Princess Health and Regan Hunt, executive director of Kentucky Voices for Health, leaves for a new position at insurer Humana Inc..Princessiccia

Princess Health and Regan Hunt, executive director of Kentucky Voices for Health, leaves for a new position at insurer Humana Inc..Princessiccia

advocacy health insurance Humana Medicaid

Gusty 18:09 Add Comment

The executive director of Kentucky Voices for Health, a group that worked for the implementation of the Patient Protection and Affordable Care Act, is now working for Humana Inc. as a product development consultant.

Regan Hunt

Regan Hunt switched jobs after working in a way that won her the Consumer Health Advocate of the Year Award by Families USA, which cited her work for expansion of Medicaid in Kentucky and her efforts to increase health coverage under the Affordable Care Act. In her new job, she will be a product development consultant, working on design of benefits for those covered by the Medicaid expansion.

During her time at KVH, Hunt worked with a coalition of more than 200 partners to address the many health care needs of Kentuckians, including access, prevention, quality and value. Hunt said in an interview that she was most proud of  KVH's role in enrolling so many Kentuckians in coverage during 2013-15.

"Kentucky is one of those states that did it right," she said.

Hunt said that she was also proud of the group's collaboration between Gov. Steve Beshear, the state Cabinet for Health and Family Services: "We all worked together and that was an amazing thing ... all working together to make sure that people got the information that they needed and got covered. ... It was a once-in-a-lifetime sort of thing." KVH is not a lobbying group, but many of its members are.

At Humana, Hunt will research the Medicaid expansion landscape in other states to determine what new beneficiaries that population might need or want in a benefits package, beyond what is required by law.

"I am an advocate, probably until the day I die," she said, noting that she will now work as an individual advocate, instead of under the umbrella of KVH, to help people gain access to health coverage. "I've been doing that since I was 22, so it is not something that I am going to give up doing."

Hunt is a native of Pike County, She earned her undergraduate degree at Transylvania University and her Masters in Public Administration degree from the University of Kentucky. She also holds a certificate in health-care management from the University of North Carolina, according to the KVH website.

Princess Health and . Princessiccia

Princess Health and . Princessiccia

academic corruption conflict of interest evidence-based medicine institutional conflicts of interest NEJM pharmaceuticals physicians

Gusty 13:59 Add Comment

Why is the New England Journal of Medicine Scolding "Pharmascolds"?

I, a normally quiet blogger on this site, was disquieted by what may be a backlash aimed at quashing the anti-conflict-of-interest movement.

Lisa Rosenbaum just published her second of three treatises in the highly prestigious New England Journal of Medine, scolding "pharmascolds" (see Conflicts of Interest: Understanding Bias � The Case for Careful Study). "Pharmascolds" is the term Rosenbaum and others use for those of us at Health Care Renewal, the Institute of Medicine, and countless medical journals and institutions.  Why?  Because we dare assert there is great danger when providers practice though saddled by (potential) conflicts of interests in medicine.  Such conflicts are created when physicians (up to 94% of us, according to Rosenbaum's research), other health care providers in practice, and health care organizations accept, not only gifts and trinkets, but also large, sometimes clandestine consulting fees and other arrangements from pharma and device companies, all the while providing direct patient care using the companies' products.

Rosenbaum and others say we pharmascolds are essentially self-righteous and obstructionist, holding back the progress of medical science.  In this article, she seems to claim that not proving direct patient harm from a specific questionable financial arrangement with a company whose product we may therefore more likely prescribe, speak well of, or publish (pseudo)evidence supporting the use of, is enough of a reason to justify the arrangement. 

Wouldn't that be the same as saying, "Until you actually crash into another car while texting, it's ok to text while driving, even if it's distracting."?

Rosenbaum uses mainly anecdote to prove her point, and appeals to a little-quoted, but still important, heuristic/bias called "moral liscensing."  Rosenbaum describes the phenomenon correctly: "once disclosure [of a conflict of interest] gets the weight [of guilt] off your chest, you feel liberated and may feel licensed to behave immorally."  True.  But then Rosenbaum seems to support non-disclosure of acts that create conflicts of interest, because disclosure doesn't decrease the acts themselves.

Rosenbaum goes further. At the same time as she supports non-disclosure of conflicts, she attempts to paint those who accept conflict-generating arrangements and keep them clandestine as victims--afraid to "come out of the closet" because doing so is socially taboo, though the activity is not wrong. 

I beg to differ.  For certain acts, potential conflicts, and actual conflicts, it seems to me that mere disclosure of the act or conflict shouldn't relieve one of the guilt associated with the act or conflict.  It also seems disclosure of a conflict should not make a speaker seem more credible to his/her audience because of its disclosure, though some research Rosenbaum quotes seems to show that disclosure improves credibility. 

Perhaps the stronger argument for disclosure is to disqualify people from activities that should be prohibited for people in conflict, as well as to warn people away from engaging in questionable activities that would result in conflicts. 

In an unbelievable twist of logic, Rosenbaum seems to be arguing in this article for more, not less of these questionable activities, in the interest of advancing science, until we prove patients are directly hurt by them, i.e., we have a "wreck."  Heck, let's get rid of traffic lights too, while we're at it.  People have eyes. We should trust them. They should be able to avoid accidents voluntarily, on their own.

In short, how could Dr. Rosenbaum not see that the best solution for the "problem" of conflicts of interests is avoidance when possible?  One can't help but wonder if she and the Journal aren't blinded by the shimmer and pull of powerful, influential organizations, ones so shiny, so strong, and so ubiquitous that resistance is just too hard for her, the Journal, and for 94% of us.

Conflicts of interest should be avoided.  Society has accepted that improved health will result not just from secondary prevention (e.g., not texting while driving after one has had an accident from the activity), but also from primary prevention (not texting while driving, even before an accident occurs). 

Wally R. Smith, MD

Princess Health and Lexington Herald-Leader says Kentucky Hospital Association report on members' finances damages the group's credibility.Princessiccia

Princess Health and Lexington Herald-Leader says Kentucky Hospital Association report on members' finances damages the group's credibility.Princessiccia

health insurance hospitals Medicaid obamacare Patient Protection and Affordable Care Act

Gusty 19:54 Add Comment

The Kentucky Hospital Association's recent "Code Blue" report on its members' finances is a symptom of "financial hypochondria," the Lexington Herald-Leader said in a long editorial Sunday. It said the title, "signaling a patient needs resuscitation, is an unintentionally fitting title because the KHA's credibility could use a little CPR."

Read more here: http://www.kentucky.com/2015/05/17/3855678/hospitals-suffering-financial.html#storylink=cpy

The report "voices a universal human desire: more money, less accountability. The association implies that federal financial penalties aimed at reducing harm to patients are too onerous for hospitals that care for Kentuckians," the editorial says. "Little more than anecdotes are offered with no acknowledgment that some Kentucky hospitals are recording record bottom lines and steep drops in uncompensated care."

The newspaper offered its own anecdote, a large one, noting that the University of Kentucky's medical center is a major beneficiary of the Medicaid expansion under federal health reform: "The 2014 period saw an 83 percent drop in non-paying inpatients, a 66 percent drop in non-paying outpatients and a $60 million increase in Medicaid revenue. UK Healthcare's annual net income through March is up $70 million over the same time last year. Not all of that increase is due to the Medicaid expansion or Kynect," the state exchange for enrolling in Medicaid or buying private insurance.

"The important point," the paper says, is that "Slowing down spending on hospital care is one of the best things we can do for the economy and our health. The United States spends the highest percentage of its GDP on health care of any country but gets worse outcomes. Even by U.S. standards, Kentuckians over-utilize hospital care."

Read more here: http://www.kentucky.com/2015/05/17/3855678/hospitals-suffering-financial.html#storylink=cpy

Princess Health and BLOGSCAN - New England Journal of Medicine Scoffs at "Pharmascolds" . Princessiccia

Princess Health and BLOGSCAN - New England Journal of Medicine Scoffs at "Pharmascolds" . Princessiccia

conflicts of interest New England Journal of Medicine pharmaceuticals

Gusty 09:18 Add Comment

The venerable New England Journal of Medicine has now published an editorial,(1) and two commentaries(2-3), with one more promised, hailing physician industry "partnership," as per NEJM editor Jeffrey Drazen,(1) and deploring the "pharmascolds,"(3) who might question the glorious innovations that could arise when industry pays academic and practicing physicians.   

In a tweet, Dr Harlan Krumholz said he was "shocked" that a NEJM commentary would "give credence to the 'pharmascold' narrative.  

So far, the only more detailed questions about this new direction for the Journal came in a guest blog by Dr Susan Molchan in the HealthNewsReview blog, which responded only to the editorial(1) and the first commentary(2).  Dr Molchan wrote, 

Dr. Rosenbaum makes a nice try at reinterpreting financial conflicts between physicians and pharma, but however one twists and turns it, the dots still reconnect into dollar signs. She asks, �Have stories about industry greed so permeated our collective consciousness that we have forgotten that industry and physicians often share a mission � to fight disease?� Is Dr. Rosenbaum�s consciousness so clouded as to think that pharmaceutical companies don�t exist first and foremost to make money? That their primary responsibility is not to their shareholders?  It�s true that a means to this end is fighting disease, (including new �diseases,� tailored to one�s drug), but this should not be confused or conflated with the primary mission of (hopefully most) physicians.

I and many others suggest that the 'stories about industry greed' have not permeated enough, and that this problem has polluted much of medical research and medical practice, to the point where trust of the medical research enterprise has been eroded....

The airtime the NEJM is giving this issue, including publishing three - count them - strongly opinionated but hardly journalistic commentaries by their ostensible"national correspondent," suggest a major push against the "pharmascolds."  Again, note this this inflammatory and ad hominem term was used in a supposedly serious article on "Medicine and Society."  I strongly doubt we have heard the last of this.  Stay tuned. 

ADDENDUM (20 May, 2015) - See also comments by Mickey on the 1BoringOldMan blog.  

References
1.  Drazen JM.  Revisiting the commercial-academic interface.  N Eng J Med 2015; ; 372:1853-1854.  Link here.
2.  Rosenbaum L.  Reconnecting the dots - reinterpreting industry-physician relations.  N Eng J Med 2015;  372:1860-1864.  Link here. 
3.  Rosenbaum L. Understanding bias - the case for careful study.  N Engl J Med 2015;  372:1959-1963.  Link here. 

Princess Health andCDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored.Princessiccia

Princess Health andCDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored.Princessiccia

Appalachia Centers for Disease Control and Prevention health

Gusty 06:20 Add Comment

By Melissa Patrick
Kentucky Health News

Shaping Our Appalachian Region, the bipartisan effort to revitalize and diversify Eastern Kentucky's economy, will focus its health efforts on substance abuse, obesity and diabetes, SOAR Executive Director Jared Arnett told Kentucky Health News.

"We believe they have the greatest impact on our ability to create jobs and build a world class workforce," Arnett said in an email. He said David Roberts of the federal Centers for Disease Control and Prevention, determined the priorities after spending three months at the SOAR office in Pikeville.

The priorities differ from those put forth by SOAR's Health Working Group, which made two major recommendations after a series of public forums: a coordinated health program in schools, and a study of the health effects of large-scale surface mining. However, when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. No recommendations appear on the health group's webpage.

At the health session of SOAR's "Strategy Summit" May 11, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the CDC, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it, Al Cross reported for the Appalachian Kentucky page of The Rural Blog.  

"That dismayed me," Cross writes. Later, upon raising his hand and being recognized by Seymour, he told her and the audience that it was "disconcerting and almost unbelievable" that she was unaware of the recommendation about mountaintop mining. Seymour replied that she had, in fact, heard about it.

Cross wrote, "Noting that the Pike County Fiscal Court Room was nearly full, I told Seymour that a lot of people had attended meetings and made their concerns known, and that even though this issue was "a hot potato," because of the coal industry's role, she needed to "go back to the powers that be, and tell them there's a room full of people who want answers."

Cross wrote that he was not for or against a study on the health effects of mountaintop mining, and " Unless they're writing opinion pieces, journalists aren't supposed to take sides," he wrote. "But they do need to speak up when issues of broad community concern aren't being addressed, especially when those concerns have been solicited."

The SOAR working groups concluded their meetings last summer and submitted their final reports. Since then, the SOAR executive board has decided to launch a SOAR Advisory Council and hold annual roundtables, or more as needed. They have made a request for a community health representative to be appointed to serve on this council, and Arnett said he expects this person to be appointed by June 1 or so. 

In addition, a follow-up CDC representative will be assigned to the SOAR office for one year beginning in late summer to help put together a strategic plan to address the three areas of focus recommended by the CDC at the summit. This person will also lead a Community Health Action Team for SOAR to work on building a blueprint for improved public health in the region, Arnett said.

"We are focused on working with our corporate partners and the Community Health roundtable to address these issues identified by the CDC on what can have the broadest reach and the greatest impact," Arnett said. A full report of all of the CDCs recommendations is expected in the near future, he said.

Princess Health andLaw requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue.Princessiccia

Princess Health andLaw requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue.Princessiccia

health care access mental health mental illness Patient Protection and Affordable Care Act substance abuse

Gusty 06:13 Add Comment

By Melissa Patrick
Kentucky Health News

By law, mental health benefits must be offered equally to medical and surgical benefits if the plan offers them, but this isn't always the case.

Not only does a 2008 federal law require most employer-sponsored plans to provide equal access to mental health benefits, but that parity was expanded and strengthened in 2010 by the Patient Protection and Affordable Care Act. Twenty-three states, including Kentucky since 2000, require some level of parity.

Common requirements of these laws prohibit insurers from charging higher co-payments and deductibles for mental-health services; require insurers to pay for mental-health treatment in the same scope and duration as medical treatments; ban insurers from requiring additional authorizations for mental-health services; and says they must offer an equal number of mental-health providers and approved drugs.

While insurers typically keep track of the copayment and deductible requirements, they struggle with keeping track of the compliance requirements related to actual delivery of medical services, Michael Ollove reports for Stateline.

The spokeswoman for the Kentucky Department of Insurance, Ronda Sloan, said in an e-mail that Kentucky is very diligent about parity requirements. "Kentucky insurance companies must cover mental-health treatment like other covered services," she wrote. "We review both provider networks and drug formularies for compliance and (make sure) both meet the requirements of the ACA."

A recent report by the National Alliance on Mental Illness found that this isn't always the case. Nearly one-third of those surveyed were denied authorization for mental health and substance abuse treatment, with this rate nearly twice as high for those on ACA plans.

It also found other barriers to care including the number of mental health providers in health insurance plan networks; more than half of the health plans analyzed covered less than 50 percent of anti-psychotic medications; high out-of-pocket costs for prescription drugs; high co-pays, deductible and co-insurance rates; and a lack of information about mental health coverage to consumers to help them make informed decisions in choosing their health plans.

The survey was conducted by Avalere Health and is based on a survey of 2,720 individuals with mental illness or with someone in their family with mental illness and an analysis of 84 insurance plan drug formularies in 15 states.

Sloan said that in Kentucky, "Work is being done on many fronts to increase access and progress is being made to address some of the access issues."

She said Kentucky monitors provider networks to make sure they are meeting their minimum requirements. She also said that a recent law passed by the 2015 General Assembly, which created three levels of drug and alcohol counselors with varying degrees of  certification, will have a "positive impact" on access to treatment.

Gwenda Bond, spokeswoman for the state Cabinet for Health and Family Services, said in an e-mail, "We also opened the provider network for behavioral-health services in early 2014 to a range of private providers of such services, increasing the number of options available for members, who previously could only receive treatment through the community mental health centers."

One of the main obstacles for consumers and providers is that it is not clear what criteria insurance companies and managed-care Medicaid organizations use to determine medical necessity for mental-health and substance-abuse care, and aren't transparent with this information.

"Without that information," Ollove wrotes, "it is difficult for regulators and consumers to determine whether the denial of coverage is warranted." 

Ollove also notes other problems include the federal governments delay in creating regulation guidelines, the challenges states and the federal government have had in simply implementing the ACA, let alone regulating parity and the stigma that is still associated with mental illness and addictions that make regulators not want to get involved.

Two states, New York and California, are leading the way in enforcing parity rules, Patrick Kennedy, a former Democratic congressman from Rhode Island, told Ollove, saying that they were the "only states that consistently enforce mental health parity."

Sloan took issue with that, saying, "We believe Kentucky consistently enforces the rules related to mental health and substance abuse parity." 

Kentuckians who believe they have been improperly denied mental-health and substance-abuse care should contact the Department of Insurance.

Princess Health and Apologies to All - Sitemeter Forced Redirect Problem Now Fixed. Princessiccia

Princess Health and Apologies to All - Sitemeter Forced Redirect Problem Now Fixed. Princessiccia

Gusty 13:52 Add Comment

My apologies.  Starting yesterday I discovered that anyone attempting to view this blog was involuntarily transferred to a non-working URL, gogardenclub.com.  The problem seemed to result from the Site Meter widget, which was originally meant to keep track of our blog hits.  I have removed Site Meter, and I believe the problem is solved.