AN: Yeah. And I needed science in my mid-30s to prove to me that emotions were real, even though I was literally a professional musician and expressing emotion was my job. I guess the performance aspect of it made me able to separate myself. Okay, emotions are cycles that happen in your body. They are neurological events, and when I say neurological, I mean not just happening in your brain but your whole nervous system, the intelligence of your body extends to your nervous system from the top of your head to the tip of your toes and also beyond your skin. Emotions are an involuntary neurological response. They have a beginning, a middle and an end.
AN: All of that is fine and good, and it works in gazelles and it works in human beings too, but there is a barrier that gets in our way. We all know about fight and flight. Most of us even know about freeze.
EN: And you flop down, put your hands on the ground and let your body soak and release. And that, even by itself, is going to begin to release the physical chemical stuff that was happening in your body with the stress. Any movement of your body.
EN: Yes, yes, yes. Even when I first started learning the stuff, like everything, I underestimated how powerful it was, it sounded too easy, it sounded like it was kind of just like a hippie, made up thing.
EN: Right now, my whole body is like the most important thing, the most powerful thing to be aware of is sisterhood. So not just Amelia, my actual sister, but the experience of sisterhood, you being with your sister, and the idea of the ways that our book can facilitate a feeling of sisterhood among women.
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The proposed Transforming Episode Accountability Model (TEAM) would be a mandatory episode-based alternative payment model in which selected acute care hospitals would coordinate care for people with Traditional Medicare who undergo one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes. The surgical procedures included in the model would be lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. For purposes of TEAM, CMS would provide participating hospitals with a target price that would represent most Medicare spending during an episode of care, which would include the surgery (including the hospital inpatient stay or outpatient procedure) and items and services following hospital discharge, such as skilled nursing facility stays or provider follow-up visits. Holding individuals accountable for all the costs of care for an episode may incentivize care coordination, improve patient care transitions, and decrease the risk of avoidable readmission. In addition, TEAM includes a proposed voluntary Decarbonization and Resilience Initiative, through which CMS would assist individuals in increasing quality of care by addressing threats to patient health and the health care system presented by climate change.
People with Traditional Medicare undergoing a surgical procedure either in the hospital or as an outpatient may experience fragmented care that can lead to complications in recovery, avoidable hospitalization, and other high costs. This is because in a fee-for-service (FFS) payment system, providers and suppliers are paid separately for each service and procedure, potentially resulting in fragmented care, duplicative use of resources, and avoidable utilization. TEAM would test an episode-based payment approach in which the selected acute care hospitals would receive a target price to cover all costs associated with the episode of care, including the cost of the hospital inpatient stay or outpatient procedure and items and services following hospital discharge, such as skilled nursing facility stays or provider follow-up visits. Through the target price, CMS would hold individuals accountable for spending and quality performance, which can motivate health care providers to better coordinate care and improve the quality of care. TEAM could benefit people with Traditional Medicare who receive one of the included surgical procedures by potentially improving care transitions, encouraging provider investment in health care infrastructure and redesigned care processes, and incentivizing higher value care across the inpatient and post-acute care settings for the episode. Five different surgical procedures would be included in TEAM: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.
TEAM would be a five-year, mandatory episode-based payment model that would start in January 2026. Hospitals required to participate would be based on selected geographic regions, Core-Based Statistical Areas (CBSAs), from across the United States. The proposed TEAM design includes a one-year glide path, which would allow individuals to ease into full financial risk. TEAM would have three participation tracks: Track 1 would have no downside risk and lower levels of reward for the first year; Track 2 would be associated with lower levels of risk and reward for certain hospitals, such as safety net hospitals, for years 2 through 5; and Track 3 would be associated with higher levels of risk and reward for years 1 through 5.
Episodes would begin with a hospital inpatient stay or a hospital outpatient procedure for one of the following surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. Each episode would end 30 days after the individual leaves the hospital.
Notably, and consistent with the CMS Innovation Center strategy to drive accountable care and integrate specialty care and primary care, the model is designed to complement longitudinal care management through policies that align with Accountable Care Organizations (ACO) and promote primary care referral. Under TEAM, a person receiving care from (aligned to) providers in an ACO would still be able to be in an episode if they receive one of the surgeries included in TEAM at a hospital that is selected to participate in TEAM. Allowing a person with traditional Medicare to be included in both TEAM and ACO initiatives would help to promote provider collaboration to find opportunities to improve quality of care and reduce Medicare spending. Also, TEAM would require hospitals to refer patients to primary care services to support continuity of care and positive long-term health outcomes.
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Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.
Sometimes people have both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. During an episode with mixed features, people may feel very sad, empty, or hopeless while at the same time feeling extremely energized.
A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar II disorder experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.
Receiving the right diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a health care provider is the first step. The health care provider can complete a physical exam and other necessary medical tests to rule out other possible causes. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.
Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene causes the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.
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