Sunday, August 17, 2014

Busy Woodford County girl is one of 20 youth ambassadors in national campaign against childhood obesity

Genna Ringler of Woodford County has been named to the youth advisory board of the Alliance for a Healthier Generation, a national anti-childhood obesity group, John McGary reports for The Woodford Sun.

Geena Ringler, Alliance for a Healthier Generation
youth ambassador (Woodford Sun photo)
"I  see a lot of kids at my school every day.  They want to be healthier, but they don't know how, so I'm hoping that when I serve on the board, and even after that, that I show them ways that they can lead a healthier lifestyle," Ringler told McGary.

The 12-year-old's life is already full.  She peer-tutors children with special needs, teaches special-needs children to swim, runs cross-country, is on the local swim team and enjoys bicycling, McGary reports.  She has also led a fundraiser that generated nearly $2,800 for the Muscular Dystrophy Association, to honor a friend and classmate who passed away.

She applied for the ambassador position in Febuary, was selected in May and was off in July for training in Utah, where she met the 19 other selected ambassadors, received media and interview training, and consulted with the adult ambassadors to develop goals for her project.

"I didn't know that it wasn't just playing video games," she told McGary, referring to the causes of childhood obesity. "It's so much more.  It's your economic background and how your parents raise you ... and all that kind of stuff."

Ringler told McGary that childhood obesity is an epidemic and that "it takes a lot of people to help change one person's lifestyle and I thought that one more person could help make a difference." (Read more) Kentucky ranks eighth nationally in child obesity.

Friday, August 15, 2014

Women leading Ky. Health: With less than 16 months left, Haynes tries to 'bake in' health reform, managed care, more

This is the last in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

How does a person create lasting change in an ever-changing political environment? “Bake it in,” says Audrey Tayse Haynes.

Secretary Audrey Haynes
As secretary for the Cabinet for Health and Family Services since 2012, Haynes has led the state's efforts to implement the federal health-reform law, dealt with the controlled chaos that was the transition to managed-care Medicaid and faced controversies in the social-services system. Now, with less than 16 months left in Gov. Steve Beshear's administration, she wants to make big improvements in the state’s behavioral-health system.

“We want to get as much (done) as we can get and we want to get it baked in,” Haynes said, “so hopefully the next person that comes will be as enthusiastic about building on the foundation that we have laid.”

Haynes brought more than 25 years of leadership experience to her job, including appointments under three earlier governors. From 1997 to 2001, she was deputy assistant to President Bill Clinton and director of the Office for Women’s Initiatives and Outreach, then special assistant to Vice President Al Gore and chief of staff for Tipper Gore. For the next decade, she was senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C.
  
She says her personal style of leadership – “collaboration, inclusion and transparency” – took her staff a while to get used to, but is paying off with results.

“I’m all about forcing people to work together and trying to figure it out because you get a better product,” she said. “We don’t sign things around here unless it’s been vetted through the agency that it is going to impact. It took a while for people to get used to that.”

At her recommendation, Beshear named Carrie Banahan to run the state insurance exchange, Kynect, which has enrolled 521,000 people and become the nation’s model of how to run a successful exchange.
.
“We all collaborate and all work together,” Banahan said in a separate interview. “Audrey has comprised a good team in the cabinet and we support her 100 percent.”

“I couldn’t get a better boss,” Public Health Commissioner Stephanie Mayfield said in a separate interview.  “She is genuinely concerned about not just her employees, but the health of the public.”

Haynes said the expanded access to coverage under health reform will improve the health of Kentuckians and the state's health statistics, something employers consider when choosing sites.

“Kentucky has worked so long and hard on building a better, more educated citizenry, so that we (can) recruit more industry and have a stronger economic development base. I believe that is important,” she said. “But equally as important is that we have healthy employees. … I do believe that our state will see many, many benefits from this.

Health reform has been the most controversial domestic issue of the last few years, but for many people in the health-care industry, there has been more tooth-gnashing over the managed-care Medicaid system that began several months before Haynes became secretary.

Managed care, in which insurance-company subsidiaries get a certain sum per patient and increase their profits by controlling costs, “has not been a walk in the park to implement,” Haynes acknowledged. Providers have complained about slow payment and rejection of claims, and one managed-care firm left Kentucky, saying the state gave it misleading financial information.

She said all involved had to “stop, take a breath and stop screaming long enough to sit down and honestly work through the problems. . . . We have just forced people to the table month in and month out to work out these issues.”

Haynes began collaboration with providers and managed-care firms, and held public forums for all stakeholders to ask questions and get answers. It recently started a second round of forums, and she says things are much calmer now, almost three years after managed care began.

“Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” she said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act.”

The next big frontier in managed care is integrating behavioral health with physical health, she said. Noting that more behavioral-health providers are now eligible to receive Medicaid reimbursements, she said that increases accountability toward better outcomes for such patients.

Haynes has little more than a  year left to “bake it in,” because Beshear cannot seek re-election. She acknowledges that the changes in health care are “turning people’s worlds upside down.”

“There are a lot of changes going on, and they are not going to be able to just move on a dime,” she said. “So we have to be able to push, cajole, be patient, teach and then repeat all of that constantly.”

Thursday, August 14, 2014

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson
This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”

Wednesday, August 13, 2014

Fort Thomas joins other wealthy school districts in U.S. that have dropped federal school-lunch program

The wealthy Fort Thomas school district in Northern Kentucky is dropping out of the federal school-lunch program because "Kids didn't like their healthful lunches," Jessica Brown reports for The Cincinnati Enquirer.

"The 2,800-student district joins a small but growing number of school districts across the country – mostly wealthy districts who can afford to forfeit the money – who have dropped out of the federal program in the wake of stricter nutritional standards," Brown writes. "Schools said students don't like the unsalted potatoes, low-fat cheese or the mandatory fruits and vegetables. They throw food away or decide not to eat at all."

Forsaking federal funding will cost the district an estimated $260,000 a year, Brown reports. "Children who get free or reduced-price lunches – about 17 percent of the student body – will still get them at that price." (Read more)

Tuesday, August 12, 2014

Women Leading Kentucky Health: Insurance Commissioner Sharon Clark is key player in making health-reform law work

This is the second in a series, Women Leading Kentucky Health, of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

The day after the Patient Protection and Affordable Care Act was signed into law, a reporter called the state Department of Insurance and asked what it all meant. The reply? People in the agency had to read it first – all 2,700 pages of it, Commissioner Sharon P. Clark recalled.

Commissioner Sharon P. Clark
“We hit the ground running on March 24, 2010 and have continued since then,” Clark said in an interview. “It has been a lot of strain on the resources here and people’s time just to get a grasp of it. I am not exaggerating when I say there have been thousands of hours involved with it.”

Clark’s department is not in the Cabinet for Health and Family Services, but she is chair of the 19-member advisory board for Kynect, the brand the state uses for the health-insurance exchange Gov. Steve Beshear created under the law.

That strategic appointment was made by Cabinet Secretary Audrey Haynes, who said she realized early on how important it was to have the Insurance Department “at the table.” Haynes said the committee has had a “united front” since the beginning.

Clark attributes the success of Kynect, which has enrolled 521,000 people in health coverage, to collaboration and communication. “Everybody has just had to roll up our sleeves,” she said. “It has been the governor’s expectation that we work together and we get the job done. I don’t think any of us ever had any hesitancy with it.”

Clark, who was the Insurance Department’s director of consumer protection and education from 1998 to 2003, has seen the disruption and disasters that can happen to people without health insurance.

“I can’t tell you how much financial devastation there has been for people that did not have insurance coverage,” she said. They “have had, due to medical conditions, had to file for bankruptcy. … . I think anything that gives people the opportunity to get insurance has a significant impact on their lives.”

But the reform law and its implementation have been controversial, and Clark said, “The times continue to be challenging.”

One of the early challenges was making sure everyone was on board. Clark said it was important to the committee to make sure all stakeholders, such as hospitals, insurance agents and companies, doctors and the Kentucky Chamber of Commerce, were able to offer input and be involved in the process.

“The first collective voice was that Kentucky needed its own exchange” for people to sign up for health insurance or Medicaid, Clark said. She laughed and said, “I have been involved in government for over 20 years and it is rare that you get everybody saying the same thing.”

A more recent challenge has been President Obama’s decisions to allow states to extend existing health-insurance policies that don’t meet the requirements of the law for two more years, or policy years beginning on or before Oct. 1, 2016. Beshear allowed insurance companies to make such extensions.

Clark said the extensions created confusion in the marketplace. She said it is difficult for insurance companies to make such changes in mid-stream, because policy and technology systems have already been put in place toward compliance with the law.

The department’s major role in the new system is approving insurance companies’ rates, policies and forms. “We must approve the product or there is nothing out there to be sold,” Clark said.

Clark, like Beshear a longtime Democratic Party activist, says insuring Kentuckians will not only improve their health, but to also make a difference in their lives. “Health care is for all of us,” she said. “It is for all of us, society as a whole.”

Poll: Kynect considered a success, but voters haven't embraced it, and they still disapprove of the Affordable Care Act

By Al Cross
Kentucky Health News

A new poll again indicates that Kentuckians marginally approve of the state health-insurance exchange created under the federal health-reform law, but clearly disapprove of the law itself.

The poll, taken Aug. 7-10, surveyed Kentuckians who said they were likely to vote in the Nov. 4 election for the U.S. Senate. After questions about the Senate race, President Obama and the 2015 governor's race, would-be voters were asked, "Do you approve or disapprove of the Affordable Care Act?" then "Do you approve or disapprove of Kynect?" The terms were not defined; the Patient Protection and Affordable Care Act is widely known as Obamacare, so opinion of the president influences opinion of the law.

Fifty-one percent said they disapproved of the law, while 34 percent said they approved and 14 percent said they were not sure. But regarding Kynect, the brand for the insurance exchange, 34 percent said they approved, 27 percent said they disapproved and 40 percent said they weren't sure. The poll's error margin, which applies to each figure, was plus or minus 3.1 percentage points.

The more liberal voters were, the more likely they were to approve of the reform law and the insurance exchange. Among moderate voters, 47 percent approved of both, while 36 percent disapproved of the law and only 17 percent disapproved of Kynect. The remainders were undecided.

Women and Democrats were more likely to approve of both measures. Independents disapproved of the reform law more strongly than Republicans did, and were evenly divided about Kynect, but they were only 10 percent of the total, so the error margin for their results is almost 10 percentage points.

When asked about "implementation of the Affordable Care Act," 41 percent of self-described likely voters said it has been very successful or somewhat successful, while 54 percent said it had been very or somewhat unsuccessful. Six percent were undecided. The detailed percentages were: very successful, 15 percent; somewhat successful, 26 percent; somewhat unsuccessful, 20 percent; and very unsuccessful, 34 percent.

Asked about "implementation of Kynect," 21 percent said it has been very successful and 24 percent said it has been somewhat succcessful, for a total of 45 percent. Sixteen percent said it has been somewhat unsuccessful and 13 percent said it has been very successful, for a total of 29 percent. The other 26 percent said they were not sure.

The survey was taken by Public Policy Polling, a North Carolina firm that usually polls for Democrats but produces results that have leaned only slightly Democratic. Eighty percent of the respondents were contacted by an automated telephone call and 20 percent were contacted through the Internet. The online respondents were more likely to approve of the law and Kynect. The main poll results are at http://www.publicpolicypolling.com/main/2014/08/mcconnell-leading-in-re-election-bid.html#more and the details are at http://www.publicpolicypolling.com/pdf/2014/PPP_Release_KY_8121205.pdf.

Nationally, opinions about the reform law "have been locked in partisan stasis, occasionally moving slightly up and down," since it was enacted in March 2010, Kaiser Family Foundation President Drew Altman writes for The Wall Street Journal., citing the foundation's polling. Altman adds that opinions of the law "are stuck in neutral because the law is a proxy for people’s feelings about the president and the direction of the country, which are similarly divided along partisan lines. For many voters, it is almost impossible to tell where opinion on Obamacare ends and opinion on its namesake begins." Obama is unpopular in Kentucky, getting a 32 percent job-approval rating in the latest public, statewide poll.

Fayette County Board of Health wants to regulate electronic cigarettes, raising some questions

The Lexington-Fayette County Board of Health is discussing ways to restrict the use of electronic cigarettes in public places and strategies to inform people about their potential dangers, Mary Meehan writes for the Lexington Herald-Leader. This continues not only the debate about whether or not e-cigarettes should be regulated the same way as traditional tobacco products but also how much power health boards may have in such matters.

E-cigarettes are battery-powered, and the liquid nicotine turns to vapor that can be inhaled. Though they don't contain tobacco, nicotine is sometimes used as a pesticide and can be harmful to humans as well. The General Assembly recently passed a law regulating e-cigarette sales, making them illegal to minors. The Danville City Commission has already banned the indoor use of e-cigarettes. “The state now classifies them as a tobacco product. What makes them different? By our ordinance, there is no distinction,” City Manager Ron Scott said.

Sometimes advertisements make it seem as though e-cigarettes are a safe alternative to traditional smoking, Meehan writes. Fayette Health Board Chairman Scott White, an attorney, noted that some e-cigarette flavors, such as bubble gum, target children. "If marketing a deadly product to children isn't evil, I don't know what is," he said. "We have enough history with the tobacco industry to know we need to get ahead of this."

Some think e-cigarettes can help people quit smoking, but that hasn't been proven. More research is still needed. Also, even if e-cigarettes help some people quit smoking, they may be a "gateway drug" to others.

The board may change "Lexington's current smoking ban to include e-cigarettes" and create "a public education campaign," Meehan reports. It's unclear how the board would do that, since the ban was passed by the Urban County Council. Also, the state Supreme Court recently ruled that health boards couldn't pass smoking bans, and it's unclear whether that decision would come into play.

Ellen Hahn, director of Kentucky Center for Smoke-Free Policy, told Meehan it would be best to "include electronic cigarettes in smoke-free laws because they are a tobacco product, and they pollute the air," Meehan writes. "E-cigarettes give off tiny particles that can lodge in the lungs and cause disease."

Though public health departments are helping reduce smoking rates in Kentucky, the "rates remain high, with about 29 percent of adults smoking and approximately 18 percent of people younger than 18," Meehan reports. "The state has also reported a leap in nicotine poisonings, and that leap has been tied to e-cigarettes." (Read more)

Monday, August 11, 2014

UK researchers find surprising differences in teens' concussion symptoms and physical and emotional effects

University of Kentucky researchers have discovered surprising differences in symptoms student athletes experience following a concussion, a particular concern as high-school football season nears.

Lisa Koehl, a doctoral candidate in the university's Department of Psychology, and Dan Han, director of the Multidisciplinary Concussion Program at UK HealthCare, drew from a UK database of patients with brain injury and drew a sample of 37 athletes aged 12 to 17.

Koehl said in a press release that 22 of the 37 participants had emotional symptoms after suffering concussions. Among those with such symptoms, 23 percent also had sensitivity to light, while 14 percent had sensitivity to noise. Of the teens who did not have emotional symptoms, 13 percent had light sensitivity, but none of them had noise sensitivity.

Han said said participants who reported anxiety were 55 percent more inclined to have attention difficulties than those who didn't report anxiety. Teens who were irritable or aggressive were 35 percent more likely to report issues with attention those those who were not irritable.

The two groups did not show differences in how many experienced "loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of the severity of concussion," the press release says.

Koehl said the research helped them understand how physical and emotional symptoms in concussion patients interact, with each causing the other in different cases. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery," Han said. (Read more)

UK president sees the need for 'irrational optimism' and working as a community to improve Kentucky's health

The health and economic issues facing Appalachian Kentucky are daunting, but still worthy of "irrational optimism," as espoused by the head of the federal Centers for Disease Control and Prevention, University of Kentucky President Eli Capilouto says in his most recent short essay.

Dr. Thomas Frieden of the CDC, who toured Eastern Kentucky with Capilouto and U.S. Rep. Hal Rogers last week, had a daily motto for his staff while working in India, a place with even greater challenges: "Irrational optimism is a pre-requisite for sucess," Capilouto writes. He says he saw the power of that in a day-long symposium on health issues sponsored by the Shaping Our Appalachian Region initiative started by Rogers and Gov. Steve Beshear.

"Where so many see problems, Kentuckians see potential," Capilouto writes. "Where others place limits and barriers, Kentuckians see the promise of a brighter tomorrow," especially when they can work together. To illustrate that, he tells the story of a Denver minister he heard on a radio show.

"She was discussing the idea of what it means to be human; what it means to be part of a community," Capilouto writes. "The minister said she disagreed with the notion that God will never give you more than you can handle. 'God,' she said, 'will never give you more than your community can bear or you as a member of a community.' The idea, of course, is that we all need each other. And we all have responsibilities to each other. That’s what it means to be part of — and partners with — community." (Read more)

Women Leading Ky. Health: Exchange Director Carrie Banahan says getting people health insurance is highlight of her career

This is the first in a series, Women Leading Kentucky Health, of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

Energy exudes from Carrie Banahan when she talks about her work with others to bring affordable health care to more than half a million Kentuckians.

Banahan discussed Kynect with a man in Pikeville last
 summer. (Wall Street Journal photo by Ian Bates)
“I worked all my life to see this happen, that we can provide affordable health insurance to people, and it has actually happened,” she said. “I am thrilled that we are actually helping people in Kentucky. It is the highlight of my career.”

Banahan is executive director of the Kentucky Health Benefits Exchange, which the state has branded as Kynect, partly to avoid identification with the pejorative nickname Obamacare. She shares the credit for its success.

“One thing that I am proud to say I am part of is our team in general,” she said in an interview. “Everybody is very dedicated to this project and wants it to succeed and believes, as we all do, that we are going to make a huge difference in people’s lives.  We are going to improve the health status of Kentuckians.”

She attributes the success of Kynect to early planning, collaboration and teamwork.  Outside state government, she credits the support of community groups and a pent-up demand in Kentucky for access to affordable health insurance.

Banahan was executive director of the state Office of Health Policy when the Patient Protection and Affordable Care Act passed in 2010. Gov. Steve Beshear immediately gave her the task of investigating whether Kentucky should establish its own health-insurance exchange.

Beshear decided to do that, but they had to wait until the U.S. Supreme Court ruled on the law. On June 28, 2012, the court voted 5-4 to uphold it, except the part that would have denied Medicaid funds to states that did not expand the program.

Beshear created the exchange and named Banahan its director. With its successful rollout little more than a year later, Kentucky has become the national model for how to start and run a successful state exchange.

Banahan knew the landscape of Kentucky health care and insurance because of her work in the key departments involved: Insurance, Medicaid and Community Based Services, formerly Social Services.

“I think it has been beneficial that I am a veteran,” she said.  “They all know me. They all trust me. I have good working relationships with all of them.  So I think that has helped to sell this.”

She said much credit should go to others. “We have just tremendous support from the business community, the Kentucky Chamber of Commerce . . . all of the medical related associations, advocacy groups, insurers, agents.”

But Banahan was key to making it happen, said her boss, Audrey Haynes, secretary of the Cabinet for Health and Family Services.

“There was not another person that was in this state as suited for that job at this time as Carrie Banahan,” she said. “And when I recommended her to the governor, he was also convinced that there was no one else.”

So far, more than 521,000 Kentuckians have enrolled for health-care coverage through Kynect, three fourths of them through Medicaid.

That was more than expected; when Banahan was interviewed this spring, her staff was celebrating with a cake for only 275,000 signups.

Banahan said her biggest surprise was “the overwhelming response, people applying. People out there on our website.  That has been the biggest surprise for everybody, how successful the rollout was, the support we have had.  It was a wonderful surprise.”

She added, “That just demonstrates that there was certainly pent-up demand from folks who needed affordable health insurance coverage. . . . There are people who couldn’t afford to get treatment and now they can seek services.”

Looking to the future, she said, “It will be hard to top next year.”

Banahan’s “next year” is closer than it sounds. She and her team are planning for the next open enrollments, which will run from Nov. 15, 2014, through Jan. 15, 2015.

She said her primary focus of the next enrollment period will be informing individuals about the subsidy component of Kynect, even those with private health insurance.  A family of four making as much as $94,000 a year qualifies for a subsidy.

Kynect will also work on improving its Small Business Health Options Program (SHOP), which allows employers with fewer than 50 workers to enroll them for health coverage through Kynect; increasing outreach and education for those age 18-29, known as the “young invincibles;” and making sure people understand that the eligibility for Medicaid has expanded, and that many who qualify haven’t applied for it, Banahan said.

“I am always energized and very optimistic,” she said.  “I am ready for the next open enrollment to see if we can reach more people.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Friday, August 8, 2014

Health issues facing Appalachia, focus of CDC director's tour, could be a forewarning of where the country is heading

The chronic health issues of Appalachia, the focus of a recent tour by the head of the federal Centers for Disease Control and Prevention, are really no different than the chronic health issues the entire country faces; they are simply more concentrated in one area, Laura Ungar writes for The Courier-Journal and USA Today.

"It's about proportion and intensity rather than something unique that's happening there," Jesse Roman, chairman of the Department of Medicine at the University of Louisville, told Ungar. "The problem is larger and more visible there, but they're not alone."

Ungar describes the health challenges of one couple in Appalachia, 48-year-old Alisha Blankenbeckler and her husband, Tony. Alisha has diabetes, bowel and bladder problems and is on oxygen. Her condition makes it hard to take care of her husband who has heart disease and hip problems since being struck by lightening in 2010. He takes 11 pills a day; she takes 30.

"Dying is something I think about every day," Alisha told Ungar.

This story, Ungar reports, is common in the Appalachian region, which is considered one of the nation's unhealthiest regions.

Heart disease prevalence is 84 percent higher in the region than the national average, diabetes is 47 percent higher, and lung cancer kills at a rate 83 percent higher. The region has the highest-in-the-nation smoking rates, with nearly a third of adults smoking cigarettes, and Kentucky has the highest number of deaths caused by cancer.

"We're in the stroke belt, the diabetes belt, the coronary valley. We get all those labels," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health at Hazard, told Ungar. "We're in a sad state here."

Some experts say Appalachia "may be a harbinger of where the country is headed if we don't rein in epidemics like obesity," Ungar writes. Obesity spawns "diabetes, heart disease and many cancers and spanning all socioeconomic levels/."

CDC Director Tom Frieden recently toured Eastern Kentucky to "find out more about the underlying causes of the region's ills and how to treat them -- and in the process gain traction against the rising burden of chronic disease that ails the nation," Ungar reports.

"The Appalachian region is just like the rest of the U.S. — only more," Frieden said on the tour. "We want to help an entire community and a whole nation."

Ungar writes, "Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty."

Alisha Blankenbeckler told Ungar that at times she has had to stretch her insulin by taking less than the prescribed amount and once needed to go to the hospital but didn't because she had no insurance or money to pay the bill. She recently got insurance through the state's Medicaid expansion, and her husband is on Medicare, but that doesn't guarantee access to all the care they need because of required Medicare co-payments, medical equipment that is not covered, and gas to get to the doctor. The couple gets disability benefits of $1,427 a month.

Though more than half a million Kentuckians have enrolled in health insurance through the Affordable Care Act, "access to health care is difficult in Appalachia," Roman told Ungar.  "And there seems to be something about culture — a sense of fatalism, that whatever happens, happens."

Ungar writes that Friden and Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health "say improving the health of Appalachia and like communities will not be easy, because it depends on changing seemingly intractable socioeconomic disparities and personal health habits."

Frieden said that while outreach and health education is crucial, he will "listen and take cues from local communities about how best to attack their particular health problems. If he finds an effective program, he said, he will replicate it and fit it to other communities."

Thursday, August 7, 2014

State gives 5 health departments money for mobile dental-hygiene teams that will examine children at schools; 5 more next year

Using new money in the state budget, the state Department for Public Health has given five local health departments grants to launch mobile dental hygiene programs.

The one-year awards of $160,000 will pay for a full-time dental hygienist and assistant; portable dental equipment to set up two treatment areas; a transport vehicle and transportation costs; and dental supplies.

“Hundreds of thousands of children in this state don’t see a dentist regularly and many not at all,” Gov. Steve Beshear said. “The vast majority of both childhood and adult dental problems could be avoided through routine dental care and other preventive efforts.”

The hygienists and assistants will visit schools for "assessments, age-appropriate cleaning services, fluoride varnishes and dental sealants on permanent teeth for children at the beginning of the school year," says a release from the Kentucky Press News Service. "They can also serve local day care centers and Head Start programs. Hygienists will work with parents to facilitate any needed follow-up care with a local dentist."

The grants went to the Lincoln Trail District Health Department, which serves Hardin, LaRue, Marion, Meade, Nelson and Washington counties; the Purchase District Health Department, which serves Ballard, Carlisle, Fulton, Hickman and McCracken counties; the Pike County Health Department and the departments in Jessamine County, which will also serve Mercer County; and Lawrence County, which will also serve Martin County.

Three health departments – Madison County, the Barren River district, and the Northern Kentucky district – already have dental hygiene programs in place. Five more health departments are to get grants next year two for similar programs.

The legislature appropriated $1.2 million in the current fiscal year and $2.1 million in fiscal 2016 for the grants and other enhancements to the state oral health program, overseen by state dental director Julie W. McKee.

“Placing public health dental hygienists in the community where they can provide front-line support and services to our young people is a great leap forward in terms of not only being able to assess problems, but provide on-site cleanings and dental care,” McKee said.

Improving the oral health of Kentuckians is one of the goals of kyhealthnow, Beshear's plan to improve Kentuckians' health. It aims to reduce the percentage of children with untreated dental decay by 25 percent and increase adult dental visits by 10 percent.

Beshear has been more active on oral health than other recent governors. He launched an effort in 2009 to enroll all eligible children in state health insurance through the Kentucky Children's Health Insurance Program and Medicaid; authorized the "Healthy Smiles Kentucky" initiative, which includes training for general dentists on how to care for young patients; community oral health coalitions; and started the "Smiling Schools" program, which provided free protective tooth varnishes to school children in first through fifth grades in 16 Appalachian counties.