Humana says it will drop commercial employer-sponsored health insurance and hopes to grow through government programs

Humana's headquarters on Main Street in Louisville

Kentucky Health News

Louisivlle-based Humana Inc., which originated as a nursing-home company 60 years ago, then became a hospital company and then a health-insurance company, is planning to transform itself again – into a compaany that offers general health insurance only through government plans: Medicare Advantage, Medicaid and the military plan.

Humana announced Thursday that it would stop providing employer-sponsored commercial coverage, including self-funded and Federal Employee Health Benefit plans, over the next 18 to 24 months. "Humana will still provide insurance through its military service business," reports Tom Murphy of The Associated Press. "It also will still provide employer-sponsored specialty coverage like vision and dental benefits."

Humana covers more than 13 million people, but fewer than 1 million are in employer-sponsored health insurance, not counting the Tricare plan for active-duty service members, families and retirees, which has an enrolment of nearly 6 million.

“This decision enables Humana to focus resources on our greatest opportunities for growth and where we can deliver industry leading value for our members and customers,” President and CEO Bruce Broussard said. “It is in line with the company’s strategy to focus our health plan offerings primarily on government-funded programs . . . ”

Half of Kentuckians on Medicare have Advantage plans, in which the federal government pays the insurer a flat fee per enrollee, creating an incentive for the insurer to limit the cost of claims. Managed-care Medicaid plans, like those Humana and other insurers have in Kentuckym, are funded likewise.

"Employer-sponsored enrollment growth has largely slowed for insurers, including market leaders like UnitedHealthcare," Murphy reports. "Companies have turned more to government-backed coverage like Medicare Advantage or Medicaid for growth. They also have pushed deeper into managing prescription drug plans and providing care in order to control health-care costs."

FDA approves painkiller 10 times stronger than fentanyl, over objections of UK anesthesiologist and other doctors

The Food and Drug Administration approved a powerful new painkiller Friday over the objections of a Kentucky doctor who co-chairs its advisory committee on such matters, and other physicians.

Dr. Raeford Brown

Dr. Raeford Brown of the University of Kentucky and others argue that sufentanil, 10 times more powerful than fentanyl, "would inevitably be diverted to illicit use and cause more overdose deaths," reports Lenny Bernstein of The Washington Post.

Brown, a professor of anesthesiology and pediatrics, is the longtime chair of the FDA’s Anesthetic and Analgesic Drug Products Advisory Committee. The panel voted 10-3 on Oct. 12 to support approval of the drug, which was developed with millions of dollars from the Pentagon, which wants an easier-to-use painkiller for the battlefield.

The drug, branded as Dsuvia, is "a tablet version of an opioid marketed for intravenous delivery, but is administered under the tongue using a specially developed, single-dose applicator," reports Ed Silverman of Stat. That makes it "well-suited for the military and therefore was a priority for the Pentagon, a point that factored heavily into the decision," according to FDA Commissioner Scott Gottlieb.

“The FDA has made it a high priority to make sure our soldiers have access to treatments that meet the unique needs of the battlefield, including when intravenous administration is not possible for the treatment of acute pain,” Gottlieb wrote in what the Post called "an unusual statement, saying he would seek more authority for the agency to consider whether there are too many similar drugs on the market. That might allow the agency to turn down future applications for new opioid approvals if the drugs are not filling an unmet need."

Gottlieb's words did not satisfy Brown and the advocacy group Public Citizen, who said in a statement that AcelRx, the manufacturer, had not proven the pill's effectiveness or adequately responded to safety concerns. They noted that the FDA did not convene its Drug Safety and Risk Management Advisory Committee to consider the application.

“Clearly, the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” Brown said. “I will continue to hold the agency accountable for their response to the worst public-health problem since the 1918 influenza epidemic.”

Dr. Andrew Kolodny, who heads the Opioid Policy Research Collaborative at Brandeis University and is executive director of Physicians for Responsible Opioid Prescribing, an education and advocacy group, told Stat, “There is absolutely no need for this product. Claiming we need it on the market to help soldiers on the battlefield is ridiculous,” because fentanyl administered under the tongue is available for battlefield use.

Gottlieb said, “There are very tight restrictions being placed on the distribution and use of this product. We’ve learned much from the harmful impact that other oral opioid products can have in the context of the opioid crisis. We’ve applied those hard lessons as part of the steps we’re taking to address safety concerns for Dsuvia.”

The Post reports, "The FDA says that controls on drugs inside medical facilities are tight and the greatest risk of diversion is among medical personnel themselves. A 2016 survey conducted by the federal Substance Abuse and Mental Health Services Administration shows that narcotics are rarely stolen from doctor’s offices, clinics, hospitals or pharmacies. Fewer than 1 percent of people said they acquired opioids that way."

The rate of overdose deaths among health care workers is relatively high, however, according to an August study by the Centers for Disease Control and Prevention, with 876 succumbing to prescription opioids between 2007 and 2012.

Sufentanil is "commonly used after surgery and in emergency rooms," the Post notes. The Dsuvia pills "would not be available in retail pharmacies" and would carry a wholesale price of $50 to $60 per dose. "A spokeswoman said the company is not providing information on expected sales."

Military members are providing free screenings and medical care in Breathitt, Owsley, Lee and Estill counties through June 24

The Kentucky Air National Guard is leading an effort to provide free medical screenings and care at four adjoining counties in Eastern Kentucky through June 24.

Starting June 15, the guard's 123rd Medical Group, Navy Reserve and active-duty Air Force and Navy personnel will offer medical screenings, non-emergency treatments; physical examinations for student athletes; dental exams, cleanings, fillings and extractions; eye exams, and single-prescription eyeglasses.

Clinics are being held at Lee County High School in Beattyville, Owsley County High School in Booneville, Estill County High School in Irvine and Breathitt County High School in Jackson, from 8 a.m. to 4 p.m. Monday through Saturday, and noon to 4 p.m. Sunday.

Residents of other counties can receive screenings and care, as long as they are at least 2 years old. Insurance cards and identification are not being required.

The 215 military members in "Operation Bobcat" will see patients on a first-come, first-served basis. A similar effort in Western Kentucky in 2016 provided more than 13,000 medical, dental and optometric procedures. More than 1,500 pairs of prescription eyeglasses and $20,000 worth of medications were provided free, according to a news release from the guard.

The Kentucky Department for Local Government, which is cosponsoring the program, is hosting a resource center with information on wellness, nutrition and immunizations.

The program is designed to simulate how military medical responses are conducted in times of crisis, conflict or disaster, the guard said in a news release.

“This kind of training helps hone our expeditionary skills so we’re ready to deploy at a moment’s notice to provide care anywhere in the world,” said Lt. Col. Amy Mundell, a medical administrative officer in the Guard’s 123rd Medical Group.

Local Government Commissioner Sandra K. Dunahoo said, “We’re very pleased to support a program that gives our military health-care troops essential training in field operations and logistics, keeping their skills sharp so they can be prepared to respond wherever they’re needed. At the same time, the program will be providing crucial services to citizens of the commonwealth who may not have ready access to care. This is a win for everyone.”

Trump order aims to reduce suicide among new veterans

Trump before signing the executive order Tuesday
(Associated Press photo by Evan Vucci)

President Trump signed an executive order Jan. 9 to expand mental health care for veterans who are transitioning from military to civilian life in an effort to reduce suicides in that group.

"The order will take effect March 9 and is expected to provide all new veterans with mental-health care for at least a year after they leave the military," Dan Lamothe reports for The Washington Post. "Trump gave the Defense Department, the Department of Homeland Security and the Department of Veterans Affairs 60 days to iron out details and develop a joint plan, Veterans Affairs Secretary David Shulkin said in phone call with reporters."

New veterans are particularly at risk of suicide, and 60 percent of the 265,000 service members who transition out of the military each year don't qualify for care until the government establishes that a medical issue is related to their military service. Shulkin told Lamothe that people who have been out of military service for less than a year are 1 1/2 to two times more likely to commit suicide than any other age group. About 20 veterans a day commit suicide.

The full details of the plan aren't yet clear, but will likely include making peer-group therapy sessions available at all VA Whole Health facilities; such sessions are now only available at 18 of the facilities. An anonymous source told Lamothe that the Defense Department will expand the services of its Military OneSource program to allow veterans to access its counseling and 24-hour call line services for a full year after leaving the military instead of the current 180 days. The source said that the Pentagon will look for ways to start the transition process for service members while they are still in uniform.

Shulkin said the program is expected to cost a few hundred million dollars a year from the Defense and VA budgets, but will be paid for with existing money.

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.

Generals ask Congress to renew school nutrition rules, note 73% of young adult Kentuckians too fat to fight, 8th highest in nation

By Melissa Patrick
Kentucky Health News

A new report from the Department of Defense found that 73 percent of young adults in Kentucky aren't qualified to serve in the military, mostly because they are overweight. That is the eighth highest ineligibility rate in the nation.

Nearly one-third of all Americans ages 17 to 24 are too overweight for military service.

“Too many young people today have unhealthy eating and exercise habits,” retired U.S. Marine Corps Maj. Gen. Jerry D. Humble of Russellville said in a press release from Mission: Readiness / Military Leaders for Kids. “This problem threatens to diminish our future military strength and put our national security at risk.”

In Kentucky, 33 percent of teens are overweight or obese, and 78 percent don't get the recommended hour of exercise daily.

This report documents the "staggering impact of obesity on America's military" and has prompted more than 450 retired admirals and generals, many from Kentucky, to support the reauthorization of the Child Nutrition Act, commonly known as the Healthy Hunger-Free Kids Act,which is set to expire in September.

“As a doctor, I can tell you that we must turn the tide on the obesity epidemic by instilling good eating and exercise habits from an early age," Gen. Rhonda Cornum, a surgeon and former director of the U.S. Army's Comprehensive Soldier Fitness program, said in the release. "Good nutrition starts at home, and parents play a central role in combating childhood obesity, but it’s critical to remember that children consume up to half of their daily calories while at school and out of sight of their parents.”

As Congress prepares to reauthorize the program, it is certain that many will push for changes that address "inedible meals, food waste and misspent funds," Julie Kelly and Jeff Stier report for the Wall Street Journal.

Many of the GOP lawmakers are backed by the School Nutrition Association, which is asking for changes, citing the increase in food waste and decline in student participation in the school-lunch program in the past three years, Lydia Wheeler and Kate Hardiman report for The Hill.

SNA is asking Congress "to revert back to 2010 standards that require only half of all grains offered to be whole-grain rich, leave sodium levels where they are until research proves further reductions benefit children and do away with the requirement that forces kids to take the half cup of fruit and vegetables with every meal, since most students end up throwing them away," the Hill reports.

Advocates are urging constituents to call their representatives and tell them that the new nutrition standards are working, citing studies that say students are responding positively to the healthier lunches and are eating more fruits and vegetables and are wasting less since before the new nutrition standards were enacted, Chef Ann Cooper writes for U.S. News and World Report.

Results from poll sponsored by Robert Wood Johnson Foundation,
 the Pew Charitable Trusts and the American Heart Association

The military report included the same research support for the new school nutrition standards that Cooper included in her article, but also added a poll released last week by the Pew Charitable Trusts, Robert Wood Johnson Foundation and the American Heart Association that found 72 percent of parents nationwide favor updated nutritional standards for school meals and school snacks, while 91 percent favor requiring schools to serve fruits or vegetables with every meals.

The report also provided the results from the Kids' Safe and Healthful Foods Project poll that found 75 percent of Kentucky voters and 76 percent of public school parents support the new federal school nutrition guidelines. And roughly 70 percent support the higher nutrition standards placed on vending machines, snacks and a la carte menus.

Susan Zepeda, President and CEO of The Foundation for a Healthy Kentucky, said, "The health and well being of our next generation is at stake, We must remove the barriers to good health that stand in the way of Kentucky kids being ready to learn in school and prepared for any career they choose."

Retired Army Maj. Gen. D. Allen Youngman said, “Look, plenty of students don’t like algebra. Does that mean we stop teaching math? Of course not. Change can be hard, but if we want kids to grow up fit and healthy, it’s just plain common sense to serve nutritious meals in schools.”

Youngman added, “More than 30 million children have eaten healthier school meals since 2012. We need to keep that momentum going, because when our children’s health and our national security are at stake, retreat is not an option.”

Generals say obesity is a national-security issue, and the main medical reason 73% of Ky. young adults can't join the service

"Obesity is the leading medical reason why 73 percent of our young adults cannot qualify for military service" in Kentucky, two former state adjutants general write in The Courier-Journal. They endorse the Obama administration's nutrition standards for school meals.

"We must turn the tide on the obesity epidemic by instilling good eating and exercise habits from an early age. Good nutrition starts at home, but many kids get up to half of their daily calories at school so it just makes sense to ensure they’re eating healthfully there, too," write Maj. Gens. Michael Davidson and Allen Youngman.

"Unfortunately, there is a misguided effort afoot to enable schools to retreat from these improved nutrition standards," they write. "The move is driven by complaints that some students are having trouble adjusting to the healthier offerings, and that some schools are struggling to procure healthier ingredients and the necessary equipment for preparing the new meals. In response, the USDA is offering significant flexibility to these schools. They permanently removed caps on proteins because of the challenges some schools were facing, and offered flexibility on rules regarding whole grain pasta. They also extended the grant period for funds to help schools meet the new standards, and are providing workshops to help schools that are struggling learn what works from those that are succeeding.

C-J finds gaps in medical care for female soldiers, vets

Though women now account for almost 15 percent of active-duty troops in the U.S. military, the medical care they receive is often not on par with that of their male counterparts.

A 2007 Department of Defense report showed that "In half of focus groups, women expressed concerns about a lack of female-specific facilities and equipment, such as machinery to perform mammograms, in field hospitals," The Courier-Journal's Laura Ungar reports. Department of Veterans Affairs "hospitals don't provide obstetrics, for example, and most don't offer mammograms on-site."

Military officials acknowledge more needs to be done, but progress is being made. "Are we perfect? No. But we work our hardest to be," said Laura Boyd, public affairs officers for Fort Campbell's Blanchfield Hospital.

Efforts are being made to boost privacy for women and improve training. The VA has also hired managers to handle women's care and has launched an awareness program in which employers are reminded to assume that any woman who walks in is a veteran. Spending has also gone up, with the VA asking for $270 million in 2012, up $28 million from last year.

Still, the 2007 report found medical care was wanting in field centers. Women complained "about limits on access to gynecological exams, procedures and lab tests; and too few birth-control options in field pharmacies," Ungar reports. "In nearly half the focus groups, women said there was too little privacy in field facilities, and many felt they were seen as whiners for seeking care."

Officials at Blanchfield admit they can't provide all the care women need and do rely on outside providers, such as Vanderbilt University, for complicated cases and for routine wellness services. Most outside providers are within an hour's drive of a VA facility, which Patty Hayes, the VA's director of women's health, acknowledged is "not ideal." Still, there are no plans to provide obstetrics or other specialty care for women at VA hospitals. (Read more)

Louisville vascular surgeon provides 'hands on' support for troops

Dr. Andrea Yancey, a vascular surgeon from Louisville, has completed two weeks of volunteer service treating wounded American soldiers transported from Afghanistan and Iraq to the U.S. Army’s Landstuhl Regional Medical Center in Germany.

“I now have a better understanding and enhanced respect and appreciation for our military,” Yancey said in a press release from the Society for Vascular Surgery, which has provided continuous two-week rotations of vascular surgeons at LRMC for the past four years, the release said.

“The soldiers were young, polite, and grateful,” Yancey said. “Their mental and physical toughness and capacity for resilience were hard to comprehend. In spite of their injuries, they never complained or asked for pain medicine. They did not want to inconvenience anyone.”

Yancey is an assistant professor of surgery at the University of Louisville and a surgeon at the Robley Rex Veterans Affairs Medical Center in Louisville.

Generals in Kentucky, the national leader in young-adult obesity, say the 'too fat to fight' trend is endangering national security

Recent commanders of the Kentucky National Guard say the country could be at risk because America's youth is too fat to fight, and they urge Congress to take action. A study recently showed more than half of adults 18 to 24 in Kentucky are overweight or obese — the highest share of any state. Nationally, one in four young adults are too overweight to enlist.

"What can we do to combat child obesity and help expand the pool of young adults qualified for military service?" former Adjutant Gens. Donald Storm (right), Michael Davidson and D. Allen Youngman write in an op-ed piece for Kentucky newspapers. "School is a good place to start. Many children consume nearly half of their daily calories at school, and more than half of kids eat at least one meal served in school every day."

The Healthy, Hunger-Free Kids Act, which updates school nutrition standards for the first time in decades and provides more funding for each meal served in school cafeterias, is a step in the right direction, they say, "but more is needed to prevent our childhood obesity crisis from becoming a national security crisis."

Updating school equipment and personnel seem necessary. A recent survey of 13 southeastern Kentucky school districts found that nine use deep fryers and only five use salad bars. The survey also found that the vast majority of districts do not have the funds necessary to update or repair equipment that will be needed to comply with the new nutrition standards. Also, 11 of the 13 school food-service directors said their cafeteria workers need more training in order to be prepared for new standards.

"We are urging members of Congress to help schools meet the standards of the new child-nutrition law and provide additional support for kitchen equipment and training," they write. "These funds will help ensure that all of our children can lead healthy lives and that those who wish to serve their country are fit enough to do so." (Read more)

Fort Campbell using simulated battlefields to assess brain injuries

Doctors at Fort Campbell are using a mock battlefield to assess whether or not soldiers who have suffered a traumatic brain injury are ready to return to combat. The clinic has been recognized by the Department of Defense as a national model.

"Soldiers are making life and death decisions, so doesn't it make sense to use demonstrated competence as the standard for returning someone to duty?" Dr. David Twillie told National Public Radio's Blake Farmer.

In exercises meant to simulate scenarios they face when fighting in Iraq and Afghanistan, soldiers sweep a gravel road for possible roadside bombs, take fire from insurgents and are told to insert chest tubes and tie tourniquets while listening to sound from a scene in Saving Private Ryan. The goal is to assess how well the soldiers handle the stress of the situations. Patients must also take written tests that assess their competence. The combination of both simulated and written assessments is important.

"Very recently we had a soldier that had a desire to stay in, had done well in all our simulations," Twillie said. "But when all the different sights, sounds, smells came back, he just wasn't able to change his focus, and that's very important in combat."

Memory loss, mood swings and difficulties balancing are common symptoms of a traumatic brain injury. About 115,000 soldiers have experienced such an injury, the Defense Department estimates. (Read more)

More than half of Ky. 18-to-24-year-olds have a weight problem

"More than half of 18-to-24-year-olds in Kentucky are overweight or obese — the highest percentage in the nation," The Courier-Journal's Laura Ungar reports. Their weight is not only bad for their health, but limits their ability to serve effectively in the military. (C-J chart)

These findings come from a report called "Too Fat to Fight," released Wednesday and compiled by Mission: Readiness, whose members are retired generals and other high-ranking military officials concerned about the physical fitness of the services' recruitment pools. The reports shows 51 percent of young adults in Kentucky were either overweight or obese in 2007-9, up from 38 percent in 1997-99. Nationwide, only about 1 on 4 17-to-24-year-olds were too heavy to serve in the military.

Another report released by the U.S. Centers for Disease Control and Prevention looked at what is being done to fight the obesity epidemic in each state, by examining behavioral indicators and environmental factors. The report showed nearly 36 percent of Kentucky students, such as those at Bloom Elementary in Louisville (C-J photo by David R. Lutman), drink at least one soft drink a day, compared to 29.2 percent nationwide. More than 68 percent of Kentucky middle and high schools allow the advertising of unhealthy foods, compared to 49 percent nationwide.

Both reports concluded schools can play a key role in helping children lose weight. "Mission: Readiness urges Congress to help upgrade school equipment such as freezers, ovens and salad bars and train cafeteria workers to prepare meals with fresh ingredients," Ungar reports. (Read more)

Fort Campbell soldier who went AWOL, and says his Kentucky PTSD treatment was inadequate, is set to return to Afghanistan

A Fort Campbell-based soldier who went absent without leave because of alleged post-traumatic stress disorder will return to finish his tour in Afghanistan.

"My family doesn't want me to go, but I am not disobeying a command order," Spc. Jeff Hanks, 30, told Kristin M. Hall of The Associated Press. Hanks, right, said his mental health issues date back to a 2008 deployment in Iraq. Last year, he spent six months in Afghanistan, during which he sustained a concussion when a mortar landed near him. Since turning himself in on Nov. 11, 2010, he said he has been treated for nightmares and headaches and was told to get counseling when re-deployed. Hanks told the AP he does not feel his PTSD has been treated adequately.

Hanks, a married father from North Carolina, said he will likely serve another four months in the country to complete his one-year tour. He has committed to serve in the Army another two and a half years. A Fort Campbell spokeswoman told the AP that Hanks is scheduled to re-deploy in the coming days. (Read more)

Hanks was deployed overseas in May 2010 and did not return after a mid-tour leave in October, reports Jake Lowary of The Leaf-Chronicle in Clarksville, Tenn. After turning himself in on Veterans Day, the Army opted to send Hanks for treatment at a facility in Hopkinsville, Ky., rather than send him back to Afghanistan. (Read more)