KentuckyOne Health teaches diabetics to manage the disease

KentuckyOne Health has launched a new program to help Kentuckians with diabetes learn how to self-manage their disease, according to a news release.

"Giving patients the tools and knowledge they need to manage their own health, including their diabetes, is an important way to empower them to take charge of their health," said Amanda Goldman, director of diabetes and nutrition care for KentuckyOne and quality and wellness director for food and nutrition services of Catholic Health Initiatives, a partner in KentuckyOne.

More than one in 10 Kentuckians have diabetes and the state ranks 17th in the nation in incidence of the disease, according to the 2014 "State of Obesity" report. The Kentucky Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes.

The new program will teach classes to help its participants learn how to manage diabetes testing and medication as well as the basics of using diet and exercise to improve their health. It will also offer individualized counseling sessions for those who need outpatient medical nutrition therapy.

The program is accredited through the American Association of Diabetes Educators and will be offered at the Healthy Lifestyle Centers at Jewish Hospital Medical Center Northeast, Sts. Mary and Elizabeth Hospital, Saint Joseph Hospital in Lexington, Saint Joseph East in Lexington, Saint Joseph Berea, Saint Joseph London, and Saint Joseph Jessamine. It will also offer outpatient services in downtown Louisville.

"Maintaining a healthy weight and a diet that's filled with nutrient-rich fruits, vegetables and whole grains can help not only to manage diabetes, but other health concerns like high blood pressure, high cholesterol, heart disease, stroke and more," says the release. The release also recommends regular exercise, under the direction of a health care provider, to "curb the effects of diabetes and other health concerns,"

Research indicates that students throw away less food since new, healthier lunch rules were put in place

One of the most consistent complaints about the healthier school-lunch standards is that more food ends up in the garbage can, but a three-year study at urban middle schools says the opposite is true.

"Overall, the revised meal standards and policies appear to have significantly lowered plate waste in school cafeterias," says the report of the study, conducted by the Rudd Center for Food Policy & Obesity at the University of Connecticut and published in Childhood Obesity. It found that since the new standards have been in place, students have "consumed more fruit, threw away less of the entrees and vegetables and consumed the same amount of milk."

The researchers tracked students at 12 urban, low-income middle schools in an unidentified "urban school district" for three years, from spring 2012 to spring 2014. They analyzed students' food selection and consumption by photographing and weighing students' lunch trays.

The 2010 Healthy and Hunger-Free Kids Act, which requires schools to reduce salt and fat; use more fresh fruits, vegetables and whole grains; and limit calories by age, was implemented in fall 2012.

The standards were put into place as an effort to combat child obesity. Kentucky is the first in the nation for high-school obesity, eighth in obesity of children 10-17, and sixth among 1-to 4-year-olds from low-income families, according to the "States of Obesity" report.

The study found that students ate more of their lunch entrees after the new standards went into effect, with 84 percent of students eating an entree in 2014, compared to 71 percent in 2012.

"Despite concerns that students do not like the new entrees that meet the whole grain and meat/meat alternate regulations, our data show that more students are selecting the entree and they are wasting significantly less because consumption is up to 84 percent," says the report.

It also found the share of students choosing vegetables dropped to 52 percent from 68 percent, but the students who chose vegetables ate nearly 20 percent more of them, "effectively lowering vegetable waste," says the report. The percentage of students choosing fruit "significantly increased" to 66 percent from 54 percent, with 74 percent of all students eating fruit.

Marlene Schwartz, the study's lead author and director of the Rudd Center, told Politico's Morning Agriculture that she expects the findings to be attacked, but said they are supported by solid data.

“I know that food directors have a really difficult job,” she told Morning Agriculture.“It’s hard to please all of the children all of the time, while keeping a tight budget … But I think [the shift to new standards] is the right thing to do."

The study was funded by the Robert Wood Johnson Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

State Senate passes bill for independent appeals process for managed-care claims; hearing gets into details of the problem

By Melissa Patrick
Kentucky Health News

Managed-care organizations' contracts allow them to deny Medicaid claims and not reimburse for services if they deem them not medically necessary. That means health-care providers often don't get paid for providing care, and their only recourse is an internal review by the MCO.

Sen. Ralph Alvarado

"It appears some of our MCOs are using this denial method in order to, as they term it, 'manage care'," Republican Sen. Ralph Alvarado said at a Senate Health and Welfare Committee hearing on his Senate Bill 120, which would set up an independent appeals process for providers, much like those in Georgia and Virginia.

The  bill, which had been in the works for several years, passed the Senate March 2 and was received in the House March 3. Its prospects in the House appear poor because it is opposed by the Cabinet for Health and Family Services, which oversees Medicaid. Its main targets are MCOs WellCare of Kentucky and Coventry Cares of Kentucky.

Alvarado, a Winchester physician, said in an interview that he pointed out these companies because they have the highest denial rates. While other companies also have complaints, "They are very small and minor, what you would expect in the normal course of business," he said. "It is WellCare and Coventry; these two are the names that keep coming up over and over again."

Asked for comment, Coventry said in an e-mail, "Coventry continues to monitor the legislation as it moves through the process. We are working with lawmakers to protect the integrity of the managed Medicaid program and be responsible with taxpayer dollars."

WellCare said in an e-mail that its appeals process is adequate, offering two additional remediation alternatives, negotiation and arbitration. The company said MCOs are "continuously subjected to rigorous oversight by state, federal and national accreditation entities," which ensure that they "adhere to strict standards and evidence-based guidelines in determining medical necessity."

Nina Eisner, board member of the Kentucky Hospital Association and chair of its Chemical Dependency Treatment Program, told the committee that providers deserve the same sort of state appeals process that patients have for denial of service.

"Kentucky's providers are under tremendous pressure from payment cuts from Medicare and slowed and denied payments by MCOs," Eisner said. "It is untenable and unreasonable to expect that Kentucky providers can provide health care services for free."

She said that many of the disputes stem from MCO reviews using out-of-state physicians who "don't always understand the rural nature of our state and the lack of resources." She said one example is discharging rural patients from inpatient to outpatient behavioral-health or substance-abuse treatment where no outpatient services are easily acessible.

"The MCOs in Kentucky are quite profitable," Eisner said, citing a November analysis by Citi Research that found Kentucky's MCO plans generated over $450 million in earnings before interest, taxes and depreciation from the state Medicaid program. "This is a margin of 10.6 percent, which is more than two times the 3 to 5 percent margin most Medicaid plans target."

Sen. David Givens, R-Greensburg, said he was compelled to remind those at the hearing that private companies need to be profitable to keep the system working. Later, Sen. Danny Carroll, R-Paducah, disagreed, saying MCOs' profits need to be more balanced.

Medicaid Commissioner Lisa Lee said that it is balanced, because MCOs were required to spend 87 percent of their payments on the population newly eligible for Medicaid or give it back to the federal government, and that rates going forward depend on what they spend today.

KHA's Nancy Galvagni said another reason for a state appeals process is the variation between plans' denial rates, ranging from a low of 7 percent to a high of 18 percent. She said that providers have gone to state hearings on behalf of their patients and had favorable opinions, only to have them overturned by the Cabinet.

Tina Heavrin, general counsel for the cabinet, said that occurs because the cabinet only has authority to decide whether patients received services, and if they did, there is no claim and any dispute regarding payment is between the MCO and the health-care provider.

Sen. Julie Raque Adams, the committee chair, replied, "I think that is the impetus behind this bill, that once the patient receives their service, they are done, but the provider is not. ... I don't want to go to work and not be paid for it. And I don't think that is an unreasonable thing to request or require and I think that is all that this bill does."

Heavrin said that providers do have a process to resolve these issues, "It is called the judiciary." She said the cabinet can't run an appeals process for MCOs because it "as part of the executive branch, doesn't have jurisdiction or legal authority over an adjudication of private contract rights." She added, "The MCOs are our contractors and it would be difficult to not have a financial interest in the outcomes of those appeals," meaning that upholding an appeal would cost the state money.

Lee said the cabinet acknowledges issues with MCOs. She said that while state officials should not get in the middle of contract disputes, "We do listen to our providers" and "want to hold our MCOs accountable," noting that they had "made some significant progress with managed care" since its inception in 2011.

Carroll, who deals daily with MCOs through his non-profit agency that provides therapy services and medical-based child care, said, "It is an absolute nightmare dealing with MCOs," because of all the "hoops to jump through in order to get reimbursement."

He asked if there was any way for the cabinet to work these issues out in its new contracts and said it felt like the state had "brought in these MCOs and basically washed their hands of all the issues associated with it."

Heavrin said it would not be possible to include a state appeals process in the contracts because "We can't be a judiciary."

Lee told Carroll that state officials had not "washed their hands" of the MCOs and closely monitor their activities. "We also have an obligation to the Center for Medicare and Medicaid Services to make sure that every single thing that we pay for does meet medical necessity," she said. CMS is the federal agency that oversees those programs.

Senate Republican leaders killed the smoking-ban bill passed by the Democratic House but some of them say its time may come

By Melissa Patrick
Kentucky Health News

On Feb. 13, for the first time, the Kentucky House of Representatives passed a statewide smoking ban to prohibit smoking in workplaces and indoor places. The bill moved to the Senate for consideration. On the same day, a state senator proposed a nearly identical bill. And on Feb. 19, both bills were assigned to a committee that was never going to give them a hearing.

Sen. Julie Raque Adams

Sen. Julie Raque Adams, R-Louisville, sponsor of the Senate bill, said it and the House bill would have been approved by the Senate Health and Welfare Committee, which she chairs. But leaders of the Senate's Republican majority sent it to the Veterans, Military Affairs and Public Protection Committee, chaired by Sen. Albert Robinson, R-London, who, like Senate President Robert Stivers, R-Manchester, opposes it.

“The time has come and gone," Adams said of chances to pass the ban.

If the bill is dead, who killed it? The most common explanation offered during a series of short interviews with senators was the "leadership," members of which have publicly said the bill didn't have the support it needed to bring it to a vote. However, some senators said it did.

“Leadership is not willing to hear it,” said Amy Barkley, chair of the Kentucky Smoke-free Coalition. “It is a small group of people in leadership who don't want to bring it to a vote. Why should a small group hold it up?” Barkley said that she would like leadership to "allow a vote, regardless of the results."

Sen. Tom Buford, R-Nicholasville, said the leadership "makes the decision about whether we hear a bill or not."

Stivers has said he opposes the bill because it would be too much government intervention into private business, and Buford said many other Republicans feel likewise. He said many members of his party "just do not want anybody to tell anybody what to do anymore."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat and Public Protection Committee member, said Republican leaders strategically placed the bill in the committee.

"It doesn't look like it will [be passed] as long as it is in Albert Robinson's committee," Clark said. "He is adamantly opposed to it. They knew that when they put it in his committee. They could have put it in Julie's committee and she is adamantly for it," he said.

The co-chair of the committee, Sen. C.B. Embry, R-Morgantown, said "Leadership determines what we vote on and when we vote. All the committees serve at the will of the leadership."

"If leadership wants it to pass, it's going to be heard," said Sen. Dennis Parrett, D-Vine Grove, a member of the committee.

Stivers, asked where the leadership stood on the issue, said "Until I see, or other people see in the leadership group, that there is support in the caucus for the issue, it is not going to come to the floor. If there is, it will. I haven't seen that groundswell of support for the issue." Floor Leader Damon Thayer, R-Georgetown, said likewise.

Another obstacle contributing to the bill's death was the Republican policy of not allowing bills to reach the full Senate unless they are favored by a majority Republicans, who have 27 of the 38 Senate seats.

Perhaps another was indicated by the latest lobbying report from the parent firm of Philip Morris Cos., Altria Group, saying that its legislative agents were lobbying against it. The sponsor of the House bill, Rep. Susan Westrom, D-Lexington, has said Kentucky Farm Bureau was her main foe.

Still, some senators thought there were enough votes for it to pass a floor vote.

“It would pass the floor," Buford said. "I think when you turn the light bulb on and they all have to show their hand, it would pass." Parrett agreed, and so did Sen. Morgan McGarvey, D-Louisville, a co-sponsor of the bill.

While Adams said she thought likewise, she also said she could not say that with "full confidence" because she had found in talking to the senators that many of the potential "yes" votes in the Senate wanted a bill without amendments. The House added provisions that these senators needed time to "digest" and "this session just wasn't long enough for us to do it," Adams said.

Advocates and sponsors continued to work on the bill even after its unfavorable assignment. Early on, co-sponsor Dr. Ralph Alvarado, R-Winchester, explored fellow senators' interest in an amendment allowing local governments to opt out of the ban, trying to make it more palatable to those who strongly favor local control. The advocacy groups opposed such an amendment.

"We rolled it out there and I just don't know that we had enough support," Alvarado said. "I asked individual members what their thoughts were and I got a lot to switch their vote and some who came to the fence, but the fence is not a yes, so that makes it a bit tougher. It would probably get some votes."

Buford said the opt-out option "keeps us from getting a vote" because he thought most senators wanted the law, if passed, to be consistent among all 120 counties.

Sen. Julian Carroll, D-Frankfort, a Public Protection Committee member, said he also opposed the amendment. "I think to make it an effective health statement and to attack the problem associated with so many diseases that result from not only smoking, but secondhand smoke, we have got to attack the problem itself," he said.

Senate President Pro Tem David Givens, R-Greensburg, said the opt-out option "never really caught fire" but he was "confident that it would have caught some votes."

Plans to resuscitate the smoking-ban bill are already under discussion.

"It is not going away," Adams said. "It is very near and dear to my heart, not only from a health standpoint, but from an economic development standpoint – it is very good for business in Kentucky – and finally from a fiscal standpoint, because the savings that we could realize from implementing a smoke-free statewide policy are just too dramatic to discount."

Adams said that they "would take up the House bill in the interim and see what those amendments mean and see if we can't get those people a clean smoke-free bill."

But Alvarado remains interested in compromise. "I think having an all or none response is going to probably get more of a none, so you have to find some method of coming to the middle," he said. "We are hoping that as more and more people come to side with us that they will put pressure on legislators to say this is OK."

Even Stivers offered advoctes some hope when he said that he was "one of 38" senators and that he had been known to put bills on the floor for a vote, despite his opposition, if "there was support in this chamber for that issue" and noted that more Republicans were "wanting to push the issue forward."

Republican Caucus Chair Dan Seum of Louisville said, "I think it is an idea whose time will come. It is about education and moving people (forward). It is also a generational thing."

Givens said that he did see a future for a smoke-free Kentucky, complementing the proponents and how they have conducted themselves in the discussion.

"It is an advocacy effort," he said. "What is happening is the same as what happens with lots of pieces of legislation. There is a large educational component to it and by the proponents continuing the conversation, continuing to promote the effort, they are educating the populace and educating people that elect us – when they start to move the electorate, they certainly start to move us."

Polls in the last year have shown that 57 to 66 percent of Kentucky adults support a smoking ban.

Casey County High School, which will be smoke-free next year, curbs smoking by locking the restrooms most used by smokers

For two weeks in February, Casey County High School students who wanted to smoke in one of the restrooms were unable to do so because they were locked, Editor Larry Rowell reports for the Casey County News. Principal Josh Blevins said he locked restrooms "most frequented by the students who chose to smoke."

In September, the Casey County School Board passed a prospective tobacco-free rule, so students and staff will not be allowed to smoke in school buildings next year. Locking the restrooms was a way of sending a message. "That was not my long-term plan," Blevins said. "I was using this as a launch pad saying it [smoking] wouldn't be tolerated."

Blevins started a policy requiring students to ask permission and use a sign-out sheet to use the bathroom during class. The restrooms located near the administrative offices are never locked. he said students have the option of reporting to class and asking to use the restroom.

At least one parent did not agree with the new rules. Ellena Hussey, whose daughter attends the school, told Rowell that the students should have bathroom access between classes. She said her daughter has received 10 tardy slips because she had to wait in line to use the only unlocked restroom. Blevins said he had not heard from any parents who had a problem with his actions.

Local building contractor Kenneth Blevins said one restroom with four stalls is enough for the 200 students who attend the school. "The building code says you have to have one facility for the first 49 people and an additional one for every 50 you have," he said.

Breathitt County High School employed another method to curb student smoking. "We open all bathrooms at break time between classes," Supt. Larry Hammond told the Casey County News. "They are locked during class, and they can go to the bathroom between classes, before school, during lunch and after school. They are supervised by teachers." Students who need to use the bathroom during class get a pass and use the restroom in the principal's office.

"It at least controls the smell of smoke in the school building," Hammond said. "You don't smell it down the hallway." (Read more)