Princess Health and Ashland hospital expands into wellness and prevention programs. Princessiccia

Princess Health and Ashland hospital expands into wellness and prevention programs. Princessiccia

diabetes employers health insurance hospitals jobs physical activity prevention wellness

Gusty 06:12 Add Comment

By Judi Kanne
Kentucky Health News

Hospitals� basic business is taking care of the sick and injured, not keeping people from getting sick. But more and more of them are getting into wellness and prevention, not only to help their communities but to make money.

King's Daughters Heart and Vascular Center

One of those is King�s Daughters Medical Center in Ashland, which has developed an innovative strategy for building relationships with local employers to help their employees live healthier lives.

King�s Daughters began by focusing on self-insured employers, who can get the most direct benefit from reduced health-care expenses. It used one-to-one employer outreach activities such as a farm-to-table employer lunch, to which more than 126 local employers were invited.

The first question for employers, said Matt Ebaugh, vice president and chief strategy officer at King�s Daughters, is �Do you understand what is driving the cost for your employees?� because �Self-funded employers do not always have the analytics or tools needed to understand where those costs come from.�

King�s Daughters used Strategic Health Services of Alpharetta, Ga., to create a portal for health risk assessment, biometric screening results, claims analytics and personal health profiles of employees.

While the program is aimed at wellness, it also finds new cases for the hospital. �We knew if we did a smart thing for local employers, demonstrated value, and coupled it with good customer service, then when employees needed a higher level of care, they would come to us,� Ebaugh said.

By means of screenings for diabetes, cholesterol, and body mass index, employees become patients.

Diabetes screening can be critical. About 86 million American adults are pre-diabetic, but nine out of 10 people who are don�t know it, according to the federal Centers for Disease Control and Prevention. That can be detected with health-risk assessment lifestyle questionnaires.

Beyond individual screenings, hospitals can examine the emerging risks in a population using claims data. That can also help them show employers what�s driving up their costs. Claims also indicate which employees are most likely to use hospital and pharmacy services.

�We need to find innovative ways to motivate individuals to change old and dangerous patterns,� Ebaugh said, because simple lifestyle changes can dramatically cut the risk for developing diabetes.

But getting healthy may require offering financial and other incentives to get people to participate in wellness programs. The Ashland hospital plans to try gamification, incorporating into the workday a set of programmed games and activities that remind sedentary employees to get up, stretch, and move around.

The idea is to make health and fitness fun, a social experience and accessible to as many members as possible. Gamification programs include computer notifications or other reminders that stimulate sedentary disruption and track activity. In some cases, motivation includes team competition in which employees win points by stopping to stretch.

Ebaugh said such programs have been shown to work and are critical in some cases, because a pre-diabetic employee may not be motivated enough to change eating and exercise patterns. �Knowing is not enough,� he said. �We anticipate the energy and participation with gamification will increase as a result of more engaging activities.�

The hospital first started a wellness program for its own employees, and plans to add gamification to it, Ebaugh said: �It�s important our model work well to show our employers the success we are having with our internal employees.�

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

health insurance Kynect Medicaid obamacare state government

Gusty 16:00 Add Comment

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

drug abuse health insurance health reform heroin obamacare poll polls prescription drug abuse smoking smoking ban smoking bans tobacco

Gusty 21:01 Add Comment

By Al Cross
Kentucky Health News

In a state that once had more tobacco farms than any other, Kentuckians in all regions of the state support policies that discourage use of the product, according to the Kentucky Health Issues Poll.

"Such policies could greatly improve Kentucky's overall health," says the Foundation for a Healthy Kentucky, which co-sponsors the poll each fall. It issued a package of reports that broke down a wife range of previously reported poll results on a regional basis.

Kentucky has fewer than 5,000 tobacco farms, down from a high of 60,000 in 1982, but still has one of the nation's highest smoking rates, 26 percent. That leads to an estimated $2 billion in annual health-care costs.

In every region of the state, a majority (ranging from 59 to 70 percent) of people polled said it would be "difficult" or "very difficult" to make the most important change in their personal health behavior, which for most smokers would be to stop smoking.

"Kentucky adults in every region recognize that improving diet, getting more exercise and quitting smoking could help improve personal health, but the changes are difficult," said Susan Zepeda, president and CEO of the foundation. "Policies around these areas could help all Kentuckians improve their personal health."

The policy getting the strongest support in the poll was tobacco-free school campuses, favored by 85 percent statewide. Fewer than a third of Kentucky's school districts have such policies, but enough do to cover almost half the population.

A statewide ban on smoking in workplaces got 66 percent support. Such a ban is unlikely during the administration of Gov. Matt Bevin, who says the issue should be decided locally. About a third of the state's population lives in jurisdictions with comprehensive smoke-free ordinances; another 10 percent or so live in places that have ordinances with varying exceptions.

There was little difference among the five regions in polling on the two issues.

The poll found regional differences in the percentage of Kentucky adults who said they had no insurance, from 18 percent in Western Kentucky to 8 percent in Eastern Kentucky. The statewide uninsured rate reported at the time of the poll was 13 percent. Other surveys have showed the number in the single digits statewide, after expansion of the Medicaid program under federal health reform.

Health reform also provided subsidies for buying insurance, but some consumers have complained about high deductibles and co-payments. In Northern Kentucky, 34 percent of poll respondents said they had difficulties paying their medical bills in the previous 12 months. The figure was 31 percent in Appalachian Kentucky, 30 percent in Greater Louisville, 25 percent in Western Kentucky, and 22 percent in Greater Lexington.

"An increasing number of Kentuckians have health insurance, but many are still delaying or simply can't afford necessary health care," Zepeda said.

Federal health reform was most popular in the Louisville area, at 44 percent support, and least popular in Northern Kentucky, with 33 percent. Generally, the more impact people said reform had on them, the more likely they were to support it. Three of five Northern Kentuckians said they had not been affected by the reforms but only 45 percent in the Louisville area said that.

There are bigger differences in the impact of drug abuse. One-third of Eastern Kentucky residents in the poll reported reported family members or friends struggling with prescription drug abuse, but only 16 percent in Western Kentucky said so.

Heroin use has caused problems for 35 percent of respondents' families and friends in Northern Kentucky, 17 percent in Greater Louisville, 14 percent in Greater Lexington, 10 percent in Eastern Kentucky, and 8 percent in Western Kentucky.

The regional reports for Eastern Kentucky, Greater Lexington, Greater Louisville, Northern Kentucky, and Western Kentucky, and associated news releases, are available at http://healthy-ky.org/news-events/press-releases.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by landlines and cell phones. The statewide poll has a margin of error of plus or minus 2.4 percentage points, but the smaller regional samples have higher error margins. The complete data file, codebook and survey instrument will be posted by June 30 at http://www.oasisdataarchive.org/ with other data files from previous polls.

Princess Health and WellCare provides twist-on naloxone nasal atomizers for free, encourages those who know addicts to have naloxone on hand. Princessiccia

Princess Health and WellCare provides twist-on naloxone nasal atomizers for free, encourages those who know addicts to have naloxone on hand. Princessiccia

drug abuse drug treatment drug use health insurance heroin pharmacists

Gusty 15:15 Add Comment

WellCare of Kentucky and the Kentucky Pharmacists Association have teamed up to provide 1000 twist-on naloxone nasal atomizers for free, in hopes of making it easier for people to administer the drug.

Dr. Paul Kensicki

"We believe this will make it easier, and less intimidating, for people with no medical background to administer it in an emergency situation," Paul Kensicki, medical director of behavioral health at WellCare of Kentucky, said in op-ed released by Wellcare.

WellCare will provide the atomizers to pharmacists, who will then distribute them to Medicaid recipients and individuals with no insurance coverage.

Kentucky's 2015 anti-heroin law allows pharmacists to dispense naloxone (brand name Narcan), a drug that can reverse the effects of a heroin overdose, without a prescription.Traditionally, the drug has been given as an injection, but the atomizer transforms the syringe to allow it to be administered as a nasal spray.

Naloxone immediately reverses the effects of an opioid overdose by physiologically blocking the effects of the drug. It has no side effects and cannot be abused. "It�s nothing short of a miracle drug," Kensicki writes. "It can absolutely save a life."

More than 1,000 Kentuckians die each year from drug overdoses, with more than 200 of these deaths from heroin. It has become a more common cause of death than car accidents in Kentucky.

"People who know someone who is using opioids, such as a spouse, parent or a roommate, should have naloxone readily available in case they discover an overdose in progress," Kensicki writes.

He notes that patients may be at the most risk of an overdose during recovery, because if they relapse their bodies aren't able to process the same amount of the drug they had been accustomed to before trying to quit.

"Making naloxone available does not mean it is �okay� to use heroin, and we are certainly not removing all the risks of addiction," Kensicki writes. "But we are giving friends and families a tool they can use to help save their loved ones in emergency situations � buying people the time they need to fight their addiction."

Princess Health and Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

Princess Health and Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

health care costs health insurance insurance coverage Medicaid

Gusty 14:16 Add Comment

By Melissa Patrick
Kentucky Health News

A health-care advocacy group says the redesign of the Medicaid program should build on the expansion of eligibility and not include any more costs for patients.

�Kentucky has made tremendous gains in improving the health of its people since the expansion of Medicaid. More Kentuckians are receiving preventive services, substance use treatment and other critically needed care than ever before,� Emily Beauregard, executive director of Kentucky Voices for Health, said in a news release. �Any changes to the program should build on this success.�

Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to households with incomes up to 138 percent of the federal poverty level, which added about 400,000 more Kentuckians to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020. In all, about 1.3 million Kentuckians get free health care through Medicaid.

Gov. Matt Bevin has said the state can't afford to have more than a fourth of its population on Medicaid and has charged his administration to come up with a revised program that will improve health outcomes while making the expansion financially sustainable. Bevin hopes to accomplish this through a waiver from the federal government.

Bevin has said he favors a waiver program like Indiana's, which includes premiums and co-pays in some tiers of coverage, but has also said that he is not limited by this model and will develop a waiver to best fit the needs of Kentucky.

Kentucky Voices for Health is a coalition  of organizations that favor federal health reform, some of of which lobby the government. It said changes should engage consumers in their care and develop new ways to deliver care, without any obstacles to coverage such as premiums.

�Coverage is foundational,� Rich Seckel, executive director of Kentucky Equal Justice Center, said in the release. �It empowers us with tools to achieve and maintain health.�

The coalition also said the program should focus on coordination of care in areas with high use, and build on Kentucky's Health Data Trust, which provides complete and transparent information about healthcare utilization and outcomes to improve public health and quality of care delivery. Click here for the full report.

The group stressed the importance of meaningful stakeholder input to ensure the waiver is designed to meet the unique needs of Kentucky. So far, the administration has had no formal stakeholder meetings on the issue.

Under federal law, states seeking a waiver must hold at least two public hearings; one before it is submitted to the Centers for Medicare and Medicaid Services and the second after CMS accepts the application.

Amanda Stamper, press secretary to Bevin, told The Courier-Journal that the administration welcomed "this sort of thoughtful input," and when asked if the waiver would include any premiums or co-pays said, "Everything is on the table and no decisions have been finalized."

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

governor health insurance health reform Medicaid obamacare politics state budget state government

Gusty 19:05 Add Comment

The state's revised Medicaid program won't require any beneficiaries to pay premiums, but it may offer fewer benefits, Medicaid Commissioner Stephen Miller told Adam Beam of The Associated Press.

But Gov. Matt Bevin's office told Beam that Miller's comments were preliminary: "Everything is on the table and no decisions have been finalized," spokeswoman Jessica Ditto told him.

Bevin has said Medicaid recipients should have some "skin in the game" and has pointed to Indiana, which received a federal waiver allowing it to charge premiums based on income levels to people who want benefits beyond the basic Medicaid program.

The idea drew strong opposition from health-care providers, consumer advocates, public-health professionals and representatives of higher education in a May 12 meeting, according to the Foundation for a Healthy Kentucky, which convened the gathering.

"Miller said negotiations with officials at the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, indicate they will not approve a plan that requires Kentucky's expanded Medicaid population to pay for a portion of their health insurance," Beam reports.

Miller told him, "That, today, is not part of the plan. That is something that's going to be a tough sell."

Bevin is seeking changes that will save the state money. Starting Jan. 1, it will have to pay 5 percent of the costs of those who have joined Medicaid under the expanded eligibility created by the federal health-reform law. Its share will rise in annual steps to the law's limit of 10 percent in 2020. The state's expected bill for 2017 and the first half of 2018 is $257 million.

Now it seems that savings are likely to come by cutting benefits. "Miller said some Medicaid recipients could see fewer benefits under the new plan," Beam reports. "He said the health insurance plan for the state's Medicaid recipients is better than the basic plan offered to state employees. He said the new plan will likely bring the Medicaid plan more in line with the health plan offered to state workers." Miller said, "That would be a reduction in some benefit levels, such as in vision, dental."

Also, Miller said the program could encourage healthier behaviors by funding health savings accounts if they did such things as participating in smoking-cessation and weight-loss programs. "It may sound like we are rewarding them for that, but the long-term effect is it makes their health care coverage less expensive,"  Miller told Beam.

He said the state hopes to submit its waiver application in September. HHS spokesman Ben Wakana, told Beam that any changes "should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security." Before the expansion; 20 percent of Kentuckians had no health coverage; now the figure is 7.5 percent.

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

federal spending health care costs health insurance insurance coverage managed care Medicaid obamacare Patient Protection and Affordable Care Act state government

Gusty 13:11 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Groups of people concerned about changes in Kentucky's Medicaid program are open to the state offering incentives for healthy behaviors, but they don't want to penalize recipients who can't or won't pay premiums, deductibles or co-payments.

So reports the Foundation for a Healthy Kentucky, which convened a meeting May 12 to hear from people with stakes in the program: individual health-care providers, health systems, consumers, consumer advocates, payers, public-health professionals and representatives of higher education.

�Participants were unified in opposing penalties to enforce cost-sharing provisions� such as premiums, deductibles or co-payments, the foundation's consultant said in a report on the meeting.

However, they supported cost sharing for procedures not deemed medically necessary and �had diverse perspectives on this matter, ranging from opposing any cost-sharing in Medicaid to proposing specific premium and co-payment amounts,� such as $5 monthly premiums.

Also, �Participants were generally very supportive of implementing incentives for healthy behaviors such as smoking cessation and health risk assessments,� the report said. �Incentives might be reductions in the amount of cost-sharing or themselves supportive of healthy behavior,� such as gym membership.

Gov. Matt Bevin has said he wants Medicaid recipients to have "skin in the game" through cost-sharing, arguing that Kentucky can't afford to have more than a fourth of its population getting free medical care.

Under federal health reform, then-Gov, Steve Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level, adding more than 400,000 more people to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin's administration is working on getting a waiver from the federal Centers for Medicare and Medicaid Services to create new ways to cover those in the expansion. Six states have such waivers, including Indiana, which Bevin has cited as an example of how Kentucky might change its program.

In Indiana, recipients who pay premiums based on income levels, ranging from $1 a month to 2 percent of income ($27 a month for those at 138 percent of poverty) get expanded benefits and are charged co-payments only for non-emergency use of emergency rooms, according to the Kaiser Family Foundation. Those above the poverty level who fail to pay are disenrolled and barred from re-enrolling for six months, in what is known as a "lock-out" rule.

Bevin has indicated that he wants to announce his plan this summer. By law, states that seek a waiver must hold at least two public hearings: one at least 20 days before submitting the application to CMS, and the second after CMS accepts the application.

Stakeholders who attended the foundation's May 12 convening wanted to make sure their voices were heard early on in the process.

"Our goal is to help inform the process of changing the way Kentucky provides Medicaid services to ensure that we maintain the gains achieved under the Affordable Care Act, while also enabling the state to try new methods of ensuring access to affordable quality health care for Medicaid beneficiaries," Foundation President and CEO Susan Zepeda said in a news release.

"The biggest takeaway for me was the energy and commitment in the room," Zepeda said in a telephone interview. "A lot of thoughtfulness clearly went into sharing their experience and making suggestions on how to make the system more cost effective."

Before breaking into groups to offer their imput, stakeholders were given an overview of the state's Medicaid expansion and an overview of an issue brief created by the State Health Access Data Assistance Center at the University of Minnesota that looked at how waiver provisions are set up in five other states. Foundation staff wrote the 25-page "Stakeholder Input Report" that summarized suggestions and concerns and broke them into eight areas:

Cost-sharing and penalties: Health-care providers strongly opposed any cost-sharing, and uniformly opposed to any measure that involved "lock-out" penalties for failure to pay premiums, co-pays or deductibles.

"Our shared experience has been that we�ve been prohibited from denying care if a patient refuses or is unable to pay," the Physical and Oral Health Provider group said. "Therefore, the desired behavior isn�t actually enforced."

The Behavioral Health Provider group offered a compromise: �If the administration chooses to explore lock-outs we recommend that lock-outs be immediately lifted (upon payment) and payment be retroactive to the date the consumer re-enrolls.�

Participants in general were open to the idea of low co-payments, cost-sharing for non-medically necessary services, using Medicaid dollars to pay premiums for employer-sponsored insurance plans and charging co-payments for non-emergency use of the ER. They also agreed that certain groups, like those with chronic illnesses or disabilities, should be exempted.

Incentives: Most post-ACA waiver programs have implemented incentives for healthy behavior, and those at the meeting generally supported implementing evidence-based incentives, such as smoking cessation and health-risk assessments.

Zepeda said that most of the stakeholders wanted to see healthy behavior incentives used as credits against premiums, especially for recipients who can't afford them. "There is a recognition that people have a role to play in their own health care and the health decisions that they make," she said.

Benefits: Benefits include services covered under the health insurance plan. Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits like housing. All agreed that medically necessary services should be covered for all enrollees.

Reimbursement: Kentucky shifted Medicaid in 2011 to managed care, in which managed-care organizations (usually insurance-company subsidiaries) are paid a flat fee per person as an incentive to limit claims. Providers have complained about the slow and low reimbursement, and participant suggestions included streamlining and accelerating the reimbursement process, increasing provider reimbursement rates, and adding new categories of reimbursed services and providers, like telehealth.

Systems improvement: Participants suggested simplifying administrative processes for providers; expanding providers' scope of practice; adding review panels; reducing the number of managed-care organizations; and creating a single list of drugs for all MCOs.

Health system transformation: Waivers allow states to explore ways to provide care differently through various transformation approaches. Suggestions included creating price transparency, through an all-payer, all-claims database; improving consumer health literacy; and moving beyond coverage issues to addressing access and quality.

�There was also interest among our group in examining a PCMH (patient-centered medical home) or health homes model to promote care coordination, and we feel strongly that pharmacists are essential part of the team and should be used in novel and more expansive ways,� the Colleges and Universities group said.

Evaluation: Waivers require states to perform an evaluation and make it public. Participants agreed that the process should include stakeholders and that findings should be made public periodically.

The Physical and Oral Health Provider group suggested the evaluation should answer the questions, �Have we maintained coverage levels? Have we improved access to care?�

Overarching themes: Many of the stakeholders mentioned two issues that were not included in the issue brief or discussion: integrating behavioral, physical and oral health services, and addressing the wide set of social factors that shape Kentucky's relatively poor health.

�Waivers should include methods to address social determinants of health as these areas are proving most effective in improving outcomes and reducing cost,� the Physical and Oral Health Provider group said. �We encourage inclusion of community health workers, peer support, medical respite care and other innovations to support social needs of patients.�

Zepeda said the Medicaid waiver drafting team faces many challenges. "We consider the rich conversation that happened on May 12 to be the start of the conversation," she said. "We have to find the cost effective win/win strategies that can reduce the cost of Medicaid going forward and let us continue to serve this expanded number of Kentuckians who now have health insurance."

Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

health insurance health reform insurance coverage insurance exchange obamacare

Gusty 13:25 Add Comment

Department of Insurance website

Health insurers want rate increases averaging 22.3 percent in 2017 for individual policies in Kentucky. Counting small-group plans, the overall increase would be 17 percent, "continuing a national trend of hefty hikes as insurers adapt to a market reshaped by President Barack Obama's signature health care law," Adam Beam reports for The Associated Press.

"But the rate increases, if approved by state regulators, do not guarantee double-digit increases in the monthly premiums people have to pay," Beam notes. "The base rate is one of many factors companies use to determine how much someone pays in a monthly premium. Other factors include age, where a person lives and whether the person smokes."

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

The average requested increases for individual policies range from 7.6 percent for Aetna Health Inc. to 33.7 percent for Louisville-based Humana Inc., which said recently that it was losing money on Obamacare plans and is working on a merger with Aetna (to which Missouri objected this week). Baptist Health Plan wants 26.68 percent more, Anthem Health Plans 22.9 percent, and CareSource 20.55 percent, all on average.

�The Department of Insurance will fully investigate all proposed rate increase requests to make sure they are warranted,� Commissioner Brian Maynard said in a release. �Insurance rate increases are not specific to Kentucky; states across the nation are dealing with this issue.�

The department said some of the rate increases "appear to be attributed to the failure of the Kentucky Health Cooperative Inc.," a non-profit that was created under the reform law to provide more competition but then was not fully funded by Congress.

"The co-op went bankrupt and was placed into liquidation earlier this year, leaving other insurance companies to cover the more than 51,000 former co-op customers," the department noted. "Many of those customers were high-risk, and Kentucky�s remaining insurers appear to project that those high-risk customers will affect the risk pool." Anthem spokesman Mark Robinson told AP that the expectation of insuring co-op customers was responsible for its rate request.

UnitedHealth Group Inc. said recently that it would stop selling exchange policies in Kentucky, leaving many counties with only one insurer on the exchange. The only company that seeks to sell individual policies statewide is Anthem. It will be the only choice on the exchange in 54 counties.

However, Indianapolis-based Golden Rule Insurance Co., a United subsidiary, will sell "in all counties, off the exchange," the department said. Golden Rule, which still won't sell exchange policies, is seeking a rate increase of 65 percent.

Anthem, Aetna and Baptist will also offer non-exchange policies. Aetna plans to sell in only 10 counties: Jefferson, Fayette, Kenton, Campbell, Boone, Oldham, Trimble, Henry, Owen and Madison. Baptist will sell in 38 counties off the exchange and 20 on the exchange. Humana will sell on the exchange in nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton). CareSource will sell in 61 counties, all on the exchange.

Consumers in Fayette, Jefferson and Oldham counties will have five insurers to choose from on the exchange. Jessamine, Woodford, Bullitt, Henry, Madison and Trimble counties will have four. Thirteen counties will have three choices, and 44 will have two. An Excel spreadsheet listing the policies for each county is available at www.uky.edu/comminfostudies/irjci/Kyhealthinsbycounty2017.xlsx.

The filings are online at insurance.ky.gov/ratefil/default.aspx. Rates must be approved within 60 days of each filing, or no later than July 11.

The administration of Gov. Matt Bevin is dismantling the Kynect health-insurance exchange and will use the federal exchange, HealthCare.gov, as a portal for enrollment in exchange policies.

Princess Health and Health-care consumers get little help resolving complaints, columnist says, citing some horrific examples. Princessiccia

Princess Health and Health-care consumers get little help resolving complaints, columnist says, citing some horrific examples. Princessiccia

consumers health care costs health insurance hospitals lung disease Medicare politics state governments

Gusty 18:08 Add Comment

By Trudy Lieberman
Rural Health News Service

Who protects consumers of health care?

Two recent emails from readers got me thinking about that question. I don�t mean consumers in their role as patients whose medical well-being is looked after by state medical boards and health departments that police doctors and hospitals. Those organizations don�t always do a perfect job protecting patients from harm, but at least they are in place.

But who protects patients when things go wrong on health care�s financial side? What happens when you receive a bill you didn�t expect and can�t afford to pay? What happens when insurers send unintelligible explanations of benefits you can�t understand? What about questionable loan arrangements to avoid medical bankruptcy? Consumers of health care are pretty much on their own.

From the 1960s though the 1980s when people complained, they got action from consumer organizations, government and even businesses that set up departments to handle complaints. That consumer movement is now but a flicker.

�We don�t have as many public-interest minded regulators, and officials who try to grab these issues by the horns and deal with them,� says Chuck Bell, director of programs for Consumers Union.

The emails I received show that although it�s an uphill battle to get redress, fighting back as an individual can get attention and may ultimately lead to better protections for everyone.

John Rutledge, a retiree, got snared in Medicare�s three-day rule by a hospital near his hometown Wheaton, Ill. At the end of March he took his wife, who was having breathing problems, to the hospital where she was held for three nights of �observation.� Patients must be in a hospital for three days as an in-patient before they are entitled to Medicare benefits for 100 days of skilled nursing home care, as I noted in a recent column.

Thousands of families have been caught when hospitals decide their loved ones are admitted for �observation,� a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as �in-patients.� Playing the �observational� game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn�t qualify for Medicare-covered skilled nursing care.

Rutledge knew about the three-day rule. Both his doctor and a pulmonologist at the same medical practice recommended an in-patient stay, and Rutledge refused to sign a hospital document saying his wife was admitted for observation. Still, the hospital prevailed, claiming a consultant made the decision to keep her for �observation.�

Rutledge was stuck with a bill that, so far, totals over $15,000 for the skilled nursing care his wife did need. He said he had been a �significant donor� to the hospital foundation, and �I have told the foundation that what I spend as a result of �observation� will come out of what I planned to give them, starting with the annual gift.�

The second email came from Kathryn Green, a college history professor who lives in Greenwood, Miss. Green is fighting an air-ambulance company, which transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This �nightmare,� as she calls it, is a bill from the transport company that claims it�s outside her insurance network, and says she owes them $50,950.

�I am 63 and will have a devastated retirement if this is upheld,� Green told me.

Blue Cross & Blue Shield of Mississippi, the administrator for her insurance carrier the State and School Employees� Health Insurance Plan, paid $7,192 of the $58,142 the transport company billed. Blue Cross has told Green that she should be held harmless and should not be charged for the �balance after payment of the Allowable Charge has been made directly to that provider.�

Green is raising a ruckus and has taken her case to state and national media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Program. The company has told her it will begin collection efforts.

In both cases there�s a legislative solution. The three-day rule can be fixed by counting all the time a patient spends in the hospital whether they�re classified as an �in� or as an �observational� patient. The ambulance problem can be fixed by changing the 1978 airline deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rutledge and Green.

�It�s like playing a game of health-insurance roulette,� Bell says. �Your coverage exposes you to these gaps that have been normalized. It�s become the way of doing business.� A resurgent consumer movement could change all that.

What consumer problems have you had with balance billing? Write to trudy.lieberman@gmail.com.

Princess Health and Air ambulances save lives in rural Kentucky, but are costly; Junction City buys Air Evac memberships for everyone in town. Princessiccia

Princess Health and Air ambulances save lives in rural Kentucky, but are costly; Junction City buys Air Evac memberships for everyone in town. Princessiccia

emergency medical service health care cost health insurance

Gusty 12:49 Add Comment

Medical helicopters are especially important to rural Kentucky because they get people to the medical care they need quickly, but this service comes at a cost that many can't afford, Miranda Combs reports for WKYT.

Air Evac Program Director Donald Hare told WKYT that "the average cost of a flight is around $32,000 and insurance pays, on average, $8,000 and $12,000 of that cost," Combs writes.

"About 14 to 16 percent of our flights are people with no insurance whatsoever and don't have the ability to pay for that flight," Hare said, noting that they try to work with people to set up a payment plan in this situation.

Jim Douglas, the mayor of Junction City, told Combs that his city council has decided to buy memberships with Air Evac Lifeteam, which has a hub in the Danville Airport, for everyone in the city to cover them if they need to use the service. He said more than 60 people were flown out of Boyle County on a medical helicopter last year.

"It could be a lifesaving thing," Douglas told Combs, and said it will "cost the city just under $12,000," Combs writes. And while he said he fully expected some people to use the service for non-emergency reasons, he asked,  "But who's to make the call? I wouldn't want to."

Michael Bentley, a paramedic, assured WKYT that most of their transfers are emergencies.

"We generally get called out to the sickest of the sick patients. We're generally not going out to 'Joe that stubbed his toe on the refrigerator at home.' Our patients are major trauma type patients or cardiac events that have happened to these patients," Bentley told WKYT.

Adam Tubbs, an EMT in Nicholas County, told Combs that medical flights were important because it takes "precious time by ground to get to an emergency call" in such a large rural county. He noted that, on average, they call for air ambulances several times a week. The Nicholas County Hospital closed more than one year ago.

The cost of these air transports has become such a problem that Rep. Tom McKee, D-Cynthiana, filed a bill during the last legislative session calling for a study of air-ambulance charges. The bill passed out of the House, but did not make it out of committee in the Senate.

Princess Health and Insurance commissioner sues contractor for failed Kentucky Health Cooperative, alleging gross negligence in handling claims. Princessiccia

Princess Health and Insurance commissioner sues contractor for failed Kentucky Health Cooperative, alleging gross negligence in handling claims. Princessiccia

Congress courts health insurance health reform obamacare politics state government

Gusty 19:41 Add Comment

State Insurance Commissioner Brian Maynard, acting as liquidator of the failed Kentucky Health Cooperative, filed suit in Franklin Circuit Court Friday against against the company that the co-op hired to process and pay claims. The suit contends that CGI Technologies and Solutions Inc. was "grossly negligent" in processing and paying claims and thus breached its contract.

The co-op, created by federal health reform to compete with insurance companies and hold down premium costs, had financial problems from the start. This year Republicans accused former Gov. Steve Beshear, a Democrat who embraced health reform, of holding down co-op premiums to make the reforms look good. Beshear denied the charge.

The co-op announced in October 2015 that it would close because Congress did not provide sufficient "risk corridor" payments to insurers with disproportionately sick policyholders and the Obama administration was unwilling or unable to make up the difference. The co-op, which had a deficit of $50 million in 2014, was expecting a risk-corridor payment of $77 million but got only $9.7 million. Most other co-ops also failed.

�We have a duty to investigate the causes of the co-op�s collapse and to hold responsible those individuals who caused the collapse,� Maynard said in a press release. �This includes recovering funds from responsible parties so that the doctors, nurses, and hospitals that treated Kentuckians insured by the co-op are fairly compensated for their services.�

Thousands of patients and thousands of providers will have to wait until Oct. 15 or later to find out how much of their medical bills sent to the co-op will be paid, Kentucky Health News reported in February. The co-op "left thousands of providers waiting for payment," Stephanie Armour reported for The Wall Street Journal. It covered about 51,000 people through the end of 2015. Franklin Circuit Judge Phillip Shepherd will decide how much will be paid to whom.

Princess Health and Health-insurance stocks fall in reaction to federal judge striking down one Obamacare subsidy; ruling is stayed pending appeal. Princessiccia

Princess Health and Health-insurance stocks fall in reaction to federal judge striking down one Obamacare subsidy; ruling is stayed pending appeal. Princessiccia

health insurance health reform insurance deductibles insurance exchange obamacare

Gusty 18:34 Add Comment

"Shares of Humana, Aetna and other health insurance companies tumbled on Thursday, as a federal judge ruled that Affordable Care Act subsidies could not be dispensed without congressional approval," Boris Ladwig reports for Insider Louisville. "Humana�s shares slid 2.5 percent, and Aetna�s dropped 3.26 percent. Insurers Anthem and UnitedHealth Group also booked declines."

District Judge Rosemary Collyer of the District of Columbia ruled that Congress had never provided money for the subsidies to people who buy health insurance through Kynect and other exchanges. "Without subsidies, fewer people would be able to afford to purchase health insurance, which means insurance companies would lose customers," Ladwig explains.

Collyer, an appointee of George W. Bush, allowed the program to continue while the Obama administration appeals her ruling to the D.C. Circuit Court of Appeals. The Supreme Court appears likely to decide the issue.

The suit by House Republicans involved only cost-sharing subsidies, not the income-tax credits that apply to monthly premium payments. The Obama administration funded the cost-sharing with money from the tax-credit account.

The cost-sharing subsidies are available to people with incomes between 100 and 250 percent of the federal poverty level � between $24,300 and $60,750 for a family of four. "Several million Obamacare customers receive cost-sharing subsidies, but the exact figure is unknown," Jennifer Haberkorn reports for Politico. "As of the middle of the last Obamacare enrollment period, 57 percent of people who signed up for coverage through the federal exchange on HealthCare.gov receive them. . . . If the subsidies are ultimately struck, it would reinforce claims from opponents of the health law that the Obamacare insurance plans are not actually affordable."

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Foundation for a Healthy Kentucky health care access health insurance insurance coverage Kynect Medicaid prevention research

Gusty 13:54 Add Comment

By Melissa Patrick
Kentucky Health News

The share of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform's impact in the state.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the Patient Protection and Affordable Care Act is affecting Kentuckians.

The report found that the rate of people without health insurance in Kentucky continues to drop.

In December 2015, the uninsured rate was 7.5 percent, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the PPACA, Kentucky's uninsured rate was 20.4 percent.

Since December 2013, Kentucky's uninsured rate has dropped 12.9 percentage points, more than double the national decline of 5.6 percentage points, says the report. Uninsurance rates can vary depending on how they are measured. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.

"Lack of insurance is a significant barrier to getting necessary health care and preventive services timely," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions."

Kentucky also continues to have a lower uninsured rate than its eight nearest surrounding states, although Ohio (7.6 percent) and West Virginia (7.7 percent) are catching up. Missouri (11.6 percent), Tennessee (13 percent) and Virginia (12.6 percent), the three states surrounding Kentucky that did not expand Medicaid, have the highest uninsured rates. (SHADAC map)

And while the state saw a smaller share of new health-insurance customers than the country overall (20 percent versus 39 percent), Kentucky had the largest percentage of re-enrollees (59 percent) return to Kynect, the state's health insurance marketplace, to select plans compared to the rest of the nation (36 percent). Twenty-two percent of Kentuckians were automatically re-enrolled in plans.

Kynect, created by the Democratic administration of Steve Beshear, is in the process of being dismantled by the administration of Republican Gov. Matt Bevin, so Kentuckians will have to sign up for their health insurance through the federal exchange, healthcare.gov, during the next enrollment period which begins Nov. 1, 2016 and runs through Jan. 31, 2017.

Traditional Medicaid enrollees will sign up through Benefind, the state's new one-stop-shop website that can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

Expansion of Medicaid added about 400,000 Kentuckians to the program, and many of them have taken advantage of its free services to get screened for diseases and have physical or dental examinations.

Dark blue: traditional Medicaid enrollees
Light blue: Medicaid expansion enrollees

The latest report, which covers the fourth quarter of 2015, says 823 traditional Medicaid enrollees got screened for diabetes, compared to 2,959 Medicaid expansion enrollees. This was also true for colorectal screenings (see graph).

Overall, the study found that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance-abuse treatment services, and 5,589 colorectal-cancer screenings to enrollees aged 19-64.

Under federal health reform, Beshear expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

However, the future of the expansion is uncertain. Bevin has said that the state cannot afford its Medicaid population of about 1.3 million, and has charged his administration with designing a new Medicaid program, which will require federal government approval. He told reporters in early May that he was optimistic that the Centers for Medicare and Medicaid Services will approve the state's new plan, but if they don't it will be because "CMS does not want to see expanded Medicaid continue in Kentucky."

The study found that Medicaid enrollment continues to be the highest in Eastern Kentucky with 31 percent participation, followed by Western Kentucky at 26 percent participation.

It also notes that while levels of uncompensated care have dropped for both urban and rural hospitals since 2013, rural hospitals saw slight increases in uncompensated care in 2015. (SHADAC graphic)

For the full report, click here.

Princess Health and Many Americans, including those on Obamacare plans, can't afford their health-insurance deductibles, studies show. Princessiccia

Princess Health and Many Americans, including those on Obamacare plans, can't afford their health-insurance deductibles, studies show. Princessiccia

health care access health care costs health insurance obamacare Patient Protection and Affordable Care Act prescription drugs

Gusty 12:14 Add Comment

The United States has entered the era of high out-of-pocket medical cost as a way to keep insurance premiums low, but recent studies have found that many Americans are having trouble paying them, and the presidential candidates are hardly talking about this issue, Harris Meyer reports for Modern Healthcare.

Graph: Urban Institue's Health Reform Monitoring Survey

Nearly 25 percent of Americans surveyed last September who had coverage through employer plans, the Affordable Care Act, or individual plans outside health-insurance exchanges reported problems paying family medical bills in the previous 12 months, according to the Urban Institute's Health Reform Monitoring Survey. That compared with 16 percent of people on Medicaid and 27.8 percent of the uninsured.

The Kaiser Family Foundation also found that people on Medicaid or policies bought through the federal or state exchanges, also called marketplaces, couldn't afford their deductibles. This 2016 focus group study of 91 low-income Medicaid and exchange-plan enrollees in six cities found that "all reported that they had trouble affording some aspect of their current coverage, including premiums, deductibles, and/or co-payments." It also found that "nearly all marketplace participants" said they had received unexpected bills for services they thought were covered, and fear of this often led them to forgo care.

The latest Kentucky Health Issues Poll found that affordability is also a problem in Kentucky, with 28 percent of Kentucky households having at least one person who reported struggling to pay their medical bills in the previous 12 months. This rate was about the same as in 2014 and didn't vary much between those with insurance or without insurance.  In addition, the poll found that 20 percent of Kentucky households did not get the medical care they needed, or delayed care because of cost in the past 12 months.

This lack of affordability also affects health-care providers. Meyer reports that the chief financial officer for Community Health System told analysts at the first-quarter earnings report meeting that the fourth quarter of 2016 will be his company's best quarter, because patients will have hit their insurance deductibles and only then be able to afford needed care at their facilities.

�As individuals take on high deductibles and higher co-pays, they are essentially taking on insurance risk they can't necessarily afford,� Trevor Fetter, CEO of Tenet Healthcare Corp., told Meyer. Fetter told Meyer that his company now focuses on helping patients understand how to pay their bills, "including pressing for cash payments at the point of service."

What are the presidential candidates saying?

Meyers writes that Democratic front-runner Hillary Clinton offers the most help for those who can't afford their high deductible. She says she "would require health plans to: cover three annual visits to a doctor for illness without applying the deductible; give insured people a $5,000-per-family refundable tax credit for out-of-pocket costs exceeding 5 percent of their income; cap out-of-pocket costs for prescription drugs; bar providers and insurers from charging patients out-of-network bills for services received at an in-network hospital; and strengthen states' authority to block excessive insurance premium increases."

"Vermont Sen. Bernie Sanders, Clinton's Democratic opponent, wants to eliminate premiums and cost-sharing entirely by establishing a tax-funded, government single-payer insurance program covering the full range of healthcare services, including long-term care," Meyer writes.

"Donald Trump, the presumptive Republican nominee, has released a seven-point health policy agenda that doesn't directly address out-of-pocket costs. It would offer households a tax deduction for buying coverage, expand health savings accounts, and let insurers sell plans across state lines," Meyers writes.

Meyers calls the issues surrounding high deductible plans and high prescription drug costs "the domestic policy elephant in the room," and says these issues are not getting enough attention.

Princess Health and Humana leaving some state health-insurance exchanges to cut its Obamacare losses. Princessiccia

Princess Health and Humana leaving some state health-insurance exchanges to cut its Obamacare losses. Princessiccia

health insurance health reform insurance exchange obamacare

Gusty 07:40 Add Comment

Humana Inc. said last week that it may leave some state health-insurance exchanges to cut its losses, and then left two, in Alabama and Virginia. "Humana also continues to reel after losing a large Medicare Advantage employer account," Bob Herman reports for Modern Healthcare. "Those factors and others forced the first-quarter profit at the Louisville, Ky.-based insurer to fall 46 percent to $234 million."

Humana said it would probably raise exchange-policy premiums "heavily and ditch some on- and off-exchange policies in 'certain statewide' markets," Herman reported. Later, Zachary Tracer of Bloomberg News reported that the company wouldn't sell Affordable Care Act policies in Alabama and Virginia in 2017.

"Humana is a relatively small player in the ACA, with about 554,300 individual members from the exchanges as of March 31," Tracer noted. "About 12.7 million people picked ACA plans for this year in the government-run markets. The company offers Obamacare plans in 15 states," including Kentucky.

"Humana did not hold an investor call because of its pending merger with Aetna," Herman reported. "If Humana ditches some ACA marketplaces, it would be the second major investor-owned insurer to back away" from them, following United Healthcare. That company "said last month it was losing money and would largely exit the 34 states where it sells plans," report Amrutha Penumudi and Caroline Humer of Reuters.

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 UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

Princess Health and UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

health insurance health reform Kynect obamacare Patient Protection and Affordable Care Act

Gusty 16:44 Add Comment

UnitedHealth Group Inc. won't be participating in Kentucky's individual insurance plans offered through the Affordable Care Act marketplace next year, which could leave about 20 percent of the state with just one insurer to choose from for next year and another 22 percent with only two choices, according to an analysis by the Kaiser Family Foundation.

Including Kentucky, this brings the number of states the health insurer is quitting next year to 26, Zachary Tracer reports for Bloomberg.

"The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state�s Affordable Care Act exchange, as well as the small-business exchange," United said in a letter dated March 28 to the state�s insurance department, Tracer reports. Bloomberg noted that it obtained the letter through an open-records request.

United warned in November that this would likely happen after reporting that "low enrollment and high usage cost the company millions of dollars," USA Today reported.

�UnitedHealthcare�s intent to withdraw from the market was not unexpected,� Doug Hogan, a spokesman for the state Public Protection Cabinet, which oversees the state�s insurance regulator, said in an e-mail to Bloomberg. �Insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses.�

The administration of Republican Gov. Matt Bevin is shutting down the state's Kynect exchange and moving its 100,000 or so users to the federal exchange, but plans on that exchange are offered state by state.

Bloomberg says it has confirmed that United is leaving at least 26 of the 34 states where it sold 2016 coverage, but will continue to offer small-business plans off the exchange. New York and Nevada confirmed for Bloomberg that United plans to sell ACA plans in those states next year. The company has also filed plans to participate in Virginia.

Princess Health and Poll finds many Kentuckians continue to struggle with cost of health care, though fewer are uninsured and struggling. Princessiccia

Princess Health and Poll finds many Kentuckians continue to struggle with cost of health care, though fewer are uninsured and struggling. Princessiccia

Foundation for a Healthy Kentucky health care costs health insurance health reform Medicaid poll

Gusty 17:21 Add Comment

While having health insurance certainly eases the cost burden of health care, nearly one-third of Kentucky adults struggle to pay their medical bills whether they have health insurance or not, and two in 10 say they often delay or skip needed medical care because of the cost, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 17-Oct 7, found that in 28 percent of Kentucky households, someone had trouble paying medical bills in the previous 12 months. This didn't vary much between those with or without insurance, and was about the same as in 2014.

However, fewer Kentucky adults without insurance said they had difficulty paying their medical bills in 2015 than in 2014: down to 31 percent from 47 percent. In 2014, the Patient Protection and Affordable Care Act was fully implemented in Kentucky with expansion of the federal-state Medicaid program to people with incomes up to 138 percent of the federal poverty level.

According to the Kaiser Family Foundation, the average annual out-of-pocket cost per person for health care in the United States in 2014 was $1,036,which includes costs for any expenses not covered by insurance, says the report.

The Kentucky Health Issues Poll also found that 20 percent of Kentucky households did not get the medical care they needed, or delayed care because of the cost, in the past 12 months. This was more common among Kentucky's uninsured (27 percent) than those with insurance (19 percent).

However, these figures were an improvement from 2009, when 58 percent of uninsured Kentucky adults said they delayed or didn't get needed care, and from 2014, when 38 percent said so.

Poorer adults, those eligible for Medicaid, were more likely to forgo health care because they can't afford it; 29 percent of them said they had in the previous year, while only 16 percent of people with higher incomes said so.

"Being able to access medical care and being able to afford that care are two important factors to improve health in Kentucky," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "KHIP data indicate that fewer Kentucky adults are delaying medical care. This helps Kentuckians get and stay healthier, getting timely preventive services and early help with management of chronic conditions like diabetes and asthma and with smoking cessation counseling."

The poll was conducted by Institute for Policy Research at the University of Cincinnati and for the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,608 adults via landline and cell phone, and has a margin of error of plus or minus 2.4 percentage points.

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

electronic health records health insurance insurance exchange Kynect privacy

Gusty 14:41 Add Comment

State health-insurance exchanges in Kentucky, Vermont and California had "significant weaknesses" in protecting their electronic information from hackers, the Government Accountability Office said in a report last month.

"These included insufficient encryption and inadequately configured firewalls, among others," said the report from the investigating arm of Congress. "In September 2015, GAO reported these results to the three states, which generally agreed and have plans in place to address the weaknesses."

Ricardo Alonso-Zaldivar and Frankfort-based Adam Beam of The Associated Press report, "Vermont authorities would not discuss the findings, but officials in California and Kentucky said this week that there was no evidence hackers succeeded in stealing anything."

The report said the federal Centers for Medicare and Medicaid Services, which oversees the exchanges, had not fully implemented its oversight of their security and privacy protections.

"The GAO report examined the three states' systems from October 2013 to March 2015 and released an abbreviated, public version of its findings last month without identifying the states," AP reports. "Thursday, the GAO revealed the states' names in response to a Freedom of Information [Act] request from the AP. According to the GAO, one state did not encrypt passwords, potentially making it easy for hackers to gain access to individual accounts. One state did not properly use a filter to block hostile attempts to visit the website. And one state did not use the proper encryption on its servers, making it easier for hackers to get in. The report did not say which state had what problem."

Steve Beshear, who was governor until early December, told AP through a spokeswoman that "because of the time required to fix the technical issues, not all those issues had been addressed" when Republican Gov. Matt Bevin took over. "It is important to note that there were never any security breaches of any kind, and no one's information was ever compromised."

Doug Hogan, spokesman for the Cabinet for Health and Family Services, told AP the fixes "are in various stages of completion and implementation" and security is "of the utmost importance" to the Bevin administration.

Bevin is dismantling Kentucky's exchange, which Beshear branded as Kynect, and planning to transfer the 93,000-plus people who used it to buy federally subsidized policies to the federal exchange, Healthcare.gov.

"But Kentuckians' information might not be any safer on the federal exchange," AP reports. "According to the GAO report, Healthcare.gov had 316 security incidents between October 2013 and March 2015. Such incidents can include unauthorized access, disclosure of data or violations of security practices. None resulted in lost or stolen data, but the GAO said technical weaknesses with the federal system 'will likely continue to jeopardize the confidentiality, integrity and availability of Healthcare.gov.'"

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

Cabinet for Health and Family Services food stamps health insurance KCHIP Kynect Medicaid

Gusty 07:47 Add Comment

Update: 4/8/16 This story has been updated with comments from the Cabinet for Health and Family Services. 

By Melissa Patrick
Kentucky Health News

On Feb. 29, Gov. Matt Bevin's administration launched a new one-stop-shopping website for state benefits that was designed to make life easier for the one-fourth of Kentuckians eligible to use it. Instead, it caused an unprecedented disruptions of services after thousands received erroneous letters notifying them they would no longer receive their benefits.

Deborah Yetter of The Courier-Journal has reported extensively on the problem, with stories of Kentuckians who have lost their benefits and found it nearly impossible to get help because of hours-long waits in the state benefits offices and a phone system that tells them to call back later.

The website, called Benefind, can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

The problem goes beyond those programs. The 500 paid Kynectors, who help Kentuckians use the Kynect health-insurance exchange, have not been able to help because federal regulations require participants who use multiple services to first go though the Department of Community Based Services, the state agency that manages Benefind. As of now, Kynectors can only help Kentuckians who have never received other state benefits.

Health advocates have called the launch of Benefind a "disaster." At a March 31 news conference, Bevin, along with health officials from the Cabinet for Health and Family Services and a Deloitte Consulting official, acknowledged the widespread problems and said they were working tirelessly to correct them.

�Our primary focus is to ensure that we deliver, as seamlessly as possible, as safely as possible, as expediently as possible all the benefits that folks expect and need from the Commonwealth of Kentucky," Bevin said.

State officials at the news conference said they had worked with federal officials to extend benefits through April, so that no one should be cut off from Medicaid or SNAP if they qualified for those benefits in March. The state has also stopped automatic letters generated by Benefind.

In addition, they have updated websites and changed the phone message to better explain what is going on; extended the re-certification time frame for SNAP benefits from six months to 12 months, allowing those cases to continue with a simple review instead of a client interview; hired an additional 185 people to help with the deluge of telephone calls and visits to the local state benefit offices; and Deloitte has assigned trainers to every county to help the DCBS staff.

Officials have encouraged the public to log on to the Benefind self-service portal at https://benefind.ky.gov/ to ease the burden on processing centers.

So, what happened?

Deloitte built Benefind under the administration of Gov. Steve Beshear at a cost of $101.5 million to replace an outdated eligibility system. Deborah Sills of Deloitte said at the news conference that they believed the system was ready to launch at the end of February, but "there were some issues that didn't present themselves until after the system went live."

However, Ryland Barton of Louisville's WFPL reported that on Feb. 25, a 27-page "Worker Portal Defect Workaround Guide" was distributed to DCBS staff showing that the administration knew there would be problems with the rollout.

But the cabinet says a guide like this is standard procedure.

"Deloitte says a guide like that is standard operating procedure when you�re dealing with a huge system rollout like this," Doug Hogan, spokesman for the cabinet said in an e-mail. "It�s a new system and (this was) a guide to help staff navigate the system better and help them work though issues they might encounter. Additionally, there were these same types of documents for the original rollout of Kynect."

Bevin's administration explained that the problem has been caused by an automatic review of cases where information from Kynect and the old eligibility system didn't match.

�Cases where information between the Kynect case and legacy case did not match (for example, household composition or income) are required to be managed by a state agent before they can be acted upon by agents or Kynectors,� Jessica Ditto, Bevin�s communications director, told WFPL in an e-mail. �This constraint has been placed to protect program and data integrity � plus, this is required by federal law.�

Ditto told Barton about 51,000 cases are under review, and noted that once the conflicting data has been reconciled, "the cases will become open for Kynectors and agents again, just as before.�

Sills told reporters that Benefind had not been altered in any way from its original 2014 design and affirmed Bevin's stance that the move to Benefind had nothing to do with his administrations decision to close Kynect and move to the federal exchange.

"None of these issues are caused by any changes the current administration has made to the system's purpose or design," Sills said.

However, Beshear said in a news release that Kynect and Benefind were meant to work together, not for Benefind to take over signing people up for Medicaid.

"The Benefind program was developed to complement Kynect, the state-run exchange," Beshear said in the release. "Although he attempts to blame the 'prior administration,' Governor Bevin�s administration mismanaged the launch of this new system, and in doing so, created a disastrous situation for thousands of families in Kentucky."

Bevin and Deloitte say the system was always designed to support Medicaid enrollees. "Benefind is Kynect, Kynect is Benefind," Bevin said at the news conference.

Not really, says Kentucky Voices for Health, a coalition of groups supporting Kynect,  "For people needing Medicaid coverage and other social benefits right now, there is no right door for access, let alone 'one door'," the group said in a press release Wednesday. "Kynect was built to provide access to health insurance and Medicaid enrollment; and Benefind was built to enhance Kynect with additional social services benefits. While they�re part of the same system, they provide different essential functions."

However, Hogan noted  in the e-mail that page 15 of a training document for Kynectors originally posted November 2015 "clearly shows that Benefind was intended to process all Medicaid plans, even Qualified Health Plans...it was truly designed to process all benefits."

Beshear and his advocacy group, Save Kentucky Healthcare, have also released a one-minute video entitled "If It Ain't Broke Don't Fix It" criticizing the Bevin administration's rollout of the system.