Princess Health and Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction.Princessiccia

Princess Health and Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction.Princessiccia

addiction drug abuse drugs managed care Medicaid state government

Gusty 11:29 Add Comment

Coventry Cares, one of the four firms that manage patient care for the state Medicaid program, has once again hit the headlines, this time for its plans to stop paying for medicine that helps addicts keep their opioid addiction at bay. State officials quickly condemned the move Thursday and called it a contract violation, reports Beth Musgrave of the Lexington Herald-Leader.

Coventry decided to stop paying for buprenorphine, more commonly known as Suboxone, which helps curtain cravings for drugs such as Oxycontin and Vicodin. A 30-day supply of the drug can cost more than $450, Musgrave reports.

"They will be at risk for relapsing and going back to using illegal opioids," Dr. Michelle Lofwall, an addiction specialist and assistant professor at the University of Kentucky, told Musgrave. "Whenever you are using illegal opioids, there is a risk of overdose and death."

Coventry said it will no longer offer the coverage because only pregnant women, women who recently gave birth and those under the age of 21 are eligible for addiction treatment in Kentucky's Medicaid program. "What we've done is align our coverage with the cabinet's Medicaid policy," said Matt Eyles, a Coventry spokesman.

However, the state Cabinet for Health and Family Services said the decision violates the contract and "cannot take this unilateral action without the cabinet's approval," said Jill Midkiff, a cabinet spokeswoman. 

A company that operates addiction treatment centers across the state was planning to file suit over the move Friday, but, after learning of the cabinet's reaction, "We are going to give them the chance to work this out," Anna Whites, an attorney who represents SelfRefind.

Coventry already caused controversy this week when it informed Baptist Health System wants to renegotiate its contract. The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The company has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26. (Read more)

Princess Health and Cancer battle of UK faculty member to air on KET.Princessiccia

Princess Health and Cancer battle of UK faculty member to air on KET.Princessiccia

Gusty 05:27 Add Comment

A documentary chronicling a former University of Kentucky faculty member's battle with cancer will air six times in May on KET.

Nancy Clauder, an oboist whose research focused on arranging and performance, was diagnosed with multiple myeloma in 2008 when she went to the doctor with what she thought were symptoms of the flu. She was diagnosed with the disease, a rare, blood-related cancer with no cure. Clauder underwent a stem cell transplant, endured high-dose chemotherapy and lost her ability to play her instrument for six months, a UK press release says.

Eventually, she was able play again and recorded a CD with artists from UK and the Lexington Philharmonic. "This is the right time, and I'm so grateful that there was the opportunity to do it through UK, and a grant research program, because I would not be able to afford the musicians," she said.

The documentary "The Ascending Journey" will air at 4 p.m. and 10:30 p.m. May 13; at 10:30 p.m. Thursday, May 17 on KET2; midnight Monday, May 21 on KET2; 5 a.m. Monday, May 28 on KETKY; and 9:30 p.m. May 30 on KETKY. (Read more)

Princess Health and 42 percent of Americans will be obese by 2030, study predicts.Princessiccia

Princess Health and 42 percent of Americans will be obese by 2030, study predicts.Princessiccia

diabetes nutrition obesity

Gusty 17:03 Add Comment

If trends continue, 42 percent of American adults will be obese by 2030 and about one quarter of whom will be grossly obese, a new study warns. The results are only slightly less troubling than those published four years ago, which forecast that 51 percent of the population would be obese by 2030.

Right now, 34 percent of American adults are obese and some evidence indicates obesity rates have reached a plateau. "Regardless which is correct, we still have a very serious problem," said William H. Dietz, head of the Centers for Disease Control and Prevention's obesity program. The results were discussed Monday at the "Weight of the Nation" conference in Washington, D.C.

The study, published in the American Journal of Preventive Medicine, used obesity prevalence data from 1990 to 2008 to analyze trends. Information came from the widely regarded Behavioral Risk Factor Surveillance System, but because people tend to underestimate their weight when asked on the phone, a mathematical equation was used to compensate for the shortfalls, David Brown reports for The Washington Post. (Read more)

Princess Health and Without a partner, University Hospital's viability is 'questionable at best,' consulting group concludes.Princessiccia

Princess Health and Without a partner, University Hospital's viability is 'questionable at best,' consulting group concludes.Princessiccia

Gusty 07:14 Add Comment

University Hospital in Louisville needs a partner that will help it grow, a consulting firm informed a committee reviewing the facility's operations Wednesday. "Even with operational and strategic improvements, the economic viability of University Hospital is questionable at best," they said.

"While the organization is working very hard to make improvements ... the gap between where you are as an organization and where you need to get to be a viable organization is very steep," said consultant Craig Anderson Sr. of Dixon Hughes Goodman of Hudson, Ohio. "At the end of the day, any organization need an access to capital."

Laura Ungar of The Courier-Journal notes that the findings are in keeping with University Hospital's search for a partner, which it has long been looking to find. Last year, Gov. Steve Beshear nixed plans for the publicly-owned hospital to join, among others, a Catholic-based organization that would have limited some procedures it could offer because of the organization's religious tenets.

University Hospital has delayed its selection of a new partner until the end of June to give more time for negotiation.

"The two major conclusions are what the university would like to have heard: That partners and capital are needed," said Dr. Peter Hasselbacher, a merger critic and former professor of medicine at U of L who attended the meeting. "We need to ask: How did we get here?" (Read more)

Princess Health and Managed-care firm Coventry threatens to terminate contracts of Baptist Healthcare and big Ashland hospital.Princessiccia

Princess Health and Managed-care firm Coventry threatens to terminate contracts of Baptist Healthcare and big Ashland hospital.Princessiccia

Gusty 06:58 Add Comment

Lexington Herald-Leader photo by Charles Bertram

Issues with the state's managed-care companies continue to mount. Now Coventry Cares has told Baptist Healthcare System, which has hospitals in Lexington, Louisville, La Grange, Paducah and Corbin, that it wants to renegotiate its contract. 

The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The managed-care firm has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26.

Kentucky moved its Medicaid population to managed care Nov. 1, a move that is expected to save the state a lot of money. The three managed-care organizations that coordinate care for Medicaid recipients outside the Louisville area are paid on a per-month, per-patient basis, regardless of what care is needed. Coventry alleges "that it has too many high-risk patients and that the state needs to adjust the risk model so Coventry can receive more money for sicker patients," report Beth Musgrave and Valarie Honeycutt-Spears for the Lexington Herald-Leader.

Unlike the state's other two managed-care companies, Kentucky Spirit and Well Care, Coventry "opted not to charge patients a co-pay for pharmacy services. That business decision meant it got more people into the system who likely had more complicated health problems," Musgrave and Honeycutt-Spears report. House Speaker Greg Stumbo has questioned the move not to charge a co-pay and wondered if it was akin to Medicaid fraud. (Read more)

Princess Health and Former head of Massachusetts health exchange says it's better to offer fewer, well-defined plans than set general criteria.Princessiccia

Princess Health and Former head of Massachusetts health exchange says it's better to offer fewer, well-defined plans than set general criteria.Princessiccia

health insurance health reform insurance exchange Patient Protection and Affordable Care Act state governments

Gusty 06:33 Add Comment

With  Kentucky stakeholders discussing their options to set up a state-run health insurance exchange � something Gov. Steve Beshear said last week he intends to do if the Affordable Care Act is upheld by the U.S. Supreme Court � research shows the fewer plans offered in the exchange, the better.

An article in Health Affairs says officials should follow the lead Massachusetts' health-reform system when creating their own exchanges. "A hands-on exchange with the power to set standards on top of the federal health-care law will help prevent consumers from being 'overwhelmed' by the process of buying insurance," reports Sam Baker for The Hill's global affairs blog.

The Health Affairs article's lead author, Rosemarie Day, is a former deputy director of the Massachusetts exchange. She said consumers prefer choosing from "a handful of carefully vetted, clearly described health-care plans," Baker reports. The model used in Utah to allow any plan that meets criteria to be featured in the exchange is less popular, the paper found, but was more popular among conservatives.

"Findings from consumer research emphasized the value of limiting insurance plan choices on the exchange," the analysis states. "Specifically, early focus groups showed that consumers wanted four to six carrier options at 'low, medium and high' benefit levels." (Read more)

Princess Health and Tea Party protesters object to state-run health insurance exchange; leader says if there is one, feds should run it.Princessiccia

Princess Health and Tea Party protesters object to state-run health insurance exchange; leader says if there is one, feds should run it.Princessiccia

health insurance health reform insurance exchange Patient Protection and Affordable Care Act politics state government

Gusty 09:36 Add Comment

By Tara Kaprowy
Kentucky Health News

A public meeting in Frankfort to get stakeholders' input about development of a state-operated health insurance exchange Monday was attended by dozens of Tea Party activists taking issue with Gov. Steve Beshear's intention to create it.

"It was absolutely a formal protest," said organizer David Adams, who writes the blog Kentucky Progress and managed Louisville businessman Phil Moffett's campaign for the Republican nomination for governor last year. "We are very, very strongly opposed and we're just getting started with our protest."

Last week, Beshear announced his intention to create a state-run exchange if the Affordable Care Act is upheld in the U.S. Supreme Court. Since 30 million Americans who don't have coverage now would be required to buy insurance under the law's mandate, the exchange would act as a marketplace in which individuals and employees of small business can choose from several plans that have coverage packages pre-approved by state and federal governments. The people buying from the exchange would be given subsidies to help pay their premiums.

States have the option to create their own exchange or have the federal government run one for them. Through February, Kentucky had received nearly $60 million to help set up an exchange, money officials said would be used for planning.

Several major business lobbies have said the state should have its own exchange, but Adams argues that if there is an exchange, the federal government should run it.

"This idea that if the state does it then we have some kind of control is like saying since we run Medicaid, we have control over Medicaid, which is absolutely not the case," he said. "If we have a state-run health insurance exchange, we will run it in the exact way that the federal government wants us to." He said he fears that once a state-run exchange is set up, "when federal funds run out, we'll be responsible for financing it."

"There is a place for helping people who absolutely can't help themselves," Adams acknowledged, but since people with an income of up to 133 percent of the federal poverty level qualify for the exchange, "We've changed the definition of who can't help themselves. We've moved that line way up into the middle class. In every part of life that we've done that, that has been very counter-productive."

Though the Supreme Court's decision about whether to uphold the mandate won't be known until June, Adams said he felt it was necessary to protest Monday's meeting "to demand that the government send back the $60 million and stop any activities of setting up an exchange." "I don't think anybody really believes that we need $60 million in federal grant money to set up a website to help people buy health insurance," he said. "We need to return that money and operate on a more fiscally feasible path."

In response to a question, Adams said the protest was not held to stir anti-Obama sentiment that might help Kentucky Republican candidates in the November elections. He said the insurance exchange is "just the tip of the spear" and that "the best thing we can do in managing our health care problems is stop going in the wrong direction."

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.