Baptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort

Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.

“Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,” Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. “Our participation in SOAR reflects this pledge. Besides Richmond, we’ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors’ offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."

The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.

Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.

“Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,” Beshear said in the release. “I’m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."

Health reform law drives a trend to include lifestyle changes in a patient's health care plan, alongside traditional medicine

Lifestyle changes can play a huge role in treating and warding off many health conditions and thanks to the Patient Protection and Affordable Care Act there is now a shift to include helping people make these changes part of their health care plan, Laura Ungar reports for The Courier-Journal and USA Today.

In the first of an occasional series called "HealthVoices" that focuses on "areas where policy, public health and people intersect," Ungar tells the story of Kevin French, who self-describes himself as "the quintessential unhealthy Kentuckian" and how lifestyle changes have made a difference in his health.

French tells Ungar that with the help of medical professionals and The KentuckyOne Healthy Lifestyle Center in Louisville he has "learned how to eat well, handle stress, exercise and "basically change everything."

"My medicine usage has declined somewhat. I'm still on medicines but not the dramatic type like I was. Some of them's been cut in half," French told Ungar. "Several costs of medicines have declined dramatically."

The center provides "medically supervised exercise, nutrition counseling, stress management and classes in disciplines such as yoga" and is the third such facility the medical system has opened in Louisville, Ungar writes.

Experts say that the ACA is driving this "colossal shift" in health care away from the "traditional reliance on pills and procedures by patients as well as the American medical system," Ungar writes, but she also notes that the patient must also make a commitment to these lifestyle changes if it is to work, as French has.

A cardiologist at the center, Paul Rogers, told Ungar about the importance of lifestyle changes, especially exercise. in warding off cardiovascular disease, one of the state's biggest killers.

"Compared to even the best medical therapy, we can decrease heart attacks, strokes and deaths by between 35 and 45 percent by changing lifestyle. The thing I see that holds people back most probably is effort and fear," Rogers told Ungar. "The recommendations these days are 30 minutes of…aerobic activity six times a week. I think if people started devoting themselves to that, that would change the health of our state dramatically."

Midwest pollen count indicates that seasonal allergies are expected to be worse than usual this year

Seasonal allergy sufferers beware. Allergy season is officially here and is predicted to be worse than usual, says a news release from Chicago's Loyola University Health System.

image from healthguru.com

After weeks of evaluation, the Gottlieb Allergy Count, which is the official daily allergy count for the Midwest, has detected moderate pollen in the air at a time that is typically low.

Dr. Joseph Leija,  retired allergist who continues to conduct the official daily allergy count, said in the release that the long cold winter with heavy snow is likely to cause "a bad allergy season."

“The prolonged, fierce winter may mean that tree, grass and mold spores appear simultaneously early in the season, causing a triple threat," he said in the release. "Heavy snow means lots of moisture to nourish budding trees and plant life. The continued dampness also fosters the growth of mold."

Here are some allergy relief tips from WebMD :

• Take your shoes off at the door.
• Wipe down your dog's coat before it comes in the house.
• Wash your hair before bed.
• Close the windows and doors, especially on high-pollen days.
• Use the "recirculate" option in the car.
• Service the filters in your furnace and air conditioner.
• Use a dehumidifier to maintain a humidity level of less than 60 percent in your home.
• Check the daily pollen count and plan accordingly.
• If possible, have someone else mow the lawn.
• Avoid sitting outside around freshly cut grass.
• Dry your clothes in a clothes dryer, not on an outdoor line. 

“People with allergies or breathing difficulties should be proactive now to preserve health," Leija said in the release. "Consult your allergist, have the ducts cleaned on your air conditioning system and start taking your allergy medicine so that when things really heat up, you are protected."

Click here to get the daily pollen count in your county from pollen.com.

Conference focuses attention on importance of patient- and family-centered care, health education, communication

Health education, communicating with physicians, and patient- and family-centered care that empowers patients to be their own best health advocates, were some of the topics discussed at the Health Watch USA conference in Lexington this month.

Joycelyn Elders

“Patient empowerment is the right of the patient to take an active role in decisions about his or her own care,” said former U.S. surgeon general Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas. “But you can't make a good decision if you have not been educated. You can't keep an ignorant population healthy.”

Waiting until a person is old and set in their ways and then trying to teach them better health strategies doesn't work, Elders said. For patients to really be involved in their health, health education must start early.

“We must push for comprehensive health education in our school systems from kindergarten through 12th grade,” she said. “It is just as important as teaching reading, writing, and arithmetic. . . . We need to have science-based answers rather than ubiquitous myths. We need to protect people by arming them with correct information.”

Elders offered some practical suggestions to help patients become more empowered during their doctor's visits:

• Take a trusted person with you.
• Ask questions if you don't understand.
• Bring all of your medications with you.
• Write down questions and concerns before you go.
• Ask your doctor to write down information and instructions discussed.
• Make sure to tell your doctor if you have vision or hearing problems.

Elders said health education for physicians could also be improved, by putting more emphasis on preventive care and the treatment of chronic diseases, which are 75 percent of diseases in the United States, rather than acute diseases.

“We spend only 3 percent of our health-care dollars on keeping people well,” Elders said. “We have to do a better job. We haven’t educated our doctors.”

Karen D. Meyers

Karen D. Meyers, a lawyer who works with catastrophic-injury victims and health-care providers, said medical schools must start teaching doctors how to become better collaborators, not only between specialties, but with their patients as we move toward a model of patient and family centered care.

“They must learn to treat patients with dignity and respect, listen and share information with their patients, and allow patients to participate in their care,” said Meyers, who became an advocate for patient- and family-centered care after becoming a health advocate for her mother, who was in a coma for 40 days.

Elders said patient empowerment requires the patient to take some responsibility for his or her care, which requires respectful communication and shared decision-making between the doctor and the patient. The current physician-patient model of care does not support this concept, Elders said: “This has to change.”

Meyers concurred, saying physicians, hospitals and patients must change the attitude of “my patient, my treatment plan, my procedure, my case” to a model that recognizes that “everything about a patient's health belongs to the patient and their family.” She added, “Patients have to understand, because they are responsible for their care.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, according to its website. For its report on the conference, in PDF format, click here.

The price for health care could be right, if it's known

By Molly Burchett
Kentucky Health News

People often shop around and compare prices when making a large purchase, and some consumer advocates, employers and health plans are pushing for price transparency in health care so it's easier for consumers to compare prices. However, many questions remain about whether or not price transparency is possible, or if it would even affect health costs and outcomes.

Making it easier for consumers and patients to compare prices encourages them to look around for a better deal, says a study published in the Journal of the American Medical Association. The study focused on the use of Castlight Health's online pricing platform and explored whether there was a reduction in costs to employers and employees for laboratory tests, advanced imaging services and clinician office visits.

Lab tests and imaging saw the biggest savings in the study, dropping 14 percent and 13 percent, and primary care offices visits also dropped by 1 percent, according to the study. Additionally, the study showed that claim payments were lower for all services for employes who used Castlight versus those employees who did not.

But less expensive care doesn't always equal higher quality care. Price transparency’s impact is realized only to the extent that it empowers consumers and influences their behavior, and price is only one of the variables that consumers need to evaluate the value of health services.

"One thing the study can't answer is whether patients are making better decisions or just cheaper ones. They're finding lower-cost options, the study finds, but it doesn't tell us how patients are taking into account things like patient satisfaction, years of clinician experience and other provider characteristics," writes Jason Millman of The Washington Post.

Another important thing the study both can't and wasn't designed to predict is whether transparency will reduce overall health spending, writes Millman. Health-care economist Uwe Reinhardt writes, in a separate JAMA editorial, that early results of research suggest that price transparency in health care can result in less spending.

Other experts have expressed doubts about this "free market" approach. In a Huffington Post article, physician and systems theorist Deane Waldman says that price is not one of the pieces of information consumers need to re-install free market forces into health care because the present health-care market in the U.S. is not free.

"The consumer can have all the information in the world, but without control of his/her own money, and without sellers competing for those dollars, the market will not work. One cannot have the advantages of free market forces if the market is not free," writes Waldman.

Similarly, Reinhardt says that comparing the costs of procedures only works if people have a choice between healthcare providers. That may be a major complication for Kentuckians in rural areas where providers may be scarce or insurance coverage may not be comprehensive.

Massachusetts is the first state to mandate some level of price transparency. However, resistance from both provider and payer communities suggests that large-scale adoption of transparency initiatives will likely be both heavily debated and slow.

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

Health care jobs are expected to expand as we age; newspaper in Bowling Green looks at its region

Jobs in health care are not only available for those without bachelor's degrees, such jobs are likely to become more prevalent, according to data collected in the Barren River Area Development District, Monica Spees reports for The Daily News in Bowling Green.

Ron Crouch, director of research and statistics for the Kentucky Education and Workforce Development Cabinet, compiled the data after the release of a national report of health care and health care education by the Brookings Institution.

“The demand for health care is going up,” Crouch told Spees. He said positions such as dentists, pharmacists, anesthesiologists, surgeons and other occupations will see in increase by 2020; and many of these jobs don't require more than an associate degree.

Crouch said there were 477 medical assistants in the region in 2010, with a projection of 573 by 2020. Medical assistants were paid $12.54 per hour in 2013. He also cited 634 licensed practical and licensed vocational nurses in the region in 2010, with a projection of 776 by 2020. These positions were paid $16.47 per hour in 2013. Health billing and maintenance jobs, which don't require a degree, are also available in the region.

Jobs that require a lower level of education are in high demand because they help people provide for themselves and their families without incurring college debt, Crouch told Spees. He also said that while 83.2 percent of health care positions in the region are filled by women, these jobs are suitable for both men and women.

As the population ages, the demands for health care will increase, Crouch said. In 1980, there were approximately 58,600 people older than 50 in the region. In 2010, there were almost 93,000.

As Virginia governor fights to follow Kentucky's lead on Medicaid, free-clinic user says she doesn't want government handout

Kentucky's success with federal health reform hasn't been mirrored in adjoining states. It is a complex topic that was made more complex by the Supreme Court ruling that made it easy for states to reject the law's main device for helping the poor, expansion of the federal-state Medicaid program. That added political complexity to a subject that has philosophical complexity, which showed up at the end of an recent article in The Washington Post about Virginia Gov. Terry McAuliffe's campaign to expand Medicaid against the wishes of his Republican-led legislature.

To illustrate the need, McAuliffe attended a free medical and dental clinic in Wise, in Virginia's southwestern coalfield, just across Cumberland Mountain from Kentucky's Letcher County. The Post's Laura Vozzella ended the story with her interview of Gilda Mountcastle, who had been waiting in line since 5:30 a.m. Mountcastle said she would not have access to a dentist or eye doctor without the free clinic, but said "she did not support Medicaid expansion, which she saw as a government handout." She told told reporters, “We’re hardworking, hillbilly mountain people. We’re too proud to beg and bum.” From the government, at least. (Read more)