UofL Trager Institute Shares Tips for National Alzheimer’s and Brain Awareness Month

(Note: This guest blog post was written by Samantha Cotton, PhD, MSSW, GWEP Program Manager, ADRD Director, University of Louisville Trager Institute)

June is National Alzheimer’s and Brain Awareness Month and to honor this, our team at the University of Louisville Trager Institute would like to share some tips on maintaining brain health and wellness while dealing with the impacts of COVID-19.

Check-in on your mental health. It is important to recognize that we are dealing with an unprecedented pandemic. All of the emotions that you might be feeling, whether you are feeling stress, anxiety or sadness, are all normal. It is okay for us to mourn our previous lives, even the small things that we are missing out on. Regardless of how you are responding to the pandemic, be compassionate to yourself. Recognize that this is a time of uncertainty and anxiety for everyone. Make sure that you are taking time out of your day to check in on your emotions and manage your stress. If you are overwhelmed by recent events and find yourself engaging in too much screen time, try disconnecting.

Eat Smart, Think Better. When we are feeling stressed, sometimes we need tend to gravitate towards foods that are comforting and not necessarily healthy. It is important to remember the motto: Eat Smart, Think Better. Research has shown that eating a diet rich in fish, whole grain, green leafy vegetables, and nuts can help maintain brain health and potentially reduce the risk of Alzheimer’s type-dementia. It is important to avoid or reduce consumption of foods high in saturated fats are associated with a risk for disease like heart disease and Alzheimer’s disease. While this might be more difficult during the pandemic, you might try making it fun by learning a new healthy recipe or trying foods you have not had before 

Get moving. While your gym might still be closed, you can still find ways to get moving. Talking walks can be a great start to your day. If you are looking for other activities, try looking at online for videos for activities such as yoga, tai chi or chair-based exercises. For example, at the UofL Trager Institute, we have recently started offering a variety of Wellness Lifestyle Services that consists of classes and services that promote a holistic approach to overall health.

Find meaningful activities to participate in. Find activities that bring you joy during this time. Tap into your creative side and try writing, painting or playing music. You might finally take time to delve into that new book or complete the puzzle you have been working on. It does not matter what activity you choose, rather it is more important that you enjoy doing it!

Find Ways to Connect. If it is not possible for you to get your family together, you might try using a video chat program such as Zoom, Skype or Facetime to connect. All of these platforms offer free versions so you can figure out which one works best for your family. You might try a virtual game night – many classic board games now have apps or online versions where you can play together virtually.

Need more support? Reach out to us! If you or your loved ones are concerned about your health and need guidance, you can reach us at the Republic Bank Foundation Optimal Aging Clinic by calling 502-588-4340. Learn more online here. In addition to our other services, the UofL Trager Institute works to support those caring for a loved one that is 60 or older in the Bullitt, Henry, Oldham, Shelby, Spencer, and Trimble Counties in Kentucky. If you are a caregiver in one of those counties you can contact us to have access to free support groups, counseling, trainings, and case management through our Caregiver Program.

If you want to learn more about COVID-19, join us for our weekly Coronavirus (COVID-19) Virtual Information Sessions. We meet every Tuesday from 10am-11am. For more information about joining us, visit https://www.tragerinstitute.org/


Data Transparency Needed to Address Racial Disparities in Coronavirus Outcomes

As KHC staff put together our COVID-19 data dashboard looking at the regional Kentuckiana view of the spread of the virus, one of the factors we wanted to include how rates might differ between races.

The problem was: we couldn’t get that information.

We know that generally speaking, there are disparities between racial groups when it comes to who contracts the virus and who has severe complications from the disease. In Kentucky, for example, despite making up only 8% of the total population, African-Americans now account for 15% of the nearly 14,000 COVID-19 cases and approximately 17% of the deaths caused by it.

However, when we tried to dig deeper into these disparities, at a more local level, we weren’t able to do so. I got excited a couple of times, thinking I had stumbled on the information I was looking for, only to find it was just the population statistics I was already familiar with. As a data scientist, I look to data to help inform my decisions. How are we supposed to solve a problem when that’s lacking? How can we solve problems that we don’t fully understand? What could this missing data tell us?

We have to do better than simply saying, “there are differences in outcomes according to race,” and moving on to other things. We need to understand what those differences actually are, what is causing them, and how we might solve them.

As outlined superbly by The Commonwealth Fund’s “Corona Question Corner” (seriously, check it out, it asks the questions that I haven’t seen in other places), the data could give us insight on whether the answer lies in genetics, socioeconomic differences, structural racism, a combination of the above, or another variable (or variables). “We can’t know for sure which scenario is true until we have the individual-level data,” writes the author.

We have to do better than simply saying, “there are differences in outcomes according to race,” and moving on to other things. We need to understand what those differences actually are, what is causing them, and how we might solve them. There are limitations to what can be reported, specifically in regards to HIPAA laws, but we should be able to get information at a level that’s more granular and meaningful than state averages that may or may not be representative of the area of the state that we live in.

KHC Develops COVID-19 Data Dashboard for Kentuckiana

Over the past few months, the KHC team has been developing numerous COVID-19 resources for our community members, healthcare stakeholders, employers, and more. Along with the COVID-19 Testing Employer Resource Guide, the KHC recently developed a dashboard that displays COVID-19 data specific to the Kentuckiana region. While data is readily available at the state and county level, few resources exist reporting on how COVID-19 is affecting Kentuckiana. To mend this, the KHC team developed a dashboard that provides a snapshot of how COVID-19 is impacting the region. Kentuckiana as defined by the KHC consists of the seven counties included in the former Louisville metropolitan statistical area (MSA). This includes Kentucky’s Jefferson, Oldham, and Bullitt counties and Indiana’s Floyd, Clark, Harrison, and Scott counties. The dashboard, which is available on the COVID-19 Resources page, includes graphs of cumulative case rates as well as new cases per day presented at the county level. Presented below is a snapshot of the dashboard.

On the bar graph, users will find the number of new cases per day for each county. The graph is helpful in seeing peaks, trends, and differences among counties. For instance, Jefferson County has continuously reported a higher number of new cases compared to other counties. When viewing this graph, users should be mindful of factors contributing to variability between days including when cases are reported and when test results are available in each county.

The dashboard also includes a map and line graph presenting cumulative case rates per county. By viewing the map, users may notice the stark difference in case rates between counties; all of Indiana’s counties – Harrison, Floyd, Clark and Scott – have higher rates of COVID-19 than Kentucky’s counties. The line graph includes both cumulative case rates over time and information on key COVID-19-related events for Kentucky. Hovering over any of the vertical lines will display descriptions of these events. For more county-specific breakdowns of data and key events pertaining to Indiana, visit https://covidkentuckianadata.com/.

By viewing the dashboard, users will gain a better understanding of how COVID-19 is not just impacting Kentucky or Indiana, but how it is affecting Kentuckiana counties both distinctively and as a whole. The dashboard will be updated regularly so users should check back often to stay informed.

KHC Releases COVID-19 Testing Employer Resource Guide

The Kentuckiana Health Collaborative has assumed a role during the COVID-19 pandemic as a key resource hub for pulling together the variety of perspectives that now, more than ever, must convene and collaborate to make a measurable impact on our healthcare system and community. As part of this role, the KHC built a COVID-19 resource page. The information found on this page caters to a variety of perspectives: community members, healthcare providers and payers, employers, and more. Recognizing the information fatigue that many of us may be experiencing, the goal of this resource page is to provide a one-stop-shop for direct guidance on personal, business, and healthcare practices while also providing opportunities to dive deeper into topics of interest.

In addition to the consolidation of resources from national, state, and local leaders, the KHC is striving to build resources that meet community needs and strongly benefit from the perspective of thought-leaders across all stakeholder groups. Despite the wealth of resources available, there are many key questions that remain unaddressed. A number of these questions surround COVID-19 testing technologies and procedures, specifically when it comes to the workplace. As Kentucky and Indiana reopen and employers begin to implement their workplace COVID-19 plan, testing is a critical, but convoluted component. To bridge the gap between clinical recommendations and workplace guidelines and logistics, the KHC has developed a COVID-19 Testing Employer Resource Guide.

The guide provides a high-level look at the different types of COVID-19 tests that are available, their usefulness, and their flaws. Noting that COVID-19 should only be a component of an employer’s larger COVID-19 workplace plan, the guide elaborates on regulations and testing logistics that employers may consider when building their plan. Part of this plan might include establishing a new partnership with a testing provider or establishing a new service with an existing health care partner. The guide provides instruction on how to determine which partner is providing evidence-based and reliable testing and promoting care coordination.

This guide was released on June 2 at the KHC Community Health Forum, “The Impact of COVID-19 on our Healthcare System and Community.” For questions, comments, or additional information, contact Natalie Middaugh, KHC Community Health Program Manager, at nmiddaugh@khcollaborative.org.

Organizations Across the Country Consider Return to Work Strategies During Pandemic

Late last year, the KHC received word that we were going to have a major infrastructure change, and one of the decisions that had to be made was about office space. Would we find a new office to house us, or go 100% remote? Under no uncertain terms, I was completely against the idea of working remotely. I truly didn’t think that I or the KHC would thrive under that environment, given the collaborative nature of our work. We found a new space and in December moved in.

Six months later, and so much has changed. Like many organizations across the country, the KHC staff has been working remotely since March 12. And I must say, it hasn’t been bad! In fact, I dare to say that I’ve been pleasantly surprised to find that from my perspective, we’ve been just as effective during the last two-and-counting months. I’ve even taken the opportunity to visit my parents for a few weeks, staying in my childhood bedroom, albeit on an air mattress, as my bedroom has been converted to a gym.

I definitely have “rules” and routines that set me up for success, as I know my co-workers also have to thrive and generally stay sane during this extended time of distance (my colleague Natalie has also written a piece that’s worth a read where we share talk about our strategies for coping). But eventually we will return to the office, and organizations across the region and throughout the country will have to think through the logistics of doing so safely and responsibly.

The KHC hosted an all-member discussion about what our members are facing for return-to-work planning, and the conversation was fascinating. I hadn’t thought about lunchtime policies and whether it was safer to use a common kitchen or go out to lunch. Or how large office buildings’ elevator use policies could cause a logistical nightmare. What is the best process for temperature checks, and what needs to be in place before an organization can legally even open for business?

The National Alliance of Healthcare Purchaser Coalitions, a nonprofit, purchaser-led organization to which the KHC is a member, recently conducted a survey on just this. The National Alliance has been very active during this time of crisis, hosting bi-weekly employer town halls on various topics relevant to employers, which you can find on our KHC COVID-19 resources page. Their most recent survey of 210 employers of varying size found that U.S. employers are making plans to ensure their employees can safely return to work with 90% considering a phased re-entry and 88% having a multi-disciplinary task force in place.

“There is a clear pivot across America as employers prepare to go back to work, but this will hardly be business as usual,” said Michael Thompson, National Alliance president and CEO. “In general, employees who can work from home will continue to do so for the foreseeable future. Other employees will return to the workplace in a phased manner with a clear plan of action intended to mitigate risk and accommodate those most at risk or concerned for their safety. This is likely our ‘new normal’ in the COVID-19 era.”

You can find the full results of the survey here, but some highlights include:

  • Of those employers with over 1,000 employees, 97% already have a multi-disciplinary return to work task force in place. Over 7 in 10 of smaller employer indicated they have a task force in place.
  • More than 90% of employers are including these functions in their return to work task force: senior leadership, human resources, communications, operations and safety. Surprisingly, just 50% indicated the inclusion of a clinical advisor.
  • Employers are looking to guidance from all levels – federal (96%), state (95%) and county/city/local (92%). The Centers for Disease Control is viewed as a key resource for guidance by 95% of employers.
  • As for timing, 60% of employers indicated that they are not considering opening the work site for all employees within the next 60 days. Policies currently in place include mandatory social distancing (87%), mandatory 100% work from home for those who can (70%), and 59% have accommodations for parents while schools are closed.
  • Testing is not currently a major factor for most companies in their phased re-entry as only 43% indicated testing capability is currently in place, 24% are considering within the next 60 days, and 33% are not considering within 60 days.
  • The top five safety strategies are increased cleaning of workspace (90%), mandatory use of masks (88%), restrictions on meeting size (81%), personal protection equipment (beyond masks, 58%) and alternate shifts (55%).
  • The top criteria being considered in clearing employees to come back to the workplace are daily screenings for COVID-19 symptoms (51% in place and 28% considering), employee pledge to social distance both inside and outside the workplace (46% in place, 38% considering), tested and free of COVID-19 (22% currently, 39% considering) and positive antibody testing (45% considering and 54% are not considering).

It’s clear that this pandemic will permanently change the way we think about work and working remotely. I suspect that we will see more working from home options going forward, after realizing through this unplanned national experiment that was can be productive even if not physically in the office. Just how much will change remains to be seen, but as we enter the next phase of re-entry, we still have many logistical items to work through.

To keep up with the latest in pandemic-related information, visit our KHC resources page, which includes relevant news, events, guides, and more.

Mental Health Month Highlights ‘Tools 2 Thrive’ During COVID-19 Pandemic

If there was ever a time for us to recognize the universal nature of mental health, it is now. With the spread of the COVID-19 pandemic, most of us have experienced loneliness, anxiety, fear, anger, and sadness, among other challenging feelings. Perhaps these challenges are new for some, and perhaps for the one in five people with a preexisting mental health condition, these challenges have been exacerbated. Regardless of your perception or relationship to mental health prior to the pandemicthis situation has reinforced the fact that all of us have mental health to consider. As we all adapt to new recommendations for protecting our physical health such as wearing masks and social distancing, let us also take action to protect and promote our mental health. 

In timely fashion, May is Mental Health Month. A tradition dating back to 1949, Mental Health America observes every May as a time to promote the message that mental health is something that everyone should care about. This Mental Health Months’ theme is “Tools 2 Thrive” and aims to share practical tools that everyone can use to improve their mental health and increase their resiliency when facing challenges. Mental Health America has consolidated these tools in their 2020 Mental Health Month Toolkit. Here, readers can see tips, facts, and worksheets for:  

  • Connecting with Others 
  • Creating Healthy Routines 
  • Finding the Positive After Loss
  • Eliminating Toxic Influences 
  • Owning Your Feelings 
  • Supporting Others 

In support of Mental Health Month, the Kentuckiana Health Collaborative team is sharing how we have been taking care of our mental health during these challenging times. 

 

Stephanie Clouser 

As an introvert who often overschedules herself socially to the point of exhaustion, in a way I feel like I’ve been craving an extended moment like this. I’ve welcomed the opportunity to recharge. Still, there are added pressures and anxieties that come along with it. I have found success navigating the last couple of months through a balance of structure and spontaneity. From the beginning, I set up a working routine that included getting dressed in the morning even if I wasn’t leaving the house, only working from my home office and not from the couch, and more. But too much structure and planning doesn’t leave a lot of room for happiness, so when it comes to how I spend my non-working time, I give myself the space to pursue what inspires me that day. Maybe that includes going for a walk instead of a run or reading instead of journaling. As long as I’m doing something that’s either productive or good for my soul, I go with it! 

Emily Divino 

At the beginning of the week, I write in my planner a small goal I want to accomplish every day. These goals can be as small as just doing my laundry or carving out time to go run. For me, this process instills a sense of productivity and helps me maintain some sort of routine amongst the ongoing chaos. The extra time at home has also allowed me to start on household projects that I have been meaning to do for a while. I am also making sure to partake in activities that bring me joy, like listening to music or crafting. However, I do still find myself struggling at times adjusting to this new normal. I find that talking to my friends and family about the current situation and how we are feeling helps me cope. Virtual platforms, like Zoom, have been a great way for me to stay connected to my friends and family during these times.  

Natalie Middaugh  

I know I am not alone in saying that life has felt like a roller-coaster since the onset of COVID-19.  Some days and weeks, I settle into a groove and am thriving with working from home, connecting with friends and family, and making the most of newfound free time. Other days and weeks, I feel incredibly overwhelmed with uncertainty, anxiety, and stress. What has helped me most in managing these ups and downs is checking in with myself, recognizing how I’m feeling, and identifying what I need to do to honor and manage those feelings. Helpful habits for me have included maintaining my sleep and exercise routine, reducing screen time, taking long leisurely walks with my dog, reading, and exploring new and old hobbies alike. 

 

Demonstrated here, there are a variety of ways to support mental health. Although this may look different for each of us, it’s important to remember that this is shared experience. Mental Health Month can help serve as a reminder of this fact and provide useful tools for managing and promoting our mental well-being.

If you are concerned about yourself or a loved one, Mental Health America offers a free mental health screening tool. For free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals, call the National Suicide Prevention Lifeline at 1(800) 273-8255.

Community Reports Highlight Improvements in Quality Metrics, but the Effects of COVID-19 on Primary Care Remain to be Seen

2019 Kentuckiana Community Report

In April, the Kentuckiana Health Collaborative sent private reports to nearly 450 group practices throughout Kentucky and Southern Indiana. Soon after, the KHC released its annual community reports, featuring highlights of where the community performs well and where there are gaps in care.

On Thursday, the KHC held a webinar introducing the 2019 community reports and diving into some of those highlights. If you missed it, you can access the recording here. As a community, Kentuckiana and the Commonwealth have seen an improvement in historical trouble spots, we have new information on opioid prescribing, and there are opportunities for growth and exploration in some new measures.

IMPROVEMENTS IN DIABETES CARE AND VACCINATIONS, OPPORTUNITIES FOR GROWTH IN NUTRITION COUNSELING

I encourage you to go to our website and look through the reports yourself. Once you account for age stratifications or multiple rates per measure – such as antidepressant medication, which has two rates, for acute period and continued period of treatment – there are 73 total measures to have fun with. You can access the full reports here.

Retinal eye exams for individuals is an area where we have traditionally fallen woefully short. Left unmanaged, diabetes can lead to serious complications, including blindness. In Kentucky, diabetes is the leading cause of blindness. For more than the last decade, Kentucky fell in the low-40% range, far below national averages, which tended to be in the mid to high 50s. The KHC has done quality improvement projects in the past on this critical aspect of care, as have many organizations across the state.

But in the last couple of years, as you can see, we have improved pretty spectacularly. In fact, we are above national rates for commercial AND Medicaid!

Comprehensive Diabetes Care: Retinal Eye Exams (2012-2018)

This is a perfect example of why we need quality reporting like this. Without knowing where we stand, we wouldn’t be able to know where to focus our efforts and resources. Additionally, we are often surprised when we assume we do well in things that the data tells us the opposite, and vice versa!

Another area that Kentucky continues to improve is in a relatively new focus area of HPV vaccination. This measure only became part of the HEDIS program in 2017 (using 2016 data), and the Kentucky Core Healthcare Measures Set committee selected it as a high priority, recognizing that Kentucky has the highest rate of HPV-related cancers.

Adolescent Immunizations: HPV (2016-2018)

Unsurprisingly, when our first baseline year of data came in, Kentucky and Kentuckiana fell below the national rates. But in our third year of reporting, Kentucky has made double digit improvements. Anecdotally, it seems like providers are getting more and more comfortable talking to patients and patients’ parents about HPV and making it a part of routine adolescent immunizations.

As you might be aware, a big focus in the past few years has been appropriate opioid use, as part of a partnership with the Kentucky Opioid Response Effort, as part of a SAMHSA Grant awarded to the Kentucky Cabinet for Health and Family Services. We have two new measures related to this work – use of opioids at high dosage and use of opioids from multiple prescribers.

For all opioid measures, lower is better. So the graph below that shows regional and state rates lower than national commercial and Medicaid rates is a good thing. A smaller proportion of Kentucky’s patients received high dosages of opioids in 2018 than the rest of the nation.

Use of Opioids at High Dosage (2018)

Another new measure to this year’s reports you will notice is all over our “areas for improvement” section at the top of the reports: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents.

There are three rates in this measure – BMI percentile documentation, counseling for nutrition, and counseling for physical activity. This was a huge topic of discussion for the Pediatric Committee on the core measures set team. While any measure that includes counseling can be tough for a provider to “get credit for,” the committee, about half of whom were pediatricians, felt strongly that this is the crux of the work they do – providing the foundation for a lifetime of healthy habits – and wanted it included, despite the challenges.

Since many of these pediatricians felt like they were doing this well to begin with, they saw it as an opportunity to “get credit for” the good work they’re already doing. By focusing on documentation improvements and practice flow, they feel we can make great progress as a state in this measure.

The last measure I wanted to highlight to you actually will not see on the 2019 KHC Community Reports. Part of the Comprehensive Diabetes Care set, that includes eye exams, foot exams, and HbA1c poor control, Blood Pressure Control is a measure new to the Kentucky Core Healthcare Measures Set, so this year was the first year we collected data for it.

But you won’t see it on the reports, because we are still establishing a baseline for that data and seeking to understand what the data is telling us. Information for this measure is usually recorded by providers in the medical record data and typically not administrative data. If a provider bills a CPT code that is <140/90, the data could be captured administratively but that does not typically occur. So that’s why we see a wide range of results. We are looking into how to best use this data and work on this measure. Stay tuned for more information!

COVID-19 AND ITS IMPACT ON QUALITY MEASUREMENT

Already, there have been major changes to the 2020 NCQA HEDIS program reporting requirements, and it seems like every day, more things are changing. Much is unknown right now. NCQA has a webpage dedicated to the pandemic that I encourage everyone to visit for more information. Of course, while HEDIS is the program we most closely work with at the KHC, it certainly isn’t the only one. CMS’s Medicare quality reporting programs have granted a variety of exceptions and extensions to providers for reporting.

However, despite all of these changes, we don’t expect a delay in our KHC 2020 reports. Changes to the HEDIS program primarily affect hybrid measures, measures that combine administrative claims data and medical chart reviews, and the measures that the KHC collects use just administrative data. We’ve been having one-on-one meetings with our health plan partners, as well as our KHC Measurement Strategy Team, and haven’t heard of any concerns for submitting data for the KHC annual reports.

It is still too early to tell, but I expect big changes in measurement programs for next year. Preventive care has already seen a big impact, as has medication access and adherence for chronic conditions, etc. Efforts around telehealth services and behavioral health services, which were already large areas of focus, have been a big area of discussion. Many expect these efforts to be ramped up in response to the pandemic. Health plan partners have also been addressing social determinants of health, such as food insecurity, as a result. Again, these plans were already working in these areas, but have been forced to scale those programs and pilots in a compressed time span.

Employers Mobilizing Benefits and Policy Changes in Light of COVID-19

As the coronavirus disrupts lives and businesses around the world, employers are mobilizing to support their employees and community efforts related to COVID-19 testing, treatment, and social distancing. Their approaches are not universal, with significant variations among organizations and across industries. This is among the findings of a survey from the National Alliance of Healthcare Purchaser Coalitions (National Alliance) conducted to help employers understand and benchmark the handling of COVID-19 from a benefits and policy perspective.

The Kentuckiana Health Collaborative (KHC) is a member of the National Alliance. Some of KHC’s employer members participated in this online survey, which was conducted from March 18-23, 2020 and completed nationally by 256 employers of varying size and industry that are members of coalitions affiliated with the National Alliance.

“We’re faced with a tale of two cities,” said Michael Thompson, National Alliance president and CEO. “While most salaried employees can effectively work from home, the great majority of hourly workers don’t have the same flexibility. Where possible, employers are moving rapidly to enable a virtual workplace. Where this is not possible, they are working to maintain a certain level of operations and support social distancing. All are looking at how to best mitigate the financial impact for their employees as well as their own bottom line.”

Additional survey findings:

  • Almost all organizations have banned unessential travel, hosting, and attendance at in-person meetings (98+%).
  • In general, over 70% of salaried employees and less than 50% of hourly employees can work from home and effectively perform their jobs. The ability to effectively work from home also varies by industry as finance, insurance, and professional services are more adaptable than retail and manufacturing.
  • For those employees who can work from home, 69% of employers have implemented telecommunication policies, with 50% on a mandatory basis.
  • For those employees that cannot effectively do their jobs at home, 60% of employers are implementing flex hours for jobs that require employees at the worksite; 24% are shutting operations temporarily with pay (another 20% considering); and 5% are shuttering operations without pay (another 24% considering).
  • Telemedicine is rapidly becoming a mainstream strategy with waived copays for testing visits.
  • The emotional impact of COVID-19 is also being addressed as 53% of employers are providing special programs for their workforce.
  • Accommodations for caregiving responsibilities due to COVID-19 (e.g., as schools and daycares shut down) are also being considered by employers with 59% offering unpaid family leave and 46% offering paid family leave.
  • Considering the recent IRS guidance for benefit coverage under HSA-compatible high deductible plans, 89% of employers are offering or considering offering first dollar coverage of COVID-19 testing. At this time, 37% are also covering the actual treatment of conditions related to COVID-19 on a first dollar basis.
  • Well over half (66%) are waiving or considering waiving copays for office visits associated with the COVID-19 testing and three out of four are waiving or considering waiving copays related to COVID-19 related telemedicine visits.
  • Employers are generally not offering similar COVID-19 coverage for non-benefit eligible employees or contractors. Few employers are currently offering COVID-19 testing at onsite/near site clinics.

Full details on the survey findings can be found here. The survey results have been used to structure a series of Employer Town Hall events hosted by the National Alliance, open to all employers, regardless of membership with the National Alliance or KHC. Five Employer Town Hall conversations have been held so far, and three more are planned for May. Each Town Hall focuses on a specific aspect of the pandemic and includes an expert panel, round-robin conversation, and questions from participants. To access past recordings or register for future events, click here.

KHC COMPILES CORONAVIRUS RESOURCES PAGE FOR HEALTHCARE STAKEHOLDERS

Additionally, the KHC has created a COVID-19 Resources page that serves as a one-stop shop for providers, purchasers, plans, and consumers for pandemic-related issues. The page includes relevant news, events, guides, and more and will be updated frequently. Inboxes are being flooded each day with webinars and more, and the page compiles all of this into one page. If you have a resource or event that you believe would be of interest to KHC partners, please send to Natalie Middaugh at nmiddaugh@khcollaborative.org.

The KHC also is planning several events and town halls related to the pandemic and strategies to navigate these unprecedented times. KHC members are invited to attend a town hall discussing back-to-work strategies and concerns, which will be announced soon. Additionally, the KHC is speaking with experts to host educational webinars for KHC members and the public. To receive announcements about these events, be sure to sign up for the KHC newsletter mailing list.

 

Bridging Our Past, Present, and Future in the Face of COVID-19

One of my first exposures to the field of public health was the story of John Snow, the “Father of Epidemiology,” not to be confused with the wolf-friendly character from Game of Thrones. In 1854, London suffered from a cholera outbreak. The prevailing medical opinion was that the disease was spread by miasma, or “bad air” produced from rotting waste. John Snow, a physician, had other suspicions. By being one of the first to successfully implement epidemiologic principles of disease tracking, Snow was able to trace incidences of cholera back to a contaminated water pump that much of the city was drinking from. In an oversimplification of the situation, Snow removed the handle from the pump and the transmission of cholera was controlled.

The world has long experienced disease outbreaks such as this one; The Black Plague, Smallpox, H1N1, and Ebola are all commonly known. Each of these outbreaks has held valuable lessons for how we understand and approach the transmission of infectious diseases, as well as mitigate many of the societal consequences. As we find ourselves in the middle of a pandemic much unlike any of the outbreaks that we’ve seen in modern history, many of us may be finding that retroactively examining disease outbreaks may not provide as much comfort as one would hope. The spread of COVID-19 has conjured a myriad of feelings among the world’s population: fear, uncertainty, stress, loneliness, panic, and the list goes on. Day-to-day life has been significantly disrupted, and many of the systems and patterns that provide us security are unstable. Certain populations have been disproportionately vulnerable to the virus and/or the effects of infrastructure changes being made to control its spread.

Our New Normal

Although the coming weeks and months will remain questionable times for our world, some comfort can be provided by understanding this virus and what actions we can take together to prevent its spread. Here are some key questions about COVID-19 and guidance on what we can do as a community to stay informed and stop its spread.

What is COVID-19?

COVID-19 is disease caused by the 2019 novel, or “new”, coronavirus. Coronaviruses are a large family of viruses that can cause respiratory distress in humans and includes illness such as the common cold. Some types of coronaviruses are only transmitted between people, while others are transmitted only between animals, such as the canine or feline flu. Occasionally, animal coronaviruses can be transmitted to humans and then be spread to others. This is the suspected situation for COVID-19, as it has not previously been identified in humans.

How is COVID-19 transmitted?

As COVID-19 is a new virus, we are still learning much about its severity and how it spreads. Current understanding is that the virus is primarily spread through respiratory droplets produced when someone with the virus coughs or sneezes. It can be picked up by another person in two ways: those nearby can inhale these droplets through their nose or mouths or pick up the droplets by touching contaminated surfaces then touching their nose, mouth, or eyes. The former is thought to be the main mode of transmission.

What are the symptoms of COVID-19?

Symptoms of COVID-19 can range from mild to severe and include fever, cough, and difficulty breathing. The “incubation period”, or time between exposure and symptom presentation, can be two to 14 days, although most people show symptoms around five days. Some people can have the virus but not show symptoms. This is called being “asymptomatic.” Even when not showing symptoms, these individuals can still transmit the virus to others. This is why it is important for all people to following community and personal prevention measures in order to slow the spread, not only those who are susceptible or already sick.

How can COVID-19 be prevented?

The best way to prevent COVID-19 is to avoid being exposed to the virus. Currently, there is no vaccine available.

Until further notice, all people should be participating in the following personal prevention measures:

  • Practice social distancing (staying six feet away from others)
  • Do not attend gatherings with more than 10 people
  • Avoid touching the eyes, nose, and mouth
  • Restrict all non-essential travel
  • Regularly wash hands with warm soap and water for at least 20 seconds, especially after touching public surfaces and sneezing, coughing, or blowing your nose and before eating. If soap and water are not available, hand sanitizer with at least 60% alcohol can temporarily substitute.  
  • Clean and disinfect commonly touched objects and surfaces including but not limited to tabletops, door handles, keys, cell phones, or other electronics.

Until further notice, all businesses and organizations should be participating in the following community prevention measures:

  • Cancel, postpone, or virtually hold gatherings with more than 10 people
  • In gathering with less than 10 people, practice social distancing and provide opportunities and materials for hand washing and sanitization
  • Restrict all non-essential travel
  • Implement regular and complete environmental sanitation measures as recommended by the Centers for Disease Control and Prevention (CDC).
  • Allow employees to work from home. For those who’s duties cannot be fulfilled remotely, provide paid sick leave or direct employees on how to receive unemployment services.

May of these measures are difficult adjustments for people to make. The circumstances of this situation are anxiety producing, and many of these measures promote isolation and reduce the daily activities that we rely on for purpose and pleasure. During this time, it is equally as important to take care of mental health as it is physical.

What should someone do if they think they have COVID-19?

Diagnosis of COVID-19 requires testing and is a reportable disease in the state of Kentucky. If someone is presenting with symptoms of COVID-19, it is most important they stay home except to receive medical care. As they are able, they should isolate themselves from other people in their home to reduce the likelihood of exposing them to the virus. Before seeking medical care, they individual should call their local healthcare provider or local health department, who can provide addition guidance. If someone is unsure of next steps, the Kentucky COVID-19 Hotline can provide guidance at 1(800) 722-5725. It is important to contact these groups prior to visiting because the person suspected of having the virus may spread it to others en route. Additionally, the volume of people contracting COVID-19 and requiring in-facility medical care has the potential to overwhelm our healthcare system. Those who are able to recover from the disease at home while in self-isolation should do so.

If someone who is older or has underlying health conditions is presenting symptoms, they should contact their health provider sooner rather than later. COVID-19 affects these populations more severely.

Currently, there is no recommended medicine to treat or prevent COVID-19. Those who are infected can receive care to alleviate symptoms, treat co-occurring conditions, and provide comfort. Most mild cases can be treated at home, while those with more severe cases may be require hospitalization.

What resources are available for the community during this time?

Local, state, and federal organizations are working in real time to leverage resources for the community and provide relief for people who have been negatively impacted. To stay up to date, the following sources are trusted places to find information:

Looking Forward

The scope of COVID-19’s repercussions is much larger than is presented here. The aftermath of the outbreak is likely to fundamentally change how we as individuals, communities, and organizations operate and interact. It can be difficult to look beyond the news of economic hardship, failing health of loved ones, and upheaval of infrastructure. However, a lesson that we can hold onto from past outbreaks is that we will continue to learn, adapt, and respond, eventually bringing it to an end.

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” This quote from Fred Rogers is frequently circulated during times of hardship, and for good reason. COVID-19 is a scary thing, but the helpers are everywhere you look: healthcare workers on the front lines of caring for those who are infected, employees of businesses continuing to provide essential services to the community, policymakers and public health leaders who are working to provide information and relief, and the neighbors lending a helping hand to those who are at higher risk.

During this time, we all have a personal responsibility to stop the spread of COVID-19. Using the information presented here and relying on trusted sources of information can help any community member be prepared to fulfill this responsibility. Beyond a personal responsibility, we all also have an opportunity to consider how we might also be helper during this scary time. As the lessons of this outbreak persist in our history, let also the lessons of how we can be the helpers in our community.