Annual health-policy forum Oct. 8 in Frankfort will focus on how a civic engagement approach can change health outcomes in Ky.

By Melissa Patrick
Kentucky Health News

What if the way to improving the health of Kentuckians is to create a culture where every person shares the same goal? That will be the focus of the Foundation for a Healthy Kentucky's 2024 Howard L. Bost Memorial Health Policy Forum, to be held at the Kentucky Historical Society, 100 West Broadway Street, Frankfort from 8:30 a.m. to 1 p.m. ET Oct. 8.

The forum, titled "Finding Common Ground on our Path to Better Health," will look at how to unite the state around a shared goal of addressing unmet health needs. The event is free, but reservations are required. To register, click here.

"Kentucky is consistently ranked as one of the unhealthier states in the country, despite the efforts by a dedicated few to improve the well-being of our communities," according to a news release for the event. "To make real progress, every single Kentuckian will need to play their part because we are stronger together."

Kentucky has been ranked among the bottom 10 states in health status since the America's Health Rankings began in 1990, except in 2008, when it ranked 39th. In 2023, Kentucky ranked No. 41.

The forum will host national and local experts who will talk about how to more authentically engage community members and find common ground on the path toward better health.

The sessions include:

• Enough, Time to Build: How Communities Can Forge a Civic Path Forward: Rich Harwood, president and founder of The Harwood Institute, will talk about that the way forward is a new civic path, not more divisive politics.
• Philanthropy + Democracy: Centering Humanity: Joy Ossei-Anto, managing director of Funder Engagement, Philanthropy for Active Civic Engagement will explore the role philanthropy can play in ensuring democracy is larger than politics and that humanity is centered.
• Moving from Ally to Advocate: A Call to Action: Colene Elridge, CEO of Be More Consulting, will delve into the critical journey from allyship to advocacy within healthcare policy.

The annual forum was created in memory of Dr. Howard L. Bost, a notable health economist and founding member of the foundation's board of directors. The forum aims to raise awareness of the health issues impacting Kentuckians and highlight model strategies and policy opportunities to improve Kentucky’s health. It welcomes a range of audiences from inside and outside the health industry, including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Eastern State Hospital is 200 years old; ex-patient, who says it saved his life, urges those who need mental-health care to get it

By Melissa Patrick
Kentucky Health News

This story mentions suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

Eastern State Hospital in Lexington, which is celebrating its 200th anniversary this month, is the oldest continuously operating state psychiatric hospital in the United States.

When Eastern State opened its doors as part of the old Fayette Hospital on May 1, 1824, it was just the second state psychiatric hospital in the nation, according to a University of Kentucky news release. 

“We believe that health care is a right for all Kentuckians; this includes access to mental-health resources,” said Lt. Gov. Jacqueline Coleman, who spoke at the official observance of the anniversary. “For 200 years, Eastern State Hospital has provided care for Kentuckians in need of help. The staff at Eastern State Hospital is knowledgeable and compassionate. They deserve to be called health-care heroes.”

Lexington lawyer Bruce Simpson – who received treatment at Eastern State following a suicide attempt in January 2023 – shared his personal story and thanked the staff who helped him at the anniversary celebration. Below is a YouTube video, produced by UK, of Simpson telling his story. 

The UK news release notes that after his evaluation at Eastern State, Simpson began medication for his illness and began ongoing therapy, which he says has vastly improved his health. 

“I said, ‘I’m fine’ a million times. I was not fine,” Simpson said in the release. “But we need to talk openly about mental-health treatment. If you have a stomach ache, you’re going to the doctor. If your heart is palpitating, you’re going to the doctor. But if you have depression, you’re just as likely to not see anyone or even acknowledge you have a problem. That is a cultural correction we need to make. Mental illness is just as legitimate as cancer, heart disease, broken bones and a stomachache.”

For Simpson, who said he had dealt with ideas of suicide for nearly four decades, the stay at Eastern State completely changed his life.

“The clarity of my thinking now is so much better than it’s ever been,” he said in the release. “Eastern State got me on a different track. I want people to know that it is the best place to be if you’re in serious struggles with mental health. I wish I had gotten treated 40 years ago, and I don’t want anyone to suffer 40 years like I did. If things get difficult, don’t be afraid of going to Eastern State.”

"I can't say enough about the care I received at Eastern State along with my fellow patients," he said at the event. "But we're entitled to the same courtesy, respect and treatment as someone that's completely mentally healthy as human beings. And an Eastern State Hospital, I have 100% certainty that that takes place and I applaud the staff and I thank you for saving my life."

Health and Family Services Secretary Eric Friedlander said Eastern State's history "mirrors the many astounding developments in mental-health treatment over the past two centuries, from long-term custodial care in the 19th century, to the advent of modern medications in the mid-20th century, and the present focus on evidence-based, recovery-oriented services. Today the staff of Eastern State provide state-of-the-art care in a state-of-the-art facility to meet its unwavering goal of enhancing the behavioral health and quality of life of the Kentuckians it serves."

At the event, Kelly Gunning, director of advocacy and policy for the National Alliance on Mental Illness Lexington, said in 2002 she understood why her youngest son was "horrified" to be admitted to Eastern State Hospital -- and it had nothing to do with the dedicated staff.

"But the place itself was so foreboding and so off putting and so scary that it was stigmatizing for the patients that had to go there," she said. "Together, we decided we were going to start a campaign to make it better." 

Eastern State Hospital (Photo provided)

The state opened a modern, 300,000-square-foot Eastern State facility on UK’s Coldstream Research Campus in 2013 that houses 195 acute care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

In 2021, then hospital became the first state psychiatric facility to achieve Magnet status, the gold standard for nursing excellence.

Later this summer the hospital will open its new Emergency Psychiatric Assessment Treatment and Healing unit, known as EmPATH. This program will offer an individual-centered, evidence-based care model designed to address the increasing needs for inpatient and emergency psychiatric care across Kentucky, according to the release. 

Kentucky tobacco-free advocates win Campaign for Tobacco-Free Kids' national Group Youth Advocates of the Year award

The Campaign for Tobacco-Free Kids named the #iCANendthetrend Youth Advisory Board Group Youth Advocates of the Year. Front, from left: Saumya Sikhwal, Jasmin Hernandez, Sarah Larkin and Philena Ash. Back: Jordan Joslin, Chloe Brady, Ksenia Miller, Relena Aispuro and Olivia Hardigree.

By Melissa Patrick

Kentucky Health News

The University of Kentucky's #iCANendthetrend Youth Advisory Board has been named the Campaign for Tobacco-Free Kids' 2024 Group Youth Advocates of the Year.

The Campaign for Tobacco-Free Kids says it is the leading advocacy organization working to reduce tobacco use in the United States and around the world. 

The group was recognized for its advocacy summit at the state Capitol, where over 100 youth came together to push for stronger enforcement of Kentucky’s law prohibiting the sale of tobacco products to anyone under the age of 21. This event was held Feb. 15, following its second Kentucky Youth Tobacco Control Conference the day before. 

The #iCANendthetrend Youth Advisory Board is made up of high school students from across the state who applied to join the group, which works on empowering young people to prevent tobacco and e-cigarette use.

The board is part of UK's #iCANendthetrend program, which utilizes college-student facilitators who offer presentations in schools across the state about the dangers of tobacco and electronic-cigarette use.

The program was started in 2019 and the students found such passion from the high-school students that they created a program for them in 2021, said Griffin Nemeth, the group's coordinator and a student  at UK's College of Pharmacy.

Board member Saumya Sikhwal, a senior at South Warren High School, said one of the board's biggest projects this year was to advocate for compliance checks and enforcement of the law barring sales to those under 21. 

"So my main thing was to advocate for having stricter policies and compliance checks . . . holding retailers accountable for selling nicotine products to underage youth," Sikhwal said. 

She said that for most of the students, including herself, it was the first time they had talked directly to the legislators and that they got both positive and negative feedback to their requests. 

Board member Ksenia Miller, a freshman at Villa Madonna Academy in Kenton County, said students at the conference were educated about the tobacco laws in Kentucky and how they are enforced and were then able to talk with legislators the next day "about putting in more laws to further enforce the laws."

"It was a really, really big project to work on," she said. "But it was definitely a fun one."

The students who attended the awards ceremony in Washington, D.C. and accepted the award on behalf of the group, spoke about their work in a video. Sikhwal and Miller were joined by board member Jasmin Hernandez, a junior from Casey County High School.

Asked about their experience, Miller said she enjoyed sharing the hard work that the Youth Advisory Board did and meeting fellow advocates. "It was a really great experience," she said. 

Sikhwal agreed. "It was definitely not just an award, it was more of an experience where you get to learn from others," she said. " I did not know how big Campaign for Tobacco Free Kids was. Just seeing people from across the world being there and advocating for tobacco prevention was really eye opening for me, and more inspiring. And it motivated me to do more advocacy work as I go into my next college years. " 

Sikhwal added that she was moved by Campaign for Tobacco-Free Kids' President and CEO Derrick Johnson's words, when he said we should put "people above the profits."

She said, "I will remember that for a long time."

Nemeth said, "It really just goes to show the amazing work of all the young advocates."

Ky. Center for Smoke-free Policy seeks nominations by March 15 for smoke-free advocates to be honored at next conference

The Kentucky Center for Smoke-free Policy is accepting nominations for local smoke-free advocates who deserve to be recognized for their dedication to improving smoke-free policy and secondhand smoke education in Kentucky. Self-nominations are welcome. 

The winners will be honored at the 2024 Kentucky Tobacco Control Conference, to be held April 23-24. One of the advocates will be awarded the Dr. David B. Stevens Smoke-free Advocate of the Year Award. 

Nominations are due March 15. The nomination form requires a minimum of 500 characters to describe the advocate’s smoke-free work. Also, please remember that the Advocate of the Year Award is intended for individuals and that nominations of groups or organizations will not be considered. 

Submit nominations here: https://uky.az1.qualtrics.com/jfe/form/SV_2osikEukP52JfWS

Bardstown woman who needs a kidney transplant testifies in Congress to change transplant policy; bill passes

LaQuayia Goldring of Bardstown prepared to testify before a U.S. Senate committee about the organ transplant process as she continues her nine year wait for a kidney. (WDRB photo)

A Bardstown woman waiting on a kidney transplant shared her story with Congress and asked them to support legislation that would allow more than one organization to manage the country's organ donations and transplants, Monica Harkins reports for WDRB. 

"I'm just asking that you all stand behind this legislation as we move forth and that all of Congress stands together to pass this legislation so more lives can be saved and less can be put in coffins," LaQuayia Goldring told senators in July.

The legislation passed, and at the end of September, President Biden signed it into law. 

Goldring told Harkins that she was three years old when she was diagnosed with a rare kidney cancer. Harkins writes that Goldring "beat the cancer" in about a year, but more than a decade later she was told there were signs of kidney failure. 

A week after her 17th birthday, Goldring said she learned she needed a kidney transplant and that it only took 10 days to get a match and get the procedure.

"It was able to last from the age of 17 to 25," she told Harkins.  "I'm now 34. I've been waiting nine years for a kidney transplant. And our system is broken." For nine years she's been required to do dialysis treatments five days a week to stay alive.

Harkins writes that part of the waiting process is getting your name registered with the United Network for Organ Sharing,  the sole organization that managed the country's organ donation policies for the past 40 years.

Just a few months ago, Harkins reports that "Goldring found out her name had been removed from the list due to a clerical error. A mistake that fueled part of her testimony in front of U.S. Senators in July." 

Goldring told the senators of her struggles with UNOS and asked them to break up the UNOS monopoly and allow more contracts to be considered for handling organ transplants. 

When Biden signed the legislation to do just that, Goldring told Harkins she was "overjoyed, with, with just joy and tears of relief." 

"It's one thing to hear leaders, like our President, talk about organ donation and how their administration is going to do something to change it, but to actually have a law after 40 years signed doesn't get any better than that," she said.

Goldring is still waiting and praying for a life-saving donation. 

"I'm just staying hopeful that that one match will come and, you know, this will be a thing of the past," she told Harkins. 

According to Donate Life, more than 105,000 Americans are waiting for life-saving organ transplants, 1,000 of them Kentuckians. Goldring has a social media campaign for people who would like to see if they are eligible to donate and to follow her journey. 

Lawmakers say drug stores' issues with Medicaid pharmacy benefit managers will be a key issue in the next legislative session

By Melissa Patrick
Kentucky Health News

State Rep. Danny Bentley didn't mince words when he told a health advocacy group that a priority of the next legislative session will be to deal with pharmacy benefit managers' Medicaid payments to drug stores.

Independent pharmacies in Kentucky and around the nation have said for years that the problems are so bad that PBMs threaten their survival.

L to R: Reps. Russell Weber, Joni Jenkins and Danny Bentley
and Sens. Stephen Meredith and Morgan McGarvey

"I'm ready to do away with all of them," Bentley said, adding later, "PBMs are not honest, period."

Bentley, a Republican from Russell in Greenup County, was speaking as part of a legislative panel titled, ""Preparing for the 2020 General Assembly" at the Oct. 11 Kentucky Voices for Health annual meeting in Lexington.

In his effort to explain what PBMs do, Bentley first noted that he had dealt with them for 44 years as a registered pharmacist and opined, "Really, they don't do anything." He said one of the main issues with them is their lack of price transparency and the lack of legislation to require them to be so.

PBMs are middlemen between insurers and drug manufacturers. They determine what drugs are offered, how much someone pays for the drug, and the payments to pharmacists.

Lawmakers have been working on PBM issues for years. Most recently, in 2018, they passed Senate Bill 5, which let the Department of Medicaid Services, rather than managed-care organizations that handle relations between patients and health-care providers, set pharmacists' reimbursement rates.

The law lets the agency regulate contracts between the MCOs, pharmacists, and PBMs; requires more transparency in how PBMs spend the $1.7 billion a year they get for processing prescriptions in Kentucky; and gives the state authority to penalize the MCOs and PBMs for noncompliance.

In a report earlier this year, "Medicaid Pharmacy Pricing: Opening the Black Box," the state said two PBMs kept $123.5 million last year from the Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drug.

Medicaid Commissioner Carol Steckel assured members of the Medicaid Oversight and Advisory Committee in July that the state was committed to resolving the payment issues of PBMs, which she called "predators." The state is negotiating contracts with the MCOs, which will take effect in July 2020. MCOs hire PBMs to oversee their drug benefits.

The attorney general's office is investigating whether PBMs have overcharged the state and discriminated against independent pharmacies.

Ohio is among the states that have tried to rein in questionable payment practices of PBMs. Last year, two Ohio PBMs "billed Medicaid $244 million more in a single year than they paid pharmacies, allowing them to profit three to six times the industry standard," Catherine Candisky and Darrel Rowland reported for The Columbus Dispatch.

Ohio Medicaid officials, among other things, then banned "spread pricing," in which a PBM keeps the difference between what it bills Medicaid and what it pays the pharmacy; and imposed a "pass-through" pricing model, which requires PBMs to pay pharmacies the same amount they bill the state.

A new analysis shows that this new model "netted an additional $38 million, a 5.7% increase, in the rates paid pharmacies to fill prescriptions during the first quarter of this year compared with the final quarter of last year," the Dispatch reported.

Kentucky's Medicaid department told lawmakers in July that one of the proposed changes in the state's new MCO contracts will require all PBMs to use a "pass-through model" of payment.

Other states have fired their PBMs. Michigan has proposed to fire its PBMs and manage its drug program itself starting Dec. 1, which is expected to save the state $40 million; California will shift all Medicaid benefits from PBMs by 2021; and West Virginia fired its PBM in 2017, Axios reports.

Steckel, the Kentucky Medicaid boss, said in July that she was using Kentucky data to replicate a West Virginia study showing the impact of removing pharmacy services from MCOs, which is what the Kentucky pharmacists' lobby and many legislators want. The West Virginia study found that the state saved $54 million by removing prescription drugs from Medicaid managed care.

State Sen. Ralph Alvarado spoke at the Kentucky Voices
for Health annual meeting. (Photos by Melissa Patrick)

Sen. Ralph Alvarado, the lieutenant governor candidate running with Gov. Matt Bevin, did not participate in the panel, but spoke to the group briefly beforehand. He said if the state's analysis shows it would make financial sense to remove pharmacy services from the MCOs, "you can expect that to be brought back in" to the government.

Also on the panel were Rep. Joni Jenkins and Sen. Morgan McGarvey, Democrats from Louisville, and Sen. Stephen Meredith of Leitchfield and Rep. Russell Weber of Shepherdsville, Republicans.

The legislators said other issues likely to be brought up in the next session are medical marijuana; expanding nurse practitioners' scope of practice; insulin cost; health department funding; and electronic cigarettes. Weber, who sits on the Public Assistance Reform Task Force, said he was not sure if it would recommend legislation.

Alvarado told the group that he and Bevin had discussed ways to approach e-cigarettes, which as of Oct. 8 had been associated with 1,299 cases of lung injury and 26 deaths in the U.S. He said the ideas include outlawing "vaping" altogether, as a few states have done; taxing it at a higher rate and using the money to pay for education and getting people off of tobacco products; and placing all e-cig products behind the counter and requiring proof of age, with limits on purchases. He said that would allow adults who want to use the products in order to quit smoking combustible tobacco to get them.

Resources meet volunteers: Foundation for a Healthy Kentucky, Friedell Committee for Health System Transformation merge

By Melissa Patrick
Kentucky Health News

The Foundation for a Healthy Kentucky and the Friedell Committee for Health System Transformation have joined together and will function as one organization, a change that takes effect immediately.

In announcing the merger, the groups "emphasized the organizations' congruent missions and committed volunteers, and the value of speaking with a single, amplified voice to influence community and statewide health policy change," says the release.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky,
at Dec. 3 luncheon announcing a merger with the Friedell Committee.

The groups announced the union at a Dec. 3 luncheon to honor the late Dr. Gil Friedell, who founded the committee and was well-known for his mantra: "If the problem is in the community, the solution is in the community."

J.D. Miller, chairman of the Friedell Committee, citing the quote, said this philosophy was something they all agreed on.

"One of the things that is important to all of us is to be engaged in our communities . . . I think we all believe that and that we all understand that whatever we want to do in health and advocacy, it must be with community engagement," Miller said.

Bonnie Hackbarth, spokeswoman for the foundation, said after the luncheon that many committee members had already joined the foundation's Community Advisory Council. Its members advise the foundation's overall policy and strategic direction, and serve as liaisons to Kentucky communities.

"Potentially tripling the size of our council and adding Friedell Committee members' wealth of knowledge and expertise means reaching far deeper into Kentucky communities," LeChrista Finn, incoming chair of the advisory council, said in the release. She added that the new members will also help the foundation "better understand both the local issues and local solutions."

"This is one of the most engaged, dedicated groups of health advocates in our state," Miller said.

Richard Heine (Photo: Foundation for a
Healthy Kentucky)

Richard Heine, executive director of the Friedell Committee, said after the luncheon that he was "very pleased" with the merger.

"I think that what we bring is a lot of community presence and I think they are going to benefit particularly in the council to have our people, community level people," he said. "And we've done a lot of thinking about what needs to happen in terms of health care in the future, so I think we bring a lot of that with us when we come."

Asked what the foundation offered the committee, Heine said funding and resources.

The news release said the legacy of the Friedell Committee, especially in the areas of diabetes and obesity prevention, will continue through the foundation.

"The prevention of obesity and diabetes is among the work included in the foundation's 2019-2020 strategic plan, which we just approved," Mark Carter, chair of the foundation's board of directors, said in the release. "Our hope is to leverage Friedell Committee members' expertise in this area to better bring coordinated community-wide solutions to this increasingly serious societal health issue."

Miller said Friedell was aware of the potential merger before his death on Sept. 23.

"He was very much in support of joining together with the foundation, which was very important to us," Miller said. "We realized that as we joined, we could actually increase the impact of both organizations. And more than increasing the impact, we could learn from each other."

Jane Chiles, who was chair of the Friedell Committee for several years and is now chair of Kentucky One Health, said Friedell's legacy had come full circle, noting that he had been part of the vision for the foundation when it was "just a twinkle in the eye."

"The circle is complete," she said.

Foundation President and CEO Ben Chandler said, "We are so excited about this unification. It is something that's come full circle and I hope Dr. Friedell would be pleased. We want to continue making progress together and I think we can really, really attain great things."

Chandler announced that the Foundation's Healthy Kentucky Policy Champion of the Year award has been renamed the Gil Friedell Health Policy Champion award.

Anti-smoking group says cigarette manufacturers purposely target military members and people with mental illness

An anti-smoking group has released two videos accusing cigarette companies of purposely targeting mentally ill people and U.S. soldiers.

“As the number of smokers drops, the industry is finding it harder and harder to find those replacement smokers,” Robin Koval, chief executive of Truth Initiative, told William Wan of The Washington Post. “So the industry is targeting people based on their challenges in life, on who they are. It’s shocking and appalling.”

The group released the advertisements on Aug 24. They are also available on their website and on social media,

One says 40 percent of cigarettes sold in the U.S. are to people with mental-health issues, including depression, anxiety and substance-use disorders. The other says 38 percent of military smokers start after enlisting.

According to the Centers for Disease Control and Prevention, 36 percent of people with a mental illness smoke, and 24 percent of all active-duty military personnel are smokers. Nationwide, only 15 percent of adults and 6 percent of teens are smokers, both rates at an all-time low. Kentucky's smoking rates have also declined, but continue to be significantly higher than the national average, at 26 percent and 17 percent respectively.

Wan writes that in addition to the military and those with mental illness, many other groups also continue to have high smoking rates, including Native Americans and minorities, people who live in rural areas and people with low incomes.

The ad that focuses on mental illness and smoking cites internal tobacco-industry documents that discuss ways to target the mentally ill population, adding that tobacco companies even distributed free cigarettes to psychiatric facilities at one point, saying they would help steady patients' nerves.

The one about the military cites a tobacco industry document that targets young military servicemen. Truth Initiative's website also refers to a series of  industry initiatives, including sending free cigarettes overseas to troops as late as the 1990s (the U.S. Department of Defense no longer allows this); sending troops Marlboro racing-team caps and playing cards, among other things; and leading a Christmas-card campaign that features cards that resembled Marlboro ads.

Wan writes that "tobacco companies for the most part have not responded to the growing accusations that they are targeting vulnerable populations," but  notes that in response to a separate Washington Post article on the socioeconomic divides in smokers, Altria, the country's largest cigarette company, told Wan it uses the same marketing approach across the nation.

He writes, "The company pointed to more than $112 billion that tobacco companies have handed over to help smokers and encourage smoking prevention as part of the 1998 Tobacco Master Settlement Agreement." Actually, states have not used most of that money for tobacco prevention; Kentucky gets about $93 million a year from the settlement but spends only $2.5 million on tobacco prevention.

Anecdotal reports suggest that injured teen athletes who are prescribed opioids are getting addicted, but research is conflicted

By Melissa Patrick
Kentucky Health News

Three high-school athletes, two playing football and one a swimmer, recently told NBC News how they got hooked on opioids after being prescribed them for sports injuries. The news story warned parents to ask questions before allowing their children to be prescribed opioids.

John Haskell was one of those teens. He said at age 15 he was prescribed a powerful painkiller after his fourth concussion playing football to treat his excruciating headache.

"He looked in my ears, checked my hearing, checked my eyes. And the next thing I know, I'm at CVS getting Vicodin," Haskell told Jenna Bush Hager and Aliza Nadi of NBC News.

After going through his third refill of Vicodin, Haskell said he started buying it illegally, but eventually switched to heroin because it was cheaper.

A health expert encouraged parents to talk to their doctors about alternative treatments to opioids.

"As a parent, you need to take a more advocating role and ask your provider why are they going this route," Dr. Harold Shinitzky, a sports psychologist, told NBC. "Why is it automatically an opioid or a painkiller?"

After going through treatment, Haskell, now 18, is sober, as are the other two teens in the video.

What the research says

While a study published in Pediatrics released earlier this year found that teen athletes are less likely to abuse prescription painkillers than those who don't play sports or exercise, other research, published in the American Journal of Public Health, says that teen athletes participating in high-injury sports have a 50 percent higher odds of doing so.

Philip Veliz ,the lead author of both studies said that while anecdotal evidence that prescribing opioids to teens after a sports injury is leading some of them to becoming heroin addicts, current research does not support this claim, James Bernstein of HealthDay News reports.

Bernstein writes, "Veliz said, no large-scale studies have assessed whether abuse of recommended painkillers is actually leading to an "epidemic" of heroin use among teens who frequently engage in sports and exercise. On the contrary, this new study suggests there may be "positive social connections embedded in sports that can deter youth from serious types of illicit substance use," such as heroin or cocaine."

However, Veliz also noted that more research is needed to determine why some intense contact sports, like football and wrestling, place teens "at greater risk" for painkiller abuse,

The 2015 Youth Behavior Risk Behavior Survey found that almost 13 percent of Kentucky's high school students said they have ever taken a prescription drug without a doctor's prescription. Nationally, that number is closer to 17 percent.

Kentucky leads the nation in cancer deaths, but falls short on policies to prevent cancer, especially when it comes to tobacco

Kentucky ranks first in deaths from cancer and has for several years, but falls short in its fight against cancer when it comes to supporting policies and passing legislation to prevent it, according to an American Cancer Society report released Aug. 11.

The latest edition of "How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality" found that Kentucky followed ACS policy recommendations in only two of the 10 issue areas ranked, and showed some progress in two areas, but fell short in six.

How Kentucky measures up.
Red: Falling short  Yellow: Some progress  Green: Doing Well

“We’ve made tremendous progress in the way we diagnose and treat cancer across the country. But to leverage this progress, Kentucky legislators must take advantage of the opportunities to pass evidence-based laws and policies that are proven to save lives and money,” Erica Palmer Smith, Kentucky government relations director at ACS, said in a news release.

The report used a color-coded system to rate states in 10 specific areas of public policy that can help fight cancer, including smoke-free laws, tobacco tax levels, funding for tobacco prevention and cessation programs, cessation coverage, funding for cancer screening programs under Medicaid and restricting indoor tanning to minors.

The report also looked at whether or not a state had increased access to health care by expanding Medicaid under federal health reform to people who earn up to 138 percent of the federal poverty level, had passed laws to increase patient quality of life, had passed laws to ensure oral chemotherapy drugs are covered by insurance the same as intravenous chemotherapy, and whether the state offered a well-balanced approach to pain medications.

Green shows that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short.

Kentucky fell short for all four tobacco policy measures in the report.

"Tobacco use remains the number one preventable cause of death, so Kentucky’s biggest opportunity to save lives and reduce health care costs starts with addressing the state’s current tobacco control policies," says the release.

The report found that Kentucky's cigarette tax, at 60 cents per pack, is less than 50 percent of the national average of $1.65 per pack. The report recommends increasing cigarette taxes by at least a $1 per pack, and then to use that money to pay for tobacco prevention and cessation program. It also recommends similar increases for all tobacco products.

"Evidence clearly shows that raising tobacco prices through regular and significant excise tax increases, encourages tobacco users to quit or cut back and helps prevent young people from ever starting to use tobacco," says the report.

Kentucky has also been unable to pass a comprehensive statewide smoke-free law and isn't likely to do so under the leadership of Republican Gov. Matt Bevin, who doesn't support a statewide ban on smoking, saying the issue should be decided locally.

That being said, about a third of Kentucky's population is covered by local comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

American Cancer Society map; click on it for a larger image and a more readable legend

Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to the latest Kentucky Health Issues Poll, and have since 2013.

"Smoke-free laws reduce exposure to secondhand smoke, encourage and increase quitting among current smokers and reduce health care, cleaning and lost productivity costs," says the report. "Smoke-free laws also reduce the incidence of cancer, heart disease and other conditions caused by smoking and exposure to tobacco smoke."

Kentucky's tobacco-cessation policies also fell short. The report noted that while all Medicaid programs offer some tobacco-cessation coverage, most have varying restrictions that create barriers, like limits on the length of time a person can use certain services.The report says such barriers reduce utilization.

In addition, the amount of money Kentucky spends on tobacco prevention and cessation programs is only 4.4 percent of the amount recommended by the federal Centers for Disease Control and Prevention. In 2016, Kentucky allocated $2.5 million for tobacco prevention; the CDC recommends the state spend $56.4 million.

"For every $20 Big Tobacco spends on marketing their deadly products, states spend just $1 on programs to reduce tobacco use and save lives," says the report. "States with sustained, well-funded prevention programs have cut youth smoking rates in half or even more, saving lives and reducing state health-care costs."

In Kentucky, high school smoking rates are 56 percent higher than nationwide, and the adult rate is 74 percent higher. The report blames that on lack of "statewide tobacco-control policies" and says the higher rates cost the state more than $2.7 billion a year in health-care costs.

Kentucky also fell short on its control of indoor tanning, ACS said. The report says Kentucky lawmakers missed out on an opportunity in 2016 to pass legislation to protect minors from the dangers of indoor tanning beds. A bill cleared the Senate Health and Welfare Committee, but wasn't heard in the Senate.

The other area in which the state fell short, in ACS's opinion, was state appropriations for breast and cervical cancer screening programs.

Kentucky scored best on policies that centered around access to care. The report said the state has made some progress with its cancer pain control and palliative care policies and was ranked as doing well in the areas of oral chemotherapy fairness and expanding access to care through Medicaid.

Foundation for a Healthy Kentucky invested more than $3.1 million in 2015 toward improving the health of Kentuckians

The Foundation for a Healthy Kentucky invested more than $3.1 million in 2015 to help communities and health policy advocates improve the health of Kentuckians, according to its annual report. The report also suggested that Kentucky is experiencing turbulence in health care.

"In turbulent times, it may be tempting to seek shelter and hope the danger passes," Susan Zepeda, outgoing president and CEO of the foundation, wrote in her opening remarks."But unlike tornado season, these times call for all who care about the health of Kentuckians to be informed and engaged in shaping a future where all residents have access to safe, effective, affordable health care."

Zepeda was likely referring to Gov. Matt Bevin's Medicaid plan that would require participants to pay premiums and have a higher level of involvement in their care, including "community engagement and employment activities" for able-bodied adults who aren't primary caregivers of dependents; the impending shut-down of Kynect, the state's online health insurance exchange, and the resulting shift to the federal exchange; and the ongoing issues with Benefind, a recently launched one-stop-shop website for state benefits.

The report notes that the two primary initiatives of the foundation include Promoting Responsive Health Policy, which provides grants to "help strong, statewide health advocacy organizations work together for increased impact," and Investing in Kentucky's Future, which provides grants to "support community-designed solutions to problems like childhood obesity and adverse childhood experiences."

The Investing in Kentucky's Future grantees include: Partnership for a Healthy McLean County, Purchase Area Connections for Health, Fitness for Life Around Grant County, Breathitt County Health Planning Council for Children, Perry County Wellness Coalition, Clinton County Healthy Hometown Coalition, all of which focus on childhood obesity and Bounce Coalition in Jefferson County, which focuses on adverse childhood experiences.

The Promoting Responsive Health Policy Initiative included funding work of the Kentucky Center for Smoke-free Policy, Kentucky Voices for Health, Kentucky Youth Advocates, the Kentucky Population Health Institute and the Kentucky Equal Justice Center.

The foundation was created in 2001 from the charitable assets of Anthem Inc., recovered in a lawsuit by then-Attorney General Ben Chandler, after the company converted from a mutual insurance firm to a stock company. Under the settlement, the $45 million was invested and only the earnings from it may be spent. Since 2001, the foundation has awarded nearly $25.5 million in grants with $1,669,367 awarded in 2015.

Illustration from annual report

The foundation's mission is to "address the unmet health-care needs of Kentuckians by informing and influencing health policy, improving access to care, reducing health risks and disparities, and promoting health equity," says the release.

The foundation hosts several policy meetings including its biennial Data! Forum and its annual Howard L. Bost Memorial Health Policy Forum. It also host regular "Health for a Change" training workshops and webinars and has provided free conference and meeting space to more than 40 health-related not-for-profit organizations this year.

The foundation funds research to inform health policy, including a study that looked at the benefits and challenges associated with Kentucky's transition to Medicaid managed care and another that goes through January 2018 that evaluates how federal health reform affects coverage, access, cost, quality and health outcomes in the state.

The foundation, along with Cincinnati-based Interact for Health, also conducts the annual Kentucky Health Issues Poll, which found, among other things, that fewer Kentucky adults were delaying or skipping medical care due to costs, and that a majority of Kentuckians support a state-wide smoking ban, as well as smoke-free schools.

The foundation also works to increase health coverage in the state through its partnerships with Kentucky Educational Television, Louisville Public Media and The Institute for Rural Journalism and Community Issues at the University of Kentucky, which publishes Kentucky Health News.

"The Foundation for a Healthy Kentucky has become known as an innovator in several aspects of health philanthropy," Zepeda said. "We are recognized for building the capacity of Foundation grantees to create meaningful health policy changes through a mix of approaches. These include combining multi-year funding with training and technical assistance, funding and sharing research, and gatherings of diverse stakeholders to learn from one another and collaborate."

This year's smoking-ban bill is dead; Senate advocates have bill to make insurers provide all smoking cessation treatments

By Melissa Patrick
Kentucky Health News

Despite early hope, the bill to ban smoking in Kentucky workplaces was likely dead on arrival this year.

"I haven't heard anything about the smoking ban bill in . . . well, really since the start of the session," House Speaker Greg Stumbo, D-Prestonsburg, said in an interview. "So, I would say yes, it's dead."

Rep. Susan Westrom

"The timing has just not been right," said Susan Westrom, D-Lexington, sponsor of the bill. "We don't have the votes. It seems like in every election year, people are afraid to vote on something like this that they perceive to be controversial."

In addition to it being an election year, Westrom elaborated on a long list of other reasons for why the smoking-ban bill hasn't had any support this year, including: it being a budget year, a new Republican governor and Senate leadership that don't support it, less organization from advocates, a quiet public and the loss of several funding streams.

"There's always next year," Westrom said. "This isn't an issue that will go away because we can't ignore that Kentucky is one of the least healthy states in the country. It always has to be at the top of our priority list."

The latest Kentucky Health Issues Poll found that two-thirds of Kentucky adults support a comprehensive statewide smoking ban, and have since 2013. The ban has support from solid majorities in each political party and has majority support in every region of the state. But more than one-fourth of Kentucky adults are smokers.

Last year was the first year Westrom's smoking ban bill passed out of the House with a vote of 51-46. The bill was then placed in an unfavorable Senate committee and never brought up for discussion. This is the sixth year she has sponsored this bill.

"I have enjoyed carrying this bill more than anything I've done over the years because it is the right thing to do and because I really, really care about the health of Kentucky," she said wistfully.

Republican Sen. Ralph Alvarado, a Winchester physician, said in an interview that he had worked very hard this session to get a smoke-free bill together in the Senate, but he just couldn't get the votes.

Instead, Republican senators Julie Raque Adams from Louisville and Alvarado have filed Senate Bill 291 that would require insurers in Kentucky to cover all approved smoking cessation treatments, counseling and medication. Currently, many plans only cover some physician-prescribed treatments and/or medications.

A flyer to drum up support for SB291 says the state has nine-thousand smoking related deaths per year; $1.92 billion in smoking related health expenditures; and $590 million in smoking related Medicaid costs. The statewide smoking rate in Kentucky is 26 percent.

"Tobacco is still one of the most expensive cost for our healthcare system in the state," Alvarado said. "Anything that we can do to help get people off of cigarettes voluntarily...I think is going to benefit us financially and is going to save lives."

Adams was pessimistic about the bills chance of passing this year, but said she was hoping for a hearing on it to continue the education process and keep the issue alive.

"The fact that insurance does cover cessation, I think that is a really important thing to get out to the consumer," she said in an interview.

According to Run Switch PR, this bill has the support of the following: American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco Free Kids, Kentucky Medical Association, Kentucky Hospital Association, Kentucky Rural Health Association, Kentucky Voices for Health, Kentucky One and Baptist Health. It is currently in the Senate Baking and Insurance committee.

Kentucky Voices For Health names new executive director

Emily Beauregard

Emily Beauregard has been named executive director of Kentucky Voices for Health.

“We had an excellent pool of candidates for the position and are thrilled to have found in Emily the winning combination of broad health policy knowledge and experience, strong administrative capabilities and a passion for the mission of KVH to improve the health of Kentuckians," KVH Chair Sheila Schuster said in a news release.

KVH is a group of organizations and individuals working to improve health and coverage for Kentuckians, and was organized in response to the federal health-reform law. It includes groups that lobby, but it does not lobby.

The executive director position has been empty since May, when KVH's former executive director, Regan Hunt, left the position to join Humana Inc. as a product development consultant.

Prior to joining KVH, Beauregard, who has a master's degree in public health from the University of Illinois at Chicago, served as director of planning and communications at the Kentucky Primary Care Association and prior to that, as the health planner and refugee health coordinator at the Family Health Centers in Louisville.

KVH Board Officer Rich Sekel said of Beauregard, “She has been very active with KVH as a coalition member, understands the mission and vision of our organization, and will be able to immediately make a difference in broadening our outreach and increasing our impact.”

Ky. Rural Health Association meets in Bowling Green Sept. 17-18; major candidates for governor will speak back to back

The Kentucky Rural Health Association's annual conference will be held Sept. 17-18 in Bowling Green, with "a broader range of topics than ever before," KRHA says: "Whether you are a health-care provider, hospital or clinic administrator, community member, rural advocate, student, or simply curious about the rural healthcare landscape, we’ve got you covered."

KRHA says that at the end of the day-and-a-half meeting, attendees will be able to "build an overview of the state of rural health in Kentucky" and "become more skilled advocates for rural health at the local, regional and state levels," as well as explore opportunties for partnerships and collaboration.

A forum for the party nominees for governor will be held after the conclusion of the conference on Friday afternoon. Republican Matt Bevin is scheduled to speak and answer questions from 1:15 to 2 p.m., and Democratic Attorney General Jack Conway is scheduled to do likewise from 2:15 to 3 p.m. Bowling Green is on Central Time. The forum is co-sponsored by the Foundation for a Healthy Kentucky, the Friedell Committee, the Kentucky Academy of Family Physicians, the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky Primary Care Association and Kentucky Voices for Health. Before lunch, candidates for governor and other statewide offices will have a meet-and-greet session.

The conference and the forum will be held at Western Kentucky University's Knicely Center on Nashville Road, with lodging at the adjacent Staybridge Suites on Campbell Lane and the new Hyatt Place, next to the WKU campus on Center Street (with shuttle service). The registration fees until Sept. 3 are $125 for KRHA members, $200 for non-members and $45 for student members. For the draft agenda, registration form and hotel information, in a PDF, click here.

Regan Hunt, executive director of Kentucky Voices for Health, leaves for a new position at insurer Humana Inc.

The executive director of Kentucky Voices for Health, a group that worked for the implementation of the Patient Protection and Affordable Care Act, is now working for Humana Inc. as a product development consultant.

Regan Hunt

Regan Hunt switched jobs after working in a way that won her the Consumer Health Advocate of the Year Award by Families USA, which cited her work for expansion of Medicaid in Kentucky and her efforts to increase health coverage under the Affordable Care Act. In her new job, she will be a product development consultant, working on design of benefits for those covered by the Medicaid expansion.

During her time at KVH, Hunt worked with a coalition of more than 200 partners to address the many health care needs of Kentuckians, including access, prevention, quality and value. Hunt said in an interview that she was most proud of  KVH's role in enrolling so many Kentuckians in coverage during 2013-15.

"Kentucky is one of those states that did it right," she said.

Hunt said that she was also proud of the group's collaboration between Gov. Steve Beshear, the state Cabinet for Health and Family Services: "We all worked together and that was an amazing thing ... all working together to make sure that people got the information that they needed and got covered. ... It was a once-in-a-lifetime sort of thing." KVH is not a lobbying group, but many of its members are.

At Humana, Hunt will research the Medicaid expansion landscape in other states to determine what new beneficiaries that population might need or want in a benefits package, beyond what is required by law.

"I am an advocate, probably until the day I die," she said, noting that she will now work as an individual advocate, instead of under the umbrella of KVH, to help people gain access to health coverage. "I've been doing that since I was 22, so it is not something that I am going to give up doing."

Hunt is a native of Pike County, She earned her undergraduate degree at Transylvania University and her Masters in Public Administration degree from the University of Kentucky. She also holds a certificate in health-care management from the University of North Carolina, according to the KVH website.

U of L plans to create statewide health institute with $4 million, three-year grant from KentuckyOne Health hospital firm

The University of Louisville is creating an institute to improve Kentucky's health through research, education and advocacy of health policies.

KentuckyOne Health is giving the university $4 million over three years to establish the Commonwealth Institute of Kentucky in U of L's School of Public Health and Information Sciences. Dean Craig Blakely said the institute will work in western Louisville but also on statewide issues, focusing on data gathering and analysis.

"Kentucky has the nation's highest rates of cancer deaths and smoking, and ranks among the top for cardiovascular disease, obesity, prescription drug abuse and other health problems," Laura Ungar notes for The Courier-Journal. "And certain neighborhoods, regions and populations suffer disproportionately, with even higher rates."

The price for health care could be right, if it's known

By Molly Burchett
Kentucky Health News

People often shop around and compare prices when making a large purchase, and some consumer advocates, employers and health plans are pushing for price transparency in health care so it's easier for consumers to compare prices. However, many questions remain about whether or not price transparency is possible, or if it would even affect health costs and outcomes.

Making it easier for consumers and patients to compare prices encourages them to look around for a better deal, says a study published in the Journal of the American Medical Association. The study focused on the use of Castlight Health's online pricing platform and explored whether there was a reduction in costs to employers and employees for laboratory tests, advanced imaging services and clinician office visits.

Lab tests and imaging saw the biggest savings in the study, dropping 14 percent and 13 percent, and primary care offices visits also dropped by 1 percent, according to the study. Additionally, the study showed that claim payments were lower for all services for employes who used Castlight versus those employees who did not.

But less expensive care doesn't always equal higher quality care. Price transparency’s impact is realized only to the extent that it empowers consumers and influences their behavior, and price is only one of the variables that consumers need to evaluate the value of health services.

"One thing the study can't answer is whether patients are making better decisions or just cheaper ones. They're finding lower-cost options, the study finds, but it doesn't tell us how patients are taking into account things like patient satisfaction, years of clinician experience and other provider characteristics," writes Jason Millman of The Washington Post.

Another important thing the study both can't and wasn't designed to predict is whether transparency will reduce overall health spending, writes Millman. Health-care economist Uwe Reinhardt writes, in a separate JAMA editorial, that early results of research suggest that price transparency in health care can result in less spending.

Other experts have expressed doubts about this "free market" approach. In a Huffington Post article, physician and systems theorist Deane Waldman says that price is not one of the pieces of information consumers need to re-install free market forces into health care because the present health-care market in the U.S. is not free.

"The consumer can have all the information in the world, but without control of his/her own money, and without sellers competing for those dollars, the market will not work. One cannot have the advantages of free market forces if the market is not free," writes Waldman.

Similarly, Reinhardt says that comparing the costs of procedures only works if people have a choice between healthcare providers. That may be a major complication for Kentuckians in rural areas where providers may be scarce or insurance coverage may not be comprehensive.

Massachusetts is the first state to mandate some level of price transparency. However, resistance from both provider and payer communities suggests that large-scale adoption of transparency initiatives will likely be both heavily debated and slow.

Kentucky nursing homes rank 40th in the nation in new survey; reformers ask governor to create special task force for action

Kentucky got a D grade and a rank of 40th among the states in a new national survey of nursing-home care, and reform advocates are calling on Gov. Steve Beshear and other policymakers to take corrective action.

The state ranks lowest in the Southeast, the lowest ranked region, in nursing home care quality; one in five Kentucky nursing homes were cited as having a severe deficiency, "indicating widespread abuse, neglect and mistreatment of residents," says the report of the survey, created by a Florida-based advocacy group Families for Better Care.

"The results of this first-ever survey sadly represent real people, human beings being abused and neglected every day," writes Bernie Vonderheide, president of the Kentuckians for Nursing Home Reform, the lobby that spearheaded the call for action. A representative of the Kentucky Association of Healthcare Facilities, the lobby for for-profit nursing homes in the state, was unavailable for comment.

The survey analyzed eight federal measures gauging nursing home care, and the state's nursing homes scored below average in five of the eight categories. For example, only a third of Kentucky facilities reported health inspections above average. Click here for more information or to see survey results.

In the letter to the governor, Vonderheide requested the creation of a special task force to address the issues, which they say affect thousands of Kentuckians, many who cannot speak up for themselves: "It’s time to stop this growing crisis in our state before it gets so big that we cannot manage it."

Webinar Wednesday will focus on lobbying, advocacy in Health for a Change series

The Foundation for a Healthy Kentucky will host another webinar this Wednesday as part of its Health for a Change training series. This session will focus on the differences between lobbying and advocacy work done by non-profit organizations. The session will be presented by April Carson, a legislative advisor and counsel at Alliance for Justice.

The free, one-hour webinar starts at 3 p.m. EST. To register, click here.

Another training webinar will be hosted at 3 p.m. Wednesday, Aug. 24 and will focus on communication with policymakers. It will help listeners learn about the basic rules needed to figure out how public policy is made in state, county and local governments and how to become involved in the policy-making process.

The Health for a Change training series is geared to community health coalitions, agencies, businesses, advocacy organizations and individuals looking to improve skills, create community participation and create health changes at the local level. The sessions run until December. (Read more)