Cabinet seeks proposals for managed-care Medicaid services

Acting on Gov. Steve Beshear's promise to moved to managed care for Medicaid recipients in order to lower costs, implemented by the recent special session of the General Assembly, the Cabinet for Health and Family Services is asking organizations to submit proposals to provide physical, mental and dental health care services for Kentuckians on Medicaid.

The goal is to improve health care outcomes, particularly in the areas of diabetes, coronary artery disease, colon cancer, cervical cancer, behavioral health, prenatal care and oral hygiene. The effort also also aims to lower costs, improve coordination of care and reduce overuse of services such as unnecessary visits to emergency rooms. Responses to the request for proposals are due May 25, and the cabinet says contracts should be in place by July 1. (Read more)

Passport Health Plan drops secrecy as managed care expands

Passport Health Plan, the managed-care organization for Medicaid in the Louisville area, announced today that it would no longer fight to keep its records secret, deciding not to appeal a ruling by Attorney General Jack Conway that it had to give records to The Courier-Journal because most of its money comes from the state.

Passport's interim CEO, Mark Carter, said in an article on the Louisville newspaper's op-ed page that the decision "was not based upon legal advice but was made as part of the continuing evolution, perhaps even transformation, of the plan." He said state Auditor Crit Luallen's scathing report on the plan "has served as a very beneficial wake-up call to our organization."

Today the state issued a request for proposals to expand Medicaid managed care to other parts of the state. Luallen told The C-J's Deborah Yetter, “I think if government is going to privatize services … we have to have a higher level of accountability, not a lower level of accountability.” (Read more)

Play about breast cancer set for premiere at UK April 22

A woman dealing with her faith after being diagnosed with breast cancer is the subject of a new play that will premiere at the University of Kentucky this month.

"Nevertheless: A Story of Resolve" is a story of faith, hope and perseverance. "I want to engage the audience with a meaningful story that will impact their lives," said playwright Lisa A. Brown, left. "Each of us has been affected by breast cancer. We either have a personal history with it or we know someone who has," said Brown, who works in the UK School of Journalism and Telecommunications. "Breast cancer does not discriminate based on race, economic status, political affiation or even gender."

The play will premiere April 22 and also be presented April 23, April 29 and May 1 at UK's Memorial Hall. Tickets are $20 in advance and $25 the day of the performance and are available online at www.ticketmaster.com, by phone at (859) 257-TICS or by visiting the UK Student Center Ticket Office, room 253.

The performances on April 22 and May 1 will include a question and answer session with the cast and playwright. The April 29 performance will include sign interpreters and special seating will be designated for the hearing impaired. To further raise awareness about breast cancer, a local representative of the Susan G. Komen Foundation will be at each performance to hand out information about the disease. (Read more)

Nonpartisan budget office says Republican's Medicare plan would make those now under 54 pay more

A proposal meant to reduce the federal deficit and cut spending would have future retirees paying more for health care, the non-partisan Congressional Budget Office estimates. The proposal by House Budget Committee Chairman Paul Ryan would repeal many of the much-touted benefits of the new health care law but is likely to die in the Senate, Ricardo Alonso-Zaldivar of The Associated Press reports.

Under Ryan's plan, future retirees now 54 and younger would be enrolled "in a different kind of health care program when they retire," Alonso-Zaldivar reports. "Instead of coverage for a set of benefits prescribed from Washington, they'd get a federal payment to buy private insurance from a choice of government-regulated plans." That would mean those retirees would pay more than they would under the current program, the nonpartisan Congressional Budget Office estimated.

Ryan, left, of Wisconsin, proposes repealing health-insurance expansion, which is expected to cover 30 million people who don't have coverage now; bringing back the coverage gap or "doughnut hole" in the Medicare prescription drug benefit; gradually raising the Medicare eligibility age (starting in 2022, it would rise by two months each year until it reaches 67 in 2033); and the amount of money juries could award in medical malpractice suits would be limited. (Photo: AP's J. Scott Applewhite)

The proposal would reduce spending by about $5 trillion over the next 10 years, but would not balance the federal budget. Ryan's plan "would shift more of the risk from rising health care costs from federal taxpayers to individual beneficiaries, medical service providers and states, giving them all a powerful incentive to avoid waste and aim for quality and efficiency," Alonzo-Zaldivar reports. "If it doesn't work, as the budget office suggests might happen, future Medicare beneficiaries, providers and states will feel the pain directly. That could send them right back to Washington clamoring for more subsidies." (Read more)

Public Health Week tips remind us that safety is part of health

In celebration of 2011 National Public Health Week, being honored April 4-10, the Kentucky Department of Public Health offers tips on preventing injuries. Each year, injuries account for $80 billion spent on medical care and another $326 billion in lost productivity.

"Kentuckians can make a real difference in their homes and communities by committing to safe behaviors for themselves, their children and families," said Dr. William Hacker, commissioner of the department. "Implementing preventive measures into our daily routines can make a dramatic difference in both the overall health of our population and the amount of health care dollars spent on injury treatment."

To prevent injuries, the department recommends: wearing a helmet and protective gear while playing sports; wearing sunscreen with an SPF of 15 or higher; having a physical before starting a new sport; warming up before playing sports; putting away items like toys and shoes lying on the floor or staircase to prevent falls; monitoring children while they play; drinking lots of water to prevent dehydration; always wearing a seatbelt; and avoiding distracted driving by not talking on the phone, texting or eating.

"We need to realize that public health requires more than the obvious examples we all know, such as eating fruits and vegetables, getting vaccinations and quitting smoking," Hacker said.

More Kentuckians had health insurance in 2010, survey finds

Fewer Kentuckians lacked health insurance in 2010, the Kentucky Health Issues Poll has found. About one in four Kentuckians ages 18 to 64 were uninsured last year, much the same as in 2008. Last year, at the depth of the recession, the uninsured were one out of three.

Young adults tend to be uninsured more often than older adults. More than one-third of adults ages 18 to 29 in the latest poll said they did not have health insurance, double the rate for adults 46 to 64.

"It's encouraging to see the number of currently uninsured Kentuckians decreasing because this suggests that they will have better access to needed health care services," said Dr. Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "However, we remain concerned about the one-third of Kentuckians who had a gap in health coverage at some point in the past year. If a serious illness strikes, it can have catastrophic effects on an uninsured family's finances."

The poll was conducted Dec. 3-22 and Dec. 27-28 by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,677 adults, 1,469 by landline phone and 208 via cell phone. The poll was also sponsored by The Health Foundation of Greater Cincinnati.

Respondents were asked more than 50 questions that covered a range of health-related topics, including financial stresses related to health care; characteristics of their neighborhood (examples: is it easy to buy fresh produce or ride a bicycle?); degree of civic engagement, such as donation of blood, work on a community project or attendance at a political meeting or rally; using cell phones while driving; health insurance coverage; the new health care law; and smoking policy. To see poll results on the majority of these issues, click here.

National poll shows opposition to major cuts in Medicaid

In this year's legislative sessions, Kentucky lawmakers wrangled to find a solution for a $166.5 million hole in the Medicaid budget. Now Congress is looking at reducing the federal deficit by reducing spending on programs and services. Medicaid is likely on the chopping block, which will likely leave Kentucky legislators scrambling again. The program, which provides health insurance for low-income people and people with disabilities, covers 60 million people nationwide. In Kentucky, 800,000 people are covered by the program.

The fact that Congress is eyeing Medicaid as a target does not come as a surprise to Drew Altman, president and CEO of the Kaiser Family Foundation. He writes, "Conservatives don't like Medicaid on ideological grounds; it's a government entitlement program. Providers complain about the program's reimbursement rates. And liberals have long complained about the program's limitations, especially the gaps in whom Medicaid covers and the large variations in coverage among states."

But a new poll  by the foundation shows only 13 percent of U.S. adults support major reductions to Medicaid, in the same neighborhood as the 8 percent who said they support major reductions to Social Security and Medicare. Nearly half of those polled said they'd prefer to see no reductions to Medicaid at all. In the same poll, 39 percent of people said the program was "very important" to them and their family. A little more than 1 in 5 people said it was not important to them at all.

Two conferences this summer will focus on children's health

The 2011 Coordinated School Health Institute conference is set for June 29 in Lexington. The conference will focus on the roles community partners and families play in creating healthy places to learn and work.

The Growing Healthy Kids in Kentucky conference will follow June 30 and July 1. The conference will address how to create healthy, hunger-free communities.

Both conferences will be at the Marriott Griffin Gate hotel. Cost for both events is $205. To register, click here.

Yum! Brands asks state to allow elderly, disabled and homeless to use food stamps at restaurants

Louisville-based Yum! Brands, which owns the KFC, Pizza Hut and Taco Bell chains, wants the homeless, disabled and elderly to be able to pay for their meals with food stamps. The company registered last month to lobby the administration of Gov. Steve Beshear on the matter. Yum! executives have given to Beshear's re-election campaign, The Courier-Journal's Tom Loftus notes.

"Under the federal food-stamp program, states may authorize (use of food stamps) by the elderly, disabled or homeless, who often have difficulty preparing meals," Loftus writes. "Only Michigan, Arizona and parts of California have done so."

"We think it's a win-win," said Paul Carothers, the company's vice president for government affairs. "It's obviously of interest from a business standpoint, and it provides access to the elderly, homeless and disabled who are often underserved."

But state Rep. Jim Wayne, D-Louisville, told Loftus, "My concern is that so much of that food is the most unhealthy food in America ... and it leads to obesity and all kinds of other health problems."

Carothers said he did not see a difference between customers being able to pay for their meals at KFC, Pizza Hut and Taco Bell with food stamps and being able to buy candy bars and soda at the grocery store, which is allowed. "The only thing they cannot use their benefits for ... now are household products, alcohol, tobacco and those sorts of things," Carothers said, adding that Yum! meals "stack up nutritionally quite well. For some of these people access to a restaurant may be their only opportunity for a hot meal."

The Cabinet for Health and Family Services told Loftus that about 814,000 Kentuckians receive food stamps, but could not say what percentage are elderly, disabled or homeless. (Read more)

April 21 Appalachian Health Summit will focus on obesity

Focusing on obesity, a topic that affects the majority of adult Kentuckians, the Appalachian Health Summit will be from 8 a.m. to 5 p.m. April 21 in Lexington. The meeting is designed for clinicians and researchers, but it would alos be a place for  journalists interested in the issue to find story ideas and sources. The registration deadline is Friday, April 8.

The first session of the gathering will focus on health disparities and health behaviors in Appalachia. The keynote address will discuss federal, state and local initiatives that address the obesity epidemic. It will be given by Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity with the Center for Chronic Disease Prevention and Health Promotion.

Concurrent sessions will discuss childhood obesity, food and nutrition; research networks and collaboratives; social networking for energy balance; and the link between obesity and cancer.

The summit is sponsored by the University of Kentucky, The Ohio State University, the University of Cincinnati, Marshall University, the Pikeville College of Osteopathic Medicine and the Appalachian Regional Commission. To read details and register, click here.

Kentucky continues to lead nation in cancer death rate

Though cancer deaths rates are falling nationwide, Kentucky continues to rank worst in the country for its number of cancer deaths, The Courier-Journal's Laura Ungar has determined. (C-J graphic shows rates for the nation, Kentucky and Indiana, the southern part of which the Louisville newspaper serves.)

Ungar's analysis stems from Thursday's release of the Annual Report to the Nation on the Status of Cancer, which concluded cancer death rates declined about 1.6 percent each year between 2003 and 2007 nationwide. Kentucky's death rate declined an average of 0.7 percent each of those years.

The state had a cancer death rate of 213.7 per 100,000 residents in 2007, which translates to about 9,700 Kentuckians dying each year from cancer. In 2007, Kentucky had a lung cancer death rate 50 percent higher than the national average, ranking it highest in the nation. It also ranked eighth highest in brain and other nervous-system cancers and higher than average for colorectal, prostate and breast cancer death rates.

Lung cancer is the most deadly cancer in the country, though researchers found, for the first time, a decrease in the number of women who die from lung cancer nationwide. The decline comes "more than a decade after deaths began dropping in men," Ungar reports.

Doctors are hoping to make more strides in battling the disease in the years to come. Thomas Tucker, director of the Kentucky Cancer Registry, told Ungar that smoking bans, higher cigarette taxes and anti-smoking messages should help drive down lung cancer rates. There has also been progress in the percentage of Kentuckians who are getting colonoscopies, a screening for colon cancer. Though more Kentuckians died of colorectal cancer than any other state in 2007, the rate has declined since. (Read more)

Many school districts need more school nurses, report finds

Many if not most Kentucky public school districts have fewer school nurses than national guidelines call for, a Kentucky Youth Advocates report says.

"A Picture of Health: School Health Services in Kentucky" found that "only 38 percent of school districts responding to its survey met or exceeded a National Nurses Association recommendation calling for one school nurse for every 750 students. The average Kentucky district provided one nurse for every 1,254 students," the Lexington Herald-Leader's Jim Warren reports.

The report also found the average  district spends less than 1 percent of its operating budget on health services. That number only factored in direct spending by the districts and did not include support that might come from health departments, universities or other organizations.

Of Kentucky's 174 districts, 137 responded to the survey. KYA Executive Director Terry Brooks called the report a "starting point" for looking at ways to expand health services in schools. (Read more)