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 June, 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 info@khcollaborative.org.

Mental Health Month a Time to Focus on the Connection between Physical and Mental Health

(Note: This guest piece was written by Marcie Timmerman, Executive Director of Mental Health America of Kentucky)

Marcie Timmerman
Executive Director
Mental Health America of Kentucky

Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable. So much of what we do physically impacts us mentally. It is important to pay attention to both your physical health and your mental health, which can help you achieve overall wellness and set you on a path to recovery.

Did you know that Mental Health America (MHA) founded May as Mental Health Month back in 1949? That means this year marks MHA’s 70th year celebrating Mental Health Month! This May, Mental Health America of Kentucky is expanding its focus from 2018 and raising awareness about the connection between physical health and mental health, through the theme #4Mind4Body. We are exploring the topics of animal companionship, spirituality and religion, humor, work-life balance, and recreation and social connections as ways to boost mental health and general wellness.

A healthy lifestyle can help to prevent the onset or worsening of mental health conditions, as well as chronic conditions like heart disease, diabetes, and obesity. It can also help people recover from these conditions. For those dealing with a chronic health condition and the people who care for them, it can be especially important to focus on mental health. When dealing with dueling diagnoses, focusing on both physical and mental health concerns can be daunting but critically important in achieving overall wellness.

There are things you can do that may help. Finding a reason to laugh, going for a walk with a friend, meditating, playing with a pet, or working from home once a week can go a long way in making you both physically and mentally healthy. The company of animals – whether as pets or service animals – can have a profound impact on a person’s quality of life and ability to recover from illnesses. A pet can be a source of comfort and can help us to live mentally healthier lives. And whether you go to church, meditate daily, or simply find time to enjoy that cup of tea each morning while checking in with yourself– it can be important to connect with your spiritual side in order to find that mind-body connection.

Mental illnesses are real, and recovery is always the goal. Living a healthy lifestyle may not be easy but can be achieved by gradually making small changes and building on those successes. Finding the balance between work and play, the ups and downs of life, physical health, and mental health, can help you on the path towards focusing both #4Mind4Body.

Everyone has mental health. Isn’t it time we start taking care of it?

Concerned about yourself or someone you love? Take a free online mental health screening here.

Call for Applications – 2019 KY Performance Measures Alignment Committee

The Kentuckiana Health Collaborative is accepting applications for the 2019 Kentucky Performance Measures Alignment Committee (PMAC), which will select the 2019 Kentucky Core Healthcare Measures (KCHMS), a core healthcare measures set for Kentucky’s primary care providers, with the ultimate goal of aligning the priorities of Medicare, Medicaid, and commercial insurers.

The KCHMS was first released in June 2018 and includes 34 primary care measures in the areas of preventive care, behavioral health, chronic and acute care, pediatric care, and cost and utilization. The intent is to align measurement efforts toward shared areas of focus, making Kentucky one of the first states in the nation to create a healthcare measurement set.

PMAC, which selects the measures that are included in the core measures set, consists of an oversight committee and five subcommittees in the follow areas:

  • Behavioral Health
  • Chronic and Acute Care
  • Pediatrics
  • Preventive
  • Cost and Utilization

The 2019 PMAC team will consist of previous committee members and new applicants. Slots are limited and will reflect a diverse mix of payers, providers, purchasers, and consumers.

While the 2018 KCHMS timeline was approximately one year from conception to release, this year’s cycle will be more condensed and run from June 2019 to August 2019. Both subcommittee and oversight committee members will participate in an overview call in early June, each subcommittee will meet approximately twice in June and July, and the oversight committee will meet an anticipated two times in July and August. The 2019 KCHMS measures will be finalized by August 31, 2019.

For more information about the project, visit the KCHMS page on the KHC website. To apply for the oversight committee or subcommittee, click here.

Submissions are due by Friday, May 31. Any questions, please contact Stephanie Clouser at sclouser@khcollaborative.org.

Tackling Opioids in the Workplace

(Note: This guest piece was written by Tiffany Cardwell, Human Resources Consulting Principal, Mountjoy Chilton Medley and Director of Wellness, Louisville Society of Human Resources Management)

Tiffany Cardwell is a member of the KHC’s Worksite Addiction Group.

Opioids in the workplace is a topic that often gives pause for human resource professionals. The pause occurs since there are so many taboos and unknowns surrounding this issue for employers—no matter the size and no matter the industry. For the past year, I’ve had the wonderful opportunity to work with a talented team of experts through the KHC to create a toolkit for employers for supporting opioid prevention, treatment and recovery. Monthly meetings were held to focus on creating a tool for employers and their managers to assist with addressing opioids in the workplace. The toolkit was released last month at a half-day event where area employers explored the toolkit’s application and other relevant topics.

As an HR practitioner, I wasn’t quite sure what I would be able to add to the many experts who were involved with this initiative. What I quickly discovered is that everyone is in a continuous learning process with the subject matter of opioids. Although we had expert clinicians who have been practicing in the field for years, I was able to provide some insights from an HR professional consulting with managers daily who are doing their best to combat this issue. Although I do not have a clinical background, it was great to be able to share how we can create tools that employers will find easy to use and helpful as they address concerns with their direct reports.

Out of all of our discussions, I found it most helpful to become more educated about the definitions surrounding opioids. Using common language to speak with managers and employees provides clarity for this complicated workplace issue. Open communication is also key to successfully tackling opioids in the workplace. The more employees and employers are comfortable discussing this issue with each other, the quicker resolutions can be made to assist the employee to return back to work and effectively assist them through recovery.

If you have not downloaded your copy of the employer toolkit or reviewed it online, I encourage you to do so. Even if you’re not running into this issue now, it is helpful to proactively gain understanding about what you may run into in the future.

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.

RAND STUDY SHOWS VARIATION IN PRICE, QUALITY IN KENTUCKY’S 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.

KHC BRINGS IN RAND STUDY LEADERS FOR COMMUNITY FORUM

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.

“Opioids and the Workplace” Employer Roundtable Paves the Way for Continued Work

If you have visited the Kentuckiana Health Collaborative’s website in recent months, you may have noticed a small box in the lower right-hand corner of the home page. Minute by minute, hour by hour, and day by day this countdown marked the nearing release date of “Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery.” As part of the Kentucky Opioid Response Effort (KORE), the KHC spent the past year convening employers and key healthcare stakeholders alike to guide the development of a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD).

As countdown ended on Thursday April 18, employers and other key healthcare stakeholders gathered at GE Appliance Park’s Monogram Hall for the release of the toolkit and to lay the foundation for next steps and implementation. The four-hour event, presented by the KHC Employer and Healthcare Purchaser Network, was full of presentations and discussions that explored the toolkit’s application and other relevant topics.

DIVERSE PERSPECTIVES BRING THE DISCUSSION FULL CIRCLE

Attendees kicked off the program by answering a poll about what they hoped to gain from the event.

To set the stage for the day, Patrick Kullman, an interventionist, shared his personal story of how an employer can be instrumental in supporting an employee facing substance and opioid related challenges. He was followed by addiction psychiatrist Dr. Kelly Clark, Addiction Crisis Solutions, who presented on facts and debunked myths surrounding opioids, addiction, and what it looks like in the workplace.

With the employee perspective at the forefront of the discussion and the record set straight on the chronic disease of addiction, a panel, moderated by Tiffany Cardwell, Mountjoy Chilton Medley, gave context to the challenges employers face in this area and opportunities for improvements. As employers and early adopters of strategies to address opioid misuse, Dr. Diana Han, GE Appliances, a Haier company, and Amanda Elder, LG&E and KU, highlighted their experiences and paths forward in adapting their data analytics and workplace policies to best support their employees and their dependents, as well as their business. Eric Bailly, Anthem, explored the health plan’s role as an employer partner for determining and provider optimal benefit design. Cynthia Doll, Fisher & Phillips, LLP, addressed many of the legalities that employers may need to consider. Highlights of the conversation included the available of Narcan in the workplace, workplace accommodations for employees on Medication Assisted Treatment (MAT), the identification and utilization of high-quality evidence-based treatment, and the Mental Health Parity and Addiction Equity Act (MHPAEA).

Panelists discuss challenges and paths forward in adapting policies to best support employees and their dependents, as well as their business.

As the lead author of “Opioids in the Workplace,” I presented on the toolkit itself, exploring what exactly employers can expect to learn from it and explaining how it can be used.

Dr. Brittney Allen and Dr. Katie Marks from the Kentucky Opioid Response Effort (KORE) closed out the day of by highlighting available community resources for people facing opioid related challenges, including Find Help Now KY and the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator.

EMPLOYERS TO DRIVE CONTINUED WORK

“Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery” is now available on the KHC website.

Although the countdown is now at zero, the work is certainly not over. In the upcoming year, the KHC will continue to improve this toolkit based on industry advancements and employers’ needs and feedback. At the roundtable, attendees were offered a chance to communicate their needs and give input on the potential direction of the toolkit. Three key questions were presented:

  • The business community has an active role in supporting the health and well-being of their employees. What should be their primary role in addressing the opioid crisis?
  • What is your biggest personal obstacle in acknowledging substance use in your workplace?
  • What tools can help you overcome this obstacle?

A major theme of this discussion was employers’ role in addressing stigma and creating awareness among employees not only about opioid related risks and addiction, but about what their employer can do to support them. Challenges to fulfilling this role included communication among different parts of the workplace chain of command, lack of understanding around confidentiality, and community culture’s that lacked empathy. Tools to overcome these challenges aligned closely with what the toolkit already offers, but also called for increased interconnectedness and partnership among employers, employees, and community supports.

To continue this conversation, the KHC will be convening a cohort of employers to discuss the implementation of the recommendations presented in the toolkit. Additionally, the KHC will be taking an increased focus on how employers can play a role in chronic pain management – a prominent factor in the development of the opioid crisis. If you are an employer interested in getting involved with this cohort, please contact me at nmiddaugh@khcollaborative.org.

The KHC will also be offering a complementary webinar on May 15 from 12pm to 1pm to review the employer toolkit. The toolkit and registration for the webinar can be found here.

We know employers play an important role in driving health of their employees and their families. By continuing to engage and invest in their specific role of supporting them through opioid related challenges, employers will be best positioned to achieve optimal health and workplace outcomes.

KHC Highlights Work at the Rx Drug Abuse & Heroin Summit

For the past couple of years, Kentucky employers have come together to not only address the opioid crisis within their own population but at a broader community level through the Kentuckiana Health Collaborative, and we had the opportunity to highlight that work last week at the Rx Drug Abuse & Heroin Summit. The summit brings together stakeholders to discuss what’s working in prevention and treatment each year.

Dr. Kelly Clark, Dr. Diana Han, and I presented “Employers Respond: Kentuckiana Health Collaborative’s Evidence-Based Approach to Community Health.” Clark, a national expert on opioid use disorder, played a key role in the development of the KHC’s “Opioids and the Workplace” employer toolkit that was released this month. An addiction psychiatrist and KHC member, Clark is the immediate past president of the American Society of Addiction Medicine and founder of Addiction Crisis Solutions. Han, Global Medical Director for GE Appliances and KHC Co-Chair, has also played an integral role with her team in providing boots-on-the-ground feedback for the newly released toolkit.

Clark kicked off the session by explaining the differences between opioid use, misuse, dependence, and disorder and the current evidenced-based guidelines for opioid use disorder treatment. Han then discussed how the opioid epidemic is impacting Kentucky’s businesses and the significant commitment employers are making to identify strategies to better ensure employees and family members are being supported through prevention, treatment, and recovery. Finally, I presented how employers are coming together to find and share opioid-related best practices and how the coalition has prioritized opioid-related initiatives into all four pillars of its work:


Healthcare Measurement: Improving quality and value of care through measurement, alignment, and transparency

Selection of two opioid stewardship measures into the Kentucky Core Healthcare Measures Set

Service on the National Quality Forum’s Opioid Stewardship Committee


Community Health: Improving health and wellbeing

Development and distribution of the Screening, Brief Intervention, and Referral to Treatment guide to 4,000+ Kentucky providers

Partnership with Student Alliance for Mental Health Innovation and Action (StAMINA) to improve youth mental health


Employer and Healthcare Purchaser Network: Engaging employers to drive the Triple Aim goals

Creation and distribution of “Opioids and the Workplace” toolkit

Communication of relevant information in newsletter and action briefs


Education: Catalyzing transformation of healthcare through education, communication, and collaboration

Convening of an employer focus group on the impact and needs around opioid use disorder in the workplace

Hosting of an employer roundtable sharing opioid-related benefits and policy best practices

Hosting of two annual conferences with specific sessions around opioid use disorder


As part of my presentation, I spent a good deal of time focused on the “Opioids and the Workplace” toolkit that was developed through the KHC’s worksite addiction committee, a cross section of employers and opioid use disorder experts. The Kentucky Opioid Response Effort (KORE), which funded the development of the toolkit, has been very visionary about how employers can be key partners in the prevention, treatment, and recovery of opioid use disorder. One of the goals of our session was to help other communities engage the business community in their opioid-related efforts.

The “Opioid and the Workplace” toolkit was released this month with an employer roundtable. The KHC’s opioid toolkit has received excellent reviews and will be distributed more widely in the coming months at the Kentucky Chamber’s opioid summit and the Kennedy Forum Annual Meeting in Chicago this summer. If you would like to learn more about the toolkit, be sure to sign up for our webinar on May 15. The webinar will feature Natalie Middaugh, KHC Community Health Program Manager, who led the development of the toolkit.

The Rx Drug Abuse & Heroin Summit has Kentucky roots and began in 2012 under the leadership of Operation UNITE and U.S. Rep. Harold “Hal” Rogers (KY-5th). Notable speakers in past years have included President Barack Obama in 2016, Congressmen Patrick Kennedy and Newt Gingrich in 2017, former President Bill Clinton and Counselor to the President Kellyanne Conway in 2018. This year, President Donald Trump and First Lady Melania Trump addressed attendees. Unfortunately, I didn’t get to rub elbows with any of the notable speakers, but I did make a commitment to put this event on the KHC’s list of conferences to attend next year.

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.

INDIANA STUDY REVEALED HIGH HOSPITAL PRICES, EXPANDED NATIONALLY

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.

NATIONAL HOSPITAL PRICE TRANSPARENCY RESULTS: HOW DOES OUR REGION STACK UP?

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.

Toolkit Released for Employers to Address Opioid Misuse and Opioid Use Disorder in the Workplace

Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery

Employers play an important role in influencing the health and safety of their employees, their families, and the communities they live in. Taking strides to support employees and their families can have a measurable positive impact not only in their lives, but in the success of a business. With the nation in the midst of an opioid crisis, the employer’s role as an agent of change is more important than ever. In the workplace, opioid-related issues are impacting businesses and the safety and well-being of their employees.

Outdated workplace policies and culture can be contributing to stigma and leave current and potential employees fearful of repercussions associated with seeking help. Addressing opioid-related issues in the workplace is new to many employers and finding solutions can be confusing and complex as most employers do not have expertise in this domain. Adding to employer challenges, a behavioral health care system that does not consistently provide high-quality, evidence-based care can exacerbate, rather than alleviate, the problems. In some cases, poor quality addiction treatment can lead to worse outcomes for patients.

As part of the Kentuckiana Health Collaborative’s (KHC) ongoing focus on high value behavioral healthcare and second year of partnership with the Kentucky Opioid Response Effort (KORE), the KHC has developed a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD). Using this toolkit, employers can expect to learn:

  • What the basics of opioid use and addiction are and how it affects the workplace
  • How to use data to understand the status of opioid use, misuse, and OUD among employees and dependents with healthcare coverage
  • What benefit strategies direct employees to evidence-based care for prevention, treatment, and recovery from opioid misuse and OUD
  • How to design workplace policies that protect and support employees and employers and improve workplace culture
  • What legal issues may pertain to addressing substance use in the workplace

The toolkit can be viewed here. Today, approximately 80 employers and other healthcare stakeholders convened to mark the release on this toolkit and discuss the recommendations made and existing goals and challenges that remain. For employers who were unable to join us at this event, the KHC will be offering a complementary webinar on May 15, 2019 from 12 pm to 1 pm. Stay in touch with the KHC for reflections and updates this ongoing initiative.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

We packed a ton of great content into a small amount of time, so we didn’t get to all of the questions submitted by participants on our web application.

Let’s remedy that.

The KHC has spent the last couple of weeks following up with speakers on these questions, and we’ve compiled them below. Note that some answers have been edited for space.


“For Mental Health, Let’s Act Before Stage 4”

Paul Gionfriddo | President and CEO | Mental Health America

In other countries they have programs to integrate mental health treatment and the community. What do you think the barriers are to doing that in the US?

We tend to favor the system with which we have the most experience. In the United States, that has been characterized by separate and unequal care, first in state hospitals, now in jails and prisons, for people with mental illnesses. Our challenge is to change the way we think about mental health conditions, because thinking about them as public safety concerns (i.e. dangerous to self or others) makes it hard to fully integrate the services and treatment for them into the community.

How do we get people to seek treatment without the fear of retribution or ostracization?

First, we should screen everyone for mental health conditions as ubiquitously as we screen for blood pressure in adults, and hearing and vision in children. That’s what’s recommended for everyone over the age of 11 by the U.S. Preventive Services Task Force, but it’s just not done. By screening, we normalize mental health and mental health care and make this a part of overall health and health care. And then we can treat right away when it’s warranted, instead of letting up to ten years pass between the emergence of symptoms and getting the right diagnosis and treatment.


“Roadmap for Employers to Achieve High Value Behavioral Healthcare”

Mike Thompson | President and CEO | National Alliance of Healthcare Purchaser Coalitions

The National Alliance recommends ensuring health plans have network adequacy for behavioral health services. How is this best measured?

Most health plans have directory of network psychiatrists. However, few know whether those psychiatrists are taking new patients – ask them, by specialty if possible (eg child psychiatrists), what percentage of network behavioral health specialists are taking new patients.

Most health plans measure access to network providers by driving distance but few know or monitor how long it takes to schedule an appointment – ask them, by specialty if possible, what is the average wait time for an appointment for a new patient?

Most health plans will indicate that it is difficult to get behavioral health specialists to join networks but few have taken a positive step toward change this trend – ask them, by specialty if possible, how do network reimbursement rates for behavioral health specialists compare to non-behavioral health specialists? How do network reimbursement rates compare to out-of-network charges for behavioral health specialists? What is you plan to improve network participation rates of behavioral health specialist?

What do you think has shifted within our world society to now have this be recognized as a top 5 issues when it’s always been perceived as a personal and economic issue?

Three things that have contributed to Mental Health rising to be among the top issues facing companies and organizations globally:

1) growing recognition of the huge and disproportionate economic impact of the issue to companies and societies, well beyond the costs of treatment (e.g. impact on co-morbidity, impact on productivity. Impact on caregivers).

2) growing understanding of the physical and environment underpinning of behavioral health issues (genetics, social determinants and trauma, brain science) as well as how to prevent and treat it.

3) cultural change giving a growing voice to its wide prevalence and new acceptance as a human condition rather than a character flaw. This has been led by advocates, celebrities, businesses and policy makers.


“Unaddressed Drivers of Poor Mental Health (PANEL)”

Aja Barber | Community Health Administrator, Center for Health Equity | Louisville Metro Dept of Public Health

When is the next Health Equity Report slated to be released?

In keeping with the timeline so far, we’re anticipating releasing a 2020 or 2021 Health Equity Report.

From the CHE perspective, what can be done on a policy level to help close mental health disparities throughout our community?

We’re currently in process of building the legislative agenda for Public Health & Wellness so I don’t have a specific answer to this yet. But I do believe policies ensuring physical and mental healthcare as a guaranteed right for every individual are critical first steps.

Danesh Mazloomdoost, MD | Founder | Wellward Regenerative Medicine

What can we do as community members, professionals, and advocates for change to get the appropriate word out about the model that Wellward works off of?

Wellward looks for opportunities to work with the community and educating both patients and clinicians on this paradigm shift in addressing painful conditions. Any opportunity to speak or inform the public about Fifty Shades of Pain would be welcomed. While the book became an international bestseller, any purchase or review helps boost its visibility to the public, even a $0.99 Kindle purchase does a lot. Our goal is to simply create greater awareness about sustainable ways to think about pain in improved the health of our community such that pain problems become less prevalent. Your assistance in spreading that message in any capacity is helpful.


“Incenting Recovery Rather than Relapse through Bundled Payments (PANEL)”

Kelly Clark, MD | Founder, Addiction Crisis Solutions | President, American Society of Addiction Medicine

David Smith | Founder| Third Horizon Strategies

In a bundled payment model for medications treatment for Opioid Use Disorder, what non medicine therapies should be included?

Clark: In the PCOAT payment model, medications themselves are not core services/products being delivered.  The core elements to be covered are those consistent with the ASAM Guidelines for Use of Medications in the Treatment of Addiction Involving Opioids: Medical services for diagnosis, treatment planning and medication management; core psychosocial interventions including the levels of counselling which can be done by the prescriber with sufficient time and expertise; and care coordination activities.  There are different approaches in this bundle, depending on the capacity and capabilities of the provider/provider group.  More information can be found here.

Smith: We would be deferential to the professionals empaneled to provide care for the patient. The entire ARMH-APM turns on the axis of a treatment and recovery plan that addresses a range of mental and social considerations (in addition to clinical) that support a patient’s recovery. The clinical professionals and support teams that work with the patients are required to work with the patient in identifying specific therapies, in addition to addressing exogenous determinants that would interfere with the recovery plan and facilitate resources accordingly. The concept APM does set general guidelines regarding the need for evidence-based approaches to therapies holistically, but we also believe that the payment mechanism and the associated risk will play a role in motivating the underlying delivery system to provide non-medical services and therapies in a way that will sustain impact.

How do we move to a model that values quality care and implements metrics around performance?

Clark: We start by defining quality and performance. We can use the Triple Aim concept of Value = Quality/Cost, but quality of care in medical systems is an ever-expanding construct…Beginning by ensuring baseline process measures are used to ensure standards of care are being met – we don’t want to incent performance of cost savings by allowing care considered not to meet baseline standard of care quality metrics…Next, we need to consider the goals of managing chronic diseases: Decreased disease related morbidity, early mortality, total cost of care, and increased functioning/quality of life…To be operationalized, “Quality” is a very granular concept, and we must move boldly ahead to save lives.

Smith: It’s a collaborative enterprise and requires a payer to lean into a payment model that provides adequate resources for care that has a long-term orientation and supports the delivery system in its integration for the purpose of a more seamless patient experience. Our approach is to facilitate this through a risk-bearing provider entity capable of centrally managing a care team and the associated care transitions through a network of providers that engage the patient based on need and subsequently (or initially, depending on the patient) supports the patient’s assimilation back into their environment (or a new environment depending on the underlying circumstances).

Why don’t all clinics require counseling along with the administration of these medications? How is a patient supposed to differentiate between these clinics?

Clark: In an ideal world, people with any disease would have access to whatever interventions they need to help them manage their chronic disease at the time they need it, and also have access to things which would possibly benefit them. In the case of addiction, an individual at one point in time may require 24-hour care in addition to ongoing medication management, or require intensive outpatient care at another point in time, or require no further outpatient services than meetings with their prescriber. There is no one size fits all… 

We do not expect people with brain or other diseases to “talk their way out of their illness.” The currently available data we have for opioid addiction does not show improved outcomes by adding 60-minute formal counselling sessions to the regular physician medication management visits (which include supportive counselling and other techniques)…And forcing people into higher than needed levels of care does not improve outcomes – I have seen it simply discourage them from receiving the care they do need. Finally, there are structural and payment barriers to providing psychotherapy (done by licensed masters level professionals) in the same offices as prescribers which include licensing and payment issues as well as a shortage of either psychotherapists or counselors of lower educational requirements.

Patients and their families currently have few ways to determine the quality of care being provided by any provider or program. The ASAM/CARF certification, as well as the proposed Shatterproof rating system, are looking to make information about programs more transparent by means of independent site surveys (ASAM/CARF) or provider/patient/payer data collection (Shatterproof).

Patients with opioid addiction and their families can look here for information:

http://eguideline.guidelinecentral.com/i/706017-asam-opioid-patient-piece/0?

https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Where are these programs being piloted?

Clark: The P-COAT model does not currently have formal piloting occurring, but it does delineate the types of bundled payment approaches which are already being provided in some communities by forward thinking health plans working with engaged providers. 

Smith: Like everything in health care, we are living under our potential. We don’t get the results we pay for and have developed a delivery system that receives enormous financial benefit when patients have a recovery disruption or cycle through recovery. Our perverse incentives prevent us from driving the type of alignment across this diffuse ecosystem of resources that does a tremendous disservice to patients and their families.

Are recovery models serving people equally across socio-economic levels, including the homeless?

Smith: Today, no, not generally (in my opinion). This is where we need to go. Most Americans can access some form of coverage (non-expansion states notwithstanding). Even for those Americans unable to access coverage, the financial burden of addiction on our entire emergency infrastructure creates an economic rationale for society to provide these services. If we build a delivery model that supports this and link patients under the auspices of their coverage/non-coverage considerations, an underlying economic calculus that isolates value for parties (government, society, payer, etc.) should be a catalyst for establishing the right access to services for patients.