Politicians, economists and journalists debate the reasons for, and the impact of, proposed sale of Humana to Aetna

By Al Cross
Kentucky Health News

The purchase of Louisville-based Humana Inc. by fellow health-insurance giant Aetna Inc. for $37 billion still needs approval from federal anti-trust officials, partly because of the possibility that the merger will reduce competition and increase premiums.

Some other public officials, the elected kind, wasted no time weighing in on the sale. And, since it deals with health insurance, it may come as no surprise that their statements followed partisan lines, reflecting their views of the Patient Protection and Affordable Care Act.

Wall Street Journal graphic

Even before the deal was announced, Senate Majority Leader Mitch McConnell, R-Ky., said Thursday, "You’ve seen the rumors about Humana being gobbled up by someone who’s even bigger. This kind of government takeover of the private health-insurance market – think of it this way: what Obamacare has basically done is taken the private health insurance market and turned it almost into a regulated utility."

In a press release Friday, McConnell said, "This morning’s announcement, as I predicted during the debate five years ago, is the inevitable result of Obamacare’s push toward consolidation as doctors, hospitals, and insurers merge in response to an ever-growing government."

U.S. Rep. John Yarmuth, D-Louisville, said consolidation in the health-care industry has been going on for decades, "and it is appropriate for the Department of Justice to scrutinize the pending merger to ensure it does not reduce competition, and therefore, consumers' options."

Louisville Mayor Greg Fischer, a Democrat who ran in the primary for McConnell's seat in 2008, said he was "a little surprised by the political nature" of the senator's statement. Fischer and Democratic Gov. Steve Beshear were generally upbeat about the merger. "I am cautiously optimistic that this merger will be a net positive for Louisville and the commonwealth," Beshear said.

Humana has 12,500 employees and 1,500 contractors in the Louisville area. Fischer said, "I think it's very fair to speculate that it will lead to more jobs," and Bruce Broussard, president and CEO of Humana, said, "I think Louisville will be a net beneficiary as a result of this transaction."

However, University of Louisville finance professor David Dubofsky "said it may not turn out so well for the Louisville and Humana employees after all," The Courier-Journal reports, quoting him: "When two companies in the same industry merge, and the acquirer is paying a premium, you have to generate cost savings," partly by reducing employment among workers with similar jobs.

There is a connection between the merger of health-care providers, such as the creation of Kentucky One Health by several hospital groups, and the merger of insurance companies. "Many experts have said that the provider consolidation can drive higher rates—and that more-powerful insurers might have a better chance of countering them and striking pacts for new forms of payment that incentivize efficiency," Anna Wilde Matthews and Christopher Weaver write for The Wall Street Journal.

But they also note, "Research suggests that having fewer insurers leads to higher premiums, said Leemore S. Dafny, a former Federal Trade Commission official who is a professor at Northwestern University’s Kellogg School of Management.

Aetna with Humana would dominate the Medicare Advantage market in some states, with 90 percent of it in Kansas, notes Drew Altman, president of the Kaiser Family Foundation. "Of course, regulators could insist that companies take steps to maintain more competitive markets."

The Journal reports that it analyzed a Medicare database and found, "An Aetna-Humana tie-up would increase by about 180 the number of U.S. counties where at least 75 percent of customers for Medicare Advantage plans are in the hands of a single insurer." Most of those counties are in the South and Midwest. Using another federal database, it found that "In eight states, an Aetna-Humana merger would remove a competitor from the exchanges where individuals can buy coverage under the Affordable Care Act."

The prospect that jobs might be lost in Louisville doesn't mean that the ACA has put financial pressure on Aetna or Humana, Dan Diamond writes for Forbes magazine: "There’s limited evidence that the biggest players are struggling. While the ACA capped insurers’ ability to take profits, industry analysts have been fairly bullish on the sector. . . . And as I wrote earlier this week, the ACA appears to have only helped major insurers, by driving millions of new customers into the market. Aetna and Humana have seen their stock valuations triple in the past five years, since the ACA was signed into law, and the other three major insurers also have seen huge gains."

Diamond also isn't buying the argument, advanced by Aetna officials, that the combined company will be more efficient than the separate ones. "Aetna and Humana already are giant, scaled entities," he notes. "And economists aren’t buying the claim that insurer consolidation will lead to lower costs." As Judy Woodruff noted on "PBS Newshour" Friday, the deal would give the combined company more leverage to negotiate payments to health-care providers.

Health insurers' shares of total Medicare Advantage business
(Kaiser Family Foundation chart)

Diamond says the best case for Aetna's purchase is that it gets the company deeply into the Medicare Advantage business, without having to expend "a great deal of work and time," as Michael Bernstein, a partner at Baird Capital partner who focuses on health care, told Bloomberg News last month. Aetna has only 7 percent of that business, Humana 19 percent -- and about 65 percent of its revenues came from Medicare Advantage plans in 2014, Altman notes. The combined company is expected to get 56 percent of its revenue from government programs.

Diamond says economists see one more possible reason for the merger: "Amid health care’s merger mania, insurers are feeling psychological pressure to make deals of their own." And that does take us back to Obamacare. But the impact on Kentucky has yet to be seen, and so do the reasons.

Ky.'s pro-Obamacare policies led to more enrollment and support for it, but many poor are still uninsured and under-informed

Update: This story was updated to reflect the study's results for those who said they were hurt  by and not directly impacted by the ACA. 

State policy appears to have a major impact on poor people's thinking about the Patient Protection and Affordable Care Act, as well as how they describe their experience with it, according to a Harvard University study published in the journal Health Affairs.

The study surveyed nearly 3,000 low-income residents in three Southern states that had varying approaches to the ACA and its implementation: "Kentucky, which expanded Medicaid, created a successful state marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators" who help people with the federal and state marketplaces.

The survey found that Kentucky, which has enrolled more than 500,000 people in Medicaid and another 109,000 in private health plans through the Kynect health-insurance exchange, had the highest success in application rates, successful enrollments and positive experiences with the ACA, followed by Arkansas and then Texas.

"This corresponds to the general pattern of state-level engagement and support for the ACA coverage expansions in these three states," the researchers write.

The study also found that limited awareness and poor information continue to be two of the greatest barriers to the ACA. Even in Kentucky, where awareness was the highest, only half of the poor people surveyed said they had heard "some" or "a lot" about the ACA's coverage options. About 10 percent of Kentuckians remain without health insurance.

Another barrier to applying for coverage was the perception that it would cost too much, but for those with incomes below 138 percent of poverty in states that have expanded Medicaid, coverage is available without having to pay a premium.

"This adds to previous evidence that information gaps about the law remain a major challenge, particularly among low-income populations who likely have the most to gain from the coverage expansions," the researchers write.

The study also found that application assistance from navigators and others was the strongest predictor of enrollment, increasing enrollment to 93.1 percent from 84.9 percent. Application assistance was most common in Kentucky (46.2 percent) and least common in Texas (31.9 percent). Navigators help consumers choose health-insurance plans to meet their needs and assist them with the application process.

Kentucky reported an overall better application experience than the other two states in the study, and had a significantly higher enrollment rate (92.4 percent) than Arkansas (87 percent) and Texas (84.8 percent).

The study found that advertising about the law didn't seem to affect whether people applied for coverage or enrolled in a plan. However, ads were strongly associated with perceptions of the law.

About 20 percent of respondents said they had read or heard more negative ads and approximately 12 percent recalled more positive ads, and two-thirds said ads were about equal. (Negative ads were most frequently reported in Arkansas, where Obamacare was an issue in a U.S. Senate race last year.)

Twice as many respondents felt that the ACA had helped them as hurt them, although the majority reported no direct impact. In Kentucky, 40 percent said it had helped them, 12 percent said it had hurt them and 48 percent said it had not impacted them directly;  In Arkansas, 30 percent said it had helped them, 17 percent said it had hurt them and 54 percent said it had not impacted them directly; and in Texas, 21 percent said it had helped them, 14 percent said it had hurt them and 66 percent said it had not directly impacted them.

"Nonetheless, 48 to 66 percent of low-income adults in all three states felt the law had not directly impacted them in 2014," the researchers wrote, "which suggests that the ACA has not yet reached many who might benefit from it."

Pulaski County hits the mark with a community program to get kids up and moving; a great model for other communities to follow

Communities wondering what they could start that is fun, and will also improve the health of local families, might consider hosting something like "The Longest Day of Play," which Pulaski County has done for the last five years.

The Longest Day of Play at SomerSplash Waterpark
(Photo by Katie Pratt, UK Agricultural Communications)

The Longest Day of Play is a day, typically around the longest day of the year, on which SomerSplash Waterpark invites families from across the region for a day of physical activity and healthy living, Katie Pratt reports for the University of Kentucky. For those under 18, the event includes free admission, a healthy lunch, a book to read for the summer and sunscreen.

“A lot of times the people who are here today wouldn’t otherwise get to come, so it’s an opportunity for us to give back to the community,” Stephen Sims, manager of the waterpark, told Pratt. “It’s a way to get kids out and let them be active and not just simply stay at the house all summer long.”

The event is hosted by Pulaski County schools, UK's Cooperative Extension Service, the Lake Cumberland Health District Department, Eastern Kentucky Personal Responsibility in a Desirable Environment (PRIDE), and the city of Somerset.

“We have a Working on Wellness group in the community, and we wanted an event to give children nutrition, physical activity and to help our new waterpark grow," Edith Lovett, Pulaski County family and consumer sciences extension agent, told Pratt.

While Pulaski County has an awesome venue for the event, most communities have something special to offer -- parks, swimming pools, bike trails, school running tracks -- that could bring families together for a day of physical activity, fun and nutritious food.

Centers for Disease Control working to find ways to prevent traumatic brain injury; affects one in five Kentucky households

The federal Centers for Disease Control and Prevention is using a public-health approach to find strategies to prevent traumatic brain injuries and reduce the physical, psychological, economic and social impacts they cause.

Image: brainline.org

Traumatic brain injuries are those that happen because of a blow or jolt to the head, like a fall or a motor vehicle accident. It contributes to 30 percent of all injury deaths in the U.S., killing 138 people every day, according to the CDC.

Nationwide, the most common cause of brain injury is falls, but in Kentucky, most brain injuries and brain-injury-related deaths are caused by traffic accidents. About 5 percent of Kentucky's population has a brain injury, which is double the nation-wide rate, affecting one if five Kentucky households,  according to the Brain Injury Alliance of Kentucky.

Survivors of serious brain injuries have a range of disabilities, from memory issues, personality changes to debilitating physical disabilities, having a lasting effect on families and communities.

In partnership with the traumatic brain injury and rehabilitation communities, the CDC, using research, is working to meet these goals and results of this research can be found in a special issue of the Journal of Head Trauma Rehabilitation.

One article looks at the problems of unemployment after traumatic brain injury, with data showing that 60 percent of patients who received inpatient rehabilitation for TBI are still unemployed after two years of discharge -- and 35 percent of those who were employed two years after injury were employed only part-time. In Kentucky, 45 percent of those with brain injury reported a loss of employment or educational opportunity because of their injury.

Another article focuses on motorcycle crashes as a cause of TBI and says, "People injured in motorcycle crashes use more health-care resources and are three times more likely to die in the emergency department, compared to those with other causes of TBI." Kentucky had 6,552 hospital visits in 2013 for TBI caused by motor vehicle crash and of these 419 were motorcycle related, according to the Brain Injury Alliance. Kentucky no longer has a law requiring motorcyclists to wear helmets.

Other articles look at the high impact of sports- and recreation-related TBIs, reporting that "About 7 percent of all emergency department visits for sports- and recreation-related injuries are TBIs, with at least 3.4 million sports- and recreation-related TBI emergency department visits occurring over a 12-year study period." Kentucky hospitals had 2,600 TBIs in 2013 related to sports and recreation injury, according to the alliance.

Medicaid managed-care firms get new contracts with new rules aimed at resolving health-care providers' issues with program

Kentucky has signed new contracts with five managed-care firms that will manage Medicaid coverage for more than 1.1 million Kentuckians. Contracts were awarded to Anthem, Coventry Cares, Humana, Passport and Wellcare.

Kentucky changed Medicaid to managed care from a traditional fee-for-service model in 2011 to save money, and officials say it has worked. Health-care providers remain unhappy about denial and delay of claims by the managed-care organizations (MCOs).

“Statistics confirm that moving to a managed-care model has saved Kentucky taxpayers more than $1.3 billion in state and federal funds while simultaneously improving the delivery of health-care services to our Medicaid population," Health Secretary Audrey Haynes said in a news release.

At the same time, managed care has been a good deal for the companies, except Humana. "Last year, [they] cleared more than $500 million in income above expenses, according to statements companies must file with the Kentucky Department of Insurance," Debby Yetter reports for The Courier-Journal. "Some of the profits ranged from 7 percent to nearly 18 percent in 2014," but the new contracts limit that to about 6 percent.

They also require 82 to 87 percent of the payments to the MCOs to be spent on direct services to its members. The payments are per-person fees, based on the number of people whose care is being managed.

Haynes said the contract improvements "should please consumers, advocates and our health care providers" and "will translate into more options and improved services from our managed care companies."

The new contracts also address many of the issues about which hospitals and other providers have been unhappy, such as slow and reduced payments, complicated paperwork and other procedural differences among the companies.

The new contracts require a standardized contract and standardized forms for prior-authorization requests, grievances, appeals and claims.

Two passionately debated bills in the recent legislative session challenged some of the practices of the current MCOs: one seeking an appeals process for denial of payment and the other removing a cap of "triage fees" for emergency room services that MCOs later deem not to be emergencies.

Both issues were addressed in the new contracts. Now, MCOs must make sure they are using appropriate medical specialist to determine "medical necessity," initially and in any review process, and the cabinet will be responsible for reviewing denials of "medical necessity" appeals and denials of payment for emergency-room use.

Sen. Ralph Alvarado, R-Winchester, co-chair of the joint House-Senate Medicaid Oversight Committee, told Yetter that "he hopes the new contracts will clear up the problems" and he also hopes "the state succeeds in controlling profits of the managed-care companies, calling it an outrage that some companies are reaping millions off the program while denying care or delaying payment."

The new contracts also include incentives for MCOs and Medicaid members to decrease use of emergency rooms, and encourage the expansion of behavioral health services.

They offer incentives to to MCOs to continue to improve health outcomes for their members, and spells out new, stringent standards for companies that don't comply with their contracts.

The contracts are for one year beginning July 1, with the option of four annual renewals.

As vacation season arrives, here are travel tips for diabetics

It's vacation season. Traveling offers unique challenges for diabetics, but nothing that careful planning and a few precautions won't overcome, says the federal Centers for Disease Control and Prevention.

Image: diabeticlivingonline.com

The CDC offers these tips for diabetics to travel safely:

Before you leave

Discuss any concerns you may have about anticipated increased levels of activity, expected changes in diet and what to do if you have changes in your glucose readings with your physician. If you are traveling across time zones, let your doctor help you plan the timing of your injections. If you wear an insulin pump, make sure you know how to update the built in clock to reflect the change in time zone. The American Diabetes Association recommends making sure your blood sugars are well controlled before you leave.

Don't forget your supplies

Always keep your supplies close at hand and accessible, no matter how you travel. And don't forget to store them correctly; insulin stored in very hot or very cold temperatures may lose strength. Meters and supplies are also sensitive to extreme temperatures. There are cooling packs available made specifically for diabetes supplies.

To allow for any unexpected travel delays, it is recommended to pack twice the amount of diabetic supplies you expect to need. All supplies should be clearly labeled, with their original labels if possible, and don't forget to bring a copy your prescriptions with you.

It is also important to plan ahead for the possibility that your blood sugar might drop. Changes in what you eat, activity levels, and time zones can affect your blood glucose, so you need to monitor your blood glucose more often. If you use insulin, pack a glucagon emergency kit and all diabetics should pack glucose gel or glucose tablets, along with a few snacks.

Carry documentation and let others know

Carry a laminated 3-by-5 card in your wallet that says you have diabetes along with a list of any medications you use. Joslin Diabetes Center recommends that if you are traveling to a country where they speak a language other than your own, translate the note into this language. The ADA recommends that this card also say, "Sugar or orange juice please" in the language of the country you will be visiting.

In addition to wearing medical identification that says you have diabetes, tell the people you are traveling with that you have diabetes and tell them what to do in the case of an emergency. It is also a good idea to give them a copy of your medical card.

Keep your health insurance card and emergency phone numbers on hand at all times, including your doctor's name and phone number. First respondents are trained to look at cell phones for a contact labeled "emergency contact," so make sure you put one in there. All phone numbers should also include the country code if traveling abroad.

Once you arrive, find the closest medical care facility that could provide care if necessary. You can get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers at www.iamat.org or 716-754-4883, according to the ADA.

Nutrition

Do your homework before you go to determine the carbohydrate grams in the foods typically served where you are going. You might also want to pack a few bottles of water and some pre-measured dried fruit, nuts and seeds for snacks.

Air travel

If flying, put your diabetes supplies in a quart-size plastic bag separate from your toiletries. If you wear an insulin pump and don't want to walk through the metal detector with it on, tell the security officer about it and ask them to visually inspect the pump and do a security pat-down.

It is also important to call the airline ahead of time to assess whether your nutritional needs will be met while traveling. If a meal will be served, you can put in a request for a diabetic meal. If not, make sure to bring appropriate food with you.

Another thing to remember is that air on an airplane is probably pressurized, so when drawing up your dose of insulin, don't inject air into the bottle because the pressure differences can cause the plunger to "fight you," says the ADA. For more information about air travel and diabetes, click here.

To reduce your risk for blood clots, move around every hour or two.

Protect your feet

As always, diabetics need to protect their feet, being especially careful of hot pavement by pools and hot sand on beaches. Wear comfortable shoes and make sure to check your feet daily for blisters, cuts, redness, swelling and scratches.The general rule is to never go barefoot.

McConnell, Mass. Democrats find common ground on opioid-overdose epidemic; Kentucky ranks 3rd in overdose deaths

Republican U.S. Sen. Mitch McConnell and two Massachusetts Democrats have found common ground in efforts to fight the opioid-overdose crisis and are working across the aisle to push for legislation and information to address it, Asma Khalid reports for WBUR, a Boston NPR affiliate.

Sens. Ed Markey, D-Mass., and Mitch McConnell, R-Ky.,
agree on fighting the opoid overdose epidemic. (AP photos)

“McConnell and I are requesting that there be a surgeon general report on the opioid overdose epidemic in the United States,” Sen. Ed Markey told Khalid. Markey is also co-sponsoring a bill with Sen. Rand Paul, R-Ky., to expand the use of medication-assisted treatment, like Suboxone.

Kentucky has the third highest overdose death rate in the nation, with more than 1,000 people dying each year, according to the state attorney general's website. Massachusetts has the 32nd highest overdose death rate in the nation, according to Trust for America's Health. Most of these opioid deaths in both states are from prescription drugs.

“The reason I can do that with two senators from Kentucky, who are Republicans, is that there really is no difference between Lexington, Massachusetts, and Lexington, Kentucky,” Markey said. “We have an epidemic in both states, and we have to ensure that we put together a national plan.”

McConnell has also partnered with Rep. Katerine Clark, D-Mass,, on a bill that focuses on infants and neonatal abstinence syndrome. “Mitch McConnell and I may disagree on 98 percent of topics, but we agree on this,” Clark told Khalid.

Drug-dependent newborns in Kentucky increased by 48 percent last year, to 1,409 from 955 in 2013, which was up from only 28 in 2000, Laura Ungar reported for The Courier-Journal last week. "Research in the Journal of Perinatology shows opioid addiction in babies grew nearly five-fold between 2000 and 2012," Khalid notes.

The McConnell-Clark proposal "tries to pull the best practices from around the country to improve treatment and prevention for sick babies. The bill has 80 cosponsors so far, and they’re from both sides of the aisle," Khalid reports, with no opposition voiced at the House Committee Energy and Commerce last week.

Another Massachusetts Democrat on the committee said he supports the effort, but the key is money -- something McConnell has been stingy with, supporting automatic cuts to reduce the federal budget deficit.

“The big push that I’ve been trying to focus on in our hearings is this comes back to the lack of resources — lack of doctors, lack of treatment facilities, lack of beds, lack of continuum of care,” said Rep. Joe Kennedy III, D-Mass., “because our federal government has systematically underfunded resources for prevention and treatment.”

Eating trans fat weakens memory in younger men, study says

Trans fats, the use of which the U.S. Food and Drug Administration limited last month, are associated with reduced memory function in men 45 and younger, says a University of California San Diego School of Medicine study published in the online journal PLOS ONE.

Researchers asked 1,018 men and women to fill out a dietary survey and take a word-recall memory test. Men 45 and younger remembered an average of 86 words, but for each additional gram of trans fats eaten daily, memory dropped by 0.76 words. Compared to the men who didn't consume trans fats, those in the study who consumed the most recalled 12 fewer words.

"Trans fats were mostly strongly linked to worse memory in men during their high-productivity years," said Beatrice A. Golomb, lead author and professor of medicine at UCSD. "Trans fat consumption has previously shown adverse associations to behavior and mood—other pillars of brain function. However, to our knowledge a relation to memory or cognition had not been shown."

Other research has shown that trans fatty acid consumption is linked to negative effects on lipid profile, metabolic function, insulin resistance, inflammation and cardiac and general health. "As I tell patients: While trans fats increase the shelf life of foods, they reduce the shelf life of people," Golomb said.

Obese children's parents say kids are 'about the right weight,' likely comparing them to other kids instead of growth standards

Most parents of overweight children consider them to be "about the right weight," which poses a real concern because parents aren't likely to help their children change their behaviors toward weight reduction if they don't recognize there is a problem, according to a study from the NYU Langone Medical Center.

Photo: nydailynews.com

"Parental recognition of their child's overweight status is paramount in childhood obesity prevention efforts," says the report. "Previous research has shown that parents with accurate perceptions have a greater readiness to make weight-related changes in health-related behaviors and are more effective in doing so.

Kentucky ranks sixth among the states for obesity among preschoolers, with 15.5 percent of 2-to 4-year-olds from low-income families considered obese, according to the "States of Obesity" report. This percentage has remained consistent for several years, but it's worth noting that in 1989, only 9.4 percent of of this population was considered obese. "Children who are overweight or obese as preschoolers are five times as likely as normal-weight children to be overweight or obese as adults," says the federal Centers for Disease Control and Prevention.

The study, published in the journal Childhood Obesity, analyzed data from two groups of children over two time periods from the National Health and Nutrition Examination Survey, one between 1988 and 1994 and the other between 2007 and 2012, both samples had over 3,000 children. The survey asked parents whether they considered their child, ages 2–5-years-old, to be overweight, underweight, or just about the right weight.

Nearly 97 percent of parents of overweight boys in the earlier group identified their sons as "just about the right weight," compared to 95 percent in the second group; 88 percent of parents of overweight girls thought they were "just about the right weight" in the first group, compared to 93 percent in the later group. Experts have dubbed this misperception "The Goldilocks syndrome."

Notably, the researchers said that "the children in the second study group were significantly more overweight than the children in the first study group, yet the parents’ perception of their children remained relatively unchanged." In fact, "the misperception became more prevalent in the recent survey given that an estimated 30 percent reduction in correct perception was observed, compared to the earlier survey," says the report.

"It shows that essentially we're more obese as a society and we're not recognizing our obesity as a society, in this case in children," Dustin Duncan, lead author of the study and assistant professor in the Department of Population Health at NYU Langone, told Lisa Flam on NBC's "Today" show. "Obesity is a well-known medical condition associated with immediate and long-term health risks for children. This is an alarming finding."

The study also found that these misperceptions were more pronounced among the African-American families. "This was especially concerning because African-American and low-income children in the U.S. have the highest rates of obesity," Duncan said in the release.

One reason given for these misperceptions is that parents often compare their own child to other kids in deciding if their child is overweight instead of using science-backed growth charts. The authors also noted that poor communication between parents and their pediatricians could also contribute to these misperceptions.

“We need effective strategies to encourage clinician discussions with parents about appropriate weight for their child. This will be critical for childhood weight management and obesity prevention," Jian Zhang, senior author of the study, said in the release.

Louisville dental school ranked second in U.S. by website that surveys students and recent graduates

The University of Louisville School of Dentistry is ranked second among dental schools in the U.S. by GraduatePrograms.com, a peer-written rating and review site for graduate schools. Last year the school ranked fourth. The No. 1-ranked program on the site was Western University of Health Sciences in Pomona, Calif.

Students and recent graduates, contacted via scholarship entries and social media, rate schools on 15 areas, including academic competitiveness, workload and faculty accessibility, a university news release said.

 “It is gratifying to know that students at the UofL School of Dentistry value their experience in the program, even if it is from a limited sampling,” Dean John Sauk said in the release. “In any case, we will persevere to continually seek to improve the quality of our educational programs and develop the empathy and skills of the professionals we educate.”

Researchers find genetic biomarker that could indicate mental illness in women

Patients' behaviors and feelings often serve as identifying factors for psychiatric disorders, which can make diagnoses difficult. Researchers at the University of California San Diego School of Medicine have discovered that the over-production of specific genes may indicate mental illness in female psychiatric patients, according to a study published in the journal EBioMedicine.

The gene XIST, which deactivates one of the two X chromosomes in cells responsible for storing genetic material, works too hard in female patients who have mental illnesses such as bipolar disorder, major depression and schizophrenia. According to the study, over-production of XIST and genes from the inactive X chromosome are common factors in patients with psychiatric disorders and rare chromosome disorders like Klinefelter syndrome and Triple X syndrome.

"There has been an utmost urgency to identify biomarkers for mental illness that could significantly impact research and drug development, said XianJin Zhou, assistant professor in the UCSD Department of Psychiatry and lead author of the study.

About half of the participants—most of whom had a family history of mental illness—had unusually higher levels of XIST and other genes related to the X chromosome. Zhou and his team said stopping the abnormal activity of the inactive X chromosome may be a new strategy for treating those with psychiatric disorders. "These results are powerful in that early diagnosis of mental illness could possibly happen with a simple blood test, leading to better interventions, therapy and treatment options," Zhou said.

Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death

Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.

How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient’s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized — and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended

By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, “Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.”

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

“Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,” the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.

Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states—Kentucky, North Carolina, Virginia, South Carolina and Tennessee—fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Half again as many Kentucky newborns were hospitalized for drug dependency last year as the year before

Mother Samantha Adams and her newborn Leopoldo Bautista,
10 days old, spend quality time inside the Louisville Norton
Healthcare child care center for children experiencing drug
withdrawal. (Photo by Alton Strupp, The Courier-Journal)

Increasing drug abuse drove up hospitalizations of drug-dependent newborns in Kentucky by 48 percent last year, to 1,409 from 955 in 2013. "The latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000," reports Laura Ungar of The Courier-Journal.

"The seemingly never-ending increase every year is so frustrating to see," Van Ingram, executive director of the state Office of Drug Control Policy, told Ungar. "It's a horrible thing to spend the first days of your life in agony."

"These infants are born into suffering," Ungar writes. "They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures — and even respiratory distress if they're born prematurely."

Drug-dependent newborns are becoming more common nationwide, Ungar notes, but "Vanderbilt University researchers publishing in the Journal of Perinatology [a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies] say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky."

While the increase is blamed mostly on illegal drug use, the Vanderbilt study found that 28 percent of pregnant Medicaid recipients in Tennessee filled at least one painkiller prescription, Ungar writes: "Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction."

While Medicaid now pays for behavioral-health and substance-abuse treatment, "Drug treatment for pregnant women is sorely lacking," Ungar reports. In Kentucky, only 71 of the 286 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration treat pregnant women. 

Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate

By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through “an Exchange established by the State.” The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare “a rolling disaster for the American people,” with a “multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today’s ruling won’t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.”

Maps: Percentage uninsured in 2012, above, and 2014, below

Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to “say you’re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.” A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision “reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.”

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians – and all Americans – have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits – and incentivizes – local health care innovation. We can and must shape Kentucky solutions to Kentucky’s health challenges."

The Homeplace at Midway opens, with cottages for nursing, assisted living, memory care; first 'Green House' facility in Ky.

By Kacie Kelly and Al Cross
University of Kentucky School of Journalism and Telecommunications

The Homeplace at Midway was formally opened Thursday, June 25, bringing to fruition a 16-year campaign for a nursing home in the Woodford County town of 1,700. For photos from its June 28 open house, click here.

Construction this spring (Christian Care Communities photo)

The Homeplace, which has four residential buildings that look like single-family homes, is more than a nursing home. Two of the buildings are for skilled nursing, but one is for assisted living and the other is for "memory care" or personal care of patients with dementia and other cognitive impairments.

“The Homeplace at Midway represents a new beginning for older adults in Kentucky and for communities across the commonwealth to embrace them as living treasures, not a burden or a challenge,” Dr. Keith Knapp, president and chief executive officer of Christian Care Communities, which built the Homeplace and will operate it, said at the ribbon-cutting ceremony.

Assisted living cottage (Photo by Kacie Kelly)

“We are extremely grateful to the City of Midway, the Midway Nursing Home Task Force, Midway College, state and local government agencies, our capital campaign’s Leadership Council and all our friends and supporters who championed this new direction and envisioned with us a new day when older adults would receive the highest quality care and support, without feeling their lives are being disrupted or overtaken,” Knapp said. “We trust that it will inspire other senior living providers to move in a similar direction.”

The Homeplace is the first facility in Kentucky built with The Green House model, which includes home-like environments and strong relationships with caregivers, with the goal of meaningful lives for residents. Dr. William Thomas, creator of the model, told the crowd at the event, “The Homeplace, with its emphasis on home, shows how care can be made more loving, community centered and effective.”

One of the two skilled-care cottages (Photo by Kacie Kelly)

Patients have been moving in all month. The staff at The Homeplace is trained to use the “best friend approach,” Laurie Dorough, the facility's community-relations manager, said in an interview. Staff and volunteers are to treat residents as they would treat a best friend.

Knapp said at the ribbon-cutting, “Each resident will have a private bedroom and bath and share, just as people do in any home, the kitchen, living room, den and porch areas. It’s all designed to give residents the freedom to set their own daily routines and to live life to its fullest, while receiving the individual care they need – within each cottage.

The assisted-living cottage is larger than the others, to provide room for more activities and “the potential for spouses to live there,” said Laurie Dorough. “It’s kind of the first step out of independent living,” she said. The cottage has an open kitchen where residents can get involved with meal preparation or “come out and see what’s cooking.”

Skilled-care cottage bathroom lift system (Photo by Kacie Kelly)

The skilled-nursing cottages have bedrooms with medicine cupboards rather than medical carts, and a bathroom lift system (photo at right) that takes the resident straight to their own bathroom. The bedrooms are relatively small, an incentive for residents to spend more time in the communal living space.

The Homeplace campus, across Weisenberger Mill Road from Midway College, also includes an administrative cottage and the Lucy Simms Lloyd Gathering House for special gatherings, worship services and activities.

Between the cottages is the courtyard, with lighted walking paths from building to building, a gazebo, and space for outdoor activities. “Our hope is to maybe start a community garden,” said Dorough.

The long campaign for a nursing home, led by the Midway Nursing Home Task Force, began to see success in 2010 when Louisville-based Christian Care agreed to be the developer. Christian Care has facilities in 11 Kentucky cities, and a church-outreach program with more than 230 churches as partners.

The Homeplace will have a partnership with Midway College, which becomes Midway University July 1. “We are excited to work with Midway College to not only provide learning opportunities for students but also for the residents of The Homeplace,” said Tonya Cox, the facility's executive director.

The Homeplace will be offering internships and other learning opportunities for students. This partnership will also benefit residents, Cox said: “Our residents will also have the opportunity to attend events and classes to foster their lifelong learning.”

Cox said The Homeplace aims to provide “unique long-term care in a way that honors their preferences and desires to be home.” More information is on the facility's website. It will host an open house from 1 to 3 p.m. Sunday, June 28.

Aetna is close to a deal to buy Humana, Bloomberg reports

Getty Images, via CNBC

Health insurer Aetna "is said to be closing in on a deal to buy" Louisville-based Humana Inc., Julie Hyman reports for Bloomberg News, "and a deal could come "as soon as this weekend."

Humana is also expecting an offer from Cigna Inc., but Humana's board of directors "prefers the Aetna offer," Hyman reports, citing unnamed people familiar with the negotiations. The deal has been discussed for weeks, but Aetna didn't make a formal proposal until this week.

The last major obstacle to a deal may have been the Supreme Court's ruling today that people in all states are entitled to tax subsidies for health insurance under the Patient Protection and Affordable Care Act, Hyman suggests, noting higher stock prices for health-insurance companies.

"Shares of Humana rallied more than 8 percent after trading was briefly halted for volatility," Reem Nasr of CNBC reports.

Humana is an attractive buy because "a great deal of its business — 73 percent of its premiums revenue — comes from contracts with the federal government," David Mann reports for Louisville Business First. "That means Humana is flush with Medicare business, which is a fast-growing category in the industry as many baby boomers are reaching the eligibility age. Its competitors, including Aetna, don't have nearly as much of this business."

"Consolidation among the country's top insurers follows a massive consolidation among providers in pharmacy, hospital and patient care, which has increased the leverage against insurers like Humana and Aetna," Grace Schneider reports for The Courier-Journal.

Doctor discusses myths about sun exposure and sunburn

As the weather grows warmer and more people spend longer periods of time outside in the sun, it's important to understand the dangers of sun exposure. "Ultraviolet radiation is a known carcinogen, which means, similar to cigarette smoking, it can cause lasting damage to the body," said Dr. Holly Kanavy, assistant professor of medicine at the Albert Einstein College of Medicine and director of pharmacology at Montefiore Health System. Kanavy discussed five myths people often believe about sun damage:

Myth 1: Some people believe they only need to protect themselves from the sun during peak hours. Although extra precautions should be taken between the hours of 10 a.m. and 4 p.m., people are susceptible to damage from the sun anytime it's out.

Myth 2: Some people think if children do not get burned, they must be wearing enough sunblock. However, young children are particularly susceptible to sun damage and should wear and reapply SPF 30 or higher sunblock. Hats and sunglasses as well as clothing are also helpful, but wet clothes don't offer much protection from the sun.

Myth 3: Some individuals think sun exposure is required to obtain vitamin D. In truth, it only takes 10-15 minutes of sun exposure several times per week. Some people do not wear sunscreen because they're trying to get vitamin D. However, that isn't necessary because it takes sunscreen about 20 minutes to start working, and people can get their vitamin D intake during that time. Also the vitamin can be acquired through certain foods.

Myth 4: Some people believe that the only important factor to look for in sunscreen is the SPF. However, people should make sure their sunblock protects against both UVA and UVB rays. UVA rays age the skin and can cause skin cancer. To make sure a sunblock protects against both kinds of rays, look for the words "broad spectrum" and ingredients like avobenzone, oxybenzone, zinc oxide and/or titanium oxide.

Myth 5: Some people think sun protection is unnecessary indoors or on cold days. However, temperature doesn't affect radiation, and UVA rays can go through clouds and glass. UVA rays don't cause tanning, but can cause damage.

Kanavy also recommended steps to take after getting sunburn. "Immediately after a burn, take a cool shower and keep the burn moisturized," he said. "Ingredients like vitamin C and vitamin E can help control damage."

Annual health policy forum set Sept. 28 in Bowling Green

This year's annual Howard L. Bost Health Policy Forum "will offer new insights and opportunities from a range of civic sectors for a shared vision, policies, and actions for community health," says its lead sponsor, the Foundation for a Healthy Kentucky.

"Local, regional, and national speakers will share their knowledge and experiences in building healthy communities, with a focus on transportation and housing, education, food systems and policy, and employers and workplaces," the foundation says. "TED style" speakers will make presentations on each of the forum's four focus areas: education, food systems and policy, employer/workplace, and transportation/housing.

The forum will be held at the Sloan Convention Center in Bowling Green on Monday, Sept. 28. For the registration website, click here.

Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers

A drug that was supposed to help people get off heroin has "created a new cash-for-pills market and a street trade" that state officials are trying to stop, Mary Meehan reports for the Lexington Herald-Leader.

The drug is buprenorphine, the active ingredient in the brand-name drugs Suboxone and Subutex, which became more popular in 2012, when the state cracked down on "pill mills" that were freely handing out prescriptions for painkillers. "A lot of the pill mills morphed into facilities that dispense these prescriptions," Dr. John Langefeld, medical director for the state's Medicaid program, told Meehan.

Also, Meehan writes, the Patient Protection and Affordable Care Act required insurance plans to cover treatment for substance abuse, and "as more Medicaid patients and others got health-insurance coverage, more people obtained prescriptions for buprenorphine, Langefeld said. . . . According to a state report, one user obtained prescriptions from nine doctors."

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Lexington Herald-Leader chart by Chris Ware from state data

Use of the drug in Kentucky "has increased 241 percent since 2012," Meehan reports. "And 80 percent of the prescriptions for it were being written by 20 percent of the state's 470 certified prescribers, said Dr. Allen Brenzel, medical director of the state's Department of Behavioral Health. . . . Since 2011, 10 doctors have been sanctioned by the Kentucky Board of Medical Licensure because of problems prescribing Suboxone."

Suboxone is supposed to be taken in conjunction with therapy and drug testing. "a patient receives a controlled dose of a legal drug as the dose is tapered by a physician for a safe and effective withdrawal," Meehan notes. However, "doctors started to see Suboxone patients on a cash basis, asking for as much as $300 for an office visit that included a prescription for the maximum allowable amount of Suboxone. Patients often received no therapy or drug testing. Some patients were on the maximum dose indefinitely, Brenzel said." Some doctors prescribed the drug with other painkillers, creating an illegal market.

To prevent such abuse by unscrupulous doctors, the medical-licensure board has issued regulations that require "more physician education and the requirement that the drug be prescribed only for medically supervised withdrawal and not be given to pregnant women," Meehan writes. "Patients should also be closely monitored and drug tested. If those rules are not followed, a doctor can face sanctions or restrictions to his medical license."

Suboxone was in the national news recently because the accused killer in the Charleston, S.C., shootings was arrested for illegal possession of it four months ago at a South Carolina shopping mall, the Herald-Leader notes.

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy