Prescriptions for better health care and health: empowering patients, increasing health education and collaboration

By Melissa Patrick
University of Kentucky School of Journalism and Telecommunications

The importance of empowering patients, increasing health education and collaboration were a few of the topics discussed at the Health Watch USA 2013 Conference in Lexington Nov. 1.

"Patients must be empowered with knowledge" was the primary message of Dr. Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas School of Medical Science and former surgeon general under President Clinton.

“You can’t keep ignorant people healthy,” Elders said. “We must educate our patients or we will continue to have major problems.”

Elders called for doctors to fight for comprehensive health education, everyone must be involved – the schools, the Internet, social media – and said that as a country we need to embrace comprehensive health education instead of being afraid that all discussions will lead to sex.

Patients have a responsibility to ask questions about their health care, Elders said, and if people are better educated in health care they will have a better idea of what to ask.

Karen Meyers, who works with catastrophic-injury victims and health-care providers, shared the story about her elderly mother who was critically injured during a fall; the doctor said she was terminal. Meyer persuaded the physicians to try to save her critically injured mother eight years ago, and that spurred her passion for the importance of patient and family-centered care. She attributes her mom’s recovery to doctors who listened to her and excellent nursing care.

 “Patient and family centered care,” Meyers said, “is based in dignity, respect, information sharing, participation and collaboration. We must teach doctors collaboration and that the patient and family are part of the team. We are not a threat. We are not ignorant. We should not be dismissed.”

Meyers went on to say that “The home care agency of the future is the patient, the family and the support systems. We have to have a support system that works and we have to include them.”

Elders also talked about collaboration between physicians. She said they need to provide integrated, comprehensive and transparent care because when a patient is seen on the same day by a team of specialist, they receive better care and experience better outcomes.

Martha Deed, a retired psychologist and a member of the Consumers Union Safe Patient Project's patient safety advocates network, was a seasoned patient advocate for her daughter, Millie Niss. who had Behcet's disease, a chronic disorder of the blood vessels.  Millie was hospitalized with a severe case of swine flu in 2009, coding within one hour of arrival at the hospital, and died less than a month later.

While in the hospital, Deed and Niss documented everything.  They voiced their concerns, followed the proper channels of communication, documented faulty medical equipment, found inaccuracies in nursing and doctor reports and requested test.  Despite this high level of advocacy, Millie died.

Millie's autopsy revealed a missed diagnosis that might have saved her if it had been discovered and treated, Deed said. She has since applied her research skill to investigate both the specific medical as well as hospital culture/system causes of her daughter's death. Her goal is to prevent future premature deaths in the hospital. "Patients and families very much need to be listened to," Deed said.

Elders offered advice on how to be an empowered, health literate patient:
• Take a trusted person with you when you go to the doctor
• Ask questions, write them down before you go to the doctor
• Bring all of your medications with you to each doctor visit
• Ask the doctor to write down suggested actions and medications
• Let your doctor know if you have vision and/or hearing problems
• Ask your doctor about the results of your test and what they mean

“Our health care system is presently physician centered, but patients need to be involved,” Elders said. “The largest health care work force that we are going to have is our own patients. We need to push for education.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

280,000 Kentuckians, almost all those with individual and small-group insurance policies, will have to change under Obamacare

By Molly Burchett
Kentucky Health News

About 280,000 Kentuckians will have to give up their current insurance policies, which are being discontinued because they don't comply with the Patient Protection and Affordable Care Act, according to the state Department of Insurance.

Department spokeswoman Ronda Sloan said individual policies for about 130,000 people and small-group policies for about 150,000 more will be discontinued. This means that almost all Kentuckians in the individual (134,086) and small group (153,943) private insurance market segments will face policy discontinuation, requiring them to get different insurance coverage even if they like their current coverage.

These Kentuckians join the millions of Americans who are getting or will get cancellation letters for their health insurance under Obamacare. An estimated 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive this type of letter over the next year because existing policies don’t meet the standards mandated by the health care law, reports NBC News.

NBC says the Obama administration has known this would happen for three years, despite President Obama's statement that people who liked their health insurance would be able to keep it under the health law.

The plans that are being discontinued do not meet the requirements of the law, which standardized policies and set minimum standards. "This is not a ‘cancellation’ or a ‘termination.’ No one is losing coverage,” Sloan  said in an email to The Associated Press. Discontinuation letters will offering a compliant plan that the consumer can switch to upon renewal, she said.

The consumer can also take this opportunity to shop around for other options through an insurance agent or on the state's Kynect website, where they may qualify for a subsidy or Medicaid coverage, Sloan noted.  Kentuckians should be sure to purchase a plan that is from a licensed Kentucky company and is a qualified health plan, she said.

The health law requires all plans to offer 10 essential benefits, such as mental health care, prescription drug coverage and maternity and newborn care. Plans that don't cover such services typically have lower premiums.

In the small-group market, businesses can shop for employee coverage in the same way that individuals shop for coverage, through an insurance company, agent or Kynect.

Small employers have expressed concern about being able to afford coverage for their employees, citing rising premiums, and Sloan says there is no way for the Insurance Department to know whether or not an employer is planning to continue offering coverage to employees whose policies are being discontinued. "If not, those employees could purchase coverage on the individual market," she said.

Humana's misleading letter to policyholders

After Humana Inc. sent discontinuation letters to 6,543 policyholders, the Insurance Department fined it $65,430 because the letters were misleading. They called for customers to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the health law, and didn't clearly say that policyholders could compare and choose competing plans, for which they could possibly qualify for federal subsidies. In addition, they said that a customer could get the cheaper premium option by agreeing to changes not yet approved by the Insurance Department.

“The Department of Insurance fined Humana for providing members with a policy amendment form that was not approved. This was a clear-cut violation of Kentucky’s insurance code,” Insurance Commissioner Sharon Clark told Chris Kenning of The Courier-Journal.

State officials are also reviewing a letter sent by Anthem Blue Cross Blue Shield that asked people to "call now to lock in "today's affordable rates,", reports USA Today. The insurance department determined that the letter was marketing to potential customers, and thus did not violate the insurance code. "Humana’s letter, by contrast, went to current policyholders," Kenning reports.

KET offers program about diabetes prevention and control

KET's "Connections with Renee Shaw" is offering a program about diabetes prevention and control on KET2 Friday, Nov. 8 at 5 p.m. and KET Sunday, Nov. 10 at 1:30 p.m.

This programming could not be more timely, since Kentucky, along with parts of Appalachia and the Deep South, is part of the nation's Diabetes Belt. Diabetes rates are 11 percent or higher in many counties, and as much as 25 percent of Kentucky's Medicaid budget goes towards treating the complications of type 2 diabetes, according to the program guide.

Experts will discuss statewide education and prevention methods and the changes individuals can make to avoid diabetes.

This show will explain the difference between type 1 and type 2 diabetes, the function of the pancreas and insulin, and the role that diet and exercise play to help control diabetes complications and even prevent the onset of diabetes.  It will offer personal stories of people who are living with diabetes, explain the concept of pre-diabetes and how to prevent it, and discuss specific ways we can help resolve this growing problem.

Program guests include Dr. Raymond Reynolds, professor of internal medicine, endocrinology fellowship program director, and director of the Barnstable Brown Diabetes and Obesity Center at the University of Kentucky; Theresa Renn, coordinator of the Kentucky Diabetes Prevention and Control Program; Tami Ross, a registered dietitian, certified diabetes educator, and nationally recognized speaker and health and nutrition writer; Stewart Perry, a Lexington insurance broker who has been living with Type 2 diabetes for more than 20 years and is a policy advocate on the state and national level for the Kentucky Diabetes Prevention and Control Program and the American Diabetes Association.

Speakers at conference discuss impacts and possible solutions for deadly mistakes and near misses in hospitals

By Melissa Patrick
Kentucky Health News

Medical mistakes made in hospitals cause 98,000 deaths per year. Or four times that many?

That is the widely accepted number based on a 1999 Institute of Medicine report, but a study published in the Journal of Patient Safety says that as many as 210,000 to 440,000 Americans die each year in the hospital because of a preventable harm, Marshall Allen of ProPublica reports on NPR. But the current culture in health care does not support the reporting of mistakes or near misses, said speakers at the Health Watch USA 2013 Conference on Nov. 1 in Lexington.

Keith Widmeier, training officer for the Wayne County Emergency Medical Service, talked about the importance of reporting medical errors: "How are we supposed to fix things if we don't address the near misses?" he asked. "We must look at patterns and address them, learn from the data. Reliable data helps promote systemic change. The current system creates a system of not reporting."

Helen Haskell, president of the grassroots patient-safety organization Mothers Against Medical Error, said there are many contributing factors to this culture, and suggested that there is much to be learned from patient stories.

She told story after tragic story of young patients who had died because of medical error, including the story of her son, Lewis Blackman.

Lewis was a healthy 15-year-old who developed severe upper abdominal pain while on a non-steroidal anti-inflammatory drug and a narcotic following an elective surgery. Nurses and residents failed to act upon increasing signs of instability, including 24 hours with no urine output and four hours with no blood pressure. Haskell asked repeatedly for an attending physician. Four days after the operation, her son died. The autopsy showed a giant duodenal ulcer and 2.8 liters of blood and gastric secretions in the peritoneal cavity. He had been bleeding internally.

It is the responsibility of our health care system to become more transparent, listen to people's stories and put systems in place to decrease the chance of medical errors, Haskell said. Health care must improve in the areas that errors most commonly occur, she said, such as true informed consent, unnecessary surgeries, medication and diagnostic error, failure to rescue, and communication errors.

To decrease medical errors, Haskell suggested that the system use technology as the driver of improvement, providing continuous feedback between everyone involved in the care of a patient and involve the community and government.

Nurse burnout and job dissatisfaction also lead to medical error in hospitals.

"We cannot expect high quality health care with burnout," said Jeannie Cimiotte, a Ph.D., RN and associate professor at the Rutgers University College of Nursing and executive director of the New Jersey Collaborating Center for Nursing.
Cimiotte cited a Pennsylvania study that found the implications of increases in nurse workload are burnout and job dissatisfaction, missing important changes in patient conditions and failing to report important patient information at shift change. She said the study also found high nurse burnout appears to be a possible explanation for the association between nurse staffing and infection, jeopardizing patient safety resulting in hospital-acquired conditions and poor health care outcomes.

A culture of change and transparency has been implemented and is working at the Department of Veterans Affairs hospitals in Lexington since 1987, said Dr. Steve Kraman, who was chief of staff and chairman of the Risk Management Committee of the hospitals from 1986 to 2003. They not only require the reporting of medical errors and near misses, but provide full disclosure to patients who have been injured because of accidents or medical negligence, and offer fair compensation for injuries, Kraman said.

The VA has used this model since 1987 and has had "encouragingly moderate liability payments," said Kraman. In 2010, the University of Michigan reported remarkable decreases in suits, costs, trials and time to resolution. They also linked the openness of such a program with patient safety benefits due to reduced need for secrecy surrounding errors. The University of Illinois reports no increase in either number or suits or payouts since participating in this model of care, according to Kraman.

Kraman asked the participants: Is full accountability and transparency the way we should do health care? The answer was a resounding yes.

"This is a decision based on how we behave in society.  We should behave in a stand-up manner," Kraman said.

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

1 in 3 don't get potentially life-saving screening for colon cancer, second leading cause of cancer death in Ky. and U.S.

Federal officials said Tuesday that although detecting colon cancer early saves lives, only about two-thirds of Americans aged 50 to 75 have undergone recommended screening.

The U.S. Preventive Services Task Force recommends that men and women 50 and older get screened for colon caner, which is about 23 million Americans. However, only 28 percent of people who should be screened have ever done so and about 7 percent of people have received but are not up-to-date with their screening, says the federal Centers for Disease Control and Prevention.

Colon cancer is the second leading cause of cancer mortality in Kentucky and nationwide, and it affects men and women of all ethnicities. Kentuckians have a higher than average risk of colon cancer due to higher rates of obesity, diets high in fat, and lack of regular exercise.

"Despite research that shows colorectal cancer screening saves lives, screening rates remain far too low," CDC Director Dr. Tom Frieden said during a noon press briefing Tuesday. "Colon cancer is the second-leading cancer killer for both men and women. In fact, it's the leading killer of nonsmokers in this country, killing about 50,000 people a year," he said. The CDC report was published online Nov. 5 in its Morbidity and Mortality Weekly Report.

The number one reason people aren't being screened is because their doctor didn't recommend it, Frieden said, and the CDC is encouraging doctors to talk with their patients about screening. Certain preventive screening tests may be free under the Affordable Care Act, but be sure to check your individual policy.

"It is also important that individuals learn about testing options and get the test that's right for them," Frieden said. "But, we also know that not having health insurance greatly reduces the likelihood that someone will get tested and that's why increasing coverage is another way of saving lives."

MedLine Plus reports that several screening options can be used alone or in combination, including the following: Fecal occult blood test or fecal immunochemical test every year. These tests can be done at home; Flexible sigmoidoscopy, done every five years, with home fecal tests done every three years; Colonoscopy done every 10 years.

All these tests are effective and one is not necessarily better than another, Frieden said.  The CDC says that as many as 60 percent of deaths from colorectal cancer could be prevented if everyone age 50 and older were screened regularly.

"The best test is the one that gets done," he said. For some people, however, colonoscopy may be the best option, Frieden said. "These are people with a strong family history of colon cancer or an intestinal condition such as inflammatory bowel disease, or people who have had polyps removed in the past. But for everyone else, and that's the majority of people, there is no proven benefit to one versus another," Frieden said.

Latest New York Times look at Obamacare in Kentucky examines highs and lows of enrollees and people helping them

 Navigator Kelli Cauley helps an applicant. (Luke Sharrett, NYT)

While many states have suffered through complications in signing up uninsured people for health insurance under the Affordable Care Act, Kentucky has been leading the way in efficiency, enrolling about 1,000 people per day. Abby Goodnough of The New York Times was already using Kentucky as a lens to view the rollout of health reform, and in her latest story looks at major players in the enrollment process -- including the navigators for the state's Kynect website, insurance agents, and the uninsured -- exploring the ups and downs of each group.

"Though people can sign up on their own, navigators can help those confused by the sea of insurance options," Goodnough writes. "The navigators listen to people voice their hopes and fears about the law, and their hard stories about being uninsured. Often hugs are exchanged. Sometimes tears flow." One such navigator, or Kynector, is Kelli Cauley. The Louisville resident has put 1,000 miles on her car in the last month, and the stress of the high pressure job has caused her to lose 12 pounds. As part of her job, Cauley is one of eight Kynectors who have "to enroll 699 people per month in Medicaid or private plans through the exchange. They are required to hold educational events around the region, and the agency’s phones have been ringing nonstop with requests for enrollment help at health fairs, cultural festivals and other events that the uninsured might attend."

Cauley, a former home-economics teacher, said she "expects the job to get harder as she comes under pressure to help people who might be more reluctant to sign up than the early enrollees," Goodnough writes. "But she has some strategies: visiting small day-care centers, for example, where workers are likely to be uninsured. For now, just meeting the initial flood of requests is a strain." Cauley told Goodnough, "You do have to be on your A game constantly." The reward, though, is that she has been able to help dozens of people get coverage.

Insurance agents aren't getting the same warm feeling. Some agents "refuse to sell plans through the exchanges, which they see as a threat, and have instead focused on selling other insurance, like property and casualty," Goodnough writes. Some agents who are selling the plans, aren't seeing a silver lining in the results. Donald Mucci, who has been "an insurance agent for more than three decades, has yet to get comfortable with the new system and does not much like it. (He) resents that the health care law prompted insurance companies to cut commissions paid to agents. And he thinks the exchange website makes it hard for people to understand the pros and cons of various plans, such as which hospitals and doctors they cover. Yet Mucci, an affable man in monogrammed shirt cuffs, said he wants the system to work."

Mucci, whose firm, the Garrett-Stotz Co., has been in Louisville 82 years, has only enrolled a few customers in exchange programs. During a recent enrollment, his commission was $18, far less than what he normally gets, Goodnough writes. "The law requires insurers to spend at least 80 percent of money from premiums on medical care instead of on administrative costs, which include commissions to agents and brokers. Consequently, some insurers cut commissions, infuriating many agents and brokers."

Despite the long hours put in by navigators, and the concerns of insurance agents, the plan appears to be helping people in dire need of insurance. And in some instances, people are getting what they need, without feeling like they're being handed charity. One such case revolves around a woman Cauley helped, who would identify herself only as Kay. The well-dressed substitute teacher "learned that she would be eligible for Medicaid under the new law, but she was unwilling to enroll because of what she saw as a stigma attached to the program," Goodnough writes. She told Goodnough, “I don’t want to be a freeloader.”

But the cheapest option for Kay "through the exchange would be a plan with a $356 monthly premium and a $6,300 deductible," Goodnough writes. With that amount being too high, Cauley was able to find her an alternative. "Kay could sign up for Medicaid, but only use it in catastrophic events. For checkups and other routine care, Kay could pay her own way, perhaps negotiating a discount with her doctors." She summed up her situation, and perhaps the point of what health reform hopes to accomplish, saying, “You’re giving me an alternative I can live with." (Read more)

Appalachian Ky. newspapers emphasized political voices in coverage of Obamacare in 2 months before exchange opened

Newspaper readers in Appalachian Kentucky rarely had the opportunity to read factual, impartial information about health-care reform in the two months before the new health-insurance system opened for enrollment.

That is among the preliminary findings of an ongoing study by the Institute for Rural Journalism and Community Issues, part of the School of Journalism and Telecommunications at the University of Kentucky and publisher of Kentucky Health News. The research found that coverage was dominated by opinions of public officials, largely those opposed to the law.

The research examined most newspapers in one of the unhealthiest and poorest regions of the country to see how well they were preparing their communities for a huge change in the health-insurance system. For the story by UK student Justin Richter, click here.

15 to 25% of uninsured Kentuckians may be eligible for free, non-Medicaid coverage, but watch those out-of-pocket costs

Millions of Americans who don't quite qualify for Medicaid could still get free health insurance through federal subsidies, but this free coverage hasn't gotten much attention, since most of the zero premium plans come with some trade-offs.

An analysis by an independent consulting firm, McKinsey and Co., found that 5 to 6 million uninsured Americans will qualify for subsidies greater than the cost of the cheapest "bronze" or "silver" plan. However, many insurers have been careful not to publicize this free coverage because these plans have high out-of-pocket costs and some people will be better off paying higher premiums to get more coverage, reports The New York Times.

In a zero-net-premium plan, the federal subsidy covers the entire premium, but many people still face significant out-of-pocket costs for health services. Most zero-net premium plans are bronze plans, which are the least expensive available on exchanges and cover about 60 percent of a person's medical costs; the consumer must pay for the remaining 40 percent. So, choosing this type of plan means that you may sacrifice coverage compared to other plans on the exchange.

As the metal level increases in value from bronze to platinum, so does the percentage of medical expenses that the plan will cover. Silver plans cover about 70 percent, gold plans cover about 80 percent and platinum plans cover about 90 percent of medical costs. Regardless of the plan tier, all plans must cover standard benefits like prescription drugs, maternity care and mental health treatment. Preventive services are free in all plans.

The McKinsey report says 15 to 25 percent of Kentucky's non-elderly uninsured will be eligible for a zero-net-premium plan that will either be a bronze or silver plan. Nationwide, about half of the individuals who qualify for a zero-net-premium plan are younger than 39 and are uninsured.

Individuals with lower incomes are more likely to be eligible for these plans and most will have income levels not far above the Medicaid coverage threshold, which is 138 percent of the federal poverty level. Remember persons with income up to 400 percent of the poverty line qualify for federal tax subsidies to assist with premium payment.

Experts say the higher deductibles and higher annual out-of-pocket costs of the bronze plans may not be suited for someone with a lower income. “They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute told The New York Times.

Low-cost plans may encourage younger, healthier people to enroll in Obamacare, but they have the highest out-of-pocket cost limit and highest deductible amounts. Out-of-pocket costs, including the deductible, co-payments and co-insurance (a percentage of charges), are limited to $6,350 for individuals and $12,700 for families in bronze plans. So, for some, the silver plan may be a better option, and some individuals may also qualify for a zero-net premium silver plan.

When choosing a lower-tier plan, be ready for significant cost sharing, and be careful to check that your doctors and nearby hospitals are in the plan's network. When it comes to health insurance coverage, for individuals who don't qualify for programs like Medicaid and Medicare, there's free coverage but no free lunches.

Primary care clinics added to Ky. Health Cooperative's network

The Kentucky Primary Care Association, a nonprofit charitable organization that promotes access to comprehensive primary health care services for the under-served, has been added to the Kentucky Health Cooperative’s provider network. This will significantly increase prospective members’ access to clinical providers, according to a press release from the co-op.

Physicians in member clinics will be added to the provider lists maintained by the co-op and Kynect, the state's online health-insurance marketplace, in the coming weeks.

The Kentucky Health Cooperative is a new, private, non-profit, consumer-governed health insurance company and is available through enrollment on Kynect. Its coverage begins as early as Jan. 1.

“We are pleased to add the Kentucky Primary Care Association’s physicians to our growing provider network,” said Janie Miller, the co-op’s chief executive officer. "This is a partnership between like-minded organizations that will potentially benefit tens of thousands of Kentuckians.”

Kynect allows consumers to compare and select insurance plans. Consumers can also determine if they qualify for premium payment assistance, special discounts or tax credits to help decrease the cost of services.

Find out more about Kentucky Health Cooperative at www.mykyhc.org or the its Facebook page. Information about the Kentucky Primary Care Association is at http://www.kypca.net/index.cfm.

Flu vaccine recommended for all over 6 months; pneumonia vaccine recommended for those 65 and older and at high risk

Vaccination is the best way to keep from getting the flu, and with two influenza cases already reported in Kentucky, now is the time to schedule your annual flu shot, says the state Department for Public Health.

Kentucky's flu season typically begins in October or November, so many health-care providers have vaccine supplies on hand. Adequate supplies of flu vaccine should be available for this year's season, according to a news release from the department.

It is best to get your flu vaccine early because it takes about two weeks for the vaccination to take effect, but flu shots can be given any time during the flu season.  It is recommended that you have a new flu vaccination each season, and children younger than 9 who did not receive a flu shot last season should get a second dose four or more weeks after their first vaccination, according to the release.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness,” said Stephanie Mayfield, M.D., commissioner of the department. She suggested following a few simple steps to reduce the risk of getting the flu and other illnesses: Wash your hands frequently, cover your mouth when you cough or sneeze, and stay home when you’re sick.

The Department for Public Health and the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals older than 6 months. The vaccine is especially recommended for people who are at higher risk for complications or negative consequences from the flu. 
 These include:
 • Children 6 months to 19 years
 • Pregnant women 
 • People 50 years old or older
 • People of any age with chronic health problems
 • People who live in nursing homes and other long-term care facilities
 • Health care workers
 • Caregivers of or people who live with a person at high risk for complications from the flu
 • Out-of-home caregivers of or people who live with children less than 6 months old

A variety of vaccine options are available, including injections, nasal vaccine spray, intradermal vaccination and high dose flu vaccines, so many consumers have a choice about how they get vaccinated.  Ask your health care provider which option is best for you.

Flu is a contagious disease caused by the flu virus and spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches. Seasonal flu and its complications cause an average of 23,000 deaths  each year in the U.S.

In addition to the flu vaccine, the Department for Public Health also strongly encourages all adults 65 or older and others in high risk groups to ask their health care provider about the pneumococcal vaccine.  This vaccine can help prevent a type of pneumonia, one of the flu's most serious and potentially deadly complications, according to the release.

High risk groups for invasive pneumococcal disease are:

• persons with chronic pulmonary disease
• asthma
• chronic heart disease
• diabetes
• chronic renal disease
• chronic liver disease
• smokers aged 19 through 64 years

Between 20,000 and 40,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older, according to the release.

For more information on influenza or the availability of flu vaccine, contact your local health department or visit http://healthalerts.ky.gov.

New CEO of Owensboro Health says hospitals are working to improve care, regardless of federal health reform

Philip Patterson, the new CEO of the Owensboro Health, says hospitals are moving towards health reform regardless of what happens with the Patient Protection and Affordable Care Act.

Patterson is coming to Owensboro from Bon Secours Charity Health System in New York and New Jersey, a three-hospital system with net patient revenue of nearly $500 million.  Patterson says he wants to build a stronger network for regional care in the Owensboro area.

The Affordable Care Act has changed physician and hospital payment structures, encouraging wellness participation, Patterson said in an interview with Ryan Alessi of cn|2's "Pure Politics." Patterson said the law creates incentives for hospitals to keep patients from being readmitted, and to only provide necessary care.

Regardless of what happens with the law, health organizations and providers need to be more than providers, Patterson said: They need to be health partners to their communities, to improve community members' overall health by managing care through screenings and education.

The health care law penalizes health systems for providing care that is not needed, and it encourages a change in thinking for providers who need to start providing care more economically, said Patterson. One way to do that is by building a strong network of providers who coordinate care.

"To create a sustainable system, you've got to cover a unique and significant population," he told Alessi. To cover a larger geographic area in New York and New Jersey, Patterson said, he created a loosely affiliated network of independent facilities that all worked toward the common goals of improving care coordination and quality.

As a result of Medicaid expansion in Kentucky, which now covers households earning up to 138 percent of the poverty level, an additional 400,000 people may have health insurance coverage that have never had it before.

"There's always a cost when you build something new and try to integrate a population into it," said Patterson. Unfortunately, those who lack insurance tend to have lower education levels and potentially neglected health care needs as a result of not having coverage or the perception of not having access to health care, Patterson told Alessi.

"The process of making this [integration] work is going to be clearly on the structure of health care providers as they try to manage that population to keep them out of the hospital where the most expense is," he said. Provider networks can coordinate to manage disease processes before they require care, and education and communication about how to access care is crucial, Patterson told Alessi.

Asked what will happen to hospitals if the health law is delayed or repealed, Patterson said, "It really hasn't been rolled out yet. We are still in a wait and see mode in a lot of these pieces." He said if health care systems buy into the law's overall goals, and they are already working towards the goal of better health care management. "The issue is the infrastructure and how to pay for it," he said.

"Repeal? I don't know what's going to happen there. I think as long as the goals are to create a better health model for a community, you're going to work towards them anyway," said Patterson.

November is National Diabetes Month; here are some tips to stay healthy and keep the disease from stealing your vision

November is National Diabetes Month, and if you're one of more than 370,000 Kentuckians with the disease, in addition to watching your diet and keeping track of your blood sugar, it’s also important to have regular eye exams.

A comprehensive dilated eye exam can catch
diabetic eye disease early, before symptoms appear

Diabetic eye disease is the leading cause of vision loss among working-age Americans, says a release from the National Institutes of Health.  Diabetic retinopathy is the most common form of this disease, affects=ing more than 7 million Americans, a number that is expected to reach 11 million by the year 2030.

Since diabetic retinopathy has no symptoms until it reaches an advanced stage, it is important to get regular dilated eye exams so it can be detected early, says the release. Fortunately with early detection and timely treatment, the risk of severe vision loss from the diabetic retinopathy can be reduced by 95 percent.

If you have diabetes, controlling the disease will reduce your risk of developing diabetic eye disease. It’s now a good time to remember these health tips too:

• Get a comprehensive dilated eye exam at least once a year. 
• Tell your doctor if you're feeling down or if your eyesight changes.
• Control your blood sugar, blood pressure and cholesterol levels.  
• Take your medicine even when you feel Ok.
• Be active for 30 to 60 minutes on most days of the week.
  
• Eat healthy foods like:
• fruits, vegetables, fish, lean meats and poultry, dried peas or beans, lentils, and low-fat or skim milk and cheese
• whole grain foods such as whole wheat bread and crackers, oatmeal, brown rice, and cereals
• food prepared with little added fat, oil, salt, or sugar
• smaller servings of meat, fish, and poultry
• larger servings of fruits and vegetables. 

Click here to learn more about diabetic eye disease from the National Eye Institute. Click here to learn more about preventing and managing diabetes from the National Diabetes Education Program or here for additional tips on staying healthy with diabetes.