the coherence between our deeds and words, between what we believe and what we live, to ask ourselves about the coherence between our private lives and the public exercise of our professions, about the coherence between the lives we live and the society and the world for which we yearn.</span></p><p style="text-align: justify;"><span style="font-family: georgia;">I invite everyone to live life as an everlasting "Pascua," or journey, a daily and permanent "passage" to be better human beings and professionals who seek the construction of a better society and a "new" world.</span></p><div style="text-align: justify;"><br /></div><div style="text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1s9s3AyRwM0VeeZY8XT0H00-mP7OC7hZp/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-87563945892344754462023-04-08T08:00:00.007-04:002023-04-08T08:00:00.177-04:00Easter Forever<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7ZZY2kmXdj2cWPPpsECqyMaXiXYgP5qtq3oN-dsvxOCnRpp5fCwalJuyFFnfYEjyh8PAUAAbo_q9Stn6tslogqFmArDktqsW4HBWKMrl0ueIUfTneoWeV1bvqkMDvmQgd8midhP3LJxrU7GympwVpW9Wz0DiwV6Y6NuqIp-RyiLIPqhi0T9cjOieT/s963/Easter%20Forever_560.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="963" data-original-width="560" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7ZZY2kmXdj2cWPPpsECqyMaXiXYgP5qtq3oN-dsvxOCnRpp5fCwalJuyFFnfYEjyh8PAUAAbo_q9Stn6tslogqFmArDktqsW4HBWKMrl0ueIUfTneoWeV1bvqkMDvmQgd8midhP3LJxrU7GympwVpW9Wz0DiwV6Y6NuqIp-RyiLIPqhi0T9cjOieT/s16000/Easter%20Forever_560.jpg" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1lLLOZBpdu03CYetgxYmlzfAGTTJqB-8G/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></div><br /> <p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-42390698603515044212023-03-31T21:16:00.001-04:002023-04-02T14:27:45.202-04:00Our Holy Week, Every Day<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitwC-NbCChC7bgfT-swjH1UjsKXiyYI-ySUlQaiOZVx_lv1Be0pNmk7p2wO1EP4CAIqMd3259CGgN9OjeB7iYOEjii3j-pER0cJy9CS42Y9H9MoJCw4Vuts0yY2kbHKJu3MAmxRh8MeARD45C9WzBVuCkGTFYp2Yj4VQU8jyM4MSNf74a4N0HEXCGI/s963/OUR%20HOLY%20WEEK,%20EVERY%20DAY%20%E2%80%A6560.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="963" data-original-width="560" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitwC-NbCChC7bgfT-swjH1UjsKXiyYI-ySUlQaiOZVx_lv1Be0pNmk7p2wO1EP4CAIqMd3259CGgN9OjeB7iYOEjii3j-pER0cJy9CS42Y9H9MoJCw4Vuts0yY2kbHKJu3MAmxRh8MeARD45C9WzBVuCkGTFYp2Yj4VQU8jyM4MSNf74a4N0HEXCGI/s16000/OUR%20HOLY%20WEEK,%20EVERY%20DAY%20%E2%80%A6560.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: georgia;"><a href="https://docs.google.com/document/d/1sOSicSTIplyg3V8HPCR1aLWf6NpQUoo0/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text File</a></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-7977823485349907207.post-67157546354889811212023-03-13T14:05:00.000-04:002023-03-31T14:13:25.554-04:00Ten Years of Good Shepherding<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyBizVT4LEzl4NClf2sr__M2IFGjcQj36-l95BWVCcGkhVw7XdtsKFiXZHIYLixE3Y97HCDBGqqHiEJ3-dWcGGIhIq2iebJ_y4Qnb9A0r61pHdSVXugQLOYPqhdHd_Px4_T4gqkJjifL_AePOyljhytOzYFCP4kJ-0jqAtuTarhJnDWkAw-un-l5Yo/s1115/Ten%20Years%20640.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1115" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyBizVT4LEzl4NClf2sr__M2IFGjcQj36-l95BWVCcGkhVw7XdtsKFiXZHIYLixE3Y97HCDBGqqHiEJ3-dWcGGIhIq2iebJ_y4Qnb9A0r61pHdSVXugQLOYPqhdHd_Px4_T4gqkJjifL_AePOyljhytOzYFCP4kJ-0jqAtuTarhJnDWkAw-un-l5Yo/s16000/Ten%20Years%20640.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b><a href="https://docs.google.com/document/d/1yDmZP8Wswb9Efn8CEjWM4JDN8AtliABk/edit?usp=sharing&ouid=110040297242628018491&rtpof=true&sd=true" target="_blank">Text file</a></b></div><br /><div class="separator"><br /></div>Unknownnoreply@blogger.com0