KHC’s Stephanie Clouser Named to Core Quality Measures Collaborative Implementation Team

KHC Data Scientist Stephanie Clouser

Continuing the KHC’s work both regionally and nationally in healthcare quality measurement alignment, KHC data scientist, Stephanie Clouser, has been named to the Core Quality Measures Collaborative (CQMC) Implementation Roster. She has also previously participated in the CQMC Primary Care and Gastroenterology workgroups.

CQMC, a partnership between the National Quality Forum, Centers for Medicare and Medicaid Services, and America’s Health Insurance Plans, develops core sets of quality measures for implementation across both commercial and government payers. The CQMC relies on workgroups to select measures for the core sets, guide the development and refinement of materials used to update the core sets, and prioritize gaps and areas for future core set development.

Regionally, Clouser leads the KHC’s measurement alignment work to identify the measures that reduce measurement burden, improve focus, and ultimately measure what matters most to key stakeholders. A public-private committee of the experts convened by the KHC has finalized the Kentucky Core Healthcare Measures Set (KCHMS), with 38 core primary care measures. The measures listed on the KCHMS are included in KHC annual reporting.

Also named to the CQMC Implementation Workgroup was KHC member Faith Green, Director, Office of the Chief Medical Officer, Humana. Green has also participated on other CQMC workgroups and the KCHMS committee.

As members of the Implementation Workgroup, Clouser and Green will be charged with developing an implementation guide that addresses:

  • Guidance on technical aspects of core set implementation for payment and quality reporting purposes
  • Strategies to encourage buy-in among clinicians, provider facilities, and consumers
  • Strategies to increase core set adoption to raise awareness and increase stakeholder knowledge

KHC Releases 2019 Annual Report

Click on the image above to read the full report.

Last year, in an effort to do a better job of celebrating and reflecting on our accomplishments, the KHC released its first-ever KHC annual report, highlighting the historic year we had in 2018 and setting the tone for 2019.

If we thought 2018 was historic, we weren’t at all prepared for what 2019 would bring! This year was arguably more eventful than 2018, marked with new hires, new grants, creating a new webinar series and for the first time recording those educational webinars, participation in national efforts, and an office move to close out the year.

The design of this year’s annual report is a “roadways” theme, signifying the continuous drive and journey to address the complex health problems that face our local community. While there is no clear “road map” to achieving the Triple Aim goals of Better Health, Better Care, and Better Value, we work to accomplish this mission through a variety of healthcare measurement and community health initiatives that leverage employer engagement, multi-stakeholder collaboration, and education to transform and optimize healthcare. The KHC acts as a bridge to connect the healthcare stakeholders needed to drive this change.

The heart of the KHC Annual Report is divided up into accomplishments made in each of four core areas of focus: Healthcare Quality Measurement and Transparency, Community Health Improvement, Employer and Purchaser Network, and Education. Some of the biggest projects highlighted in the report were:

  • Releasing the 2019 Kentucky Core Healthcare Measures Set
  • Developing the “Opioids and the Workplace” Employer Toolkit
  • Hosting the fifth KHC annual conference
  • Starting the conversation around hospital pricing
Click on the image above to read the full report.

Take a few minutes to read through the KHC 2019 Annual Report. Current KHC member organizations will receive physical copies with their membership renewal packets that will be mailed in the near future. On our website, we have an online version that includes live links that you can click on to find out more about each project mentioned in the report.

Hop on the KHC roadway in 2020 and help us drive change!

2019 Round-up: Top Stories from the KHC

In what has become an annual tradition, we are launching 2020 with a “Best of” for our blog, looking at the 2019 posts that had the heaviest readership and those that our staff deemed its favorites.

Most Read Posts

  1. Toolkit Released for Employers to Address Opioid Misuse and Opioid Use Disorder in the Workplace. The KHC convened employers and key healthcare stakeholders to guide the development of a toolkit to provide best practices for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder.
  2. Seeking Employers to Partner in Addressing Kentucky’s Opioid Crisis. The KHC launched a six-month cohort of employers dedicated to becoming partners in fighting the opioid crisis in Kentucky. The cohort, representing 23% of commercially-insured Kentuckians, is diving deeper into how the KHC’s “Opioids and the Workplace” toolkit recommendations can be implemented by national and local employers through healthcare best practice sharing of benefit design and workplace policies.
  3. Kentucky Core Healthcare Measures Set Expands to 38 Adult and Primary Care Measures. In September, the second core healthcare performance measures set, developed by experts from across the Commonwealth, was released at our KHC Community Health Forum. National and local experts were featured at the event.
  4. KHC Member Spotlight: Amanda Newton. Our monthly Member Spotlight series, featuring a KHC member, is always a popular post. Our spotlight on Amanda Newton from Recovery Concierge and Renew Recovery cracked the top five in views for 2019.
  5. National Hospital Prices: How do Kentucky Hospitals Stack up? Healthcare affordability is one of the most pressing issues facing employers, healthcare purchasers, and patients. The KHC partnered with the Employers’ Forum of Indiana to participate in the RAND National Hospital Price Study 2.0, which revealed the price of commercial hospital pricing relative to Medicare.

KHC Staff Favorites

I used to scoff at breast cancer “awareness” activities. That was before I worked in healthcare.

Selected by: Teresa Couts

This blog post made women aware that breast cancer can occur at an early age, before the recommended guideline age for screening. Women should know and listen to your body for changes. When breast cancer is detected and treated at Stage 0 or 1 the chances of survival is greater. So when you see the pink in observance of breast cancer awareness take the time to do a self-check on your breast.  

Changing the Narrative One Day at a Time

Selected by: Randa Deaton

My favorite blog post of the year was from KHC Co-Chair, Jason Scherzinger, as he kicked off the new year. His message resonated with me personally in my managing my own health and my mother’s as I struggled transitioning my primary caregiving role to that of hospice. With this personal perspective always guides my professional one, I appreciated Jason’s vision for how we can all come together to improve healthcare for everyone. It is this vision that drives the work of individuals and organizations like the KHC, and as we kick off a new decade full of unknowns for the KHC, I think Jason’s words remind us of our best path forward.  

KHC Member Spotlights

Selected by: Michele Ganote

I enjoy the member spotlights! Everyone has different priorities and agendas based on the work they do, so it’s interesting to see what our members are focused on at any given time. Since there are numerous healthcare related projects happening in our community all the time, the spotlights remind me how much other work is being done to achieve better healthcare. I also enjoy learning why our members belong to the KHC and why they feel the KHC’s work is important. The best part of the member spotlights is getting to know someone outside of work. It’s fun to learn their favorite quotes, their guilty pleasures, favorite vacation spots, and what they like to do in their spare time. If you don’t read our member spotlights, I would encourage you to do so!

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

Selected by: Natalie Middaugh

My favorite blog post of 2019 was from Marcie Timmerman, Executive Director for Mental Health America (MHA) of Kentucky. Marcie’s post highlighted MHA’s Mental Health Month and its theme of #4Mind4Body to raise awareness about the connection between physical health and mental health. An emphasis on this mind-body connection is such an important piece of supporting both physical and mental wellness and recovery. Mental Health Month highlighted many ways to support this approach, including animal companionship, spirituality and religion, humor, work-life balance, recreation, and social connections. As someone who continually uses many of these approaches to support my own mental wellness, Marcie’s message of balance, practicality, and encouragement resonated with me.

Children’s Seven-County Health Initiative Serves as Model for Entire State

Selected by: Emily Divino

One of my favorite posts of the year was written by Ben Chandler, the President and CEO for the Foundation for a Healthy Kentucky. Ben writes about the amazing work being done by the Foundation’s community health initiative, Investing in Kentucky’s Future (IKF). The initiative has made amazing strides in increasing youth physical activity and improving student eating habits, among many other great accomplishments. Whether it was through helping create policy change or helping communities improve their built environments, the IKF initiative was able to address many of the various contributing factors that play a role in childhood obesity. To be honest, I was initially unfamiliar with the IKF initiative before reading Ben’s post, so it was inspiring to read about all of the great work that the initiative has accomplished.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Selected by: Stephanie Clouser

For our KHC Annual Conference, we transitioned to a new platform for audience members to ask questions and give comments, adding a new level of engagement. We had so many great questions that we didn’t have enough time to answer all of them, so we followed up with speakers and panelists in a special social media chat and blog post. This post marked the beginning of a higher level of dialogue with our events and initiatives that we will continue into 2020.

2020 April Pain Symposium

KHC Partners with IBM Watson Health to Develop Employer Benchmarks for Prevention, Treatment, and Recovery of OUD

The Kentuckiana Health Collaborative is a data-driven organization. For more than 15 years, we’ve led the way in driving healthcare quality and value of care through our measurement and transparency work, primarily through our annual quality healthcare reports. We know that you can’t truly address an issue without first understanding its components, often revealed through data. And this fall, the KHC dived deeply into data as part of our continued partnership in the Kentucky Opioid Response Effort (KORE), partnering with national data leaders to explore opioid use trends for Kentucky’s residents.

This fall, the KHC partnered with IBM Watson Health to develop benchmarks for key metrics related to the prevention, treatment, and recovery of opioid misuse and opioid use disorder. IBM Watson Health derived these benchmarks from MarketScan, a fully integrated drug and medical claims database that includes more than 350 carriers and 25% of U.S employer-sponsored healthcare beneficiaries. The benchmarks are specific to Kentucky and represent 22% of the state’s two million commercially insured members, ranging in age from 18 to 64. The claims covered service dates from January 2016 to December 2017 and were compared alongside national averages.

In November 2019, experts from IBM Watson presented the key findings and recommended next steps in a webinar to 44 attendees, including the opioid employer cohort and KHC members. Compared to national figures, the Commonwealth had a 12% higher opioid utilization rate in 2017, and while Kentucky saw a 4% decrease from 2016, national rates decreased by 8%.

In Kentucky, 8% of opioid users accounted for 62% of the opioid supply in 2017, and half of those individuals received enough supply to cover more than 360 days in the year, meaning they likely had overlapping prescriptions. In fact, the Kentucky annual average opioid supply per patient was 16% higher than the national average. While Kentucky received longer supply of opioids, they had lower utilization of high-dose opioids, meaning that the strength of the opioids prescribed was lower.

On the opioid abuse treatment side, Kentucky showed very positive results for use of medication assisted treatment (MAT), demonstrating higher prevalence of and adherence to MAT. Kentucky patients overall were less expensive for opioid abuse treatment.

In the webinar, IBM Watson outlined 18 key next steps for Kentucky’s employers, ranging from reducing stigma and expanding education to medication benefit design reform.

While 18 items to focus on might seem overwhelming, those items were categorized into the entity which is appropriate to take the lead on each of those items: either with health plans, provider groups, PBMs, or employers.

So how can employers utilize this data? For employers who can access their own data, the benchmarks are useful tools for them in determining where they lie. Are they above or below the average? Is this a positive or negative indicator? What changes can be made in response? For employers who do not have access to their data, the benchmarks can provide useful insight into Kentucky’s workforce and serve as loose representations of their own.

If interested in learning more detail about this data and key takeways, a recording of our November webinar can be viewed here. In the coming months, the KHC will be utilizing these benchmarks to develop resources for employers to be included in the Opioids and the Workplace toolkit. If you are an employer interested in learning more about how to retrieve or interpret your data, please contact Natalie Middaugh at nmiddaugh@khcollaborative.org or Stephanie Clouser at sclouser@khcollaborative.org for assistance.

KHC Moves to New Location

The KHC office has moved to the 31E Building at 1415 Bardstown Road.

The new year will bring with it some changes at the Kentuckiana Health Collaborative. As of December 16, the KHC has moved to a new location, in the 31E Building at 1415 Bardstown Road, Suite 300, Mailbox #19, in the Highlands. There will be a new funding structure moving forward for the KHC, and this move will allow us to continue the collaborative work we are best at while also adjusting to these changes.

Please note that we could possibly have some inconsistencies over the next few days as we transfer over our services. If you need immediate assistance, you can email one of our KHC team members or info@khcollaborative.org.

We look forward to continuing to work with everyone in the new year!

Louisville’s Syringe Exchange – Preventing HIV Transmission while Pointing to Recovery

(Note: This guest piece was written by Dr. Sarah Moyer, Louisville’s Chief Health Strategist and director of the Louisville Metro Department of Public Health and Wellness)

December 1 was World AIDS Day.

Louisville, like the rest of our region and most of our country, has been facing tremendous challenges brought on by the worst opioid epidemic in American history. One of those challenges has been protecting the community from HIV which can be spread when people who inject drugs share needles. When this happens, not only are drug users at risk, but so is the community.

Many people who do not use drugs are at risk for HIV because they are sexual partners of injection drug users. Pregnant women who inject drugs or who are partners of injection drug users run the risk of transmitting HIV to their children in utero.  HIV transmission can easily spread from those injecting drugs to the overall community.

Protecting the community from HIV was a primary consideration when Louisville created Kentucky’s first syringe exchange program in June 2015.  The small city of Austin, Indiana, just 35 miles north of Louisville on I-65, had an unprecedented new 235 HIV cases that year as a result of needle sharing among those injecting drugs. Given the relative populations of the two cities, Austin’s 235 cases would have translated to more than 36,000 new HIV cases in Louisville.

Numerous studies have found that syringe exchanges are successful in preventing the spread of HIV and other viruses such as hepatitis C. A series of three-year longitudinal studies investigating the effect of New York’s legalization of syringe exchange programs found that HIV prevalence fell from 50 percent to 17 percent.  The number of HIV cases linked to injection drug use in Washington D.C. dropped by 95 percent from 2001, prior to DC’s syringe exchange program, to 8 cases in 2015.

The CDC has released a study of 220 counties across the United States that are most vulnerable to outbreaks of HIV and hepatitis C based on factors such as overdose deaths, per capita income, unemployment and sales of painkillers. Fifty-four of those vulnerable counties are in Kentucky, mostly in the southern and eastern parts of the state.  The study said that there were 18 Kentucky counties that were even more vulnerable to spikes in HIV and hepatitis C than was Austin, Indiana.

The primary goal of Louisville’s Syringe Exchange program is to prevent the transmission of HIV, hepatitis C and other blood-borne diseases. The program brings people with opioid use disorder in contact with the healthcare system where they can be tested and treated for HIV and hepatitis C.  It provides free sterile syringes, HIV and hepatitis C testing, disease prevention supplies and education on wound care and proper syringe disposal.  It also provides life-saving fentanyl test strips and the overdose reversal drug naloxone.

The Louisville Metro Syringe Exchange Program also makes referrals to drug treatment. Our Syringe Exchange staff members have developed a bond of trust with the people they serve.  When someone is ready to enter treatment, they turn to our staff for guidance. National studies have shown that syringe exchange participants are five times more likely to enter drug treatment than drug users who do not use a syringe exchange.

Our Syringe Exchange program was also a valuable resource in fighting Louisville’s recent hepatitis A outbreak. People who were homeless as well as people who used drugs were at highest risk and much of our vaccination efforts was focused on them. Hepatitis A is not a blood borne pathogen that is spread by needle sharing as is HIV or hepatitis C, but the unsanitary conditions that drug users often find themselves in greatly increased their chance for contracting and spreading the disease during last year’s outbreak. Using our syringe exchange program combined with outreach to homeless camps and shelters, we gave more than 25,000 hepatitis A immunizations to these high-risk groups.  More than 100,000 immunizations were given throughout the city.

Since it began in 2015, Louisville’s Syringe Exchange program has expanded from a mobile unit parked outside of our headquarters to a site inside the building that is open six days a week. The program now also operates seven additional satellite sites at various locations throughout the city.

The numbers point to our success. Since it was created in June 2015 the program has served more than 20,000 unique participants with nearly 115,000 visits and has distributed more than five million sterile syringes. It has tested more than 3,500 people for HIV and referred 29 for treatment. The program has also tested more than 4,800 people for hepatitis C and referred nearly 700 for medical treatment.

We’ve also referred 719 people for drug treatment and more than 300 have been connected to other community services.

Louisville has averted the catastrophic rise in new HIV cases that Austin, Indiana experienced in 2015.  Rates of new HIV infection in Louisville have stayed steady. In 2014, the year before our syringe exchange opened, the rate of new HIV infection for the five-county area which includes Louisville, stood at 15.3 per 100,000. In 2017, the last year for which data is available, it stood at 13.9.

There has also been a glimmer of good news regarding the city’s opioid epidemic. According to the Kentucky Office for Drug Control Policy and the Jefferson County Coroner’s Office, overdose deaths in Louisville fell 21% last year, the largest decrease of any county in the state.

In 2017 the Department of Public Health and Wellness convened a wide-ranging group that included people in recovery, leaders of nonprofits, law enforcement, healthcare institutions, experts of social work, school officials, concerned parents and scholars. The resulting report, Coming Together for Hope, Healing and Recovery called for implementing specific science-based, best practice strategies to respond to substance use disorder in the city.  It is encouraging to see that some of our efforts are now beginning to bear fruit.

Louisville’s Syringe Exchange program is preventing the spread of HIV and other blood-borne diseases in while pointing program participants toward recovery. It has proven vital to keeping the city safe from infectious disease, while helping to control Louisville’s epidemic of opioid use disorder epidemic.

Tackling the Opioid Epidemic: The Unintended Consequences

(Note: This guest piece was written by Lori Earnshaw, MD FAAHPM HMDC, Senior Hospice and Palliative Medicine Physician, Associate Clinical Professor, University of Louisville Department of Medicine. All opinions are the author’s own.)

Every day, I think about the patients I have seen in my practice of hospice and palliative care. You may be surprised to learn that most of them wish they had met me sooner. Their reflections are based on years of suffering in pain that was not adequately addressed by our healthcare system.

I remember a single mom who was one of my first patients. She had juvenile rheumatoid arthritis that caused joint destruction and resulted in chronic pain. Her primacy care provider prescribed methadone to treat her pain, and her rheumatologist managed her disease with methotrexate. She was able to enjoy a productive and relatively pain-free life, while she worked two jobs and supported her son.

House Bill 1 passed in Kentucky in 2012. While it targeted pill mills and attempted to shape safer prescribing practices, the unintended consequences were soon obvious. Prescribing opioids became more challenging.

My patient’s PCP moved out of state but assured her that her colleague would prescribe methadone for her. This promise would not be fulfilled. Her pain escalated, and she struggled to work and care for her son. A friend told her about a methadone maintenance clinic, where she went to find relief. The problem was that she did not have a substance use disorder and was turned away. She was wiser by the time she attended the second clinic, where she obtained methadone after claiming addiction in order to relieve her pain.

After a screening mammography demonstrated a suspicious mass, she received a new diagnosis: breast cancer. The pathology report identified triple negative breast cancer, which is one of the most aggressive types. She met me in the hospital after her first chemotherapy caused complications, and my colleagues weren’t sure what to do about her pain management, given her methadone treatment.

My consultation resulted in a year-long relationship with her as she rotated from hospital to clinic. One of the nicest complimentsI received from her was also one of the most heartbreaking: “I guess something good came out of my cancer diagnosis.” She was referring to the effective pain treatment and support she received from palliative care and later hospice care.

What makes patients so desperate for pain relief that they would view having cancer as a positive? As lawmakers, policy makers, healthcare professionals, insurance companies, healthcare organizations, and law enforcement attempt to tackle the opioid epidemic, they create a stigmatizing and inefficient labyrinth that is nearly impossible to navigate.

The problem seems to get worse, not better. When the CDC came out with their 2016 “guidelines for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care,” they triggered a cascade of poor decision-making from the C-suite to the bedside. Kentucky adopted one of the recommendations in April 2017, which limited opioids for acute pain to a duration of three days, with the same exceptions listed above.

I have been in healthcare long enough to know that “guidelines” often become “standards” and “policies” from which prescribers are fearful to waiver. I can assure you that the 90-year-old grandmother who falls and sustains a compression fracture from osteoporosis will not make a full recovery in three days, nor will the trauma patient who suffers an amputation. Chronic pain is created from inadequate treatment of acute pain. Common sense and experience make these “guidelines” seem absurd when interpreted rigidly.

More Americans suffer from chronic pain than heart disease, diabetes, and cancer combined. Chronic pain is the number one reason that Americans seek medical care and impacts 11% to 40% of the U.S. population. Chronic pain is a complex biopsychosocial phenomenon and is labeled as “chronic” when it occurs at least half of the days for six months or more.

While the use of opioids in treating chronic pain has been blamed as contributor to the opioid crisis, the evidence suggests that opioid use disorder in chronic pain patients is not as pronounced as one may expect.

In one analysis, consistent exposure to opioid therapy in chronic pain patients led to addiction in 3.27% of patients. In patients who did not have a current or past history of use, abuse, or addiction, the rate of abuse was only 0.59%. Of 801 patients treated with prescription opioids in a primary care setting, only 3.8% met the criteria for opioid use disorders. My patient belonged the majority of chronic pain patients who do not have or develop an opioid use disorder because they are using opioids appropriately to treat their pain.

What the opioid epidemic should highlight for all of us is the elephant in the room: substance use disorder. Restricting access to opioids cannot be the sole focus of curbing the opioid epidemic, and this strategy fails to make a significant impact.

The national CDC data on overdose rates involving opioids mirrors that of Kentucky. Despite the efforts of House Bill 1, there was an increase in overdose fatalities in 2016, with the largest demographic of opioid deaths being adults ages 35-44. Autopsy and toxicology reports from 2016 showed that 47% of overdose deaths involved fentanyl (up from 34% in 2015) and 34% of overdose deaths involved heroin (up from 28% in 2015).

A University of Kentucky study found that individuals in state-funded treatment had an increase in heroin use of 2.4% per year after House Bill 1 was passed. Until the same fervor that prompted us to address the opioid epidemic is applied to substance use disorder, we will continue to inadequately impact the suffering of both patients with pain and those with addiction.

I hope that we are open to learning the important lessons that my patients have taught me. While we must take action in curbing opioid abuse and deaths, we must also compassionately treat those with pain and substance use disorder. The approach must be multi-faceted and acknowledge the uniqueness of each population and practice setting.

Solutions should include:

  1. Identifying and mitigating individual risk factors
  2. Identifying patients eligible for palliative care and hospice much sooner
  3. Utilizing available resources for treatment of both pain and substance use disorder
  4. Improving education for pain treatment and referral to specialists
  5. Providing funding for research and training of pain, addiction psychiatry, and palliative care specialists
  6. Advocating for a holistic, team-based approach that includes social determinants of health and the value of all health profession disciplines

Congress has markedly increased funding for research into opioid misuse and pain, with the National Institutes of Health nearly doubling its investment in finding solutions. When approaches are tried and fail to demonstrate an impact, they should be phased out. I would recommend starting with onerous insurance prior authorizations and restrictions on the prescribing of opioids that consume resources in already stretched-thin physician practices.

The unintended casualties of tackling the opioid epidemic are people. They are our brothers, neighbors, mothers, grandmothers, and coworkers. I have met many of them in my practice of hospice and palliative care, and I hear the disappointment and anger that they feel in not being treated with compassion, not being heard, and suffering without relief.

We must change our approach to the opioid epidemic. Unnecessary pain and suffering are the enemies.

National Diabetes Month 2019 – “Take Diabetes to Heart” by Promoting Diabetes Self-management Education and Support

(Note: This guest piece was written by Reita Jones, RN, KY Department of Public Health, Diabetes Prevention and Control)

According to the Centers for Disease Control and Prevention and the Kentucky Department for Public Heath, nearly 600,000 Kentucky adults are estimated to have diabetes. Of these, one in four don’t know they have it. Additionally, adults with diabetes are nearly twice as likely to die from heart disease and stroke. And for women with diabetes, the risks for cardiovascular disease are three to seven times greater compared with women who do not have diabetes. Thus, the 2019 theme for National Diabetes Month is “Take Diabetes to Heart”. This November and in the year ahead, you are encouraged to join organizations and communities across Kentucky to raise awareness about risk for this serious chronic health condition and the strong link between diabetes and risks for heart disease. You are also encouraged to share resources from links in this article and engage in discussion and action to make a difference in your client population and in the lives of people with diabetes.

Early Detection is Critical

First consider, could members of your family or client population be one of the four adults who have diabetes and don’t know it? Early detection and appropriate management are key in preventing or delaying devastating complications of poorly managed diabetes. How many times have you known of individuals seeking medical attention for a health problem that turns out to be a complication of diabetes and the diabetes had likely been present but undiagnosed for several years? Take steps now to engage and screen your client population at risk for diabetes or prediabetes, especially those who have not been seen for some time. See page 3, section 2 in the Standards of Medical Care in Diabetes – 2019, Abridged for Primary Care Providers for screening guidance. If you are not in a clinical setting, it is also a good choose to share the diabetes risk test with your network of influence, community and family.

Gaps in Diabetes Control and Cardiovascular Risk Reduction

Second, in bringing awareness around the strong link of diabetes and risk for heart disease, it is important to acknowledge that managing diabetes is much more than meeting blood glucose targets. Blood pressure and lipid management are equally important for reducing cardiovascular risks related to diabetes. However, despite many advances in therapies over the past 30 years, large gaps persist in cardiovascular risk reduction and heart disease management in people with diabetes. A January 2019 article with analysis of data in the U.S. Collaborative Diabetes Registry shows that only one in five individuals with diabetes meet appropriate targets for comprehensive cardiovascular risk factor control (ABCs – A1C, Blood pressure, LDL Cholesterol and non-Smoking status). Even fewer meet the recommendations for physical activity, healthy eating and body mass index.

Opportunity for Diabetes and Cardiovascular Improvement with DSMES

This low baseline, presents a tremendous opportunity for improvement in cardiovascular outcomes among individuals as well as populations of people with diabetes. Lifestyle management is a fundamental aspect of diabetes care and diabetes self-management education and support (DSMES) is the most comprehensive evidence-based intervention recommended in the latest American Diabetes Association standards of care for lifestyle management. It is an underutilized intervention which can be very effective in addressing the achievement gap for diabetes ABCs goals, especially considering that at least 90 percent of diabetes care is carried out by the person with diabetes or a family member.

DSMES services are an ongoing process to facilitate the knowledge, skill and ability necessary for optimal diabetes self-care. They include activities and tools that assist in implementing and sustaining the behaviors needed to manage diabetes. DSMES services incorporate the needs, goals and life experience of the person with diabetes and support informed and shared decision-making for active collaboration with healthcare teams to improve clinical outcomes over the course of a lifetime. DSMES services are provided by licensed/certified diabetes educators and are recommended at diagnosis, annually (based on assessment of education, nutrient and emotional needs), when new complicating factors arise and when transition in care occurs.

Benefits DSMES

Studies have found that individuals who attend ongoing DSMES are more likely to use primary care and preventive services or follow-up on treatment recommendations. DSMES attendance is also associated with improved self-care behaviors; lowered A1C, blood pressure, and cholesterol levels; lower self-reported weight; healthy coping; improved medication adherence and quality of life; and reduced hospital admissions, readmissions and healthcare costs. It is also important to note that outcomes associated with DSMES services have been shown to be dose responsive in that more DSMES leads to better outcomes. It may also be helpful to look at the benefits rating for diabetes education with the parameters utilized to evaluate medications.

Despite the well documented benefits and reimbursement for the service, reports indicate that only 5-7% of individuals eligible for DSMES through Medicare or a private insurance plan actually receive it. In addition, licensed/certified diabetes educators, who deliver the services (within an organization or in the community), are seldom included on the multidisciplinary care team that plays a critical role in managing diabetes and all the relevant risk factors.

Everyone Can Play a Role to Increase DSMES Participation

During National Diabetes Month and in the year ahead “Take Diabetes to Heart” by taking steps to become familiar with the accredited and recognized DSMES programs in the Kentuckiana region and your community. The Kentucky Diabetes Resource Directory is an easily accessible source to search for programs by county and surrounding counties in the state. All public and private insurance plans in Kentucky cover the DSMES service although, provider referral, deductibles and copayments may apply. Access to diabetes education is less abundant, and in some cases non-existent, in rural areas of the Commonwealth. To address this gap, the Kentucky Department for Public Health’s accredited DSMES program (Healthy Living with Diabetes), services 58 counties across Kentucky through 16 local or district health departments.

And lastly, you are encouraged to take action on the steps below, as applicable, to promote DSMES access and participation in your network of influence. Health systems, employers, health plans, public health, academic organizations, consumer advocacy groups, local pharmacies, diabetes sales companies, communities and individuals can all play an important role to help drive improvement in diabetes ABCs and cardiovascular outcomes.

Spotlight: Get to Know KHC’s Newest Employee

As the Kentuckiana Health Collaborative continues to add projects that drive health and healthcare delivery in the region, the coalition has hired a part-time staff member to support various projects. Emily Divino, the KHC’s new Project Administrative Assistant, was added to develop marketing and communication materials, support event planning, and provide administrative support to any ongoing projects of the KHC.

Emily, a Louisville native, earned a degree in Health Sciences from DePaul University in Chicago, but she has returned to the region and is currently pursuing a Master of Public Health at the University of Louisville, with a concentration in Health Promotions and Behavioral Sciences.

“I’m excited to support the efforts of the opioid employer cohort that is about to begin,” Emily said. “It will be interesting to see what results and future directions it will produce. Additionally, I’m interested in supporting future collaborative work between our members that will hopefully lead to some great new health initiatives to implement in the community.”

Related to healthcare, Emily is interested in reducing health disparities in marginalized communities, community engagement, program planning and women’s health and wellness.

A Little More About Emily

What do you like to do in your spare time?

I love listening to music, kayaking, hiking, and playing with my cat even though she hates me.

What is something people might find surprising about you?

I can juggle.

What are your favorite places to travel?

“I love exploring cities so travelling to New York City or Chicago is always fun. Hopefully I will be lucky enough to visit Tokyo one day!”

What is your favorite quote?

“Don’t count the days; make the days count.” – Muhammad Ali

If someone wrote a biography about you, what do you think the title should be?

“The True Life of a Punctual Procrastinator”

If Hollywood made a movie about your life, who would you like to see play you?

Sandra Oh because she is great in everything she does.