Raising Ky.'s health status has 'a ways to go,' hospital chief says; Chandler says people need to demand change in health policies

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, and Christopher Roty, president of Baptist Health Lexington, spoke at the April 4 Lexington Forum. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

A discussion on health care at the April 4 Lexington Forum led to information about the many challenges Kentucky faces when it comes to improving the health of its people, and a few solutions.

At several points, Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said little will be done to improve health care and health-care costs as long as people don't demand change from their lawmakers in Frankfort and Washington.

"Apparently, it's OK with you guys," Chandler told the Lexington business-and-civic group. "That's all I can say, is that apparently it's OK with you guys because you are not demanding that it change. We can change it through public policy if the citizens of this country wants to do it - and apparently, we don't."

Chandler, 64 and a Democrat, was state auditor and attorney general before losing the 2003 governor's race and representing the 6th District in Congress from 2004 through 2012.

'Kentucky uglies'

Asked about what then-University of Kentucky President Lee Todd called "the Kentucky uglies," referencing the state's most troubling and chronic health issues, Chandler said we don't pay enough attention to them.

"Kentucky's numbers are abysmal," he said. "We have some of the worst health numbers in the United States in almost any health indicator that you can think of, starting with cancer. We lead the nation in cancer . . . and in cancer mortality."

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

Chandler said many Kentuckians work on this problem from a health-care standpoint every day, but "a long, long way to go" remains toward improvement. 

"I think there are some solutions," he said. "But we as a society, at least right now, are not prepared to deal with" them. 

Christopher Roty, president of Baptist Health Lexington, agreed that health-care providers are working on these Kentucky uglies, like obesity, diabetes and lung cancer. 

One way, he said, is by employing new technology, pointing to new protocols for lung-cancer screening that include low-dose CT scans and remote monitoring tools that reduce hospital readmissions. But when it comes to prevention, which involves things like education and poverty, he said, "We've got a ways to go." 

Opioid epidemic

Asked about the opioid epidemic in Kentucky, Roty noted that the hospital has instituted new pain-medication protocols that send people home with just enough medicine for a few days, with instructions to call their doctor if they need more. Also, an addiction nurse at the hospital is available to patients. 

"Lots and lots of progress, but then, we've got a ways to go with that," he said. 

Chandler said the prescription-monitoring system that was created out of a task force he created while serving as state attorney general worked to stop the "proliferation of the pills on the street," heroin quickly followed and "it has been a significant problem ever since." 

Further, he said that despite all of the "really good work" being done to deal with opioid addiction, we haven't figured out how to effectively treat it. 

"We have yet as a society, not gotten the tools to deal with this dreadful addiction," he said. "It's just dreadful. My own brother died of a fentanyl overdose a couple of years ago. . . . There are very few people who have not been affected by this." Chandler was speaking of his brother, Matthew Chandler. 

He added, "We're pouring a whole lot of money into well-intentioned efforts to try to fix people who are already addicted. And we're not doing enough on the preventive side to stop the addiction in the first place. And that's where the money. We need to see what we can do to go upstream to try to deal with some of these things."

That would include, he said, addressing what are often called the social determinants of health, or the social drivers of health status. These include things like education, housing, transportation, food insecurity, education, access to health care, employment and poverty.

'As important as health care is, and it's very, very important, it's only a piece of the problem," he said. "If we want people in our society to be well and to live healthy lives, we've got to work on these social determinants," the biggest of which is poverty. 

"People who don't have resources are less healthy and they live less long," he said, adding later, "It's a problem of equity in our society and quite frankly, I think we ought to be deeply concerned about it." 

The state's latest annual Overdose Fatality Report shows that  2,135 Kentuckians died from overdoses in 2022, with opioids involved in 90% of those deaths, led by fentanyl, which was involved in 72.5% of the deaths. 

Health worker shortage

Roty said a shortage of health-care workers continues to be a problem, saying about 5% of his nurses are "agency" workers for outside firms. Another challenge is that they see a lot of first-year turnover among the nurses, who he said leave for various reasons, including a dislike of shift work. 

Asked how they are addressing this issue, Roty said they are doing what many hospitals are doing, offering all kinds of bonuses and loan forgiveness programs. 

He said some of the schools that produce health-care workers aren't graduating enough students to take care of the shortages: "We've got a new class of nurses coming in this spring, but it's not going to . . . get rid of all the agency workers," who are generally paid more.

Roty noted that Baptist Health is opening a second Lexington hospital, on Interstate 75, in phases. He said the outpatient facility, with a freestanding emergency department, cancer center, surgery center and medical office building will open first, followed by a hospital bed tower.

The hospital's site was selected party to serve rural areas south and east of Lexington. Chandler noted, "The people in rural areas don't have the same services. . . . It's just an urban/rural problem." 

This led to him talking about the "institutional problems" in health care, including the fact that the U.S. spends about twice as much per capita on health care as any other industrialized country in the world, while ranking near the bottom for health outcomes.

"Now, something is wrong institutionally with a system that spends twice as much per capita on a problem and ends up with the 60th best result," he said, adding that any other business with such results would surmise that "something has got to give."  

"People in this country are dying because we can't fix this issue," he said. "They are dying and their quality of life is much poorer than it ought to be. And again, I go back to the social determinants of health. One of the reasons that other societies are doing better than we are . . . is that they do a better job on the social determinants."  

Health-care costs

Roty said they do their best to work with people challenged by the costs of health care, whether that is getting them signed up for Medicaid or a financial assistance program. "It's a broken system when it comes right down to it," he said. 

Chandler added, "There are a lot of citizens who are going bankrupt because they can't pay for their health care." 

Further, he said, the health-care system is hard to navigate, while agreeing with Roty that the system is "incredibly complex" for patients and providers. 

"And for a country as strong and capable as we are, it's just amazing to me that we can't come together and find the answers to these problems," he said. " We actually have an idea about what the answers are, we're just unwilling to implement them. And it's because, as you can imagine, there are interests that are not interested in seeing that implemented. " 

Legislative priorities

Chandler opened this segment of the conversation by saying, "The legislature is not easy to work with, we have found, particularly on these kinds of issues." 

This year, he said the foundation's priority was creation of an "all-payers claims database," which would track all health-care insurance claims (including Medicaid and Medicare) in Kentucky to improve the transparaency of health-care costs in the state. He said 22 states already have this in place. 

"We were unsuccessful in that effort, " he said. "And that's not surprising because it's a complicated thing and it's not really sexy." He added, "At some point, we're going to need to get to the bottom of where all the money is going." 

Other priorities, he said, revolved around the social determinants of health and adverse childhood experiences, which he called "childhood trauma." He added, "We're trying to address those things, but we can't seem to get the legislature to invest in the solutions."

The foundation funds Kentucky Health News but does not control its content.

Drugs for weight loss

Asked about the use of the new weight-loss drugs, like Ozempic and Wegovy, in which Kentucky leads the nation, Roty said Baptist Health would no longer cover them for weight loss because they are too expensive, effective May 1. He said they would only cover it for the treatment of diabetes. Roty said the company, Kentucky's largest hospital chain, has spent $24 million on this drug this year in its employee health plan. 

"We are not going to reimburse for that anymore . . . for weight loss purposes, obesity," Roty said. He acknowledged that "A lot of people are seeing results," but "The expense to us, so to speak, is incredible."

"Baptist Health’s employee health plan has seen significant growth in usage of both these medications since they were introduced, with Wegovy alone seeing a 600% increase in users over the past 13 months," according to a statement provided by Baptist Health. 

Chandler suggested that tackling obesity would ultimately result in overall health-care savings, since so many health conditions are caused by or worsened by obesity. 

"If they are working and they are healthy and they are not hurting people, then ultimately in the long run, while the short-term expense may be very high, in the long term the expenses ought to go down for the society in general in savings on health care." 

The 20th annual State of Obesity report from Trust for America’s Health says 37.7% of Kentucky adults are obese and nearly 72% of the state’s adults are either obese or overweight, tied for sixth place with Delaware. Among the state’s high-school students, 19.6% are obese and 16.2% are overweight.

Sen. Stephen Meredith calls for a new health-care delivery system in Kentucky, with Medicaid block grants to local governments

By Melissa Patrick
Kentucky Health News

It's time to invent a new health care delivery system in Kentucky, and it should be driven by health-care providers, state Sen. Stephen Meredith of Leitchfield said in the keynote address at the Foundation for a Healthy Kentucky's 2023 Howard L Bost Memorial Health Policy Forum, held Oct. 11 in Lexington. 

Before making this assertion, Meredith pointed to a quote attributed to Abraham Lincoln and Peter Drucker: "The best way to predict the future is to create it." Then he said, "Let's do that. Let's create a new health-care delivery system." 

State Sen. Stephen Meredith was the 
keynote speaker at the 2023 Howard
L. Bost Memorial Policy Forum Oct. 11.

The address was titled "How Do You Fix an Irretrievably Broken Health-Care System?"

Meredith spent decades as a leader in health-care administration before being elected to the Senate in 2016. When he retired as boss of Twin Lakes Regional Medical Center, now a subsidiary of Owensboro Health, was one of the four financially strongest hospitals with under 100 beds in Kentucky. He was also CEO of the Grayson County Hospital Foundation, which employed most of the local medical practitioners and managed their practices.

Meredith, a Republican, is chair of the Senate’s Health Services Committee, co-chair of the Government Contract Review Committee, and a member of other committees, including the recently formed Family and Children Committee.

"He knows the challenges facing our health-care delivery system, because he's seen them firsthand," Ben Chandler, CEO president of the foundation, said in introducing him. 

Meredith opened his address by listing several known challenges with the existing health-care system, including the "astronomical" cost of care that has resulted in the average person no longer being able to afford it. 

He also called the "mass" of health-care professionals who are leaving the system "alarming" and called one of the largest insurance companies in the U.S. making a profit of $86.4 billion in the last year one of the "most damning indictments of our current health-care delivery system. "

He noted that the U.S. is spending $1.2 trillion on health care, but has some of the worst health outcomes. 

"The problem is, we know what the issues are; we don't act on the issues," Meredith said. 

He went on to point out that the state's move to a managed-care program for Medicaid has been in place since 2012, "and we have not improved the health of our population." Further, he said the state Medicaid budget was $10 billion to serve 1.3 million people, and that is as large as it should ever be. 

"In inventing a new health-care delivery system in the future, we all have to agree and acknowledge,  there's enough money already in the health-care delivery system to take care of every man, woman and child in this country if we spend it the right way," he said.  

Further, he said, "If we're truly improving the health of the population and we are getting people back to gainful employment, we should have enough money to take care of everyone." 

To do this, he said we must have a clear mission and vision for how to fix the system.

"If we're all united in this, it's quite simple," he said. "We're here to cure the sick, to help relieve pain and suffering, to give comfort to the dying and improve the quality of life for the people we serve. If we're all united in that, doesn't that move us in one direction.

"And one thing I haven't mentioned is, it doesn't say anywhere in there to make a profit. Now, I'm a capitalist to the nth degree, and I believe in making a profit. But it's when you bring value to the system. You increase efficiencies, and you do it a better way. And we're not doing that." 

He said changes should be made on the local level by moving to a Medicaid block grant program, which would allow local governments to determine how Medicaid dollars are spent, with an incentive to save money for other local purposes.

"If you improve the health of population, whatever savings you achieve, you get to keep to improve your community," he said. "If you want to invest in your school system, you want to invest in tje infrastructure, you want to invest in broadband, it's yours to keep." 

Meredith said the main reason we don't do such things is fear: "People don't like risk. Fear keeps us from doing what we need to do."

Health insurers, drug companies and other middlemen account for 45% of America's huge health-care bill, up from 25% in 2013

UnitedHealthcare, the largest insurer, is based in Indianapolis.

Kentucky Health News

Americans spend $4.3 trillion a year looking after their health. That is 17% of the nation's gross domestic product, "twice as much as the average in other rich economies, and yet, American adults live shorter lives and American infants die more often than in similarly affluent places," The Economist reports. "Pharmaceutical firms and hospitals attract much of the public ire for the inflated costs. Much less attention is paid to a small number of middlemen who extract far bigger rents from the system’s complexity."

These are the for-profit health-insurance companies, pharmacies, drug distributors and pharmacy-benefit managers (PBMs), which The Economist dubs "Big Health." They account for about 45% of our health-care bill, "up from 25% in 2013," the British-based magazine reports. "Big Health accounts for eight of the top 25 companies by revenue in the S&P 500 index of America’s leading stocks, compared with four for Big Tech and none for Big Pharma."

The largest private health insurer, UnitedHealth Group, took in $324 billion last year, behind only Walmart, Amazon, Apple and ExxonMobil, "and $25 billion in pre-tax profit," The Economost notes. "Four pharmacy giants generate 60% of America’s drug-dispensing revenues. The mightiest of them, CVS Health, alone made up a quarter of all pharmacy sales. Just three PBMs handled 80% of all prescription claims. And a whopping 92% of all drugs flow through three wholesalers." Kentucky has reined in PBMs, now using only one for Medicaid and using the savings to expand the program.

The Patient Protection and Affordable Care Act of 2010 limited health insurers' profits "to between 15% and 20% of collected premiums, depending on the size of the health plan, but it imposed no restrictions on what physicians or other intermediaries can earn," so that "created an incentive for insurers to acquire clinics, pharmacies and the like, and to steer customers to them rather than rival providers," The Economist explains. "The strategy channels revenue from the profit-capped insurance business to uncapped subsidiaries, which in theory could allow insurers to keep more of the premiums paid by patients. . . . Between 2013 and August 2023 the nine health-care giants spent around $325 billion on over 130 mergers and acquisitions."

These businesses "say that bringing all parts of patient care—primary-care clinics, pharmacy services, pbms and insurance—under one roof is beneficial for all. In the old fee-for-service model, big health argues, doctors or hospitals are paid for each service they provide, encouraging them to perform as many as possible and charge as much as they can. If doctors and insurance companies are part of the same business, by contrast, incentives should be aligned and overall costs should be lower," The Economist reports.

"That, at least, is the theory. And there is some truth to it, [but] vertical integration can have adverse side effects. For example, many studies have found that after hospitals acquire physician practices, prices increase but quality of care does not. A health-care company that controls many aspects of patient care could raise prices for rivals wishing to access its network. Some also worry about physicians being nudged towards offering the cheapest treatment to patients, lowering the quality of care."

Amid misinformation, few adults put significant trust in any health institution or media to be accurate about health topics, poll finds

Many falsely believe that a dewormer can treat Covid-19.
(Photo by Dimas Ardian, Bloomberg, via Getty Images)

By Darius Tahir
KFF Health News

Around 3 in 10 Americans still believe ivermectin, a dewormer for animals, is an effective treatment for Covid-19. And few of them place significant trust in any form of news media or official institution to accurately convey information about health topics, from covid treatments and vaccines to reproductive health issues. So says a new poll from the Kaiser Family Foundation, an independent source of health-policy research, polling and journalism.

The confusion about what’s true — and who’s telling the truth — is of critical importance to public health, experts in political science said. “Misinformation leads to lives being lost and health problems not being resolved,” Bob Blendon, a professor emeritus of public health at Harvard University, said in an interview. Blendon was not associated with the survey.

The KFF poll of 2,007 U.S. adults found that nearly a third said ivermectin was definitely or probably an effective treatment for Covid-19. It’s not. Numerous randomized controlled trials have found otherwise. But only 22% in the poll thought ivermectin was definitely ineffective.

A fifth of those polled thought it was definitely or probably true that the Covid-19 vaccine had killed more people than the virus itself. Under half, 47%, thought that claim was definitely false, which it is. And 30% of respondents thought parents should not be required to vaccinate their children against measles, mumps and rubella, which all states do.

The prevalence of vaccine misinformation is “alarming,” said Brendan Nyhan, a professor of government at Dartmouth College who has spent years studying the transmission of false information.

Lunna Lopes, a senior survey analyst at KFF and one of the poll’s authors, said the results show wide exposure to, but limited uptake of, false claims. “Just because they’re exposed to it doesn’t mean they’re buying into it,” she said. Still, the din of misinformation might leave the populace unsure what to believe. “You might be less trusting, and less likely to outright reject false information.”

The poll also found only grudging trust, at best, for media sources of all kinds and the federal government. The limited trust the survey recorded is colored by wide partisan gaps, noted Nyhan.

KFF Health News graph; for a larger version, click on it.

Respondents did not have “a lot” of trust in the information relayed by any news media institution. Just over a quarter had this high level of trust for local TV news, and that was the highest mark of the news media tested, which ran the ideological and stylistic gamut from MSNBC to The New York Times to Fox News and Newsmax. More people had just “a little” trust in each of these institutions.

For Blendon, the mildness of the trust is a problem. It suggests that “we are short” of trusted sources of news about health.

He said journalists and editors should consider that there’s “something about the way you’re presenting information that’s not seen as credible by viewers.” Seventy percent of those in the poll said news media don't do enough to limit the spread of health misinformation, and 69% said social-media companies weren't doing enough.

Blendon said the public conversation about these topics tends to focus on the often-extreme declarations and wild claims featured on social media and on corporate and government attempts to regulate the medium. 

While the poll shows Americans use social media quite frequently, they have very little faith in the health information they see there. No social media outlet enjoyed a double-digit percentage of respondents saying they had “a lot” of trust in it.

Even so, said Lopes, a significant slice of the public — about a quarter — turn to these platforms for health information and advice. “That stood out to us,” she said. Latinos and the young are especially likely to use the forums.

KFF Health News graph; for a larger version, click on it.

The picture is similarly bleak for official institutions. Around a quarter of respondents said they had “a great deal” of trust in the Centers for Disease Control and Prevention’s recommendations. That dropped to a fifth when it came to the Food and Drug Administration. The Biden administration and Donald Trump lagged behind.

Asked about state and local public-health officials, 13% said they trusted them "a great deal" and 51% said "a fair amount, ranking their overall trust just behind the FDA and the CDC.

Those numbers, combined with the partisan gaps in trust, were especially discouraging for Nyhan. “They will be essential sources of information in future pandemics despite their errors and misjudgments during the pandemic,” he said of public-health institutions.

By far the most highly trusted source of health information? One’s own doctor. Forty-eight percent of respondents had a great deal of trust in their recommendations.

The survey, the KFF Health Misinformation Tracking Poll Pilot, was conducted May 23 through June 12, online and by telephone among a nationally representative sample of U.S. adults in English and Spanish.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

Big health-insurance company and major health-care foundation among lead investors in Invest Appalachia venture-capital fund

Kentucky Health News

Two big players in health care are the major financiers of a venture-capital firm that calls itself "a regional social investment platform" for Eastern Kentucky and most of Appalachia. Invest Appalachia says it "has secured $19 million of new investment" and is already investing in projects.

ARC.gov map, adapted by Kentucky Health News

The fund's press release says 90% of the money is "new capital from outside the region," which it defines as as the Appalachian counties of Kentucky, West Virginia, Virginia, Tennessee, North Carolina and Ohio, and it has a target of $40 million by November. The lead investors are UnitedHealth Group, a big insurance company, which has put in $10 million; the Robert Wood Johnson Foundation, a major funder of health research and projects; and the Appalachian Regional Commission, a federal-state agency that serves 54 of Kentucky's 120 counties. The release did not list ARC's and RWJF's amounts.

Andy McMahon, a vice president of UnitedHealth, said, “Advancing health equity and addressing social needs like housing and access to health care in rural and underserved areas is an integral part of making the health-care system better for everyone. We are fortunate to work with partners like Invest Appalachia, who really understand the rich culture of Appalachia and are creating new ways to address community needs to improve quality of life and health.”

Zoila Jennings, impact investment lead with the foundation, said “Invest Appalachia is pioneering regionally controlled creative capital solutions in Appalachia that support inclusive economic growth for the region and offer new opportunities for national investors. We see the Invest Appalachia Fund as an innovative model for foundations and other impact investors who want to get capital to the people and places that need it most.”

CEO Andrew Crosson told The Rural Blog that his fund has invested in real estate for downtown revitalization, "support for consumer and business lending for flood-impacted communities" in Eastern Kentucky, "solar and energy efficient equipment for a rural grocery store, and expansion of rural eye care clinics." He said in an email that he couldn't give specifics because "these deals aren't public yet" but said his priorities are "downtown revitalization/community-focused real estate, solar and energy efficiency for rural businesses and institutions, and community health facilities and social enterprises."

Robert Slaton dies at 81; was a catalyst for many health projects, including Passport Health Plan and Kentucky Health News

Robert Slaton, Ed.D.

Robert Slaton, a health-care consultant and former Kentucky public-health commissioner who was a catalyst for various health-improvement projects in the state, including Passport Health Plan and Kentucky Health News, died Dec. 27 after suffering a stroke a few days earlier. He was 81 and lived in Louisville.

Slaton, who had master's degrees in education and social work and a doctorate in education administration, was state health commissioner in 1978-79, then ran the Public Service Institute at Kentucky State University and was external-affairs administrator for Trover Clinic, now Baptist Health Deaconness Madisonville, his hometown, from 1983 to 1989. While at the University of Louisville, he was Gov. Brereton Jones' special assistant for health-care reform, executive director of the university's primary-care center, executive director of the Medical School Practice Association and executive vice president of University Health Care, retiring in 2007. As primary-care director, Slaton was part of a small group that planned, developed, and implemented Passport Health Plan, which started in 1997 and became a national model for managed care of Medicaid patients.

As a member of the national advisory board of the Institute for Rural Journalism and Community Issues at the University of Kentucky, he was the catalyst for funding of the institute's Kentucky Health News by the Foundation for a Healthy Kentucky. Sitting with Institute Director Al Cross and then-Foundation President Susan Zepeda at a Kentucky Chamber of Commerce luncheon in 2010, he said, "Al, you ought to ask Susan for some money." When Zepeda asked what the money would be for, Cross (who had no idea the proposition was coming) replied that the goal would be improving health coverage in Kentucky news media. The foundation continues to fund Kentucky Health News.

Slaton later chaired the advisory board, helping the Institiute develop a strategic plan. He was a member of the foundation's Community Advisory Council and chair of the chamber's Health Care Policy Council. In 2018, he won the Russell E. Teague Award from the Kentucky Public Health Association for his achievements and contributions to public health.

"Throughout his career in both public service and as a health-care consultant, he provided a politically savvy perspective and an astute management style that enabled institutions and organizations to make significant headway in policy change to improve the health of Kentuckians," his obituary says. "Robert always believed that health care was a right, not a commodity, and he worked very hard in a variety of settings to help move it in that direction."

As health commissioner, "He demonstrated an understanding of social and structural determinants of health that was ahead of its time," the obituary says. "Robert was a consensus builder and a natural organizer who was described as generous and down-to-earth. His talents included problem solving, strategic planning, and organizing a group of people to get a project done. He was proud that over his career he had helped young staff members develop beyond what they thought they could do. He could often see what needed to be done before most people, and he could handle personalities and egos to bring about change in organizations. Robert focused much of his career on building linkages and coalitions between different groups. This was eased by his genuine rapport with people. Robert’s strategic planning skills, insightful opinions, and wise counsel were valued by many leaders in the business, nonprofit, and political world."

He was co-author of two books about management, From Green Persimmons to Cranky Parrots, and Caught in the Middle Management. At the time of his death, he was working on a book about his mother’s life, based on the diaries she kept for decades. As he moved into assisted living, Robert was already making plans for his next book, stories of his colorful adventures as a parole officer in Western Kentucky in the 1960s. He was a delegate to the 1992 Democratic convention.

Slaton is survived by five adult children, Andrea, Lyle, Tom, Danny (Elizabeth), and Mike (Jake), and three grandchildren: Thia, Henry, and Lila. He is also survived by his companion, Mary B. Bradley, and her two children, whom he very much thought of as his own: Lizi Hagan and Clay McClure.

A memorial service will be held at 10 a.m. ET Saturday, Dec. 31 at Pearson’s, 149 Breckenridge Lane, Louisville. Visitation will be held from 4 to 7 p.m. ET Dec. 30 at Pearson’s. In lieu of flowers, donations may be made to Down Syndrome of Louisville, the Foundation for a Healthy Kentucky, or the Institute for Rural Journalism and Community Issues.

Foundation for a Healthy Kentucky's new five-year strategic plan focuses on children's health and access to health care

Major part of the one-page synopsis of the Foundation for a Healthy Kentucky's strategic plan

Directors of the Foundation for a Healthy Kentucky have approved a new, five-year strategic plan that narrows the foundation's focus to health-care access and children's health.

The board acted after an 18-month strategic planning process with "external and internal interviews, surveys, data, research and other inputs," the foundation said in a press release.

"While Kentucky's uninsured rate has declined, increasing chronic health issues and continued low rankings compared to other states, in areas such as cancer mortality, show Kentuckians still face many barriers to accessing health care," the foundation said. "Issues include a high number of medically underserved areas and a health care workforce shortage."

In this area, the foundation will address access to quality care, immunization, cancer screening, public health services and data on claims to insurance companies, which can show important trends.

On children's health, the foundation noted that the annual Kids Count Data Book ranks Kentucky 37th in the nation for the overall condition of its children and said, "Investing in our next generation may have the biggest impact of any investment in health. Historically, Healthy Kentucky has prioritized early intervention and prevention strategies with its children's health initiatives, building capacity and relationships to be successful in this area. 

In this area, the foundation will address childhood obesity prevention, children's mental health, equitable child health and reducing tobacco use by children.

The foundation's stated vision is "a Kentucky where every individual and community reaches their highest levels of health." It says its mission is "to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity."

For a one-page synopsis of the plan, click here.

State senator selected for national fellowship on population health

State Sen. Ralph Alvarado

State Sen. Ralph Alvarado, R-Winchester, is one of 23 fellows from 20 states selected for the 2022-23 class of the Milbank Fellows Program for senior executive-branch and legislative leaders who are committed to improving population health in their states and communities.

The fellowship is funded by the Milbank Memorial Fund, a nonpartisan foundation focused on improving population health and health equity.

“I’m honored to be selected for a fellowship for which so few are even considered,“ said Alvarado, who is a physician. “Improving health outcomes for Kentuckians remains a focus area for me in my role both as a physician and as a state legislator.”

Working in partnership with the Colorado Health Institute and the Public Leadership Group, Milbank will support the fellows gaining knowledge about population health issues, interdisciplinary health and human services systems, and evidence-based approaches to improving population health; expanding their personal insight and leadership capacities in support of defining and advancing a population health vision and agenda; and creating meaningful connections with a network of colleagues from within the cohort and the Milbank State Leadership Network, so they can leverage their new knowledge and capacities to take action in their states.

“Each Fellow in our new cohort brings a remarkable wealth of health policy expertise as well as diversity of life experience,” Milbank program officer Kate McEvoy, who oversees the state leadership programs, said in a news release. “We look forward to engaging with the Fellows and supporting them in continuous learning and the development of successful population health initiatives.”

Since 2015, Alvarado has represented the 28th Senate District, now Bath, Clark, Menifee and Montgomery counties and part of eastern Fayette County. He was then-Gov. Matt Bevin's choice for lieutenant governor in 2019. His current responsibilities include co-chair of the Interim Joint Committee on Health, Welfare and Family Services; member of the Medicaid Oversight and Advisory Committee, the Administrative Regulation Review Subcommittee, and the Cabinet for Health and Family Services Organizational Structure, Operations and Administration Task Force; and liaison member of the Budget Review Subcommittee on Human Resources.

Ky. health-system performance ranked 41st, Covid-19 response 49th; highest hospitalization rate, relatively low vaccination rate

Chart from 2022 Scorecard on State Health System Performance, The Commonwealth Fund

By Melissa Patrick
Kentucky Health News

Kentucky ranks 41st among the states and Washington, D.C. in the latest ranking of states' health systems, but when it comes to how well those systems and their states' populations have handled the pandemic, Kentucky ranked 49th, ahead of only Alabama and Oklahoma.

The rankings are done annually by The Commonwealth Fund, a New York-based foundation that says it aims to promote a high-performing health-care system. In past years, the Scorecard on State Health System Performance has asked three questions: 

• Do Americans have good access to health care? Does their health insurance enable them to get the care they need to stay healthy? Are they protected from high out-of-pocket health costs?
• Are Americans getting the right health care, at the right time, and in the right setting? To what extent are they seeking care from emergency departments or other costly settings instead of visiting a primary care provider? Has health care use and spending gone up or down?
• How healthy is America? How prevalent are high-risk behaviors like smoking or health conditions like obesity that put people at higher risk for poor health? What are Americans’ chances of dying early in life from preventable or treatable causes?

This year, the fund added a question: "How well has each state responded to and managed the Covid-19 pandemic?"

"Covid-19 has disrupted aspects of care and we wanted to take a closer look at how states have responded," said David Radley, senior scientist at the fund, said in an online press briefing.

To do that, the researchers used seven metrics for Covid-19 through March 2022: hospitalization rates (Kentucky was No.1), stress on intensive-care units, hospital staffing shortages, deaths in nursing homes and overall, percentage of adults vaccinated and boosted, and the number of days it took to get 70% of the state's 12-and-over population fully vaccinated. Kentucky is one of 21 states that still hasn't achieved that; the scorecard ranked it 31st in vaccination.

Graph from Scorecard on State Health System Performance; for a larger version, click on it.

While the scorecard is for state health systems, Radley acknowledged that it also reflects the choices of a state's residents. Noting Kentucky's relatively low vaccination rate, he said that even if the state made a strong effort to get Kentuckians vaccinated, "People also have to be willing to get the shot."

Overall, the scorecard evaluated states on 56 health-care indicators in seven areas: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, which includes things like  premature death, health status and risky behaviors, income disparity, racial and ethnic equity, and the new Covid-19 indicators. 

Kentucky's top rankings were in racial and ethnic equity (21st), prevention and treatment (22nd), and access and affordability (32nd). It ranked 43rd for income disparity, and ranked 49th in three measures: Covid-19, avoidable hospital use and cost and healthy lives. The last four are reflections of the state's low health status, which the report ranked second from the bottom.

Among indicators used to measure the above categories, Kentucky's best were its percentage of home- health patients with improved mobility, ranked 10th; the infant death rate (11th) and percentage of uninsured adults (12th). The state's expansion of Medicaid under the Patient Protection and Affordable Care Act gave it perhaps the nation's largest reduction in the percentage of residents without health insurance.

Kentucky's bottom-ranked indicators, other than worst of all in Covid-19 hospitalizations, were adults who report fair or poor health, adults without a dental visit in the past year, adults who have lost six or more teeth, adults who smoke, children who are overweight or obese (all next to last)) and preventable hospitalizations of seniors (47th, or fourth from the worst). 

In the overall ranking of health systems, Kentucky was sixth among the 12 southeastern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia).

Kentucky's pandemic management and outcomes

The scorecard shows the impact of the pandemic on each of the measured domains; states that entered the pandemic with stronger health status and systems fared better with the pandemic. Hawaii, Maine, Vermont, Washington, and Oregon ranked tops in handling the pandemic, while Alabama, Oklahoma, Kentucky, Mississippi, and Georgia ranked at the bottom.

Commonwealth Fund table, adapted by Ky. Health News; click it to enlarge

Among the seven indicators used to measure the Covid-19 response in states and Washington, D.C., Kentucky ranked ninth worst (43rd) for Covid-19 deaths among nursing home residents. 

And despite a huge effort by state officials to get Kentuckians vaccinated, the state ranked 34th in percentage of fully vaccinated adults who had gotten a booster shot by the end of March 2022 (31%)

Kentucky ranked 39th for three Covid-19 indicators: days of high use of intensive-care units (126 days); days of hospital staffing shortages (180); and excess deaths from February 2020 through March 2022. Excess deaths are the number above what would have been expected from historic mortality patterns; they include Covid-19 deaths.

"Because the pandemic disrupted their ability to get timely care for conditions other than Covid-19, many more people likely died sooner than they otherwise would have," says the report.

Asked if these rankings have more to do with the strength or weakness of the state's health-care systems than states' policies to address the pandemic, Sara Collins, vice-president of coverage and access for The Commonwealth Fund, said it's important to look at the whole picture to understand why Kentucky has such a low Covid-19 score.

Collins said "It is striking" that Kentucky ranked so low after expanding Medicaid and having a low uninsured rate, but it also has high Covid-19 hospitalization rates and a highly vulnerable population that has high levels of pre-existing health conditions like obesity and smoking. 

"It just goes to show you that coverage is a necessary condition for access to health care and good outcomes, but it is not a sufficient condition," she said.

The state Cabinet for Health and Family Services was asked for comment on Kentucky's ranking of 49th in handling the pandemic, but did not respond before the 12:01 a.m. Thursday time of publication.

Other indicators affected by the pandemic

The indicator that worsened most in Kentucky during the pandemic was drug-overdose deaths. Kentucky ranked third for this measure, with 49 overdose deaths per 100,000 residents, a 51% increase from 2019 to 2020. 

Graph from Scorecard on State Health System Performance; to enlarge, click on it.

"Immediately after the pandemic began, deaths spiked, as people dealt with physical isolation, disrupted addiction treatment, and a supply of deadlier drugs like fentanyl," says the report.

The latest overdose-death report in Kentucky shows  that while this rate continues to go up, it increased by much less from 2020 to 2021, when it went up 14.6%.  

Kentucky also had one of the highest rates for deaths from treatable conditions (such as heart disease and diabetes) before age 75. Kentucky ranked seventh for this indicator, with 113 premature deaths from treatable causes per 100,000 residents. This increase is largely attributed to people postponing routine health services because of Covid-19, says the report. 

Dr. David Blumenthal, president of The Commonwealth Fund, told reporters that as the U.S. faces an ongoing public-health crisis, it is important for states to prioritize policy solutions that focus on equity, safety and health. 

"Lawmakers should look for ways to ensure that people can get the health care they need, shoring up the health insurance safety net and building on coverage gains achieved during the pandemic," he said. "Finally, states need to invest in their health-care infrastructure. As the scorecard shows high performing health care systems that provide comprehensive, high quality care every day, also performed better during a pandemic. Having a strong health care system is the best preparation for any public health crisis." 

The report's findings are based on the authors’ analysis of the most recent publicly available data from federal agencies including the U.S. Census Bureau, Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services, as well as other data sources.    

Free dental, health and vision clinic comes to Hazard June 11-12

Free dental, vision and medical care will be provided in Hazard on a first-come, first-served basis on the second weekend in June.

The clinic will open at 6 a.m. Saturday, June 11 and Sunday, June 12 at East Perry Elementary School at 301 Perry Circle Rd. in Hazard. The clinic's closing time may vary, based on the service area’s daily capacity.

All of the services are free and no identification is required, but patients will be required to wear a face covering and must undergo a Covid-19 screening before entering the clinic. Patients are also asked to bring a list of their medications, or pictures of the bottles with the label visible, and to take their medications on the morning of the clinic as directed. 

The patient parking lot will open no later than midnight on Friday night, June 10, and remain open for the duration of the clinic. Once in the parking lot, additional information will be provided regarding next steps.

Photo provided

RAM encourages everyone who would like services, especially dental services, to arrive as early as possible. 

Due to time constraints, patients should be prepared to choose between dental or vision services. Medical services will be offered free to every patient attending the clinic. 

"Services include dental cleanings, dental fillings, dental extractions, dental x-rays, eye exams, glaucoma testing, eyeglass prescriptions, eyeglasses made on-site, women's health exams, general medical exams and mental health services. Free take-home colon cancer screening test kits will also be available," says the news release. 

The clinic is sponsored by Remote Area Medical Volunteer Corps, a nonprofit provider of free pop-up health clinics, and the Hazard-based University of Kentucky Center for Excellence in Rural Health. 

For more information or to donate or to volunteer, please visit www.ramusa.org or call 865-579-1530. Click here for RAM's webpage of frequently asked questions. 

Health commissioner says to expect more coronavirus surges, so it's important to keep encouraging vaccines despite resistance

Steven Stack, M.D. (State photo)

By Melissa Patrick
Kentucky Health News

Kentucky will continue to see coronavirus surges from time to time, and because Covid-19 still has the potential to overwhelm the health-care system, it's too early to start treating it as just another infection to live with, state Health Commissioner Steven Stack told Kentucky Health News in an interview.

"Covid is here to stay," Stack said. "I think the sooner people acknowledge that, the better off we'll be, but it's still premature to just try to mainstream it as if it were like any other condition, because it still has the very real potential to swamp hospitals." That is "a threat not only to people who become infected with Covid, but also to every other person in society" who needs a hospital.

"It's not yet time to say that it is just a regular part of our daily lives because it isn't," he added. "It will cause problems that the common cold and influenza don't typically cause, but we have to accept the fact that our behaviors will matter and the choices we make will determine how quickly we can normalize this and not have it be so exceptional." 

One of those behaviors is getting a Covid-19 vaccine, but a substantial number of people say in polls that they will never get one, no matter what.

Stack said that ultimately, society will need to "normalize the expectation" that getting the Covid-19 vaccine is "something all of us have to do," just like we have to follow the rules of the road when we drive an automobile. 

"The adverse consequences of the pandemic are being extended because there are still too many people vulnerable to its worst impact," and those aren't just the unvaccinated, he said. "When those consequences compromise the safety and well being of whole communities and larger populations, it is still a very much a societal need to work on this." 

Right now, Stack said, the messaging to get hold-outs vaccinated must come from people that they personally trust and respect, like local leaders. He came to the interview just after a conference call with Gov. Andy Beshear and 121 county judge-executives and mayors. They have such a call every two weeks or so, according to the Cabinet for Health and Family Services. 

Stack said he didn't have specific numbers for how many unvaccinated Kentuckians are firmly resistant to all messages, even from people they trust, but he said Kentucky is a conservative state and its vaccination rates are lower than many other states, so such resistance is probably strong. 

"We have work to do, and we have to continue to try, because giving up is just not an option," he said. "The consequences are too substantial. I mean, literally, people's health, wellness and lives are potentially in the balance if we don't find a way to get through this." 

In October, 27% of U.S. adults in the Kaiser Family Foundation Covid-19 Vaccine Monitor poll said they had not gotten a Covid-19 vaccine, and 60% of those identified themselves as Republican or Republican-leaning and 17% called themselves Democrats or Democratic-leaning. 

Only 5% of those polled said they will "wait and see" before getting vaccinated, a share that has steadily declined since the survey was first taken in December 2020, when 39% said so. Four percent said they would only get a shot if it is required, and 16% said they would "definitely not," a share that has held steady throughout the polling.

According to the Centers for Disease Control and Prevention, 60.5% of Kentucky's eligible population is fully vaccinated; and less than half of the total population in 67 Kentucky counties have received at least one dose of a vaccine. Becker's Hospital Review ranks Kentucky 36th among the states and Washington, D.C., for the number of people fully vaccinated. 

Stack agreed with President Joe Biden and others who have said the pandemic is now driven by people who are unvaccinated, but said, "It doesn't really serve us well to castigate and scold and lecture people and tell them that they are wrong. That's not the way to persuade people." 

And as he's said before, we have mastered the science of why such vaccines are necessary, but we haven't mastered human behavior, or the sociology of it.

"And that's a tale as old as time," he said. Drawing on his love of classical literature, he said reading Greek poet Homer's The Iliad and The Odyssey to find "that behavior has been alive and well in the human population for a very long time." 

One of the many challenges public-health officials face is behavior influenced by the plethora of Covid-19 vaccine misinformation on social media. To that end, Stack's advice is to "unplug" from all of it regularly. 

"I think we would find we would still know all of the stuff that's really important and we would be less revved up and less polarized to see each other as enemies, instead of fellow members of our community," he said. 

One key recommendation for getting Kentuckians vaccinated is easy access, a challenge for families of some youth, since most of the state's pediatric offices don't offer the vaccine at this time. 

Stack acknowledged that's a challenge in a convenience-driven society, he said more than 1,600 registered vaccination sites across the state give plenty of access, and that he expects more pediatricians to start offering vaccines, especially with them now approved for children five and older.  

At the end of the interview, Stack was asked what has surprised, disappointed and frustrated him most in the pandemic. 

He said he's been surprised that despite all of the negative comments about the state's efforts, "Hands down, 99% of what I've received has been positive." He said when he runs into folks in public, "They always have said, 'Thank you.' They've always had a smile on their face."

"As far as disappointed, it's just that we haven't found, despite all of our efforts, a way to take what unites and focus on that, instead of what divides us. I mean, we are waging a war with ourselves, where we have taken a very simple tool that works -- the vaccination -- and made it into an identity statement, whether or not I'm going to accept it. So I'm disappointed that humanity still hasn't found a way to rise above Homer or Shakespeare, or any of these others who have described it so well."

Beshear honors health-care workers at Morehead; state reports 994 new virus cases Friday, with positive-test rate of almost 7%

A screenshot of the crowd showed at least one masked person, at far left. (WKYT; click to enlarge)

Hundreds of front-line health-care workers gathered at St. Claire Regional Medical Center in Morehead Wednesday night to get thanks from Gov. Andy Beshear and others for their work during the pandemic.

“You all engaged in one of the most remarkable acts of heroism that I've ever seen,” Beshear said, speaking in the past tense – though he said the next day that the recent surge of coronavirus cases poses the prospect that the health-care system in some places could be overwhelmed.

Showing emotion, Beshear said, “The hardest thing I've ever done in my life is to read out the ages and the counties and the genders of those we lost over and over every day. But I showed up every day because I didn't want anybody else to have to do that. But you were sitting there holding their hands and you knew their names and you were going to talk to their family members. And that is something so special that we needed you for above and beyond your regular jobs. You are all super-heroes.”

The state no longer lists the age, sex and county of Kentuckians who die from Covid-19. Deaths are averaging fewer than four per day; two months ago, the average was about eight per day. But deaths are a lagging indicator of the pandemic, which has resurged with a more contagious variant of the virus.

Friday, Kentucky reported 994 new cases, raising its seven-day average to 713, more than double what it was 10 days ago. The share of Kentuckians testing positive for the virus rose for the 29th straight day, to 6.97%. The seven-day infection rate rose to 15.09 per 100,000 residents, more than triple what it was two weeks ago.

Few masks were visible at the Morehead event. Beshear said at his press conference the next day that everyone wore a badge saying they had been vaccinated for the virus. However, the more contagious Delta variant is causing many cases in vaccinated people, and it generates a much heavier viral load, which is amplified in large crowds, and people can spread the virus without knowing they have it.

At the event, though, the accent was on the positive.

Dr. Steven Stack, who became state public-health commissioner about a month before the pandemic hit, told the workers, "Up until March last year, I would have been in an emergency department. I would have been on the front lines with all of you. So as much as this has been difficult and hard, and as much as I've had this incredible privilege to get to serve with and advise a governor and support a state, it does feel in a way like I've been on the sidelines throughout this. Because I would have been in the Emergency Department with all of you. So I want to thank you very much for what you have done.”

Nikita Gibbs, a registered nurse who has worked at the Morehead's coronavirus testing site every day received a "Service Above Self" award. “She has seen over a hundred thousand nostrils, and she is exposed herself almost 3,000 times to Covid-positive patients. We all know her as the girl and scrubs the wears cowboy boots,” said Donald H. Lloyd II, the hospital's president and CEO.

"Gibbs said the journey has been a difficult one," reports Karyn Czar of WUKY. "But like all her counterparts, one she felt called to do." She told Czar, “It was definitely pretty terrifying at first because I do have a four year-old at home, and she's my pride and joy. So taking that home to her, I was definitely on edge about that. I just wanted to make sure that I help serve my community and the best way that I could.”

Gibbs and other health professionals told Czar that the best way you can thank them is by getting vaccinated. “I really encourage you to get vaccinated, because it is not just for you but the people around you and your loved ones … All my family is vaccinated,” Gibbs said. “I have strongly supported it. Every friend that I talk to, I strongly support getting it.”

The local star at the event was Beshear's senior adviser, Rocky Adkins of Sandy Hook, who was a state representative in the area for many years before challenging Beshear in the 2019 gubernatorial primary. He tearfully thanked St. Claire employees for helping his father, Jess Adkins, then 84, survive Covid-19 last year.

“My father started his journey of whipping Covid at Saint Claire,” Adkins said. “If any of you are in this room that treated my father, thank you from the bottom of my heart because I want to report to you your good work. My father has fully recovered. My father is on a tractor. My father is plowing, disking, and raising a half-acre garden and doing it without any oxygen whatsoever. My father is healed because of your good work, and I appreciate that from the bottom of my heart.”

Information for this story was also gathered from WUKY and WKYT-TV.

Opinion: Unvaccinated people needed vaccine information should get it from health-care providers, who should be proactive about it

By Dale Toney and Sarah Moyer

There’s no doubt it’s been an incredibly difficult year for health care providers around the world. Stories of nurses, doctors and other medical professionals battling Covid-19, and the firsthand accounts of its tragic impacts, are all too familiar.

Even those in health care who don’t work on the frontlines in emergency rooms and intensive-care units have worked hard to stay up to date on ever-changing recommendations and news all while serving as a trusted provider of information to patients, family and friends.

A recent poll for the Foundation for a Healthy Kentucky found that the most trusted sources for Covid-19 vaccine information are physicians, pharmacists and health-department directors.

Earlier this year the Kentucky Medical Association partnered with other health care organizations to launch the "Take it From Me" campaign. The goal of this campaign is to encourage Kentuckians to trust in trained and informed medical professionals that the Covid-19 vaccine is safe and effective.

Now that mask mandates and capacity restrictions are lifted, those who are not yet vaccinated are at an even greater risk.

Even with almost half the Louisville population fully vaccinated, we are still seeing severe symptoms from and hospitalizations for Covid-19 in unvaccinated individuals.

Getting vaccinated reduces the likelihood of developing severe Covid-19 symptoms by 95 percent, and it reduces the likelihood of hospitalization from Covid-19 by 100%.

In an age where information is rapid and infinite, and with so much misinformation surrounding vaccines out there, there is no doubt why so many people feel overwhelmed or untrusting.

Those who are not yet vaccinated because they still have questions or concerns should seek out information from trusted health-care providers.

All this is to say, now that mask mandates and capacity restrictions are lifted, those who are not yet vaccinated are at an even greater risk.

Even with almost half the Louisville population fully vaccinated, we are still seeing severe symptoms from and hospitalizations for Covid-19 in unvaccinated individuals.

Getting vaccinated reduces the likelihood of developing severe Covid-19 symptoms by 95%, and it reduces the likelihood of hospitalization from Covid-19 by 100%.

In an age where information is rapid and infinite, and with so much misinformation surrounding vaccines out there, there is no doubt why so many people feel overwhelmed or untrusting.

Those who are not yet vaccinated because they still have questions or concerns should seek out information from trusted health care providers.

The Kentucky Medical Association and the Louisville Metro Department of Public Health and Wellness encourage the public to utilize the expertise of their health-care providers and the health department to get answers, gain clarity and increase confidence.

We also encourage health-care providers to proactively talk to their patients about the vaccine and, of course, to get vaccinated if you are not part of the 96% of physicians already vaccinated.

The bottom line is this: The Covid-19 vaccines were developed using safe, sound science.

Those who receive the vaccine are much less likely to contract Covid-19, much less likely to spread it to others, and much less likely to be hospitalized with symptoms if they do contract the virus (which is rare).

If you have questions about the various Covid-19 vaccines, please reach out to your doctor or the health department to get answers. We are here to give you the clarity you need. Today is the day to get your Covid-19 vaccine.

Dr. Dale Toney is president of the Kentucky Medical Association; Dr. Sarah Moyer is director of the Louisville Metro Department of Public Health and Wellness. This was first published in the Louisville Courier Journal.

Beshear says he'll wait for full-week data on virus case numbers to determine need for more action; 7-day avg. rose 12% in a day

Washington Post chart, adapted by Ky. Health News; click here for interactive version.

By Melissa Patrick and Al Cross
Kentucky Health News

Gov. Andy Beshear reiterated Thursday that his administration will look at calendar-week coronavirus trends when making decisions about any additional actions to combat a possible resurgence of the virus, the prospect of which has been raised by two days of increases in the seven-day average of new cases.

For the second time this week, Beshear asserted that case numbers were declining when they were not. Wednesday's report showed 351 new cases, raising the seven-day rolling average by 20, to 188 per day. That was the largest daily increase in more than two months, except on June 8, when hundreds of delayed cases were reported. The state reported 244 new cases Tuesday, raising the average to 168. Except on two days when it rose by one case, the average had declined every day for three weeks.

The state did not post a report Thursday, saying that the federal reporting system was not updated. The state Covid-19 website says a report will be posted Monday through Friday by 4:45 p.m. At about 1:15 p.m., Kentucky Health News pointed out to Beshear that Wednesday 's report showed a 12 percent increase in the seven-day average. The seven-day positive-test rate also increased Wednesday, to 1.92%.

Asked what sort of numbers would prompt additional action, Beshear said the state is not getting "real numbers" on Saturdays and Sundays, which means it takes several days into the week for the numbers to level out. For months, the state has used Monday-through-Sunday figures to define the pace of the pandemic.

Health Secretary Eric Friedlander noted that those numbers have declined for many weeks, and he expects next week's numbers to be stable. 

Beshear said the trend would have to be be "concerning enough" to take any additional actions, especially as vaccinations increase. In the past seven days, they have totaled 6 percent more than the previous seven days, when the daily average dropped below 10,000. It is now slightly above that.

Vaccinations have generally declined since mid-April, when the average was around 40,000 a day, the major exception being mid-June, with the June 4 announcement of drawings for big prizes for vaccinated people. The first was held Thursday; announcements are set Friday, after confirmation of eligibility.

Beshear also said the state must consider what it would ask of people who have done all they can to to protect themselves in order to protect those who have been unwilling to protect themselves with vaccination. 

The drawings offer $1 million each for three residents who have received at least one dose of a vaccine, and 15 education scholarships for children between the ages of 12 and 17 who have received at least one shot. 

Beshear said Thursday "I am convinced" that the incentives have spurred interest among those who had not been vaccinated, and added that he expects that interest to increase after the state gives out the first round of prizes. The next two drawings will be held July 29 and Aug. 26, with announcements on July 30 and Aug. 27. Click here for more information. 

Despite Beshear's stated belief, vaccination numbers don't indicate that the incentive has had a huge impact; 98,000 fewer Kentuckians have been vaccinated since the incentive was announced four weeks ago than in the four weeks preceding the announcement.

In the last four weeks, Friedlander said, almost 122,000 people have gotten a shot. In the four weeks prior to the announcement, going back to May 7, 220,000 had gotten a shot, according to data from the Lexington Herald-Leader's Coronavirus Tracker. 

The state vaccine dashboard shows 2.19 million Kentuckians have received at least one dose of a vaccine, which amounts to 49% of the total population, 60% of adults, and 83% of seniors.

“These are scientific miracles,” Friedlander said. “If we get vaccinated, we drive down these rates; we drive down hospitalizations. This is the most effective thing you can do. Get vaccinated. . . . It is the way we return to normal."

State graph, adapted by Kentucky Health News; click on it to enlarge

Health experts say vaccination is becoming more important as the more contagious Delta variant spreads. Beshear said is scarier than earlier variants, but if you are fully vaccinated with the Pfizer or Moderna vaccine, you are 88% safe against it. Friedlander urged unvaccinated Kentuckians to wear masks because they have no protection otherwise. 

Vox, in an article that details why the Delta variant appears to be so dangerous, reports that in the U.S., it accounts for 20% of new cases and is on track to become dominant variant -- and that the way to quash it is following public-health measures that many are tired of: vaccinations, masks, and social distancing.

Beshear pointed to research reported in The New York Times suggesting that the Pfizer-BioNTech and Moderna vaccines may offer immunity for multiple years. The study did not include the one-dose Johnson & Johnson vaccine. He said these findings are important, especially as scientists work to determine whether vaccinated people will need boosters. 

The governor said vaccinated Kentuckians do not need to wear a mask in most situations, in keeping with the Centers for Disease Control and Prevention's guidance. 

Team Kentucky All-Stars: Beshear recognized two high-school students for their efforts to get senior citizens vaccinated: Jacqueline Teague and Amelie Beck, of Louisville, who are co-founders of VaxConnectKY. 

Beshear said they have helped nearly 1,000 seniors sign up for a vaccine appointment, planned a vaccine clinic for their school, and are using this platform to encourage students to sign up. He added that VaxConnectKY was recently recognized by Scientific American magazine and Prince Harry when Teague won the Diana Award named after Princess Diana.

Jobs: Beshear announced nine high-tech Kentucky companies will receive a total of $900,000 in state matching grants to support high-paying jobs and technology development, with several of them related to health, including:  Active Therapy Systems LLC in Nicholasville, a project that involves physical therapies for people with Parkinson’s disease; Adelphi Technology LLC in Bowling Green, which is developing a compact gas analyzer that has a broad range of potential applications, including the detection of bacterial infections from the air near a wound; HealthTech Solutions Inc. OmniLife in Lexington, which will address the need for an efficient communications software technology for organ procurement organizations and transplant centers;  Kentucky Imaging Technologies LLC in Louisville , which is working to combat colorectal cancer by developing a system that more accurately detects polyps in a patient’s colon; MEMStim LLC in Louisville, which is working on a project that involves cochlear implants; and Wild Dog Physics LLC in Lexington, which is working on a project that involves improved cancer care. 

Educational supports: Lt. Gov. Jacqueline Coleman awarded $15 million in grants to 150 local Family Resource and Youth Service Centers from the second round of the Governor's Emergency Education Relief Fund 2. The money is to be used for early childhood education, childcare and family crisis and mental health counseling. Coleman said the need for these services is great, noting that they had received 215 applications for this grant.