Beware of scams citing Medicare, Medicaid, other health plans

By Kentucky Voices for Health

Fall brings open enrollment season, and while this year looks a little different with the ongoing renewals for Medicaid enrollees, scammers are still busy targeting Kentuckians looking for Medicare, Medicaid, or marketplace plans.

Medicare open enrollment runs through Dec. 7. There are a number of things to be excited about this year including a new cap on insulin costs, more covered vaccines (including the updated 2023 Covid-19 vaccine and the new RSV vaccine for seniors), and a cap on out-of-pocket drug costs that will start when coverage begins in 2024. But misleading marketing and unsolicited calls continue to plague members. Fortunately the Centers for Medicare and Medicaid Services is enforcing new advertising rules that are designed to cut down on the confusion.

We also continue hearing about increased scam attempts since Medicaid renewals returned earlier this year. With redeterminations on hold since the pandemic began, many members are new or unfamiliar with the renewal process and scammers are looking to take advantage. While it’s very possible that Kentucky Medicaid will need new information from you to complete your renewal, remember you will never have to pay to complete your renewal.

Lastly, open enrollment for health coverage from the Kynect marketplace begins Nov. 1. With Medicaid disenrollments, this will likely be a big year for enrollment in Kynect's qualified health plans. Beyond scam attempts, marketplace enrollees should also take careful consideration of so-called “junk plans.” These short-term plans are intended to fill temporary coverage gaps, but some exploit this loophole to offer cheap plans that come with usage restrictions, hidden fees, and major coverage limitations. It’s always important to do your research and remember that if something sounds too good to be true, it probably is.

Regardless of coverage, all enrollees need to be on guard for outright fraud and identity theft. If someone calls claiming to be from the government, but lacks your Medicare, Medicaid, or Social Security numbers or asks for credit card or banking info, it’s probably time to hang up. If something seems off, it's always best to make contact yourself through a verified channel and make changes directly rather than offering your personal info immediately to someone you don’t know.

Breast-cancer patient unites community with the 'power of pink,' especially in October, which is Breast Cancer Awareness Month

Pink Sisters event at the Woodford County Courthouse (Photo by Catherine Anderson via UK)

By Elizabeth Chapin
University of Kentucky

Every October, the city of Versailles is adorned in pink. Light poles downtown don bright pink banners — each with the photo of someone diagnosed with breast cancer — patients, survivors and those who lost their lives to the disease.

Versailles resident Catherine Anderson and her daughter Peyton came up with the idea in 2021 and raised funds to get them installed with the support of local businesses and the community.

The banners do more than spread awareness. They recognize family members, friends and neighbors and serve as a reminder of how many lives are affected by the disease. For patients, they also serve as a reminder that they have a support system right in Versailles.

As a breast cancer survivor, Catherine knows the power of connection can make all the difference for someone going through treatment.

In 2018, Catherine detected a lump in her breast. Her doctor ordered a mammogram and she got the news soon after — breast cancer. For the busy mom and current college business officer at University of Kentucky’s Graduate School, the diagnosis was unexpected. She was just 36.

Peyton and Catherine Anderson (UK photo by Arden Barnes)

From the very first day of her cancer journey, Catherine and her significant other, Josh, made it a priority to keep life as normal as possible — especially for their daughter, Peyton who was then 12 years old.

“It was such an emotional time,” said Catherine. “At first I was uncertain about what the future would hold, but I remember telling Peyton, ‘I'm not going anywhere.’”

“I remember being so scared when I heard the awful news,” Peyton said. “On days when my parents would be gone for appointments, my grandparents and our friends would always make sure I got to where I needed to be so my parents and I didn’t have to worry.”

During Catherine’s first appointment at the UK Markey Cancer Center at Lexington Clinic, her oncologist, Rachel Harper, worked with a multidisciplinary team to develop a plan of care.

Catherine was diagnosed with stage 2 HR+/HER2+ breast cancer, also known as triple-positive breast cancer. “Triple positive breast cancer is driven by hormones and the HER2 protein,’’ Harper said. “While these features cause cancer to grow, they also offer more targets for treatment, so patients with this subtype can have good results with therapy.”

Her treatment regimen included five months of chemotherapy infusions followed by bilateral mastectomy and breast reconstruction surgery. She also took a targeted therapy called Herceptin for a year and remains on endocrine therapy.

Finding encouragement through connection

After her diagnosis, Catherine noticed how many people in her own community, including many other women under 40, were affected by the disease.

“Of course it was something I was more aware of,” Catherine said. “But now, looking back, I think other people going through the same thing just felt more comfortable sharing their story with me.”

One of the things that helped Catherine the most was connecting with other breast cancer patients and survivors. She formed a close friendship with another woman from Versailles who was diagnosed around the same time. The two would often get their chemotherapy infusions on the same day and talk for hours.

“If I didn't have her, I probably would have been lost,” she said. “It’s just not the same talking to people who haven't gone through this. The emotions you have when you find out you have cancer ... you feel like you have cooties. And nobody wants to come close to you.”

Catherine also found comfort in her care team, especially Harper.

“As my doctor, she was the one person I could truly believe when she told me everything was going to be OK, and that reassurance was so important,” Catherine said. “When I was done with treatment and visited her less, it felt like we were breaking up.”

Pink Sisters

Once she was cancer-free, Catherine was determined to give back to the community that had supported her so much.

“I think the positive side of that was she had such a sense of community surrounding her going through that fight, so we wanted to create that sense of community for others going through it,” said Peyton.

Catherine and Peyton created Pink Sisters, a nonprofit organization aimed at raising breast cancer awareness and providing resources to those affected. The name represents patients, survivors and the broader community of individuals affected by breast cancer.

“It's not just for the person fighting — and my daughter would attest to this — because it affects everybody,” Catherine said.

Pink Sisters is behind more than the pink banners installed in town each October. Since it became a 501(c)(3) in 2021, the group has raised funds to assist patient needs and become a resource to the community.

They also hold several local events where they share information about awareness and early detection, including self-examination — which saved Catherine’s life.

Most importantly, the group offers other patients and survivors the opportunity to connect through social events, a support group and online via their Facebook page.

“I was lucky to have a strong support group to help me through my breast cancer journey, but not everyone does,” Catherine said. “No one should go through it alone.”

Proponents of freestanding birthing centers say they have a better bill, but hospital association keeps lobbying against it

Kentucky Hospital Association President Nancy Galvagni opposed the idea. (Image via Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

Two Kentucky legislators who have championed freestanding birth centers said Monday that they have agreed to concessions in their latest proposal, but the head of the state’s hospital association and two obstetrician-gynecologists testified that the changes are not enough to protect patients.

Advocates for each side of the years-long debate spoke Monday before the Interim Joint Committee on Licensing, Occupations, & Administrative Regulations, as Kentucky lawmakers consider changes in the state’s certificate-of-need law, which has been used to block the opening of freestanding birth centers.

Both sides agree on at least one point: Safety of the baby and the person giving birth is the most important consideration.

The Kentucky Hospital Association and two OB-GYNs testified that birth is unpredictable, and hospitals are best equipped to handle complications like hemorrhage.

The idea behind certificate-of-need laws is to limit health-care costs. Thirty-five states and Washington D.C. had such laws as of December 2021.

To obtain a certificate in Kentucky, a freestanding birth center would have to prove there is a lack of similar services. These facilities are home-like settings for low-risk births and do not offer services like surgery.

The existence of the requirement makes it nearly impossible to get centers in the state. Kentucky hasn’t had any since the 1980s, Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, testified previously.

Meanwhile, hundreds of Kentuckians seeking to give birth outside a hospital are traveling to neighboring states that have freestanding birth centers for the service.

A longtime sponsor of freestanding birthing center legislation, Rep. Jason Nemes, R-Louisville, told his colleagues that “over the years we’ve made a lot of improvements, a lot of changes” in proposals to satisfy the hospital association and The American College of Obstetricians and Gynecologists (ACOG).

Nemes testified alongside Sen. Shelley Funke Frommeyer, R-Alexandria, who sponsored legislation on the issue in the 2023 session, and DeLodder.

They told the committee that their new legislation would limit birth centers to four beds, include language to address the need for malpractice insurance, and unifying language that defines the centers across all state laws. The result, Funke Frommeyer said, will be a “very attractive” piece of legislation in 2024. But hurdles to a law passing remain.

Childbirth: ‘Normal until it’s not’

Going through labor and giving birth is “normal until it’s not,” said Dr. Dan Goulson, chairman of the physician leadership forum in the hospital association, the chief medical officer for the CHI St. Joseph’s Health System and a board-certified anesthesiologist.

“Once it’s not normal anymore, time is critical,” Goulson told lawmakers.

St. Elizabeth Healthcare obstetrician Dr. Allana Oak said she handles many transfer births in Northern Kentucky, and “Catastrophic things can happen during childbirth.”

She asked, “And in areas where there is limited access to care, do we really want to create legislation that can put a birthing center far from a birthing hospital because then you cannot deal with it in a timely fashion?”

Nancy Galvagni, president and CEO of the hospital association, said hemorrhage is a top problem that’s both unpredictable and not treatable at a birthing center.

“We feel that removing birthing centers from certificate of need and weakening the licensing standards would put women and babies at risk,” Galvagni argued. “This is really going to roll back decades of progress in maternal care.”

These witnesses said they’re not opposed to the freestanding birthing center model of care, but argued that such facilities should be covered by certificate of need laws, should have transfer agreements with hospitals, and an OB-GYN in a director's position.

On the other hand, Nemes said, “In Kentucky, you can have a birth at home. A lot of the women who would be choosing this option would otherwise have them at home. So it’d be a more safe environment for that person.”

Committee Co-Chair Sen. John Schickel, R-Union, also seemed to lean into Nemes’ point.

“For me, it boils down to this,” Schickel said. “Is there anywhere geographically in Kentucky you’re not allowed to have a home birth?”

Oak’s answer: “No.”

“It’s not against the law to be high risk and deliver at home,” she said, adding that she wants mothers to have informed consent. “That’s a choice that every mother can make.”

Food and Drug Administration sends White House office proposed regulations banning menthol cigarettes and flavored cigars

Ash.org

On Friday, the Food and Drug Administration sent the White House Office of Management & Budget its long-in-the-making regulations that would ban the sale of menthol cigarettes and flavored cigars.

 

OMB "serves as a clearinghouse of sorts for executive actions like this," notes Halfwheel, a cigar site. "While the Biden administration is in favor of both bans, OMB is also likely to add scrutiny to FDA’s plans, including asking the agency questions about the economic impacts of the bans—both for the government and businesses—as well as questioning certain legal aspects of the proposal. Historically, OMB has also been a place where the tobacco industry has lobbied to try to soften the impact of rules."

Ten years ago, citizens petitioned the FDA for impose the bans, and went to federal court to force the agency to act. Ordered to respond by April 29, 2021, the FDA said "it was planning on banning both flavored cigars and menthol cigarettes, plans that it said would be announced within a year," Halfwheel notes. "Nearly a year to the date—April 28, 2022—FDA announced that it was moving forward with both proposed regulations, starting the formal rulemaking process that the agency must follow when it crafts new regulations. This included creating proposed rules, as well as allowing for comments about the proposed rules. The commenting period ended in early August 2022."

Menthol cigarettes made up 36% of all cigarette sales in the U.S. in 2018. Anti-smoking groups have cited research that shows cigarette companies have deliberately targeted African American communities, especially youth, with marketing menthol cigarettes, cigars and other tobacco products. Menthol products also have a strong appeal for youth, since menthol numbs the throat and reduces irritation from smoking and makes it easier for them to start smoking.

Once the rules clear OMB, expected before the end of the year, they would not take effect for a year, FDA has said. "The tobacco industry is likely to sue FDA and will likely ask for an injunction until after those lawsuits are resolved, further delaying the enforcement," Halfwheel reports.

What's new in Medicare plans? 'Check, check and double check'

Photo illustration by iStock/Getty Images via KFF Health News

By Julie Appleby

KFF Health News

Consumers know it’s fall when stores start offering Halloween candy and flu shots — and airwaves and mailboxes are filled with advertisements for Medicare options. (Editor's note: One of the latest ads plays off a "viewer" saying she's tired of the ads.)

It’s annual open enrollment time again for the 65 million Americans covered by Medicare, the federal health program for older people and some people with disabilities.

From Oct. 15 to Dec. 7, enrollees in either the traditional program or Medicare Advantage plans, which are offered by private insurers, can change their coverage. (First-time enrollees generally sign up within a few months of their 65th birthday, whether that’s during open enrollment season or not.)

There are a few new features for 2024, including a lower out-of-pocket cost limit for some patients taking expensive drugs.

No matter what, experts say, it’s a good idea for beneficiaries to examine their current coverage because health and drug plans may have made changes — including to the pharmacies or medical providers in their networks and how much prescriptions cost.

“The advice is to check, check, and double check,” said Bonnie Burns, a consultant with California Health Advocates, a nonprofit Medicare advocacy program.

But as anyone in the program or who helps friends or relatives with coverage decisions knows, it is complicated.
Here are a few things to keep in mind.

Know the basics: Medicare vs. Medicare Advantage

People in traditional Medicare can see any participating doctor or hospital (and most do participate), while those in Medicare Advantage must select from a specified list of providers — a network — unique to that plan. Some Advantage plans offer a broader network than others. Always check to see if your preferred doctors, hospitals, and pharmacies are covered.

Because traditional Medicare doesn’t cover prescriptions, its members should also consider signing up for Part D, the optional drug benefit, which includes a separate premium.

Most Advantage plans include drug coverage, but make sure before enrolling, because some don’t. These private plans are advertised heavily, often touting that they offer “extras” unavailable in traditional Medicare, such as dental or vision coverage. Read the fine print to see what limits, if any, are placed on such benefits.

Those 65 and older joining traditional Medicare for the first time can buy a supplemental, or “Medigap,” policy, which covers many out-of-pocket costs, such as deductibles and copays, which can be substantial. Generally, beneficiaries have a six-month window after they enroll in Medicare Part B to purchase a Medigap policy.

So, switching from Medicare Advantage back to traditional Medicare during open enrollment can raise issues for those who want to buy a supplemental Medigap policy. That’s because, with some exceptions, private insurers offering Medigap plans can reject applicants with health conditions, or raise premiums or limit coverage of preexisting conditions.

Some states offer beneficiaries more guarantees that they can switch Medigap plans without answering health questions, although rules vary.

Making all of this more confusing, there is a second open enrollment period each year, but it’s only for those in Medicare Advantage plans. They can change plans, or switch back to traditional Medicare, from Jan. 1 to March 31.

Drug coverage has changed — for the better

Beneficiaries who signed up for a Part D drug plan or get drug coverage through their Medicare Advantage plan know there are a lot of copays and deductibles. But in 2024, for those who require a lot of high-priced medications, some of these expenses will disappear.

The 2021 Inflation Reduction Act places a new annual limit on Medicare beneficiaries’ out-of-pocket costs for drugs.

“That policy is going to help people who have very expensive medications for conditions like cancer, rheumatoid arthritis, and hepatitis,” said Tricia Neuman, senior vice president and head of the Kaiser Family Foundation's Medicare policy program.

The cap will greatly help beneficiaries who fall into Medicare’s “catastrophic” coverage tier — an estimated 1.5 million Americans in 2019, according to KFF.

Here’s how it works: The cap is triggered after patients and their drug plans spend about $8,000 combined on drugs. KFF estimates that, for many patients, that means about $3,300 in out-of-pocket spending.

Some people could hit the cap in a single month, given the high prices of many drugs for serious conditions. After reaching the cap, beneficiaries don’t have to pay anything out-of-pocket for their medicines that year, potentially saving them thousands of dollars annually.

It’s important to note that this new cap won’t apply to drugs that are infused into patients, generally at doctor’s offices, such as many chemotherapies for cancer. Those medicines are covered by Medicare Part B, which pays for doctor visits and other outpatient services.

Medicare next year is also expanding eligibility for some low-income beneficiaries to qualify for low- or zero-premium drug coverage that comes with no deductibles and lower copayments, according to the Medicare Rights Center.

Insurers offering Part D and Advantage plans might have also made other changes to drug coverage, Burns said.

Beneficiaries should check their plan’s “formulary,” a list of covered drugs, and how much they must pay for the medications. Be sure to note whether prescriptions require a copayment, which is a flat dollar amount, or coinsurance, which is a percentage of the drug cost. Generally, copayments mean lower out-of-pocket costs than coinsurance, Burns said.

Help is available

In many parts of the country, consumers have a choice of more than 40 Medicare Advantage plans. That can be overwhelming.

Medicare’s online plan finder provides details on the Advantage and Part D drug plans available by ZIP code. It allows users to drill down into details about benefits and costs and each plan’s network of health providers.

Insurers are supposed to keep their provider directories up to date. But experts say enrollees should check directly with doctors and hospitals they prefer to confirm they participate in any given Advantage plan. People concerned about drug costs should “check whether their pharmacy is a ‘preferred’ pharmacy and if it’s in network” under their Advantage or Part D plan, Neuman said.

“There can be a significant difference in out-of-pocket spending between one pharmacy and another, even in the same plan,” she said.

To get the fullest picture of estimated drug costs, Medicare beneficiaries should look up their prescriptions, the dosages, and their pharmacies, said Emily Whicheloe, director of education at the Medicare Rights Center.

“For people with specific drug needs, it’s also a good idea to contact the plan and say, ‘Hey, are you still covering this drug next year?’ If not, change to a plan that is,” she said.

Additional help with enrollment can be had for free through the State Health Insurance Assistance Program, which operates in all states.

Beneficiaries can also ask questions via a toll-free hotline run by Medicare: 1-800-633-4227, or 1-800-MEDICARE.

Insurance brokers can also help, but with a caveat. “Working with a broker can be nice for that personalized touch, but know they might not represent all the plans in their state,” said Whicheloe.

Whatever you do, avoid telemarketers, Burns said. In addition to TV and mail advertisements, telephone calls hawking private plans bombard many Medicare beneficiaries.

”Just hang up,” Burns said.

Sen. Stephen Meredith calls for a new health-care delivery system in Kentucky, with Medicaid block grants to local governments

By Melissa Patrick
Kentucky Health News

It's time to invent a new health care delivery system in Kentucky, and it should be driven by health-care providers, state Sen. Stephen Meredith of Leitchfield said in the keynote address at the Foundation for a Healthy Kentucky's 2023 Howard L Bost Memorial Health Policy Forum, held Oct. 11 in Lexington. 

Before making this assertion, Meredith pointed to a quote attributed to Abraham Lincoln and Peter Drucker: "The best way to predict the future is to create it." Then he said, "Let's do that. Let's create a new health-care delivery system." 

State Sen. Stephen Meredith was the 
keynote speaker at the 2023 Howard
L. Bost Memorial Policy Forum Oct. 11.

The address was titled "How Do You Fix an Irretrievably Broken Health-Care System?"

Meredith spent decades as a leader in health-care administration before being elected to the Senate in 2016. When he retired as boss of Twin Lakes Regional Medical Center, now a subsidiary of Owensboro Health, was one of the four financially strongest hospitals with under 100 beds in Kentucky. He was also CEO of the Grayson County Hospital Foundation, which employed most of the local medical practitioners and managed their practices.

Meredith, a Republican, is chair of the Senate’s Health Services Committee, co-chair of the Government Contract Review Committee, and a member of other committees, including the recently formed Family and Children Committee.

"He knows the challenges facing our health-care delivery system, because he's seen them firsthand," Ben Chandler, CEO president of the foundation, said in introducing him. 

Meredith opened his address by listing several known challenges with the existing health-care system, including the "astronomical" cost of care that has resulted in the average person no longer being able to afford it. 

He also called the "mass" of health-care professionals who are leaving the system "alarming" and called one of the largest insurance companies in the U.S. making a profit of $86.4 billion in the last year one of the "most damning indictments of our current health-care delivery system. "

He noted that the U.S. is spending $1.2 trillion on health care, but has some of the worst health outcomes. 

"The problem is, we know what the issues are; we don't act on the issues," Meredith said. 

He went on to point out that the state's move to a managed-care program for Medicaid has been in place since 2012, "and we have not improved the health of our population." Further, he said the state Medicaid budget was $10 billion to serve 1.3 million people, and that is as large as it should ever be. 

"In inventing a new health-care delivery system in the future, we all have to agree and acknowledge,  there's enough money already in the health-care delivery system to take care of every man, woman and child in this country if we spend it the right way," he said.  

Further, he said, "If we're truly improving the health of the population and we are getting people back to gainful employment, we should have enough money to take care of everyone." 

To do this, he said we must have a clear mission and vision for how to fix the system.

"If we're all united in this, it's quite simple," he said. "We're here to cure the sick, to help relieve pain and suffering, to give comfort to the dying and improve the quality of life for the people we serve. If we're all united in that, doesn't that move us in one direction.

"And one thing I haven't mentioned is, it doesn't say anywhere in there to make a profit. Now, I'm a capitalist to the nth degree, and I believe in making a profit. But it's when you bring value to the system. You increase efficiencies, and you do it a better way. And we're not doing that." 

He said changes should be made on the local level by moving to a Medicaid block grant program, which would allow local governments to determine how Medicaid dollars are spent, with an incentive to save money for other local purposes.

"If you improve the health of population, whatever savings you achieve, you get to keep to improve your community," he said. "If you want to invest in your school system, you want to invest in tje infrastructure, you want to invest in broadband, it's yours to keep." 

Meredith said the main reason we don't do such things is fear: "People don't like risk. Fear keeps us from doing what we need to do."

Report: Big political giver boosted stake in psychedelic research implicitly endorsed by Cameron, then funded anti-Beshear ads

Jeff Yass (Photo from MIT Sloan Sports Analytics)

Kentucky Health News

Around the time Attorney General Daniel Cameron implicitly endorsed using 5 percent of the state's opioid settlements to fund research to win federal approval of a psychedelic drug for addiction treatment, a firm owned by a major national political contributor increased its investment in such research and gave Cameron a political boost, Roger Sollenberger of the Daily Beast reports.

Jeff Yass of Philadelphia increased his investment in the second quarter of the year, and on June 8, he "gave $3 million to a super PAC that has recently pumped out at least $1.2 million worth of ads backing Cameron’s candidacy, according to Federal Election Commission filings," Sollenberger reports. "That donation has accounted for roughly 98 percent of the group’s total reported fundraising this year." Cameron is the Republican nominee for governor; the ads attacked Democratic Gov. Andy Beshear, who has criticized the plan to fund research into ibogaine, a psychedelic.

The contribution came nine days after Bryan Hubbard, a Cameron aide who heads the state Opioid Abatement Advisory Commission, proposed that the commssion put $42 million into research that would show the usefulness of ibogaine and help it win approval from the Food and Drug Administration.

Cameron appeared at the May 31 event where Hubbard issued his call, saying, "Something has to change. Obviously, we need to continue to fund the work that has been ongoing in Kentucky. We also need to explore a new approach. We have to imagine new possibilities. We have to invest in programs and potential solutions for tomorrow."

Also at the event was Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky and a former Democratic attorney general and congressman. He applauded the proposal, and later endorsed it, citing the low success rate of drug treatment and recovery. Ibogaine has been reported to relieve withdrawal symptoms, but poses risks to the heart and is legal only in Mexico and New Zealand.

At a public hearing held by the commission in July, all the witnesses testified for the idea, including executives at two firms getting the investment from Yass. Sollenberger's story did not mention any attempt to reach Yass for comment.

Hubbard "declined to answer questions on the record," Sollenberger reports. "After an off-the-record phone call, Hubbard texted The Daily Beast the email address of Brett Waters, the head of a nonprofit that has been closely involved in the ibogaine project from the beginning. Waters is co-founder and executive director of Reason for Hope, a group whose CEO—a former Sen. Mitch McConnell appointee—joined Hubbard and Cameron at the May 31 press conference.

"The group has no corporate backers, Waters said. He also called Hubbard an 'incredibly positive figure' in this process, one who ensured that 'diverse voices' contributed to the discussion, including indigenous voices." He said of Hubbard, “He is genuine in his desire to help people break free of substance use disorder, and this is a brave proposal.”

Cameron's office "provided a 264-word statement expressing confidence in the commission and promoting the Kentucky Opioid Symposium," Sollenberger reports. "It did not address almost any of the detailed information and questions we provided as the focus of this article. The office did not respond when offered the chance to follow up."

However, the statement said the work on the synposium “required that certain agenda items be pushed until the commission’s November meeting.” Sollenberger writes that he asked "why the vote on the grant was pushed back to Nov. 15—a week after the election, and more than a month after the symposium."

Yass, the nation's fourth-largest political megadonor, "stands to profit massively from ibogaine, especially in the long run," Sollenberger writes. "Yass’s investment firm, Susquehanna International Group, currently holds around $5 million in ground-floor stakes with four biopharmaceutical firms focused on developing psychedelic addiction treatments. More than $4 million of it lies with two entities leading the charge on ibogaine, according to SIG’s August filing with the Securities and Exchange Commission.

SIG's total investment portfolio is $491 billion, Sollenberger reports: "If treatments like ibogaine gain traction with the public—and more importantly, with regulators—that niche market, and those holdings, will explode. As The Daily Beast previously reported, the entire purpose of the Kentucky program is to help ibogaine receive federal approval as a 'breakthrough therapy,' which would 'accelerate the regulatory pathway for legal status nationwide.'"

Witnesses from the two firms testified at the opioid commission's public hearing in July, Sollenbergher notes: "The meeting agenda published by the OAAC only discloses the corporate background of one of them—Dr. Srinivas Rao, co-founder of German biopharmaceutical firm ATAI Life Sciences. The other person in the joint venture, Dr. Deborah Mash, was only identified as professor emerita at the University of Miami School of Medicine, not in her capacity as founder and CEO of DemeRx—where ATAI holds majority control, according to SEC filings. Kentucky Health News reported that affiliation, which was included in a press release about the hearing.

Mash's ties were noted by commission member Sharon Walsh at the last meeting before she resigned from the commission. She told Hubbard, “So she’s going to come and talk to us about the development of this with it, you know, with the hope of getting money. There’s a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market. That’s why I’m asking for balance,” with contrary testimony.

"Two people familiar with the events told The Daily Beast that she stepped down in protest of funding ibogaine," Sollenberger reports. Walsh told Kentucky Health News in July that she resigned because UK's largest-ever grant, which she supervises, was extended for two years.

Sollenberger reports, "Yass has stakes in ATAI, which is heavily backed by another billionaire Republican megadonor, Peter Thiel. . . . ATAI also owns a considerable share of another one of Yass’ psychedelic investments, Compass Pathways. According to an SEC quarterly filing submitted in August, after ditching the stock entirely months earlier, Yass’ firm upped its ATAI investment significantly between April 1 and June 30. That filing also shows about $3.6 million in a company called Mind Medicine, which has been conducting ibogaine opioid abatement trials. All of these investments would stand to give SIG exponential returns if regulatory gatekeepers begin to clear the way for ibogaine development—and a partnership with a state government is a major step along that path."

Sollenberger also reports on "Rex Elsass, an influential longtime GOP strategist and media buyer who has performed millions of dollars of work for Yass-aligned groups. Elsass’ son, Reid, died tragically of an overdose, and his family created a nonprofit called the REID Foundation dedicated to recovery efforts, including emergent therapies." At the commission's Sept. 15 hearing, "Elsass, an Ohio resident, spoke movingly at a public hearing in support of ibogaine, reportedly describing himself to the commissioners as 'your neighbor next door' without apparently disclosing his long and unavoidably political background."

Sollenberger adds, "A former adviser at Elsass’ company, The Strategy Group, named Sally Hauser, now heads a group called the Kentucky Ibogaine Initiative, according to her LinkedIn. The nonprofit just registered with Kentucky this year. (Hauser’s position with the group disappeared from her LinkedIn page at some point after The Daily Beast sent out comment requests.)

"Elsass told The Daily Beast in a phone call that, to the best of his knowledge, he had never met Jeff [Yass] in person, and that he had been first tipped to Kentucky’s potential by the Etheridge Foundation, started by folk-rock LGBTQ icon Melissa Etheridge. He explained that his ibogaine advocacy—a 'miracle medicine that needs to be researched'—is rooted in deep, personal loss and a desire to help mitigate tremendous future tragedy."

Elsass told Sollenberger, “The solutions just weren’t there, and I was desperate for new methods to help my son. So we looked for other means, and as a result, he ended up in Peru” for an ibogaine treatment. “Plant medicines helped him and extended his life for several years, and left me with a mission.”

Sollenberger adds one more politician to the mix, U.S. Sen. Rand Paul. He notes that Paul and Sen. Cory Booker (D-N.J.) introduced a bill to "make it easier for patients to access controlled substances for medical treatment, starting with psilocybin and MDMA. . . . Last October, the Louisville Courier Journal said Paul was Yass’s 'favorite politician on the national scene.' The relationship also runs deep, with Yass pouring more than $15 million into the Paul-aligned Protecting Freedom super PAC since 2017, according to Federal Election Commission data. Protecting Freedom also contracts with Elsass, with one of his entities as its top vendor in the 2022 cycle, according to data compiled by the Center for Responsive Politics."

State launches new one-stop website, CoverYourCough.ky.gov, with information on Covid-19, flu and RSV, updated weekly

The state Department for Public Health has launched a new one-stop website for information on Covid-19, influenza and respiratory syncytial virus.

“As we continue into the fall and winter cold and flu season, this site, and a new Respiratory Virus Data Dashboard that is part of this site, will provide awareness of where Kentucky stands with regard to spikes and decreases in these viruses to help inform personal decisions,” Health Commissioner Steven Stack said in a news release. 

The website, at CoverYourCough.ky.gov, joins the Centers for Disease Control and Prevention and other states in putting all of this information in one location, says the release. 

The state site includes a Respiratory Virus Data Dashboard,with data starting the first week of October, which marked the official start of flu season. Flu season in Kentucky runs through mid-May. 

Data will be updated on Thursdays and will replace the state's previous weekly flu report and Covid-19 dashboard. Weekly reports will be archived.

The dashboard will provide the number of positive laboratory tests for Covid-19 that have been reported to the state; the percentage of outpatient medical visits attributed to flu-like illness in the Sentinel Health Care provider network; the number of emergency department visits and hospitalizations associated with Covid-19, the flu and/or RSV; the number of reported deaths associated with Covid-19 and/or influenza; and pediatric deaths attributed to Covid or the flu.

The provider network includes doctors' offices, hospitals and health departments that voluntarily submit their flu data. 

The health department cautions that while anyone can get a respiratory infection, some people are at high risk for serious illness, so it's important for Kentuckians to follow the tips listed on the site to protect themselves and others this fall and winter.

Medicare open enrollment runs through Dec. 7; your advantage isn't always with Advantage; use caution when choosing a plan

AARP graphic

By Melissa Patrick

Kentucky Health News

Open enrollment for Medicare occurs each year from Oct. 15 through Dec. 7, with new coverage starting Jan. 1. During this period you can change your choice of health coverage or add, drop, or change Medicare drug coverage.

People with Medicare can get coverage through either original Medicare or one of the Medicare Advantage plans, which are private insurance offerings under contract with the federal government to provide Medicare-covered benefits.

It is often reported that one of the biggest pitfalls of Advantage plans, which manage the care for most Medicare beneficiaries, is that they often have a limited network of doctors and hospitals and often charge more to see out-of-network providers, if a person is allowed to see them at all. In other words, a person doesn't have the same level of choice as they would with an original Medicare plan. Also, Advantage plans are reported to require a high number of prior authorizations that can lead to denial of coverage.  

Longtime health journalist Trudy Lieberman has often written about the challenges of Medicare Advantage plans, noting that the lure of low premiums and added benefits like dental care and gym memberships seems great when you are well, but it's important to remember that these plans may not offer what you need if you get sick. 

Lieberman reminds you to see what an Advantage plan offers if you get sick or get a get a serious illness, including your out-of-pocket maximums, and what the rules are if you switch back to an original Medicare plan; if you developed a health condition while on Advantage, it could be hard to switch back. 

The rationale for Advantage plans is the flat fee they get for each enrollee and their management of the enrolleees' care to limit claims for care. Writing for Jacobin, which calls itself "a leading voice of the American left," Matthew Cunningham-Cook and Lucy Dean Stockton call the approach an incentive to "ration care, leading to high rates of wrongful claim denials, worse health outcomes, and costly administrative headaches for providers."

The writers note that research by the Medicare Payment Advisory Council, an independent agency that advises Congress on Medicare, shows that the program has not yielded savings in the two decades since it was established, despite proponents' claims that it would do so. A report by Physicians for a National Health Program says Advantage plans overcharge $88 billion to $140 billion a year.

The report "identified four major ways that private insurers systematically exploit the publicly funded national health insurance program while denying care to the nation’s most vulnerable patients," the Jacobin article says. The four ways are favorable selection and deselection, which causes Advantage clients to use fewer services than those on original Medicare; upcoding, which makes patients appear sicker than they are; quality benchmarks and county bonuses that "fail to capture savings for the Medicare program [according to MedPAC]; and induced utilization, an assumption that Advantage plans provide more care than they actually do, so they get paid more. 

Lieberman, noting that the federal government continues to move away from traditional Medicare to some version of privatized managed care, like Medicare Advantage, Lieberman concludes her story for the USC Annenberg Center for Health Journalism by asking, "Will this latest Medicare experiment, which brings in more private equity firms that want a piece of the program, really solve Medicare’s cost problem, or will it simply hand over more of the program to private companies seeking to grow their profits? Is this solution really in the best interest of America’s seniors and their health, or another clever instance of American companies mining the health-care system for fresh profits?"

CEO of Pikeville Medical Center wins 2023 Gil Friedell Memorial Health Policy Award from the Foundation for a Healthy Kentucky

Donovan Blackburn

By Melissa Patrick
Kentucky Health News

Donovan Blackburn, CEO of Pikeville Medical Center, is the latest winner of the Foundation for a Healthy Kentucky's Gil Friedell Memorial Health Policy Award for his work in changing the landscape of health care in Eastern Kentucky. 

“Donovan Blackburn has been a visionary for Eastern Kentucky and has helped bring the type of high-quality care to the region that its residents have long deserved,” Ben Chandler, president and CEO of the foundation, said in a news release. “A chance for a healthy life shouldn’t be determined by the area of Kentucky in which you live, and Donovan’s work is making the commonwealth a more equitable place to access healthcare.”

Gary Dryden of Louisville, chair of the foundation's Community Advisory Council, noted that the expansion of health-care options in Appalachia facilitated by Blackburn's hospital has provided care that residents previously had to travel hours to larger cities to obtain. 

"Because of his vison," Dryden said Wednesday, "thousands of Kentuckians have access to resources needed to sustain a healthy life." 

Blackburn’s ability to foster consensus through collaboration has helped secure millions in investment in healthcare delivery, the release said.

Under his leadership, in 2020, PMC opened its Appalachian Valley Autism Center.  In 2021, the Mettu Children’s Hospital opened, allowing clinicians to partner with specialists in cardiology, endocrinology, and pulmonology at the University of Kentucky Children’s Hospital. In 2022, a satellite center in Floyd County opened, enabling the Autism Center to provide services to children from Pikeville and Prestonsburg.

PMC also opened its Heart and Vascular Institute of Eastern Kentucky, the result of a $35.2 million capital investment. The new space includes a new cardiac rehabilitation department, 29 exam rooms and three state-of-the-art interventional cardiac catheterization labs. 

“I am deeply honored and humbled and honored," Blackburn said about receiving the award. "I recognize and realize what this award stands for and I wear it as such also as a badge of honor, not for myself, but for the 3,100 employees that I have the opportunity to lead from the back. . . . And so on behalf of our organization, I'm very proud to accept this award."

Donovan Blackburn accepts a $5,000 donation to the non-profit of his choice, Appalachian Valley Autism Center from Ben Chandler, and Gary Dryden. (Foundation for a Healthy Kentucky photo). 

Blackburn also expressed his gratitude for the $5,000 donation to the non-profit of his choice.  Blackburn selected the Autism Center, which provides applied-behavior-analysis therapy to children between the ages of 2 and 12 on the autism spectrum. 

Blackburn explained that his granddaughter, Ava, who is now 6, was the inspiration for the center because she was born with sensory disorder and is on the spectrum. His wife, Debbie Blackford, is the executive director of the center, which is called the AVA Center. 

"We sincerely appreciate not only the award, acknowledging the work that we've done throughout Eastern Kentucky, but also for the generosity and the gift for the AVA Center that is changing so many kids lives in the region as well," he said. 

According to the news release, the center supports 90 children and is projected to double that by the end of 2024.

The winner of the Gil Friedell Memorial Health Policy Award is chosen from recipients of a Healthy Kentucky Champions Award, which recognizes Kentuckians who are working to improve the health of their community and the commonwealth. This year, there was a record number of nominees. Click here to read more about each of them.

The other 2023 Healthy Kentucky Champions are: 

• Dr. Muhammad Babar – Doctors for Healthy Communities, Louisville
• Shelly Baer – Emerald Therapy Center of Murray
• Mark Birdwhistell – UK HealthCare
• Lacretia Dye – Western Kentucky University
• Donald Frazier – UK Science Outreach Center
• Ellen Hahn - UK Kentucky Center for Smoke-free Policy
• Jeremy Harrell – Veteran’s Club of Louisville
• Susan Jones – Western Kentucky University
• Dr. Whitney Jones – Colon Cancer Prevention Project
• Dr. Karl Lange – Mission Health Lexington
• Katherine Marks – Commissioner, state Department of Behavioral Health, Developmental and Intellectual Disabilities
• Rhondell Miller – Hotel Inc. of Bowling Green
• Jerry Ugrin – Lewis County Primary Care Center

Rogers, citing treatment-bed increase, says E. Ky. is becoming U.S. drug-recovery capital; state has launched anti-stigma effort

L-R: Bryan Hubbard, chair of the state opioid commission; Behavioral Health Commissioner Katie Marks; state drug-policy director Van Ingram; Operation UNITE Director Vic Brown, Jeffersontown Police Chief Rick Sanders; and Amanda Peters of the Northern Ky. Office of Drug Control Policy.

By Al Cross

Kentucky Health News

Kentucky, especially its Appalachian counties, continues to be a hotbed of the opioid epidemic. But it is also a leader in fighting it, and getting people into treatment and recovery, the congressman who represents most of Appalachian Kentucky told the Kentucky Opioid Symposium Tuesday.

Rep. Harold "Hal" Rogers of the 5th District recalled a 2003 Lexington Herald-Leader headline that said Eastern Kentucky was the “nation’s painkiller capital” and said, After all the great strides that we’ve made from ground zero, and seeing the volume of treatment beds increase ten-fold over the last 20 years, I think it’s time for a new headline: Eastern Kentucky is now becoming the nation’s recovery capital, and it’s time to spread the message of hope in our commonwealth."

Rogers said Dr. Nora Volkow, director of the National Institute on Drug Abuse, "tells me that Kentucky has had so much success that while other states appear to be making great gains, they're merely catching up to Kentucky."

Rogers (Spectrum News image)

Rogers, a Republican from Somerset, said the battle is "one of the few issues in Frankfort and Washington that is truly bipartisan," and "shows what we can do when we put partisanship aside." But that didn't keep him from making two pointed compliments of Republican gubernatorial nominee Daniel Cameron, who as attorney general appointed most of the members of the Opioid Abatement Advisory Commission, which sponsored the symposium.

The summit began Monday with a keynote address by Sam Quiñones, author of Dreamland and The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. He reiterated the message he has delivered before in Kentucky, that the solution for the opioid crisis lies in communities, not capitals.

To that end, a panel discussion Tuesday about the course of the opioid epidemic included a local police chief, a regional drug-policy director, two state officials and the director of Operation UNITE, the Rogers-founded anti-drug nonprofit for Appalachian Kentucky.

Jeffersontown Police Chief Rick Sanders said he opened his department for addicts to seek treatment, then did likewise when he ran the state police. He said the idea met resistance from some officers "until we proved that it worked." Now his departnent has three "embedded social workers."

Sanders added, "Two of the biggest problems in law enforcement are addiction and mental health. We're sending way too many people to jail that should be going to hospitals for treatment, and opening up those beds at the jail for people we really need to be afraid of."

Amanda Peters of the Northern Kentucky Office of Drug Control Policy said that as the region gained more treatment beds, it built a "long-term recovery pipeline" with employers and community organizations. She said that can also be done in rural communities, and cited the counties of Grant, Gallatin and Carroll as examples other rural counties could follow.

Van Ingram, director of the state Office of Drug Control Policy, said that 20 years ago, different regions of Kentucky had different drug issues, but "that distinction just doesn't exist anymore."

Behavioral Health Commissioner Katie Marks showed this slide.

State Behavioral Health Commissioner Katie Marks outlined the basic steps to dealing with the problem, in succession: prevent initiation of drug use, prvent misuse, identify the need for treatment early on, provide treatment access and engagement, support completion of treatment, and sustain remission and recovery. She said the final step "is really important when we think about a community response."

Marks also talked about specific stratgeies for prevention and harm reduction, including syringe exchanges, "vital infrastructure" that has still not been established in many Kentucky counties that the federal government considers at high risk for spread of disease among intravenous drug users.

Also, there needs to be more naloxone, the drug that counteracts overdoses, "in the hands of people most likely to witness an overdose or respond to an overdose," Marks said, noting that the state is part of a national effort to determine how best to do that.

This effort is aimed at the stigma of drugs. (Photos by Al Cross)

Marks promoted Unshame Kentucky, an effort to combat the stigma that many people still attach to the subject: "This is a community-driven, statewide anti-stigma campaign, developed by the voices of Kentuckians to say that we are going to unshame, we are going to reduce the stigma of addiction, of seeking treatment, of long-term recovery."

The state's partner in the effort is Shatterproof, a national nonprofit that says it is dedicated to "revolutionizing the treatment system, breaking down addiction-related stigma, and supporting and empowering our communities."

Kentucky Children's Hospital branch to open Monday in former home of Shriners Hospital on Richmond Road in Lexington

Every aspect of the clinic was designed to meet the unique needs of patients with complex medical and developmental conditions. (Photo by Adam Padgett, via UK HealthCare strategic communications)

Kentucky Children’s Hospital, part of the University of Kentucky, will open a facility with four pediatric specialty clinics Monday, Oct. 16 in Lexington.

A university press release said the four clinics are:

• Complex Care Clinic, which provides medical and developmental follow-up care for infants and young children up to age 5 with medical complexity.
• Developmental Pediatrics Clinic, which offers screening, diagnostic and therapeutic services for children with complex developmental-behavioral conditions such as autism.
• NICU Graduate Clinic, a clinical site for babies and young children with special medical needs. The clinic not only serves babies who were cared for in the KCH Neonatal Intensive Care Unit but also children born prematurely who are at risk for developmental problems.
• Physical Medicine and Rehabilitation Clinic, where patients over age 5 with complex care needs can go to improve their functional abilities and strength.

"Children with complex medical and behavior needs may not feel comfortable or have their needs met in a traditional clinic space," the release said. "Kentucky Children’s Richmond Road was designed with this unique patient population in mind. Carefully considered features were included to not just alleviate the stress of appointments and treatment for patients, but to also reduce the physical and logistical obstacles for parents and caregivers.

The facility's amenities include "a quiet waiting room with soothing features for patients with complex sensory needs who need a calming environment in which to wait prior to their appointment," the release said. It includes "an observation area where parents and caregivers can watch providers interact with and assess their children without interruption" and "comfortable, private areas for one-on-one treatment, discussion and interaction between the provider and the patient."

The facility is in the former Shriners Hospital building, in space shared space with Easterseals Bluegrass, a nonprofit organization that serves adults and children with special needs. Funding for the renovation and services expansion of services came partly from the local community partners of Children’s Miracle Network Hospitals.

“The mission of Kentucky Children’s Hospital has always been to provide the most advanced, comprehensive care to our patients and their families without them having to travel far from home,” said Dr. Scottie B. Day, KCH physician-in-chief. “Having access to a full range of specialized medical and developmental care in one location, reduces the travel burden on families, and allows us to offer a continuity of care not found elsewhere in the commonwealth.”