4 community mental health centers in 35 counties to consolidate

Graphic from mental-health agencies' press release

Four nonprofit mental-health agencies in Kentucky are creating a new partnership that they say will help them improve clinical programs and alliances and protect the safety-net services in rural communities.

LifeSkills Inc. of Bowling Green, Communicare Inc. of Elizabethtown, Four Rivers Behavioral Health of Paducah and Pennyroyal Center of Hopkinsville would form one of the largest community health centers in the state.

The agencies say they have signed a letter of intent, are near the end of the due-diligence process, and expect to complete the consolidation by July 1. A name for the new organization will be announced later.

Joe Dan Beavers

Joe Dan Beavers, president and CEO of LifeSkills, will serve as the initial CEO but existing leaders from all four agencies will play a role in the partnership.

The organizations say they support more than 47,000 individuals annually and employ 1,700 people across 35 counties.

The new organization will offer more than 70 programs and services in 129 locations and employ more than 220 licensed behavioral-health clinicians. It will also serve children and adults in more than 225 schools and have budget of more than $180 million.

Traditional orthodontics remain popular, but the sale of invisible braces boomed during pandemic, and a 'high-stakes war' is on

Photo from healthline.com

As invisible braces offered by Invisalign and direct-to-consumer companies like SmileDirectClub become more popular, the firms are in a "high-stakes war" with traditional orthodontists over how best to straighten your teeth, Nathan Bomey reports for Axios.

The new products are taking traditional orthodontists' profits, pitting them "against new upstarts against state dental boards, with millions of dollars in marketing and legal bills piling up along the way," Bomey reports.

Invisalign and consumer-direct companies like SmileDirectClub offer clear-plastic aligners that progressively straighten your teeth. The aligners can also be removed as needed. 

The difference between these two companies is that Invisalign involves in-person oversight from a dentist or orthodontist while consumer-direct companies allow users to obtain their teeth aligners through an online process that largely does not require office visits. Bomey reports, "Invisalign costs about $5,000 to $6,000 per case," while "SmileDirectClub typically costs a few thousand less." 

The American Association of Orthodontists has discouraged the use of direct-to-consumer orthodontics and has issued a consumer alert on its website that cautions: "Orthodontic treatment involves the movement of biological material, which could lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites and other issues if not done correctly." 

Bomey reports that while sales boomed during the pandemic for Invisalign and SmiledirectClub, they have since "trailed off over the past year, bruising manufacturers' stock prices."  

And after years of legal battles and aggressive marketing, SmileDirectClub is in "particularly rough financial shape,"  Bomey reports. And in an effort to increase opportunities for grown, SmileDirectClub has attacked state dental boards, which it views as protecting the orthodontics industry, he wriets. 

All that said, Jefferies analyst Brandon Couillard, who tracks the teeth alignment industry, told Axios that traditional braces are still used in about eight in 10 cases, including in most children -- leaving lots of room for the aligner industry to grow. 

Owensboro Health in deal with Leitchfield hospital, which says it sought partner because of rising costs, declining reimbursements

Twin Lakes Regional Medical Center is in Leitchfield.

Owensboro Health, which absorbed Muhlenberg Community Hospital in Greenville five years ago, is preparing to do likewise with Twin Lakes Regional Medical Center in Grayson County.

The two "have signed an official letter of intent, an agreement that opens the door for the Leitchfield-based hospital to officially join Owensboro Health later this summer," they announced. "The letter of intent is the first step toward more a more formalized affiliation agreement."

Directors of the 75-bed hospital and the county taxing district that supports it picked Owensboro Health from other potential partners, which they did not reveal. The closest major hospital, 300-bed Hardin Memorial Hospital in Elizabethtown, about 30 minutes from Leitchfield, recently became part of Baptist Health, the state's largest hospital chain. The Owensboro hospital, an hour away, has 475 beds.

"More than any other prospective partner we met with, Owensboro Health demonstrated a commitment to our people, our strategic objectives and our vision for the future," the directors said in a Q-and-A sheet that the hospital issued in response to questions.

The directors said they were impressed by the experience of the Greenville hospital, which since joining Owensboro Health "has grown in terms of revenue and patient volumes and earlier this year received a five-star rating from the U.S. Centers for Medicare and Medicaid Services, making it one of only three five-star rated hospitals in Kentucky."

Twin Lakes, a familiar site to motorists on the Western Kentucky Parkway, "was and is in a solid financial position," they said, but "the board was concerned that the costs of providing care were increasing while reimbursements were decreasing, a situation that is not sustainable and will only become more challenging." Many rural hospitals have affiliated with, or sold to, larger hospitals or chains.

The county-owned hospital described the deal this way: "This is an affiliation/partnership of our patient services, medical staff and employees. The real property of the hospital and related facilities will continue to be owned by the Grayson County Hospital District and leased to TLRMC. . . . The local community will continue to have substantial representation on the governing board of the hospital, and Owensboro Health has made a commitment to make substantial capital investments in TLRMC, fund a new community charitable foundation, and establish an integrated electronic medical-record system."

Before the letter of intent was announced, Owensboro Health agreed to take critically ill covid-19 patients from TLRMC, whose administrator, Wayne Meriwether, said it has six ventilators, only two of which “will do what needs to be done to give covid-19 patients their best chance at survival.” He said “Owensboro Health has probably treated more covid-19 patients than any other hospital in the state, so they’re prepared.”

U of L's pass on buying Jewish Hospital raises fears about the hospital's future, including its large number of low-income patients

University of Louisville President Neeli Bendapudi says there is no immediate risk of Jewish Hospital closing, in the wake of the university's decision not to buy the money-losing but medically significant facility. But there is much worry in the Louisville region about its future.

Courier Journal photo

CommonSpirit Health, formerly known as Catholic Health Initiatives, have been trying to sell Jewish and eight other facilities under the KentuckyOne Health brand for two and a half years. U of L said it could not find a suitable partner to help fund the acquisition and couldn't afford to do it alone.

Bendapudi said June 13 that there is also no immediate plan to reduce the services that the university provides through Jewish, including a wide range of care provided by U of L physicians, including its cardiology and transplant services, and training of residents from the university's medical school. She added that the university must receive at least 90 days' notice before its contracts with KentuckyOne can be terminated.

KentuckyOne spokeswoman Lannette VandeToil said there were no current plans to close Jewish or any other facilities, adding that two other organizations have been in ongoing talks with KentuckyOne Health about a possible deal: hedge fund BlueMountain Capital Management an anonymous entity, Morgan Watkins reports for the Louisville Courier Journal. 

Despite all of these assurances, local health experts worry about the future of Jewish Hospital and the tens of thousands of patients that it cares for,  Boris Ladwig reports for Insider Louisville.

Ladwig reports that Jewish and Sts. Mary & Elizabeth hospitals have been incurring operating losses of more than $1 million per week.

Dr. Peter Hasselbacher, emeritus professor of medicine at U of L, told Ladwig that he was disappointed in the university's decision to walk away, but not surprised. He added that he didn't see "any signs that instill confidence in the facility's future," Ladwig writes.

"All I see are warning signs that the community should be prepared to take up the slack to take up the medical needs of urban Louisville," he told Ladwig. "I'd love to be more optimistic, but I can't be. I see us slowly circling the [drain]."

Hasselbacher also expressed his concern about what would happen to the tens of thousands of patients that Jewish Hospital cares for if it were to close or reduce its services, many of them without insurance or covered by the federal government, which Ladwig notes generally pays hospitals less than it costs to provide the care. Hasselbacher notes that the financial issues that come with taking care of this population will follow them to other hospitals in the area if Jewish were to close.

"I'm seeing challenges . . . to the city and state that they are going to be very reluctant to" address, Hasselbacher told Ladwig, who reports: "According to recent filings, Jewish and Sts. Mary & Elizabeth hospitals have a combined 78,000 annual emergency-room visits, compared to 65,000 at nearby University Hospital. Bendapudi said University is “at capacity” and Norton Healthcare’s downtown hospital, too, sometimes has to divert patients to other facilities."

Evolent Health to buy 70% of Passport Health Plan; will continue to serve the company's more than 300,000 Medicaid beneficiaries

Evolent Health, a for-profit national health management company, has agreed to purchase Passport Health Plan, the struggling, nonprofit Medicaid insurer based in Louisville.

WHAS11.com image

Evolent, which has provided services and staff to Passport since 2016, will purchase a 70% share of Passport for $70 million, and invest additional funds to shore up the company's finances.

Passport has struggled since the state cut its Medicaid rates for the Louisville region last year, where it does most of its business, notes Deborah Yetter of the Louisville Courier Journal.

Scott Bowers, Evolent's national Medicaid president, has been named the new CEO of Passport, replacing Mark Carter on June 7, Yetter reports. Carter will remain on for a period as an adviser.

The company will continue to serve the more than 300,000 Kentuckians who get their Medicaid health coverage through Passport and will continue to operate under the same name, it said.

The remaining 30 percent of Passport will remain with its founding members, including the University of Louisville, the U of L Medical Center, University of Louisville Physicians, the Jewish Heritage Fund for Excellence and Norton Healthcare. U of L will get nearly $45 million from Passport's sale to Evolent, Morgan Watkins reports in a separate Courier Journal article.

The university owns 64% of Passport, and 70% of that will be sold for about $44.7 million, U of L President Neeli Bendapudi told reporters. That will leave it with a 19.2% stake in the company.

Bendapudi said $16 million from the sale would be used to retire U of L Physicians' bank debt; $3.5 million to stabilize U of L Physicians' cash position; and $16 million to reduce the School of Medicine's deficits. She declined to provide details on the nature of the deficits, and said the sale wouldn't be enough to resolve financial issues at the school and the physicians' practice.

The deal is subject to approval of state and federal regulatory authorities including the federal Securities and Exchange Commission, a process that is expected to take 60 to 90 days.

Officials with Passport and Evolent told Yetter that they are committed to resuming work on the company's new headquarters in West Louisville, which was suspended in February. Carter and Bowers told Yetter that they are still in discussions about how to revive the stalled project.

Passport is one of five companies that manage most of the state's $11 billion-a-year Medicaid program that serves around 1.3 million people. Passport is the only nonprofit; the others are subsidiaries of for-profit insurance companies.

Passport fell into trouble last year when the Cabinet for Health and Family Services changed its geographic allocation of Medicaid money, cutting the Louisville region that Passport serves by 4.1% while the rest of the state was raised 2.2%. State officials have held firm that the new rates were developed with the aid of an independent actuary and were not aimed at any individual company.

The state recently enacted revised rates that effectively restored Passport to its original, higher rate, Yetter reports, but Carter told her that that wasn't enough to make up for the roughly $100 million it lost since July 1. He said the additional investment by Evolent should make Passport solvent.

This isn't the first time Passport, which was founded in 1997 as a pilot project to control Medicaid costs in the Louisville region at the request of state officials, has found itself in the news.

In 2010, a state auditor's report found "wasteful spending of Medicaid funds" at Passport. Along with a strong reprimand from then-Gov. Steve Beshear, the report resulted in sweeping reforms, including a restructure of Passport's board, hiring new executive leadership, cutting expenses and firing its outside lobbyists, Tom Loftus reported in a 2015 Courier Journal article.

And while Beshear asked Passport to stop spending money on anything not directly related to patient care, he later asked for, and Passport provided in May 2015, a $25,000 contribution to the Democratic Governors Association in May 2015, which had already given "$600,000 to Democratic super PAC supporting the election of Attorney General Jack Conway as governor."

Beshear and Carter told Loftus that the $25,000 was not a political contribution, but for sponsorship of a one-day health policy conference co-hosted by the DGA in Louisville. Senate Republican Leader Damon Thayer, of Georgetown, disagreed, saying, "I'm not saying this is illegal, I'm just saying call this what it is -- a political contribution." Only three states elected governors in 2015.

At the time, Conway was running against Republican Matt Bevin, now governor, and they had starkly different opinions about Beshear expansion of Medicaid to people who earn up to 138% of the federal poverty line, under the 2010 Patient Protection and Affordable Care Act. Conway fully supported the expansion, while Bevin said he would end it if elected. In July, he changed positions, saying he would seek a waiver from federal rules that would make Kentucky Medicaid more like the program in Indiana, in which beneficiaries pay small premiums based on income.

Since being elected, Bevin has sought a waiver that includes premiums and "community engagement" requirements, including work, for "able-bodied" beneficiaries. A federal judge twice rejected the plan, which is now before the U.S. Court of Appeals for the District of Columbia.

Louisville's ResCare becomes BrightSpring Health Services

Rendering of new company headquarters

ResCare, a Kentucky-born-and-based firm that provides home and community health services to about 60,000 people in 44 states, has changed its name to BrightSpring Health Services, the company announced Aug. 15.

The privately owned firm provides "clinical and nonclinical habilitative care services for people of all ages and health and skill levels, across home and community settings," its news release said. "As care preferences and health-care needs are changing, BrightSpring’s new name reflects the company’s evolution that began nearly two years ago to successfully meet the multifaceted and multidisciplinary requirements of the populations it serves amid this changing health'care landscape."

The firm is "the parent company of several brands that, in some cases, will get renamed, too," Darla Carter reports for Insider Louisville. She notes that the company plans to move into new offices on Whittington Parkway in eastern Louisville this fall.

"BrightSpring will move into its new headquarters in early November, occupying about half of the 140,000-square-foot building and housing about 360 people," Carter reports. "The company, which is owned by Toronto-based private equity firm Onex, is receiving about $550,000 in state tax incentives and grants for the building project. The development cost of the building is about $30 million and BrightSpring is investing about $15 million over the course of a multiyear lease."

BrtightSpring haS about 45,000 employees, including 1,900 in Kentucky. It was founded by Louisville accountant Ron Geary after he served as revenue secretary in the 1979-83 administration of Gov. John Y. Brown Jr. Geary retired in 2011.