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News in Brief page 2 | People in Brief page 4 | Event Calendar page 6 UofL scholars plan to improve health equity in Louisville Students are selected based on their commitment ADVERSE to social justice and health equity. CHILDHOOD Read more on page 2
EXPERIENCES Corner Office ARE COMMON This month we spoke to Eric Friedlander, chief resilience ASSOCIATED WITH officer with Louisville Metro Office of Resilience and HEALTH PROBLEMS Community Services. AS AN ADULT Read more on page 5
Safeguarding By Sally McMahon healthcare During the last 20 years, research Lexington lawyers discuss their experience has shown that there is a direct correlation combatting healthcare fraud at the U.S. Attorney’s Office. between childhood trauma and adult illness. Among those Kentuckians experi- Science shows the effects This childhood trauma, called Adverse encing five or more ACEs compared to Read more on page 11 of ACEs are not permanent Childhood Experiences (ACEs), can cause those with no ACEs, they are: academic and behavioral problems. It and identifying and treating − Five times as likely to have an HIV test. can also lead to an increased risk for heart children with high ACE scores − Almost five times as likely to have Policy over programs disease, depression, cancer, diabetes, obesity early on is important.” depression. Policies that include families in our leadership and more, if left untreated. − Over four times as likely to have poor structure and committees has been shown Local Impact ACEs are very common. According mental health. nationally to improve health outcomes. Kentucky started surveying for to the CDC-Kaiser Permanente Adverse − Almost four times as likely to be a ACEs on its 2015 Kentucky Behavioral Read more on page 17 Childhood Experiences (ACE) Study, of current smoker. Risk Factor Surveillance (KyBRFS), a the 17,000 ACE study participants, 64 − Almost two and a half times as likely telephone health survey co-sponsored by percent have at least one childhood ACE. to have asthma. Examples of ACEs include abuse the CDC and the Kentucky Department In Kentucky, a review of data from IN THIS ISSUE (physical, emotional, sexual), neglect for Public Health. the National Survey of Children’s Health, (physical, emotional) and household In Kentucky, nearly 60 percent of demonstrates a significantly higher dysfunction (mental illness, mother residents have experienced at least one frequency of ACEs for children living at or SOCIAL treated violently, divorce, incarcerated ACE. Of those that have experienced below the federal poverty level, a rate that DETERMINANTS relative, substance abuse). at least one ACE, 64 percent have decreases dramatically as income rises. ACEs cause toxic stress affecting experienced two or more ACEs. OF HEALTH Hope for High ACEs short-and long-term health, and can Of those Kentuckians experiencing at This month Medical News delves into social impact every part of the body. Possible risk least one ACE: If programs are developed and determinants of health (SDOH). SDOH are outcomes include certain behaviors (lack − 32 percent experienced divorce in implemented to protect and nurture conditions in the environments in which people of physical activity, smoking, alcoholism, the household. children, these prevalent health problems are born, live, learn, work, play, worship and age drug use), as well as physical and mental − 27 percent experienced drinking can be significantly reduced. Science shows that affect a wide range of health, functioning and health issues (obesity, diabetes, depression, (problem drinker or alcoholism) in the effects of ACEs are not permanent and quality-of-life outcomes and risks. heart disease, stroke, COPD). the household. identifying and treating children with high − 26 percent experienced verbal abuse. ACE scores early on is important. Articles start on page 12 A Louisville program, BOUNCE: Building Resilient Children and Families (formerly the Coalition for Louisville Youth), provides training on ACEs and resiliency to school staff and out-of-school activity providers in Jefferson County Public Schools (JCPS).
Monroe, GA Monroe, This work, funded by a grant from
Permit #15 Permit the Foundation for a Healthy Kentucky
PAID in 2012, is expected to evolve into a state US Postage US
Continued on page 8 PRSRT STD PRSRT PAGE 2 MEDICAL NEWS • FEBRUARY 2018 NEWS IN BRIEF
UofL scholars plan to improve Kentucky saves $2.5 million through health equity in Louisville healthcare initiative
The first cohort of the University residents. Several areas in central The Kentucky Personnel of Louisville (UofL) Health and Louisville have been identified as Cabinet and Secretary Tom Stephens Social Justice Scholars (HSJS) is ready food deserts. Kuo plans to evaluate announced $2.5 million in cost of to begin implementing strategies whether neighborhood international care savings achieved through an to improve health equity in the markets are good sources of fresh innovative health and wellness service. Louisville community. food for the community. The “LiveHealth Online Medical The Health Sciences Center + Behavioral Health” initiative, made students, who began the program last Jade Montanez: School of Nursing available to plan participants in June is viewed as an industry innovation summer, presented project plans to a “Confronting 2015, is a unique program allowing and will continue to expand services group of faculty members, program Health Disparities nearly 300,000 health plan members throughout the year through enhanced directors and future scholars that include Through Post- to take advantage of virtual doctor outreach and marketing. In addition research and action aimed at improving Secondary Health consultations and receive medical care to medical and behavioral specialties, the health of Louisville residents. Sciences Degree at home and at no cost to plan members. psychiatric virtual visits began in Each of the students worked with a Attainment” This creative program allows January of 2018. faculty or community mentor to develop M o n t a n e z participants to have access to free The cost benefits to Kentucky a plan for a project to be completed over hopes to support web-based medical professionals on- should continue to improve as people the next two years. Their projects focus an increase in demand and saves the patients time take further advantage of this user- on improvements in access to fresh food, MONTANEZ the number of and money. This successful approach friendly program. community trust in healthcare providers, underrepresented minorities in nursing dental care for HIV patients and diversity by strengthening a program that in the healthcare workforce. prepares junior high and high school Youths using tobacco products Eligible participants in the HSJS students for post-secondary education. program are doctoral students in one She anticipates that a more diverse may have greater risk of of the four schools on the UofL Health healthcare workforce will benefit Science Center campus: School of not only the students themselves, but cigarette smoking Dentistry, School of Medicine, School also the community through reduced Teens who use e-cigarettes, hookah, the same percentage reported vaping, of Nursing and School of Public Health health disparities. chewing tobacco and other cigarette which is similar to e-cigarettes. and Information Sciences. alternatives are almost twice as likely to For the new JAMA study, authors The students are selected based on Mallika Sabharwal: School of Medicine eventually smoke cigarettes than teens set out to find out if using e-cigarettes their commitment to social justice and “Understanding who never use those alternatives. That’s and similar products eventually led teens health equity to engage in a program Medical Mistrust in according to a new study in the Journal to smoke cigarettes. That’s important designed to help them learn techniques Smoketown” of the American Medical Association because cigarette smoking rates have for working interprofessionally and with Mistrust (JAMA). gone down in teens, which could be community members to improve the of the medical In Kentucky, a sizable portion of seen as a win by health advocates. But overall health of residents. community can teenagers already smoke cigarettes, for many teenagers, e-cigarettes have according to a state government survey taken the place of traditional cigarettes, Their projects are to include prevent individuals published in 2017. A little more than according to a University of Michigan community-based research conducted from receiving along with a faculty mentor and a report 14 percent of Kentucky high schoolers study from 2014. care and cloud reported smoking cigarettes, while about prepared for scholarly publication. SABHARWAL interactions with In addition, they participate in healthcare providers. Sabharwal plans community service projects and attend to survey residents of Smoketown and UK Transplant Center sets new monthly discussions. UofL students and providers to assess mistrust of health professionals. She Diana Kuo: School of Public Health and record for 2017 total transplants Information Sciences then will develop tools to improve cultural competency among providers “Examining and improve communication between The University of Kentucky and Addressing providers and Smoketown residents. Transplant Center performed 208 the Effects of She hopes to include a focus group total transplants in 2017, setting a new Food Systems on for creative expression by Smoketown record for most transplants performed Health Outcomes residents, providers and students, by any Kentucky medical center in a in Louisville” possibly resulting in a creative project. single year. Neighborhoods In total, UK HealthCare with limited access to transplant teams performed 101 healthy food, known kidney transplants (including three KUO as food deserts, are kidney-pancreas transplants), 43 heart In addition to a steady increase in associated with reduced health among transplants, 41 liver transplants and transplant volume over the past few 23 lung transplants. This milestone years, UK Transplant Center’s outcome cements UK HealthCare’s place in success consistently meets and exceeds the top 25th percentile of transplant national standards. centers nationally based on volume. MEDICAL NEWS • FEBRUARY 2018 PAGE 3 NEWS IN BRIEF
First-in-nation Medicaid work requirements approved for Kentucky
MORE PATIENTS WITH ACCESS 10 STATES APPLIED FOR WAIVERS INVOLVING WORK REQUIREMENTS OR COMMUNITY INVOLVEMENT FOR MEDICAID RECIPIENTS. TO EARLY-STAGE Kentucky has become the first to maintain their Medicaid eligibility. state in the nation to receive federal Former foster care youth, approval to impose work requirements pregnant women, primary caregivers CLINICAL TRIALS as a condition of Medicaid coverage. of a dependent, beneficiaries In a letter sent to Kentucky state considered medically frail and full- officials, the Trump administration time students are exempt from the said it would approve similar waivers new requirements. for other states. Kentucky will lock beneficiaries MARKEY CANCER CENTER Nine other states—Arizona, out of coverage for noncompliance. A Arkansas, Indiana, Kansas, Maine, person’s coverage can only be reactivated New Hampshire, North Carolina, on the first day of the month after See how at ukhealthcare.com/lesscancer Utah and Wisconsin—have also they complete 80 hours of community applied for the Section 1115 waivers. engagement in a 30-day period. Adult beneficiaries in Kentucky As of October 2017, Kentucky between 19 to 64 will be required has more than 1.2 million people in to complete 80 hours per month of Medicaid and the Children’s Health community engagement activities, Insurance Program, a net increase of such as employment, education, job 108 percent since Medicaid expansion skills training and community service under the ACA. CHFS, Home of the Innocents partner to provide healthcare to foster youth
Gov. Matt Bevin, First Lady this month. The goal of the program is Glenna Bevin and leadership of to provide mental and medical health the Cabinet for Health and Family interventions and assessments to help Services (CHFS) and the Home of the to prepare children to transition to Innocents in Louisville announced a the appropriate placement in the new partnership to provide improved least restrictive setting. The CHFS transitional behavioral health services Department of Community Based to children in foster care. Services (DCBS) and the Home As part of a collaboration developed this center to improve with CHFS, the Home opened outcomes for children entering the the Children’s Assessment and state’s custody. Transitional Service (CATS) Center News in Brief continued on page 10 PAGE 4 MEDICAL NEWS • FEBRUARY 2018 PEOPLE IN BRIEF
Bluegrass Care Navigators Dickinson Wright Methodist Hospital Liz Fowler, Attorney Emma Randy McCleese, Robert Sawyer, president and Wolfe has been with Henderson, M.D., joined Norton CEO, has been elected as a new Ky.-based Heart Specialists. selected as chair member to the Methodist of the Kentucky Lexington office. Hospital, has been Association of named the 2017 Hospice and John E. Gall Jr. Palliative Care. CIO of the year. MCCLEESE WOLFE SAWYER FOWLER Louisville Healthcare CEO Council Norton Hospital Stephanie Osborne Tammy York Day, Kelly McCants, B. Brian Sosnin Greene, previously previously with M.D., joined Jr., D.O., joined with Caretenders Delta Dental, was Norton Heart Norton Community and Almost Family, named president. Specialists. Medical Associates was hired as vice – Mallard Creek. president and chief hospice officer.
GREENE DAY MCCANTS SOSNIN Community Foundation of Louisville Louisville Metro Government Sullivan University Monique Lori Caloia, M.D., Olga Pinkston, Chris Ernst, previously Kuykendoll was named medical M.D., joined executive director of Quarterman was director for the Norton the Sullivan College of selected as the Department of Public Rheumatology Technology and Design, 2018 Hunger Health and Wellness. Specialists. has been appointed Innovation Fellow senior vice president of for the Community Sullivan University. Foundation of Louisville and the Lift a Life QUARTERMAN Foundation. CALOIA PINKSTON ERNST
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Conversations about leadership and management in the healthcare world Eric Friedlander, chief resilience officer, Louisville Metro Office of Resilience and Community Services
Medical News: locally. In April 2017, I was appointed by EF: Because resilience is such a broad How did you end Mayor Greg Fischer as our city’s first chief FAST FACTS and all-encompassing concept, I had a lot up being chief resil- resilience officer. to learn about those areas where I had less experience. I am the first chief resilience ience officer in Lou- Hometown: Louisville isville? MN: What is it like? officer who does not have a background in Eric Friedlander: EF: I’ve had a lot to learn. This work Family: My wife, Indigo, disaster preparedness or city planning. My background is in health and hu- In early 2017, while has, so far, been about the identification three dogs and three cats. serving as the direc- of the intersectionality of resilience. I have man services. I worked for the Cabinet for tor of the Depart- been involved in discussions around equi- Hobbies: Photography Health and Family Services for 30 years. ment for Communi- table economic development, racial equity, This is a different perspective than most all FRIEDLANDER and singing of my colleagues in the 100 Resilient Cities ty Services for Metro homelessness, sustainability, environment network. I tend to focus on those chronic Louisville, I attended an agenda setting (trees, weather, solar, Air Louisville) and Currently reading: The stresses in a community that make the in- workshop led by 100 Resilient Cities with infrastructure (Metropolitan Sewer Dis- Color of Law: A Forgotten evitable acute shock or disaster worse, as a broad range of over 200 stakeholders. I trict in particular). History of How Our opposed to the disaster revealing the un- was very intrigued by this experience. My primary goal at this point is to get Government Segregated derlying stressors. This has led to some The work of resilience in Louisville feedback from the community so we can America (Liveright, 2017) communication and translation challenges seemed like it might have a little different have confidence that we are working on that have caused me to take some extra flavor than some of the other cities in the what our community has identified as Your motto: Don’t time to gain perspective and understand- network. The attendees at this workshop most important. postpone joy. ing of the process outlined for all the 100 identified the expected things like extreme A great benefit to being in the 100 Resil- Resilient Cities. weather and aging infrastructure, but also ient Cities network is that we have the op- economic and environmental challenges. It Read full portunity to bring in leading world experts business and Metro community as a whole. was in these areas that education, health to help us identify solutions. These solutions interview online and equality were identified. I was inter- should focus not only on the overall com- MN: What has been the most challeng- at medicalnews.md ested in the intersection of these issues and munity, but must begin with the individual, ing part of your job? how we might go about addressing them through the neighborhood, to the larger
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Kentucky Nonprofit Day at the Capitol UK HealthCare Recruitment Fair
Feb. Info: Provides an opportunity to learn from and educate Feb. Time: 4 to 8 p.m. 1 state government officials and network with nonprofits 22 Location: UK HealthCare, 1000 S. Limestone, Pavilion from across Kentucky. More information can be found at A, Lexington, Ky. 40517 kynonprofits.org/advocate/ky-nonprofit-day. Info: Meet with patient care managers, service directors, physicians and staff at UK HealthCare and Eastern State KORE: The Community’s Role in Addressing Hospital. Recruiters will be available to answer questions about the Opioid Crisis employment opportunities. 45th Dr. McMillan National Conference on the Feb. Time: Noon to 1 p.m. 5 Location: Jessamine County Health Department, 210 Black Family in America East Walnut St., Nicholasville, Ky. 40356 Info: Sponsored by Bluegrass Regional Prevention Centers Feb. Location: Louisville Central Community Center, 1300 and the Jessamine County Health Department. Covers the Kentucky 23-24 W. Muhammad Ali Blvd., Louisville, Ky. 40203 Opioid Response Effort (KORE) in Kentucky and how to reduce Info: “Elevating the Health and Safety of the Black the toll of opioid misuse in the community. Family and Community.” Educate families to become more empowered, engaged, equipped and able to elevate every member to maximize their quality of life. Visit louisville.edu/ Kentucky Coalition of Nurse Practitioners & Nurse culturalcenter/bfc for more information. Mid-Wives Legislative Day
Feb. Location: Capitol Annex, 700 Capital The American Society of Addiction Medicine 7 Ave., Frankfort, Ky. 40601 (ASAM) Treatment of Opioid Use Disorder Time: Meet and greet 8:30 a.m.; Presentation by Sheila Schuster, Ph.D., 9 a.m.; Individual or Feb. Time: 9 a.m. to 1:15 p.m. small group meetings with legislators 9:30 a.m. to 1 p.m. 24 Location: Bluegrass.org Board Room, Building 2, 1351 Newtown Pike, Lexington, Ky. 40511 Info: Hosted by the Kentucky Opioid Response Effort KMA Physicians’ Day at the Capitol (KORE), Department for Behavioral Health, Developmental and Intellectual Disabilities This course covers all medications Feb. Time: 8 a.m. to 2 p.m. and treatments for opioid use disorder, and provides the required 7 Location: Kentucky State Capitol Building, 700 Capital education needed to obtain the waiver to prescribe buprenorphine. Ave., Frankfort, Ky. 40601 Visit elearning.asam.org/p/Bluegrass for more information. Info: Physicians from across the Commonwealth will gather in Frankfort in support of issues of importance to the medical community. Includes a legislative briefing and visits with Midwest Post-Acute Executive state legislators, in addition to lunch and a feedback session. Leadership Summit
The 2018 Minority Pre-Health Symposium: Location: Belterra Casino Resort, 777 Belterra Dr., Feb. 27 – Florence, Ind. 47020 Changing the Face of Healthcare Mar. 2 Info: Sponsored by the American College of Health Feb. Time: 9 a.m. to 4 p.m. Care Administrators - District 3. Brings together 10 Location: Clinical Translational Research Building, 505 key executives, industry experts, thought leaders and future S. Hancock St., Louisville, Ky. 40202 professionals representing the post-acute industry in the Midwest, Info: Sponsored by the UofL Health Sciences Center for extensive training, skills enhancement and networking in an Office of Diversity and Inclusion. Providing high school, community informal setting. Visit achcad3.org for more information. college and university students with the information necessary to succeed in the professional and graduate school admissions process. The Power of Prescribing: Addiction Consequences of Opioid Rx Enhancing Substance Use Disorder Treatment Feb. Time: 5 to 8:30 p.m. Responsiveness for LGBT Clients 27 Location: Clark County Extension Office, 1400 Fortune Dr., Winchester, Ky. 40291 Feb. Time: Presentation 9 a.m.; Workshop 10 to 11:30 a.m. Info: Sponsored by the Northeast Kentucky Area Health 16 Location: University of Louisville Health Sciences Education Center. Visit kypca.net for more information. Center, Kornhauser Library Auditorium, 500 S. Preston St., Louisville, Ky. 40202 Info: This is the morning session of the LGBT Healthcare Summit sponsored by Humana. Training will review best practices HAVE AN EVENT FOR OUR PRINT to engage and retain LGBT clients in substance use disorder care. OR ENEWS CALENDAR? Email [email protected] MEDICAL NEWS • FEBRUARY 2018 PAGE 7
HAND-IN-HAND, WE HEAL THE HEART
What happens when you combine the expertise of one of the country’s best children’s hospitals with the #1 hospital in Kentucky? Life-saving heart care for Kentucky children, close-to-home. That’s exactly what we’ve done.
See how, together, we’re bringing world-class pediatric heart care to Kentucky families. ukhealthcare.com/kidshearts PAGE 8 MEDICAL NEWS • FEBRUARY 2018 COVER STORY
Adverse Childhood Experiences associated with health problems as an adult
Continued from cover model for addressing ACEs. Why is resiliency important? Currently there are five BOUNCE Resiliency is the ability to thrive, adapt, schools within the JCPS district. and cope despite tough and stressful Bouncing back BOUNCE is closely tracking student, times. Resilience is a natural counter- staff and parent outcomes, which to date weight to ACEs. The more resilient in healthcare have shown considerable progress. children are, the more likely they are to Norton University, an internal educational program deal with negative situations in a healthy way that won’t have prolonged and at Norton Healthcare, recently trained key members unfavorable outcomes. of its education team in the BOUNCE curriculum for implementation in the healthcare system.
According to Mary Jo Bean, senior vice president of planning In Kentucky, nearly 60 and business analysis, Norton Healthcare is aware of the Louisville’s BOUNCE Coalition percent of residents have impact of social determinants on the health of those that they will serve as the lead agency to take the experienced at least one ACE. serve, both in the pediatric, as well as the adult population. next steps to continue the community dialogue, convene stakeholders and Further, Bean explained, Kentucky is a state that has a shortage provide training so that Louisville is Healthcare Setting of behavioral health providers and social workers. Given those more effective in preventing, identifying, This success within the school system variables, Norton felt it would be valuable to increase education and responding to ACEs. has built the framework for the BOUNCE around ACEs, focusing on how to react, respond and provide resources to build resiliency skills for patients and caregivers. The Norton University leadership team attended a pilot program, called Bouncing Back, conducted by the BOUNCE Coalition to establish a baseline program and develop modifications to meet the healthcare environment. There are plans to make it available to internal Norton staff and external parties in the community, region and state.
Reimbursement Concerns There are concerns that investing in children and families with high ACE scores is difficult because of reimbursement policies. Bean explained that high ACE scores tend to indicate high risk for chronic conditions so this is information helps the healthcare provider work with the family to identify chronic conditions at an earlier stage and make care plan recommendations to help them prevent the onset or manage those conditions more effectively.
Currently the reimbursement system for healthcare offers limited reimbursement for integrated services. However, Norton currently has Licensed Clinical Social Workers in a number of their practices to clinically assist patients and Coalition’s next phase: serving as the help them get connected to resources in the community. Resiliency Matters catalyst for fostering trauma informed
BOUNCE is promoting a shift in systems and organizations across the the perspective by bringing a trauma Commonwealth, specifically into medical informed system into schools. This schools and in the healthcare setting. with their patients is seen as difficult for time. Why would a health center ask a perspective encourages the question, Data suggest that ACEs should be a number of reasons, including lack of patient for more, seemingly non-health “What happened to this student?” instead addressed during routine healthcare visits, time, complexity of the topics, limited related information? of “What is wrong with this student?” and many individuals and organizations referral resources and discomfort. BOUNCE hopes to improve the are beginning to implement trauma- It’s understandable, considering how future health of children, fostering the informed, resilience-building practices. health centers struggle to address every skills to bounce back from adversity with However, for many physicians, need of the patient in a short window of resiliency and grit. addressing exposure to traumatic events MEDICAL NEWS • FEBRUARY 2018 PAGE 9
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Owensboro Health joins Markey Healing Place expands Affiliate Network
Owensboro Health has joined the UK Markey Cancer Center Affiliate Network, enhancing cancer care available to patients in Western Kentucky and Southern Indiana and allowing them to stay closer to home and their support systems The Healing Place, a nonprofit, More than 700 men and women for most treatments. Markey long-term social model recovery are enrolled in the recovery program is the only National Cancer program based in Louisville, Kentucky, daily with more than 500 completing Institute-designated cancer center is expanding the Men’s Campus in the program every year. in Kentucky. Cancer Center is working toward the next downtown Louisville, Ky. The James Graham Brown Owensboro Health’s Mitchell tier of designation – an NCI-designated Phase one of the $29 million Foundation provided the lead gift Memorial Cancer Center (MMCC) Comprehensive Cancer Center. Currently, project was completed in December of $1.5 million. Louisville Metro serves the health system’s coverage area, 45 of the 69 NCI-designated cancer centers 2017 and clients moved into the first Council approved $1.12 million for a population of nearly 400,000 people in the country hold a comprehensive cancer wing of the new facility. Phase two of the expansion and the Kentucky across 14 counties in Western Kentucky center status. The UK Markey Cancer the building has begun, which will add Office for Substance Abuse Policy and Southern Indiana. More than 1,000 Center Affiliate Network will play a large nearly 200 beds to the program. Work contributed $500,000. Bosse Mattingly patients are treated at the center annually. role in bringing that next level of cancer is expected to be complete in January Constructors Inc. is the general Last year, Owensboro Health also joined funding to Kentucky. 2019. Once construction is complete, contractor for the project. Markey’s Research Network, which allows The affiliate network was created in 426 beds will be available. MMCC to run many of Markey’s clinical 2006 and is made up of 20 hospitals across trials on-site. the Commonwealth of Kentucky. Moving forward, the UK Markey Kentucky agencies provide employment, training to SNAP recipients
Kentuckians who receive building and Supplemental Nutrition Assistance i n t e r v i e w Program (SNAP) benefits and are eligible preparation. for the federally funded Employment Currently, and Training (E&T) program will SNAP recipients now receive assistance from Kentucky can receive Career Centers to meet education and services through this collaboration employment training needs. in the following 20 Kentucky To better serve the people of counties: Anderson, Bullitt, Calloway, Kentucky, several agencies in the state Campbell, Daviess, Fayette, Franklin, government created a new system Hardin, Henderson, Henry, Jefferson, for SNAP recipients to access locally Jessamine, Logan, Oldham, Owen, available training opportunities and find Shelby, Simpson, Spencer, Warren and open jobs. Because an Ounce of Prevention… Woodford. This new system became available However, throughout 2018, the In the always complex world of health care and health insurance law, in January, thanks to this collaboration program will expand to 112 counties. Bingham Greenebaum Doll LLP is uniquely equipped to assist health care between the Cabinet for Health and companies, practices and providers with strategic initiatives, daily operations Family Services (CHFS), which The remaining eight counties in eastern Kentucky, which are part of the Paths 2 and regulatory matters. We continually monitor emerging market trends, new administers the SNAP program through Promise program, will not be affected. technologies, and the changing laws that impact all phases of your health care the Department for Community Based Services (DCBS), the Kentucky Approximately 35,421 individuals in business. Find out how BGD can help your business stay healthy by calling Education and Workforce Development Kentucky are eligible to participate. 800.436.3644, or visiting BGDlegal.com. Cabinet’s Department of Workforce The 1996 federal welfare reform law Investment (DWI) and the 10 local required that able-bodied adults ages 18- workforce development boards. 49 who do not have dependents must Kentucky Career Centers are meet work, skills training, or community led in each of the Commonwealth’s engagement requirements of 20 hours 10 workforce development areas by per week in order to remain eligible for local workforce development boards. SNAP (formerly known as food stamp)
THIS IS AN ADVERTISEMENT This gives each board the ability to benefits. The requirement was waived work directly with employers, and in 2008 to 2015 due to the economic Louisville Lexington Cincinnati Indianapolis Jasper Evansville BGDlegal.com to determine the job availability and recession, but never scaled back up as training needs on a local level. Some the economy improved. services provided by the Career Centers include skills assessments, resume MEDICAL NEWS • FEBRUARY 2018 PAGE 11 NEWS IN BRIEF
Safeguarding healthcare Lexington lawyers discuss their experience fighting healthcare fraud at U.S. Attorney’s Office.
By Ben Keeton of taking cash for prescriptions, healthcare providers give prescriptions, The clearest way to Healthcare fraud costs the United complete unnecessary tasks and charge measure our success of States tens of billions of dollars each the government. dual enforcement was the year. Healthcare fraud schemes continue to grow in complexity and seriousness. AS: People used to visit pill mills amount of money recovered. Kerry Harvey and Andrew Sparks, in strip malls and pay with cash. We We recovered more than succeeded in shutting those down. with Dickinson Wright in Lexington, Ky., $100 million dollars.” have a long history of fighting healthcare Providers then began doing tests during fraud. Before joining Dickinson Wright, office visits and falsifying the medical they were with the U.S. Attorney’s Office records by upcoding it. I’d prosecute — Andrew Sparks, in the eastern district of Kentucky. providers seeing up to 150 people per day Dickinson Wright When Harvey started, he correctly at a level three-to-four office visit. assumed there would be an abundance of It’s difficult to determine fraudulence which could take months, sometimes work to do in the healthcare space. He just by the medical records. In fact, if you years, to bring to fruition. created a new, separate white-collar fraud There is a more common just look at the medical record, it often division and chose Andrew Sparks as the defendant, which is the looks appropriate. You need to take a deep MN: Did people commit crimes chief of that division. Harvey and Sparks dive. Fraud that is educated and complex one who did not intend, knowingly or accidently? sat down with me to discuss the fraud is very difficult to prosecute and get a at the outset, to break the KH: I’d say about 99 percent of unit. Below are highlights. recovery from. law. Slowly, they would people working in healthcare are decent and honest. There is a small percent that Medical News: Why was the fraud MN: What government resources get closer to the line, are criminals every day. For example, they are needed in a large fraud department? unit created? driven by the desire to bill for services that were never provided KH: There wasn’t a long history of Kerry Harvey: or they have the sham durable medical maximize their revenue.” doing sophisticated healthcare fraud The U.S. Attorney’s equipment stores. Office needed to do work in this district. You need a vast — Kerry Harvey, There is a more common defendant, more white-collar, supply of investigative resources, which which is the one who did not intend, at financial crime and Dickinson Wright the federal government was short of. the outset, to break the law. Slowly, they false claims work The U.S. Department of Health and would get closer to the line, driven by the on the civil side Human Services (HHS) and the Office desire to maximize their revenue. One day because it wasn’t the organization returned the money of Inspector General (OIG) are great they realize they are on the other side of HARVEY being done by the to taxpayers. In the same way, we held organizations, but there are only four the line. It may have been unintentional federal government. individuals accountable for their criminal agents for the state of Kentucky. The FBI at first, but they get addicted to money, The State’s Commonwealth Attorney was conduct by recovering the money or is great, but healthcare fraud is only a and rationalize what they do because of doing a great job prosecuting street crime, assigning jail time. small sliver of what they do. the addiction. drug offenses and violent crimes, but they The clearest way to measure We built a self-contained unit to didn’t have the resources or the skill-set our success of dual enforcement was develop, investigate and prosecute our MN: How do you advise your clients to prosecute complex financial crimes. the amount of money recovered. We own leads. The best advance was the use to stay on this side of the line? It turned out to be a huge success, recovered more than $100 million of data mining. We had access to all the AS: It’s important to review billing mostly because of Sparks’ initiative dollars. The money taken from federal payor data, in almost real time. practices on a regular occasion— and ability. We did cases that were Medicare and Medicaid programs was We also employed auditors and preferably annually—to ensure your unprecedented in Eastern Kentucky, returned to the taxpayers. investigators who could slice and dice practices are justifiable. Be careful with a number of cases drawing the data anyway you’d want it and we had about who you hire. Cultivate a positive, national attention. MN: Can you give an example of a access to experts at the Department of honest culture within your practice. Do case you worked on? Justice in Washington DC who analyzed the due diligence. MN: What was the day-to-day work KH: We began to see an uptick in the data. We could easily see the outliers. like in the fraud unit? unnecessary procedures. For example, We hired good people, such as KH: Healthcare laws and regulations Andrew Sparks: healthcare providers were performing auditors, retired federal agents from the are not intuitive. We add value by looking We used affirmative unnecessary, interventional procedures. Secret Service, retired postal inspectors at the facts from the government’s civil enforcement, There are physicians, specifically who were skilled at investigations. We perspective. We anticipate how someone false claims act cardiologists, who have been convicted built a self-contained unit taking cases at Health & Human Services or at the cases and criminal of criminal conduct for placing from A-Z, working in a space comparable U.S. Attorney’s office is likely to view prosecutions of unnecessary stents. to much bigger districts. those facts. From the standpoint of the individuals. We There are many schemes meant to AS: We were fortunate to have healthcare providers, it is a completely were good at cash in on the opioid epidemic. For talented FBI and Health & Human different context. It’s easy, even for SPARKS parallel procedures. example, there was an increase in urine Services agents who were willing to providers with the best intentions, to run For example, if an toxicology screens and lab work. There dig in with the prosecutors. Kerry gave into problems. organization committed a fraud, then is an evolution of pill mills. Instead us freedom to go deep on these cases, News in Brief continued on page 18 PAGE 12 MEDICAL NEWS • FEBRUARY 2018
SOCIAL DETERMINANTS OF HEALTH
Moving healthcare upstream Smoketown Family Wellness Center aims to improve health at community level.
By Sally McMahon
Smoketown Family Wellness Center (SFWC), a cross between a pediatric office and a community center, is set to open on March 24 in the historic Presbyterian Community Center in Smoketown, one of the poorest neighborhoods in Louisville, Ky. SFWC will work to establish healthy lifestyles from the beginning of life, supporting parents with the tools needed to raise their children to be healthy in mind, body and spirit. They will provide clinical care for children, as well as address social determinants of health in a supportive community-based setting.
Location, Location SMOKETOWN FAMILY WELLNESS CENTER AT 760 SOUTH HANCOCK ST. IN LOUISVILLE, KY. Smoketown has the highest rate of ACE Scores Addressed death due to diabetes in Louisville. Life creating a positive culture of health and wellness. According to Stites, one of the reasons expectancy is 69 years, 10 years below Birth offers a new beginning the Louisville average, according to the for opening SFWC is to develop models Looking Upstream 2014 Health Equity Report created by the for parents. They want what for improved health equity, where access to Center for Health Equity. The SFWC model of healthcare is best for their child and care and integration of needs are provided. delivery will move care upstream Research has shown that individuals This statistic are willing to make changes b o t h e r e d D r. to provide primary prevention of with high ACE scores have higher risk Charlotte Stites, a diseases that begin in childhood. to improve themselves.” for chronic diseases and shortened life pediatrician who has Stites believes it’s “common sense expectancy. They often become high to look upstream to provide primary healthcare utilizers. worked in private — Charlotte Stites, MD, prevention of chronic diseases.” Adverse childhood experiences practice in the east According to the CDC, 75 percent of Smoketown Family (ACEs) are stressful or traumatic events, end. As a result, all healthcare costs are spent on treatment including abuse and neglect. According to she conceptualized Wellness Center of preventable chronic diseases. the Adverse Childhood Experiences study, STITES a wellness center A growing body of evidence shows the rougher your childhood, the higher that focused on that healthcare providers can play an employment, and social support networks, your risk for later health problems. comprehensive care and healthy lifestyles— important role in collaborating with as well as access to healthcare. addressing social determinants of health. other community-based organizations Reimbursement Challenges to help children, patients and families Integrating Research Stites believes that by providing Magic Window access new resources and influence those SFWC will collaborate with Spalding comprehensive healthcare (clinical Stites believes there is a magic factors that play an important role in University, the recipient of a $1.15 million care, healthy living, addressing social window—a period of time after birth determining their health. grant from the U.S. Department of Health determinants of health) they can reach where parents are willing and motivated It means focusing efforts on the early and Human Services’ Health Resources improved health outcomes, prevent more to learn. Stites said, “Birth offers a new years when the foundations of life-long and Services Administration (HRSA) to disease and fundamentally save money beginning for parents. They want what is health are established and the return on bring in fourth-year psychology Ph.D. in healthcare costs, prison systems and best for their child and are willing to make investment in prevention is greatest. candidates and social work students into social services. Stites said, “The trick is finding changes to improve themselves. Babies are Social Determinants of Health SFWC as an integrated care model. It will clean slates. It is easier to establish healthy allow SFWC to provide behavioral health investors to support the model, and to According to Stites, overall health and habits from the beginning of life than to services upfront. begin to invest in maintaining health well-being for individuals is determined rather than paying for the management fight to change well-established bad habits Research will be collected by clinical care (about 20 percent), of disease.” She continued, “A high ACE later in life.” concerning needs for the family and lifestyle (about 30 percent) and physical score is a risk factor for poor outcomes, According to Stites, “There is research health outcomes—to include educational environment (about 10 percent). The but not a death sentence. Individuals with out of the University of Denver showing measures—quantitative and qualitative remaining 40 percent is a product of social high ACE scores need more support to that there is a period of brain elasticity determinants of health. research. Programming will be data- attenuate these risks. We believe that around the time of a birth—greater for the Social determinants of health are the driven and modified accordingly, but providing this integrated care and mother, but also for the father.” structural determinants and conditions in overall, the needs of the families served tracking outcomes, we will help effect Parents can be healthcare experts which people are born, grow, live, work and at SFWC will drive the programming change in the reimbursement policies.” themselves, spreading their knowledge age. They include factors like socioeconomic offered in the Center. to family, friends and neighbors, thus status, education, the physical environment, MEDICAL NEWS • FEBRUARY 2018 PAGE 13
SOCIAL DETERMINANTS OF HEALTH
Lethal combination Unhealthy diets paired with food insecurity a recipe for disaster.
By Kate Marx Today in Kentuckiana, there Food insecurity is defined by the Food Insecurity and Health: A Tool Kit for U.S. Department of Agriculture (USDA) are 181,000 food insecure Physicians and Healthcare Organizations can as “limited or uncertain availability of individuals. That’s a lot of nutritionally adequate and safe foods or be found online at https://goo.gl/nfkWyF. limited or uncertain ability to acquire people who are making acceptable foods in socially acceptable real choices every day, ways.” Feeding America and Louisville’s like do I buy food for the surrounding communities, Dare to Care have the information they need to accurately Dare to Care Food Bank state it more offers a Prescriptive Pantry Program. screen patients and refer to food assistance simply - food insecurity is the lack of access family or do I pay rent?” These pantries are located inside programs and community resources. The to enough food for a healthy, active life. healthcare providers’ facilities. food insecurity discussion needs to be one Brian Riendeau, executive director of — Brian Riendeau, “The physician’s office is a natural place about health.” Dare to Care, explained, “Food insecurity to address food insecurity, due to the strong Once a clinician is aware of a patient’s can be a temporary situation. It could last Dare to Care correlation between food and health,” said food insecurity status, they might consider for several months. It could last for a year.” Emily McGrath, who leads Humana’s other aspects of care that should be He continued, “Today in Kentuckiana, − Kids Cafes: Hot nutritious meals, pre- strategy to address food insecurity. “Food addressed, such as medications, health and there are 181,000 food insecure individuals. pared by the Dare to Care team, to after insecurity negatively impacts disease risk, nutrition education and mental health. That’s a lot of people who are making real school sites. condition self-management and healthcare —Kate Marx is with Humana. choices every day, like do I buy food for the − Backpack Buddy: Nutritious, kid-friend- costs, so it is important for physicians to family or do I pay rent?” ly foods for children from low-income families to take home on the weekends. Toolkit − Summer Meals for Kids: Breakfast, Humana, a health and well-being lunch and dinner for children during company based in Louisville, partnered the summer months. with Feeding America, the largest − Cooking Matters: Empowers families to domestic hunger-relief charity in the prepare healthy and affordable meals. United States, to develop a toolkit for − Mobile Pantry: Brings a pantry directly addressing food insecurity. to a neighborhood, and provides fresh One of the points the toolkit makes produce and other nutritious food items. is that food assistance programs, such as − Senior Outreach: Provides nutritionally- the Supplemental Nutrition Assistance balanced food boxes to seniors through Program (SNAP, formerly known as food a unique partnership with the Louisville stamps); the Women, Infant, and Children’s Metro Police Department, mobile pan- Program (WIC); and the National School tries for seniors and the Commodities Lunch and School Breakfast programs, Supplemental Food Program. We Are help feed many low-income families across Healthcare professionals can support the country. their patients’ nutritional needs and keep That means that many households them food secure by using a validated, BLUEGRASS under the Federal Poverty Line are food two-item screener known as Hunger secure, while those with slightly higher Vital Sign. This screener is a subset of the incomes, but without access to other USDA’s 18-item screener. The screener is We assist children, adults and families live their support, may be food insecure. available as part of the standard base build best life through mental health, substance use and It goes on to cite USDA Economic in EPIC (EMR). intellectual and developmental disability services. Research Service findings that unhealthy The screener identifies individuals and diets amplify the negative outcomes families as being at risk for food insecurity experienced by food insecure individuals. if they answer that either or both of the The combination of an unhealthy diet and following two statements is ‘often true’ or For Appointments & Support food insecurity leads to impaired growth ‘sometimes true’ (vs. ‘never true’): 24-Hour Helpline 1.800.928.8000 in children, more chronic disease for 1. Within the past 12 months we worried adults, higher healthcare costs and missed whether our food would run out before work days. we got money to buy more. Dare to Care is working to combat 2. Within the past 12 months the food we food insecurity by delivering more than bought just didn’t last and we didn’t have 19 million meals through a network of money to get more. 270 emergency kitchens, shelters and food A response of ‘sometimes true’ or pantries. Dare to Care also operates several ‘often true’ to either or both questions www.bluegrass.org programs targeting the most vulnerable in should trigger a referral for food our community, including: security support. In Louisville and the PAGE 14 MEDICAL NEWS • FEBRUARY 2018
SOCIAL DETERMINANTS OF HEALTH
Obstacles to better health Solutions to many health issues lie in better access to clinical care, better social policy.
By Sarah Moyer, MD Building Infrastructure
The solutions to so many The solutions to so many individual The next greatest health Many of our patients often face real- health issues that our patients face lie in individual health issues impact will come from life situations that can make controlling building an infrastructure for good health such chronic conditions as diabetes and that our patients face lie in throughout the community. This requires changing the social context hypertension difficult. As physicians, we building an infrastructure collaboration from many sectors— so that the healthy choice are often unaware of the daily struggles for good health throughout physicians, businesses, government, becomes an individual’s preventing patients from adhering to the community.” schools, civic and nonprofit organizations. default choice.” our best-laid treatment plans. A recent We know that social determinants— experience with a patient suffering with of the problem. your income, the neighborhood in which interventions as a daily asthma forecast diabetes made me acutely aware of this. Her early and mid-month glucose you live, your race, your education email, changing truck routes to reduce My patient’s blood glucose levels levels were in range because that’s level—are powerful predictors of how exposure to fuel emissions and planting would be under control at one visit and when she got paid and could afford to healthy you will be. Only when we trees in high-risk areas. horribly out of control at the next. For buy healthy food. When her money ran understand these outside factors, can we months we adjusted medications and tight toward the end of the month, she address the obstacles that stand in the Physicians Needed discussed the importance of adhering to was forced to rely on neighbors and food way of better health. Physicians are vital to the work of a regimen of healthy eating and physical pantries for food, often eating processed In the case of my patient, connecting building a healthier community. The activity. After several months of yo-yoing foods high in sugar, causing her levels to her with a community health worker who Louisville Health Advisory Board, a glucose levels, we finally got to the root rise precipitously. helped her connect to reliable resources collaboration of more than 60 private to free up her finances for food made the and public organizations committed difference in her ability to gain control of to making our city healthier, hosted by her glucose levels. Humana, needs your involvement. The solutions to many health issues The board’s mission is to improve the lie not just in better access to clinical care, physical, mental and social well-being of but in better social policy. In fact, research Louisville, with the goal of increasing YOUR KENTUCKY indicates that the greatest impacts on the number of Healthy Days–your health are such socio-economic factors quality of life–20 percent by 2020 and as food security, housing and education. beyond. Healthy Days is a tool created The next greatest health impact will come by the CDC that tracks quality of life by LAW FIRM FOR from changing the social context so that measuring individual physical and mental the healthy choice becomes an individual’s health in a 30-day period. default choice. We believe that creating a healthier HEALTHCARE. Smart Tech community depends on collaboration This is an advertisement. Services may be provided by others. to build an infrastructure for good Technology can also help to capture health. We believe that public health and analyze data about the patient’s real- is the work of all of us. It’s what we do For more information about our rm, our healthcare world activities to inform patient care and together that gives every single person practice, and how we can beneet you, please contact one public policy. in our community the best possible of our nationally-recognized healthcare lawyers. AIR Louisville—a collaborative chance at a healthy and productive initiative of Propeller Health; the life. Together we can break down the Kerry B. Harvey Institute for Healthy Air, Water, and 859.899.8739 | [email protected] barriers to better health. Soil; and the city of Louisville uses smart- —Dr. Sarah Moyer is director of C. Timothy Gary technology to equip asthma patients and Louisville Metro Department of Public 615.780.1105 | [email protected] their physicians with data to identify Health and Wellness, the city’s chief health asthma triggers to better control the strategist and an assistant professor at condition. It also provides data that city the UofL School of Public Health and officials can use to implement solutions. Information Sciences. DickinsonWrightpllc In a 12-month period, there has DICKINSONWRIGHT.COM DWFCG.COM been an 82 percent reduction in asthma For more rescue inhaler use among participants; 29 information, visit percent of uncontrolled patients gained control of their asthma; and on average, louisvillecultureofhealth.com participants more than doubled their ARIZONA FLORIDA KENTUCKY MICHIGAN NEVADA OHIO TENNESSEE TEXAS WASHINGTON DC TORONTO | 300 West Vine Street, Suite 1700 | Lexington, KY 40507 symptom-free days. By identifying local asthma hotspots, we’ve also developed such MEDICAL NEWS • FEBRUARY 2018 PAGE 15 What happened 25 years ago?
MEDICAL Special The business of healthcare Guest Editor $2.50 NEWS The year was 1993… Edition People in Brief page 5 | Behavioral Health News in Brief page 6 | Physician Spotlight page 8 | News in Brief page 9 | Commentary page 23 | Healthcare Innovation page 25
M March 2013 On the CUSPThe business ofEDICAL ofThe casehealthcare for integrated care Our healthcare delivery system has been broken $2.50 for quite some time. The rising cost of healthcare culture change has driven policy and decision makers to come up • Bill Clinton (D) inaugurated as with a fix. Read more on page 11 News in Brief page 2 | People in BriefN page 5 | Event Calendar page 6 | Commentary page 18 Making patient safety, quality a shared priority. EWS Myths of mental illness Myths and stereotypes have long fueled the fear and prejudice that keep us from truly being a compassionate and healthy society. Some will argue that recent years have witnessed a By Cindy Sanders decline in prejudice against people of different races, faiths or sexual orientation, the myths “We miraculously rates among participants. 42nd U.S. President. Mistakes happen. concerning people with a severe mental illness For many years that was the con thought just “We’ve prevented nearly 500 have flourished. ventional wisdom in healthcare settings, deaths and averted nearly $36 million March 2016 - Read more on page 14 but innovative programming from the providing the in costs—and that’s a conservative es BEHAVIORAL Agency for Healthcare Research and information would timate,” Battles noted. - Autism Spectrum Quality (AHRQ ) shows mistakes don’t lead to change.” Disorder just as complex, Physician have to happen if everyone is on board to New CUSP Programs varied as treatments Spotlight make safety and quality a priority. — James Battles, PhD, a Building on that success, other James Battles, PhD, a social science social science analyst with CUSP programs have been launched Autism is a brain-based developmental disorder Meet Julie Daftari, MD, that is part of a group of complex disorders HEALTH market medical director for analyst with AHRQ’s Center for Qual with similar results. The next, Battles AHRQ’s Center for Quality classified as Autism Spectrum Disorders (ASD). UnitedHealthcare of Indiana ity Improvement and Patient Safety,- noted, is a new national CUSP program noted the Comprehensive Unit-based in the area of labor and delivery. The Children with autism demonstrate restricted and Kentucky. Improvement and Patient Safety or repetitive patterns of behavior, interests or Safety Program (CUSP) is an example Perinatal Safety Improvement Program Read more on page 4 of how to change the culture to achieve is expected to roll out this fall. activities in addition to these other difficulties. The bridge between traditional medical care and dramatic results. the renowned patient safety advocate CUSP is a strategic intervention Read more on page 16 Meet Your Provider Battles, who has worked in the field with Johns Hopkins. The roots of CUSP thatsocial integrates services,communication, keyleader to improving population health. • Blizzard of 1993 dumps record amounts Sam Millhollan graduated since the mid-1990s, was focused on can be found within that early work. ship and teamwork to create a culture of- Special Legal Series: patient safety even before the landmark In 2003, a large-scale demonstration safety. The program utilizes evidence- HIPAA Final Rule from the radiologic technology program at Institute of Medicine Report, “To Err project for CUSP focused on CLABSIs based strategies and includes training What’s a covered entity is Human,” was released in November (central line-associated blood stream in tools, standards for consistent measure Spencerian College in 2004 supposed to do? 1999. The report became a catalyst for fections) was underway. ment, leadership engagement and meth and is currently the director - By Catherine Batscha - the creation of intervention strategies The unique partnership between ods to improve teamwork among physi - This is part one of a four-part series of updates of Practice Operations and and Anthony Zipple to avert medical errors. A year after its AHRQ , the Health Research & Edu cians, nurses and others impacting the- summarizing the HIPAA Final Rules and addressing Ancillary Services at the implementation concerns that many organizations Norton Medical Group Administration. release, Battles became the first expert cational Trust (HRET), Johns Hop - safety and well-being of patients. hired by AHRQ to focus strictly on pa Healthcare EWSoutcomes are may encounter. kins University Quality and Safetydetermined - N“The by a CUSPrange modelof factors. is designed An for a Read more on page 8 tient safety initiatives. unit of care, but that unit of care can be January 2013 EDICAL- Research Group, the Michigan Healthactual medical intervention accounts Read more on page 26 M & Hospital Association’s Keystone anything. CUSP itself is an intervention An Expensive Population Roots of CUSPThe business of healthcarefor only approximately 20 percent of Improving “code blue” of snow on Kentucky. Center for Patient Safety & Quality strategy, and then the areas where you the varianceapply itin are outcomes. the targets Population of CUSP,” Battles — The most expensive fi ve percent of the U.S. population, hospital team response By 2001,$2.50 AHRQ began funding and more than 1,000 U.S. hospitals AbouT THIS the work of Peter Pronovost, MD, PhD, yielded dramatic outcomes. Battleshealth explained.variables Basedincluding on the poverty, success seen in typically people with multiple ISSue chronic conditions, Lorrel Brown, MD, assistant professor of People insaid Brief the national page program5 | News has resulted ineducation, Brief demonstration pageemployment, 6 | projects, Healthcareand housing he continued, Innovation accountb page for20 49 | percent Commentary of all healthcare page 22 spending. cardiology at the University of Louisville School in a 41 percent decrease in CLABSIsituation “Weaccount are ‘CUSP-izing’ for as much everything.” as 40 ehavioral HealthShredding the safety net of Medicine, is working to improve the way staff — Almost invariable, people with multiple chronic percent of variance in outcomes. While This month Medical News presents respond when a hospital patient experiences Continued on page 3 No problem is in greater need of a solution and cardiac arrest. Brown has received a grant to the healthcare industry has traditionally conditionsits Behavioral have Health issue—one orno more issue asbehavioral packed with healthpotential issue.catastrophic develop and evaluate a new protocol to improve — Whenwith it a comes twist. Medical to Newsmanagingconsequences chronic as conditions the insolvency such of the state’s ’ communication and fine tune the staff team that first-ever guest editor, retirement system for its public (and certain as asthma,Anthony M. heartZipple, Sc.D., failure, diabetes or hypertension, the responds to these patient emergencies. The most expensive five other) employees. For the community mental 2012 year additionpresident of and a CEO,behavioral Seven health condition increases health centers of Kentucky, including Seven Read more on page 17 percent of the U.S. population, healthcareCounties Services, costs Inc.,by two to 300 percent. helped develop and manage Counties Services, solving the problem in the typically people with — Management of behavioral health problems will be the editorial for the issue. Our right way is a matter of survival. in review multiple chronic conditions, essentialcomprehensive in achieving coverage optimal includes Read outcomes more foron pageother 10 IN THIS ISSUE chronicfeatures conditions about autism, and mental in reducing costs of care. account for 49 percent of • The World Wide Web born at illness myths, legislative issues, mood all healthcare spending. disorders and integration success stories.Moving We even to the next level think more broadly. The best clinical BEHAVIORAL Medical News recaps the year’s biggest included a special behavioral health newsFor sectionits inaugural in Not-For-Profit of the Year care must pay attention to a wide range HEALTH prioritized the medical intervention our News in Brief department. program, LeapFrog Interactive (LFI), a Kentucky healthcareServing stories. Kentucky and Southern Indianaof non-medical and social supports component of the health outcomes Articles begin on page 11 full-service digital agency, asked their internal Each March, as well as more traditional medical Medical News equation, we know that if we want to payers.staff The to nominate most expensive local non-profits five percent near and comprehensive coverage on behavioral health. interventions. M provides make big improvements in the health of The businessof the dear U.S.of to population, their healthcare hearts. typically people This year we hear from Beth Swann, of Lee Increasingly, it has become EDICALclear with Readmultiple more chronic on page conditions, 15 Specialty Clinic, who discusses the importance peopleJanuary in our communities, we need to of Kentucky that the atbest the clinical University care must include of comprehensive programs for patients with Breast Care Center $2.50 -account for 49 percent of all healthcare By Melanie Wolkoff Wachsman comprehensive behavioral health services. People with Intellectual & Developmental Disabilities (IDD). M • The center inspending. When Almost waste invariable, leads topeople health EDICAL medical multiple chronic the conditions only are an The business of healthcareMarkey Cancer Center begins offering UK willstate-of-the-art be digital tomosynwith multiple chronic conditions have Katharine Dobbins from Wellspring explores CERN (European Organization - cancer screening. As one year ends and another be thesis for breast expensive population for providersSERVING and KENTUCKYLouisville-based, Supplies Over Seas recently how supportive housing saves money and N ANDNews SOUTHERN in Briefone or page more INDIANAreceived 2behavioral |a grant People ofhealth $35,000 in issue. fromBrief The UPSpage 4 | Event Calendar page 6 | Commentary page 18 the state with this new technology.EWS improves health outcomes for those with $2.50gins, it’s time to reflect on the good, When- it comes to managing chronic Foundation, the charitable arm of UPS. Suppliesmental illness. Finally, we hear from Michael the bad, the major and small within our Lourdes Hospital offers a new minimally inva conditions suchOver as Seas asthma, (SOS) heartis a local failure, nonprofit organizationN healthcare community. The national • sive cardiac surgery (MICS). Only 20 percent of Gosser with Our Lady of Peace about how News in Brief page 2 | People in Brief page 4 | Event Calendar page 6 | Commentary pagethat 18collects medical surplus to assist increased behavioralEWS health awareness leads to stage saw many exciting changes in cardiothoracic surgeonsServing across Kentucky the country and Southernare developing Indiana countries. healthcare—The Affordable Care CHANGES TO both increased identification and treatment to qualified to do the procedure. Lourdes is first in the state and region to Read moreContinued on page on page 17 3 Act ruled constitutional, ICD-10 March 2017 address a problem. offer the MICS procedure. deadline extensions and Medicare Articles begin on page 13 beginning its value-based purchasing NortonMEDICAID IN Cancer Institute joins Healthcare Innovation • Kentuckiana Health- program—to name a few. What about part of the Norton UK physicians perform for Nuclear Research). Institute, here in the Commonwealth? Kentucky- Cancer careJAILS System. AS THEKENTUCKY transcatheter aortic valve had no shortage of healthcare recaps happen our Inside Opioid Addiction Forum ings. Below Medical News replacements Kentucky Gov. Steve Beshear determined that the proposed choices for the top healthcare business • When he learned that a valve in his heart needed merger of University of Louisville Hospital, Jewish Hospital and policy stories of 2012. NEW ASYLUMS to be replaced, 81-year-old Robert Kraus was & St. Mary’s HealthCare Inc., and Denver-based Catholic totally against it. He was adamant that doctors Bluegrass.orgHealth Initiatives and Inc theshould not proceed. would not perform an open-chest procedure on July 2016 Fayette County Detention launches him. Not at his age. Healthcare in Edgewood • St.Center Elizabeth partnership provides Read more on page 20 Hospitalists first emergency department-based telepsychiatry enhance quality of in Northern Kentucky. careprogram for mentallyhealthier, ill. Kentucky transition HEALTH toPart commercial of KET’s ongoingencourages Inside Opioid health Kentuckians insurance to model get care for patients Addiction initiative. ABOUT THIS ISSUE Hospital medicine is the By Peter Taylor, with February fastest growing specialty in contributions by Tiffany Arrows independent of governmentMore events on program. page 6 Beginning in 1982, clinicians started The Legislative the history of screening at-risk inmates• as they were Jewishbooked Hospital & St. Mary’s Healthcare American medicine. Th e Treatment Advocacy Center reports • Ruth Bader Ginsburg nominated and Saint Joseph Health System form M into the Fayette County Jail and provided Issue/Nonprofits Read more on page 2 EDICAL Mitigating risks: over the past decade county jails and prisons The businessservices of based healthcare on assessments. Th KentuckyOneThe FCDC Health, programBy Ben the Keeton state’s served largest as health have emerged as America’s new asylums SERVINGFive key KENTUCKY areas of focus. This month Medical News covers two important began operations with three employees e program andsystem. It Moreis effective than one retroactively in three Kentuckians to January 1, 2012.Continued Ruth on page W. 3 area catalyst on Medicaid. for the Any development significant ANDAs partSOUTHERN of a commitment toINDIANA help healthcare housing 10 times more mentally ill persons NEWS Brinkley will serve as president and chief executive officer. $2.50 a part-time psychiatrist working inside the changes to the Medicaid program topics—legislation and nonprofits—in our special Physician than hospitals. As many communities of the Bluegrass.org Jail Triage providers reduce risk, Jeremy Wale with detention center. Since then, the program in Kentucky will have dramatic ProAssurance is sharing informationLegislative designed to Issue. Our contributors write about Spotlight struggle to manage this mental health crisis, implications to the healthcare system in become independent of the government has continued to grow to keep pace with the Program which facilitates help remind healthcare providers of issuescommon close risk to their hearts. For example, were you Meet Maggie Abraham, MD, Bluegrass.org marks 35 yearsNews of mental in Brief page 2 | People in Brief pageKentucky. 4 | This Event month, Calendar Governor Matt page 6 program,| Commentary Bevin said. page 18 increasing inmate population with mental community mental health management issues with a variety ofaware patient how types. pension system solutions just might kill a gynecology specialist with health services to the Fayette County Bevin announced sweeping changes to Among other changes that must be health problems. approved by the Obama administration, Kosair Children’s Hospital. Detention Center. the state’sand countyprogram jailfor thepartnerships poor and Read more on page 9 Februarycommunity mental 2017 health and what can be done In 2005, Bluegrass increased servicesuninsured, to promising to dramatically Governor Bevin’s proposal would allow Read more on page 5 provide staff throughout the state. to help the growing medical costs for our seniors? 24 hours a day, seven days reshape a the delivery of healthcare in monthly premiums. These premiums week. Having staff would be scaled based on income and From a nonprofitcarefully standpoint, when weit explorecomes creativeto approving to the U.S. Supreme Court. our region. Getting Kentucky out of the SOCIAL on-site around the clock changes to what has been widely viewed According to the Bureau of provides a high level of care for inmates would be darkcollected ages by by the improving Managed accesspartnerships, innovative programs and funding that 10th annual MediStar Awards Continuity of Care Care Organizations (MCO’s). Like more as a highly successful program. Justice Statistics a jail the and support to jail administration. FCDC to care and lower costs. will surely make a difference in our communities. We’ve been honoring excellence in the business Providing continuity of care measurablytraditional insuranceFrom plans, the recipients Publisher: New Year’sMany healthcare leaders have come DETERMINANTSis one of only two county jails in KentuckyBevin said he wants to Lowering healthcare costs by reducing the burdensto the defense of Governor Bevin’s new of healthcare since 2007 and will continue the size of the Fayette County improves an inmate’s quality of life whilewould allow the state toreflections cut off Medicaid and renewalArticles begin on page 10 with on-site mental health services. Th of an antiquated legal system will make Kentuckyplan, a stating that the Medicaid model tradition this October. Nominate a person or ensure thatincarcerated people andcovered the goal is to carry thiscoverage for those who don’t pay. Detention Center would FCDC program served as a catalyst for the e place that Asphysicians we kick offwant the to new practice year, medicine.we alwaysput likein to takeplace by Governor Beshear program from June 27 to July 25. OF HEALTHdevelopment of the Bluegrass.org Jailby TriageMedicaid improvement become more after release. With dischargeWhile the plan keepsthe opportunityin place some to celebrate the successeswas unsustainable. of the However, many average 6.75 suicides a year. of the benefit Readdesigns more of ontraditional page 18 More information on page 6 planning, Bluegrass.org matches clients to healthcare advocates believe that the In the past 10 years, there Program which facilitates communityengaged in their own Medicaid, it does makepast significant year and look forward to new initiatives and Impacting healthcaremental health and countyfrom jail partnerships a range of community partners includingchanges that could impact projectsthe healthcare in the coming year. new model will put significant barriers healthcare andServing become Kentucky and Southern Indiana to care in place that may harm the have been no suicides. throughout the state. outpatient services, recovery programs,community. In additionIN toTHISRead the premium more ISSUE on page 2 outside the system. better consumers. overall health of Kentucky. Managing risk and providing hospitals, Assertive Community charges,Treatment the plan also reduces instant Th e Fayette County Detention Center teams, Adult Protective Services access andM the to dental and vision coverage and “I’m very disappointed,” said THE 2016 psychiatric care have proven to be a highly Sullivan, SpencerianBill Wagner, executive director of M (FCDC) Mental Health program was created Fayette Mental Health Court. limitsTh The access tobusiness MedicaidBehavioral for those low of Health healthcare eff ective strategy for reducing suicideIn his and statement announcing the EDICALFamily Health Centers. “I’m most EDI administrators invited new 1115 waiver, Governor Bevin income is program employees that have access to as a partnership betweenBy theBen Lexington- Keeton self-injury at FCDC. Th was created to address the high suicide rate in Kentucky disappointed that they’ve introduced indicated that his goal was to model benefits$2.50 through their employer.to White The House AWARDSS Fayette Urban County Government and rate over the last 35 years e is facility’s dramatically suicide in county jails across the nation and to premiums and lockouts.” TAR the Medicaid program after the state’s new premium model mayThis also month meanA group that of Sullivan University System • Nelson Mandela awarded the The focus of efforts to improve Bluegrass.org with the goal of lowering the lower than the rate for incarceratedemployee personsbenefit plan.provide The careproposal for persons with mental illness Physicians’ responsibility to health in the United States largely revolve Social determinantsMedicaid of health members are movethe Medical in and Newsadministrators out of were invited “Itto The creates White House a lot to of barriers,” said risk of suicide in county jails and providing As Kentuckycalled looks Kentucky for ways HEALTH towhile in(Helping custody. Sheila Schuster, a longtime Kentucky nationally. According to the Bureau of structural determinantsa “lock-out” and period,conditions meaning delves healthcare intocelebrate the university’s designation as a White obtain informed consent care for around individuals the withtraditional mental illnesshealthcare system, to Engage and Achieve Long Term News in Brief page 2health | advocatePeople andin Briefmember page of the 6 | Event Calendar page 7 | Commentary page 17 Justice Statisticssignifi cantly a jail the improve size of the Fayettethe health Th e in collaborative which people approachprovides are has born, may havegrow, additional live,behavioral hoopsHouse health to Healthy Campus and to hear remarks from A patient’s absolute right to make informed with an increasing focus on providing Health) would encourage Kentuckians group Kentucky Voices for Health. Her while in custody. County Detention Center would average signifi cantly reduced the navigate cycle of Fayettefor reimbursement. N decisions regarding his or her medical care is the former First Lady Michelle Obama. access to care through health insurance of its citizens,to get it healthier is important and transition towork the and age. They include factors like in Kentucky with group, she said, “has always been very 6.75 suicides a year. In the past 10 years, County’s most severely mentally ill citizens’ EWSfoundation of informed consent. According to recent reports in the and incentivizing consumers to make commercial health insurance modelsocioeconomic to Courier-Journal status, education, and WFPL, thea specificthe U.S. interest clear that we don’t want barriers to care.” there haveto been continue no suicides. to look at the needless involvement in the criminal better healthcare decisions. Over the past physical environment,Department foremployment, Health andin theHuman opioid More information on page 13 entire healthcare ecosystem. justice system. Further, facilitating access The new plan does improve access five years, policy efforts have primarily social supportServices networks, must approveas well the as crisis.changes, What are to mental health services, news that was to treatment promotes functional recovery praised by health advocates concerned focused on ways to increase access to access to healthcare.and a spokesman AccordingDOES for theto theagency threeYOUR saidthings and has proven to be signifi Read moreabout on thepage dramatic 2 increase in addition important, research demonstrates American theJournal review for will Public begin Health,once Kentuckyto think about health coverage and making significant cost-eff cantly more related healthcare costs and a high rate of that improving population health and ectiveresearchers than submits repetitively found its that waiver cycling social application. factors, But when the prescribing IN THIS ISSUE changes to the healthcareSUBSCRIBE system. TODAY! drug overdose deaths. The plan will help Nobel Peace Prize. achieving health equity also will requireindividuals with mentalspokesman illness saidHEALTHCARE through officials the will proceed Physician Spotlight: However, according to the Kaiser including education, racial segregation,Suboxone in Kentucky?ensure We’ll tellaccess you. How to cantreatment you options for broader approaches that address social,jail and the court system. Family Foundation, increasing access social supports and poverty accounted allow individualsMeet Julia tothose stabilize Richerson, seeking so they MD, canto tackleengage their addiction as economic and environmental factors Bluegrass.org’s mental health program HEALTHCARE LAW to healthcareSIGN and UP transforming for over a third ofBRAND total deaths in thein theNEED treatmentwith Family process?well Healthas We’ll help Centers also reduce explore that.the overall number for the that influence health. at FCDC is an integral part ofSERVING the jail’s KENTUCKY ANDin Louisville, SOUTHERN Ky. INDIANA This month we take a closer look at healthcare the healthcare delivery system areMedical News United States in a year. We also take a closerof babieslook at how born integrating with significant health daily operation. In 2016, the staff September 2016 eNewsletter at www.MedicalNews.mdSocial determinants have a behavioralRead healthchallenges andmore primary due care towill addicted improve mothers. law in Kentucky. We take a look at how the 38 contacts per day for a total of 14,366 averaged 60-day rules affect practitioners. We also brush significant impact on health outcomes. How It TranslatesTO EVOLVE?access to care.on page 5 contacts. In addition, Bluegrass.org provides up on our knowledge of informed consent and Studies have shown that theArticles start on page 12 explore how it’s ultimately the physicians’ HEALTH DISPARITIES likelihood of premature death increases Physician Continued on page 3 responsibility to obtain informed consent. Spotlight as income goes down. Similarly, lower Continued on page 3 A particular type of health difference that is closely linked education levels are directly correlated Read this and more starting Meet Robert Prichard, Jr, IN THIS ISSUE on page 13 with social, economic, and/or environmental disadvantage. with lower income, higher likelihood MD, CEO of St. Elizabeth Physicians, who strives to Health disparities adversely affect groups of people who have of smoking and shorter life expectancy. Do a gut check on whether your ‘do the right thing.’ systematically experienced greater obstacles to health based on Children born to parents who have not Social existing brand can effectively translate Read more on page 5 their racial or ethnic group; religion; socioeconomic status; gender; completed high school are more likely to Determinants • Brady Bill passes establishing five-day live in an environment that poses barriers age; mental health; cognitive, sensory, or physical disability; into potential areas of growth. to health. Their neighborhoods are more of Health sexual orientation or gender identity; geographic location; or other likely to be unsafe,By Cassandra have exposedMitchell garbage This month Medical News delves into a new topic characteristics historically linked to discrimination or exclusion. or litter, and have poor or dilapidated for us—social determinants of health (SDOH). As competition and consumer choice housingin healthcare and providersvandalism. continue There to grow,is also SDOH are conditions in the environments in — US Department of Health and Human Services. Healthy People 2020 April 2013 THE 2016 healthcaregrowing evidencebrandsEWS are demonstratingmore important that which people are born, live, learn, work, play, M thanNstress ever. negatively impacts health for worship and age that EDI children and adults across the lifespan. affect a wide range of Brands, at their core, are key In addition to expert Nominees have been announcedAWARDSS and applications health, functioning and TAR EDICAL to differentiatingThe Quarterly one Journal provider of Economicsfrom have been received and sent to an outside panel of hospice care, our team M another.reports A a brandstudy isshowing shorthand that forwhere a quality-of-life outcomes judges who have the challenging job of selecting The business of healthcare waiting period for U.S. handgun sales. everythingchild grows a providerup impacts organization his or her future providesand risks. non-hospice This month, Educatingservices, tomorrow’sCommunity Hospice of Lexington back the seven winners who will be honored on SUBSCRIBE TODAY! economic opportunities as an adult also we examine several in 1978,” said Liz Fowler, CEO of Hospice $2.50 stands for – particularly the promise of including private duty nursing,doctors today October 25. factors that impact what itsuggests delivers that to its the consumers environment and its in which of the Bluegrass. “As we expanded our Read more on page 4 News in Brief page 6 | People in Brief page 6 | Physician Spotlight page 9 | Healthcarecase management Innovation pageand 19The first| Commentary baby boomers turned page 65 in 2011,20 and SIGN UP reputationsome for individual sticking to livesthat promise.may have multi- community health, service regions to other parts of the state, for the generational impacts. palliativeincluding care.” education AARP estimateswe 8,000 changed boomers our will name hit the to Hospice of the Medical News When a healthcare brand builds magic age for Medicare every single day for the strong recognition, differentiates itself and workforce Bluegrass in 1986,” Fowler added. “And Oakwood Specialty Clinic hosts eNewsletter at www.MedicalNews.md —Liz Fowler, CEO, Hospice next 16 years. Then there are the more than grand opening from competitorsIn Kentucky and createsLegislative preference development, food that name has served us well, until now.” of the Bluegrass 30 million Americans who will have insurance Living in rural parts of our country security and access to transportation. This new South Central Kentucky clinic will provide among its audiences, that brand is in an coverage beginningThe challenge, next year under according provisions to Fowler, of enviable positioncan bring for addedgrowth. challenges. In Kentucky,brand can effectivelyArticles starttranslate on pageinto the 12 is that the organization now provides a a central location for medical providers to serve the the Affordable Care Act (ACA). But the question comprehensive health needs of individuals with wrap-uppotential new areas of growth. Does growing range of services in addition to Growth for healthcare organizationsContinued on page 3 remains: just who will care for all of these people? intellectual and developmental disabilities. hospice care, with expertise appropriate often happens by expanding service the overall brand name make sense for Read more on page 4 lines to a broader continuum of care the new extensions? Does the equity of for patients prior to a terminal diagnosis. Read more on page 10 the brand in existing services translate UK researchers“In addition to raiseexpert concernhospice care, credibly to new services or geographic our team provides non-hospice services, The state of healthcare bills in Frankfort. about heart medication Cyberchondria—don’t ask and/or increasing a regions? including private duty nursing, case Dr. Google—see a doctor! geographic presence managementDigoxin, a drugand palliativewidely used care,” to treat Fowler heart Patients have greater access to information today than A Case Study for Change disease, increases the possibility of death when with a bigger service said. “Yet our organizational brand name they ever have before in history. That can be a great footprint or adding Decades ago, it was common for is still currentlyused by patients Hospice with of thea common Bluegrass, heart rhythm thing or it can exacerbate an already tense situation. • healthcare providers to establish their problem—atrial fibrillation (AF), according to a and Medical News was born. service facilities. which no longer accurately reflects the brandsto evaluatewith a thespecific legitimacy geographic of claims Read more on page 18 scope of servicesstudy by weUK HealthCareprovide or researchers. plan to If a healthcare referencebrought as part against of their nursing names. homes Just in or- organization plans provide in Readthe future. more So on we’re page in 5 the think derof how to manyhelp hospitalseliminate started instances with of mer- MITCHELL to expand, it needs process of evolving our organization’s As the legislative session comesthe worditless county claims. or even The a specific bill passed city as out of the IN THIS ISSUE to do a gut check on brand name toSpecial expand on Legal just ‘hospice’ Series: By Ben Keeton part of theirSenate brands and – suchis stalled as Cleveland in the House. to a close,whether a few its goodexisting bills and allow the flexibilityHIPAA to Final extend Ruleservice Clinic – and still retain that reference in Marketing/ lines while retainingThis is parta cohesive two of our and four-part series of updates their name. Senate Bill 107 The beginning of April signi- were passed that will benefi t A bill to create a more transpar-consistent brand.”summarizing the HIPAA Final Rules andBrand addresses Building “Our organization was founded as implementation concerns that many organizations fies another legislative session that the healthcare providers in ent system by which independentChanging your brand name is a big This month, has come and gone. Though this was pharmacies are reimburseddeal. by Phar-The prospect oftenmay encounter.raises major expertise of leadingMedical healthcare News marketing pros to concerns because a healthcare brand may a short session, legislators took up a Kentucky, and a few bills were SERVINGmacy Benefit KENTUCKY Managers AND (PBMs)SOUTHERN for INDIANARead more on page 18 ask about hospital marketing. tapped Many healthcareinto the number of bills that directly or indi- medication dispensed tobe decadesMedicaid or even a century-plus old and organizations are large, complex institutions with rectly have an effect on the healthcare defeated that would have patients. The bill also allows pharma- Innovation in healthcarea variety of different audiences and customers. system. While many of these bills cies to appeal the Maximum Allow- A study by Kaiser Family FoundationHow do branding on and marketing initiatives differ were dead on arrival, there were sev- caused additional headaches. able Costs (MAC) prices implement- employers, regarding thefor health consumer-focused, benefits that provider-focused and eral surprises along the way. ed by PBMs to determine reimburse- Continued on page 3 community-focused initiatives? tracked they offer, showed them lacking confidence Below is a summary of the health- ment rates. The bill has passed the tic” reaction. The bill also calls upon in the effectiveness ofWe’ll any single show health you howcost starting related bills Medical News Senate and the House and is headed containment strategy. Most therefore engage schools to create an emergency action on page 13 this session and the current status at to the Governor’s desk. in multiple strategies at once—from disease plan if they choose to carry the medi- the end of the regular session: management programs to consumer driven plans cations and ensures that schools have Senate Bill 39 to higher employee cost sharing—hopeful of a access to auto-injectors. The bill has House Bill 217 A bill to prohibit Kentucky from cumulative measurable impact. passed the Senate and the House and A bill to amend a law, passed dur- participating in the expansion of is headed to the Governor’s desk. Read more on page 22 ing the 2012 legislative session that Medicaid eligibility under the Afford- cracks down on pain clinics and abuse able Care Act unless authorized by the House Bill 190 of prescription pills. The bill helps A bill to implement a comprehen- General Assembly. This bill passed remedy unintended consequences the Senate and has been assigned to a ABOUT THIS ISSUE sive statewide smoke-free law for all caused by the law, including unneces- House committee for review. indoor workplaces and public places. sary drug tests and multiple reports The bill passed out of a House com- for patients in hospitals. This bill Senate Bill 40 Health IT mittee and was reassigned to another passed both the House and the Senate A bill to prohibit Kentucky This month we focus on the many angles committee where it currently sits. and has been signed by the Governor. from operating a state-based health of health IT. Our News in Brief department benefit exchange under Continuedthe Patient on page 3 Senate Bill 9 highlights tech news. We take a look at a House Bill 172 A bill that would have estab- A bill to encourage schools to working IT department in our profile of Highland lished a medical review panel process carry epinephrine auto-injectors on Health System’s 8-person IT team. What is the campus in order to quickly treat the Covering the business of healthcare for 25 years government doing to stop healthcare fraud? onset of an allergic or “anaphylac- We’ll explain. In addition, we show how the Pharmacy Plus program reduces readmissions. Presenting technical material does not necessarily. mean using PowerPoint. We show you how Articles begin on page 10
Serving Kentucky and Southern Indiana PAGE 16 MEDICAL NEWS • FEBRUARY 2018
SOCIAL DETERMINANTS OF HEALTH
One box at a time Passport, Bluegrass Harvest partnership aims to increase access to healthier food.
A Community Ventures By Ben Keeton company, Bluegrass Harvest was created to improve the When we talk about the health and wellness of Kentuckians, we have to take health of all Kentuckians a step back and look at the social factors while lowering healthcare that have an impact on the overall health costs and increasing and well-being of individuals. When we income for local farmers.” take a closer look beginning in the home, and extending to our workplace, our schools and our neighborhoods, we can observe that will be provided at no charge to identified social determinates have obvious differences residents in this first of a kind program. in the health outcomes of individuals. With Passport as its partner, residents The pathway is not always an easy one will also have access to regular sessions to for many residents living in communities support them on this fresh food journey. where access and affordability are the Residents will be invited to attend fun major factors in the decision-making events over the five months. From cooking process of the foods they buy and eat. The demonstrations and tastings, exercise conditions in which we live explain in part MOLLY, ANNA, BRYCE, JACK, CARLA AND LOTHAR BAUMANN WITH LAZY EIGHT STOCK FARM IN PAINT LICK, KY. classes, to nutrition and diet tips, all of why some Kentuckians are healthier than this will be provided free of charge to others and why more are not as healthy as and provided from May to October. habits and lower riskier health behaviors. residents and their families participating they could be. “Bluegrass Harvest has seen Twenty weeks of locally grown produce in Bluegrass Harvest. Health Disparities measurable results in their first two years How can the healthcare community of operation,” said Kevin Smith, CEO, tackle such challenges that result out of and president of Community Ventures. these disparities? Disparities that have “Now that the company has partnered proven to show an increase in insurance with Passport Health to engage more rates, high incidents of heart disease, communities, the growth opportunities obesity, diabetes and high cholesterol? for this initiative are innumerable.” These social determinants also lead to A new sponsorship program has negative impacts through low-term been launched between Passport Health birthweights, hospital readmissions and and Bluegrass Harvest to provide CSAs emergency room visits. to residents in the Lexington’s East End One way to address this issue is to tackle these issues targeting lower by creating easier channels of access to resource families. healthier food options which have proven The program will seek to provide to positively influence overall health just by education and support to change eating shifts in a diet change. One program that is looking to do just that is Bluegrass Harvest. A Community Ventures company, Bluegrass Harvest was created to improve the health of all Kentuckians while lowering healthcare costs and increasing income for local farmers. This is accomplished through Community Supported Agriculture (CSA), or a weekly box of produce, which are sold
www.fhclouisville.org fhclouisville
ROWS OF ROMAINE LETTUCE ON ELMWOOD FARM IN GEORGETOWN, KY. MEDICAL NEWS • FEBRUARY 2018 PAGE 17 COMMENTARY
Policy over programs We must improve our institutional policies so the best healthcare is provided to every patient.
By Julia Richerson, MD
I love being a Policy, defined pediatrician. To — Policy is one potentially effective way to improve the health of populations. support families — Policy is defined as a law, regulation, procedure, administrative action, on their journey of parenthood is a incentive or voluntary practice of governments and other institutions. joy and a privilege. — Health can be influenced by policies in many different sectors, such as transportation Many days are filled policies can encourage physical activity (pedestrian- and bicycle- friendly community with healthy children RICHERSON design); policies in schools can improve nutritional content of school meals. whose families are resilient and thriving. — Centers for Disease Control and Prevention Many days, that is not the case. I work with children who are struggling with issues such as obesity, autism, depression, learning disabilities, the best outcomes for their children have been shown nationally to im- diabetes, asthma and rampant cavities. with special needs like autism and to As we continue to respond prove health outcomes. One in four of Kentucky’s children have prevent childhood obesity. in a meaningful way to − Instituting policies that support a chronic or special healthcare need. For Strong Programs trauma informed care are shown to them, navigating our healthcare delivery address health and health improve health outcomes. For basic living needs I often system can be at best overwhelming and disparity issues we must − Institution and payment policies respond by referring families to at worst, sheer chaos. that increase timely access to birth community programs and agencies that work harder for solutions control is another example of a pow- can help. We have strong programs in at the policy level.” erful solution. our neighborhoods that offer resources Policies that include families As we continue to respond in a for families. Some offer assistance for in our leadership structure Patient and Family Centered immediate needs and some offer more meaningful way to address health and and committees have ongoing aid for families struggling or We must improve our institutional health disparity issues we must work harder for solutions at the policy level. been shown nationally to in crises, such as impending eviction policies so that the best healthcare is or sudden detention of a family provided to every patient every time and — Julia Richerson, MD, FAAP is a improve health outcomes.” member who provided the family’s is patient and family centered, such as: pediatrician at Family Health Centers-Iroquois. financial stability. − Policies that include families in our Basic Needs But if you ask most of these leadership structure and committees programs, they would be so happy In addition to health challenges, to be “out of business.” Many rely on many of the families I work with face unpredictable funding and struggle to challenges meeting their basic living stay afloat themselves. The dream is needs. Having enough food to eat, for our community not to need a food having a safe and healthy living space, pantry or a homeless shelter. having reliable transportation to work, having safe and reliable child care and Solutions, Not Responses living free from domestic violence are There are responses to challenges some of the basic needs they struggle to and there are solutions. The healthcare meet. Meeting these needs is essential community can play a powerful role to building health and wellness. in finding solutions. Programs and As a pediatrician and a member of community resources are responses to my community, I struggle to respond to problems and are funding dependent. a family’s challenges. Helping a family Solutions can come in the form with a child with autism navigate the of policy, at the institution, local and world of medical specialists, therapists state level. We have a strong history of and school resources is daunting. successful health policies like Medicaid Working with a child who is morbidly expansion, tobacco free communities and obese to get the help they need is next car and booster seat laws. For example, to impossible. significantly raising the tobacco tax is a Sign up for the Medical News As a medical community we can policy that would decrease smoking rates respond better to a family’s needs and in adults and children. eNewsletter at www.MedicalNews.md support them on their journey to have PAGE 18 MEDICAL NEWS • FEBRUARY 2018
COMMENTARY
Doctors and lawyers partner up Ensuring poor families get care and services needed.
By Martha Hasselbacher
Every low-income person has Both doctors two-to-three unmet civil legal and lawyers have professional ethics needs that create barriers to that require them healthy eating, safe housing to serve those who employment and safety.” cannot afford their services. That is one Louisville Bar Association. The Legal HASSELBACHER of the factors that Aid Society also supports Doctors & distinguishes these Lawyers for Kids with its expertise in professions. How can they effectively poverty law. work together to serve this population? The answer is a Medical-Legal In Action Partnership (MLP). There are now 294 To see Doctors & Lawyers for MLPs serving individuals in 41 states Kids in action, consider Celia’s* story. throughout the country. In Louisville, Celia’s son, Tim, was diagnosed with we have Doctors & Lawyers for Kids. stage 4 cancer. She was unable to work Doctors and lawyers have joined her two jobs, and she was threatened forces in indigent pediatric clinics to with eviction. She had applied for ensure that the poor families get the care Supplemental Security Income on Tim’s and services they need. Doctors have the behalf, but his claim was denied. training and expertise to heal wounds, During this turbulent time, Tim cure diseases and provide preventive turned eighteen, and Celia needed medical care. authorization to continue making Lawyers understand that many of decisions about his medical care. Tim’s the social determinants of health–bad disease had progressed to the point where housing, poor nutrition and domestic he was unable to make those decisions violence cannot be cured with a for himself. prescription. Legal services can make With the assistance of Doctors & a difference. Lawyers for Kids, Celia avoided eviction Unmet Needs from her home. The Social Security Administration reversed their initial Every low-income person has decision on Tim’s claim and Celia was two-to-three unmet civil legal needs awarded guardianship of her son. that create barriers to healthy eating, Doctors & Lawyers for Kids safe housing employment and safety. provides training and legal services in Addressing those needs improves a the clinics of U of L Department of person’s health and helps medical Pediatrics, Family Health Center Clinics treatment work more effectively. in Portland and Iroquois neighborhoods Doctors are in a unique position to and Norton Children’s Hospital identify these problems. Our Doctors and downtown pediatric practices. & Lawyers for Kids team trains these Expanding services to other locations is healthcare professionals to identify legal planned as resources become available. problems that affect their patients’ health *names have been changed Tom Haselden and well-being. — Martha Hasselbacher is board [email protected] Legal triage in the clinical setting president at Doctors & Lawyers for Kids. www.ezoutlook.com means that we catch problems early 800-219-1721 ext. 103 before families are in crisis. Then we Read full provide free legal services on site in the commentary clinics. Legal services are provided by online at dedicated legal staff and by volunteer attorneys providing their help through medicalnews.md the Pro Bono Consortium of the MEDICAL NEWS • FEBRUARY 2018 PAGE 19
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