Four companies will oversee Medicaid coverage in 16-county Louisville region that includes 175,000 Kentuckians

Beginning Jan. 1, four companies will share management of the health care of roughly 175,000 Medicaid patients in the Jefferson County region. This reflects a major, federally mandated change that some say raises concerns about disrupting care. The nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region for 15 years. On Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies -- Humana, Wellcare of Kentucky and Coventry Cares -- to manage Medicaid recipients’ care starting next year. Other details of the contracts were not released.

The federal government has made it clear that the state it could no longer operate with a single managed-care company in the region and that it must give patients a choice among several providers. In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

According to The Courier-Journal's Tom Loftus, "Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies. The cabinet said the state will use 'a high-tech matching system' that assigns a person based on 'available provider networks and any special health care needs.' (Read more)

Andrea Bennett, deputy director of Kentucky Youth Advocates, said the new system raises concerns for child advocates. "While we still have threads of hope, we cannot ignore the ongoing Medicaid managed care issues that have occurred throughout the rest of the state over the past year.  . . . We’ve heard providers threaten to give up on Medicaid altogether because they are frustrated and still not receiving proper payment. We’ve seen lawsuits and fights between the state, the managed care companies, and the providers. And we still haven’t seen hard data showing how managed care is improving quality and access to care for children in the Commonwealth."

UK and Purdue researchers find a compound in watermelon that fights 'bad' cholesterol and arterial plaque in lab rats

A study from the University of Kentucky and Purdue University showed that mice fed a diet including watermelon juice had lower weight, cholesterol and arterial plaque than a control group. The findings, reported in the Journal of Nutritional Biochemistry, suggest that citrulline, a compound found in watermelon, plays a role in cardiovascular health. "We were interested in citrulline because previous studies showed that it may lower blood pressure,"  Shubin Saha, a Purdue Extension vegetable specialist and study co-author, told Medical Xpress. "We didn't see a lowering of blood pressure, but these other changes are promising."

"The researchers fed two groups of mice diets high in saturated fat and cholesterol," MX reports. "Half the mice received water containing 2 percent watermelon juice, while the others received the same amount of water supplemented with a solution that matched the carbohydrate content of the watermelon juice. The mice that consumed watermelon juice gained about 30 percent less weight than the control group and had about 50 percent less LDL cholesterol - the so-called bad cholesterol. The experimental group also had about a 50 percent reduction in plaque in their arteries, as well as elevated levels of citrulline." Sibu Saha, a professor of surgery at UK, explained that the researchers are not sure at what molecular level the citrulline is working, but that is their next step.

Shubin Saha was excited about the dual benefit of the findings. "Twenty percent of each year's watermelon crop is wasted either because the fruit is visibly unappealing to consumers or because some growers find it too expensive to pay for harvesting as prices drop during the height of watermelon season." The wasted melons, he explained, could be put to use extracting these very beneficial compounds.  (Read more)

Pharmacy student takes time to point out the "Top 10 things you didn't know your pharmacist could do for you"

Imagine yourself hip deep in pharmacy school. You are sweating bullets over classes in pharmokinetics, chemotherapy and biostats. What, ho! You see the calendar reads October and you realize it's American Pharmacists Month and you graduate in 2014 from the University of Kentucky's College of Pharmacy and you want people to know you are acquiring mad skills. What to do? Write a primer about how much pharmacists can do for a community. And then put that primer -- via guest column -- in the Kentucky Kernel, the school's (sort-of) daily newspaper, where people who are consumers of good data like this will gobble it and put it to good use. Student Zachary Noel's list of "the top 10 things you didn't know your pharmacist could do for you" is worth repeating because Noel wants to do more than fill prescriptions, he wants to be a trustworthy health-care partner, something a lot of Kentucky communities could use.

Here's Noel's list of what pharmacists can do:
1) Immunize. Kentucky's pharmacists can provide flu shots and vaccinations, even for the human papilloma virus.
2) Economize. Just ask if you find yourself paying too much for your meds, there might be something your pharmacist can do.
3) Educate. Pharmacist are highly educated health-care providers who are often under utilized and more accessible than traditional sources. Don't feel you have to limit those questions to medication questions.
4) Stand guard. Think of pharmacists as a super-filter and your last, best chance to check that a medication is right for you.
5) Counsel. Vitamins, herbals, over-the-counter meds baffling? The evidence-based and experience-tested pharmacist will have some advice.
6) Prescribe. Yes, some pharmacists, writes Noel, "can enter agreements with various providers allowing them to prescribe or alter medication regimens, such as within the Veteran's Affairs hospital system."
7) Practice in interesting places. Like ERs, ORs, with vets.
8) Complete a residency. Pharmacists can opt for more schooling so they can specialize.
9) Medication therapy management. This means that pharmacists can review all your meds for interactions and make recommendations.
10) Compound. This is where they make stuff not already available. Where they create eye drops or topical ointments specifically for your use as directed by your doctor.
(Read more)

Soon-to-be published UK study begins to unravel why prescription pain-killing drug Tramadol is habit-forming

In an attempt to get closer to understanding the plague of prescription pain-killer abuse, a study by a team of University of Kentucky researchers has shed new light on the potential habit-forming properties of the popular pain medication Tramadol. The research was funded by the National Institute on Drug Abuse. The paper is slated to appear in an upcoming edition of the academic journal Psychopharmacology.

"The important thing about this is I think we all assumed that any abuse of Tramadol or any abuse potential Tramadol had was because of the way it activated the opioid receptors in the brain and that may not be the case," said lead study author William W. Stoops of the UK College of Medicine Department of Behavioral Science, the UK Center on Drug and Alcohol Research (CDAR) and the UK College of Arts and Sciences Department of Psychology. "It's pretty well accepted that with opioid drugs like oxycodone, hydromorphone and hydrocodone, when you block the opioid receptors in the brain, folks aren't going to abuse the drug. That is not the case for Tramadol. Opioid receptors are important in Tramadol use and abuse, but they appear to not be the entire story."

Other University of Kentucky researchers involved in the study are Michelle R. Lofwall, Paul A. Nuzzo, Lori B. Craig, Anthony J. Siegel and Sharon L. Walsh.

Anthem PPO plan chosen as 'benchmark' for state's Kentucky Health Benefit Exchange

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued by the department states that "Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act. The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014."

According to the release, the Anthem PPO plan "is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today. Since the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan."

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

Hopkinsville mayor breaks tie to pass citywide smoking ban

After a six months of public debate, private wrangling and at least one serious local editorial page flaying, the Hopkinsville City Council narrowly passed a citywide smoking ban Tuesday night. The original ordinance that came before the council at its meeting was more of a smoking regulation than a ban because it required businesses to decide whether they would allow smoking at their establishments, and post that publicly. But once the ordinance came up for discussion, reports Carla Jimenez of the Kentucky New Era, council members opted for an all-or-nothing vote. “If we’re really, truly concerned about the health of people, then it should be everybody,” said Ward 8 Councilwoman Marby Schlegel. The exemptions to a full smoking ban vote were then removed. That vote resulted in a 6-6 tie, which was broken by Mayor Dan Kemp.

“It’s progress,” Kemp told Jimenez after the meeting. He said Hopkinsville now has a smoke-free ordinance similar to Owensboro, Bowling Green, Madisonville, Henderson, Oak Grove and  Paducah. Ward 4 Councilman Ward Henson disagreed.  "I think we took away rights from private business owners, which is something I totally disagree with, but I’m just glad to see the smoking thing out of the way.” The ordinance still has to pass on second reading before it becomes law. (Read more)

The excoriating editorial (see above) can be read here.

Study: Small business owners see bottom-line benefit from employee health and wellness programs

A study of small businesses has found that three out of four offering health and wellness programs to their employees believe the initiatives are good for their bottom line. The study, conducted by the National Small Business Association and Humana Inc., asked more than 1,000 small-business owners about their employees' health and wellness needs and what barriers they face in supplying them.  An overwhelming 93 percent said they considered their employees’ physical and mental health to be important to their financial results.

However, only one-third expressed confidence in their ability to help employees manage their well-being with initiatives aimed at encouraging them to make healthier choices such as getting preventative care, eating right and exercising.

Another key finding was that more than half of the small-business owners reported that they did not have sufficient information to introduce health and wellness programs to their employees. On the other hand, startups -- those companies less than 10 years old -- found ways to do so, with 63 percent having already adopted health and wellness programs.

“Wellness solutions likely will be an increasingly important part of the employee value proposition,” said Jerry Ganoni, President of Humana’s Small Business Division. “It will be crucial for the industry to focus on providing small-business owners with the information they need to make the wellness decisions necessary to recruit and retain employees while making an a meaningful impact on their bottom lines.”  (Read more, from The Lane Report)

Foundation for a Healthy Kentucky looking for grant applications for programs that cut chronic disease risk for school-age kids

The Foundation for a Healthy Kentucky is looking for applications for grants that will fund innovative programs to reduce chronic disease risk for school-aged children. Because chronic disease occurs at higher rates in Kentucky than in surrounding areas, the foundation sees this new "Investing in Kentucky’s Future" initiative is seen as having particular urgency. It anticipates awarding grants to five to 10 communities statewide.

This five-year, $3 million program seeks to find ways to limit those diseases that decrease quality of life and increase the risk of early death. These include conditions like cancer, diabetes, heart disease, even substance abuse and some mental illness.

Susan Zepeda, CEO of the foundation, explains that the organization's "goal is to help communities make positive changes that will help children start and sustain healthy habits to last a lifetime. Whether the challenge is access to needed routine medical check-ups, safe places to play or nutritious foods, or caring adults to show ways to communicate and avoid risky behaviors, we want to help communities find new pathways to positive solutions.”

The deadline to submit a letter of intent to apply for grant funding is Nov. 16. Following a letter of intent, the foundation will invite applicants to submit a full proposal. The deadline for the receipt of the full proposal is Feb. 28, 2013. For a complete copy of the Request For Proposal, and additional information regarding grant opportunities through the Foundation for a Healthy Kentucky, visit www.healthy-ky.org or call (toll-free) 877-326-2583.

UK researcher part of team that has identified Usher Syndrome gene, responsible for genetic loss of sight and hearing in babies

A University of Kentucky physiologist has teamed with researchers from several institutions to report a novel type of gene associated with Usher Syndrome, a hereditary disease that causes individuals to lose both hearing and sight. The work of Gregory Frolenkov, associate professor at the University of Kentucky College of Medicine, and others led by Zubair M. Ahmed from the University of Cincinnati and Cincinnati Children's Hospital Medical Center, is being published in the November 2012 issue of Nature Genetics.

 In the United States, approximately six of every 100,000 babies have Usher Syndrome. About 3 to 6 percent of all children who are deaf and another 3 to 6 percent of children who are hard of hearing have Usher Syndrome. According to the National Institute on Deafness and Other Communication Disorders, parents who have normal hearing and vision usually do not know if they are carriers of an Usher gene mutation. It is not yet possible to determine whether a person who does not have a family history of Usher syndrome is a carrier. Several genes associated with different types of Usher Syndrome have been identified.

Obesity is a dirty word: Study looks at what works in anti-obesity campaigns, and it's not telling people they're fat

What about those anti-obesity ads? Is anyone listening? If so, is anyone motivated to do better? Might they be offensive to some? Educational? Helpful? Are they working at all? More importantly, why and why not?

Researchers at Yale University's Rudd Center for Food Policy and Obesity have stepped into the breach to measure Americans' attitudes about ads meant to encourage less girth and better nutrition. According to The Atlantic's Lindsay Abrams, the researchers took a nationally representative sample of Americans and asked them to look hard at these highly visible campaigns and their somewhat showy slogans. Abrams writes: "The researchers were interested in knowing what the respondents thought about how informative, motivating, or credible the slogans seemed. They were also curious as to which ads came off as confusing, stigmatizing, or inappropriate. Finally, they asked the respondents whether they intended to follow the messages' advice."

The result? Not surprising, really. We want positive reinforcement and reject stigmatizing or otherwise negative messages. Our favorite message of the ones examined? The simple one from First Lady Michelle Obama's "Let's Move" campaign, "Move Every Day."  The most positively rated campaigns? "Those focused on encouraging specific health behaviors or actions, like eating fruits and vegetables every day or engaging in physical activity," said the study's lead author Rebecca Puhl, "And the most motivating were the ones that made no mention of obesity or weight at all."

Nobody, researchers found, likes being told that their child's obesity is their fault or that it is child abuse. Neither do we like being told we're fat but not told clearly what to do about it. 'Obesity' itself is a bad word. "Certainly what we find is when more neutral words are used, like 'unhealthy weight' or 'high BMI' those are preferred and viewed to be more motivating," said Puhl. The trick, Abrams writes, is going to be in "figuring out how to be anti-obesity without being anti-obese people" -- and boiling these issues down to a slogan is difficult to do. (Read more)

You might also be interested in a related Atlantic story about how a Minnesota "anti-obesity" campaign lies in that gray area between educating and shaming. To read the story and view the videos of the ads, go here.

Do Kentucky families care about obesity? Louisville newspaper blog says yes; now comes the hard part

In The Prime, The Courier-Journal's collection of news, features, videos and blogs "that help you thrive as you age" has taken on a new crusade: obesity. It's a brave initiative in the blog's ongoing effort to get families on board with better health, better eating and longer lives. The blog started with a simple question: Do Kentucky families care about this issue? The answer is a resounding yes. Sharon Cecil, writing for the nutritional, medical, spiritual and fitness advisers on the blog board, explains that the group has done a year's worth of work and has now scheduled focus groups for more specifics. Stay tuned here.

Louisville cardiologist John Mandrola, meanwhile, takes on sugary drinks in the Sept. 22 blog installment of In the Prime. He astonishes with the simple fact that the average male teen drinks 357 calories daily from sugar-sweetened beverages. Not a useful nutrient in sight. And, he adds, if that male is pre-determined genetically to be obese, a Harvard study just found that could be even more susceptible to the harmful effects of sugar-sweetened beverages. The bad news only gets worse. (Associated Press photo)

Lastly, Cecil, a nurse, has high marks for the HBO series, "The Weight of the Nation: Confronting America's Obesity Epidemic." Go here to see all parts of that series.

Kentucky leads nation in drug-fraud prosecutions and settlements

Kentucky leads the U.S. in pursuing pharmaceutical fraud, according to a report by the Washington, D.C.-based consumer group, Public Citizen. Since 1991, the state has pursued the most claims against pharmaceutical companies and reached more than 30 settlements. It pursued 17 single-state settlements, the most of any state.

The most common violation was overcharging Medicaid programs for services, mostly for drugs, Beth Musgrave of the Lexington Herald-Leader reports. The violations that netted the biggest penalties were for improper promotion of drugs. Attorney General Jack Conway oversees the Office of Medicaid Fraud and Abuse Control; his spokeswoman, Shelley Catherine Johnson, told Musgrave the agency has recovered or been awarded more than $265 million since Conway took office in January 2008. (Read more)