Grants of up to $10,000 available for Kentucky communities to fight colon cancer; applications are due July 15

The Colon Cancer Prevention Project has a new "Project Innovation" grant program to help fund local innovative ideas to get more people screened for colon cancer in Kentucky and Southern Indiana.

Kentucky ranks first in colon-cancer diagnoses and fourth in colon-cancer deaths. It is estimated that 60 percent of deaths from colon cancer could be prevented if everyone were screened at age 50, according to the project's website.

The project, based in Louisville, is a partner in the national initiative to increase colon screening rates to 80 percent by 2018 and hopes to reach this goal by expanding into new communities through volunteer participation.

With this goal in mind, the project is offering up to $10,000 in grants to help individuals lead efforts to raise awareness in their communities about colon cancer and educate people about the importance of screening. The number of approved projects and the amount of funding will depend on the number of applications received and the perceived effectiveness of the project.

Anyone who creates a project to support the expansion of the Colon Cancer Prevention Project that will serve Kentucky or Southern Indiana can apply.

Projects should target African Americans or rural areas of Kentucky and Appalachia. Preference will be given to projects that focus on these counties: Whitley, Knox, Bell, Clay, Madison, Fleming, Morgan, Martin, Pike, Hopkins and Hardin. However, all applications will be considered.

Project requirements can be found online and applications will be accepted through July 15. For more information and access to the application, click here: http://coloncancerpreventionproject.org/help-kick-butt/project-innovation/

Free screenings of new Kentucky colon-cancer documentary, plus Q and A, are scheduled in Louisville, Lexington and Hazard

The Colon Cancer Prevention Project is premiering its new documentary, "Catching a Killer: Colon Cancer in the Bluegrass," in three select cities, before it starts airing on KET this summer.

The 30-minute film, which features stories from Kentuckians who have been affected by colon cancer, will be shown June 18 at the Clifton Center in Louisville; June 23 at the Central Library in Lexington; and July 20 at the Perry County Library in Hazard. It includes stories from residents of Appalachia and Louisville, two areas where colon cancer rates are the highest.

All three events will run from 7 to 8 p.m. and include a question-and-answer session with expert panelists after the film is over. Free food, music and photos will be offered before the start of the film, from 5:45 to 6:45 p.m.

The Colon Cancer Prevention Project is Kentucky and Southern Indiana’s only nonprofit focused solely on work to end the second leading cancer killer among men and women. Colon cancer strikes 2,600 Kentuckians each year – making Kentucky one of the worst states in the country for colon cancer incidence – but it is highly preventable with screening.

"Catching a Killer" not only shares the heartfelt stories of our neighbors, but also shares information about screening options and resources in our state.

“Our goal is to make sure people get screened for this disease and avoid ever hearing the words: You have cancer,” Andrea Shepherd, the project's executive director, said in a news release. “We hope that after viewing this documentary, people get on the phone and start talking with their physicians and families about colon cancer screening.”

The events are free and open to the public. More information and an RSVP form is available on the project's website.

A looming danger: About 1 in 3 U.S. adults are pre-diabetic, but only about 11% say they have received such a diagnosis

Before Type 2 diabetes develops, most people experience what is called prediabetes, where the blood sugar levels are above normal, but below diabetic, Dr. Philip A. Kern, University of Kentucky professor and director of the Center for Clinical and Translational Science, writes in a UK news release.

In America, approximately one in three adults are pre-diabetic, but only around 11 percent are aware of that condition, according to the federal Centers for Disease Control and Prevention. In Kentucky, 289,000 adults, or almost 9 percent, reported that they had been diagnosed as pre-diabetic, according to the 2015 Kentucky Diabetes Report.

"Without intervention, there is a high likelihood that prediabetes will progress to diabetes within three to 10 years," Kern writes. "People with prediabetes are also at 50 percent higher risk for heart disease and stroke."

When a person is prediabetic, many of the diabetic disease processes, like nerve damage, eye problems and heart disease, begin in the body even though the person doesn't have diabetes.

And because prediabetes often has no symptoms and can affect people of all ages, Kern writes, it is important to know your blood sugar levels, especially if you have one of the following risk factors: overweight or obese, fat distributed around the abdomen, history of gestational diabetes, family history of diabetes, symptoms of diabetes (increased thirst, frequent urination, fatigue, and blurred vision), or history of elevated blood sugar levels.

Kern suggests the following lifestyle changes to help prevent the progression of prediabetes to diabetes; he notes that these changes will also help reduce your risk of heart disease, stroke, high cholesterol and high blood pressure:

• Weight loss: Losing just 10 to 20 pounds can reduce the liklihood of prediabetes progressing to diabetes.
• Healthy diet: Choose low fat, low calorie and high fiber foods, like fruits, vegetables and whole grains.
• Exercise: Incorporate 30 to 60 minutes of moderate physical activity most days of the week.
• Sleep: Research has found that getting at least six hours of sleep each night can help reduce insulin resistance. He also notes that sleep apnea can worsen prediabetes.
• Medications: Some diabetes medications are prescribed to prediabetics to prevent the condition from progressing.

If you're interested in learning about opportunities to participate in research about prediabetes at UK, visit ukclinicalresearch.com or call (859) 323-2737.

Feeling exhausted and not sure why? Ask your health-care provider to check your vitamin B12

Some doctors are adding a vitamin B check to their standard "baseline" workup, especially vitamin B12, the one most commonly deficient, Dr. Leigh Erin Connealy reports for Newport Natural Health.

"By some estimates, up to 40 percent of the population does not have sufficient levels of B12," Connealy writes.

The B vitamins work together as a family to  perform many important functions throughout the body, such as helping to convert our food to fuel, allowing us to stay energized through the day, helping maintain heart health, preventing birth defects, creating red blood cells or assisting with the production and repair of DNA, to name a few.

Vitamin B12, or cobalamin, keeps our blood, nervous system and heart healthy. It is found primarily in animal-sourced foods—all meats, dairy products, eggs, and shellfish. Liver, sardines, and salmon contain the greatest amount.

Image from webmd.com

While it is not uncommon for vegetarians and vegans to have low levels of B12, Connealy says that even meat eaters can lack it, usually because of poor absorption.

Absorption issues in younger people are often caused by acid-blocking medications, disorders such as Crohn's disease, leaky gut, diarrhea and other gastrointestinal problems.  Older people with a condition called hypocholorhydria, where the stomach does not produce enough acid to help with the absorption of nutrients, can have low levels as well, Connealy notes.

B12 deficiency can cause a wide variety of debilitating symptoms ranging from exhaustion and lethargy to depression, anxiety, memory loss, confusion, and other Alzheimer’s-like symptoms.

WebMD adds rapid heartbeat and breathing, pale skin, sore tongue, bleeding gums, stomach upset and weight loss and diarrhea or constipation to the list of symptoms.

Connealy notes that there are differing recommendations for the amount of B12 that should be in a supplement. The Dietary Reference Intake recommends between 2-3 micrograms daily, while the Center for Food Safety and Applied Nutrition recommends 6 mcg daily, based on a 2,000-calorie diet.

Connealy recommends the higher dosage, especially since "absorption problems are so common with age" and "it's nearly impossible to overdose." She also recommends B12 injections for severe deficiencies. In particular, she says that vegetarians, vegans and those age 50 and older should take an oral B12 supplement every day.

Many Americans still don't use sunscreen, which has been proven to prevent skin cancer, the most common cancer in the U.S.

Sunscreen has been proven to reduce the risk for all types of skin cancer and to prevent or delay signs of aging, but most Americans still don't use it regularly, according to a new study by the federal Centers for Disease Control and Prevention.

The study, published in the Journal of the American Academy of Dermatology, found that only 14 percent of men and 30 percent of women regularly use sunscreen both on their face and other exposed areas. It also showed that more than 40 percent of men and 27 percent of women never use sunscreen on their face or other areas of exposed skin when outdoors for an hour or more, Carrie Myers reports for HealthDay News.

"The overwhelming majority of melanomas -- the deadliest form of skin cancer -- and non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun," Dr. Deborah Sarnoff, senior vice president of the Skin Cancer Foundation, told Myers. "That's why daily sun protection is critical," she said.

The foundation recommends that when you are out in the sun you should seek shade, wear protective clothing, including a broad-brimmed hat, wear UV-blocking sunglasses and wear a broad-spectrum daily sunscreen that has an SPF of 30 or higher and is water-resistant,of which you should check the expiration date, Sarnoff told Myers.

The study also found that nearly 40 percent of sunscreen users didn't know whether their sunscreen provided broad-spectrum protection.

"Broad-spectrum means that the sunscreen protects the skin from both UVA and UVB rays. UVB rays are responsible for sunburns, while UVA rays go deeper into the skin, causing sagging and wrinkling. It is believed that both UVA and UVB rays play a role in skin cancer," Myers writes.

"To take advantage of the full protection your sunscreen offers, it should be applied thickly to all exposed skin and reapplied every two hours and after swimming, sweating, and toweling off," Dawn Holman, lead author of the study, told Myers. "Sunscreen is most effective when paired with other forms of sun protection."

Holman recommended products with physical blocks, such as titanium dioxide and zinc oxide, for those who shy away from sunscreens because they fear the chemicals in them. She also told Myers that everyone should avoid midday sun exposure because that is when the UV rays are most intense and encouraged people to check the UV index before going outdoors, saying, "The higher the UV index, the more sun protection you will need."

Skin cancer is the most common cancer in the United States, according to the CDC. The most severe form, melanoma, causes more than 9,000 deaths a year in the United States, Myers reports.

'Mind Matters' Health Fair in Lexington May 18 will focus on brain and nutrition; famous chef will make free "brain healthy" food

Ouita Michel

Nationally known Bluegrass chef Ouita Michel of Midway, who owns seven Lexington-area eateries, will be cooking up free "brain healthy" food at the seventh annual "Mind Matters" Health Fair Monday, May 18 at the Fayette County Extension Office, 1140 Red Mile Place, Lexington.

The fair, sponsored by the University of Kentucky's Sanders-Brown Center on Aging, will run from 10 a.m. to 2 p.m. Its focus of this year is proper nutrition for a healthy brain, providing information on how diet can help promote healthy brain aging and prevent age-related brain disease.

In addition to Michel's free "brain healthy" food, the event will also feature interactive exhibits, health and memory screenings, and presentations about healthy brain aging, Alzheimer's and music therapy.

The event is free and open to the public. For more information contact Sarah Tarrant at (859) 323-1331.

KentuckyOne Health is offering mobile screenings for risk of heart attack and stroke, and cancer prevention, for a price

For a price, KentuckyOne Health is offering a new, mobile, preventive screening program at various locations around the state.

Screening packages range from $179 to $347 and are designed to evaluate an individual’s risk of heart attack, stroke and cancer. Patients are responsible for the cost, since KentuckyOne is not accepting Medicare, Medicaid or private insurance funding to pay for it at the time of service, but patients can submit their final report findings to their health provider and insurer for consideration of reimbursement.

“Through mobile screenings we can now expand cardiovascular and other health screenings throughout the commonwealth, including areas that may have limited access to these tests,” Alice Bridges, KentuckyOne's vice president for healthy communities said in a press release. “A major goal of this program is to help people become more aware of their health status and encourage active involvement in proactively managing their health.”

Tests included in the exam are: echocardiogram; electrocardiogram (ECG or EKG); hardening of the arteries test; stroke/carotid artery ultrasound; abdominal aortic aneurysm ultrasound; peripheral arterial disease test; Know Your Numbers®; high sensitivity c-reactive protein test (hs-CRP); thyroid-stimulating hormone test; testosterone test; and prostate specific antigen test (PSA).

The screening unit has  private exam rooms and the process takes less than an hour, according to the release. Technicians use painless ultrasound technology to examine the patient's heart and arteries to identify potential health risks, and then board certified physicians examine all results before providing patients with the report. The process takes approximately one week. Patients are encouraged to take their report back to their primary health provider for follow-up.

Mobile screenings are also available for partners of KentuckyOne Workplace Care.

 “Mobile screenings will allow us to bring services to the employer to help employees monitor their health and meet wellness goals," Shirley Kron, regional director of KentuckyOne Health Workplace Care, said in the release.

More information, including dates and locations, is available at Kentuckyonehealth.org/screenings or -855-721-8378.

How has the federal health-reform law changed your care?

Despite the controversy that continues to surround the Patient Protection and Affordable Act five years after its passage, it has probably changed the way your health care is delivered as it drives new models of payment, forces providers to approach care differently, and changes how health care is evaluated, Kavita Patel and Domitilla Masi report for the Brookings Institution.

Here are five ways the authors say that your health care might be different than it was five years ago because of the reform law:

Your physician might be part of a patient care team. New payment models in the ACA encourage an interdisciplinary team-based approach, which evidence shows "can lead to higher quality care and better health outcomes for patient." This approach allows the physician to spend more time diagnosing and devising a treatment plan, while the patient may spend more time interacting with non-physician staff for support care.

Prevention and wellness are more important than ever. The ACA requires health plans to cover all preventive screenings, immunizations and well visits for women at no cost, as part of the minimum benefits required in order for health-insurance plans to participate in exchanges like Kynect. The new payment models also pay physicians who work toward keeping their patients healthy, instead of just treating them when they are sick. " Since the policy took effect in September 2010 it is estimated that an additional 76 million people now receive preventive care," the authors write.

You may have better access to care on evenings and weekends. New payment models are driving this change as practices are often required to offer extended hours to decrease the overuse of emergency departments. Many offices now offer clinical advice around the clock with a clinician who has immediate access to their medical records.

Chances are your health information is being stored in an electronic health record, not a paper file. A separate law encouraged the use of EHRs, but "participation in the new ACA-promoted delivery models is practically impossible" without them. And while EHRs can be used to greatly improve patient care, not all EHRs are created equal and it will take time before patients see seamless integration and exchange between different doctors and settings in "real-time".

You can access care remotely, wherever you are. Doctors are using mobile technology and tele-health in rural and remote areas to provide more efficient care to patients. Insurance companies and employers are beginning to recognize this mode of treatment not only as a way to save money, but to also provide timely access to care, that does not involve the emergency room.

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

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."

Community health groups, with focus on prevention, fight to be part of new setup for lowering health costs, improving outcomes

The Patient Protection and Affordable Care Act is forcing doctors and hospitals to collaborate on lowering health-care costs while improving health outcomes. Community health groups that focus on preventive care are battling to be included as part of the solution, Laura Ungar reports for The Courier-Journal and USA Today.

One way physicians and hospitals are coming together to "reduce the duplication of services and keep large groups of patients well" is by forming accountable care organizations. Community health groups are having to fight for a "seat at the table" in these "doctor-dominated boards of ACOs," Ungar writes.

Such groups often offer less expensive, non-medical solutions for preventive health, according to a 2014 report by a North Carolina physicians' coalition. Some ACOs are beginning to include them as partners, but Bo Bobbitt, a Raleigh health-care lawyer who was lead author of the report, told Ungar, "The bad news is that the gap between the medical system treating illness and disease and the community health system was larger than we had feared."

Jose Pagan, a health economist who directs the New York Academy of Medicine's Center for Health Innovation, told Ungar that another key challenge is that doctors and hospitals are going to keep working to keep the money flowing their way. "If you go to a surgeon for a solution, they're not going to give you massage therapy," he says. "There's going to be progress, but it's going to be very slow."

Traditionally U.S. health care has focused its attention on "costly medical intervention," Ungar reports, instead of lifestyle changes, with only 3 percent of the $2.6 trillion health-care budget being spent public health and prevention, despite preventable chronic conditions accounting for 75 percent of medical care, according to a 2012 Institute of Medicine report.

"Compared to even the best medical therapy, we can decrease heart attacks, strokes and deaths by between 35 percent and 45 percent by changing lifestyle," Paul Rogers, a Louisville cardiologist at one of KentuckyOne Health System's healthy lifestyle centers, told Ungar.

For example, losing about 10 percent of weight reduces cardiac risks significantly, and losing 15 to 20 percent begins to reverse diabetes, lowers blood pressure, improves sleep and improves cholesterol level, Rogers said.

Another challenge for community-based programs is that little money goes into research on wellness programs, "and without studies, few will invest in their programs," Ungar notes.

Some members of Congress don't see nutrition, physical fitness or stop-smoking campaigns as health funding and gripe about the "nanny factor," Georges Benjamin, a physician who is executive director of the American Public Health Association, told Ungar.

As a result, "annual funding authorized by the ACA for the Prevention and Public Health Fund was supposed to hit $2 billion starting in 2015 but won't reach that level until at least 2022," Ungar reports.

Lifestyle changes are known to help chronic conditions, and Ungar gives many examples in the article. Here is one: Kevin French, 57, a construction contractor in Louisville, told Ungar that he began having chest pain and had to have two stents implanted in his heart in 1993.  And through cardiac rehab, he learned that his previous eating habits, which included lots of fast food, lack of exercise and smoking, played a big part in his heart problems. But with the help of the healthy lifestyle center, he said he  has "basically changed everything" about  his lifestyle and that's "improved not only his health but his family's as well."

Beshear cites signs toward better health: kids are more active and getting more dental care; adults are getting more screenings

Kentucky Health News

Kentucky is moving toward achieving the broad, ambitious goals for better health that Gov. Steve Beshear laid out when he started the "Kyhealthnow" initiative in February 2014, his office says.

"More Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services" since the initiative began, Beshear said in a press release.

The program builds on federal health reform, which has made Medicaid or private insurance available to hundreds of thousands of Kentuckians, many of whom were previously uninsured and unable to afford health coverage. According to a Gallup Poll released in February, 9.8 percent of Kentucky’s population is uninsured, down from 20.4 percent in 2013.

Kyhealthnow targets seven major health goals to be met by 2019, focusing on increasing health insurance coverage; reducing the smoking rate and tobacco use; lowering the prevalence of obesity; lowering cancer deaths; reducing cardiovascular disease; treating and reducing dental decay; and reducing drug overdoses and mental health issues in Kentucky.

The report said more adults have been screened and identified as having high blood pressure and are able to control their hypertension, and more adults have had their cholesterol checked.

Significantly more children on Medicaid are being seen by dentists, and the number of children enrolled in Medicaid receiving two fluoride dental varnishes per year has increased. The state has given money to five health departments for dental-hygiene programs, and will fund five more this year. "These programs broaden access to hygiene services, such as cleanings, screening and referrals, by providing staff and resources to supply mobile units to deliver care in schools," the release said.

School districts are showing an increase in the amount of time devoted to physical activity, the state reports. The Comprehensive School Physical Activity Program has been implemented at proficient or distinguished levels at all grade levels in 515 of the state's 746 elementary schools, 186 of the 329 middle schools and 109 of the 228 high schools. Also, more schools report they are using body-mass index data to inform school wellness policy.

The state health department is using federal funds to implement physical activity and obesity-prevention curricula in early-childhood care centers. "The goal is to develop healthy habits in children before the age of 5 and prevent obesity," the news release says.

To increase physical activity and deter obesity among older children and adults, the state is establishing “trail towns.” Morehead and Olive Hill were recently certified by the state Office of Adventure Tourism and eight more are expected to be certified this year. The Dawkins Trail, an ongoing rail-to-trail project in Eastern Kentucky, has reached a length of 18 miles.

Diabetes management has improved among adults, and a study of Medicaid patients showed an overall decrease in those with poor diabetes control, the release said. State employees now have easier access to the nationally recognized Diabetes Prevention Program, which helps people who are at risk of developing diabetes reverse the onset of the disease.

Dr. Stephanie Mayfield, the state health commissioner and vice chair of Kyhealthnow, has emphasized the importance of reducing tobacco use to make Kentuckians healthier. Beshear has expanded the ban on tobacco products and e-cigarettes on executive branch properties, making Kentucky one of only five states in the country with such a policy. Smoking bans exist in 24 communities, 37 school districts and 51 college or university campuses.

Kyhealthnow, chaired by Lt. Gov. Crit Luallen, includes people from many areas of state government who develop innovative strategies for addressing the state’s health woes and challenge local governments, businesses, schools, nonprofits and individuals to take meaningful steps toward improving health in their communities, the release said.

State Senate passes bills to lower a barrier to colon-cancer screening and allow patients to synchronize their prescriptions

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Two health-related bills, one to remove a financial barrier for colorectal cancer screenings and the other to allow consumers to synchronize prescriptions so they can get all of their medications on the same day, passed the state Senate Feb. 19.

Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, would clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are preventive measures that federal health reform require to be covered by insurance. It went to the House on a vote of 31-3.

"The purpose of this bill is to identify and correct ongoing discrepancies in the coding and billing portion of this screening and prevention continuum," said Alvarado, who is a physician.

The two primary ways to screen for colon cancer are colonoscopy or a non-invasive fecal blood test.

This bill was prompted because patients are being charged for a diagnostic procedure instead of a preventive one if they do a non-invasive fecal test that comes back positive, and then get a follow-up colonoscopy. The non-invasive fecal test is coded as a preventive screening, which is covered by insurance, but the colonoscopy is coded as a diagnostic procedure, which comes with a hefty price-tag, sometimes upwards of $1,000, Alvarado said.

Patients are also being charged for a diagnostic procedure if lesions are removed during the screening process, which is standard procedure to do so, since the patient would otherwise have to return for a second colonoscopy to remove them.

This is ironic, Alvarado said in a news release, because if the patient had chosen the more expensive and invasive colonoscopy initially, the insurance company would have paid for it.

This is a "barrier to screening," he said, in a state that leads the nation in colorectal cancer and until recently led the nation in deaths caused by it.

A sister bill, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, passed the House Feb. 9 and was assigned to the Senate Health and Welfare committee Feb. 12.

By a 34-0 vote, the Senate passed SB 44, sponsored by Sen. Julie Raque Adams, R-Louisville. It would allow patients with multiple prescriptions, in consultation with their health care provider and their pharmacist, to synchronize them so that they may be picked up from the pharmacy at the same time.

"This bill will allow patients to refill and pick up their prescribed medications for chronic conditions on the same day of the month instead of making multiple trips to the pharmacy," Adams said.

"This bill is not just about convenience," Adams said, but also helps make sure patients take their medication, "improving health outcomes and lowering health care cost overall." She cited a study that found patients who participated in a med-synchronization program at their pharmacy were 30 percent more likely to take their medicine as prescribed.

Some are concerned about the front-end cost of this program, "but fail to see the potential cost savings to the health care system overall," Adams said, saying a Medicare Part D cost-benefit analysis found there was an estimated savings of $1.8 billion to the system, and also showed improved medication adherence.

A sister bill, House Bill 140, sponsored by Rep. Addia Wuchner, R-Florence, was assigned to the House Banking and Insurance Committee on Jan. 9.

'Medicaid Dashboard' gives county-by-county details on 375,000 who joined program, what screenings they got, what they found

The expansion of the federal-state Medicaid program under federal health reform marks the biggest change in Kentucky health care since Medicare began in the mid-1960s. Almost 400,000 people have joined the program, raising its rolls to more than one-fourth of the state's population. This is an important story in almost every county, and the state has the data to tell it.

As part of the $141,000 study of the first year of Medicaid expansion, Deloitte Consulting created for the state and its citizens a "Medicaid Dashboard" that gives detailed information about the newly eligible Medicaid enrollees in every county, by age, gender and chronic health conditions, along with information about payments to health-care providers in each county. Here's a partial screenshot, with one county highlighted:

And here's an example of how data from that county can be broken down by age and gender:

In addition to these data, and detailed information about payments to providers, the dashboard also reveals how many new Medicaid enrollees have been diagnosed with what chronic conditions, and what screenings and other preventive services they have received. This can also be broken down by county. For the dashboard, go here.

The data are only for people who were made eligible for Medicaid by the expansion, which raised the income limit to 138 percent of the federal poverty line, from 69 percent. The data do not include several thousand people who had been eligible for Medicaid under the old limit but did not enroll until the limit was raised.

Medicare to pay for CT scans of people at high risk of lung cancer

Medicare will now pay for low-dose CT scans for people at high risk of getting lung cancer, a change welcomed by officials in Kentucky, which leads the nation in lung cancer and deaths from it.

"This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States," Dr. Patrick Conway, chief medical officer for the federal Centers for Medicare and Medicaid Services, said in a press release.

Lung cancer is especially deadly because it doesn't cause symptoms until it's too late, killing nearly 160,000 people a year, according to the American Cancer Society.

This new preventive coverage will allow Medicare to pay for a once-a-year, low-dose CT exam for people aged 55-77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent and have a written order from a doctor, reports Maggie Fox of NBC News.

Some doctors question how many people will benefit from the test, which costs $250 to $300, and have voiced concerns that it doesn't always produce clear results, causing patients to endure further testing than might turn out to have been unnecessary. Federal officials disagree, and experts say it will prevent as many 20 percent of U.S. deaths from lung cancer, "making it akin to mammograms and colonoscopies in terms of saving lives," Fox reports.

Tips for diabetics to stay healthy during the holiday season

Most people are not affected by occasional overindulging at holiday parties, but diabetics can get in serious health trouble if they aren't careful.

“If you are someone who is not in good control of your diabetes throughout the year, the holiday season can really make your situation worse,” Laila Tabatabai, an endocrinologist with Houston Methodist Hospital, says in a news release from the hospital. “If you are not mindful, eating foods with too many carbohydrates or sugars can send your blood sugar levels into a dangerously high range."

An abundance of high-fat, high-carbohydrate foods, parties with alcohol, desserts, food gifts and a change in routine that often doesn't allow time for exercise during the holiday season are some of the challenges that make it difficult for diabetics to maintain healthy blood sugar levels during the holidays.

The American Association of Diabetes Educators says in a news release that the best way to meet these challenges is to plan ahead.

“With the holidays coming, take some time to think about how you’ll deal with the events, the family you’ll be visiting and all of the to-dos,” Joan Bardsley, president of the group, said in its release. “By planning ahead you can enjoy the fun and still be healthy.”

The diabetes educators offer some tips on how to plan for these challenges:

• Make a healthy eating contract before attending a big meal, write down some goals and stick to them.
• Plan your plate: fill half of your plate with veggies, one-quarter with carbs (whole grain if possible), and one quarter with lean meat
• Avoid dark meat and remove any skin from your meat before eating
• Avoid gravy, and if you must have it, use only a little.
• Check with your doctor to make sure it is safe for you to have alcohol as it can interfere with some medications, including insulin. Sparkling water with a lime twist is a nice alternative.
• If alcohol is allowed, limit your intake. Have one glass of wine per party and skip the mixed drinks, which have more carbs. Or have a spritzer, half sparkling water and half wine. If drinking alcohol, make sure you eat, to avoid low blood sugar.
• Stay active during the holidays. Involve the family in activities that gets everyone up and moving, volunteer or sign up for a holiday run or walk.
• Minimize stress. Make time to unwind and relax.
• See a diabetes educator; they can help you make a plan for the holidays.

Tabatabai also suggested to be selective in the foods you choose to eat, only eating the special holiday dishes instead of everything; to bring a healthy dish that you enjoy; to avoid "white" carbohydrates such as potatoes; to limit portion sizes and to make sure family and friends are aware of your diabetes so that they can accommodate your food choices.

“Planning ahead and being smart with your choices will give you the chance to eat the foods you want while maintaining healthy glucose levels,” Tabatabai said in the release.

The AADE also offers these tips on traveling with diabetes:

• Bring extra medication and supplies if you are traveling.
• Pack two weeks worth of medication and supplies for one week of travel in case of travel delays or lost supplies. Make sure you include insulin, syringes, testing strips, insulin pump supplies, a first-aid kit, glucagon emergency kit, etc.
• Bring a prescription from your doctor for insulin or oral medication in case of emergency.
• If you are traveling by air, keep your medications and supplies with you at all times.

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.

Medicare plans to pay for lung-cancer screening, a boon to Ky.

The Centers for Medicare and Medicaid Services plan to start paying for lung cancer screening with low-dose CT scans for people at high risk.

Spiral CT (computed tomography), which is used to look for lung cancer, is a low-dose form of X-ray that delivers about the same radiation as a mammogram, Maggie Fox reports for NBC News.

“I think after a long effort to get to this point, CMS got it right,” Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, told Fox. “This has the potential of being one of the most significant cancer mortality-reducing efforts to date. We are finally focusing on what is a quarter of all cancer, and that’s lung cancer.”

Fox reports, "Experts project that the screening test, which costs $250-$300, may prevent as many as 20 percent of future deaths from lung cancer, making it akin to mammograms and colonoscopies in terms of saving lives."

The proposal covers people aged 55-74 who have smoked at least a pack a day for 30 years, or the equivalent. It is now open for a 30-day comment period.

Lung cancer is especially deadly because it usually doesn’t cause symptoms until it’s already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer. Nationally, it kills nearly 160,000 people a year, according to the American Cancer Society.

Concerns about using CT scans to screen for ling cancer are that it isn't cheap, it isn't harmless, and the scans aren't always clear, often causing patients to endure further needless testing, Fox reports: "The national lung screening trial showed that for every five to six lives saved by screening, one person died because of procedures done after screening, including surgery and biopsies that collapsed the lung."

That calls for caution. “We strongly advise older current and former heavy smokers to speak with their doctors about whether CT lung cancer screening is right for them,” Dr. Ella Kazerooni, chair of the American College of Radiology Lung Cancer Screening Committee, told Fox. “If they and their doctor decide that screening is warranted, we encourage patients to seek out an ACR lung cancer screening center.” 

Millions of children on Medicaid are missing free check-ups; Kentucky is a little below the national average

Millions of low-income children across the country aren't getting free preventive exams and screenings guaranteed by Medicaid, and some experts say federal and state health officials aren't doing enough to fix the problem, according to a federal watchdog report.

The report from the Department of Health and Human Services’ Office of Inspector General says that while the Obama administration has boosted rates of participation for children getting regular wellness exams, dental checkups and vision and hearing tests, it needs to do more.

The report says that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but most states are still falling short of the department’s 80 percent goal. Only Iowa and California met that participation rate goal last year.

In Kentucky, 57 percent of the 381,231 children covered by Medicaid who should have received at least one annual screening exam did so. Most states require at least one annual exam, and more frequent exams for infants. The reports shows that Kentucky's rate is better than 20 other states and equal to the rates in North Carolina, Rhode Island and Florida.

Some experts say state officials bear most of the responsibility for the low rates because they run Medicaid, the state-federal program for the poor, reports Phil Galewitz of Kaiser Health News. The OIG reports says the federal administration should be doing more to encourage states to address the problem.

"Child health advocates cite several factors for the low completion rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits," writes Galewitz.

Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program in 1967. In Kentucky, the EPSDT benefit includes screenings and special services, according to the Cabinet for Health and Human Services. Preventive care, such as routine physicals or well-child check ups, is provided under the screenings program.

Last year, 514,298 children were eligible for Kentucky’s EPSDT, says the the cabinet's annual participation report. Based on that number and eligibility periods, about 507,000 screenings were expected, but only 391,079 were, for a ratio of 83%. Additionally, the report says 236,830 children received dental services of any kind, with 208,783 receiving preventive services.

Some states require Medicaid health plans to educate members about the EPSDT benefit and what it covers. Others have implemented incentive plans that offer gift certificates for screenings. According to the National Academy for State Health Policy, Kentucky requires Medicaid managed-care organizations to provide an EPSDT coordinator to coordinate case-management services and continuity of care. Click here for more information about EPSDT screenings in Kentucky.

Medicaid expansion boosts preventive care

More Kentuckians than ever are using preventive care services since the state expanded Medicaid on Jan. 1, reports FamiliesUSA, a lobby for federal health reform that included the expansion.

Recent data from the state Cabinet for Health and Family Services show a 37 percent increase in the use of preventive care services since 2013, report Andrea Callow, a Medicaid policy analyst and Katie Supko, a Medicaid intern for FamiliesUSA. Of particular note is that more Kentuckians are getting screened for diseases that kill so many of us.

In 2013, Kentucky ranked first in cancer deaths and sixth in all premature deaths. It ranked 41st in annual dental visits and 45th in overall health status.

Since the expansion, which has provided coverage to more than 450,000 Kentuckians, the cabinet reports a 30 percent increase in breast cancer screenings, a 3 percent increase in cervical cancer screenings, a 16 percent increase in colorectal cancer screening and a 37 percent increase in adult dental visits.

Screenings and check-ups allow medical providers to identify health issues before they advance, and improves the chance that treatment will be successful. For example, with early detection, the five-year survival rate for breast cancer, the leading cause of cancer death in women, is 90 percent, and the rate for cervical cancer is nearly 100 percent, the writers note. Screenings for colon cancer, the second leading cause of cancer deaths in the U.S., have a five-year survival rate higher than 90 percent if detected early, but only 40 percent of colon-cancer diagnoses are made during this early stage.

At least one study, over two years in Oregon, found no preventive health benefits from expanding Medicaid, but advocates say it will work in the long term. "Medicaid expansion makes preventive care possible," the authors write. "Kentucky’s decision to expand Medicaid will undoubtedly reap the state many benefits, from a drop in the uninsured rate to an increase in economic activity" by expanding health-care jobs. "But the access to critical preventive care services may be the benefit that gives Kentucky a much-needed boost in the health status of its residents."