Princess Health and Kids Count report finds Ky. remains in the bottom 1/3 of states for children's well-being; is this a predictor of the state's future?. Princessiccia

Princess Health and Kids Count report finds Ky. remains in the bottom 1/3 of states for children's well-being; is this a predictor of the state's future?. Princessiccia

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Gusty 21:01 Add Comment

By Melissa Patrick
Kentucky Health News

If Kentucky's future lies in the well-being of its children, there's reason to worry, because a recent report shows that Kentucky consistently remains in the bottom one-third of states for this measure.

The 2016 Kids Count report ranks Kentucky 35th in the overall well-being of its children, down from 34th last year. The state showed a significant improvement in its health ranking and a further drop in its teen birth rate, but otherwise didn't show much change from last year's report by the Annie E. Casey Foundation and Kentucky Youth Advocates.

"The real issue is not a drop or increase of one position, but rather that Kentucky continues to be in the bottom one-third of all states," KYA Executive Director Terry Brooks said in a news release. "Are we really content with the idea that two-thirds of America's children are better off than Kentucky kids?"

The annual report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data are for 2014, and is compared with data from the last six or so years earlier. The report focuses on four major domains: economic security, education, health and family and community security.

Kentucky continues to rank highest in health, climbing to 16th from 24th in 2015, 28th in 2014 and 31st in 2013. Contributors included a continued drop in the number of children without health insurance (4 percent); a 15 percent decrease in child and teen mortality, fewer teens abusing alcohol or drugs (4 percent) and improvements in the percentage of low-birthweight babies (8.8 percent).

The state's greatest drop among the rankings was in economic security, going down to 37th from 32nd last year. Education (27th) saw a slight improvement from the past two years and the family and community (38th) rankings remained similar to the past three years.

The release notes that the state now ranks 10th for the percentage of children with health insurance.

"We are seeing better outcomes for kids in Kentucky, and expanded health coverage and access to quality care play a vital role in making that happen," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in the release. "Research shows that when parents have health coverage, their children are more likely to also be signed up for health insurance."

Another bright spot in the report is that the state's teen birth rate continues to drop. It declined 34 percent from 2008 to 2014. While Kentucky still has one of the nation's highest teen birth rates, it dropped to 35 births per 1,000 girls aged 15-19 in 2014, down from 39 per 1,000 in 2013 and 53 per 1,000 in 2008. The national average is 24 per 1,000, an all-time low.

Kentucky consistently ranks lowest in the "family and community" domain, with 35 percent of its children living in single-parent families; 12 percent living in families where the household head lacks a high school degree; and 16 percent living in high-poverty areas, which are neighborhoods where more than 30 percent of residents live in poverty.

"Kentucky will thrive when policies that support the whole family, caregiver and child, are implemented," Adrienne Bush, executive director of Hazard Perry County Community Ministries, said in the release.

And though the state's education ranking improved to 27th from 30th, not much has changed in these indicators since the foundation started doing this report. The bottom line is that more than half of fourth graders (60 percent) still can't read at a national proficiency level and that the majority of eighth graders (72 percent) still aren't proficient in math. (In 2007, these indicators were 67 percent and 73 percent respectively.)

"Student performance should alarm parents and business leaders and jolt Kentucky leaders into making fundamental education reform a policy priority to ensure college and career readiness," Brooks said.

In addition, more than half the state's three-and four-year-olds (58 percent) don't attend pre-school and 17 percent of its high school students don't graduate on time.

Perhaps the direst message from the report is about the state's economic well-being. One in four Kentucky children live in poverty (26 percent), a rate that has remained higher than it was pre-recession when it was 23 percent, says the release. Nationally, the child poverty rate is 22 percent.

"Growing up in poverty is one of the greatest threats to healthy child development," says the report. "Poverty can impede cognitive development and a child's ability to learn."

The report also says 35 percent of Kentucky's children live in homes with parents who don't have secure employment, which places the state in the bottom 10 states for this indicator. It also found that 28 percent live in households with a high housing-cost burden.

The release suggested "bipartisan solutions" to improve the well-being of Kentucky's children, including expanding oral health coverage; supporting school-based health centers; education reform that includes public charter schools, expanded child care assistance and family-focused tax reforms.

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

economy federal spending health reform jobs Medicaid obamacare Patient Protection and Affordable Health Care Act politics prevention state budget state government

Gusty 13:15 Add Comment

By Danielle Ray

Kentucky Health News

A research group with a liberal outlook warned Monday that Republican Gov. Matt Bevin should be careful in changing the state Medicaid program.

The Kentucky Center for Economic Policy said the state�s expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has increased health screenings and job growth in health care.

Tobacco counseling and interventions increased 169 percent from 2013 to 2014, the first year of the expansion, the report noted. Influenza vaccinations went up 143 percent and breast cancer screenings increased 111 percent, it noted.

In addition, Medicaid expansion brought Kentucky health-care providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job growth in the health-care sector from 2014 to 2016, according to the report.

�No matter how you look at Medicaid expansion in Kentucky, it�s clear it has had a positive effect on access to health care that will improve our state�s economy and quality of life,� Jason Bailey, executive director of KCEP, said in a news release.

However, Bevin says the state can�t afford to have more than a fourth of its population on Medicaid and is seeking a waiver from the federal government to make changes in the program, such as �skin in the game� for beneficiaries: co-payments, deductibles or health savings accounts, as used in a year-old experiment in Indiana, which he has cited as an example.

The KCEP reports says the Medicaid waiver Bevin is seeking could result in additional costs to recipients and benefit changes. Arkansas was the first state to design a Medicaid expansion using such a waiver. So far, five other states have implemented similar waiver-based programs.

Waiver programs differ from standard Medicaid expansion in that they utilize some or all of the following: health savings accounts, a cost-sharing account to be used for health care expenses; lockouts, periods in which recipients who have been dis-enrolled for failure to pay premiums are barred from re-enrolling; and premium assistance, the use of Medicaid funds to buy private insurance plans.

These waivers are designed to grant states the freedom to enact experimental programs within Medicaid, so long as the programs continue to reflect the overall goal of Medicaid, increasing coverage of low-income individuals and improving overall health care, as well as efficiency and stability of health care programs that serve that population.

The Foundation for a Healthy Kentucky, which convened a meeting of Medicaid stakeholders last week, is holding off on making judgments of the proposed waiver program. �We believe that diverse input is essential to sustaining these gains, and to continue improving our health care system and health outcomes in Kentucky,� said Susan Zepeda, president of the foundation.

Zepeda said research the foundation has funded has shown a greater decrease in the number of Kentuckians who lack health insurance than any other state, which she attributes largely to Medicaid expansion adding about 400,000 Kentuckians to the rolls.

More than 1.4 million Kentuckians are enrolled in Medicaid, 39 percent of whom are children. Nearly 32 percent are enrolled under the expansion: childless adults in households that earn less than 138 percent of the federal poverty line, currently $33,000 for a family of four.

The KCEP report also asserts that Kentucky�s Medicaid benefits are on par with those of other states, specifically that 12 out of 13 of Kentucky�s optional benefits are also covered in at least 40 other states and territories. Kentucky Medicaid only covers services that are deemed medically necessary.

KCEP noted that Medicaid is a partnership in which the federal government funds a minimum of half of traditional Medicaid spending in each state, with poorer states receiving a larger federal match. In Kentucky, the federal share is about 70 percent. For people covered by the expansion, the federal government is paying the full cost through this year, but the state will pay 5 percent in 2017, rising in annual steps to the law�s limit of 10 percent in 2020.

The full KCEP report is at http://kypolicy.org.

Princess Health and Prescription drug addiction not only comes at a personal cost to individuals, but also at an enormous cost to employers. Princessiccia

Princess Health and Prescription drug addiction not only comes at a personal cost to individuals, but also at an enormous cost to employers. Princessiccia

drug abuse economy employers health insurance narcotics prescription drug abuse research

Gusty 20:09 Add Comment

By Melissa Patrick
Kentucky Health News

With nearly one of three opioid prescriptions being abused, employers are not only subsidizing the cost of these drugs, they are also paying for the fallout that results from the abuse, according to a new study.

"The personal impact that opioid painkiller abuse takes on individuals, their friends, and family is absolutely tragic,� Kristin Torres Mowat, senior vice president of health plan and strategic data operations for Castlight Health, the health-information firm that led the study, said in a news release. �This crisis is also having a significant impact on the nation�s employers, both in the form of direct and indirect costs. From higher spending on healthcare, to lost productivity, to the dangers associated with employees abusing medications in the workplace: these are aspects of the crisis that are too often overlooked in the current discussion.�

The study, titled "The Opioid Crisis in America's Workforce," looked at anonymous claims data from nearly a million employer-based health insurance claims between 2011 and 2015, defining abuse as those who received more than a 90-day supply of opioid prescriptions and received prescriptions from four or more providers. It excluded claims that had cancer, palliative care or convalescence care diagnoses.

Graph from "The Opioid Crisis in America's Workforce" report

The study found that 22 of the top 25 cities that abuse opioids are in the rural South. Henderson was the only Kentucky town on this list, as part of the Evansville, Ind., metropolitan area, which had a 7.8 percent opioid abuse rate.

Kentucky ranks fourth in the nation for painkiller prescriptions, at about 130 prescriptions for every 100 people, Christine Vestal reports for Stateline.

So why aren't more Kentucky towns on the list? "Anywhere with a ZIP code is included," Castlight spokeswoman Cynthia Cowen said in an email. "However, in less populated regions, showing the abuse rates may inadvertently lead to patient identification."

The Castlight study also found that on average, 4.5 percent of Americans who get narcotic painkiller prescriptions are abusers, and account for nearly one-third (32 percent) of total opioid prescriptions and 40 percent of opioid prescription spending.

And the cost to employers is huge, estimated at $10 billion annually for absenteeism and poor work productivity, says the report. In 2015, the study found that employers spent nearly twice as much ($19,450) in medical expenses on opioid abusers annually than on non-abusers ($10,853), a difference of $8,597.

The study offered some additional insights, including: baby boomers are nearly four times more likely to abuse opioids than Millennials; poorer people are twice as likely to abuse opioids as rich ones; states with medical marijuana laws have a lower opioid abuse rate than those that don't; patients with a behavioral health diagnosis of any kind are three times more likely to abuse opioids than those without one; and opioid abusers have twice as many pain-related conditions as non-abusers.

The federal Centers for Disease Control and Prevention has called this issue a public-health crisis and has asked doctors to change the way they prescribe opioids, by only prescribing them for three to seven days at the lowest possible effective dose.

According to the CDC, nearly 2 million Americans are abusing prescription opioids, resulting in 16,000 deaths per year. In 2014, the latest data available, 1,087 Kentuckians died of overdoses, according to the Kentucky Office of Drug Control Policy.

The report suggests that employers have a role to play in addressing this through the use of data and analytics to determine prescribing trends that can then help them better understand what their employers needs are as they relate to opioid use and abuse, and then to guide them to appropriate benefit programs to prevent or treat their addictions.

Princess Health and In Pineville, a new administrator from a Texas management firm is shaking up the local hospital in an effort to save it. Princessiccia

Princess Health and In Pineville, a new administrator from a Texas management firm is shaking up the local hospital in an effort to save it. Princessiccia

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Gusty 10:16 Add Comment

Kentucky Health News

The crisis in rural hospitals is driven not only by changes in federal reimbursement and patients' increasing preference for larger hospitals, but in some towns by managerial shortcomings that may follow local tradition but hurt the bottom line. Changing those practices can be difficult, but the new administrator of the Pineville Community Hospital appears to be having success as he grabs the bull by the horns.

Stace Holland (Modern Healthcare photo by Harris Meyer)

Longtime rural hospital administrator Stace Holland has put PCH "on the road to recovery by cutting costs, bringing in more federal funds and getting staffers to change their ways," Modern Healthcare reports in a long story than delves into the details, from specific expense cuts to clashes with physicians.

The 120-bed hospital is staffed for only 30 (not counting a 26-bed nursing unit) and was losing $6 million a year. Eight months after taking over as CEO, "Holland is well on the way to turning around a struggling not-for-profit facility that still expects to lose $3 million this year. With support from the Plano, Texas-based Community Hospital Corp., which took over management of the hospital in October 2014, Holland already has made significant progress toward stabilizing its finances," Harris Meyer reports.

"Holland faced a challenge that is all too familiar to rural hospital leaders around the country: declining patient volumes; a preponderance of low-paying Medicare, Medicaid and uninsured patients; public and private rate squeezes; high incidence of chronic disease and drug abuse; difficulty in recruiting physicians; and a shortage of funds to invest in new equipment and services. . . .  To save the hospital, whose previous CEO served nearly 40 years, Holland, Chief Nursing Officer Dinah Jarvis, and CHC knew they had to take tough steps that would unsettle physicians, staffers and local residents accustomed to the old comfortable ways."

The new ways included a partnership with the Baptist Health hospital in Corbin to help PCH compete with the Appalachian Regional Hospital in nearby Middlesboro, partly with a 12-bed geriatric psychiatry unit; a federal rural health facility license that significantly boosted Medicare and Medicaid payments," and "clinical protocols to improve quality of care and reduce readmissions," which were so frequent in 2013 and 2014 that they drew Medicare's maximum penalty, Meyer reports. But the new protocols, such as "pre-discharge education of congestive-heart-failure patients about medication use and weight monitoring," riled some physicians.

Dr. Steven Morgan told Meyer, �They want to pound square pegs into round holes.� Dr. Shawn Fugate said he had to fight with CHC for "what he thought were adequate nurse staffing levels, and that CHC is making too many important decisions from afar," Meyer reports. As an employee of CHC rather than the hospital, Holland can "speak frankly," Meyer writes. "He recently told an older surgeon who serves on the board that it was time for him to retire."

Pineville is on the old Wilderness Road (in red) and US 25-E.

Pineville Mayor Scott Madon told Meyer, �Stace has an unbelievable task in what he's dealing with. He's trying to reinvent the rural hospital. He has to change the whole thinking, and people don't like it.� But longtime hospital board member David Gambrell, a real-estate agent whose son will start as a family physician there soon, said Holland's approach has been �refreshing. . . . We need that kind of honesty. It's taken Stace coming here to see we needed a new vision.�

Meyer reports, "Local leaders see the Pineville hospital's survival as pivotal to the future of the town and Bell County, which has no other hospital and has lost many coal-mining jobs. They say the hospital, the city's largest employer, is key to their economic redevelopment efforts. . . . The Pineville hospital has strong customer loyalty. Its staff�most of whom are local residents who have worked there for many years�have deep ties to the patient population." Wilma Sizemore, a 70-year-old disabled woman who was admitted in mid-February for bronchitis and dizziness, told him, �I wouldn't doctor nowhere else but this hospital. They treat me like family here.�

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

accountability drug abuse economy health care access Medicaid obesity Patient Protection and Affordable Care Act rural health rural hospitals

Gusty 18:04 Add Comment

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

�We're able to do more for Kentucky patients,� Christy Elliott, the hospital's case management supervisor, told Meyer. �For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.�

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

�The care here is excellent,� a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. �Whatever you need, they are right at the door, and everyone is really friendly.�

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

�A lot depends on economic development in these communities,� Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. �What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.�

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

�There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,� Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. �You can't draw more patients if you don't have enough people to take care of them.�

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, �People would die for lack of health care if we didn't have a hospital in this community.�

Princess Health andBaptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort.Princessiccia

Princess Health andBaptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort.Princessiccia

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Gusty 18:02 Add Comment

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."

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Appalachia county health economy health status poverty research

Gusty 06:59 Add Comment

Though some people equate Appalachian areas with poverty, David Krol seeks to "shine a light" on a different picture�one that reflects "how health can flourish across Appalachia," despite data that confirms economic hardship, Krol writes for the Robert Wood Johnson Foundation.

While Krol was reviewing the Appalachian Regional Commission's county-based economic data, which compares economic indicators like poverty and unemployment rates with national averages and then ranks each county, it occurred to him to overlay this county index with the annual County Health Rankings.

For the most part, Krol said he found what he expected, "that the most economically distressed counties in Appalachia would also be in the lowest quartiles of health outcomes and factors for their state." But some counties that were economically distressed ranked in the top quarter of their state in health factors and outcomes.

"What was it about Wirt County, West Virginia; Pickett County, Tennessee; and Oktibbeha County, Mississippi, that helped them overcome significant economic challenges towards better health outcomes when similarly distressed counties in the same state did not?" he wrote.

The need to know why these "unexpected outliers" occurred has prompted Krol, with the help of the ARC and the Foundation for a Healthy Kentucky, to study how these counties have accomplished this and to look at whether this could be re-created in similar communities.

"This approach is rooted in the belief that communities have the best solutions to the problems they face�as opposed to solutions driven by outside experts," he wrote.

It�s an opportunity to �go beyond the data.. to community conversations about what�s important,� Susan Zepeda, CEO of the foundation, told Krol.

Krol wrote, "Quantitative data can get only get us so far�it�s up to us to ask those critical questions of �Why? How? What can be done? It�s up to us to turn data into action."