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.”