Friday, 16 March 2012

Princess Health and Switch to managed care happened too fast with too little knowledge, former Medicaid commissioner says.Princessiccia


States like Kansas are looking at Kentucky as a precautionary tale for what not to do when transitioning to managed care, former Kentucky Medicaid commissioner Shannon Turner told Ryan Alessi on CN|2's "Pure Politics" Wednesday. Kansas Gov. Sam Brownback "was heralding Kentucky . . . in the beginning," she said. "And last week, his office released what I call a 'Kansas is not Kentucky' statement."

Turner, who was fired from Passport Health Plan after she was linked to excessive travel expenses and is now a health-policy consultant, said Kentucky rushed into managed care too quickly � rather than a few months, the state really needed a year, she said. In Turner's view, there also isn't enough expertise in the Cabinet for Health and Family Services to deal with the three new managed-care operators. "I think the managed-care companies really don't have the resources that they need at the state level to give them direction," she said. "On the state side, you have people looking at managed-care processes that they really aren't familiar with."

In other states that switched to managed care, Turner said there was a turnover in state staffing. In Kentucky, "There haven't been cuts, there haven't been layoffs . . . so what are the people who are there at Medicaid focused on, and is there adequate training?"

On Nov. 1, 560,000 Medicaid recipients were switched to managed care, which is "essentially outsourcing" to the managed-care operators, Turner said. Lawmakers have heard complaints about delayed payments and rigid pre-authorization requirements, including one instance Alessi mentioned, involving a woman in labor who was required to get pre-authorization before she could deliver her baby.

Turner said the MCOs are "excluded from the majority of the rules that apply to HMOs," including one that would prevent them from "sitting on" payments." Turner called the process a "bloodbath" for independent pharmacists because of those delayed payments, as well as community mental health centers, who were "seeking pre-authorization . . . but the managed care companies said, 'You can't send it to us electronically.' They were literally snail-mailing these things." (Read more)

Thursday, 15 March 2012

Princess Health and Beshear names Audrey Haynes secretary of embattled Cabinet for Health and Family Services.Princessiccia

Audrey Tayse Haynes, who is a social worker by training but knows her way around politics, government and the nonprofit world, will be the new secretary of the state Cabinet for Health and Family Services. She will replace Janie Miller, who resigned last month after controversies over Medicaid managed care and release of child-abuse records.

"Audrey brings a dynamic mix of large-scale organization management, policy development, and government experience to this position," said Gov. Steve Beshear, who made the appointment. "This cabinet is a complex organization, with a broad range of programs that serve tens of thousands of our most vulnerable Kentuckians. Audrey has the right skills and resources to make sure our citizens continue to get the care and services they need."

Haynes, who starts her new job April 16, has spent the last 10 years as senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C. During the latter part of the Clinton administration, she was chief of staff to Tipper Gore and an assistant to Vice President Al Gore. She first went to Washington on an appointment from Gov. Paul Patton as head of the state's policy office in the nation's capital.

Earlier, she was director of human resource development in the Department of Mental Health in the former Cabinet for Human Resources, and ran a literacy program with First Lady Martha Wilkinson in the administration of Gov. Wallace Wilkinson. She has bachelor's and master's degrees in social work, respectively, from Spalding University in Louisville and the University of Kentucky.

"From my experience working with Audrey Haynes, I know her to be a consummate professional," former state auditor Crit Luallen, who worked with Haynes during the Patton administration, said in the Beshear administration's press release. "She will bring strong management skills, as well as national leadership experience to this critical cabinet post."

Haynes said in the release, "I am excited to be back in Kentucky full time. CHFS impacts every single Kentuckian � whether through birth certificates, health departments, restaurant inspections or services to the elderly. I feel that I am returning to my roots of social work and mental health services."

One of her first areas of focus will likely be monitoring the new Medicaid system, which brought managed care to 560,000 recipients in November. During the current legislative session, lawmakers have heard complaints about the transition, including the manner in which those with mental illnesses are being treated. "Now that Secretary Haynes is in place, we can continue to make progress on major initiatives such as managed care and ensure that our citizens get the services they deserve," said Rep. Jimmie Lee, D-Elizabethtown, chairman of the subcommittee that writes the cabinet's budget. (Read more)

Wednesday, 14 March 2012

Princess Health and Board of Dentistry's relaxation of limits on hygienists is the latest sign of hope in Kentucky's all-too-grim story of oral health.Princessiccia

By Al Smith
Kentucky Health News

With nearly a fourth of Kentucky�s 1 million children living in poverty and suffering some of the worst oral health in America, the state Board of Dentistry voted Saturday to develop regulations to permit hygienists to treat children in a public health setting perhaps stemming a near epidemic of tooth decay in the very young.

Hygienists will still be responsible to dentists when working in public-health settings such as schools, where they can apply preventive treatments on their own if the new regulation wins legislative committee approval. It isn�t as far as we want to go in confronting our horrific problems, but it may remove stones in our path that have kept a tight control on the use of hygienists.

In the past, organized dentistry in Kentucky, fearing competition from hygienists, has opposed expanding their scope of practice, but as Kentucky remains stalled near the bottom of state rankings of oral health, younger dentists are accepting the need for change, says Dr. James Cecil, a retired dentistry professor at the University of Kentucky.

Saturday�s action by the Board of Dentistry partly may have been �from desperation, over recent bad publicity as the popular press portrays the profession as unresponsive to the needs of our poor citizens,� Cecil said in an interview. �While dentistry still remains where medicine was 20 years ago,� when many doctors opposed licensing physician assistants and nurse practitioners, Cecil said dentists �will learn they can make more money when their services become more available through greater use of auxiliaries such as the hygienists.�

Cecil, former chief dental officer for the U.S. Navy and distinguished as a national leader in public health, earlier last week participated with Kentucky Youth Advocates in the organization of a new Kentucky Oral Health Coalition, whose startup is funded by a foundation grant to KYA.

This coalition of various organizations, including public health departments, nurses, physicians, insurers, and some dentists, will be independent of dental associations or the state�s two dental colleges, and it will campaign for better programs for general as well as oral health.

In the early months of a year when the Kentucky General Assembly, like the U.S. Congress, has reached little agreement on public issues, the state Department of Public Health, actively supported by Gov. Steve Beshear, seems to be gaining traction on oral-health needs.

Grants from the Appalachian Regional Commission are expected to go to two of 13 new local health coalitions in Eastern Kentucky. The grants will pay for one mobile dental van and equipment to reach out to an area with children whose teeth are so decayed they were one focus of an ABC "20/20" documentary viewed by 11 million people in 2009.

Through funding by the federal government, the oral health program will begin training general dentists in more pediatric care. And with additional funding from ARC, this project focuses on dentists in the ARC counties for participation.

Meanwhile, Dr. Cecil and KYA hope to organize more local dental coalitions in rural Western Kentucky. Coalitions may decide to include �senior days� to help older citizens with appalling dental health needs.

There are now 25 such coalitions in the state. As more are established, the challenge is to expand the reach of the state�s 3,000 hygienists, to assist and encourage the state�s 2,400 active dentists to become more pro-active about solving problems that drag down oral health in Kentucky, and to educate parents to care for their children�s teeth, beginning in their first year of life.

Historically, in a culture with so much poverty, Kentuckians have stoically accepted being toothless in old age as part of the price. First, though, there are awful workforce problems. What starts with neglect in childhood evolves into a workforce of adults with severe tooth loss and poor self-image, plus illnesses associated with dental disease (obesity, diabetes, strokes, heart disease and Alzheimer�s) and last, a distressing cohort of toothless elderly poor, sadly, among the highest in the country.

It's a grim story, but Cecil sees determination in the profession to address the problems. With a new added role for hygienists, he says, �The dam may be broken.�


Journalist Al Smith, Lexington, a former federal cochairman of the ARC, and co-founder of the Institute for Rural Journalism and Community Issues at UK, is the retired host of KET�s "Comment on Kentucky."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
Princess Health and ADDICTION: SEARCHING FOR YOUR SOUL. Princessiccia

Princess Health and ADDICTION: SEARCHING FOR YOUR SOUL. Princessiccia

You know that feeling you get right before you decide you�re breaking the rules? No matter what the consequence, you don�t care? No matter if someone gets hurt, you�re going to do it anyways, lie about it, and if someone gets in your way, they better watch out. There is no stopping you, and you�ll hide, cheat, and steal to get your entitled addiction. If someone finds out, there�s always a lie you can tell to distract the blame from yourself and to make your decision seem justifiable.

The force between you and your addiction is so strong that you�re willing to mutilate relationships, your body, and your life to get it. For me, that lying, cheating, scandalous force was against my extremist control and restriction from food and from gaining fat. As soon as I had a bite of something I judged as bad, or that was off my pre-determined and calculated food allotment (like a pastry), my mind would go into a tunnel. My decision to go off plan was usually because I thought I could handle it. That one bite wouldn�t hurt my body (which is true). But what I wasn�t aware of was the emotional reaction that one bite would start within my over controlled and rigid frame of mind.
That one bite became a sin. It was something that created guilt, shame, and something to hide.
That one split second, gave me a taste of freedom--a taste of fun and excitement that my restriction would never allow. That one bite would cascade into an emotional pendulum swing, from extreme control and protection on one side, to entitled liberty and freedom on the other. But I�d never let go of my control, until I meditated a way to get rid of the guilt, and remove my shame that arose as soon as I broke my crazy rules. I was the abuser, I enslaved myself from food, yet I was the one who justified breaking the rules for emotional freedom. However again, I justified mutilating my body through exercise and purging to make up for the shame and guilt that occurred as a direct reaction to my insane perfectionism and self criticism.  Why? It all starts with extremist ideology that defines emotional value.  This is what it�s like to be insane: control, compensate, control, and compensate again. CRAZY.
 At any point during this game with food and my body, if anyone got in my way, I�d lie or hide. Waking at 3:00am to exercise, puking in the shower so no one would know (even if they were in the bathroom with me). No one could get in my way.  Once I decided to break my rigidity, I�d time just perfectly what to eat, where it was, how I�d get it, and if I needed to hide, where I�d go and what lie I�d tell, just in case someone found out. In a single day I might puke 8 times and I�d exercise at least 90 minutes. My entire life revolved around counting calories, restricting food, eating on a strict schedule, studying food and recipes, researching exercise, obsessing over how many calories I burned, my weight, and my waist size. I�d measure my waist at least 5 times a day! Then the rest of my day was spent calculating how to get rid of shame, guilt, and anxiety when I�d cheat or break my rigidity. You can imagine the fear that occurred if I wasn�t able to puke or exercise. It felt like death. Literally, like emotional death and my body would physically react with all of the same fight or flight symptoms, as if I was getting murdered.  
Take this description of my past addiction and recognize that all addicts have the same view of the world, the same need to control and defend their addiction of choice. Wouldn�t you if you lived in that type of insanity? Whether it�s drugs, alcohol, sex, gambling, dieting, exercise, binging, working, hording, cutting, controlling another person, or liberty to physically and psychologically abuse another person-- if you relate to what I described, you can understand why people do weird things to feel better emotionally, even if it hurts another human being. I�ve come to realize it�s also very predictable and most people with addiction follow the same severe pendulum cycle of thinking. The wonderful news: you are also capable of getting out of this insanity if you choose and if you�re willing to feel vulnerable and submissive to NOT compensate, even when it feels like an emotional atomic bomb- or death.
You have to be willing to let go of restrictive control and judgment, which causes the resulting excessive liberating compensations, that when ended reduces the feeling of guilt, shame, fear, and rejection. With the submission to all of that, is the end of your need for your addiction.  
For me, I had to let myself eat too much (relative to my crazy restrictions) and then refuse to exercise and purge even when I felt severe anxiety. I had to assume the worse and submit to the idea that if I wanted to end my psychological illness, I had to face what I thought would make my life miserable: fat gain. It was a matter of choosing to stop controlling, to stop compensating, and to accept the outcome, no matter what.  It felt like death, and that emotional death came with a tremendous amount of vulnerability, acceptance of rejection, admittance of the weakness of my soul, and exposure to life without hiding.  For you, the only way to climb out of the dark, dreary, cold, grave you dug yourself into is to let go of everything that got you there.
No more control, no more perfection, no more rules, no more judgment. Let the real you be vulnerable to rejection, but first you have to stop defining yourself by outside views, objects, attainments, people, and activities. Who are you with nothing? How then do you define your value?  When you identify and sense your value that requires nothing to achieve, who can take that away or who can make it better? NO ONE.  
What then creates rejection and vulnerability?
Your indefinable awesomeness is innate to your soul and already exists, has always existed, and will continue to exist no matter what. Once you connect with the essence of your soul, it becomes obvious that others who judge you obviously haven�t yet found their own soul � the soul they lost growing up with criticism and judgment. They still think they are only as valuable as you can see, they can tell you, or from a limit that has to be communicated.  They still believe value has to be earned, controlled, followed, and that perfection based on rules is what matters most. They are addicts.
Any person who�s retrieved their soul from a psychologically controlling grave will tell you: love comes from that essence of the soul, and until you reconnect with that, you haven�t started living yet.  The moment you were taught you only have value if you do this, this, and this�was the moment you starting dying.  That was the moment you lost the awesomeness of your soul, and the moment you started focusing on seeking life outside of that soul. It�s time to go back to that child, back to that soul, and start living again.
Love who you are without control and if you don�t know what that is, list all of the rules you follow by and get rid of them. All of your definitions, let go of. Imagine who you�d be without them. Can you even imagine your value if it didn�t have to be designated by some type of conformity? If that is what you want, you�re addiction is about to end. Freedom is outside of the emotional jail and it�s yours when you�re ready to walk out. LET GO�
Princess Health and Meds-for-meth bill stalls in state House committee.Princessiccia

Princess Health and Meds-for-meth bill stalls in state House committee.Princessiccia

A measure aimed at curbing methamphetamine production failed to come to vote in the House Judiciary Committee Tuesday. Rep. John Tilley, a Hopkinsville Democrat who chairs the committee, said he hopes Senate Bill 3 will be voted on later this week.

The bill, which was passed by the Senate March 2, "would allow consumers to buy 7.2 grams per month of medications containing pseudoephedrine and up to 24 grams annually, an amount adequate for most cold or allergy sufferers, according to testimony," reports Deborah Yetter for The Courier-Journal. "A doctor's prescription would be required for an additional 7.5 grams per month or an additional 90 grams per year." The bill would exempt liquid or gel-cap formulations of the drug.

Right now, Kentuckians can buy 9 grams of the medicines per month and 120 grams per year.

Some committee members said they are concerned people could be breaking the law if they get or own too much of the drug. Rep. Joe Fischer, R-Fort Thomas, said his wife takes Claritin D, which contains pseudoephedrine, for allergies on a regular basis and asked if the bill would make it too hard for people like her to get the drugs without going to the doctor first. (Read more)


Tuesday, 13 March 2012

Princess Health and What health reform changes to expect in 2012 � assuming the Supreme Court doesn't strike down the entire law.Princessiccia

Princess Health and What health reform changes to expect in 2012 � assuming the Supreme Court doesn't strike down the entire law.Princessiccia

The U.S. Supreme Court is set to hear arguments later this month about the federal health care-reform law, and is expected to decide the law's future this summer. While the court mulls the constitutionality of an individual mandate to buy health insurance, "implementation marches on, and a number of notable changes will take effect for consumers this year," writes Michelle Andrews for Kaiser Health News.

If the high court strikes down the Patient Protection and Affordable Care Act, "all bets are off," Andrews writes. Popular provisions, such as allowing children to stay on their parents' insurance until age 26 and the 50 percent discount on brand-name drugs for seniors under the prescription drug doughnut hole, could be eliminated � and provisions set to take effect this year could be cancelled. But, if the Supreme Court does not invalidate the entire law, here's a list of new provisions consumers can expect this year:

Free contraception coverage: "Women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge," Andrews writes. Insurance plans will also have to provide basic health services for women, including screening for gestational diabetes; HPV testing; STD counseling; screening and testing for HIV; and screening and counseling for interpersonal and domestic violence. Religious employers such as churches are exempt from the new regulation, but colleges, hospitals and other employers that are religiously affiliated are not � though they do have a one-year grace period to implement it. Employees of those institutions will receive their free benefit from their employer's insurance.

Consumer rebates: Under the law, insurance companies have to spend at least 80 to 85 of their premium revenues on medical claims and quality improvement. If they don't, they have to pay the difference to policyholders, which, in most plans, means the employer. If the provision had been in place in 2010, an analysis by the National Association of Insurance Commissioners estimated that would have meant $2 billion going to consumers. In December, the Obama administration said that about 9 million Americans could receive rebates that added up to $1.4 billion.

Clearer descriptions: Starting in September, all health plans will have to give consumers benefits information that is easy to understand. "Every plan will be required to give people a short summary of coverage and a uniform glossary of terms," Andrews reports. "It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes � two common situations that should make it easier for people to compare plans."

Smaller doughnut hole: "This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit," Andrews reports. Last year, people on Medicare with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they'll also get a 14 percent discount on generic drugs. (Read more)
Princess Health and Jewish Hospital of Louisville becomes national leader in removing heart pumps from patients with heart failure.Princessiccia

Princess Health and Jewish Hospital of Louisville becomes national leader in removing heart pumps from patients with heart failure.Princessiccia

Eleven patients with advanced heart failure were able to have their heart pumps removed thanks to a combination of medication administered at Louisville's Jewish Hospital.

Texas Heart Institute is the only other institution that has removed heart pumps, also known as left ventricular assist devices. Twenty of the devices have been removed in 10 years there. At Jewish, all 11 have been taken away in the past 18 months, Laura Ungar reports for The Courier-Journal.

The program at Jewish uses a cocktail of medicines, including ACE inhibitors, beta blockers and others, in combination with the heart pump. The medication helps strengthen the heart, allowing the pump to be eventually removed. "These patients have a very good quality of life, much better, in fact, than if they continued with the LVAD alone or received a heart transplant," said Dr. Emma Birks, director of the Jewish Hospital Heart Failure, Transplant and Mechanical Support Program.

The treatment could mean "some patients with advanced heart failure may be able to forgo a heart transplant, while others can delay having one," Ungar reports. "That could mean a longer life for younger heart failure patients with LVADs; life expectancy after a transplant averages 10 years."

Nationwide, about 5 million Americans have heart failure, which translates to 300,000 deaths a year, National Heart, Lung and Blood Institute figures show. (Read more)