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.

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

Louisville’s Multi-year Focus on Suicide Prevention Ramps up to Set a World Record, Save Lives

(Note: This guest post was written by London Saunders Roth, Local Integration Leader, Louisville Bold Goal, Humana. London is a member of the Louisville Health Advisory Board Behavioral Health committee.) 

A community-wide coalition focused on suicide prevention is organizing a broad-based community effort centered around National Suicide Prevention Week: September 9-15, 2018. The Louisville Health Advisory Board (LHAB) Behavioral Health committee seeks to help Louisville set a world record by training the most individuals in one week in the technique of Question, Persuade, Refer (QPR). Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis, and it can save lives.

According to recently published data from the Centers for Disease Control and Prevention (CDC), suicide rates are on the increase, and more than half of people who died by suicide did not have a known mental health condition. For the years 2008-2014, Jefferson County ranked 11th out of 50 peer counties in terms of highest rates of suicide. This is a change from the prior ranking of 8th; however, the suicide mortality rates were higher nationally. Essentially, while other counties increased at a higher level, Louisville’s suicide mortality rate still increased. These statistics are what inspired a cross-sector of community partners to come together and set an objective to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.

Many people are uncomfortable discussing suicide, even when family or friends may be in crisis. However, the technique of “Question, Persuade, Refer” (QPR; can improve a person’s comfort and confidence in broaching this difficult subject. QPR is an intervention that can improve the “Chain of Survival,” similar to CPR’s impact on increasing public’s confidence to provide life-saving interventions. QPR focuses on three things: how to recognize warning signs of suicide, how to offer hope, and how to refer to resources to help to save a life. Early recognition of suicide warning signs is key to saving a life.

Please join Louisville, and the Louisville Health Advisory Board, in saving lives this September. If you are interested in getting involved in this effort to increase public awareness and the community’s skills in suicide prevention, please visit to sign up for a FREE training or email with questions.

Additionally, LHAB and Kentuckiana Health Collaborative will offer QPR training immediately following the KHC Community Health Forum on September 11, which will examine findings of new, rigorous qualitative research that evaluated unique youth perspectives on mental health, as well as those of adult allies. You can register for the complimentary Community Health Forum here. Space is limited for the following QPR training session. If you would like to join in on this life-saving training, click here.

Please remember that there are resources for you, family, and friends related to suicide prevention. The national suicide prevention hotline is 1-800-273-8255 and a local (Louisville) crisis line number at Centerstone (formerly Seven Counties) is 502-589-4313.

The Louisville Health Advisory Board is a cross-sector group of community organizations and leaders working to improve physical, mental and social well-being where residents of Kentuckiana live, work, worship, learn and play. The Behavioral Health committee is a part of this board, and its mission is to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.


Regarding Youth Mental Health: Parents Appreciate Sharing of Ideas, Emphasize Communication with Schools

(Note: This guest post was written Stephen O’Connor, PhD, Assistant Professor, Associate Director, University of Louisville Depression Center, Director of Faculty Research Development, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine)

The Student Alliance for Mental Health Innovation and Action (StAMINA) team recently wrapped up a series of focus groups and interviews with youth, parents, and stakeholders from across the Commonwealth of Kentucky in order to identify factors that contribute to mental health stigma and the unmet needs regarding youth mental health. We are excited to share these results at an upcoming community discussion on September 11 at the University of Louisville Clinical & Translational Research Building. For this blog post, I aim to share several observations from my experience as part of the research team.

Aside from providing research mentorship to the StAMINA team, I also facilitated the parent focus groups. Why is capturing the parents’ voices such an important aspect of a youth-driven mental health organization? Because parents have a major impact on how their children understand their own personal experiences and the degree to which it is safe to share said experiences with others. In a nutshell, family sets the stage as to whether a stigma will be associated with mental health concerns. The impact of parental attitudes towards mental health starts early and continues through an individual’s lifetime. We think that by reducing the presence and impact of stigmas applied to mental health concerns, more students will feel comfortable communicating their needs to their support network.

We purposely selected research sites that were as heterogeneous as the citizens of our state; focus groups were conducted in urban and rural counties with parents whose children attend either public or independent high schools. A few focus groups occurred in high schools, whereas others occurred at youth drop-in centers or a public organization in the Louisville community.

One powerful lesson from the focus groups is that many parents appreciate sharing ideas and having concentrated discussions on the topic of mental health. While they tended to lump the terms mental health and mental illness together, reflecting an internalized view of mental health as indicating something negative, they did believe strongly in the concept that one cannot be considered to be in good health without attending to mental health. Although we dealt with a powerful and emotional topic, parents were eager to speak with one another about mental health stigma and areas in need of improvement for youth.

I was honestly surprised by the extent to which parents formed a sincere group cohesion with one another even though we made clear that we were not intending to create a support group environment. Several groups even asked if they could meet again to continue their conversation! What a concept – as parents shared their views on mental health stigma and barriers to accessing care, they felt a sense of belongingness and helped each other consider alternative ways to support their children. Several times we had parents speak with each other afterwards about specific resources that might be helpful in supporting their children. I really got the sense that many people need a greater amount of support in their role as a worried parent, either through guidance on available services or through facilitated discussions with others who can relate.

Another observation is that parents routinely spoke about the importance of communication with schools/teachers as a key to enhancing youth mental health. Those schools with greater resources or smaller teacher to student ratios tended to have an easier time with communication. Parents were astute at identifying subtle signs that their children might be having difficulty related to mental health concerns, but they also recognized the importance of hearing teachers’ observations so that they could be as proactive as possible. The concept of embedding mental health programs into school curriculums, such as mindfulness practice or emotion regulation skills acquisition programs, was seen as a way to reduce mental health stigma and prevent normal adjustment concerns from developing into more severe forms of anxiety and depression.

The good news is that there are great examples in our state of schools that use innovative programming to support students’ mental health. The drop-in centers such as TAYLRD also offer a non-traditional alternative to mental health treatment that appeals to many youth and families. However, when less than 50% of adolescents with major depression in Kentucky report receiving treatment, there is clearly room for improvement. The barriers to treatment engagement don’t rest solely with parents; however, they are an obvious point of emphasis when trying to address mental health stigma. I am hopeful that by providing a larger platform for parents and students to share their experience and contribute to mental health programming, we can continue to create innovative approaches to enhance youth mental health and overall quality of life.





What is Functional Medicine?

(Note: This blog post was written by Carl Paige, MD, independent health care practitioner at Medical Transformation Center. Dr. Paige will speak on a panel at the KHC June Community Forum, “Obesity Fatigue.” This post first appeared on the Medical Transformation Center website.) 

Throughout the twentieth century and the beginning of the twenty-first, medical care in the western world has often revolved around attributing symptoms to a single disease and prescribing medication or more serious interventions to eliminate those symptoms. While modern advancements have allowed humans to transcend many pathogens, they have also created a new way of living that results in many of the chronic diseases experienced by those in industrialized nations. Daily life is fraught with stress and pollution. Most lead sedentary lives and consume too much food with little nutritional value. Personally, I grew weary of what seemed to be a never-ending cycle of writing prescriptions and then seeing the same patients a few months later needing help with side-effects or different manifestations of the same root cause.

Functional medicine offered me an alternate approach. It seeks to prevent disease by understanding the effects an individual’s genes and lifestyle have on health and the power of deficiencies to fuel illness and vulnerability to it. Instead of fixating on “what” the disease is, functional medicine asks “why” it is manifesting. Physicians that choose to practice in this way employ a variety of tests for genetic markers and chemical imbalances or deficiencies. They look for disorder in these core areas:

  • Immune surveillance
  • The inflammatory process
  • Digestion, absorption and barrier integrity
  • Detoxification and biotransformation
  • Oxidation and reduction
  • Hormone and neurotransmitter regulation
  • Psychological and spiritual equilibrium
  • Structural integrity

These doctors seek to use diet, exercise, supplementation and lifestyle changes when applicable, and defer to medication as a last resort. Their methods are rooted in evidence-based medicine, placing high importance on randomized controlled clinical trials. They understand and take advantage of cutting-edge discoveries from the latest research in biochemistry, physiology, immunology and nutrition. Such innovations are revealing the ways in which diseases originate at the molecular level and are influenced by the interaction of genes and the environment.

One of these breakthroughs is the discovery of Single Nucleotide Polymorphisms (SNP), often called “snips.” DNA is made up of individual nucleotides that, when taken in groups, provide the directions for the body. They are akin to the letters that make up a word, and those words comprise the book that is the human genome. When an SNP is present, a person has two different letters serving the same function in a word. For instance, should the word be hop or hip in the sentence: I broke my ? Which version of the gene is expressed depends on environmental factors. “Snips” are the most common genetic anomaly in humans. Many are benign, while others can make one more susceptible to disorders. They can change the actions of chemicals in the body, like those that bind to various vitamins and nutrients, just as the choice of hop or hip would change the above sentence, one even rendering it meaningless. By pinpointing these SNPs, a physician employing functional medicine could determine genetic inability to process essential nutrients, which can predispose a patient to certain symptoms and illnesses. He can then treat this, consequently eliminating or reducing the bothersome side effects. This approach allows the patient to truly heal instead of just masking or mitigating presenting symptoms with a drug. By administering a series of tests tailored to the individual patient’s symptoms, the functional medicine practitioner can identify biomarkers for health and disease.

Functional medicine has several key tenets that a physician seeks to apply when using this approach. They are:

  • An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness
  • Awareness of the evidence that supports a patient-centered rather than a disease-centered approach to treatment
  • Search for a dynamic balance among the internal and external body, mind, and spirit
  • Interconnections of internal physiological factors
  • Identification of health as a positive vitality, not merely the absence of disease, and emphasizing those factors that encourage the enhancement of a vigorous physiology
  • Promotion of organ reserve as the means to enhance the health span, not just the life span, of each patient
  • Taken from The Institute of Functional Medicine(Institute of Functional Medicine)

From these principles and using the information retrieved from tests and a detailed medical history and lifestyle questionnaire, the physician creates an individualized therapy plan to suit that particular patient’s needs, symptoms and lifestyle. These usually seek to eliminate triggers and ameliorate mediators (like age, sleep, hygiene and social interaction) and antecedents (factors that predispose an individual to illness). In the process, a higher level of health and function is obtained.

Our Community’s Obesity Fatigue and a Forum to Renew Discussions

Despite spending billions on obesity efforts, the adult obesity rate for Kentucky continues to rise. Source: Trust for America’s Health and Robert Wood Johnson Foundation

When the Kentuckiana Health Collaborative (KHC) was formed in 2003, obesity was one of its first three community health priorities selected by members. Over the last 15 years, the KHC has lead a comprehensive worksite wellness pilot program and a worksite fitness tracking program called Kentuckiana Metro on the Move to address obesity. In recent years, the KHC has focused much of its efforts around healthcare quality and cost but has never lost sight that obesity contributes to many of the health issues facing our community.

Obesity has been one of Kentucky’s top priorities for two decades. With the seventh highest adult obesity rate in the nation, according to “The State of Obesity: Better Policies for a Healthier America,” Kentucky’s rate has increased from 13 percent in 1990 to 34 percent in 2016. There has been an enormous amount of effort by many stakeholders on this issue with few improvements. Employers and communities have spent billions on wellness initiatives, yet few feel their investment has produced results.

No one disputes that tackling obesity is an important issue, but there is fatigue on the topic. To renew the conversation, eight business coalitions across the country, including the KHC, are hosting events on obesity through a grant from the National Alliance of Healthcare Purchasing Coalitions (NAHPC).

The KHC will be hosting its community forum, Obesity Fatigue: The Myths, Facts, Treatments, Benefits Coverage, and Paths Forward, on June 5, 2018 at the Foundation for a Healthy Kentucky from 7:30 a.m. to 11:30 a.m. Dr. Andrew Brown, Assistant Professor of Indiana University’s School of Public Health, will discuss how to separate obesity hype from fact. His recent work involves investigating myths and presumptions in nutrition and obesity literature. The event will also feature a panel of experts discussing the following treatment perspectives:

  • Functional Medicine – Dr. Carl Paige, MD, Medical Transformation Center
  • Bariatric Surgery –John S. Oldham, Jr., MD, Baptist Health
  • Pediatrics – Julia Richerson, MD, Pediatrician, Family Health Centers
  • Diabetes Prevention – Steve Tarver, CEO, YMCA

The panelists will also discuss benefits coverage of obesity treatment and community dialogue about paths forward.

Be sure to register for the forum here.