Are your children's school foods canned or in plastic? That could cause health problems, study in California suggests

Researchers have found that elementary-school children, especially low-income students who are more likely to eat federally funded foods rather than pack a lunch, are being exposed to "school meals that may contain unsafe levels of bisphenol A (BPA), a chemical often found in canned goods and plastic packaging," Paige Miller reports for Stanford University, home to some of the researchers. "BPA can disrupt human hormones and has been linked to health effects ranging from cancer to reproductive issues."

The study was done in urban, suburban and rural schools in the San Francisco Bay area by Stanford's Prevention Research Center and the Johns Hopkins Bloomberg School of Public Health, and was published in the Journal of Exposure Science and Environmental Epidemiology.

Researcher Jennifer Hartle told Miller, "During school site visits, I was shocked to see that virtually everything in school meals came from a can or plastic packaging. Meat came frozen, pre-packaged, pre-cooked and pre-seasoned. Salads were pre-cut and pre-bagged. Corn, peaches and green beans came in cans. The only items not packaged in plastic were oranges, apples and bananas."

Researchers track BPA intake in terms of micrograms per kilogram of body weight per day. Rodents experience toxicity at 2 mcg/kg, but the toxic level for humans is unknown because it's also unknown how humans metabolize BPA, Miller writes. In 1988, the Environmental Protection Agency "defined safe BPA consumption levels as 50 micrograms or less per kilogram of body weight per day," Miller writes. "Since then, hundreds of scientific papers have found detrimental biological effects of BPA at levels lower than the EPA standard. The European Food Safety Authority recently updated its standards for safe BPA intake to 4 micrograms per kilogram of body weight per day."

The study found that a student consuming pizza and milk with canned fruits and vegetables could take in anywhere from minimal levels of BPA up to 1.19 mcg/kg each school day. "While most students would not consume the maximum amount, those who do would take in more than half of the dose shown to be toxic in animal studies in just one meal," Miller writes.

Study co-author Robert Lawrence of Johns Hopkins told Miller, "With endocrine-disrupting chemicals particularly, there is so much uncertainty. We can't tie a specific dose to a specific response like we can with lead. But we know BPA is impacting human health. Animal models are showing there can be a whole range of health effects. This research shows we should take a precautionary approach." (Read more)

National Institute on Drug Abuse director, in Ky., offers solutions to stop over-prescription of painkillers, opposes pot legalization

By Melissa Patrick
Kentucky Health News

The director of the National Institute on Drug Abuse, Dr. Nora Volkow, told a group of Kentucky journalists and others at the Foundation for a Healthy Kentucky Health Journalism Workshop Sept. 21 that it is possible to decrease the over-prescription of opioids, which she says is driving the heroin epidemic, but the solutions aren't "sexy."

Prescriptions in the U.S. for opioids have increased from 76 million in 1991 to nearly 207 million in 2013.

The increase began in 2000 when The Joint Commission (on Accreditation of Health Care Organizations, then part of its name) began to require health-care providers to assess pain as a fifth vital sign and treat it as necessary, noting that addiction training is often not part of the medical curriculum, Volkow said.

Chronic pain is rampant in the U.S., with more than 100 million Americans suffering from moderate to severe pain, she said. And because there are few alternative treatments, it has led to the over-reliance on, and over-prescription of, opioids.

Kentucky saw a surge in heroin overdoses after the legislature cracked down on so-called pill mills, but the over-prescribing of opioids is what is driving heroin addiction, not the laws that have made legal opioids harder to access, said Volkow, a neurocscientist.

Volkow said there was a "horrific escalation" of babies born physically dependent on drugs and suffering withdrawal. She said she could not predict if these children would grow up to be addicts, she did know that addiction hurts babies' ability to bond with mothers, which puts them at a higher risk for increased anxiety later on.

Volkow said education and implementing solutions that we know will work is the way to combat this problem, and "It is solvable." She offered these suggestions:

• creating a shift in America's cultural attitude that says there is a pill for everything;
• educating patients about the abusive potential of opioids when they are prescribed;
• decreasing obesity rates, because obesity is a major cause of joint pain;
• exploring non-medication avenues for managing pain, such as real-time brain imaging that shows how cognitive processes influences brain activity;
• better educating health-care providers on how to recognize and treat addiction;
• making sure providers are following recommended guidelines when prescribing opioids; and
• creating new pain relievers with reduced abuse, tolerance and dependence risk.

Kentucky tied for fourth in prescription of opioids in the nation in 2012, at 128 prescriptions per 100 people, according to the IMS National Prescription Audit. Kentucky has the third highest overdose death rate in the nation, with more than 1,000 people dying each year. In 2014, 233 people died from a heroin overdose in Kentucky.

Nationwide in 2013, there were 16,000 plus deaths from opioid-prescription overdoses and 8,000 from heroin, says the Centers for Disease Control and Prevention.

The number of deaths from prescription drugs and heroin have become so dramatic that no one could ignore them, Volkow said.

She also noted that the increase in opioid use among young people was "alarming," citing that 10.5 percent of 12th graders said that they had abused Vicodin in the previous year and 5 percent of them had abused Oxycontin.

Dr. Nora Volkow

Volkow spoke at length on the importance of utilizing medications in treating opioid addicts, saying that it is proven that when drugs containing methadone and buprenorphine are part of an ongoing addiction treatment program, addicts have the most success of recovery. She noted that only 30 percent of providers prescribe such medications, and fewer than half of addicts get them.

Removing a person from the drug "is not treatment," she said, noting that this mode of "treatment" creates an almost 100 percent chance of relapse, and the best chance of success is with the use of medications like suboxone.

Volkow doesn't like the idea of legalizing marijuana. She said her view isn't driven by whether it is more or less harmful than alcohol or nicotine, but by the societal cost of legalizing another drug. She said that once a drug becomes legal, that increases exposure and addiction to it, increases the likelihood that it will be used regularly and increases the adverse effects from the drug; and marijuana is proven to have negative effects on adolescents.

She said the medical and mortality cost related to drugs comes mostly from legal drugs, noting that 400,000 people die a year from tobacco and 24,000 die from opioids, and asked, "Why do we want to expose ourselves to a third legal drug?"

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Beshear: Bevin plan to repeal Medicaid expansion is 'shortsighted'

Gov. Steve Beshear, in a statement released Tuesday, said Republican gubernatorial candidate Matt Bevin's plan to repeal the expansion of Medicaid in Kentucky and his plan to find an alternative solution through federal waivers is "short-sighted" and would cost the state more than the plan Kentucky currently has in place.

“One constant in Mr. Bevin’s ever-changing position on Kentucky’s Medicaid expansion is his consistent lack of understanding of health care. Several of his most recent statements are misleading. Regardless of the model a state chooses to cover its Medicaid expansion population, the state share remains the same – no more than 10 percent in 2020.”

Beshear challenged Bevin to “identify who among our newly insured Kentuckians he believe should lose health care coverage. Which hospitals, physicians and other providers does he think should bear the brunt of a return to increased uncompensated care?”

The governor said the Congressional Budget Office has found that waivers used to expand Medicaid in different ways “will likely cost more than the expansion as we have implemented it in Kentucky. This is a short-sighted view for the future of our Commonwealth, which is the 47th sickest state in the country. Kentucky has a plan in place that is working. Last week’s Census report showed Kentucky with the biggest drop in the uninsured rate in the country from 2013 to 2014. During this time frame, 16,000 children gained health insurance.”

Bsehear said that's good for Kentucky's economic future because “better health, especially for our workforce, has tangible positive impacts – fewer sick days, more production and a higher quality of life for our citizens. Mr. Bevin doesn't seem to understand this connection.”

Kentucky's expansion of Medicaid to people in households earning up to 138 percent of the poverty level has added about 400,000 Kentuckians to the federal-state program. The federal government pays the entire cost of the expansion through next year. In 2017, the state begins to pay 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020.

Bevin insist that Kentucky cannot afford to pay for this expansion, despite a state-funded report by Deloitte Consulting that says the expansion pays for itself through 2020 by creating health-care jobs and generating tax revenue.

At a health forum sponsored by the Kentucky Rural Health Association Sept. 18, Bevin said," "We will not, and I can't be more clear about this,we will not continue to enroll or re-enroll people at 138 percent of the federal poverty level."

He said that his plan is to apply to the Centers for Medicare and Medicaid Services for waivers under Section 1115 of the Social Security Act "to customize something that allows us to provide for these same folks." In July, he said he would use examples from other states, like Indiana, which requires Medicaid expansion patients to make co-payments.

Bevin spokeswoman Jessica Ditto did not offer a response to the governor's statement.

Sannie Overly, Attorney General Jack Conway's running mate for lieutenant governor, said at the forum, "Jack and I are going to monitor our Medicaid expansion to make sure that we can continue to afford [it] moving forward, but what we won't do, and what our opponents have said they would do, on video and in writing, is to kick nearly 500,000 Kentuckians off their health care."

UK HealthCare performs longest kidney donor chain to date; most donors and recipients meet each other for first time

The University of Kentucky hospital recently performed its first kidney donor chain, and six of the eight patients who took part in it met their respective recipients or donors for the first time at a news conference Sept. 23.

"UK HealthCare has been performing kidney transplants since 1964, but this is really a milestone for us and for the Commonwealth," Dr. Roberto Gedaly, chief of abdominal transplant surgery, said in a UK news release. "We're thrilled to come together today to celebrate our first successful kidney donor chain with donors, recipients, and many of the staff who made this complicated series of procedures possible."

"Kidney donor chains, also called kidney paired exchanges, occur when a living kidney donor is incompatible with their intended recipient. The donor (then) may agree to donate their kidney to a different patient, provided that their loved one receives a kidney from someone else. When multiple pairs are involved, this causes a domino effect, with each recipient receiving a matched kidney from a stranger," writes UKNow.

UK HealthCare performed the 8-person chain in-house over the course of two days. The chain was initiated by one altruistic donor, who was willing to give her kidney to anyone who needed it: Nicki Coulter, a former nurse from Bloomfield, Ky.

 "I used to be a nurse, and I just felt like this was something I needed to do," Coulter said. "I was blessed with good health and a good support system in my family. So I decided to do it!"

"With a kidney chain, the altruistic donor then benefits not just one person, but a whole group of people," said Dr. Stephen Strup, chief of the UK Division of Urological Surgery, said in the release. "Having that one person step up and offer to donate a kidney anonymously to anyone who needs it allows us to start matching incompatible pairs through the chain."

To date, this is the longest donor chain in Kentucky, says the release.

90 percent on state's Kentucky Employee Health Plan are enrolled in its wellness program

If a focus on wellness and prevention is the key to living a longer life, then Kentucky public employees are well on their way with 90 percent of them now participating in the HumanaVitality™ wellness program, which is offered through their Kentucky Employee Health Plan, compared to only 10 percent just three years ago, according to a state news release.

Through this wellness program nearly 158,000 members completed an annual health assessment or biometric screening this year; more than 132,000 members are enrolled in a health plan tied to wellness; and the number of plan members using a pedometer or other fitness-tracking device has increased from around 6,000 to nearly 17,000.

The wellness plan offers and encourages preventive screenings and this year it became the first in the country to offer the national Diabetes Prevention Program to nearly 85,000 members who are considered at-risk of developing the disease, with nearly 300 KEHP members taking them up on it. Plan membership totals around 160,000 plan holders and 266,000 covered lives.

“The program has been a lifesaver,” Connie Armstrong, a Clinton County schools employee, said in the release. “The program is the main reason that I have lost close to 40 pounds – and best of all, my blood sugar has dropped from high risk to normal.”

Ten major diagnostic conditions, including diabetes, heart failure, COPD, obesity, and chronic back and neck pain account for almost 80 percent of all claim costs, says the release.

“Reducing the high rates of chronic conditions has been a major focus for the health plan,” Employee Insurance Commissioner Joe Cowles said in the release. “Now we are seeing a substantial increase in cancer screenings and prevention program participation.”

Oregon Medicaid will fund alternative treatments for pain in effort to cut opioid abuse; Ky. only pays for a few alternatives

Oregon's version of Medicaid is getting ready to pay for some alternative treatments to pain pills in hopes of reducing the number of people who become addicted to opioids or abuse them, Kristian Foden-Vencil reports for NPR.

The coordinator of the Oregon Pain Management Commission, Denise Taray, told NPR that Oregon wants more patients to try alternative approaches to treat pain,. "The only thing that might have been covered in the past was narcotics," Taray sayid. "But treatments such as acupuncture, chiropractic, massage therapy, physical therapy and rehab would never have been covered."

Payment for many of these alternative treatments will begin January 2016 for those who participate in the Oregon Health Plan.

The decision was driven by the over-prescription of opioids, which is a nationwide problem.

"Oregon leads the nation in the non-medical use of opioids,and about a third of the hospitalizations related to drug abuse in Oregon are because of opioids," NPR reports.

The Centers for Disease Control and Prevention says"health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills."

NPR reports, "While the treatments may cost more than a course of pain pills, the hope is to save money by reducing the number of people who become addicted to opioids or abuse them."

Kentucky also struggles with the over-prescription of opioids, but only covers a few of these alternative pain treatment services.

According to the Department for Medicaid Services, "Medicaid covers medically necessary services," Beth Fisher, a spokeswoman for the Cabinet for Health and Family Services, said in an email. "Medicaid does cover some services mentioned in the article, such as chiropractic care and physical therapy. However, acupuncture is not a covered service. As with all treatment plans, the decision regarding specific treatment is made between the physician and individual."

In 2012, Kentucky was listed as one of the top five prescribers of painkillers in the nation, at 128 painkiller prescriptions per 100 people, according to the IMS, National Prescription Audit.

David Eisen, executive director of the Quest Center in Oregon and board-certified in traditional Chinese medicine and acupuncture, told NPR that doctors need to stop thinking of opioids as a first-line defense against pain.

"There should be an array of things for people to choose from," Eisen said, "whether it be chiropractic care, or naturopathic care, or acupuncture, nutrition, massage. Try those things — and if they don't work, you use opioids as a last resort."

Smiling Schools tooth-varnish program expands to 10 more counties; now in 40

Kentucky's Smiling Schools program is expanding to 10 more counties and will now provide its free preventive tooth varnishing treatments to children in 40 elementary schools, most in Appalachia, according to a state press release.

Gov. Steve Beshear and First Lady Jane Beshear, along with others, made the announcement at the Clark County Health Department on Sept. 22.

"Good dental health is a key component of good overall health,” the governor said, “Kentucky’s children deserve the best start in life, and the latest round of our Smiling Schools program will help even more children live up to their full potential in the classroom and beyond.”

Kentucky ranks 41st in annual dental visits; 45th in the percentage of children with untreated dental decay; and 47th in the percentage of adults 65 and older missing six or more teeth, according to the release.

Funding for the Smiling Schools program, which will now reach almost 18,000 students with the expansion, is provided by an $800,000 stream of funding from the Appalachian Regional Commission and the Kentucky Oral Health Program.

The protective varnish treatments provided by the program are administered at the participating elementary schools by local health department nurses. Oral health educational materials are also provided to the parents of the children receiving treatment.

The 10 new counties joining the program are Clark, Edmonson, Green, Greenup, Johnson, Letcher, Lewis, Nicholas, Pike and Pulaski.

The counties already participating in the program are: Bath, Bell, Breathitt, Carter, Clay, Elliott, Estill, Fleming, Floyd, Hart, Jackson, Knox, Lawrence, Leslie, Lincoln, McCreary, Magoffin, Martin, Menifee, Metcalfe, Montgomery, Monroe, Morgan, Owsley, Powell, Robertson, Rockcastle, Rowan, Whitley and Wolfe.

Health Secretary Audrey Tayse Haynes said that the Smiling Schools program had reduced tooth decay and fillings by 20 percent, according to a study by the University of Kentucky College of Dentistry.

Ky. Rural Health Assn. names state Auditor Adam Edelen "Rural Health Champion" for report on finances of rural hospitals

State Auditor Adam Edelen

The Kentucky Rural Health Association has named state Auditor Adam Edelen its first “Kentucky Rural Health Champion” for his special examination of the financial strength of 44 of the state’s 66 rural hospitals.

Edelen found that most of Kentucky’s rural hospitals were below the national average in financial strength. His report "emphasized the importance of rural hospitals, which provide healthcare to 45 percent of Kentuckians and serve a disproportionate share of low-income and elderly citizens," KRHA said in a news release. "In many rural communities, hospitals are the first or second largest employer."

“Auditor Edelen’s leadership sparked a statewide dialogue about the importance of rural hospitals, and provided policymakers with a baseline for monitoring the financial health of rural care centers in the future,” KRHA Executive Director Tina McCormick said. “He has proven himself a true advocate for rural health care.”

Bevin and Conway's running mate, state Rep. Sannie Overly, show sharp differences on health-care issues at forum

By Melissa Patrick
Kentucky Health News

The major-party campaigns for governor disagree on all of Kentucky's major health issues, sharply on such topics as the Medicaid expansion, the Kynect health-insurance exchange and a statewide smoking ban.

Those differences and others were explored Friday in Bowling Green, at a forum sponsored by the Kentucky Rural Health Association, by Republican candidate Matt Bevin and Democrat Sannie Overly, Attorney General Jack Conway's running mate for lieutenant governor.

The questions were composed from a list of questions from the audience, most of whom had attended the annual KRHA conference prior to the forum. Conway was scheduled to attend, but sent Overly, citing a scheduling conflict.

Medicaid

Overly, who spoke second, said on more than one occasion during the forum that the candidates' views on Medicaid expansion under federal health reform was their main difference on health care. Bevin says the expansion is unaffordable and he would replace it with a different program that he has yet to nail down. Conway says that would be premature.

"Jack and I are going to monitor our Medicaid expansion to make sure that we can continue to afford [it] moving forward," Overly said in her opening remarks. "But what we won't do, and what our opponents have said they would do, on video and in writing, is to kick nearly 500,000 Kentuckians off their health care. Our friends, our neighbors and our relatives. Folks in this room know just how damaging that idea can be."

The expansion of Medicaid eligibility, to people in households earning up to 138 percent of the poverty level, has added about 400,000 Kentuckians to the federal-state program. Overly cited the state-funded study by Deloitte Consulting that predicted the expansion would pay for itself, by bringing more people into the health-care system, creating jobs and tax revenue.

The study says the expansion would put $820 million into the state's economy through 2020, but would not pay for itself in 2021. Overly said, "We just simply believe that you don't throw 500,000 Kentuckians off their insurance today because of something that may or may not happen in six years," she said.

The federal government is paying the full cost of the expansion through next year. In 2017, the state would pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Bevin, who spoke first, said he expects that states will have to pay more than the law now calls for because "the federal government is broke." He said Kentucky won't be able to afford the 10 percent, let alone a higher figure.

He said Gov. Steve Beshear spent $144,000 on the study "to delude us into thinking that we are actually making money from this." He added, "We are not. . . . You don't make money by spending other people's money."

Bevin declared, "We will not, and I can't be more clear about this,we will not continue to enroll or re-enroll people at 138 percent of the federal poverty level. We can't afford to. To do otherwise is to lie to them, is to mislead them, is to put too much cost on the taxpayer, to preclude us from being able to provide for those who most desperately need it."

Asked what would happen to the 400,000 Kentuckians covered by the expansion, he offered a lengthy explanation.

Bevin acknowledged that he would have no authority as governor to "oust" the "initial folks" from Medicaid and said that we needed to "come up with a way to provide health care to them." He acknowledged, "Nobody likes the idea of getting less than anything than they currently have."

He said he would apply to the Centers for Medicare and Medicaid Services (CMS) for waivers under Section 1115 of the Social Security Act "to customize something that allows us to provide for these same folks." In July, he said he would use examples from other states, such as Indiana, which requires Medicaid patients to make co-payments.

Bevin said people need to have "skin in the game," because "When you rob people of any vested interest in their own success you rob them of any reason to care."

He added, "There is nobody who is getting it that doesn't have some element of need. There is no question about that. But I grew up well below the poverty level, we never had access to it, I managed to turn out. That isn't to say that that is the answer, it is not. I know it is not easy. I know it is a struggle. But it is not as if these people will suddenly be destitute in the street if they don't have everything that they currently have today."

Bevin said getting federal Medicaid money in a block grant could allow the program to help people between 138 percent and 200 percent of the poverty level. "Maybe they have a health savings account where they get a certain allocation of CMS dollars through this 1115 waiver where they have their own account and so that they have some incentive, if they have prescriptions, to not get the $100 prescription if they can get the $20 generic, because they have power over that and they have an allocated amount of money that has been given to them.

"If we implement things like this, and we can and we should, then ultimately we are going to find that we are covering more people with better access and empowering them in ways that actually help them to streamline themselves back into society in ways that are good."

Kynect

Bevin said the Kynect exchange has been a success only because it was built on "other people's money," meaning federal grants, and reiterated that he plans to shut it down and move Kentuckians to the federal exchange because Kynect "is a level of redundancy frankly that does not serve us well."

He said that the argument that Kynect only costs insurers 1 percent, compared to the 3.5 percent charged by the federal exchange is like comparing "apples and oranges" because the 1 percent is a fee on all health-insurance policies sold in the state, while the federal exchange's 3.5 percent fee is levied only on policies sold through that exchange.

Overly reiterated that she and Conway plan to keep Kynect.

"We've been hailed as a national model for how to take the federal law and implement it here in Kentucky," she said. "That doesn't mean it's perfect, and we will continue to work with folks in this room as we need to make additional changes to continue to improve Kynect, but I think we've done a pretty job of implementing it to this point."

Smoking ban

Bevin says bans on smoking should be local decisions, though he does support government buildings being smoke-free.

Overly said, "Jack and I are supportive of a statewide smoking ban," noting that she had voted for it in the House during this last session.

Managed care

After many complaints from hospitals and other health-care providers, the Cabinet for Health and Family Services changed its contracts with managed-care organizations that oversee Medicaid patients' care.

Bevin said the changes have not gone far enough. "At a bare minimum, we need to ensure absolute strict compliance with streamlining this to the degree possible, but we would do well to simplify it even further," he said.

Overly said she and Conway want to make sure the contracts had enough "teeth" in them to allow the cabinet to ensure compliance."We have a ways to go before we get this right and we are committed to continue to work to make sure that we are providing health care delivery to Kentucky's rural citizens."

Tort reform and medical review panels

Bevin said he absolutely supports tort reform and would be "very intentional" about moving it forward if elected. "If this race comes down to nothing else in your minds, the odds that you will have any kind of tort reform in this state in the next four plus years if Jack Conway is the governor of this state is zero."

Bevin said he also supports medical review panels for malpractice and other lawsuits against health-care providers, but says they should be set up in a way to promote "thoughtful, intentional, self-evaluation" that doesn't create a situation where the information disclosed can be used against you.

Overly, like Conway a lawyer, said, "I very strongly believe that we must keep our court system open for each and every Kentuckian. Having said that, Jack Conway has said that he would consider some amendments to tort reform here in Kentucky. We would take those on a case by case basis and where they make sense we would be willing to look at implementing those."

Quality and quantity of health care

Bevin said to improve quality and quantity of health care, we must "sit down and have a modern, up-to-date, frank conversation about things like certificate of need, things like scope of practice, things like reimbursements and whether or not the number of MCOs we have is appropriate. . . . Everything should be on the table. . . . The heart of the answer to that question is the fact that we need to empower those at the point of contact."

Overly said, "We have put forward a jobs plan, we have put forward an education plan and a number of components of those plans are things that will improve the lives of rural Kentuckians," noting their commitment to bringing broadband to all of Kentucky. She also said that she and Conway would make sure rural health issues would "have someone at the table in Frankfort."

Republicans want Medicaid members to pay something

As state officials reviewed changes in the five Kentucky Medicaid managed-care organization contracts that went into effect July 1, one Republican lawmaker said the contracts don't go far enough and that he would like to see them include co-payments and deductibles for all recipients of these services.

"What I am concerned about is that we still seem to be turning a blind eye to managing and encouraging good behavior on the recipient side," Rep. Robert Benvenuti, R-Lexingtion, said at the Sept. 16 meeting of the Medicaid Oversight and Advisory Committee.

"I am afraid with one-fourth of our population now in this program that the most vulnerable, the truly vulnerable, are going to fall through the cracks and are falling through the cracks and part of that is because a group of folks, especially through expanded Medicaid, who I don't consider truly vulnerable, are paying nothing and I just don't think that is at all sustainable or responsible."

Benvenuti said that he thought a co-payment should be mandated in the contracts because, "We've got to have folks to have skin in the game."

The five MCOs with contracts in Kentucky are Anthem, Humana, CoventryCares, WellCare and Passport.

Medicaid Commissioner Lisa Lee said that the main reason MCO's don't charge a co-payment is to assure that the providers get maximum payment for services under federal guidelines. For example, if the co-payment is built into the service billing, if the recipient doesn't pay their co-payment, then the provider loses that amount.

Benvenuti also suggested MCOs are hesitant to include co-payments on their own because it would make their plans less attractive to Medicaid clients, who choose their MCO. Certain services are exempted by federal law from any cost-sharing provisions, such as emergency services, family planning, pregnancy-related services, preventive services for children and others.

Lee agreed with Benvenuti that it was important to continue to explore ways to pay for the expansion of Medicaid under federal health reform. The state will have to start paying 5 percent of the expansion cost in 2017, rising to the law's limit of 10 percent in 2020.

"I think as a group we just need to come together and figure out what we can do to make this program sustainable going forward and look at every option on the table, put everything out there and try to see what we can do," Lee said. “And of course we know that we have a new administration coming in next year, and we’ll have opportunities to kind of look at the program and how to best move forward to make sure that we are providing services and being fiscally responsible.”

The "skin in the game" concept is one that gubernatorial candidate Matt Bevin supports, having said that this is one of the reasons he likes the Indiana model of Medicaid expansion as it requires people to be vested in their healthcare through co-payments.

"Having skin in the game is a big, big differentiator when it comes to whether or not a person has the dignity that comes with making decisions for themselves...," he said at a Kentucky Chamber of Commerce meeting in Louisville in July.

But Rep. Joni Jenkins, D-Shively, while saying all avenues should be explored, offered some caution on this idea, reminding the group that this was a complex issue.

“I think we need to remember what this population looks like and what the income requirements are to be eligible for that," she said. " I think we have to be very careful here that we are not dissuading people from seeking out health care."

Gov. Steve Beshear expanded Medicaid to include those up to 138 percent of the poverty line. For a family of four, that is $33,465. About 400,000 Kentuckians now have free health coverage because of this expansion. The total number of Medicaid members in Kentucky is 1,264,275, according to Lee's report.

Rep. David Watkins, D-Henderson, said that he was a "big proponent" of indirect charges to help promote healthier behavior, such as raising the prices of cigarettes and other tobacco products. He also stressed the importance of "educating our people when we provide these services to them."

Bevin letter says he will repeal Medicaid expansion; spokeswoman says he will find another solution

A mid-August fund-raising letter from gubernatorial candidate Matt Bevin says he would "repeal" the state's Medicaid expansion if elected, returning him to essentially the same stand he took early this year.

The Republican's campaign said he plans to replace the expansion with a different program approved by the federal government, but his vision of that appears to conflict with the federal health-reform law, which pays almost all the cost of the expansion only if states make eligible people with household incomes up to 138 percent of the federal poverty level.

“We will not continue to enroll people at 138 percent of the federal poverty level,” Bevin told Ronnie Ellis of CNHI News Service. “They will continue to be on it until we come up with a solution. But we are not going to re-enroll people at 138 percent.”

Bevin's newly named communications director, Jessica Ditto, issued a statement saying "Matt has been consistent on the issue of Medicaid expansion from day one. Kentucky simply can't afford to have a quarter or more of our citizens on Medicaid. What he has called for is repeal of Obama's Medicaid expansion by applying to CMS for 1115 waivers (as other states have successfully done) in order to better customize a solution to address the healthcare needs of the commonwealth."

The federal government pays the entire cost of the expansion through next year. In 2017, the state begins paying 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020.

A Deloitte Consulting study, funded by the state, says that the expansion will pay for itself throiugh 2020 by adding regular patients to the system, expanding jobs in health care and increasing income taxes paid by those workers. Bevin has called this report "nonsense."

At the Kentucky Chamber of Commerce's Business Summit and Annual Meeting in July, Bevin said he would not immediately end the expansion, contrary to what he said for months. “That’s not what I’m calling for, at all,” he said, adding that he favors a modified plan based on the experience of other states like Indiana, which received federal waivers to create a program in which Medicaid beneficiaries have co-payments, can pay premiums for better benefits and get partial refunds if they don't use the benefits.

Bevin told the Chamber that it was important for consumers to have some "skin in the game" when asked why he liked the Indiana plan, describing his belief that it is important for clients to have a "sense of ownership" in their healthcare and that charging them a co-payment is a way to treat people with "dignity and respect, and giving them the belief that they have control over their own situation and people are seizing that."

The Kentucky Center for Economic Policy disagrees and says that the Indiana model "could prevent low-income people from getting the care they need, making health problems costlier down the road and creating barriers to sustaining the health coverage gains Kentucky has made in recent years, " Ashley Spalding writes for the center.

In a Sept. 15 debate, Bevin said he would "tweak" the program, "largely gliding past his February declaration that he would end the expansion 'immediately'," Lexington Herald-Leader political reporter Sam Youngman notes, adding that the letter is "a far cry from a 'tweak,' and the closer we get to Election Day, the less clear Bevin's position on the issue has become. But the assumption that most voters will check out the facts and look closely at the veracity of what was said is a fool's bet, and Bevin's apparent strategy of trying to muddy the waters on the issue might help him survive his many contradictions."

First-of-its-kind conference in Lexington Oct. 2-4 will look at the role of pharmacists in public health

By Melissa Patrick
Kentucky Health News

The Advances in Pharmacy Practice 2015 Fall Conference, "Discussing the Role of the Pharmacist in Public Health," will be held Oct. 2-4 in Lexington and is open to pharmacists and public-health professionals.

The conference will offer a broad overview of public health issues and the role of the pharmacist in addressing them.

"To my knowledge, there has not been a conference like this before," Patricia Freeman, director of the Center for the Advancement of Pharmacy Practice at the University of Kentucky, told Kentucky Health News.

Freeman said that there is a real push right now by national organizations to recognize the role pharmacists play as active partners in public health.

"In Kentucky we lead the nation in many public-health issues," Freeman said. "Pharmacist, I think, have a responsibility to understand how they can contribute as part of the public health team to address these issues that have negatively impacted the citizens of Kentucky."

One of the speakers at the conference, Cmdr. Lori Hall of the federal Centers for Disease Control and Prevention, will talk about the overlap between CDC health priorities and pharmacy practice.

Freeman noted that the CDC has laid out a federal plan on how pharmacists should be utilized to improve the nations public health and said, " If they are saying that at the federal level, then we should be saying that same thing and exploring those opportunities at the state level."

Kentucky pharmacists play an active role in several public health initiatives: they provide immunizations, help the state with emergency preparedness through the mobile pharmacy, and can now, because of Senate Bill 192, dispense Naloxone for patients who are at risk for opioid overdose. Both topics will be addressed at the conference.

"The pharmacist is such an underutilized health care professional," Freeman, who is also president-elect of the Kentucky Pharmacists Association, said. "They are so accessible in all of these different communities, we've really started . . . some additional public health activities that the pharmacists could be fulfilling in a more active role."

The conference will be held at the Griffin Gate Marriott Resort in Lexington. Registration fees vary depending on the sessions chosen. Go to www.cecentral.com and click on "live events" for details.

Kentucky had the largest decrease, from 2013 to 2014, in percentage of residents without health insurance

By Melissa Patrick
Kentucky Health News

Kentucky led the nation in the largest drop in the percentage of residents without health insurance from 2013 to 2014, according to a report released Sept. 16 by the U.S. Census Bureau.

The percentage of uninsured Kentuckians dropped to 8.5 percent in 2014 from 14.3 percent in 2013. The drop of 5.8 percentage points was double the national decrease of 2.9 percent. The report says 366,000 Kentuckians were uninsured in 2014, down 250,000 from 616,000 in 2013.

"The information from the U.S. Census Bureau is yet another independent, unbiased confirmation that Kentucky is on the path to make transformational changes in the lives and health of our commonwealth and the hundreds of thousands of Kentuckians who have qualified for health care coverage through Kynect since Jan. 1, 2014,” said Gov. Steve Beshear, who created the state health-insurance exchange where Kentuckians enroll in Medicaid or private insurance subsidized by the Patient Protection and Affordable Care Act.

This report confirms other public and private surveys that have shown a significant decrease in the number of Kentuckians without insurance since implementation of the ACA, which took full effect Jan. 1, 2014. The survey results differ slightly due to methodology.

The Gallup Organization reported in August that Kentucky's uninsured rate dropped to 9 percent during the first half of 2015, compared to 20.4 percent in 2013.

The surveys show that states that expanded Medicaid eligibility, to people in households with incomes up to 138 percent of the federal poverty line, saw the greatest reductions of their uninsured populations. In Kentucky the expansion covers about 400,000 people.

Census data show that the Fifth Congressional District, Kentucky's poorest, had the greatest drop in uninsured residents, going from 17.1 percent to 8.4 percent. Other decreases by district, according to Ron Crouch of the Kentucky Education and Workforce Development Cabinet: First, 15.9 to 9.3 percent; Second, 13 to 8.2 percent; Third, 13.4 to 7.8 percent; Fourth, 12.4 to 7.9 percent; Sixth, 14.1 to 9.2 percent.

"This is important to not just for making the population and workforce healthier with access to health care insurance but also the potential to create jobs across Kentucky, needed additional training and education for many of those jobs creating higher pay, and new tax revenue to pay for Kynect and Medicaid expansion as well as other needs in Kentucky," said Crouch, the cabinet's director of research and statistics.

The figures are based on continuing Census surveys, which do not provide enough data for reilable estimates in most counties. Last year, the state gave rough estimates for the uninsured population in each county:

$3.5 million in grants allocated across state to treat heroin and prescription drug addiction and neonatal abstinence syndrome

As part of the heroin legislation passed this year, community mental health centers and residential treatment facilities across the state will receive more than $3.5 million in grants to help treat prescription drug and heroin abuse, and address neonatal abstinence syndrome in Kentucky, according to a state press release.

“Substance abuse continues to be one of the most stubborn, damaging public health and safety issues facing our Commonwealth,” Gov. Steve Beshear said in the release. "This grant funding will help us reach more people and get them the treatment they need to overcome their addiction.”

This funding is part of a larger allocation of funds attached to Senate Bill 192 and will go to centers that provide behavioral and medication assisted therapy services for people in treatment for addiction, and to residential treatment services for pregnant women battling substance abuse.

In Fiscal Year 2015, which ended June 30, community mental health centers served 15,709 individuals with substance use disorders, or about 5 percent of the population in Kentucky estimated to have a substance use disorder, Beshear said.

The community mental health centers receiving funding are: Pathways, Ashland, $320,000; Communicare, Elizabethtown, $320,000; North Key, Northern Kentucky, $320,000; River Valley, Owensboro, $193,000; Bluegrass, Lexington area, $308,300; Kentucky River, Jackson area, $320,000; Pennyroyal, Hopkinsville area, $292,200; Seven Counties, Louisville area, $247,400; and Mountain Comp Care, Prestonsburg area, $244,000.

Four additional programs providing residential treatment for pregnant women also will receive grant awards. They include: Transitions Inc., Northern Kentucky, $219,600; Mountain Comprehensive Care, Prestonsburg, $250,000; Chrysalis House, Lexington, $250,000; and Volunteers of America, Louisville, $249,300.

"The goal of the program is to serve adults diagnosed with a substance abuse disorder or a co-occurring mental illness with a substance abuse diagnosis," the release said. "Awardees must demonstrate a commitment to ensuring individuals have access to evidence-based services and supports that include outpatient, medication-assisted, individuals, group, family, intensive outpatient, crisis, case management, residential treatment and recovery support services."

Medicaid expansion brings increased revenue to hospitals, but has also created different financial challenges

Kentucky's hospitals have seen a $1 billion increase in revenues since the expansion of Medicaid and the launch of Kynect, the state's health insurance exchange program, but the influx of so many new Medicaid patients into the health system has created a new set of financial challenges, Josh Shepherd reports for The Lane Report.

Mike Rust, CEO of the Kentucky Hospital Association, told Shepherd, that "many healthcare systems have seen an overall improvement in their financial position," but Elizabeth Cobb, KHA vice president of health policy, told him that this increase in revenue varies greatly among hospitals and that "some of them are still struggling to keep their doors open despite increasing numbers of payers and a reduction in uncompensated care statewide."

Kentucky leads the nation in reducing its uninsured population, which Health Secretary Audrey Tayse Haynes told Shepherd that the Cabinet for Health and Family Services estimates has "introduced about $2.2 billion in new revenue into the healthcare industry, $1 billion of which has been shared among the state’s hospitals." and that the "ACA influence is credited also with the creation of 11,900 new jobs in the professional healthcare and social work sectors."

Kentucky's uninsured rate is currently at 9 percent, compared to the nation's rate of 11.7 percent, according to the latest data from The Gallup Organization.

But this reduction has caused a "major payer-mix shift," Shepherd writes.

“When it’s said that revenues are up, it’s a relative term,” Carl Herde, chief financial officer for the Baptist Health system, told Shepherd. “We are seeing more patients, doing more services and certainly our charges are up. But we are also experiencing a significant shift in our payer mix. If you are caring for the same or more patients but not getting the same (amount of revenue) as you used to get for services, it creates an operational challenge.”

Medicaid expansion changes"payer mix," creating new financial challenge

Payer mix, loosely defined as "the ratio of patients with commercial insurance coverage, Medicaid/Medicare or other forms of government reimbursement, and those few who still self-pay," varies per community demographic and is a "critical variable" used to assess hospital revenues, Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Shepherd..

Cobb explained that even if hospitals are seeing more patients and performing more services, if most of the patients are on Medicaid, the revenue gained from these patients will not cover the cost of treatment because "Medicaid doesn't cover 100 percent of the costs of care." Medicaid reimburses between 70 and 80 percent of charges.

Currans from Harrison Memorial and Herde from Baptist Health told Shepherd that they have seen a shift in their payer mix to more Medicaid patients.

Currans told Shepherd that rural hospitals are affected more than urban ones because they have a proportionately larger Medicaid/Medicare patient population, but Herde said he had not seen "much difference" in this among the hospitals he monitors.

Medicaid expansion has provided free health coverage to more than 400,000 Kentuckians.

Shepherd also writes that there has been speculation that "the influx of Medicaid patients may include low-income individuals and families formerly covered by commercial insurance through an employer," but also notes that this has not been proven.

High-deductible plans and bad debt

A KHA report to CHFS earlier this year showed "dramatic improvement in 2014 in the rate of uncompensated care," because of Medicaid expansion and the influence of Kynect, but Shepherd also writes that the "incidence of bad-deb accounts for hospitals actually is on the rise."

"The ACA’s intent to make healthcare more affordable to a greater number of people is happening, Rust said, but an issue of “under-insured” individuals remains," Shepherd writes.

"This typically involves people who opt for cheaper health insurance plans with high deductibles, which they then can’t pay when they receive care." Shepherd writes.

This is a challenge for hospitals, but is preferable to treating uninsured patients, which still accounts for nearly 10 percent of Kentucky's population, Shepherd writes.

“It’s a lot better for both the patient and hospital to try and work out a payment plan to cover a $5,000 deductible than writing off debts of over $100,000 in cases of injury or a catastrophic illness,” Haynes told Shepherd. Rust agreed: “At least a portion of that debt is getting paid.”

ER overuse and other fiscal pains

Most hospitals are working to decrease the overuse of emergency rooms. Some are working on the development of advance triage units to assess, prioritize and treat critical cases; Baptist Health has opened medical clinics and urgent treatment centers during off-hours; Harrison Memorial is considering adding a clinic next to its ER; and KentuckyOne Health is utilizing telehealth to address this problem, Shepherd reports.

How Kentucky will pay for the expansion continues to be a topic of debate.

The federal government is currently paying 100 percent of the cost, but that will decrease to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and then 90 percent thereafter.

Haynes told Shepherd that "she believes the program is capable of sustaining itself in the long-run and that staying the course long term will result in a healthier Kentucky population and a more vigorous economic engine moving the state’s collective private and public healthcare enterprises forward."

Surgeon general says Americans need to walk more, and U.S. needs more walkable neighborhoods

Americans should spend more time walking, and communities should be equipped with walking areas to make that possible, U.S. Surgeon General Vivek Murthy said in a report released on Wednesday.

"Maybe this sounds like obvious advice, a health tip right up there with admonitions to eat right and wear sunblock," Emily Badger writes for The Washington Post. "But for much of the last century, the federal government has backed a different idea—cars running on cheap fuel and fast asphalt should carry us everywhere—that has largely proved incompatible with walking." (Library of Congress photo: Thomas Circle in Washington, D.C., in 1920, when most of the traffic was pedestrian)

The University of Virginia's Peter Norton, who has studied the history of transportation, told Badger, "If the surgeon general had called for people to exercise more, that would be just another predictable announcement. But he called for walking. That puts him up against a long history of official discouragement of walking."

One of the main problems is that nearly one-third of Americans live in neighborhoods that lack sidewalks, Badger writes. "The federal government subsidized the construction of postwar suburban subdivisions so heavily dependent on the car they had little use for sidewalks. The government paved the highways that enabled people to live there, and kept low the gas taxes that made commuting 30 miles a day affordable. Government engineers came, over time, to think of roads as the domain solely of automobiles—and of pedestrians as an impediment to them."

Another problem is that many people live far enough away from work, grocery stores and other conveniences that walking is not possible, Badger writes. Also, narrow rural roads can discourage walkers. In an age where cars take people everywhere they need to go, many people have grown out of the habit of having to walk much more than 300 to 400 feet to get anywhere.

Murthy told reporters, "In the last few decades we have lost touch with physical activity." Badger writes, "This is true in many ways, in school days that no longer include recess, or in jobs that no longer demand physical labor. But it is primarily true in how we've built (or rebuilt) the world around us. And research is starting to show the health consequences. Communities designed around more compact, walkable street grids—places that have what the surgeon general calls 'connectivity'—have been correlated in research with reduced rates of obesity, high blood pressure and heart disease (they also have fewer fatal car crashes, another public health problem). One study of a million residents in Toronto found that people in less walkable neighborhoods were more likely to develop diabetes."

New cancer treatment for late stage lung cancer that was developed at UK is approved for clinical trials

Researchers at the University of Kentucky have pioneered a new medical device for the treatment of late stage lung cancer, which has now been approved for clinical trials by the U.S. Food and Drug Administration at UK, auniversity news release says.

The medical device, called "Exatherm Total Body Hyperthermia System (Exatherm-TBH)," is used in a treatment that heats a patient's blood to about 107 degrees. The procedure takes approximately four hours under general anesthetic.

“Cancer cells are more susceptible to damage from heat than normal tissue, so the development of a safe method to deliver heat throughout the body may be a key step forward for advanced lung cancer patients,” Jeremiah Martin, surgical director of the UK Markey Cancer Center’s Multidisciplinary Lung Cancer Clinic and part of the research team, said in the release.

Because this treatment "attacks cancer cells throughout the body all at once, the research team hopes the project will lead to a new and safe method for treating patients whose cancer has metastasized through the body," says the release.

To learn more or to find out if you are eligible for this study visit UKClinicalResearch.com or call 859-323-6494.

The device was developed through a public-private partnership with Exatherm Inc. and the project is supported by a grant from the National Institutes of Health.

State-property smoking ban seems to cut share of smokers in Executive Branch, more than other employees in state health plan

By Melissa Patrick
Kentucky Health News

State-government moves against smoking have reduced it among Executive Branch employees at a greater rate than among state employees who were not affected by Gov. Steve Beshear's order that banned smoking on state property, according to the Department of Employee Insurance.

Beshear's executive order on Nov. 20, 2014 banned all tobacco products and e-cigarettes in state-owned or state-leased buildings, in state-owned vehicles and on state property. This order was aimed at helping achieve his kyhealthnow goal of reducing smoking rates by 10 percent by 2019.

Employment Insurance Commissioner Joe Cowles compared a control group – all the self-reported smokers in the Kentucky Employees Health Plan, which includes the executive branch, school boards, retirees and quasi-groups, a total of 265,000 people – to the Executive Branch, which makes up about 20 percent of the total and was the only one affected by the order.

The study found that from fiscal year 2014 to fiscal year 2015, the number of smokers in the health plan's population decreased 13 percent while the number of smokers in the Executive Branch population fell 16 percent.

"So what we found here is two-fold," Cowles said at at the Aug. 5 kyhealthnow oversight meeting in Frankfort. "The self-reported smokers actually decreased from '14 to '15, which is good . . .  but it decreased more in the Executive Branch. We are not ready to take the trophy and have a parade on Main Street, but I think as we talk about the trends, early trends, with it eight to 10 months in, we are there."

The study also found, suggesting a trend, that more of the Executive Branch population got smoking-cessation prescriptions (40 percent) than everyone in the plan (31 percent).

The plan and policies under the Patient Protection and Affordable Care Act provide for free smoking cessation programs and nicotine-replacement therapy.

"It is very easy to see that the Executive Branch is moving much more rapidly to smoking cessation and we are spending more money on them to do that, which is exactly what the purpose [of the executive order] was," Cowles said.

The study also found that smokers were more likely to file claims on their health insurance. Their claims costs increased by 7 percent while non-smokers' fell 10.7 percent. Claims for the Executive Branch decreased 13 percent.

Newspapers across the state are reporting about school lunch and nutrition programs, of great interest to readers with students

Kentucky newspapers are writing about school meals, against the backdrop of controversy about federal nutrition guidelines, and these are stories with a high level of interest among a key demographic - readers with children of school age.

The Glasgow Daily Times  recently reported that a new deli-style option at Barren County High School has more than doubled its sales of this grab-and-go option since it has been offered this year, compared to the old grab-and-go option that was pre-assembled and served in a bag. The article noted that this new option has been well-received by both the students and staff, all while staying within the new federal nutrition guidelines.

The Hickman County Gazette reported that the county schools have increased breakfast participation to 68 percent, up from 23 percent last year and lunch participation to 95 percent, compared to 77 percent the same time last year. (This story is behind a paywall.)

Schools Nutrition Director Lynsi Barnhill told the newspaper that the increase can be attributed to the nutrition staff working with the students through surveys to create a menu that they like, but still stays within the federal nutrition guidelines; and that the school district is now classified as a Community Eligibility Provision school district, which allows schools to offer breakfast and lunch at no cost to all of its students.

The Independent in Ashland reported on a campaign, called "No Soda September,"  to encourage families in Boyd and Greenup counties to drink more water and less sugary beverages throughout the month. This effort is a partnership between The Appalachian Partnership for Positive Living and Eating and the local Boyd and Greenup counties middle and elementary schools.

"Classes that returned signed pledges received free color-changing water bottles and water trackers for students and teachers. More than 2,300 water bottles have been distributed," Adam Black writes.
  .

This idea was spurred by the health department's 5-2-1-0 APPLE program, which is funded by a grant from the AstraZeneca HeathCare Foundation’s Connections for Cardiovascular Health, that suggest kids get: • 5 servings of fruit or vegetables • 2 hours or less of screen time • 1 hour of physical activity • 0 sugar-added beverages. 

"The consumption of sugary beverages, especially among young children who drink more than one beverage a day, leads to a higher risk of being overweight or obese and children with obesity issues are more likely to suffer from health problems such as asthma, headaches, depression and type 2 diabetes," according to the health department, Black reports.

"Officials also report the consumption of sugary beverages can lead to many dental issues, including cavities that can cause pain, infection, tooth loss and in severe cases, death," he writes.

The News-Graphic in Georgetown reported on how several schools  in Scott County, like many across the state, are conducting food drives to support its "Send Out Snacks Backpack" program to make sure kids don't go hungry over the weekend.

Becky McDonald, the family resources coordinator at Garth and Eastern elementary schools told Kayla Pickrell of the News-Graphic that the backpack program helps children who are on free or reduced lunch have food over the weekend by giving them backpacks with enough easy to prepare breakfast, lunch and snack foods to last until they come back to school on Monday. 

 “We have families who struggle to feed their kids over the weekend” because they are used to the free or reduced lunch during the week, McDonald said. “It helps out the parents a lot.” (This story is behind a paywall.)

Dental outreach program in Eastern Ky. celebrates 10th year; has improved both oral health and Head Start treatment completion

The University of Kentucky, UK HealthCare and the UK North Fork Valley Community Health Center celebrated the 10th anniversary of the Ronald McDonald Care Mobile dental program in Eastern Kentucky at a ceremony held at the UK Center of Excellence in Rural Health in Hazard on Sept. 9.

"This whole program was a gift to the children of Eastern Kentucky and I am so blessed to be a part of it," Dr. Nikki Stone, director of the program, said in a telephone interview with Kentucky Health News.

The mobile dental clinic is made possible through a partnership between UK and Ronald McDonald House Charities of the Bluegrass. It provides free preventive dental care and in-classroom dental health education to some of Eastern Kentucky's children.

“Prevention is always the key to improving both oral and general health for all Kentuckians and to the many people here who have been instrumental in this program, I offer my appreciation and admiration for the great work that has been achieved," UK President Eli Capilouto said at the event.

The clinic is managed by the North Fork Valley center and serves Perry and Knott county elementary schools and all the Head Start programs in Perry, Knott, Leslie and Letcher counties.

The program also provides "case management" for each of the children in the program, referring them to the dental facility at the Appalachian Regional Hospital to see the pediatric dentist or the fixed dental clinic in Hazard if they need further care.

The fixed dental clinic in Hazard is a federally qualified health center and was awarded its first Health Resources and Services Administration grant in 2006, allowing it to offer services through a sliding scale fee to uninsured and under-insured residents of Perry and surrounding counties.

Reason to celebrate

Since its inception in 2005, the children served by the program have seen a nearly 20 percent decrease in tooth decay rates and their urgent care needs, like pain and infection, have been cut in half, Stone said.

Dr. Nikki Stone

She also noted that one of the programs greatest successes was increasing their Head Start treatment completion rates to 60 percent the second year from only 8 percent the first year. She said they accomplished this by recognizing and finding solutions to some of the transportation, logistic and access challenges many of the families in the region faced to get dental care for their children.

"We considered that to be one of the greatest successes that we have had because it was such a huge jump," Stone said. "And it was really related to seeing a problem, recognizing that something has to be done and then an opportunity that occurred when a pediatric dentist located closer to us."

Stone said that this success resulted from a partnership between the Head Start program, the dental outreach staff, the medical staff at Appalachian Regional Hospital and the pediatric dentist, who agreed to come to Hazard one day a week.

While Stone said that she was proud of their quantitative success, she said she is most proud of the things that can't be measured.

"These children are growing up with such a different attitude , they have little to no dental anxiety," Stone said. "They know the importance of oral health, they know what foods are healthy to eat, they know what drinks are healthy to drink."

Stone said in a UK news release that since being seen in the mobile dental clinic, these children are not only taking better care of their own teeth, but are teaching their families about the importance of dental care, are better students with fewer absences related to dental pain, and exude more self-confidence and self-esteem because of their healthy smiles.

Why do these children have such poor dental health?

When the program started in 2005, children in Eastern Kentucky had the worst oral health in the state and the second highest rates of untreated tooth decay in the nation.

“The baseline data was disturbing, especially when compared to national data and the HealthyPeople 2010 goals. A staggering six of every 10 Head Start children and seven of every 10 elementary-school children had untreated tooth decay, and nearly 20 percent had urgent dental needs.

“At nearly every Head Start center visited over the four-county area, at least one child in each center had all 20 baby teeth grossly decayed with multiple abscessed teeth. Compared to national data, the children in this service turned out to have the second highest untreated tooth decay rates in the nation, second only to the isolated Alaskan Native/Native American populations," Stone told UKNow.

Stone said that since that first year they have learned that transportation and lack of access to a pediatric dentist were two of the greatest barriers to these children getting dental care, noting that prior to the pediatric dentist coming to Hazard on Thursdays, the closest pediatric dentist was two hours away.

"One of the big issues that we have had that has grown exponentially in the 10 years we have been here is the number of children who are transient," Stone said. "They have parents, but the drug culture is so heavy here that their grandparents are actually raising them. So now we have grandparents who are trying to figure out how to navigate all of the needs of these small children."

Stone also noted that many of these grandparents who are responsible for these children have a generational attitude that doesn't see the value in taking care of baby teeth because "they are going to fall out anyway," increased transportation issues and poor health literacy.

She attributes some of the success of the program to the fact that it is constantly "renovating and revising" to respond to the evolving challenges families in the region face, as well as responding to the feedback they get from parents, teachers and school officials.

"Over these 10 years, I think that we have made more changes than we have kept anything stable," she said,"We have learned that flexibility is the key to the success of any program." 

Hope for the future

Stone said that programs modeled after this one are beginning to pop up all over Kentucky, although she notes that each of them are a little different to meet the needs of their communities.

She also said that because the children in the region are now being exposed to dentist, many of them are saying that they want to become one. Stone said they actively encourage the kids who express an interest to pursue this career path in hopes they will accomplish this and come back to the region to practice.

"We plant the seed," she said.

Political documentary about Ky. legislative effort to recognize the health benefits of plant-based diet debuts in Louisville Sept. 17

A political documentary, PlantPure Nation, that tells the story of Kentucky efforts to recognize the benefits of eating a plant-based diet, premieres in Kentucky Sept. 17 at the Baxter Avenue Theaters in Louisville, Jere Downs reports for The Courier-Journal.

The documentary, set in Louisville and Frankfort, showcases the proven health benefits of plant-based diets, including "markedly lower levels of cholesterol, blood pressure and glucose levels that result from 10-day 'Jump Starts' groups of people eating only plant-based foods," Downs writes. It also follows the failed efforts of filmmaker Nelson Campbell and Rep. Tom Riner, D-Louisville, to pass legislation to allow them to conduct a plant-based nutrition pilot project in Eastern Kentucky.

"PlantPure Nation" follows Forks Over Knives, a highly viewed film on Netflix that shows the work of the Cleveland Clinic and Cornell University researcher T. Colin Campbell, father of Nelson Campbell, and demonstrates how a Western diet "laden with meat, dairy and oil products is linked to chronic disease and cancer growth."

Colin Campbell is the author of The China Study, which compared the diets and health of 6,500 Chinese adults in and found "statistically significant correlations between meat and dairy consumption and mortality rates for more than 48 types of disease, including the seven most common cancers," Downs writes.

Riner, 69, says the book inspired him four years ago to follow a plant-based diet and preach about the lifestyle at his Baptist church and at a homeless shelter in Louisville.

Riner and Nelson Campbell tried and failed to establish a two-week-long, privately-funded vegan meal project or "Jump Start" in a poor community in Eastern Kentucky.

The 2012 bill to authorize the pilot, House Bill 550, sponsored by Riner and Speaker of the House Greg Stumbo, D-Prestonsburg, did not say it would be for plant-based nutrition, but would include "a science-based education component" and "a nationally recognized online nutrition education program."

"They would not hear it on the House floor unless I agreed to amendments," Riner, a state representative for 34 years, says in the film. "It was some of the most intense lobbying against a measure I'd ever seen." The bill was converted into an order for a "comprehensive review" by legislative staff of studies and programs "that focus on the nutritional habits of Kentucky citizens and the health outcomes of those habits," including risk assessments through health measurements.

The bill requires the staff to interview a wide range of "persons knowledgeable about the issue," including interest groups as the Kentucky Farm Bureau, the Kentucky Cattlemen's Association, the Kentucky Pork Producers Association, the Kentucky Poultry Federation, and the Kentucky Dairy Development Council.

"Kentucky's economic role as a major meat producer renders many in the state legislature resistant to medical advances that recognize the role of plant-based nutrition," Stumbo told Downs. "Since Kentucky is the largest cattle producer east of the Mississippi River and plays a prominent role in poultry and hogs as well, there are many who are unlikely to make the full jump toward a plant-based diet. While recognizing that, we must continue finding ways to improve our overall health and reduce obesity, the root cause of so many of our health problems."

Downs reports that the advocates tried and failed to get a "factual statement" into the legislative record that said, "Numerous scientific studies now confirm that a whole foods diet comprised primarily of vegetables, fruits, grains, legumes and nuts without added oil, sugar and salt is optimal for human health, not only preventing a broad range of disease and illnesses, but also reversing some of the most dangerous chronic conditions."

"We were shut out and not heard," Nelson Campbell told Downs. But that inspired his documentary: "We wanted to demonstrate this health truth because you've got a lot of people in Kentucky who are sick."

Riner is giving away $500 worth of tickets among his 41,000 constituents for the 7:30 p.m. showing of the documentary on Sept. 17. The film will be followed by a question-and-answer session.

The film's debut coincides with the efforts of several mainstream medical programs in Louisville that support vegan nutrition, Downs notes.

KentuckyOne Health just graduated its first class of 10 critically ill heart patients from its new nine-week Ornish Reversal Program at Medical Center Jewish Northeast. This program "combines the vegan nutrition, exercise, meditation and cardiac rehabilitation strategy of Dr. Dean Ornish, who describes The China Study as 'one of the most important books about nutrition ever written'," Downs writes.

The heart patients had an average weight loss of 7.5 pounds. Three lowered their blood pressure medication, one who had diabetes came off insulin, and another is discussing coming off cholesterol medication after 25 years, KentuckyOne spokeswoman Alice Bridges told Downs. One patient dropped out.

Meanwhile, Baptist Health is getting ready to launch its Complete Health Improvement Program on Dixie Highway in Louisville, Downs reports.

New deli-style healthy food choices are a huge success at Barren County High School; meet federal nutrition guidelines too

BCHS Director of Nutrition Services
CheyAnne Fant and Assistant Nutrition
Services Manager Danielle Certain at the
high school's new Fresh Market 95210
(Daily Times photo by Jeff Nations)

Students and staff at Barren County High School have embraced the school's new healthier "grab and go" option that looks and feels like a deli, Jeff Nations reports for the Glasgow Daily Times.

“Part of our strategic plan for nutrition services was to create areas that made you feel like you were in like, small shops or different venues that those students could go to,” CheyAnne Fant, Barren County’s director of nutrition services, told Nations. “And the second purpose of that was to decrease the time that the students were in line so that they’d have more time to eat.”

This new option offers deli-style sandwiches, fresh salads, fruits and vegetables, chips and smoothies and is called "Fresh Market 95210," which represents a district-wide wellness policy that says students should get: • 9 hours of sleep • 5 servings of fruit or vegetables • 2 hours or less of screen time • 1 hour of physical activity • 0 sugar-added beverages.

The school offered a "grab and go" option in the past, but the meal components were pre-assembled and served in a bag. Students and staff can now create their own grab-and-go lunch with some stipulations, in accordance to the National School Lunch Program’s requirements for reimbursement to the school, Nations reports.

"For example, at Fresh Market 95210 if a student chose a sandwich, they would have their choice of any fruit or vegetable and any other side item. If they select a salad (chef or vegetarian), their required fruit/vegetable serving is met and they can choose any other two sides," he writes.

Fant told Nations that the school has more than doubled its grab-and go meal sales since Fresh Market 95210 opened seven days after school began, going from about 31 a day in the first seven days of school to 67 a day, also noting that 24 percent of adult sales have since come from the Fresh Market.

Victoria Smith, a senior at BCHS, told Nations why she liked the Fresh Market: “There’s more time to sit down and talk. It’s quicker, there’s not as many people over there, and it’s healthy.”

“One of the things I think is exciting about this next generation of kids coming through that I think about is that they’re already going to have those healthy habits developed,” Shelly Young, the school’s central kitchen assistant manager, told Nations. “It’s going to be exciting to see it, but what’s really good is those things are already established so we’re going to have a whole generation of kids who are growing up healthier.”

6th annual Kentucky Health Literacy Summit in Louisville Oct. 7

The 6th Annual Kentucky Health Literacy Summit, "Health Literacy in the Age of the Affordable Care Act," will be held Wednesday, Oct. 7 at the Founder's Union Building on the University of Louisville, Shelby Campus in eastern Jefferson County.

The Summit is hosted by Health Literacy Kentucky and will showcase national health literacy and plain language experts.

Speakers will include: Wilma Alvarado-Little, principal and founder of Alvarado-Little Consulting LLC, which advocates for linguistically and culturally appropriate health services; Craig Blakely, dean of the UofL School of Public Health and Information Sciences; Elizabeth Edghill, refugee health educator and coordinator for Family Health Centers Inc.; Carlos Marin, assistant dean, Community and Cultural Engagement at the University of Kentucky's College of Medicine; Glen Mays, director of the National Coordinating Center for Public Health Services and System Research at UK; Kristen Munro-Leighton, health educator at Family Health Centers; and former journalist Kim Parson, a strategic consultant at Humana Inc.

The summit is targeted toward physicians, physician assistants, pharmacists, psychologists, social workers, health education specialists, dentists, dental hygienists, and extension agents. Continuing education credits are available. Registration fees are $95 or $25 for students. For more information and to register click here: http://www.cecentral.com/live/9828.