KHC Pain Symposium Goes Virtual

Because nothing is more important than the health and safety of our community and partners, we have decided to make KHC’s April 22 Pain Symposium a virtual event out of an abundance of caution for the spread of COVID-19.

Much of the event will stay the same including the date and only slight modifications to the times and lineup of expert speakers. We will use a platform called “BlueJeans” to stream the event. We recently utilized the platform to virtually hold our annual conference with great success. For these reasons, we are confident that we will host an engaging and informative event for our attendees.

Details on how to join virtually will be sent out to attendees once we have it. As a reminder, updates and general information on the symposium can be found on the event page here.

If your organization is interested in potential sponsorship opportunities for this event, please contact Emily Divino at

We appreciate your patience and understanding as we adjust to these challenging times. There are still some details to work through, so please continue checking emails from us and the event page for updates. If you have any specific questions or concerns about the symposium, don’t hesitate to contact the KHC staff. We are committed to delivering an educational event and look forward to you virtually joining us on April 22!

2020 April Pain Symposium

“New Frontier of Pharmaceuticals” Speaker Answers Your Questions

Last week, the KHC hosted its final Community Health Forum of 2019, pivoting from data-heavy topics to a growing area of focus: maximizing pharmacy value and outcomes while slowing the growth of the rising costs of drugs. It was one of our best conversations yet, and we followed up with our keynote speaker to answer the questions we didn’t have time to get to during the program.

The two-and-a-half-hour session included keynote Amy Ball, PharmD, Chief Pharmacy Officer of Health Strategy LLC, who discussed the current and future trends of specialty therapies in the United States. Later, an expert panel of key stakeholders discussed how their organizations are moving to value-based pharmacy management.

Dr. Ball received many questions submitted by event attendees on our web application, but we didn’t have time to answer all of them. Since the interest was high in the subject, we followed up with her after the forum.

You mentioned several tipping points in the acceleration of the FDA approval process. You said the AIDS crisis was on tipping point. What were others?

These “tipping points” come from the history of change within the FDA. We are just highlighting a few major changes – this on-line article helps provide insight to the bullets below –

  • 1906: Congress passed the Pure Food & Drugs Act (Tipping Point: Upton Sinclair’s “The Jungle) 
  • 1938: Congress passed the Food, Drug, & Cosmetic Act (Tipping point: elixir sulfanilamide/base diethylene glycol) 
  • 1962: Keefauver – Harris Amendment (Tipping point: DES to prevent miscarriages despite evidence of ineffectiveness
  • 1980s: Development of expedited review programs (Tipping Point: HIV/Aids crisis)

Any drawbacks from employers pushing for greater biosimilar use…either through PBM partnership…or more directly managed by the employer?

The goal of using Biosimilars is to get to a lowest net cost while still providing an effective therapy. Biosimilars are a great option for members and can lower their out of pocket spend. Employers have to push their PBMs to work with Biosimilar manufacturers regarding potential rebates to ensure Biosimilars have the lowest net cost. Many times, Brand manufacturers are increasing rebates on the original Brand product, limiting the use of Biosimilars. PBM’s will tend to prefer the Original Brand with a more aggressive rebate, since Rebates can be a revenue stream for PBMs. Because of these misaligned incentives, employers may need to work directly with Biosimilar manufacturers to negotiate the best deal.

Is there any data on the impact of partial/split fills on patient adherence? Particularly for short-course therapies

The goal of split/partial fill programs are to decrease waste. Adherence to therapy is the main driver of waste. If a patient takes a medication and experiences a side effect and stops therapy (non-persistence or non-adherence) after a few doses when a 30-day supply was dispensed, the member and plan spent money on a product that was not fully used. Oral Oncology, Hep C and other therapies with a high discontinuation rate, adverse side effects and non-compliance are generally the drug targeted for these split/partial fill programs. I have listed a few articles for reference. Most of these articles reference waste or discontinuation of therapy (adherence) as the driver of waste and cost savings. With partial fill programs, when done correctly, members are educated about possible side effects so they know what to expect and are given strategies to help manage side effects. This more intense education can help members work through adverse side effects and continue therapy, therefore getting the anticipated outcome by staying on the therapy instead of discontinuing.

Related articles:

Who within an organization would be responsible for assessing outcomes data?

I will answer this question based on the concept of managing a Custom Formulary. As new drugs come to market employers should be reviewing the data available for those products to determine if they want to cover the drug under their plan benefit. The employer often does not have clinical staff employed that can review the literature and evaluate the new drugs to market in therapy. Most employers would have to work with an independent third-party organization that can provide a detailed summary on the available literature. This third-party organization can assist the employer in understanding the clinical data as well as the utilization of other drugs by the employer in the same class or other therapeutic classes. So unless the employer has clinical team members on staff, an independent third party would be responsible for assessing outcomes data.

“Getting patients on the right drug” is usually the responsibility of the clinician. How do you make the determination to question the clinician’s choice?

I believe this is more of philosophical question. My philosophy of the prior authorization (assuming that is what you mean my questioning the clinician’s choice) is that as a Plan Fiduciary, it is your responsibility to ensure medications are being used appropriately. If a drug is approved as a second line therapy for the treatment of a certain disease and a physician decides to try that drug as a first line option, the PA process would deny the use of that product based on the manufacturers package insert indications. The physician may believe that what they prescribed is the best option for the patient, but if there is no clinical data to support the use of the drug in that manner, that would be considered experimental use of a drug and most plans do not cover drugs that are considered experimental. In addition, if there are certain drugs that have the same outcome and are used for the same indication, but one drug is significantly lower cost than the other, the physician may be asked to change the patient to the lower cost agent and see if that drug will provide the same outcome the MD is looking for. If both drugs provide the same outcome and there are no contraindications to using the lower cost agent, then you are still getting the member on the right drug. If there is a contraindication or issue with using the lower cost agent there is a pathway the physician can use to share additional detail with the plan or PBM through an appeal process. The appeal process provides the physician that opportunity to share detail on why they believe the product they prescribed is medical necessary.

Managing Drug Spend in the New Frontier of Pharmaceuticals

The cost of prescription drugs has become a kitchen table topic and has increasingly become part of a larger national policy conversation. Prescription drug spending accounted for 10% of the share of national health spending in 2017 with an increased share of health spending for employers at 21%, Medicare at 30%, and private insurance at a whopping 42%. Consumers are particularly hit hard by increasing drug costs with one in four indicating problems affording their prescription medications, according to a February 2019 KFF Health Tracking Poll.

One of the reasons for these increasing costs are the rapidly increasing number of specialty drugs on the market. Specialty drugs are high cost, high touch drugs that include breakthrough gene and cell therapies for rare and chronic diseases that were previously untreated. With these new cell and gene therapies ranging from $850,000 to $2.1 million, managing the costs of these life-saving and life-altering drugs is critical to healthcare purchasers, payers, and patients. According to a new analysis by Willis Towers Watson’s Rx Collaborative, employers spend 40% of their drug costs on less than 1% of prescriptions.

At the KHC’s upcoming Community Health Forum, experts will discuss how to maximize pharmacy value and outcomes while slowing the growth of the rising costs of drugs. The New Frontier of Pharmaceuticals will be held at the Foundation for a Healthy Kentucky on December 3 from 8 a.m. to 10:30 a.m.; registration is required.

Amy Ball, PharmD, Chief Pharmacy Officer of Health Strategy LLC, will kick off the morning’s forum, discussing the current and future trends of specialty therapies in the United States. Ball will discuss the strategies employers and health plans are using to make sound clinical and economic drug coverage decisions while maximizing the value of their pharmacy benefits. She will also discuss the latest benefit design modifications such as partial fills, step therapy, preferred pharmacy networks, prior authorizations, reference pricing, tiered deductibles, and price transparency used to manage the pharmacy benefit and specialty drugs. She will also discuss direct and outcomes-based drug contracting and how quality-adjusted life years are used in reviewing drug value and formulary selection.

A panel of key stakeholders will discuss how their organizations are moving to value-based pharmacy management. Diana Han, MD, Global Medical Director for GE Appliances, a Haier company, will moderate the session with representatives from Merck, Abbvie, CVS, and Baptist Health, who will describe their respective roles as drug manufacturers, PBMs, and prescribers. In addition to discussing value-based management strategies, the panel will discuss why biosimilars have had a slow adoption along with how each organization is working to optimize patient outcomes.

Measurement Alignment Efforts First Step Towards Driving Health Improvements in the Commonwealth

Stephanie Clouser

Healthcare quality measurement is not sexy. Or at least that’s what my boss, KHC Executive Co-Director Randa Deaton, has said.

As the KHC Data Scientist, I disagree. And judging by the attendance at this month’s KHC Community Health Forum, “Driving Health Improvements Through Measurement Alignment,” I’m not the only one who disagrees. On September 10, we spent the morning with a full house of attendees to learn from national and local experts in healthcare measurement and measurement alignment.

The two-hour Forum highlighted national and local measurement alignment efforts aimed at reducing measurement burden, improving focus, and ultimately measuring what matters most to patients. This included:

  • The Core Quality Measure Collaborative (CQMC), a broad-based coalition of health care leaders convened by America’s Health Insurance Plans, Centers for Medicare and Medicaid Services (CMS), and the National Quality Forum (NQF)
  • Louisville-headquartered Humana’s journey to align their measures across product lines
  • The Kentucky Core Healthcare Measures Set, convened by the KHC
  • A panel of regional experts on the current landscape and future of healthcare measurement in the Commonwealth

Packed Agenda Highlighted Measurement Alignment Opportunities and Challenges

Norton Healthcare’s Dr. Joshua Honaker, Chief Medical Administrative Officer for Norton Medical Group, kicked off the morning with an introduction to the “measurement mayhem” that contributes to physician burnout and high administrative costs, highlighting the need for the streamlining of measures and incentives.

The morning’s keynote speaker, Chinwe Nwosu, America’s Health Insurance Plans, discussed the advancement of quality measurement and improvement through core measures sets. Nwosu, the project manager for the Core Quality Measures Collaborative (CQMC), a broad-based coalition of health care leaders convened by AHIP, CMS, and NQF. In her talk, Nwosu noted several challenges to the adoption of national core measures sets, including lack of interoperability, small sample sizes, and lack of alignment with state Medicaid and commercial measurement efforts. Some proposed strategies included standardization of measure implementation across payers, alignment of CMS reporting requirements with the core measures, identification of high-impact measures with strong relationships to outcomes, and increased data capacity of electronic health records and interoperability between registries.

Faith Green, Humana, talked about her organization’s journey to align their measures across product lines, including the lessons learned from their process, which reduced their number of metrics from 1,116 to 208. I then talked about the 2019 Kentucky Core Healthcare Measures Set (KCHMS), created by experts across the Commonwealth of Kentucky and convened by the KHC. The 2019 KCHMS, the second iteration of the core measures set, was released in August. The morning ended with an expert panel discussion about the current landscape and future of healthcare measurement in the Commonwealth.

Path Forward is Challenging but Promising

If the energy at our KHC Community Health Forum was any indication, the future of measurement alignment in the Commonwealth is a promising one. Much like the AHIP/CMS/NQF Core Quality Measures Collaborative, we are now at the point where we have a core set of key quality indicators that is ready for implementation among Kentucky’s various stakeholders.

From the beginning, more than two years ago, we have been truly overwhelmed by the response that we have gotten around this initiative. With the current state of healthcare work today, it is often challenging to get volunteers to commit to “one more thing” in addition to their already overextended workload. However, we were approached – enthusiastically, I might add – by individuals from all backgrounds to serve on this project, which speaks to the importance of this work.

What we have launched is not a small lift. Healthcare measurement alignment is tough work, and it’s not for the faint of heart. It isn’t easy to sift through hundreds of measures to identify the ones that will give us the greatest insight into how our healthcare systems are performing, while also continuing to honor the various reporting standards given by dozens of other organizations. However, while the daunting quality of the work has the potential to be a deterrent, it is important to push for reduction and alignment around meaningful measures that ultimately drive change in our community, reduce measurement burden, and improve adherence to evidence-based medicine and health outcomes.

Creating a core set of healthcare measures to focus and align priorities is just the first step toward aligning incentives around the things that matter. The Kentucky Core Healthcare Measures Set brings together the priorities of consumers, providers, payers, and purchasers specifically with the needs of the Commonwealth in mind. We need to push in the coming months to get this core measures set in use by our payers, providers, and purchasers. I feel a bit like a broken record, but as always, I want to finish with this thought: By focusing on everything, we focus on nothing. But by focusing on the right things, we can drive improvements.

Did you miss the KHC Community Health Forum, “Driving Health Improvements Through Measurement Alignment”? Click here to see the agenda and slide decks from the event.

KHC Highlights Hospital Price Variation, Recruits Employers, Hospitals, and Health Plans for Workgroup

Last month, a new hospital price study by RAND Corporation revealed that depending on which side of the Ohio River they live, individuals with private insurance who receive hospital services pay more to Hoosier hospitals than to those in the Bluegrass State. On June 4, the Kentuckiana Health Collaborative brought together key healthcare stakeholders to explore the study that continues to make national headlines, from the New York Times to Modern Healthcare.

Gloria Sachdev, PharmD, President and CEO of the Employers’ Forum of Indiana and leader of the study, kicked off the KHC Community Health Forum by describing the study. She explained that employers in her coalition told her that hospital pricing, which accounts for one-third of healthcare spending in the U.S., was higher in Indiana than other locations in the U.S. She set out to find answers to their questions and partnered with RAND for a study to look at Indiana commercial hospital pricing relative to Medicare pricing. The results were startling, with outpatient pricing at 358% of Medicare prices for the same services. Indiana hospitals claimed that their pricing was normal for commercial insurance rates, so a second study was conducted comparing pricing nationally. The National Hospital Price Transparency Report, released in May, showed that Indiana’s hospital pricing was not normal as the hospitals claimed. The results of the 25 states that participated showed that on average, employers pay 241% of what Medicare would pay nationally. Indiana topped the nation at 311% of Medicare pricing. The study nationally showed prices rising and wide variation in pricing with some hospitals charging private insurance 500% of what Medicare would have paid.   

Stephanie Clouser, KHC Data Scientist, presented Kentucky’s results which looked favorably for pricing. Kentucky ranked fourth lowest of the states in the study, with an overall hospital price of 186% of Medicare pricing. In addition to below-average hospital pricing, Kentucky’s prices moved sharply downward over the three years of the study. However, Kentucky’s results showed wide variation between outpatient and inpatient pricing at 245% and 142%, respectively. Both Kentuckiana (including Southern Indiana) and Kentucky had among the worst hospital quality and safety ratings of all the regions and states in the study. Clouser explained the goal is for employers to find the hospitals in Kentucky with high value, meaning they have both high quality and best pricing. One of the big questions that came out of this study was to determine what is reasonable pricing for commercial insurance to pay above Medicare, and this answer will determine which hospitals are considered “high value.” For now, no Kentucky hospitals would be considered “high value” using Kentucky’s overall relative pricing of 186%, but there is one hospital that would be considered “high value” using the national average of 241% (see graph below).  

When comparing Kentucky hospital’s overall relative price to Medicare to their CMS quality ratings, there is wide variation in both among Kentucky’s facilities. Just one Kentucky hospital has below-national-average prices and excellent quality.

How are employers responding to this data? Christan Royer, M.Ed., Director of Benefits, Human Resources, Indiana University (IU) and Chairman of the Employers’ Forum of Indiana, told event attendees how her organizations is responding to their increasing healthcare and hospital costs. She indicated that increasing costs have affected their ability to give salary increases to employees. With their healthcare costs averaging 7% increases each year over the last four years and salary increases averaging 2% each year, healthcare costs continue to outpace employee pay and inflation year after year. Christan explained that employers can no longer keep raising premiums and deductibles or using Health Savings Accounts (HSAs) as they have always done in order to bend the cost curve. Employers will need to explore new levers to solve increasing costs, such as contracting for Medicare plus costs, direct contracting, or tiered networking. Currently, Employers’ Forum of Indiana is convening employers to explore these new ways of addressing unsustainable healthcare costs for employers. In 2018, family premiums for commercial insurance averaged nearly $20,000 per year in the U.S.

These findings turned on the light for many employers who generally operate in the dark around hospital pricing yet are responsible for purchasing healthcare for more than half (55%) of all Americans. The study showed wide variation in quality and cost among hospitals and states and illuminated that costs are often not a predictor of the quality and safety of care employees and families receive.

At the KHC, we bring together hospitals, providers, policymakers, plans, consumers, and employers to improve health status and healthcare delivery in the Louisville area and throughout the Commonwealth of Kentucky. The KHC has focused much of its efforts on working to improve primary care quality, transparency, and measurement alignment but has given little attention to hospital quality or pricing. We know that our hospital systems are committed to driving improvements to patient health and safety, but we have work to do to achieve the quality ratings of other states and communities. We are forming a new workgroup to discuss how we can collectively drive improvements to hospital value in our region. Hospitals, health plans, and employers are invited to join this workgroup.

The KHC is one of many National Alliance of Healthcare Purchaser Coalitions members participating in the study and is currently recruiting employers and health plans for the next iteration of the National Hospital Price Transparency Report, scheduled for release in January 2020. An information sheet is available for Kentucky employers along with a webpage for how to get involved. A national informational webinar for employers is scheduled for July 9.

To learn more about getting involved, email

Recent Studies Reveal Variation in Price and Quality Among Kentucky’s Hospitals

New Hospital Safety Grade state rankings by the nonprofit The Leapfrog Group shows Kentucky ranks 33rd in overall hospital safety, holding that spot for the second time in a row. This, when paired with the new study released last week by RAND Corp., reiterates that hospitals in the Commonwealth vary in both price and quality.

In the Spring 2019 Hospital Safety Grade rankings, Kentucky’s share of “A” hospitals was just 21%, down from nearly 24% in the Fall 2018 rankings. Leapfrog uses an easy-to-digest A-F grading scale, with “A” being the best. Nearly 70% of Kentucky’s 52 hospitals received a “C” or below rating, compared to the nationwide average of 43%. A new study released by The Leapfrog Group along with the state rankings showed that avoidable deaths due to errors, accidents, injuries, and infections have an 88% greater risk at “C” hospitals and 92% greater risk at “D” and “F” hospitals.


In addition to the Leapfrog safety rankings, Kentucky was one of 25 states that was included in last week’s RAND hospital price transparency report, which for the first time used actual payments by privately insured employers to report inpatient and outpatient prices by hospital. The report shows prices as a percent of what Medicare paid for the same services, thus making these relative prices comparable across the country. The study has been a hot news item in the healthcare world, featured in publications such as The New York Times, The Wall Street Journal, and Forbes.

Kentucky ranks fourth lowest in price of the 25 states in the RAND hospital price transparency study.

Overall, Kentucky came out favorably for its relative pricing to Medicare for private insurance in the report, well under the national average of the states in the study. Of the 25 states included in the data, Kentucky ranked fourth lowest in prices paid to hospitals, at 186% of Medicare compared to the national average of 241%. Similar to what the report illuminates nationally, there is large variation in price – inpatient, outpatient, and overall – among Kentucky’s facilities.

The RAND study looked at the CMS Hospital Compare five-star rating to highlight variation on quality, and that system illuminated similar trends as Leapfrog’s new results. Looking at the CMS ratings, which, like Leapfrog, puts hospitals into five levels of performance, more of Kentucky’s facilities named in the RAND study have poor to average ratings compared to the nation as a whole – 84% compared to the nation’s 51%. This means that just 16% of Kentucky’s hospitals are considered above average or excellent by CMS Hospital Compare.


These variations in price and quality in Kentucky’s hospitals will be the focus of the Kentuckiana Health Collaborative’s June 4 Community Health Forum, which will bring in the RAND study’s leaders to dive into the results and what this means for Kentucky.

Gloria Sachdev, President and CEO for Employers’ Forum of Indiana, which partnered with RAND on the study, will walk through the study results, focusing on Kentuckiana and Kentucky’s hospital prices and how they compare to the rest of the nation. We will also hear from an employer, Indiana University, that was part of that first-year study in Indiana to discuss how seeing hospital pricing information has impacted their benefit strategy.

Although hospital pricing is important to all stakeholders, this event will be particularly relevant to those interested in employee health benefits, health plan design, and provider payment. RAND is now recruiting more participants for the next iteration of the study, so any employer or health plan that is interested in participating is encouraged to attend and for more information on what is involved.

Register today to join the conversation at the UofL Shelby Campus Founders Union Building. As with most KHC Community Health Forums, attendance is free for KHC members and $35 for non-members, which includes the program, networking, and breakfast. If you are unsure if your organization is a member of the KHC, see the full list here.

National Hospital Prices: How do Kentucky Hospitals Stack up?

Imagine that you and your best friend are injured in a car accident. It’s nothing major, just some scrapes and bruises. But because the car is in pretty rough shape and you are both feeling pretty beat up, you decide to go to a hospital for a series of routine tests. You get some X-ray images and MRI to make sure that there are no broken bones, internal bleeds, etc.

You are your best friend go to different hospitals. She has one that she prefers, and your primary care provider is with another system with all your records in one place. But as you are going through these tests, you get anxious just thinking about a few weeks from now, when the bills start rolling in. Because you won’t know how much it’s actually going to cost until then.

On top of that, although you and your friend received the same or similar tests, the costs of your services are nearly twice as high as hers! Simply because you chose to go to different facilities.

Everyone is familiar with scenarios like this. The healthcare pricing system is opaque and confusing, with negotiated allowed prices that vary between payers. We’ve long been frustrated by this but have done little to shine the light on hospital pricing information.


National employers located in Indiana noticed higher healthcare costs in the Hoosier state compared to costs in other states. To examine whether these observations were true, the Employers’ Forum of Indiana, an employer-based healthcare coalition of employers, providers, payers, public health officials, and other interested parties, partnered with RAND Corporation for a first-of-its-kind study that measured average amounts paid for hospital inpatient and outpatient services using pricing relative to Medicare, and reported hospital-specific prices.

That study, released in 2017, surprised the employer and healthcare community in the Hoosier state. Indiana hospitals were paying 272% more than the Medicare prices for inpatient and outpatient services, and there were large variations in price that didn’t correlate with the quality of care patients were receiving.

That’s great insight, certainly, but as with any analysis, it’s imperative to put it into context. Thus, a second iteration of the study, this time including employer data from 25 states, was completed and will be released as part of the first national hospital price transparency study in the U.S. Because the prices use Medicare pricing as a benchmark, this makes these relative prices comparable across the country.

The new study shows that the 272% of Medicare that Indiana was paying is not typical. Although the full results haven’t been released yet with states ranked in terms of relative price, the report will show that Indiana has prices higher than the national median. Kentucky is included in this study, and hospitals throughout the Commonwealth and Kentuckiana region will be included in the results, making this study of note to our region.


The June 4 KHC Community Health Forum will reveal the results of the National Hospital Price Transparency Study.

Given the implications (nationally and locally), our June KHC Community Health Forum will reveal the results of the study and discuss its implications. Gloria Sachdev, President and CEO for Employers’ Forum of Indiana, will walk through the study results, focusing on Kentuckiana and Kentucky’s hospital prices and how they compare to the rest of the nation. We will also hear from an employer, Indiana University, that was part of that first-year study in Indiana to discuss how seeing hospital pricing information has impacted their benefit strategy. Although hospital pricing is important to all stakeholders, this event will be particularly relevant to those interested in employee health benefits, health plan design, and provider payment.

Space is limited, so register today to join the conversation on June 4 at the UofL Shelby Campus Founders Union Building. As with most KHC Community Health Forums, attendance is free for KHC members and $35 for non-members, which includes the program, networking, and breakfast. If you are unsure if your organization is a member of the KHC, see the full list here.

Action items to address healthcare affordability in the region identified at Community Health Forum

It’s no secret that we have a problem with healthcare affordability in this country. Each day, there are new headlines that highlight this problem. We are all familiar with these headlines. But what do we do about it?

That’s exactly what we addressed in last week’s Community Health Forum, “The Path to Affordable Healthcare.” In a different format from our typical Community Health Forum, which lasts a couple of hours, “The Path to Affordable Healthcare” was extended to a half-day event and included an interactive portion, where participants worked in groups to create action items to tackle healthcare affordability in the region.


In the first half of the day, participants listened to several speakers and panelists discuss the lack of agreement on an affordability definition, the current state of healthcare affordability in the nation and region, the drivers of healthcare affordability, the role of regional collaboration, and the barriers that keep us from achieving affordable healthcare.

There was much interesting information given and discussion had in first half of the day, including three speaker presentations and a panel loaded with healthcare experts from across the Commonwealth (see agenda here). But the highlight of the day was the creation of action items by event participants designed to help develop a community action plan to address healthcare affordability in our community.

“For me the event just reconfirmed how pivotal the KHC is to the region. Having healthcare stakeholders (purchasers, payers, hospitals, and so on) all working to together to understand each other’s needs is the only way we are going to get true change to a fragmented system. Everyone will win when our healthcare systems provide quality care, access to care at an affordable cost. Alone we can accomplish nothing. Working together we can gain everything.” -DeAnna Hall, Manager Corporate Health & Wellness, LG&E KU

Working in groups, participants brainstormed and defined goals to prioritize and improve healthcare affordability as it relates to health, price, and waste – the drivers of healthcare affordability. The action items were not limited to what the KHC could accomplish, but for the community as a whole. Given the range of viewpoints in the room, the task became an energetic exercise. Ten ideas were identified and discussed with the larger group, and participants then identified and voted on their top three selections.

The action items were outlined, in descending order of votes:

1. Create a state-wide data warehouse with claims, electronic health records, and public health data to map price and quality variation. The warehouse will be led by the state and the KHC and the data will be used to partner with the next iteration of the RAND hospital price transparency study.

2. Create a statewide collaboration to identify the top three costly chronic conditions that have a gap in care and work to close gaps through payment innovation, patient education, aligned cost and quality measures, and care coordination.

3. Participate in a self-insured transparency study for Kentucky with the current iteration of the RAND hospital price transparency study and use the results of the study in next year’s contract negotiations.

4. Conduct a three-year pilot to create a workflow redesign to integrate social determinants of health, physical health, and mental health into a quality patient care management plan in Louisville Metro.

5. Create a knowledge transfer center for employers and health plans to define health transparency and value-based purchasing, to be operated by the KHC.

6. Promote competition and consumerism to drive affordability through legislation. Educate legislators on price transparency.

7. Promote healthcare transparency and affordability across all parties by removing data barriers.

8. Improve patient engagement with health coaches or community health workers, with a focus on preventive screening in rural areas of Kentucky.

9. Create a defined pathway for musculoskeletal outcomes pricing with reduction in imaging for low back pain. Each year, focus on specific employers.

10. Educate consumers, employers, students, etc., on healthcare benefit literacy.

“Active engagement, interaction, and partnership among government, payors, employers, and providers is essential to solving the dilemma of healthcare affordability in Kentucky. While we all share a common objective to provide high quality care to the citizens of the Commonwealth, we need to start four-way conversations to listen and understand perspectives and challenges and then use this information to create productive solutions. In our workgroup I believe each member learned something new about another’s perspective. As a first-time participant I look forward to opportunities for further engagement to offer a providers perspective and contribute to real problem solving.” -David Zimba, Managing Director, Kentucky Health Collaborative, and event panelist


There is a clear want and need for better data around cost and quality in the Commonwealth. As the KHC data scientist, this is what I like to hear! It is impossible for any stakeholder – consumer, provider, plan, or other – to make informed and appropriate choices with large gaps in information. Transparency is key to healthcare affordability, as it provides insights and identifies problems. There was also a lot of talk around minimizing wasteful treatments and procedures that provide little or no benefit.

Many potential ideas were created at “The Path to Affordable Healthcare,” and the next step is to identify which can be and should be acted upon in the community. This event was held in partnership with the Network for Regional Healthcare Improvement (NRHI) to bring healthcare affordability to the forefront of healthcare transformation efforts through a campaign called Affordable Care Together. As part of that campaign, the KHC is required to create an action plan by January 15.

The KHC will take these action items back to its leadership team to determine which are appropriate for our organization to pursue. Look for more updates in the near future.

National Affordability Summit Sets the Stage for Local Healthcare Affordability Event

KHC representatives at the NRHI National Affordability Summit pledge to “do my part by collaborating with others to improve health, reduce price, and eliminate waste.”

“I’ll do my part by collaborating with others to improve health, reduce price, and eliminate waste” was the pledge that purchasers, payers, providers, patients, and policymakers across the country committed to at our nation’s capital at the Network for Regional Healthcare Improvement’s (NRHI) National Affordability Summit earlier this month. Several KHC members attended the summit, including Teresa Couts, UAW/Ford and KHC; Don Lovasz, KentuckyOne Health Partners; Amanda Elder, LG&E; Emily Beauregard, Kentucky Voices for Health; Stephanie Clouser, KHC; and myself.

Dr. Stuart Altman kicked off the event; he is an economist with five decades of experience working on federal, state, private, and academic health policy. His humorous keynote kept folks engaged despite the bleak prediction of family premiums rising to 100% of the US median household income by 2033 if trends continue on this trajectory. The current average family health insurance premium is approaching $20,000 per year. He gave examples of how America can change this trend by collectively eliminating the 33% waste that is estimated in medical spending. He encouraged consumers to become more engaged and employers to better control their healthcare spending. He used Massachusetts as an example of how states should track healthcare spending as total spending to include Medicare, Medicaid, and commercial payments, not just their Medicaid spending. Since 2012, Massachusetts went from one of the highest healthcare spending states to among the lowest.

Mylia Christensen of HealthInsight, also the NRHI affordability chair, presented the amazing work that is happening across the country to reduce healthcare spending by improving health, reducing price, and eliminating waste. The KHC and KY Medicaid’s Kentucky Core Healthcare Measures set was one of the projects featured by regional healthcare improvement collaboratives as a way of eliminating administrative waste. The KHC team was proud for our work to have been featured among the dozen or so strategies featured across the nation to address healthcare affordability.

At lunch, I had an enjoyable conversation with a very, soft-spoken woman with kind eyes and a quick smile. I liked her immediately. It was to my surprise when she joined the stage that afternoon as the self-described “tough negotiator grandma” who reduced Montana’s employer healthcare spending and returned big funds to the state’s budget. Marilyn Bartlett was tough indeed, and she had just proven what employers and states can do to reduce healthcare spending through referenced-based pricing and drug pricing transparency. She was my favorite speaker of the day, and I hope one day we can have her come to Kentucky to speak about her work.

One of the main takeaways from the event was that communities should not blame any healthcare sector for the current healthcare spending issues but should rather come together to solve the issues collectively. That’s what the KHC has planned for its affordability summit on Tuesday, December 4. Any stakeholder is invited to attend, and the group will identify at least two to three solutions that we can implement around healthcare affordability at this event. We invite you to join us and be part of the solution.