Program to double purchasing power of federal nutrition programs at Kentucky farmers' markets expands; now at 27 locations

Kentuckians receiving government nutritional assistance can double their spending power, up to $10 a day, if they shop at one of 25 local farmers' markets or two Fresh Stops Markets in Lexington that are participating in the “Double Dollars” program for those in the Supplemental Nutrition Assistance Program (formerly food stamps), the Women, Infants and Children program or the Senior Farmers Market Nutrition Program.

Warren Beeler, center, executive director of the Governor's Office
of Agricultural Policy, presents a proclamation from Gov. Matt Bevin
declaring Aug. 7-13 Farmers’ Market Week in Kentucky. Also pictured
are, from left: Kelly Munson, senior vice president, WellCare Health Plans;
Dr. Connie White, deputy commissioner, state Department for Public Health;
Agriculture Commissioner Ryan Quarles; Carol Baumann, chair of the
Community Farm Alliance board; CFA executive director Martin Richards;
and John Johnson, USDA. (Kentucky Department of Agriculture photo)

The state Agricultural Development Board recently authorized more than $78,000 to support the Community Farm Alliance, which administers the Double Dollars program and funds on-site managers for the state’s farmers markets. WellCare Health Plans of Kentucky donated $6,000 and the state Cabinet for Health and Family Services contributed an additional $5,500.

The program began with six markets in 2014. Surveys of users showed that people using the program felt they were eating a lot more fruits and vegetables and felt more educated about healthy eating. CFA's Martin Richards said it has been popular with both the markets and families using it.

“In many rural Kentucky communities, 25 percent of the population participates in these nutritional programs,” Richards said in a news release. “Double Dollars helps draw these people to the wholesome, fresh food of farmers markets, which is good for them and good for our farmers.”

Kelly Munson, senior vice president of WellCare, said, “We know healthier people not only save money on health care but are better able to obtain or retain employment. This program helps Kentucky families in the most straightforward way possible – by putting healthy food on the table.”

Double Dollars are available at the following markets: Bardstown Road Farmers Market, Louisville; Berea Farmers Market Cooperative, South Point Farmers Market, Louisville; Bounty of the Barrens Farmers Market, Glasgow; Boyle County Farmers Market; Community Farmers Market, Bowling Green; Cumberland County Farmers Market, Farmers Market on the Square, Columbia; Franklin County Farmers Market; Gateway Farmers Market (SoKY Marketplace), Bowling Green; Gray Street Farmers Market, Louisville; Jackson County Farmers Market; Knox County Farmers Market; Magoffin County Farmers Market; Metcalfe County Farmers Market; Owen County Farm and Craft Market; Perry County Farmers Market; Phoenix Hill-NuLu Farmers Market, Louisville; Winchester-Clark County Farmers Market; Whitesburg-Letcher County Farmers Market; Downtown Richmond Farmers Market; and five Lexington Farmers Market locations.

For more information about Kentucky’s farmers markets, visit the Kentucky Department of Agriculture at kyagr.com/marketing/farmers-market.html. For more information about the Double Dollar Program visit the Community Farm Alliance at cfaky.org/what-we-do/fmsp/. 

Ratings of hospitals may contradict their advertising, prompt low scorers to improve, health-care journalist says

Hospital rankings have been making news. Most recently, U.S. News and World Report ranked more than 5,000 U.S. hospitals and most in Kentucky. But the bigger news were the Centers for Medicare and Medicaid Services rankings of 3,662 hospitals, also including most in Kentucky.

The release of ratings by the federal agency, over the objections of the hospital industry and its allies in Congress, "sends a message that patients have a right to know what’s going on inside the hospitals they entrust with their lives or those of their family members," Trudy Lieberman says in her latest "Thinking About Health" column for the Rural Health News Service.

"The ratings reveal a contradiction between scientifically measured evidence and the advertising hospitals use to build their brand," Leiberman writes. "Hospitals like to tell their communities about new cancer treatments or new children’s wings, not mediocre ratings. . . . Those of us who have written about hospitals know that smart patients need to look way beyond the nightly advertising on TV."

The hospital industry argued that the ratings "may not take into account that many hospitals treat low-income patients with complex conditions and, thus, may not be fair to providers," Lieberman notes. "But as Leah Binder who heads The Leapfrog Group, which advocates for patient safety, has noted on Forbes.com, the letter sent by the senators did not mention responsibility to patients who may suffer harm in a hospital. The British Medical Journal reported in May that researchers who examined the scientific evidence concluded that in 2013 medical errors were the third-leading cause of death in the U.S. behind heart disease and cancer. That’s cause for alarm and may be a reason why CMS didn’t bow to political pressure."

The ratings may prompt hospitals to improve, Lieberman says. "Hospitals may also fear that consumers will see the stars, which are easy to understand, dig into the numbers behind them, ask questions, and perhaps choose other facilities if they can. If that happens, CEOs may feel mighty uncomfortable going before their boards and explaining why they received only one or two stars."

Study finds 2 new probable carcinogens in e-cigarette vapor; study author says there is no such thing as a healthy e-cigarette

ConsumerReports.org

A recent study has detected two probable carcinogens never before detected in the vapor of electronic cigarettes, lending further support to the argument that they are not a healthy alternative to tobacco cigarettes.

 “Advocates of e-cigarettes say emissions are much lower than from conventional cigarettes, so you’re better off using e-cigarettes,” researcher Hugo Destaillats said in a news release. “I would say: Regular cigarettes are super unhealthy. E-cigarettes are just unhealthy.”

The researchers, from Lawrence Berkeley National Laboratory in California, looked at the effects that temperature and the type and age of a vaping device have on e-cigarette emissions. They found that the thermal decomposition of propylene glycol and glycerin, two solvents found in most e-cigarettes, leads to the release of toxic chemicals such as acrolein and formaldehyde.

The study also found "significant levels of 31 harmful chemical compounds, including two that had never been previously found in e-cigarette vapor—propylene oxide and glycidol, both of which are probable carcinogens," says the release.

The study, published in Environmental Science and Technology, simulated vaping by using three types of e-liquids in two different vaporizers, one cheaper version with one heating coil and the other more expensive with two parallel heating coils. They were operated at different battery power settings.

The study also looked at the difference in puffs as the device heated up and found that the first and last puffs produced "widely varying emissions," depending on the device, the battery voltage and the emitted compound. For example, in later puffs there was much more acrolein, which is a severe eye and respiratory irritant.

The study also found that the emissions of acrolein, formaldehyde ans acetaldehyde, all either carcinogens or respiratory irritants, increased with usage on older devices that were used over nine consecutive 50-puff cycles and not cleaned.

“In some cases we saw aldehyde levels increase 60 percent between cycles 1 and 9,” study author Mohamad Sleiman said in the release.

Researchers also found that as voltage increased, so did the temperature and the amount of e-liquid consumed per puff. “The higher the temperature, the more emissions,” Destaillats said. But he also said, “We found there are emissions of toxic chemicals at any temperature at which you use the device.”

This research comes on the heels of the U.S. Food and Drug Administration's regulation that bans the selling of e-cigarettes to minors, effective Monday, Aug. 8. Kentucky enacted such a law in 2014. According to the federal Centers for Disease Control and Prevention, teenagers are more likely to use e-cigarettes than tobacco products.

August is National Immunization Awareness Month; as students head back to school, make sure their vaccines are up to date

August is National Immunization Awareness Month, which is meant to highlight the importance of vaccination for people of all ages, but is especially relevant to students as they head back to school.

“Vaccines are a requirement for school entry and help protect the health of children and that of their classmates and their community,” state Health Commissioner Dr. Hiram Polk said in a news release. “When children are not vaccinated, they could be at risk of disease and can possibly spread diseases to others in their classrooms and community.”

Kentucky requires every student to be current on their immunizations as they enter kindergarten and sixth grade.

Children entering kindergarten are required to have the combined TDAP vaccine for for diphtheria, tetanus and pertussis; a measles-mumps-ruebella vaccine; and vaccines for hepatitis B, polio and chicken pox.

Students entering sixth grade are required to have all of the immunizations that were required to enter kindergarten, as well as a TDAP booster, a meningitis vaccine, and a second chicken-pox vaccine.

The HPV vaccine, which protects against the human papillomavirus, is recommended for 11- and 12-year old boys and girls, but is not required. HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

Flu vaccine is also recommended for school-aged children every year as soon as it is available, but is not required. This vaccine is especially important for those with chronic conditions like asthma or diabetes.

The federal Centers for Disease Control and Prevention reminds parents that it is never too late to catch up on their child's missed immunizations, and that primary care providers can help set up an adjusted immunization schedule.

"Making sure your children stay up to date with vaccinations is the best way to help protect your communities and schools from outbreaks that can cause unnecessary illnesses and deaths," CDC says. "Getting every recommended dose of each vaccine provides children with the best protection possible."

U.S. News and World Report rankings include five Kentucky hospitals; UK ranked No.1, followed by Baptist Health Louisville

U.S. News and World Report's annual Best Hospitals Rankings have five of Kentucky hospitals meeting the "high U.S. News standards" and ranked regionally.

UK Albert B.Chandler Hospital

Those hospitals were, in this order: University of Kentucky Albert B. Chandler Hospital, Baptist Health Louisville, Baptist Health Lexington in a tie with St. Elizabeth Healthcare Edgewood-Covington Hospitals, and Louisville's Norton Hospital.

No Kentucky hospital made the magazine's Best Hospitals Honor Roll of the top 20 hospitals in the nation. Mayo Clinic in Rochester, Minn., was ranked No. 1.

The rankings compared nearly 5,000 medical centers across the country in 25 specialties, procedures and conditions. It looked at things like patient survival, number of patients, hospital-acquired infection, adequacy of nurse staffing and so on.

UK Albert B. Chandler Hospital ranked 45th nationally in geriatrics and was labeled "high performing" in six other specialties: cancer, diabetes and endocrinology, nephrology (kidneys), neurology and neurosurgery, orthopedics, and pulmonology (lungs). Hospitals so ranked are in the top 10 percent of hospitals nationally, the magazine says.

The report also gave rankings on nine procedures and conditions: including bypass surgery, heart failure, abdominal aortic aneurysm, colon cancer surgery, chronic obstructive pulmonary disease (COPD), hip replacement, knee replacement, lung cancer surgery, and aortic valve surgery.

The UK hospital was ranked high-performing in eight out of nine procedures and conditions, getting an "average" ranking for aortic valve surgery. A high performing rank for a hospital "indicates it was significantly better than the national average in a given procedure or condition," says the report.

"This acknowledges the exemplary work of our health care team in providing the highest quality patient care in the commonwealth," Dr. Michael Karpf, UK executive vice president for health affairs, said in a news release. "We are committed to being one of the premier academic medical centers in the country and dedicated in serving those who need complex medical care without ever having to travel far from their home."

Baptist Health Louisville

Baptist Health Louisville, which was ranked first in Louisville and second in the state, was not ranked in any specialty area, but was ranked high performing in all nine procedures and conditions, an honor that only 63 hospitals received.

Baptist Health Lexington, tied for third in Kentucky, was also not ranked in any specialty area, but ranked high performing in eight of the nine procedures and conditions, getting an average ranking for aortic valve surgery.

St. Elizabeth Healthcare Edgewood-Covington, tied for third in Kentucky and ranking fifth in the Cincinnati metropolitan area, received a high-performing ranking in one specialty area, diabetes and endocrinology. It also received a high-performing ranking for seven procedures and conditions, getting an average ranking for aortic valve surgery and lung cancer surgery.

Norton Hospital, ranked fifth in the state and second in Louisville, was not ranked in any specialty area, but ranked high-performing in five procedures and conditions. It was ranked average for abdominal aortic aneurysm repair, aortic valve surgery, heart bypass surgery and lung cancer surgery.

The report offers a breakdown of how more than 100 Kentucky hospitals rate in each of the measured categories, as relevant to the services the hospital provides. Click here for more about the methodology.

Feds drop advice to floss after finding scant scientific evidence that it helps, but dentists still recommend it as 'low cost, low risk'

A flossing demonstration (Associated Press photo: Julio Cortez)

Flossing might help you have better oral health. But there's no proof of it, despite decades of recommendations by dental experts, the federal government and, yes, manufacturers of floss.

Federal advice is supposed to be based on scientific evidence, so Jeff Donn of The Associated Press asked federal agencies for the evidence. They didn't reply immediately, but when they issued their latest dietary guidelines this year, "the flossing recommendation had been removed, without notice," Donn reports. "In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required."

Donn examined "the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss," he writes. "The evidence for flossing is 'weak, very unreliable,' of 'very low' quality, and carries 'a moderate to large potential for bias.'"

Flossing is often cited as a way to remove plaque, but "The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal," said a review conducted last year. "One study review in 2011 did credit floss with a slight reduction in gum inflammation — which can sometimes develop over time into full-fledged gum disease," Donn reports. "However, the reviewers ranked the evidence as 'very unreliable.' A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users."

Wayne Aldredge, president of the American Academy of Periodontology, "acknowledged the weak scientific evidence and the brief duration of many studies," Donn writes. "In an interview at his private practice in New Jersey, he said that the impact of floss might be clearer if researchers focused on patients at the highest risk of gum disease, such as diabetics and smokers. Still, he urges his patients to floss to help avoid gum disease." He told Donn, "It's like building a house and not painting two sides of it. Ultimately those two sides are going to rot away quicker."

"Aldredge also said many people use floss incorrectly, moving it in a sawing motion instead of up and down the sides of the teeth," Donn reports. "Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature."

But Tim Iafolla, a dentist with the National Institutes of Health, told Donn that Americans should still floss: "It's low risk, low cost. We know there's a possibility that it works, so we feel comfortable telling people to go ahead and do it."

Many Kentuckians have hepatitis C and don't know it, but die from it; if you were born in 1945-65 you should get tested for it

By Melissa Patrick
Kentucky Health News

Kentucky has the highest rate of hepatitis C infection in the nation, and many who have it don't know they are infected and could be at risk of dying from it, even though it is easily diagnosed through a simple blood test and medications to treat it that are 90 percent effective.

"Upwards of about 37 percent of people living with hepatitis C will eventually die of a hepatitis C related complication in the absence of testing, care and treatment.," Dr. John Ward, director of the Division of Viral Hepatitis at the federal Centers for Disease Control and Prevention, said while speaking at the Viral Hepatitis Conference in Lexington July 26.

Hepatitis C is spread when blood from an infected person enters the body of someone who is not infected. Today, it is primarily spread by people who inject drugs, but it can also be transmitted through sexual intercourse, inhaled drugs, unregulated tattooing and between mothers and babies during delivery.

Overall, Kentucky saw a 240 percent increase in acute hepatitis C between 2009 and 2013, and a recent CDC study found the rate of hepatitis C infections among Kentucky women of childbearing age, defined as 15 through 44, more than tripled, from 275 cases per 100,000 women to 862, an increase of more than 200 percent. The national increase during this period was only 22 percent.

Ward also pointed out that people born between 1945 and 1965 are at risk of being infected with hepatitis C and should be tested. He noted that one out of every 30 people born between these years has been infected, most of them before the virus was discovered in 1989.

Once infected with hepatitis C, about 70 percent of those infected in the U.S. remain infected for life, which can lead to serious conditions. The CDC says that of every 100 people infected with hepatitis C, 75 to 80 will develop a chronic infection; 60 to 70 percent will go on to develop chronic liver disease; five to 20 will get cirrhosis over a period of 20 to 30 years; and as many as five will die from cirrhosis or liver cancer.

Dr. John Ward

Ward noted that as of 2014, more than 20,000 people are dying from hepatitis C a year, which he called a conservative estimate because of poor reporting on death certificates.

Ward pointed out that many of these cases could have been treated with early diagnosis and the use of newly developed medications that have a 90 percent cure rate, estimating that by simply testing people who were born between 1945 and 1965, as well as those who inject drugs and treating them, "We could save over 321,000 deaths between now and 2030."

"We've had a transformational event in the history of medicine," Ward said. "For the first time we are able to treat and cure a chronic viral infection."

However, Ward noted that a long list of barriers to treatment still exist, including: outdated policies and clinical protocols that guide testing and treatment, poor provider knowledge, limited public health data, denial of reimbursement claims for testing and treatment and the high cost of treatment, which he said currently runs between $32,000 and $56,000 on most health plans.

"Cost has been a big, big issue for many health systems," he said.

But Ward also offered some hope, saying that a recent survey found that 14 of 36 state Medicaid programs have broadened their Medicaid reimbursement policies to either include people earlier in the disease process or to allow those who abuse alcohol or injection drugs to be tested and treated.

He also noted that while the price of treatment is still high, it cost less than it did when it was first introduced, which was upwards of $90,000 per treatment. And most importantly, he said the cost of treatment has become less than the long-term cost of caring for someone with hepatitis C.

"A look at cost-effectiveness shows that it is becoming very economical and a good value for the health system to treat people with hepatitis C," he said. "The economic justification for restricting patients and their access to life-saving medicines is falling away."

Ward wrapped up by encouraging Kentucky, and other states, to use multiple approaches to stop the spread of hepatitis C, including needle-exchange programs, medication-assisted therapies for substance abusers and a robust testing and treatment program.

"Even though the trends are heading in the wrong direction, it doesn't mean we can't think big and be optimistic," he said. " We have powerful drugs that are safe and very tolerable for patients to take and prices are falling for those and we have prevention intervention that can have a huge impact on decreasing incidence."

Kentucky Rural Health Association's annual conference to be held Aug. 25-26 in Bowling Green

The 18th annual Kentucky Rural Health Association's annual conference will be held Aug. 25 and 26 in Bowling Green.

Matt Jones, a three-time cancer survivor, author and motivational speaker, will open the meeting with the keynote address titled "Rural Health Care is a Marathon: Developing your Marathon" and state Health Secretary Vickie Yates Brown will close the meeting on Friday. The breakout sessions will cover a range of topics, including rural population health, wellness and immunization initiatives and rural health advocacy to name a few.

KRHA says that at the end of the conference attendees will be able to "build an overview of the state of rural health in Kentucky, understand current initiatives to improve rural health services" in the state and "become a skilled advocate and promoter for rural health at the local, regional and state levels."

The conference will be held at Western Kentucky University's Knicely Center on Nashville Road, US 31-W. At this time, registration fees are $175 for KRHA members, $225 for non-members, $45 for student KRHA members and $55 for students who are not members. Continuing education credits are available. Click here for the agenda, registration and hotel information.

UK gets $2.8 million grant for Rural Health Research Center; will study health-care access in poor, rural U.S., including Appalachia

By Melissa Patrick
Kentucky Health News

The University of Kentucky has received a $2.8 million competitive grant to establish a Rural Health Research Center that will focus on access to healthcare and substance abuse treatment in underserved rural areas of the United States, including Appalachia.

Ty Borders

"These are very competitive grants that are only awarded every four years," UK College of Public Health Professor Tyrone "Ty" Borders said in an interview. "We are the only center that received an award that was not previously funded, so we are now one of the seven centers nationally that has received funding for rural health research."

The funding was awarded by the U.S. Health Resources and Services Administration's Rural Health Research Center Cooperative Agreement grant program and will award the university with $700,000 a year for four years. Borders will serve as the Rural Health Research Center's project director.

“I was pleased to work with the University of Kentucky to support this important proposal,” Senate Majority Leader Mitch McConnell of Kentucky said in a news release. “The funding will be used by students and faculty at UK to research ways to address key health-care issues negatively impacting individuals in rural areas of Kentucky. The research conducted at the center will look at ways to reduce cost and strengthen access to rural health networks and methods to help rural physicians treat substance abuse and mental health disorders.”

Borders, who is also the editor of the Journal of Rural Health, said he has spent the past 20 years of his professional career focusing on rural health, especially rural access to primary care and substance abuse treatment.

"We are really building upon our expertise, and this grant will allow us to do even more research on rural health and healthcare," he said.

Borders said the research will focus on rural healthcare access in underserved, impoverished areas across the nation, including Appalachia, rural areas in the Southwest and the Mississippi Delta, among others.

He noted a few of the projects the center will work on with the federal government during the first year, including ones that involve access to substance abuse treatment in rural areas; the role of primary care providers in rural areas, how they are expanding their scope of care and how this affects healthcare access; and the relationship between rural health departments and rural hospitals and how this relationship affects rural hospital's financial viability.

"Another major aim of the center is to disseminate and translate information to the federal government and to other stakeholders, persons who are concerned about rural health policy issues," he said.

When asked what he hoped the research center would achieve he said,"I want to be sure we are producing research that really is the best science so that we can inform the best decisions. And, I hope that the work that we produce, the results that we produce, will actually be used by decision makers to try to improve healthcare delivery and access."

Borders added, "We've been doing quite a bit of work in the area of rural health research here at the University of Kentucky, but I don't think we have really been sufficiently recognized for what we do in this area and having the center will certainly help, because we will have greater visibility as well as additional resources to conduct work in this area."

Health insurers get almost all of the rate hikes they requested for plans on exchange; some get more than they asked for

The state Department of Insurance has largely approved the rate increases that health-insurance companies requested for individual and small-group plans that will be sold through the federal health-insurance exchange for 2017.

The major exceptions were a 5.6 percent hike for individual policies sold by Aetna Inc., which asked for an overall 7.6 percent increase; and CareSource Kentucky Co., which asked for a 20.55 percent increase on its individual policies, but was assigned a higher rate of 29.3 percent.

The Insurance Department concluded that the requested CareSource rate wouldn't produce enough money to pay the claims likely to be filed.

"Based on actuarial review, it was determined the rate initially requested by CareSource would be insufficient to meet the company’s obligations which would ultimately lead to a harmful scenario for consumers," Doug Hogan, spokesman for the Public Protection Cabinet, said in an e-mail to Kentucky Health News. CareSource will offer individual policies in 61 counties.

Baptist Health Plan also got a higher individual-policy increase, 27.9 percent, than what it requested, 26.7 percent. It will offer individual plans in 20 counties. Humana Inc. got the largest increase for individual plans on the exchange, 31 percent, after requesting 33.7 percent. It will offer individual plans in nine counties. Aetna will offer individual plans in 10 counties.

UnitedHealth Group Inc. announced in April that it would no longer sell individual insurance plans in Kentucky, leaving many counties with only one insurer on the exchange. As a result, Anthem Health Plans of Kentucky Inc. will be the only company offering individual policies in every county through the exchange in 2017. It will be the only choice on the exchange in 54 counties. Anthem was given a 22.9 percent increase on its individual plans, what it requested.

Insurance companies had asked for an average rate increase of 29.4 percent for individual health policies, but the state only approved an average rate increase of 27.3 percent, though this does not reflect the insurers' market share because the average is not weighted to factor in each insurer's percentage of the market.

“The Department of Insurance carefully reviewed each request to ensure its compliance with Kentucky law, pushed back where possible and sought to ensure each request was properly supported," Insurance Commissioner H. Brian Maynard said in a news release from the cabinet.

He blamed the increases on federal health reform and the failure of the still-in-liquidation Kentucky Health Cooperative, created under the reform law.

“Obamacare has infused our state’s health-insurance market with unnecessary volatility and uncertainty,”  Maynard said. “Far from helping to lower health-care costs, Obamacare is driving up costs and burdening our citizens. That’s reflected in the filings the department reviewed.”

As expected, insurers asked for higher rates because they expected to absorb the 50,000 co-op customers, most of whom were high-risk.

The cooperative attracted many of the state's unhealthiest people, causing it to pay out much more than expected in claims. It announced in October 2015 that it was closing, but said it could have survived if Republicans in Congress had not greatly reduced funding for the "risk corridor" program, which subsidizes insurers who take on high-risk customers. The co-op, which had a deficit of $50 million in 2014, was expecting a risk-corridor payment of $77 million but got only $9.7 million.

Only seven of the 23 state-based, non-profit cooperatives, created under health reform to compete with for-profit insurance companies and hold down premiums, are still operating, according to Healthinsurance.org.

Maynard encouraged Kentuckians to shop around and compare premiums before signing up for health insurance during the next open enrollment period, noting that rates are just one part of the equation insurance companies use to calculate individual premiums for Kentucky consumers. Other factors include age, where you live, tobacco use, whether it is an individual or family plan and the category of plan chosen.

Click here to see the 2017 health rate filings. Click here to see the plans offered in each county.

Large employer in London opened its own primary-care clinic and is reaping rewards in cost savings and healthier employees

Angie Patton, health and wellness director, and Winston

Griffin, CEO of Laurel Grocery Co., in one of its on-site

clinic rooms. Photo: Bill Estep, Lexington Herald-Leader

The rising cost of employee health care prompted a large, self-insured employer in London to open a primary-care clinic that saved the firm money and made its employee healthier, Bill Estep reports for the Lexington Herald-Leader.

Laurel Grocery Co. has been in business since 1922 and is a wholesale supplier to stores in nine states. It has about 250 employees.

CEO Winston Griffin told Estep the company realized in 2013 that the cost to cover its employees was trending up, from just under $140 per employee per week in 2011 to more than $160 in 2012 and $180 in 2013. “We had to do something to try to reverse that trend,” he said.

Griffin created Connected Care, a primary-care clinic that is run for a flat fee by KentuckyOne Health, which operates the local hospital. A physician is at the location once a week, a nurse-practitioner two days a week, and a manager with a public-health degree is there full time. Among other things, she runs a wellness program for employees.

The clinic is available to employees and their families free of charge and covers any service a primary-care physician would provide. In addition, Laurel Grocery provides more than 75 generic prescription drugs at cost. "The goal of the clinic is to improve the health of the company’s workforce and, in doing so, cut health-care costs," Estep reports.

Statistics show the goal is being met. Employee health screenings in 2013 found that 80 percent of had high blood pressure, nearly 40 percent used tobacco, 55 percent had high cholesterol and 38 percent did not have a primary-care provider.

Since the clinic opened in June 2014, 148 of the 250 employees have improved their blood pressure, 54 lost weight, 75 improved their blood-sugar level and 20 quit using tobacco, Estep reports. And based on a calculation of costs avoided because of improved health measures, a consultant projected the company has saved about $1.2 million.

In addition, the company provides incentives for employees to get physicals and preventive screenings, like colonoscopies. For example, the company pays 100 percent of the cost of health-insurance policies for employees and spouses who take part in an annual physical.

Griffin also calculated that the clinic has saved $195,000 a year in lost work productivity, telling Estep that that gain alone covers the fixed cost of the clinic.

Eddie Goforth, 50, is one of the clinic's success stories. He told Estep that he had worked at the company for nine years and was "overweight, had high blood pressure and diabetes and rarely went to the doctor." He said he went to the clinic because of its convenience, and ended up participating in an exercise and diet program. And in just over three months, he has lost 35 pounds, taken five inches off his waist, reduced his blood pressure and cut his blood-sugar level.

Laurel Grocery is not alone in opening its own health clinic. Larry Boress, executive director of the National Association of Worksite Health Centers, told Estep that about 30 percent of employers in the U.S. offer some form of health service to their employees, not including fitness centers.

“It clearly is being driven by productivity issues,” Boress said. “You’re improving health, keeping people on the job.”

Sharing syringes isn't like sharing a bottle or a joint; it could lead to HIV or hepatitis outbreaks, and Kentucky is most vulnerable

Map from The Guardian highlights Wolfe County.

Amanda Holpuch of The Guardian took a trip to Wolfe County, perhaps the U.S. county most vulnerable to an outbreak of HIV or hepatitis C from needle sharing by intravenous drug users, a report noted here June 16.

"A man was lying sedate after injecting drugs. His fellow users, to amuse themselves, threw needles at him like a human dartboard to see if they would stick, according to a recent police report in Wolfe County," Holpuch reports, quoting special deputy sheriff Gary Smith: “Back in the day, all we had to worry about was people drinking or smoking weed.” An unnamed captain says, “Everybody is using drugs here – end of story.”

The federal Centers for Disease Control and Prevention, in determining the 220 counties most vulnerable, used "a sobering recipe: high rates of drug overdose deaths and prescription opioid sales, a high white population, astounding rates of hepatitis C and searing poverty," Holpuch writes. "The CDC said the top 20 most vulnerable counties identified in its report are effectively equal in vulnerability because of the analysis’s margin of error, but Wolfe County is ranked first and serves as a model for the places at most risk, 13 of which are in Kentucky." Of the 220, 54 are in Kentucky.

Smith likened the sharing of syringes "to a more dangerous version of a group of men getting together to share a bottle of whiskey. Instead of swapping saliva on a bottle cap, users are exchanging all types of body fluids and pushing a needle coated with those fluids into their bodies."

Kentucky was the first state in the South to authorize syringe-exchange programs, in 2015, but local officials have yet to establish one in Wolfe County or in many of the other 54 Kentucky counties on the national list of 220, the Lexington Herald-Leader reported in July.