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Nick Goodwin

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Blood and Marrow Transplant Program

Once every four minutes, someone in the United States is diagnosed with blood cancer; every ten minutes there’s a related fatality. Musician Bill Kahler got his diagnosis in March 2012 when he visited the doctor for a bad cold and learned his condition was far worse: leukemia and lymphoma. “I had a blood test done, and the doctor called me on a Sunday afternoon to tell me that my blood was toast,” he recalls.

Traffic, more than consumer research, brought Kahler to Northside Hospital in Sandy Springs for treatment. “We didn’t have time to get on the Internet, to think about going to Sloan-Kettering or anywhere else,” he says. Kahler chose Northside because his wife, Marita, could drop him off for appointments on her way to work. (Disclosure: Marita Kahler, a longtime Atlanta magazine employee, left our staff several years ago.)

As luck would have it, the Kahlers made an ideal choice. For the third consecutive year, the bone marrow transplant program at Northside achieved the top posttransplant survival rates in the nation, besting its counterparts at Johns Hopkins, Boston’s Dana-Farber Cancer Institute, and, yes, Sloan-Kettering. In the most recent report by the National Marrow Donor Program, the one-year survival rate of Northside transplant patients was 78 percent.

Northside, which launched its program in 1997, has built a unique model focusing primarily on factors that produce better survival outcomes. Dr. Asad Bashey, medical director of research for Northside’s Blood and Marrow Transplant Program, says the culture in traditional academic medical centers rewards physicians more for getting research grants and teaching positions than for achieving patient results. “At Northside, we focus on two things: clinical outcomes and clinical research . . . not lab research,” he says.

When the first bone marrow transplants were performed in the sixties and seventies, the natural response was to keep patients in sealed, filtered hospital rooms for six to eight weeks during the initial phase of treatment. That still happens—not because patients need hospitalization, but because nobody’s revamped the process despite new drugs, research, and transplant techniques. Northside is changing that pattern, sending most patients home as early as possible, with attending physicians on twenty-four-hour call. Bashey believes patient outcomes improve when recovery happens at home. “You stay in the hospital and two things happen: You get exposed to a lot of bacteria that are highly drug resistant, and a patient who was previously quite healthy, active, or physically strong becomes less active, less healthy, and much less physically strong. The impact on the immune system is tremendous.”

For Kahler, Northside’s outcome-based clinical research meant the difference between life and death. After three months of aggressive chemotherapy destroyed the cancer in his bone marrow, his doctors were not able to contact the only matched stem cell donor in the international registry. So Kahler had a haploidentical stem cell transplant, a newer procedure pioneered eight years ago at Northside in collaboration with Johns Hopkins. The treatment uses anti-
rejection drugs and special posttransplant chemotherapy to make a 50 percent match as effective as a 100 percent match, often allowing family members to donate stem cells. Kahler’s son, Justin, was able to donate, and Kahler celebrated his one-year survival in August,

This article originally appeared in our November 2013 issue.

Meet the guy who tastes cookies for a living.

It’s Monday. You’re hunched over paperwork, willing five o’clock to get here sooner. Meanwhile, David Kaiser, vice president and cookie-taster in chief at Norcross-based Great American Cookies, has the sweetest work schedule since Willy Wonka. But before you trade in your 401(k) for a golden ticket, you should note that Kaiser got the job thanks to a business background, a degree from the Culinary Institute of America, and a year of kitchen duty in Lyon, France—the world’s food capital.

Describe a typical day. This Friday we’re going to spend three hours basically sitting around eating cookies, talking about what we like about them, what we’d like to see different, and the whole modification process.

What’s your favorite part of the job?
We spend a good amount of time out in the field at food trade shows and visiting small mom-and-pop bakeries in different cities. We’re seeing what they’re producing so we can try to catch the start of a trend.
We always make it a point to hook up to our supplier partners at food trade shows to say, “Hey, can you give us an idea of who’s doing interesting things in San Francisco, Chicago, or New York?” And our partners will literally put together a bakery tour for us in those cities.

And your favorite cookie? A cranberry-orange was ultimately one of my favorite prototypes we’ve developed this year. But it didn’t resonate with our consumer base. That’s important; you have to understand who you are as a brand. We’re much more of a peanut butter and jelly than we are a chocolate truffle cookie personality. We’re very celebratory.

Does this ever get stressful? There’s really not a lot that’s not fun about the job. Maybe if sales dip or something. [Kaiser quickly pointed out that GAC sales have been up every year for the last six years.]

This article originally appeared in our October 2013 issue.

Grady CEO John Haupert on Obamacare, Medicaid, and the value of prevention

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This week marks the most historic moment for our healthcare system since Congress passed Medicare in the Social Security Amendments of 1965. For the first time, consumers can shop for both public and private health insurance plans in one place as the healthcare.gov Marketplace launches under the Affordable Care Act. Plans must cover physician visits, preventive care, hospital stays, prescriptions, and other comprehensive benefits for all Americans—including those with pre-existing conditions.

But as nearly 1.7 million eligible, uninsured Georgians begin seeking medical care, Grady Memorial Hospital faces a new challenge in the wake of Governor Nathan Deal’s refusal to expand Medicaid. Money that once went to Grady and other safety nets as part of the federal Indigent Care Trust Fund will now be destined for states that have already opted in. Following Grady’s narrow recovery from financial collapse in 2007, our city’s provider of last-resort care will now be stripped of $45 million in federal funding each year by 2017—unless Georgia participates in the Medicaid expansion.

In anticipation of the rollout of the Affordable Care Act, I spoke with Grady Health System CEO John Haupert to talk about the hospital’s strategy of stressing preventive care to alleviate the fiscal nightmare ahead.

This interview took place in John Haupert’s office in August. It has been edited for length and clarity.

How much does serving as a safety net actually cost Grady?
Our total charity care cost in the 2012 fiscal year was $200 million. When you look at our patients, they fall into one of four buckets: 30 percent have Medicaid, 30 percent have Medicare, 10 percent have commercial insurance, and 30 percent have nothing at all.

The one thing we can do—and have been doing a lot of over the last year and a half—is working closely with our patients when they come in to see if they could qualify for Medicaid and they just haven’t done it. As it turns out, there were a significant number of our patients who were able to be on Medicaid but didn’t know or didn’t follow through on the process because it overwhelmed them or it was too difficult.

We started a whole program called the Ineligibility Program where we will even go to the patients’ homes and help them with the paperwork and the forms and walk them through the process. In 2011, the percentage of our patients who had no insurance at all was 42 percent. We got that down to 30 percent simply by helping the patients become qualified [for Medicaid] in 2012.

So, all of a sudden those folks have a form of insurance. And it’s great for us, because we’re now getting paid something; and it’s great for them because it empowers them to receive the healthcare services they need. When you have no insurance, it’s a real psychological barrier to even trying to get into a clinic or make an appointment to get the care that you need.

Most people think of Grady and the downtown ER as synonymous—but you have a network of primary care centers.
Most safety-net hospitals like us have a network of primary care centers and specialty clinics, as we do. It’s better for patients’ long-term health management to be locked in with a primary care physician, so we do everything we can to get them established in a relationship like that. It’s far less expensive there than in the emergency room. We’re talking a $30 visit versus a $600 visit.

There have been studies—including the Health Care Imperative Report by the Institute of Medicine in 2011—showing considerable waste in healthcare spending. What do you see as a major contributor to this waste?
Unnecessary services—which also goes along with inefficiently delivered services. Because of how doctors and hospitals get paid, there has not been an incentive for reducing utilization of services. So if I order three MRIs I get paid for three. If I order one MRI I get paid for one. We have enough science and information now to tell us what evidence-based medicine should look like.

Does Grady have a system for collecting information about best spending practices?
[Grady] is taking the data out of the electronic health record and feeding it into a second system [that] shows by diagnosis-related group what each individual practitioner’s utilization is. You have 12 internists that are all treating patients with simple pneumonia. And their cost per case ranges from $2,000 to $15,000. Why is this guy at $15k, why is this guy at $2k? So you look at antibiotics ordered, how many chest X-rays were ordered, how many lab tests were ordered, and then based on current science, what is best practice considered to be? Well, it may be at $2,500 per case.

Inefficiently delivered services ties into it because we’re often providing all of these primary care services in an emergency room that should be provided in a primary care center. We have this motto: “Right service, right place, right time.” This patient needs X. So what’s the right environment at the right time and the right location to provide that service to that patient that’s most cost-effective and is going to do them the best from a health perspective?

The issue around prevention is that our health system doesn’t provide any reward for helping reduce or prevent illness. It only pays you if you treat illness.

Once physicians begin using best practices, how do you promote patient accountability?
Our choice has been to do that through our primary care centers, establishing this ongoing relationship with patients in the communities they live in, with really pre-set approaches to how you address chronic disease and detect chronic disease earlier on. You invest in early detection because it’s far less expensive than treating disease after it’s detected down the road.

We do a lot of preventive testing on patients that come to us with diabetes, hypertension, heart failure, and different forms of cancer so that we can be more proactive in detection.

How do you encourage people to get primary care and preventive treatment who have been accustomed for decades—maybe generations—to just go to the ER?
One approach I’ve seen work very well is creating relationships with large churches and using the pulpit to get to the parishioners. There’s a program called congregational health nursing where you partner a nurse with a congregation and you set up screening at health fairs. One of our U.S. representatives, David Scott, has a big health fair in his district that we do every year with him.

We detect all kinds of early stage cancers and hypertension through that screening process. It saves us money in the long run.

The Georgia Health Policy Center at Georgia State has already predicted that even if we have Medicaid expansion and insurance exchanges in the state, we are vastly understaffed by primary care physicians to take care of the increased demand.
One of the big concerns I have about all of this, is you have someone who is newly empowered by insurance, and let’s say the governor decides to expand Medicaid, all of a sudden you have almost 1.2 million people who are now insured. Are they going to run into a brick wall to be seen by a physician? Are they going to end up back in someone’s ER because they can’t get to the resources? There’s not the resources to provide the care.

What is Grady doing to revamp the ER?
We are going to have a whole separate track within the ER for those non-emergency patients. Instead of treating those people in the ER the way you normally would, it will be more like a quick clinic visit. And we will have a care-delivery model primarily staffed with nurse practitioners that will get those patients in and out quickly and at the same time work to establish them with a primary care physician in the community before they leave—which we’ve not done in the past. We just treat them, send them back to the street, and then they come into the ER. We will have a deliberate discussion with them about getting established in a primary care medical homes in the community, insured or not, if they are using the ER for non-emergent purposes.

A lot of things that are known as best practice now in running emergency rooms just have to be incorporated here. And then part of the problem is we don’t have enough space, enough treatment rooms. The flow doesn’t work that well, so we are going to begin expanding the (ER) space as well.

The ER sees 350 to 400 patients a day, and that number goes up every year— particularly with the number of mental health patients. We’ve had a 20 percent increase in 2012 over 2011 in mental health patients seen in the ER. Part of the newly renovated ER will have a dedicated psychiatric center specifically for the treatment of emergent mental illness.

Day to day here, we have a lot of really serious mental health issues. In a lot of these big cities, we have a gathering of homelessness. One commonality is mental illness. I’m not talking about simple depression, I’m talking about out-of-control schizophrenia and paranoia disorder; there’s really bad stuff out there.

Grady tries to make sure that materials produced for patients are made at a ninth grade reading level. One of the requirements for our accreditation is an assessment of the competence level of each patient. We have tools we use where we draw the picture of the pill. And we say, “take the pill that looks like this when the big hand is here and the little hand is here” instead of writing “take Zithromax at 12 p.m.” and so on.

Do you expect to see more of these patients with the ACA?
I don’t expect to see more of them, because we’re already seeing them. They’re just uninsured today.

ACA delay won’t have much impact on metro Atlanta

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Early this month, the Obama administration made headlines by announcing a one-year delay of a major provision in the Patient Protection and Affordable Care Act (ACA), the mandate requiring large employers to offer health insurance or face penalties. Employers with fifty or more full-time employees (those working thirty or more hours per week on average) may now wait until January 1, 2015, to provide employees with healthcare coverage. But according to Cindy Zeldin, the executive director of consumer advocacy nonprofit Georgians for a Healthy Future, the delay shouldn’t hold much bearing on the ACA’s implementation in metro Atlanta.

Zeldin cited “the complexity of the decision-making process that employers are going though in deciding whether they want to pay or play” as a key reason for the delay. At this point, she says, it’s unlikely that other provisions of the healthcare law will change—though House Republican leaders are pushing for a similar postponement of the individual mandate for health insurance coverage.

Beginning October 1, employees will still be able to access the Health Insurance Marketplace. In fact, the ACA’s individual responsibility requirement means that all uninsured Americans must select plans by January 1, 2014, to avoid paying a penalty on their tax returns. Zeldin says all of the proposed tax credits and federal subsidies for insurance coverage will remain available when consumers log into the Marketplace this fall.

According to Zeldin, the delay should benefit medium-sized firms who do not offer insurance to their employees. “Many of them may have chosen to not offer plans to their employees in 2015, but instead to pay the penalty for their workers who go to access coverage through the Marketplace,” she said. The delay will allow them to avoid paying penalties as they find ways to implement the new policy in 2015.

Well, there’s free Wi-Fi at Woodruff Park

Those of us who work Downtown know that getting a good Wi-Fi signal is harder than finding a stretch of sidewalk not disrupted by streetcar construction. If the laptop brigade at Starbucks isn’t slurping bandwidth, it’s blocked by all the highrises. So here’s welcome news: The W Atlanta–Downtown partnered with Prenet Media to make its “WfreeWiFi” network available to anyone within a two and a half mile radius of the Woodruff Park Reading Room. The network, part of the hotel’s “W Insider” guest perks, may be accessed via any mobile device in its range or on sleek multi-touch kiosks inside the W lobby.

The partnership launched more than a year ago as part of a vision to blanket metro Atlanta in Wi-Fi and marks the first such effort since 2007. That was the year city officials looked into a contract with Atlanta-based EarthLink, which later sold its network to the city of Philadelphia for $2 million.

In addition to Woodruff Park, the W’s network encompasses dozens of spots, including most Concentrics restaurants, Bill Hallman boutique locations, and city zones in Downtown, Castleberry, Westside, and the Old Fourth Ward. “This is just the start,” said spokesperson Tara Murphy. “We’ve rolled out coverage in all of these areas and it’s barely been a year since the project started.”

Useful Tips:

  • Look for “WFREEWIFI” on your laptop or smartphone to connect.
  • The signal times out after two hours if you don’t have any action or are in continued use. After that, you can just log back on to continue browsing.
  • Snapping a profile pic in front of the Coca-Cola sign at the south end of Woodruff Park is a touristy cliché but one we tolerate. For something more original, use the ATL playscape as your backdrop.

How smart is Atlanta? That depends on whom you ask.

Well knock me down and steal muh teeth! The real-estate blog Movoto (which ranked Atlanta as the country’s top city for both nerds and rednecks) also graded America’s cities, putting Atlanta at number four on its roster of the ten smartest cities. The rankings were based on “pieces of criteria” that included: education level attained; libraries and museums per person; and public school rankings. Another factor was per capita media consumption, a broad category covering papers, TV, radio, and magazines. (Apparently we weren’t hurt much by our other recent ranking—worst city for newspapers.)

But when Atlantic Cities mapped the cognitive abilities of Internet users based on scores on a fancy schmancy brain performance program called Lumosity, we didn’t even make the top twenty large metros. Apparently things like memory, processing speed, flexibility, attention, and problem solving—five key “cognitive areas”—are absent from our city’s brainy repertoire. (The brainiest big city according to Atlantic’s maps: Milwaukee.)

While some consider Atlantans about as sharp as mashed potatoes, others give us the benefit of the doubt. “It’s important to point out that the data are based on Lumosity users and likely skew toward more highly educated and affluent individuals,” cautions Atlantic Cities’s Richard Florida. In other words, maybe our nerds were busy working on their DragonCon costumes, leaving Lumosity tests to the rednecks.

Holy guacamole: Mexican food is healthy… when it’s authentic

Try to snag a basket of chips at the slammed cantina down the street on a Friday night, and it’s obvious that Atlanta has the hots for Mexican cooking. In fact, our love for tacos spans decades. While old-timers say a few rudimentary establishments popped up in the ‘60s to feed hungry Latino work crews, a gringo-friendly version of the cuisine probably reached us around 1974. That’s when the first Monterrey Mexican Restaurant opened its doors in Doraville, paving the way for a seventy-two-location empire that straddles ten different states and counting. In the years that followed, smaller family-owned eateries thrived in Atlanta as the tequila Mexican food craze swept America.

But to beloved local cocinero Eddie Hernandez of Taqueria del Sol, too many local restaurants contribute to a prevailing misconception of Mexican fare as greasy, mystery-meat-stuffed calorie bombs with a side of rice and beans—dishes that are nowhere to be found in Mexico. He has curated a few of his favorite recipes for the masses and given us a fresh take on Mexican cuisine. And guess what: All of it is healthy.

Recipes:
Roasted Carrot and Bell Pepper Spread
Orange Salad with Serrano Dressing
Sweet Oven-Roasted Beets
Cheese Enchiladas with Morita Pepper Sauce

Before we start, could you clarify what Mexican food is—and what it isn’t?
The biggest misconception is that we eat a lot of rice and refried beans, because in Mexico we eat a lot of vegetables and even pastas. The Mayans didn’t know anything about pasta. Our food has been evolving. First we had the Spanish, who brought us the spices. And then we had the French, who taught us about sauce and helped us improve it using new techniques. We learned how and why to use wine, heavy cream, and good butter. When [invaders] came to our country, we wanted to learn as much as we could before we’d get killed!

You’ve mentioned that the food transforms from region to region.
Yes. In the north it’s really heavy in meats. When you go towards the center, it starts to change. You see all of these wonderful salsas. Then you go to the south, and they use a wide variety of freshly ground spices to make sauces. There’s a lot of seafood in one part of the country and meat in another; it’s very diverse.

How is the cuisine evolving right now in Mexico?
In Mexico City, they actually went back to the old way of cooking. [Chefs] are using modern, trendy equipment to prepare the same traditional dishes. They’ve started pickling pork skin and making tostadas with it. But they’re cooking many things in clay pots rather than really expensive copper pots. It’s 1900s cooking, and they use the old techniques rather than trying to elevate the cuisine. But there are some chefs that are trying very hard to elevate it, too. They’re wiping out the misconception that Mexicans only eat ground beef and tortillas.

Does Mexican food vary across the American South like it does in Mexico?
Of course! I love the tamales they sell at food trucks in Louisiana. And half of those people have never even been to Mexico. In Mississippi, you won’t see a Southern, independently owned Mexican restaurant to save your life. But when you get to Birmingham, Alabama, you start seeing the Tex-Mex “Southern style”—where sauces for the enchiladas are just a water-based sauce with spices. Personally, I modify things left and right to make sure that my customers get the idea of what I’m selling, and that they actually like what they’re eating.

How authentic are our Mexican restaurants in Atlanta?
I know everybody who owns a Mexican restaurant in Atlanta. But there’s part of the problem with “Mexican food” here—that people who own the Mexican restaurants are looking for money. You won’t find anything that they sell in Mexico. Here, everything revolves around the enchilada, the taco, the burrito, and the tostada. A chile relleno in a Mexican restaurant here is a piece of bell pepper that’s topped with a little ball of Mexican ground beef, coated with cheese and deep fried. It’s one of the most unhealthy foods I’ve ever seen in my life!

So how do you do things differently?
A taco to me is like an entree. It has to have a balance. It’s got to have its protein, the starch, the veggies, all on a six-inch flour tortilla. So when you bite into it, you get a nice bite of different flavors and textures. And it’s also good for you. Another thing is that I try not to use shortcuts. I buy my produce [almost] daily. In my pantry, the only two things that come in a can are creamed corn—because I can make it, but I don’t think I can make it any better than it comes from the can and it takes me a lot of work—and whole tomatoes that [Taqueria del Sol] uses for the beef red chile.

Do you have any tips for home cooks?
The most important thing in a house kitchen is a spice rack. If you have a great variety of spices, it’s limitless what you can do.

What’s your favorite local Mexican grocery store?
I like Super Mercado Jalisco on Buford Highway. It has everything you’d ever need. I like the variety and a lot of the fresh vegetables that they have. There are fourteen or fifteen different types of peppers. You can buy cactus already peeled and great Mexican chocolate— it really minimizes the amount of work that you have to do.

Sweet Oven-Roasted Beets

At home, chef Eddie Hernandez of Taqueria del Sol wraps up beets, Vidalia onions, limes, and a little fresh mint in aluminum foil and roasts them in a fire. They come out sweet and tangy. “I love Vidalias! They’re like candy to me,” he laughs.

(Click here for the full story.)

Ingredients
2 lbs peeled beets, stems removed
1/2 stick of butter
1 tablespoon salt
4 tablespoons sugar
Lime wedges and salt for garnish

Instructions
1. Preheat oven to 425 degrees.
2. Mix salt and sugar.
3. Place beets on a sheet of aluminum foil.
4. Spread butter on top, sprinkle with salt and sugar mixture.
5. Wrap and bake for 45 minutes.
6. Remove from oven, slice and serve with lime wedges and salt.

Orange Salad with Serrano Dressing

For this bright and refreshing citrus salad, chef Eddie Hernandez of Taqueria del Sol uses an 80/20 blend of vegetable oil to olive oil. “If you’re going to use 100 percent olive oil when you do a salad,” he advises, “don’t add anything else. Pure olive oil is something you want to showcase; it doesn’t make for a good mixed dressing.”

(Click here for the full story.)

Ingredients
Dressing:
1 cup sugar
1/2 cup lime juice
1 cup olive oil blend (8 parts vegetable oil, 2 parts olive oil )
pinch of salt
1 serrano pepper
romaine lettuce
oranges (peeled and sliced into wedges)
tosted almonds (optional)

Instructions
1. Place first five ingredients in a blender and puree. Chill until ready to use.
2. Arrange orange wedges on chilled romaine lettuce.
3. Drizzle with dressing, top with toasted almonds (optional).

Roasted Carrot and Bell Pepper Spread

Chef Eddie Hernandez of Taqueria del Sol shared this recipe for a low-fat spread that he prepares “all the time at home” for a healthy, flavor-packed snack.

(Click here for the full story.)

Ingredients
2 cups diced carrots
1 cup ea. red and yellow bell peppers, diced
2 tablespoons oil
pinch of salt
1/2 cup rice wine vinegar

Instructions
1. Preheat oven to 425 degrees.
2. Toss vegetables with oil and salt.
3. Roast for 30 minutes.
4. Combine roasted vegetables and vinegar in a blender; puree.
5. Chill and serve with chips or crackers.

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