Mental Health Integration: the Focus of 2018 Annual KHC Conference

In planning our 2018 annual conference, the KHC Executive Committee quickly identified mental and physical health integration as the focus, a clear indication that mental health has become the priority for many our key healthcare stakeholders.

We know that our community is facing alarming rates of mental health issues, including substance use disorders. Kentucky has three times as many deaths to suicide as homicide, and overdose deaths are rising at unprecedented rates. Nearly a third of Kentucky high school students report they feel sad or hopeless, according to the U.S. Department of Health and Human Services. Kentucky leads the nation in many of the risk factors linked to poor mental health such as poor physical health, sedentary lifestyle, poor diet, smoking, and poverty. Stress, trauma, and negative coping skills are also significant risk factors for developing depression, anxiety, and substance use disorders.

Despite these statistics, persons with mental illness are under-identified and under-treated. Primary care providers are the backbone of the healthcare delivery system and are seeing a greater volume of patients with mental health issues than even mental health providers. They “prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States,” according to researchers. Patients dying by suicide see primary care more than twice as often as mental health providers and 45 percent saw a primary care clinician in the month before their death (see research).

The World Health Organization has called integrating mental health services into primary care as the most viable way of closing the treatment gap for untreated mental illnesses. Integrated models of care are seeing success in communities across the country, including the Collaborative Care Model developed jointly by the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM). The Collaborative Care Model and other integrated care models work to better meet the whole health needs of people with mental health conditions.

The barriers individuals face in getting mental health services are many and go well beyond the healthcare delivery system. One of the biggest barriers to individuals seeking treatment is the stigma associated with mental illness. The KHC conference will feature keynote speaker Mike Veny, who will discuss his personal journey and how mental health stigma can be transformed (see keynote highlights here).

The KHC annual conference will be held on March 14, 2018. Registration will open in October. The conference will feature evidenced-based approaches, best practices, and successful models of addressing mental health and integrating care. Topics for the day include:

  • Mental Health Stigma
  • StAMINA – Student Alliance for Mental Health Innovation and Action
  • Collaborative Care Model
  • Integrated Care Models
  • Addiction Treatment Models
  • Mental Health Co-Morbidities, Hepatitis C
  • Mental Health Innovation and Technology
  • Successful Employer Models of Improving Mental Health

Having a mentally healthy community means that each of us are better able to function during stressful situations, form good interpersonal relationships, set and achieve realistic goals, seek help during difficult times, and enjoy life to the fullest.  To improve the mental health of our community, key healthcare stakeholders will need to collaborate to make systemic cultural and organizational changes. The KHC is currently investigating how to best support efforts to increase effective mental health prevention and treatment services for Kentuckiana youth and adults and will be announcing its plans at the 2018 KHC conference.

The Rise and Evolution of Onsite and Near-site Clinics

A few decades ago, I remember sitting in a meeting with our company doctor planning new hire orientation, feeling miserable, and wishing I could just have him see if my cold needed to run its course or required a prescription. Instead, I took a half day off of work for a doctor appointment, but I longed for easy and hassle free access to a healthcare provider at or near work. Today, more and more companies are adopting onsite or near-site clinics, also known as worksite health centers, as a way to meet the healthcare needs of their employees.

Onsite clinics were at one time only for the largest of corporations, but companies with as few as 500 employees are now adopting a worksite health center model. According to Springbuk, the current market penetration of worksite health centers is 16 percent and is expected to surpass 30 percent by 2020. This means that up to 10 percent of the adult population under the age of 65 will receive their healthcare through a worksite health center.

There are three primary reasons employers are adopting worksite health centers: 1) improved access to care that enhances productivity and job satisfaction, 2) improved population health management, and 3) better management of healthcare costs. The role of worksite health centers is evolving from the occupational medicine clinic – like the one my company doctor ran – to primary care clinics. We are now seeing an evolution that focuses more on employee well-being by integrating population health, wellness, and evidenced-based medicine into a more holistic approach to employee health.

With the increasing adoption of onsite and near-site clinics, employers considering an investment in a worksite health center now have access to case studies and information about how well these clinics have supported companies’ long-term healthcare goals. On September 12, 2017, the Kentuckiana Health Collaborative and the National Alliance of Worksite Health Centers will host a half-day event to discuss the latest information on worksite health centers. Confirmed speakers for the event include:

  • Diana Han, MD- Global Medical Director, GE Appliances, a Haier company featuring their onsite clinic vendor, Premise Health
  • Larry Boress- Executive Director, National Association of Worksite Health Centers
  • Gregg Potts, MD- Senior Medical Director, Papa John’s International
  • Dexter Shurney, MD- Chief Medical Director/Executive Director Global Health/Wellness, Cummins Inc.

If you are considering a worksite health center or would like to learn more, be sure to join us for The Rise of Worksite Health Centers to Address the Unmet Health Needs of Employees. This event requires registration and is free to current KHC and NAWHC members. This forum will be held at the Jewish Hospital Rudd Heart & Lung Conference Center in Louisville, KY.

 

KHC Member Spotlight: Vicki Welch

 

Vicki Welch
Louisville Metro Council

Vicki Welch is a Metro Councilwoman for Louisville’s District 13, where she serves her constituents and works with legislations involving Louisville Metro ordinances. Councilwoman Welch has been a member of the KHC for more than four years.

 


What are you currently working on that you are most excited about? How do you think it will drive improvements to health and healthcare in the community?

“After months of discussions to incorporate electronic smoking devices and hookah into our current smoking ban, I proudly report that after 3 months of deliberation, the Metro Council voted 15 to 6 in favor. It is my hope that this legislation will bring awareness of hazardous toxins in electronic smoking devices and hookah.”

What do you see as the biggest threat to our community’s health? How do you feel it needs to be addressed?

“I believe heroin usage is the most pressing threat to our community. We need more recovery beds and studies of pharmaceuticals that curb addiction to allow addicts to be rehabilitated. This threat is causing overflow of jails, increased usage of LMPD resources, and increased usage of hospitals and emergency services.”

Why do you and your organization belong to the KHC? What do you find most valuable as a member?

“As a registered nurse 34 years previous to my election to Metro Council, I am interested in how our local organizations are partnering for the greater good of the health of our community. KHC is a great resource for this collaboration to bring awareness and possible solutions to health issues.”

What is your dream vacation spot?

“My dream vacation/retirement location is my little condo in St. Petersburg, Florida where we have 20 Louisville owners and everyday is paradise!”

Improving Colorectal Cancer Screening Rates Saves Lives

About 44 percent of people in Kentuckiana were not properly screened for colorectal cancer in 2015.

Colorectal cancer (CRC) screening isn’t always a relished birthday activity, but it should be if you are turning 50 and even sooner if you are at increased risk for colorectal cancer. This is why screening at the right time is so important. In Kentuckiana, 44 percent of people 50 and older are not getting the recommended screening.

The lack of screening increases CRC incidents and deaths. According to the Colon Cancer Prevention Project, colorectal cancer is 90 percent curable if caught early. Despite the effectiveness of screening, Kentucky leads the nation in CRC prevalence and is fourth in the nation for CRC deaths, according to the Centers for Disease Control (CDC). If more Kentuckians were screened according to recommended guidelines, many of these cases could be avoided.

Kentucky leads the nation in CRC prevalence and is fourth in the nation for CRC deaths, according to the Centers for Disease Control (CDC) data.

As a partner on the Kentucky Department for Public Health’s Organized Approaches to Increase Colorectal Cancer Screening (CRC) grant, the Kentuckiana Health Collaborative distributes annual individual provider and group practice reports throughout the Commonwealth of Kentucky on colorectal cancer screening rates. We are also working with our network of local employers to provide resources for improving CRC screening rates. A new KHC Colorectal Cancer Screening Resource for Employers webpage has been created to provide businesses with tools to improve their CRC screening rates.

Providers and employers are powerful forces for driving improved colorectal screening rates in Kentucky and Kentuckiana!

Reporting Round-up: Update of KHC Measurement

Spring always marks a flurry of activity for KHC measurement, and this spring has been no exception. If it’s been a while since you’ve caught up on all that the KHC is doing, be sure to read the update below.

2016 Individual Reports for both the region and the state went out in early May. This year’s reports included 35 performance indicators in the areas of Preventive Care Management, Pediatric Care Management, Acute Care Management and Chronic Disease Care Management (see the full list of 2016 measures here).

2016 Group Reports currently are being assembled. Each year, KHC uses health plan data and the previous year’s information to attribute providers to practice locations in the Kentuckiana Region. Group practices are given 30 days to inform us of any modifications to the KHC list. Those lists were sent to practices in April, and the deadline for modifications is May 30. If you are a group practice in Kentuckiana (Jefferson, Bullitt and Oldham counties in Kentucky and Harrison, Scott, Clark and Floyd counties in Indiana), you should have received those letters.

For the first time this year, reports will be assembled for group practice locations outside of Kentuckiana. Because of the intensive amount of work that it takes to put this attribution list together, those letters did not go out with the regional groups. They will go out in the next week or so.

Updated Community Reports are available for download on the website, along a report that demonstrates Kentuckiana’s performance over time in the quality indicators that are included on the yearly reports. We are working on enhancing the design of the measurement page of our website to highlight specific measures and track changes over time.

A new Measurement Strategy Team was assembled this year to help guide KHC Measurement activities and focus, and the measures for this year have been selected. Notably, we have added for the 2017 reports measures relating to:

  • Plan All-Cause Readmissions (PCR)
  • Statin Therapy for Patients with Cardiovascular Disease
  • Statin Therapy for Patients with Diabetes

The KHC measurement team is currently working with health plans to develop the data submission guides for the 2017 KHC Reports.

Our work with the Colorectal Cancer Screening Grant continues with the distribution of our individual provider reports. In addition to the inclusion of a measure tracking CRC screening rates, a CDC Colorectal Cancer Screenings Guide was also included in the mailing packet. KHC also created a page on the website with colorectal cancer screening resources directed at employers. You can find that page here.

That wraps up KHC measurement activities. Stay tuned for more information!

2017 County Health Rankings Now Available

Last week, Robert Wood Johnson’s 2017 County Health Rankings Report was released. The report, which provides data about population health at a county level, summarizes key national findings, as well as state and county trends. Users can explore the data using the interactive online tool or even download spreadsheets of data for their own use.

Some key findings nationally include:

  • More Americans are dying prematurely, notably among younger generations. In recent years, premature death increased most among those ages 15-44.
  • Drug overdose was by far the single leading cause of premature death by injury in 2015 and contributed to the accelerated rise in premature death from 2014 to 2015.
  • A new measure of disconnected youth (individuals ages 16-24 who are not in school and not working was added), and our own Louisville, KY was highlighted as a “Community Taking Action” through IDEAS xLab’s Project HEAL, which uses art expression to expand hope for the future and fosters youth-led community leadership. Last year, Louisville was awarded RWJF’s Culture of Health prize and received $25,000 from RWJF, along with the opportunity to learn from other winners, past and present, and exchange information with those communities.

To find out how Jefferson County (or any other county) fares in the 2017 County Health Rankings report, click here.

Explore selected measures with the “Neighborhoods Matter to Health” app below.

 

Can you describe what your Regional Healthcare Improvement Collaborative (RHIC) does?

A few weeks ago in San Francisco, I was struck by a colleague’s remark that he hopes one day his mom can describe his work. We all laughed, relating to the comment. I didn’t expect that offhand remark to actually be part of the Network for Regional Healthcare Improvement (NRHI) board meeting discussion, but the need to succinctly describe the work of a Regional Healthcare Improvement Collaborative (RHIC) or, quite frankly, any organization, is vitally important and a priority for NRHI.

So, what the heck does a RHIC do? At a high level, RHICs like the Kentuckiana Health Collaborative convene multiple healthcare stakeholders to work toward the Triple AIM goals of improving healthcare quality and cost and the health of populations in a region or state. The enormity of such a vague mission also leads one to ask, could you be a little more specific?

Generally speaking, RHICs typically work in four main areas of focus:

  1. Patient/Provider Education and Engagement
  2. Quality Analysis and Reporting
  3. Value-based Healthcare Delivery
  4. Valued-based Payment/Benefits

The reality is that RHICs come in all shapes and sizes, and we don’t all work on the same things. It’s always interesting to hear the priorities of the different communities. Here were a few of the activities that caught my attention of our sister coalitions.

The Massachusetts Health Quality Partners (MHQP) recently released a study highlighting a major opportunity for improving the way physicians engage with their patients by asking patients what their overall health goals were. The New Jersey Health Care Quality Institute developed a new blueprint for the future of the New Jersey Medicaid program called Medicaid 2.0. Minnesota Community Measurement is developing a new cancer care patient reported outcome (PRO) measure focusing on pain management during radiation and/or chemotherapy. Oregon Health Care Quality Corporation (Q Corp) presented Oregon health care cost information to the House and Senate Health committees to share insights on managing healthcare costs as they deal with budget deficits.

The variety of activity happening across NRHI’s 35 member RHICs, including the KHC, is indicative of the different priorities of communities. The KHC met just last week with its new Executive Board to reassess its current priorities. Results from that meeting will be reviewed at April’s All Member meeting on April 11.

The innovative work happening by RHICs across the U.S. is encouraging. I’m excited about the opportunities that 2017 has in store for our community, our members, and the KHC. Describing this innovative work, that’s a different story.

KHC 2017 Conference Recap; Or, the Day That Almost Wasn’t

OK, so the title of this post is a little exaggerated. The show always goes on, despite what obstacles might show up and threaten to throw a major monkey wrench into your best-laid plans. However, in the days leading up to KHC’s Third Annual Conference on March 15, a major snowstorm that wreaked havoc across the Northeastern U.S. also threatened to leave the conference with almost no speakers, who were coming in from various parts of the country.

On Monday morning, two days before the conference, keynote speaker François de Brantes called with the information that it looked like he was not going to be able to find a flight out of Connecticut. By the next morning, Health Tranformation Alliance’s Michael Logan was also unable to find a flight out of the Northeast. On Tuesday afternoon, two of our speakers coming in from Colorado called to say they were stuck in Chicago, where thousands of flights were canceled or delayed. After several hours, they were able to rent the last car in Chicago and drive to Louisville Tuesday evening.

Again, the show must go on. We were able to set up Skype sessions with de Brantes and Logan, so they could give their speeches remotely, and with the rest of the speakers and panelists either in town or on their way, the KHC 2017 Conference began.

The event kicked off Tuesday evening with a reception at The Seelbach hotel, in the historic Rathskeller Room. Kentucky Cabinet for Health and Family Services Secretary Vickie Yates Brown Glisson gave some brief remarks to attendees.

 

At Wednesday’s conference, attendees heard from a variety of speakers about measurement, data, and payment innovation; cultural competency; and the game changers that could be in store over the next few years.

Dr. Steve Berkowitz kicked off the morning with an energizing discussion about how transparency and consumerism are shaping new changes in healthcare and how healthcare can learn from the successes of other industries that have achieved success without bricks and mortar.

The morning also contained several discussions about measurement alignment and transparency. Jonathan Mathieu with Colorado’s all payers claims database (APCD), Center for Improving Value in Health Care (CIVHC), shared how his state was able to build, sustain and effectively utilize their APCD to drive improved health, enhanced quality and lower costs.

Conference attendees listen to keynote speaker François de Brantes speak about APMs.

De Brantes reviewed the current state of deployment of Alternative Payment Models (APMs). Connecting remotely through Skype, he talked about the important lessons learned in implementing APMs, the critical role that market forces can play when used to improve the quality and affordability of health care and how private sector employers can accelerate the pace of change in the industry. He then joined Humana’s Misty Roberts and NRHI’s Ellen Gagnon on a panel that discussed how communities and organizations begin to get to more meaningful measurement for consumers while balancing the measurement burden to providers.

Logan kicked off the afternoon with a review of HTA’s bold and aggressive plans. With more than 30 of America’s largest corporations, HTA plans to find a better way of providing healthcare to their employees to create better health care outcomes and reduce waste.

KentuckyOne’s Dr. Stephanie Mayfield Gibson leads the social determinants of health panel discussion.

We wrapped up the afternoon with a presentation and a panel about social determinants of health, an important aspect of health outcomes that was new for a KHC Conference. Robin DiMatteo, PhD, Distinguished Emerita Professor of Psychology, Univ. of CA, Riverside, discussed essential elements of healthcare delivery including effective communication, improvement of the healthcare experience, consumer empowerment, engagement, shared decision making, cultural humility and attention to health literacy. She then was joined by Kristin Paulson, Director of Health Care Programs for CIVHC, Colorado’s APCD, and IDEAS xLab co-founder Theo Edmunds for a panel discussion about the challenges that healthcare systems and the community face when they address the socioeconomic factors that impede individuals from reaching their fullest potential.

Thank you to all of the staff, speakers, panelists, exhibitors and attendees for making this year’s conference a success. A special thanks goes to Norton Healthcare for their Gold sponsorship and Delta Dental for their silver sponsorship. Be sure to save the date for our Fourth Annual KHC Conference on March 14, 2018!

Kentucky Sees Big Gains in 2017 Commonwealth Fund State Health System Performance Scorecard

As the data scientist for the Kentuckiana Health Collaborative, I keep my eye on datasets that show how Kentucky and the Greater Louisville area stack up against our peers throughout the country in key health behaviors, outcomes, and care. When a new report is released, I scan it to see where we rank and where we might have made improvements or backslid, and I typically send out a series of tweets and/or write a blog with some of my observations and thoughts.

You can probably guess how the summaries often go. “Kentucky shows familiar problem areas,” “Kentucky holds steady at 49th in the country in [insert measure of choice here],” or “Kentucky improves slightly from 46th to 45th” all probably sound very familiar to you, if you follow national health rankings.

So you can probably imagine why my jaw literally dropped – in the best way – yesterday morning when I opened my email to find that The Commonwealth Fund had released its 2017 edition of its Scorecard on State Health System Performance, and I saw that Kentucky had jumped from 47th to 39th.

Eight spots. Let that sink in.

Kentucky joined California, Colorado, New York and Washington as one of the states that made the biggest jumps in this year’s report. Kentucky also improved on more measures than any other state.

It feels great to be able to write a blog post that celebrates Kentucky’s gains in a collection of 40 quality indicators related to healthcare accessibility, outcomes, equity, use, and cost. I highly encourage you to explore The Commonwealth Fund’s interactive report yourself here for much more detail on state and national trends. I promise it is worth your time.

A majority of Kentucky’s gains came in the Access and Affordability category, jumping from 34th to 18th in the U.S. The time period for the dataset spanned 2013 to 2015; Kentucky’s traditional Medicaid expansion took effect in January 2014. In general, The Commonwealth Fund’s report noted that states that chose to expand Medicaid saw greater gains in access to healthcare.

However, the report isn’t all roses for the Commonwealth of Kentucky. While access and affordability improved in Kentucky, other categories stayed relatively the same. Kentucky fell from 28th to 29th in Prevention and Treatment, which includes indicators such as appropriate vaccines and screenings, usual sources of care, and patient safety. The state fell from 49th to 50th in Avoidable Hospital Use and Cost, which looks at admissions, readmissions, and total cost of admission. And Kentucky rose just one place from 46th to 45th in the Healthy Lives category, which looks at various health behaviors and outcomes such as cancer deaths, premature deaths, smoking, and obesity. I’d be curious to see if, given time, that the gains in access would translate into improvements in these other categories.

There’s more work to be done and more progress to be made. Sitting at 39th still means that Kentucky falls in the bottom quartile among the states. But for a data scientist who is accustomed to seeing only the slightest of changes from year to year, a gain of eight spots is something to smile about.