Conversations on Health: How We Get There - with Stephani Shelton

Episode 33: A Conversation with Dr. Anurag Gupta, Tembo Health, on Improving Dementia Care

It’s no secret our population is aging fast. According to the US  Census Bureau, 10,000 Baby Boomers hit that 65 landmark year each day. In fact 2025 is predicted to be “peak 65” demographically – with more than 11,000 Boomers crossing the daily line. Unfortunately as we age – more of us develop dementia and Alzheimer’s – with most of the associated costs paid by Medicare. It’s estimated that for Alzheimer’s care alone – costs are as much as 2.8 times higher than for other seniors.
So Medicare has begun an experimental program called Guide. Partnering with some private, digitally oriented companies to create better dementia outcomes -  both personally for older people and their caretakers and financially for Medicare.
One of those companies is Tembo Health – founded and run by Dr. Anurag Gupta. He’s a practicing emergency physician with both an MBA and an additional degree and board certification in Clinical Infomatics. And lots and lots of real world experience at top rated hospitals.
The concept of public-private partnering in healthcare isn’t new; but it’s certainly not every venture capitalist- financed start-up which hopes to make its mark with dementia care. So here’s my really useful conversation with Dr. Anurag Gupta:
https://www.tembo.health/
https://www.cms.gov/priorities/innovation/innovation-models/guide
YouTube Episode link: https://youtu.be/3Dw1rnp8Rc0

Episode 32: A Conversation on Pain, Addiction and Prevention with Addiction Specialist Dr. Arun Gupta

Most of you know something about the opioid crisis. It’s considered one of the most devastating public health catastrophes of our time.
Just to summarize briefly – the first wave of deaths began in the mid 1990s when Purdue Pharma’s newly approved pain drug OxyContin was pushed to doctors. Purdue had lied to the FDA, saying OxyContin was less addictive than other opioids. It was, actually, even more addictive. Then came the wave of deaths from many of those addicts switching to “street” heroin. And then, as we all know, came the synthetic opioid fentanyl. 2024 figures aren’t yet finalized but even though there has been a decline in deaths - the US continues to have the highest rate in the world.
With that as the background – I just had a very illuminating discussion with Dr. Arun Gupta. He started as an internist.  But ultimately, he got so upset about the plight of his addicted patients in his mostly rural Michigan practice that he became a specialized addiction doctor. Then he wrote a book laying out the history of opioids and what needs to be done to help patients recover.  This is a conversation I don’t think you want to miss.
Note: all episodes are also available in video form on YouTube
https://thepreventableepidemicbook.com/ (website is being updated)
https://www.samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose-reversal   (NARCAN etc.)
 
 
 

Episode 31: A Conversation on How NOT to Pay Medical Bills – Legally - with Author Frank Lobb

Have you ever been hit by a huge medical bill when you thought your health insurance would be covering most of it? Do you know that unpaid medical bills are one of the top reasons Americans declare personal bankruptcy? Well, meet Frank Lobb. He’s a retired navy pilot whose later managerial background in law and compliance had nothing to do with health care. But some years ago Lobb had a very frustrating and ultimately tragic fight with his wife’s insurance company. And he began researching health insurers, personal medical bills and your rights under the law. He’s now written four books on what he’s learned – the latest  - just recently published – is called “The Big Lie in My Healthcare Bill”.  Here’s our conversation -- and I think you’ll learn a lot from Frank Lobb about how you can protect yourself and your family. I certainly did!
Note: all episodes are also available in video form on YouTube

Episode 30: A Conversation on Obesity with Dr. Naser E. Gharaibeh, Medical Director, Valley Health System Center for Weight and Wellness, New Jersey

UPDATE: The Trump administration has decided Medicare will NOT pay for the popular GLP-1 drugs just for weight loss. It would have cost the government nearly $40 Billion over 10 years.
Perhaps the hottest, most divisive topic in health care is obesity. Which in the US appears to have stabilized in 2024 at about 40% of adults. Is obesity a disease or a lifestyle result? How does it affect overall health and what diseases can it cause? Who should take the expensive new GLP-1 weight loss drugs like Wegovy? And perhaps the most divisive issue - who should pay for those drugs – and how.  Get ready for a great conversation with tons of useful information from my guest Dr. Naser Gharaibeh, MD, CPE, DABOM, NCMP – who heads the Valley Health System Center for Weight and Wellness in New Jersey. Dr. Gharaibeh is board certified in obesity medicine as well as endocrinology, diabetes, metabolism and internal medicine.
Note: all episodes are also available in video form on YouTube

Episode 29: A Conversation with Dr. Michelle P. Warren, Endocrinologist, Gynecologist. Medical Director, Center for Menopause, Hormonal Disorders & Women’s Health, Columbia University Medical Center

Is women’s health moving backward?  
The Supreme Court’s Dobbs Decision in 2022 overturned what most women believed was settled law – the landmark 1973 Roe v. Wade decision - establishing a constitutional right to abortion. Since Dobbs, many states - especially in the South and Midwest - have banned abortions for any reason or tightly restricted them.  Leaving many women in medically dangerous conditions. Even before Dobbs – the United States had a maternal death rate more than double and sometimes triple most other high income countries. More women are obese than men. Causing multiple health issues. These all suggest that after major gains – women’s health in general may be moving backwards. So i asked Dr. Michelle P. Warren to come on the podcast. She’s a distinguished New York City physician who specializes in both endocrinology and gynecology and has spent her lifetime focused on women’s health issues. In 1997, Dr. Warren founded and remains the Medical Director of the Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University Medical Center.  Where she is the Wyeth Professor Emeritus of Obstetrics, Gynecology and Medicine. Full disclosure - I have been her patient for many years.
UPDATE 2/2025: Currently – the main source of women’s health information – the CDC website – carries an advisory that it’s “being modified to comply with President Trump’s Executive Orders”. Some unavailable original pages - including many on HIV – have been archived by doctors and health writers at CDCguidelines.com and other websites. But the CDC’s scrubbed website still has much on menopause - complementing the useful women’s health information in Episode 29.
Note: all episodes are also available in video form on YouTube
http://www.center-for-menopause.com/
https://menopause.org/
 

Episode 28: A Conversation with Ateev Mehrotra MD, MPH; Chair, Department of Health Services, Policy, and Practice, Brown University School of Public Health

Late word from CMS – Medicare will keep covering telehealth use through March. Congress must OK a further extension.
Lots of us became well-acquainted with telemedicine during the pandemic. And while many of us have gone back to office appointments with our doctors – telemedicine remains useful. Especially for mental health issues. How useful? Well – recently I logged onto a fascinating Health Affairs Journal webinar on telemedicine. And with winter upon us – I thought it would make a timely episode. Joining me is one of the presenters – Ateev Mehrotra, MD, MPH. He’s a practicing physician as well as the Walter H. Annenberg Distinguished Professor and Chair of the Department of Health Services, Policy, and Practice at the Brown University School of Public Health. His research focuses on delivery innovations and their impact on access, quality, and spending. These include innovations such as telemedicine, remote patient monitoring, retail clinics and e-visits.  Our interview was recorded earlier this month  – before the Trump Administration takes office.
Note: all episodes are also available in video form on YouTube
The Impact of Telemedicine on Medicare Utilization, Spending and Quality  2019-2022. Ateev Mehrotra MD, MPH and colleagues; published 4/27/2024 in Health Affairs Journal
 
 

Episode 27: A Continued Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Medicaid and Obamacare Updates for 2025

 Open enrollment for Medicare supplement plans, which continues until December 7, runs somewhat concurrently with the annual sign up period for the Affordable Care Act plans - commonly called Obamacare. The plans became available on state marketplaces on November 1 and the window closes on December 15 for coverage beginning January 1. We explained the major Medicare changes for 2025 in Episode 26 - check it out if you or someone in your family still needs the podcast’s actionable information. But right now let’s talk about the other actionable information – the 2025 Obamacare plans and who’s eligible for them. Back again is Dr. Steven D. Culler - our expert from Episode 26 and last year’s more extensive Episodes 14 and 15. He’s an Associate Professor at the Rollins School of Public Health, and Affiliated Associate Professor at the Goizueta Business School at Emory University in Atlanta.
Note: all episodes are also available in video form on YouTube
 

Episode 26: A Conversation with Dr. Steven D. Culler, Associate Professor of Health Policy and Management at Emory University, on Medicare Updates for 2025

Once again it’s open enrollment time for Medicare plans - which runs for just 6 weeks each year - from October 15 until December 7th. Millions more Americans who don’t get health insurance through their jobs or Medicaid can find or change so-called Obamacare insurance plans from November 1st through January 15th of next year. 
In this episode we’re concentrating on the biggest changes to Medicare for 2025, including qualifications for weight loss drug Wegovy coverage and the Medicare Advantage plans used by about 50 percent of Medicare recipients. Episode 27 – dropping on November 19th – will catch you up on the Affordable Care Act changes and their relationship to the state-run Medicaid coverage. This is hard information you can – and should use right now. We’re also taking a look at the effect of the top Medicare changes on private, work–related insurance plans, which are likely to make adjustments for 2025.
If you need a primer on how these programs actually function – check out Episodes 14 and 15. Dr. Steven D. Culler - our expert from those earlier episodes – was kind enough to come back again for this update.  He’s an Associate Professor at the Rollins School of Public Health, and affiliated Associate Professor at the Goizueta Business School – at Emory University in Atlanta.
Note: all episodes are also available in video form on YouTube
https://www.kiplinger.com/retirement/medicare/three-medicare-changes-on-the-horizon-for-2025
https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-part-d-premiums/
https://www.cms.gov/
 

Episode 25: A Conversation with Dr. Mirella M.N. Minkman on Neighbors Helping Neighbors Toward Better Health in the Netherlands

Health experts in many countries – including the United States – are looking beyond standard health care and medical treatments to some kind of community-based care.  Both as a way to improve people’s general health - and as a way to cut the spiraling costs of medical procedures and new drugs.
The Netherlands appears to be well ahead of most countries with its varied efforts to re-invent what is generally called “social care” - starting right at the neighborhood level.
With the huge Boomer population aging quickly - the Netherlands also has a particular focus on integrated care for people with multiple health issues. Which includes giving them access to adequate health care before those issues become serious.
My guest is one of the Netherlands’ top experts in these areas - Professor Dr. Mirella M. N. Minkman of Tilburg University, Tias Business School and CEO of Vilans, National Center of Expertise for Care and Support. We cover a lot of territory – including what is a growing problem virtually everywhere – more and more young people with mental health needs. You’ll be surprised to find out how varied – and sometimes how simple social care can be.
Note: all episodes are also available in video form on YouTube
 
 

Episode 24: A Conversation with Maggie and Suzanne about Having Friends and Loved Ones in Rehabilitation and Skilled Nursing Facilities

Do you know someone – perhaps in your own family – who has spent time in a rehabilitation facility? Maybe after an illness or operation? Lots of people – and particularly older people who live alone – find themselves in rehab or long term care facilities. These are somewhat different from the assisted living or independent care communities we talked about in Episode 10 - when we explored one family’s exhaustive effort to find a place for their Mom in North Carolina. Rehab facilities are often affiliated with hospital groups and deal with everything from recovering from knee replacements to stroke and even dementia care.  The residents may be there for just a few weeks – or much longer.
My husband and I discovered that two good friends each have someone they care about in residential care at the same, independently owned, northern New Jersey facility. One day they started talking about the issues they’re encountering – like staffing, adequate physical therapy, mental stimulation and the overall differences between this independently owned facility and the more common and usually larger, company-owned facilities. My husband – the video editor and producer for this podcast series said – “you know -– this would make an interesting episode”. And I thought it may also be very helpful. We decided not to use the actual name of the place – or the names of our friends. So – cozy up with a cup of tea or coffee – and join “Maggie”, “Suzanne” and me for the conversation.
Note: all episodes are also available in video form on YouTube