Provider update

              OHCA
LOOKS
TO CUT
COSTS
& GO
GREEN
In the Oklahoma Health Care Authority’s continuing effort to reduce our
paper usage, the Provider Update, provider letters and a policy change
input system are all going electronic. Already up on the OHCA website,
the proposed rule change site is available for reviewing and commenting
on proposed agency rule changes. Provider letters that used to be mailed
to a physical address are now going to be sent electronically. Finally, this
publication will no longer be mailed but will be sent via email. This change
will not only allow OHCA to save on shipping costs but will also allow for
this newsletter to be interactive. Stories and content will have direct links
to various resources and will be available for easy sharing. Be on the
lookout for the electronic OHCA Provider Update coming in May.
A Publication Of The Oklahoma Health Care Authority
INDEX
02 Provider communication becomes
expeditious, electronic and eco-friendly
03 Prescriptions not covered for non-OHCA
providers
03 Online proposed rule changes page open
for comments
04 Cesarean Section Quality Initiative
06 Paving the way for electronic
health records
08 Infant health risks associated with early
elective births
09 Providers propel SoonerCare’s superior
PERM results
10 Self-care in times of stress
The Oklahoma Health Care Authority (OHCA) is pleased
to announce its new “green” provider notification process.
In going “green,” OHCA will offer providers the option of
three sources of communication instead of the paper letter
process. These options are:
E-mail notification. Provider letters will be sent
directly to the provider’s e-mail address.
Web alerts. A website banner on the OHCA
secure site will notify providers of newly posted
letters and include a link to the letters.
Fax Blasts. This option is for those wishing to opt
out of the e-mail messages. Communications will
be sent to the provider’s fax number.
Moving to solely electronic communication will enable the
dissemination of pertinent information more quickly, as well
as reducing OHCA’s environmental impact and overhead
costs. If, for some reason, issues arise with e-mail
addresses, providers will always have the option of viewing
letters via the Internet on the secure site.
OHCA is currently in the testing phase of this process and
is requesting that all providers log in to the secure site —
the same site used to verify SoonerCare eligibility — to
review their contact information and make any necessary
corrections or updates. This will ensure that providers
continue to receive all vital SoonerCare correspondence.
Providers: please verify or update your contact information
by logging in to the OHCA secure site at www.okhca.org
and following these instructions:
􀁴􀀁 􀀴􀁆􀁍􀁆􀁄􀁕􀀁􀁩􀁖􀁑􀁅􀁂􀁕􀁆􀀁􀁑􀁓􀁐􀁗􀁊􀁅􀁆􀁓􀀁􀁭􀁍􀁆􀀏􀁷􀀁
􀁴􀀁 􀀷􀁆􀁓􀁊􀁇􀁚􀀁􀁚􀁐􀁖􀁓􀀁􀁊􀁏􀁇􀁐􀁓􀁎􀁂􀁕􀁊􀁐􀁏􀀜􀀁􀁎􀁂􀁌􀁆􀀁􀁄􀁐􀁓􀁓􀁆􀁄􀁕􀁊􀁐􀁏􀁔􀀁􀁐􀁓􀀁􀁄􀁉􀁂􀁏􀁈􀁆􀁔􀀁􀁂􀁔􀀁
allowed.
􀁴􀀁 􀀤􀁍􀁊􀁄􀁌􀀁􀁕􀁉􀁆􀀁􀁩􀁔􀁖􀁃􀁎􀁊􀁕􀁷􀀁􀁃􀁖􀁕􀁕􀁐􀁏􀀏􀀁
Thank you for your dedication and commitment
to serving our SoonerCare and Insure Oklahoma
members. For questions regarding these new
communication procedures, contact Demetria
Morrison at 405-522-7641.
PROVIDER
COMMUNICATION
BECOMES
EXPEDITIOUS,
ELECTRONIC AND
ECO-FRIENDLY
1
2
3
PRESCRIPTIONS NOT COVERED FOR
NON-OHCA PROVIDERS
ONLINE PROPOSED RULE CHANGES PAGE OPEN FOR COMMENTS
Historically, SoonerCare
members’ prescriptions
have been covered when
written by any prescriber for whom
a valid National Provider Identifier
and licensure information could be
verified. In order to comply with
requirements in the federal Patient
Protection and Affordable Care Act,
the Oklahoma Health Care Authority
(OHCA) is in the process of
implementing a change to this policy.
In the future, prescriptions will be
compensable only if the prescriber
has an active provider contract
with OHCA. In addition to bringing
OHCA policies into compliance
with federal law, this change is
expected to encourage members
to seek services from medical home
providers, enhance coordination of
care, and discourage inappropriate
drug-seeking behaviors.
An individual OHCA provider
contract will be required in order
for a provider’s prescriptions
to continue to be covered by
SoonerCare, whether or not the
individual provider directly bills
OHCA for services provided to the
member. Examples of providers
who previously have been able
to prescribe for SoonerCare
members without having an OHCA
contract include emergency room
physicians, residents, physicians’
assistants and nurse practitioners.
“OHCA is moving quickly to
comply with federal law,” said
OHCA Pharmacy Director Nancy
Nesser. “My advice to prescribers
who haven’t obtained individual
contracts is to avoid delay. Get your
contracts as soon as possible.”
Providers who need to obtain
a contract can enroll online
through the OHCA secure site.
For details, please visit www.
okhca.org, or contact the OHCA
Provider Enrollment department at
800-522-0114, option 5.
The Oklahoma Health Care Authority (OHCA) is pleased to announce that, in compliance with the Oklahoma Government
Website Information Act, proposed rule changes began being posted on the OHCA public website as of fall 2010.
This change better enables OHCA to collect advice and consultation from medical professionals, professional and
tribal organizations, and the general public in developing new or amended rules. The proposed rule changes (PRC) page is
designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.
Additionally, the public, medical professionals and tribal organizations have the option to sign up for web alerts. Web alerts
notify subscribers — anyone who has signed up for the service — with e-mail alerts any time the page is changed, such as
when new rules are added.
Proposed rule changes are open to comments for 20 days and then moved to an archived section for future reference. All
comments are considered during the rulemaking process and become a part of the official work folder.!The PRC page may
be accessed at www.okhca.org by clicking on “rule changes” under the providers’ section of the home page.
03
CESAREAN
SECTION
QUALITY
INITIATIVE
EDUCATION, REVIEW AND FEEDBACK
Educational tools will be made available to interested
providers and hospitals. However, providers and
hospitals are encouraged to collaborate on initiatives
at the local level in order to meet the goal. OHCA
will generate reports monthly on C-section rates for
individual providers and hospitals from 2011 state
fiscal year (SFY) data so they may see the trend in their
rates.
Providers and hospitals will receive data that
encompasses an entire fiscal year. By providing this
information, there will be time to change processes, if
desired. After August 2011, providers and hospitals will
get data reports every quarter. There is a page on the
OHCA website that shows every hospital’s SoonerCare
C-section rate. (www.okhca.org/c-section) The website
also lists provider C-section rates, but by anonymous
ID numbers rather than names. C-section rates for
each quadrant of the state, plus the Oklahoma City
and Tulsa metro areas, will be included.
In its entirety, the C-section quality initiative is driven
by the OHCA’s desire to examine the trends of
C-section rates among SoonerCare providers. The
optimal outcome would be to find there is no problem
regarding C-section without medical indication. The
focus of the OHCA is and will continue to be to provide
an acceptable standard of care while utilizing its
resources responsibly.
BE ON THE LOOKOUT for invitations to OHCA’s spring
provider training. The invitation will have all the information
and it will be posted on the OHCA website.!Registration will
be online.!If you have any additional questions, please call
800-522-0114, option 1.
APRIL 7
HIGH PLAINS TECHNOLOGY CENTER
3921 34TH ST
WOODWARD, OK 73801
APRIL 13
PONTOTOC TECHNOLOGY CENTER
601 WEST 33RD
ADA, OK 74820
MAY 11-12
MOORE NORMAN TECHNOLOGY CENTER -
SOUTH PENN CAMPUS CONFERENCE CENTER
13301 S. PENNSYLVANIA
OKLAHOMA CITY, OK 73170
MAY 24-25
OSU - TULSA CONFERENCE CENTER
700 N. GREENWOOD AVE.
TULSA, OK 74106
1 Bettes, B.A., et. al. (2007) Cesarean delivery on maternal request: obstetrician-­gynecologists’ knowledge,
perception, and practice patterns. Obstetrics Gynecolo, 109(1), 57-­66.
Declerq, E.R., et. al. (2006). Listening to mothers II: Report of the second national U.S. survey of women’s
childbearing experiences. New York, N.Y. Childbirth Connection
National Institutes of Health (2006). NIH state of the science conference statement on cesarean delivery on
maternal request. NIH Consens Sci Statements, 23(1), 1-­29.
Wax, J.R., et. al. (2004). Patient choice cesarean: an evidence-­based review. Obstetrics & Gynecology Survey,
59 (8), 601-­616.
􀀧􀁕􀁘􀁝􀁌􀁑􀀏��􀀰􀀑􀀯􀀑􀀏􀀃􀀉􀀃􀀨􀁏􀀐􀀶􀁄􀁜􀁈􀁇􀀏􀀃􀀼􀀑􀀼􀀑􀀃􀀋􀀕􀀓􀀓􀀙􀀌􀀑􀀃􀀃􀀦􀁈􀁖􀁄􀁕􀁈􀁄􀁑􀀃􀁇􀁈􀁏􀁌􀁙􀁈􀁕􀁜􀀃􀁒􀁑􀀃􀁐􀁄􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀁕􀁈􀁔􀁘􀁈􀁖􀁗􀀝􀀃􀀺􀁌􀁖􀁈􀀃􀁘􀁖􀁈􀀃􀁒􀁉􀀃􀂿􀁑􀁌􀁗􀁈􀀃􀁕􀁈􀁖􀁒􀁘􀁕􀁆􀁈􀁖􀀢􀀃􀀃􀀤􀀃
view from the trenches. Semin. Perinatology, 30(5), 305-­308.
Clark, S, et. al. (2008). Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new
paradigm in patient safety. Am. J. Obstet-­Gynecol, 199(2), 105 e101-­107.
Reisner, R.G., et.al. (2007). Reduction of elective inductions in a large community hospital. Am. J. Obstet
Gynecol, 200(6). 674, e671-­677.
Cesarean section delivery rates continue to
rise consistently across the country and have
been seen across all maternal age, racial and
socioeconomic groups. In state fiscal year 2009, the
rate for SoonerCare members was 32.16 percent. The
state average for primary C-section delivery was 20.2
percent, with the Tulsa area having the lowest rate, at
just above 18 percent. However, these figures also have
steadily increased in our state. The Oklahoma Health
Care Authority (OHCA) has begun implementation of
a quality initiative to address the rising C-section rate
amoung SC members. The concern for potential harm
from a non-medically indicated C-section applies to
mother and baby. The mother has both short- and
long-term potential morbidity. Her newborn, if delivered
before 39 weeks, has a longer length of hospital stay,
in addition to a higher rate of respiratory complications
and neonatal ICU admission.
In the state of Oklahoma, Physicians Liability Insurance
Company (PLICO) provides malpractice insurance to
most of the obstetricians. Currently, PLICO does not
provide coverage for vaginal births after cesarean.
Therefore, vaginal delivery is often not an option many
obstetricians can offer their patients. Realistically
then, influencing the primary section rate is the only
way to impact the overall C-section rate, specifically
for those clients who have no medical indication. It is
estimated that 3 to 14 percent of all first C-sections are
truly elective.1 (Primary C-section rate is calculated as
primary C-sections divided by vaginal births plus primary
C-sections.) The OHCA C-section quality initiative is
an ongoing, multipronged approach including three
important stages: education, review and feedback. Our
goal is that this initiative will help reduce the primary
C-section rate in SoonerCare to less than or equal to
18 percent over the first year by reducing the number of
primary C-sections that have no medical indication.
This program is composed of two phases. Phase
I involves providing physicians and hospitals with
the calculated total and primary C-section rates for
their SoonerCare patients. Phase II would include
retrospective medical chart review and was scheduled to
start on Sept. 1, 2011. Parts of the original initiative plan
generated a great deal of controversy on which charts
were to be gathered and then reviewed. Therefore, the
second phase will be reevaluated by a panel of currently
practicing obstetricians and family medicine doctors
that deliver babies. This panel will be comprised of six
physicians, with two representing the Oklahoma State
Medical Association and one representing the Oklahoma
Osteopathic Association. The other three members will
be selected by OHCA to assure all necessary specialties
are represented. The final Phase II plan will depend on
the recommendations of the panel.
05
PAVING THE
WAY FOR
ELECTRONIC
HEALTH
RECORDS
Pictured from left: Melissa
Gastorf D.O., Crystal Plata,
HIT practice advisor OFMQ,
Mary Melott, HIT practice
advisor OFMQ, Mike Fogarty,
CEO OHCA, Jonathan
Kolarik, health information
technology director OFMQ,
Garth Splinter M.D., OHCA
state Medicaid director, Jeff
Gastorf D.O.
Pictured from left: Robin
Yoder, physician liaison
NRHS, Brain Yeaman chief
medical informatics officer
NRHS, Garth Splinter, M.D.,
state Medicaid director
OHCA, John Meharg, director
of health information
technology NRHS, Dr.
Cyntia Taylor, M.D., Diane
Butler A.R.N.P., and Mike
Fogarty, CEO OHCA.
Congratulations to Dr. Cynthia Taylor of the Norman
Regional Health System (NRHS), and Drs. Jeff and
Melissa Gastorf of Gastorf Family Clinic in Durant
on being part of the first payments to eligible professionals
in the country.
Oklahoma was the first state to approve eligible medical
professionals for payments through the Oklahoma
Electronic Health Records (EHR) Incentive Program. For
each participating eligible professional, $63,750 is given
over the life of the six-year program. The first payment is
$21,250 per provider.
Since these first two payments,
more than 500 professionals
and hospitals have registered
with the Centers for Medicare
& Medicaid Services to
participate in the Oklahoma
EHR Incentive Program.
OHCA has paid out more
than $3 million in incentive
payments. The Oklahoma
EHR incentive program is part
of a federal grant program in
which 100 percent of incentive
payments are federal funds.
The Oklahoma Health
Care Authority (OHCA)
procured funds from the
federal government on
behalf of the state in order
to pay professionals and
hospitals who choose to
participate in the incentive
program. The program is a federal grant that offers
major financial support to assist certain providers to
adopt (acquire and install), implement (train staff, deploy
tools, exchange data), upgrade (expand functionality
or interoperability) or meaningfully use certified
EHR technology.
State Medicaid Director, Dr. Garth L. Splinter, M.B.A, feels
this has been a long time coming for Oklahoma and its
provider community.
“Oklahomans are fortunate to have medical professionals
who care about improving patient care through available
improvements in the usage of electronic health records,”
said Splinter. “This is a huge accomplishment for these
practices and for the state of Oklahoma.”
Eastern Oklahoma Medical Center (Poteau) and McCurtain
Memorial Hospital (Idabel) will be the first Oklahoma
hospitals to receive incentive payments from the Medicaid
program for their certified EHRs. The OHCA has approved
payments! of more than $700,000! for each of these
hospitals. The incentive amounts was included in the
hospitals’ Feb. 2 payments.
Hospital payments are spread out
over three years, with 50 percent
of the total payment coming in the
first year.
The funding for the program
is coming from the American
Reinvestment and Recovery Act
(ARRA) of 2009. Within the ARRA
is the HITECH act that contains an
uncapped, entitlement grant. The
OHCA did a survey of providers
to estimate the necessary funds
Oklahoma would need to pay
providers. The state estimated
more than 1450 providers would
participate and $300 million in
incentive funds would be needed.
However, since the incentive
program is uncapped, if more
than the estimated amount were
to participate, the state would be
able to procure those funds.
State Health Information Technology Coordinator, John
Calabro, started in health IT more than 20 years ago and
has never seen an investment of this magnitude.
“This is an excellent opportunity for Oklahoma to get
funding injected for health IT,” said Calabro. “This is the
largest, longest grant I’ve ever seen and am excited to see
how it paves the way for future developments.”
For more information on the Oklahoma EHR incentive
program, visit www.okhca.org/ehr-incentive.
07
INFANT
HEALTH
RISKS
ASSOCIATED
WITH EARLY
ELECTIVE
BIRTHS
A recent article in California Watch reports the
number of women giving birth early, often without
medical reason, has increased dramatically in the
past two decades. Researchers say shorter pregnancies
coincide with a large number of women and doctors now
scheduling childbirth for convenience. The article reports
that while the risks of early delivery are well known among
maternal health experts, the general public has been left in
the dark, and a lack of knowledge seems to have driven the
trend of elective cesarean sections and artificial induction
before full gestation.
Mothers who choose to have an early birth expose
their babies to a variety of health risks that may be
avoided by waiting until at least 39 weeks to give
birth. Early deliveries can affect an infant negatively
in several ways: Lung development, vision, weight
and fine-tuning of the brain.
Babies born too early often sleep longer than normal and
have trouble learning how to breastfeed, which can cause
dehydration and jaundice. In addition, babies born early
through induction or C-section without a medical reason
are nearly twice as likely to spend time in the neonatal
intensive care unit. They also are more likely to contract
infections and need the assistance of breathing machines.
Many women believe that nine months is a full-term
pregnancy. However, a full-term pregnancy medically
counts 40 weeks rather than nine months. Because better
health outcomes are associated with waiting until at least
39 weeks gestation to deliver, it is imperative that providers
discuss with parents the potential health risks associated
with early delivery, as well as the benefits of carrying the
pregnancy to full-term whenever possible.
Many medical facilities now have systems in place to
encourage physicians to ensure medical reasons for early
births. Physician groups and health organizations in several
states also have begun implementing guidelines to reverse
both the trend of early delivery for nonmedical reasons
and the resulting child health consequences associated
with that trend. In Oklahoma, recruitment is in progress
for Oklahoma obstetric hospitals to join a statewide
collaborative effort to eliminate elective deliveries prior to
39 weeks.
To ensure your hospital is involved in the
collaboration, or for additional resources, contact
Barbara O’Brien at 405-271-7777. For a brochure
with program details, go online to www.oumedicine.
com/body.cfm?id=6129.
Note: California Watch is a project of the independent, nonpartisan
Center for Investigative Reporting. To read the entire article, visit
www.californiawatch.org and type “elective births” into the search portal.
PROVIDERS PROPEL
SOONERCARE’S SUPERIOR
PERM RESULTS
The Oklahoma Health Care Authority (OHCA) is proud
to announce the SoonerCare program had the
lowest overall Medicaid error rate of the 17 states
measured in the most recent audit cycle of the Payment
Error Rate Measurement (PERM) program by the federal
Centers for Medicare & Medicaid Services (CMS), thanks
to the outstanding work of our providers. This PERM review
cycle was for Federal Fiscal Year (FFY) 2009 (Oct. 1, 2008
– Sept. 30, 2009). In results released by CMS in the state’s
final report, issued Nov. 15, 2010, Oklahoma’s error rate
was 1.24 percent, compared to the national average error
rate of 8.98 percent. This low error rate confirms Oklahoma
as a national leader in ensuring that public funds are being
spent appropriately in the Medicaid program. In 2006,
CMS implemented the PERM program to comply with laws
requiring federal agencies to review programs they oversee
that are susceptible to significant erroneous payments. The
PERM program measures improper payments in Medicaid,
and produces state and national error rates. By identifying
and measuring payment errors, states can take action to
correct mistakes and rectify problems.
States participate in PERM reviews every three years.
􀀰􀁌􀁍􀁂􀁉􀁐􀁎􀁂􀀁􀁑􀁂􀁓􀁕􀁊􀁄􀁊􀁑􀁂􀁕􀁆􀁅􀀁􀁊􀁏􀀁􀁕􀁉􀁆􀀁􀁊􀁏􀁊􀁕􀁊􀁂􀁍􀀁􀀓􀀑􀀑􀀗􀀁􀁑􀁓􀁐􀁄􀁆􀁔􀁔􀀜􀀁􀁐􀁖􀁓􀀁􀁆􀁓􀁓􀁐􀁓􀀁
rate was 2.51%.
OHCA’s Program Integrity Unit would like to thank all the
providers who participated in the 2009 PERM project
for supplying updated contact information and for their
prompt assistance in submitting the requested records to
the federal contractor. Overall, the review went smoothly
and these stellar results would not have been possible
without your cooperation. We appreciate your continued
support of the SoonerCare program.
OHCA believes much of our success can be contributed
to the joint OHCA / provider participation in the Annual
Payment Accuracy Reviews conducted by the OHCA
Program Integrity Unit. OHCA’s Payment Accuracy
􀀱􀁓􀁐􀁈􀁓􀁂􀁎􀀁􀁄􀁍􀁐􀁔􀁆􀁍􀁚􀀁􀁎􀁊􀁓􀁓􀁐􀁓􀁔􀀁􀁕􀁉􀁆􀀁􀀱􀀦􀀳􀀮􀀁􀁑􀁓􀁐􀁈􀁓􀁂􀁎􀀜􀀁􀀰􀀩􀀤􀀢􀀁􀁇􀁆􀁆􀁍􀁔􀀁
that consistency of the programs and our conducting them
annually results in the most optimal outcome. Continuous
operations maintain stakeholder involvement, awareness,
and operational knowledge. Identified problems are
addressed and corrective action is initiated immediately.
Standard operating procedures and processes are in
operation and drive our efforts.
The next PERM cycle reviews for Oklahoma will
begin in October for FFY 2011-2012. Specific instructions
will be provided as they become available to the 2012
cycle states.
For more information related to PERM and the role
of providers in this process, visit the CMS PERM
website at www.cms.gov/perm. For additional
questions, please contact Susan Crooke, PERM
project supervisor, at 405-522-7584 or susan.
crooke@okhca.org.
COMPARISON OF MEDICAID FFS FOR
FY 2006 AND FY 2009:
Oklahoma’s Medicaid FFS error rate was lower than the
national rate in both FY 2006 and FY 2009, and, similar
to national results, the error rate decreased substantially
from FY 2006 to FY 2009.
􀁴􀀁 􀀵􀁐􀁕􀁂􀁍􀀁􀁆􀁓􀁓􀁐􀁓􀁔􀀁􀁊􀁏􀀁􀀧􀀺􀀁􀀓􀀑􀀑􀀗􀀁􀁘􀁆􀁓􀁆􀀁􀀔􀀔􀀜􀀁􀁕􀁐􀁕􀁂􀁍􀀁􀁆􀁓􀁓􀁐􀁓􀁔􀀁􀁊􀁏􀀁􀀧􀀺􀀁􀀓􀀑􀀑􀀚􀀁
were 11.
􀁴􀀁 􀀪􀁏����􀁖􀁇􀁭􀁄􀁊􀁆􀁏􀁕􀀁􀁅􀁐􀁄􀁖􀁎􀁆􀁏􀁕􀁂􀁕􀁊􀁐􀁏􀀁􀁎􀁆􀁅􀁊􀁄􀁂􀁍􀀁􀁓􀁆􀁗􀁊􀁆􀁘􀀁􀁆􀁓􀁓􀁐􀁓􀁔􀀁
decreased to zero in FY 2009 from 11 in FY 2006.
􀁴􀀁 􀀥􀁂􀁕􀁂􀀁􀁑􀁓􀁐􀁄􀁆􀁔􀁔􀁊􀁏􀁈􀀁􀁆􀁓􀁓􀁐􀁓􀁔􀀁􀁅􀁆􀁄􀁓􀁆􀁂􀁔􀁆􀁅􀀁􀁕􀁐􀀁􀁛􀁆􀁓􀁐􀀁􀁊􀁏􀀁􀀧􀀺􀀁􀀓􀀑􀀑􀀚􀀁
from seven in FY 2006.
09
If you can, turn to a magazine or the Internet and read
something you usually don’t read, something that has
nothing to do with your current situation.
Think about an activity that you love, such as singing,
running, getting a massage, laughing at a particular
television show. Imagine yourself in that situation, and
stay there for one minute.
LONG-TERM SOLUTIONS — WHEN STRESS IS
EXPERIENCED AS CONSTANT:
Eat nutritious foods. When you know you are doing
something healthy for yourself, your self-esteem goes
up and stress goes down.
Meditate every morning. Meditation in the evening is
also helpful to assist relaxation and sleep. Experiment
with different types of meditation — walking,
visualization, breathing, chanting, praying — to find
what works for you.
Engage in moderate exercise. Some studies indicate
that if you take short walks, even just 10 minutes two
or three times a day, your muscles become more
receptive to accepting insulin to burn sugar, with the
result that you become more energized.
Have a planned activity that you enjoy in your off time.
The activity should be something particularly satisfying
for you: cooking, reading, writing, running, bicycling,
artwork, etc. Schedule it at least once a week, so that
you can look forward to it and know that the stress
reliever is close at hand.
It is important that you feel like there is a part of your
life in which you are totally in control. Make a list of
goals or tasks, and determine to accomplish one of
them each day. These goals or tasks should be short
and easy to achieve.
We are all in the business of caring. Those of us who care for
others must make sure that we take care of ourselves. This
self-care requires awareness. Recognize your symptoms
of stress. Be aware of subtle changes that may appear out
of the norm. Pay close attention to the following:
􀁴􀀁 􀀮􀁆􀁎􀁐􀁓􀁚􀀁􀁐􀁓􀀁􀁄􀁐􀁏􀁄􀁆􀁏􀁕􀁓􀁂􀁕􀁊􀁐􀁏􀀁􀁑􀁓􀁐􀁃􀁍􀁆􀁎􀁔􀀍􀀁􀁍􀁐􀁔􀁊􀁏􀁈􀀁􀁇􀁐􀁄􀁖􀁔􀀁􀁐􀁓􀀁􀁏􀁐􀁕􀀁
being able to complete tasks or activities.
􀁴􀀁 􀀯􀁆􀁈􀁂􀁕􀁊􀁗􀁆􀀁 􀁕􀁉􀁐􀁖􀁈􀁉􀁕􀁔􀀁 􀁐􀁓􀀁 􀁄􀁐􀁏􀁔􀁕􀁂􀁏􀁕􀀁 􀁘􀁐􀁓􀁓􀁚􀁊􀁏􀁈􀀏􀀁 􀀪􀁕􀀁 􀁕􀁂􀁌􀁆􀁔􀀁 􀀒􀀑􀀁
positives to undo one negative (Joel Osteen, Your Best
Life Now). Your situation may not be as severe as it
appears.
􀁴􀀁 􀀢􀁄􀁉􀁆􀁔􀀁􀁂􀁏􀁅􀀁􀁑􀁂􀁊􀁏􀁔􀀍􀀁􀁏��􀁖􀁔􀁆􀁂􀀁􀁐􀁓􀀁􀁅􀁊􀁛􀁛􀁊􀁏􀁆􀁔􀁔􀀏􀀁􀀸􀁉􀁆􀁏􀀁􀁚􀁐􀁖􀁓􀀁􀁘􀁐􀁓􀁌􀀁
becomes overwhelming, take some time off and regain
perspective.
􀁴􀀁 􀀭􀁐􀁔􀁔􀀁 􀁐􀁇􀀁 􀁔􀁆􀁙􀀁 􀁅􀁓􀁊􀁗􀁆􀀏􀀁 􀀮􀁂􀁌􀁆􀀁 􀁔􀁖􀁓􀁆􀀁 􀁕􀁉􀁂􀁕􀀁 􀁚􀁐􀁖􀀁 􀁑􀁂􀁓􀁕􀁊􀁄􀁊􀁑􀁂􀁕􀁆􀀁 􀁊􀁏􀀁
extracurricular activities that you tend to enjoy.
􀁴􀀁 􀀮􀁐􀁐􀁅􀁊􀁏􀁆􀁔􀁔􀀁􀁐􀁓􀀁􀁊􀁓􀁓􀁊􀁕􀁂􀁃􀁊􀁍􀁊􀁕􀁚􀀍􀀁􀁘􀁉􀁊􀁄􀁉􀀁􀁄􀁂􀁏􀀁􀁍􀁆􀁂􀁅􀀁􀁕􀁐􀀁􀁑􀁓􀁐􀁄􀁓􀁂􀁔􀁕􀁊􀁏􀁂􀁕􀁊􀁐􀁏􀀁
and distraction.
􀁴􀀁 􀀥􀁆􀁑􀁓􀁆􀁔􀁔􀁊􀁐􀁏􀀍􀀁􀁔􀁍􀁆􀁆􀁑􀁊􀁏􀁈􀀁􀁕􀁐􀁐􀀁􀁎􀁖􀁄􀁉􀀁􀁐􀁓􀀁􀁕􀁐􀁐􀀁􀁍􀁊􀁕􀁕􀁍􀁆􀀍􀀁􀁐􀁓􀀁􀁊􀁔􀁐􀁍􀁂􀁕􀁊􀁐􀁏􀀁
from others.
􀁴􀀁 􀀦􀁂􀁕􀁊􀁏􀁈􀀁􀁎􀁐􀁓􀁆􀀁􀁐􀁓􀀁􀁍􀁆􀁔􀁔􀀍􀀁􀁐􀁓􀀁􀁖􀁔􀁊􀁏􀁈􀀁􀁂􀁍􀁄􀁐􀁉􀁐􀁍􀀍􀀁􀁄􀁊􀁈􀁂􀁓􀁆􀁕􀁕􀁆􀁔􀀁􀁐􀁓􀀁􀁅􀁓􀁖􀁈􀁔􀀁
to relax.
You are the best person to gauge what is the norm for your
body. If stress is the culprit, then some of the suggestions
in this article may be helpful.
Joining a support group or seeking advice from a
professional counselor also can be considered self-care.
When stress is overwhelming and coping solutions don’t
seem to be effective, asking for help can be a very beneficial
way of taking care of ourselves.
Note: There are many resources for stress education and information. Two
that were utilized for this article were the book Stress Less by Thea Singer
and the Canadian Mental Health Association website at www.cmha.ca.
SELF-CARE
IN TIMES OF
STRESS 1
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The issue of self-care during times of stress has
become more important as the level of stress in our
social, economic and political environments has
ratcheted up in recent decades. With a recent focus on
terrorist activities, including the 1995 bombing of the Alfred
P. Murrah Federal Building in Oklahoma City, psychological
theory has turned to sports psychology to understand how
athletes recover from their continual stressors. The result
has been an understanding of stress as the inability to
􀁓􀁆􀁃􀁐􀁖􀁏􀁅􀀜􀀁􀁕􀁉􀁂􀁕􀀁􀁔􀁕􀁓􀁆􀁔􀁔􀀁􀁊􀁔􀀁􀁂􀀁􀁄􀁐􀁏􀁔􀁕􀁂􀁏􀁕􀀁􀁊􀁏􀀁􀁐􀁖􀁓􀀁􀁍􀁊􀁗􀁆􀁔􀀁􀁂􀁏􀁅􀀁􀁂􀁍􀁘􀁂􀁚􀁔􀀁
􀁉􀁂􀁔􀀁􀁃􀁆􀁆􀁏􀀜􀀁􀁂􀁏􀁅􀀁􀁕􀁉􀁂􀁕􀀁􀁊􀁕􀀁􀁊􀁔􀀁􀁂􀀁􀁏􀁂􀁕􀁖􀁓􀁂􀁍􀀁􀁑􀁂􀁓􀁕􀀁􀁐􀁇􀀁􀁃􀁆􀁊􀁏􀁈􀀁􀁉􀁖􀁎􀁂􀁏􀀏􀀁􀀪􀁇􀀁
we were not in economic stress, we would have stressors
related to jobs, family, houses, cars, illness, etc.
Stress is a part of the human condition and not something
evil or aberrant that has been visited upon us. Since we
cannot eliminate stress from our lives, we need to focus
on the ability to rebound from it, which some people do
more easily than others. We call such individuals “resilient,”
able to cope with adverse events. Most of us, however,
are not as resilient as we would prefer. In order to rebound
more effectively, there are some short-term and long-term
solutions.
SHORT-TERM SOLUTIONS — WHEN A
STRESSFUL EVENT OCCURS IN THE MOMENT:
Practice deep breathing. This activity is the shortest,
most effective, most unobtrusive mode of rebounding.
It can be done at your desk or in the middle of a family
event, a stressful meeting or an angry moment. Slowly
breathe in through your nose, fill your lungs full so that
your stomach expands, hold the breath, and then
release it through your mouth. Do this three times.
Keep a picture — your dog, your child — nearby, or
in your mind’s eye, that will take you away from the
event and which will give you momentary peace and a
good feeling.
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Oklahoma Health Care Authority
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Chief Executive Officer Mike Fogarty
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Managing Editor Carter Kimble
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OHCA Board of Directors Lyle Roggow
Chairman, Lawton/Enid
Anthony Armstrong
􀀁 􀀁 􀀷􀁊􀁄􀁆􀀁􀀤􀁉􀁂􀁊􀁓􀁎􀁂􀁏􀀍􀀁􀀮􀁖􀁔􀁌􀁐􀁈􀁆􀁆
George A. Miller, Bethany
Sandra Langenkamp, Tulsa
􀀁 􀀁 􀀮􀁆􀁍􀁗􀁊􀁏􀀁􀀳􀀏􀀁􀀮􀁄􀀷􀁂􀁚􀀁􀀫􀁓􀀏􀀍􀀁􀀰􀁌􀁍􀁂􀁉􀁐􀁎􀁂􀀁􀀤􀁊􀁕􀁚
Ed McFall, Lawton/Frederick
Ann Bryant, Enid
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