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.

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

I have a confession to make. One that I’m embarrassed about.

October is breast cancer awareness month, a month where we see more pink than usual – on everything from cereal boxes to athletes’ gloves and shoes on the football field. And I used to roll my eyes at all of it. I mean, all of this money being spent on pink accessories that raise “awareness” but don’t necessarily raise money for research or treatment! What a waste!

That was before I worked in healthcare.

I joined the Kentuckiana Health Collaborative four years ago as the data scientist, and as a result, I’ve learned that with appropriate screening according to clinical guidelines, certain cancers, including breast, cervical, and colorectal, can have better chances for survival or even be prevented completely. “Awareness” isn’t some fluffy idea without true impact. It can save lives.

EARLY SCREENINGS RECOMMENDED FOR HIGHER RISK GROUPS

Approximately one in eight women will develop breast cancer in her lifetime, according to the American Cancer Society. Breast cancer is the second most common newly diagnosed cancer and second leading cause of cancer death among women in the U.S. Many factors play into an individual’s odds of developing breast cancer, including genetics, diet, age, and more.

There is a special emphasis on appropriate screening and early detection of breast cancer, because when breast cancer is detected early, there are more treatment choices and better chances for survival. The five-year survival rate for women who are diagnosed at Stage 0 or Stage I cancer is nearly 100 percent, while women who aren’t diagnosed until Stage IV only have about 22 percent five-year survival rate.

Current screening guidelines dictate that women ages 50 to 74 should have a mammogram at least every two years. But screenings are recommended earlier than 50 for certain groups, such as African-American women or women with a gene mutation known as BRCA.

BREAST CANCER AWARENESS TAKES MORE PERSONAL MEANING THIS YEAR

You’ve probably heard of the BRCA gene mutation, even if you didn’t know that that’s what it is called. Actress Angelina Jolie put the national spotlight on this mutation in 2013, when she announced that she had the BRCA gene mutation and, as a result, underwent a double mastectomy to reduce her chances of developing cancer. Approximately 1 in 500 women has the mutation, which makes them much more likely to develop breast cancer – estimates range from 55 percent to 85 percent lifetime risk for breast cancer for women with the mutation.

And these women with the BRCA gene mutation often develop cancer much earlier than the typical minimum screening age guidelines of 50 years old. Earlier this year, my dear friend, at just 33 years old, experienced a bit of pain when her kids laid on her chest. Even with no other symptoms, her healthcare provider recommended a screening, and they found a nine-centimeter tumor in her breast. She was found to have the BRCA gene mutation, and since then, two of her sisters have also tested positive for the mutation. By taking the proper steps, her sisters can drastically reduce their chances of developing breast cancer.

Breast cancer awareness month this year takes on a special meaning for our friend group, as she starts chemotherapy next week after having a double mastectomy in August. I’ve read more books and articles on cancer and chemotherapy than I ever thought I would, and much of our time is spent coordinating transportation, meals, donations, and distractions. There are lighter moments, too, spent laughing about the more outrageous aspects of cancer.

No longer do I eschew breast cancer “awareness,” now that I’m more informed about the impact that early intervention has on outcomes. This month, and in the following Octobers, count me in for awareness efforts.

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

(Note: This guest piece was written by Ben Chandler, President and CEO, Foundation for a Healthy Kentucky)

Ben Chandler

A Foundation for a Healthy Kentucky community-driven children’s health initiative called “Investing in Kentucky’s Future” (IKF) strengthened cross-sector coalitions in seven Kentucky counties. The initiative also improved student eating habits, increased youth physical activity, trained teachers to support students experiencing trauma, and increased youth resilience. The six-year, $2.4 million initiative also led to the adoption of 38 local ordinances and policies to help sustain the improvements and promote health equity long-term.

The IKF initiative supported demonstration programs in seven Kentucky counties and was designed to reduce the risk that school-aged children will develop chronic diseases later in life. The communities contributed another $1.7 million in matching funds under the initiative, which reached nearly 13,000 students in 28 participating schools.

Unlike most philanthropic grants, the IKF initiative’s community-driven approach allowed the local coalitions to choose the topic on which they wanted to focus, and then funded a one-year planning phase during which the Foundation also provided training and technical assistance in the development of a business plan. This made the grant program more accessible to small communities with fewer resources. The Foundation also required Coalition members to attend twice-yearly trainings it provided with national and state experts in areas such as youth engagement, health equity, developing policy and influencing policymakers.

Six of the Foundation’s IKF grantees – in Breathitt, Clinton, Grant, McLean, McCracken and Perry Counties – selected childhood obesity prevention as the issue they would address through the initiative. The Jefferson County coalition focused on Adverse Childhood Experiences (ACEs) and building resilience in children who have faced trauma. Both issues are complex and influenced by a variety of biological, behavioral, social and environmental influences, so they require the cross-sector approach that coalitions can bring. Participants told the Foundation that identifying a local champion and engaging the school system were critical to success in each of the counties. But by far the most decisive factor was ensuring that the local health coalition included multiple members from a broad range of community organizations – schools, hospitals, elected officials, youth groups, and businesses. It takes more time to get everyone aligned but the resulting collaboration makes all the difference in creating long-term change to improve health.

School-based interventions were ideal for both obesity prevention and ACEs because kids spend more than 1,000 hours a year and consume up to half their daily calories at school. The Foundation has now launched a statewide school-based health coalition to share and implement some of the lessons learned in the IKF initiative; the steering committee for that coalition will begin meeting soon.

Among the IKF initiative’s successes:

  • Policy change: A total of 38 local policies were adopted by the communities at the county, city and organizational levels.
    • Policies related to childhood obesity prevention expand physical education in middle school, require future streets to be usable by walkers and cyclers as well as cars, allow school fitness equipment to be used by the community after school, and make healthier foods available in schools and park concession stands.
    • Policies that support resilience in children include requiring trauma-informed training for all Jefferson County Public Schools (JCPS) and ACEs training certification for out-of-school youth care workers and agencies that receive funding from Metro Louisville’s Office of Youth Development.
  • Built Environment: Additions including new parks, fitness equipment, sidewalks and walking paths, playgrounds, filtered drinking water fountains, community trails and standing desks in schools. Many communities leveraged the Foundation grant to secure additional funding. For example:
    • Purchase Area Health Connections-Paducah Chapter secured another $400,000 Rotary Club grant to build a playground at the health park developed with IKF funding, and then another $500,000 donation to build a second phase of the park.
    • Sidewalks to school that were built in Grant County will be included as part of a 48-mile trail system under development thanks to a follow-up grant from Interact for Health.
    • FFLAG in Grant County also worked with five elementary schools to win another grant to fund additional outdoor play equipment for students.
  • Expanded Engagement by youth, parents and members of the community in health coalitions that develop health events, farmers markets, and school-based clinics. Several coalitions incorporated youth as members or established youth councils.
  • Increased Physical Activity and Improved Nutrition for more than 90 percent of the students in participating elementary and middle schools in the counties where obesity prevention was the focus. Among the programs:
    • Many schools incorporated classroom movement activities and standing desks.
    • Many schools eliminated deep fryers in their cafeterias, installed filtered drinking water fountains, and partnered with local farmers’ markets in farm-to-school programs that brought fresh produce to students.
    • All six coalitions began or expanded student food programs over the weekends or the summers.
    • Most students reported that school was their only source for fruits and vegetables; offering produce at snack time “appears to be a successful strategy” to increase consumption, the report found.

Additional gains specific to the trauma resilience-building model program implemented by the Bounce Coalition in Louisville, included:

  • A 56 percentage-point improvement – from 30 percent to 86 percent – among participating Jefferson County Public Schools teachers and staff who felt they could be effective in supporting students who are experiencing traumatic events in their lives.
  • Improved school climate in all nine areas measured
  • Parent conferences increased 195 percent from 2014 to 2017.
  • Teacher retention improvement, from 87.8 percent in 2014 to 90.2 percent in 201

Bounce also leveraged the Foundation grant to gain support from the Kentucky Department for Public Health for gatherings with community leaders to discuss ACEs and practical strategies for building resilience and provide training for healthcare providers and other organizations to foster resilience-building practices in several neighboring communities.

A full report regarding the Foundation’s IKF initiative is available on its website. Two videos produced by the Foundation also are available: the obesity prevention video can be found here and the ACEs video can be found here.

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

Stephanie Clouser

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

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

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

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

Packed Agenda Highlighted Measurement Alignment Opportunities and Challenges

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

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

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

Path Forward is Challenging but Promising

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

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

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

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

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

Kentucky Core Healthcare Measures Set Expands to 38 Adult and Pediatric Primary Care Measures

Stephanie Clouser

After a summer of deliberations by committees, the 2019 Kentucky Core Healthcare Measures Set has been finalized, increasing the number of core measures from 34 to 38.

The final vote resulted in the removal of three measures, addition of seven measures, and the upgrade of two measures from “standard” priority to “high” priority. Measures added include opioid treatment agreement, progress towards depression remission, diabetes blood pressure control, childhood and adolescent well care visits, HPV immunization, and patient experience. Measures related to diabetes and cardiovascular disease medication adherence and bronchitis antibiotic avoidance have been removed.

This year’s update ensures that the measures on the core measures set are current, relevant, and sound. The Kentucky Performance Alignment Committee – or PMAC – and its subcommittees have spent the last months reviewing the current measures set, examining potential measures for addition, and confirming or questioning the current measures’ relevance.

The core measures set was developed and released through a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The core measures set is focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization.

MEASURE UPDATES INCLUDE ‘STRETCH’ MEASURES TO DRIVE HEALTH OUTCOMES IN THE COMMONWEALTH

In 2018, the PMAC team chose a few “stretch measures” that might have had a few more challenges to them but ultimately were important to impacting the health of Kentuckians. This year, the committee and subcommittees chose a few more of those stretch measures, including Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents and Depression Response at Twelve Months – Progress Towards Remission. The data extraction required of these measures makes them more challenging to measure.

The full list of changes is as follows:

  • Add Documentation of Signed Opioid Treatment Agreement
  • Add Adolescent Well-Care Visits
  • Add Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Add Comprehensive Diabetes Care: Blood Pressure Control
  • Add Depression Response at Twelve Months – Progress Towards Remission
  • Add CG-CAHPS
  • Modify Immunizations for Adolescents to break out HPV
  • Upgrade Comprehensive Diabetes Care: Nephropathy to high priority
  • Upgrade Comprehensive Diabetes Care: Nephropathy to high priority
  • Remove Medication Adherence for Diabetes
  • Remove Medication Adherence for Cardiovascular Disease
  • Remove Antibiotic Avoidance in Adults with Acute Bronchitis.

You can find the complete list of 2019 KCHMS measures here. For more information on the core measures set, click here.

COMMUNITY HEALTH FORUM WILL HIGHLIGHT NATIONAL AND REGIONAL ALIGNMENT EFFORTS

The 2019 KCHMS will be rolled out at a KHC Community Health Forum on September 10, “Driving Health Improvements Through Measurement Alignment.” The Forum will highlight national and local measurement alignment efforts aimed at reducing measurement burden, improving focus, and ultimately measuring what matters most to patients.

Chinwe Nwosu, America’s Health Insurance Plans, will discuss the advancement of quality measurement and improvement through core measures sets. Nwosu, the project manager for the Core Quality Measures Collaborative (CQMC), a broad-based coalition of health care leaders convened by America’s Health Insurance Plans (AHIP) starting in 2015. It includes Centers for Medicare and Medicaid Services (CMS), the National Quality Forum (NQF), health insurance providers, medical associations, consumer groups, purchasers (including employer group representatives), and other quality collaboratives. The KHC joined this collaborative in recent months. CQMC members work to identify Core Measure Sets – parsimonious sets of scientifically sound measures that efficiently promote a patient-centered assessment of quality and should be prioritized for adoption in value-based purchasing and alternative payment models.

Faith Green, Humana, will also talk about her organization’s journey to align their measures across product lines. KHC’s Stephanie Clouser will introduce the 2019 KCHMS. The morning will end with an expert panel discussion about the current landscape and future of healthcare measurement in the Commonwealth and will include:

  • Jenny Goins, Commissioner, Department of Employee Insurance, Kentucky Personnel Cabinet
  • Michael Hagen, Professor, Dept of Family and Community Medicine, University of Kentucky
  • Amy Mattingly, Provider Collaboration Director, Anthem Blue Cross and Blue Shield of Kentucky
  • Angela Parker, Director, Program Quality and Outcomes, Department for Medicaid Services
  • Rachelle Seger, Community Health Research Officer, Foundation for a Healthy Kentucky

The Forum will take place from 7:30 a.m. to 10 a.m. on Tuesday, September, 10. As always, registration is free for individuals who work for a KHC member organization and $35 for anyone else. For more information on the Forum, click here.

More information on the core measures set, including future areas of development, will be shared in the future.

HPV Vaccination – An important, but Neglected, Piece to Adolescent Vaccine Series

(Note: This guest piece was written by Elizabeth Holtsclaw, MA, Health Systems Manager, State & Primary Care Systems, American Cancer Society)

Remember in elementary school when one of the first assignments of the new school year was to write an essay titled: How I Spent My Summer? In the spirit of the back-to-school season and recognizing August as National Immunization Month, I’d like to share how I spent my summer: Advocating for the HPV vaccination in Kentucky.

The American Cancer Society, along with the Kentucky Department for Public Health and other stakeholders and health care systems, convened community and healthcare leaders in Paducah, Louisville, Lexington and Somerset for roundtable discussions about the need for increasing HPV vaccination in the state. These HPV roundtables not only served as networking and professional development opportunities, but also helped increase awareness of the issue, and served as a catalyst for best practice sharing and idea generation on ways to close the HPV immunization disparity gap. We’ve challenged each region to develop their own SMART goals that will work in their area to increase HPV vaccination.

And that disparity gap? It’s significant. But first, a little about the vaccine.

HPV vaccination is cancer prevention

The Human Papillomavirus (HPV) is a very common virus that can lead to cancer-causing infections. In fact, every year 33,000 people are diagnosed with HPV cancers. The HPV vaccine prevents six types of cancer – cancers of the cervix, throat, anus, penis, vagina and vulva – and is expected to prevent 90% of HPV-related cancers when given before a child is exposed to the virus. 

The two-shot HPV vaccine series is best given to boys and girls at ages 11 or 12, which is generally before they are exposed to the virus and when their immune systems can provide the most protection. That’s also the age when parents are usually taking adolescents in for their meningococcal and Tdap (Tetanus, Diphtheria and Pertussis) vaccinations, so getting Kentucky adolescents vaccinated against HPV should be simple, right?

So there’s a vaccination that can prevent cancer, but people aren’t getting it

The CDC recently released its latest report from the National Immunization Service-teen (NIS-teen) survey, a national survey which gathers information on vaccination rates of 13-17 year olds in the US. You can find the report in the Morbidity and Mortality Weekly Review. The report shows that the rate of 13 to 17-year-olds with one dose of the HPV vaccine increased slightly, from 65.5% in 2017 to 68.1% in 2018, and the rate for series completion increased from 48.6% to 51.1%. However, these increases were only seen in males.

And here’s the thing about that disparity in Kentucky: Kentucky falls below the national average on HPV vaccination. We know that adolescents are getting their other vaccines (Tdap at 84.9% and meningococcal at 84.4%) but not getting the HPV vaccine (first dose of HPV is 56.9% and up-to-date vaccination is 42.6%. You can view this in the MMWR supplemental table.

Here’s a snapshot:

  • According to the Kentucky Cancer Registry, Kentucky has the highest HPV-related cancer burden in the nation
  • The Centers for Disease Control (CDC) National Immunization Survey indicates that Kentucky is 49th in the nation for HPV vaccination
  • Only 42.6% of Kentucky adolescents are up to date on completing the HPV two-shot series, which is below the national average of 51.1% (68.1% of adolescents age 13-17 have received the first dose of the series)

Why the gap?

Reasons for the vaccination gap vary, depending on a multiple factors – parents feel their child isn’t sexually active yet at age 11 or 12 and are not in need of the vaccine, or they aren’t aware of the vaccine at all – but research tells the biggest factor that leads to parents getting their children vaccinated is simply the clinician recommending it. The MMWR data referenced above emphasized the importance of a provider recommendation as HPV vaccination rates for adolescents whose parents reported receiving a provider recommendation were 28 percentage points higher than those who did not.

That’s right: Parents receiving the physician or nurse practitioner’s recommendation of the vaccine – on the same day and in the same way as other vaccines – were more likely to make sure their children were vaccinated. In fact, studies show parents value the HPV vaccine equally with other vaccines … they just need to hear the endorsement of the provider as a prompt to action. Parents need to know that the vaccine is cancer prevention, but they also want reassurances that the vaccine is safe, effective and lasts.

That seems simple enough, right?

Of course clinicians may not be comfortable recommending the vaccine if they have questions of their own, and the HPV Roundtable discussions have shown that even some healthcare providers feel like they need more information about the vaccine. More information about HPV, the vaccine, and guides for healthcare providers can be resourced at cancer.org/hpv.

And I also encourage parents or members of the community who have questions or concerns to visit cancer.org/hpv and get the facts. As a parent, I have one more task on my to-do list this summer: to get my 11-year-old son his HPV vaccination this week, along with his other adolescent vaccines. And I can assure you his passionate mom will be taking photos of him the whole time. These pictures will join the ones I have shared on social media of my 13-year-old daughter who completed the two-shot series, to show Kentucky that I want to protect all of Kentucky’s children as I have my children.

Here’s what you can do

The data is clear that a strong provider recommendation is the key to a successful increase in HPV vaccination rates.

  • Bundle your adolescent vaccine recommendation “Your child is here today for three vaccines. These will help protect her from meningitis, HPV cancers and pertussis.”
  • Engage all office staff in your commitment to increasing HPV vaccines in the office.
  • Let’s be creative in engaging diverse provider groups in this work; Pediatricians, family practice doctors, OB-GYN, dentists, orthodontists, school districts and communities.
  • There are ways to talk to parents, such as motivational interviewing or a presumptive recommendation, that are proven to help them feel comfortable in vaccinating their children.
  • Know your own data! What is our state data? Your county and school system data? Your clinic data as a whole and the individual provider data? Because HPV is not a mandated vaccine, it’s not always a priority for reporting and data collection. We often THINK we are doing better than what’s really happening.
  • Engage in our regional Roundtables and within your networks to make HPV vaccination a priority. Contact me at elizabeth.holtsclaw@cancer.org to find out more.

The opportunity we can’t miss

We have an opportunity in Kentucky and the rest of the nation to see almost immediate reduction in adverse health outcomes related to the HPV virus. Very rarely in public health are we able to see such immediate and dramatic improvements such as is being seen in areas with high vaccination rates. It’s incredibly exciting and I welcome the energy we’ve seen across the state this summer.

As summer winds down, the American Cancer Society plans to keep the conversation about HPV vaccination going, as well as continue the momentum the Roundtables have begun. Additional Roundtables are scheduled for Hazard, Bowling Green and Morehead with other activities in London and Prestonsburg in the coming months. There is an energy and excitement in each of these communities and we sincerely hope it will translate to a healthier future for Kentucky.

Together – as a community, as parents, as healthcare providers – we can truly make this a summer to be remembered in the fight against cancer.

Call for Public Comment: Proposed Changes to KY Core Healthcare Measures Set

2018 KY Core Healthcare Measures Set

Modifications are being made to the Kentucky Core Healthcare Measures Set (KCHMS), and healthcare stakeholders throughout the Commonwealth are invited and encouraged to review and comment on those submissions during a public comment period that will run through August 9.

In 2018, the core measures set was developed and released through a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The 2018 core measures set includes 34 unique measures, focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization.

This year’s update will ensure that the measures on the core measures set are current, relevant, and sound. The Kentucky Performance Alignment Committee – or PMAC – and its subcommittees have spent the last months reviewing the current measures set, examining potential measures for addition, and confirming or questioning the current measures’ relevance.

This week, the subcommittees presented their final recommendations to the PMAC Oversight Committee, which will finalize the 2019 KCHMS measures on August 20.

If all recommendations are accepted, the core measures set will increase from 34 measures to 39. Measures that would be added include opioid treatment, depression treatment, diabetes blood pressure control, childhood and adolescent well care, and patient experience measures. Measures related to medication adherence and antibiotic avoidance would be removed.

Any healthcare stakeholder is invited to provide feedback for the PMAC Oversight Committee on these recommendations. The public comment period will close August 9, and you can find details on the proposed changes and public comment form here.

PRESS RELEASE: Randa Deaton Elected to National Alliance of Healthcare Purchaser Coalition Board

Press Release from National Alliance of Healthcare Purchaser Coalitions

 

 

 

National Alliance of Healthcare Purchaser Coalitions Elects New Board Officers

WASHINGTON July 15, 2019 The National Alliance of Healthcare Purchaser Coalitions, a non-profit network of business coalitions across the country, announced its slate of new officers for the Board of Governors. Officers are elected by their board peers based on proven leadership and commitment to the National Alliance, as well as their efforts to advance and strengthen value-based purchasing strategies.

The newly elected officers are:

• Cristie Upshaw Travis, CEO, Memphis Business Group on Health – Chair
• Gaye Fortner, President and CEO, Healthcare 21 Business Coalition – Vice Chair
• Chris Syverson, CEO, Nevada Business Group on Health – Secretary-Treasurer
• Randa Deaton, Co-Executive Director, Kentuckiana Health Collaborative
• Neil Goldfarb, President and CEO, Greater Philadelphia Business Coalition on Health

“The National Alliance’s tools and educational programs prepare coalitions and purchasers to leverage their collective influence to bring meaningful change in our healthcare system nationally and in markets across the US,” said Cristie Upshaw Travis, CEO of the Memphis Business Group on Health and Board Chair. “I am excited to work with this strong Board and coalition leaders that bring expertise, experience and passion to move the market toward value-based purchasing so purchasers can obtain the highest quality care at the most reasonable cost.”

Gloria Sachdev, President and CEO, Employers’ Forum of Indiana, was elected as a Representative to the Board. Chris Skisak, Executive Director, Houston Business Coalition on Health, and Robert Smith, Executive Director, Colorado Business Group on Health, were re-elected as Representatives to the Board.

Continuing to serve their terms on the Board:

• Jessica Brooks, Chief Executive Officer, Pittsburgh Business Group on Health
• Christopher Goff, CEO and General Counsel, Employers Health
• Diane Hess, Executive Director, Central Penn Business Group on Health
• Cheryl Larson, President and CEO, Midwest Business Group on Health

There are four external board members and two are continuing second terms – Leah Binder, President and CEO, The Leapfrog Group, and Paul Fronstin, Director of the Health Research and Education Program, Employee Benefit Research Institute. Two newly elected members are:

• Lynn Quincy, Director, Healthcare Value Hub, Altarum
• Christa-Marie Singleton, Senior Medical Advisor, Centers for Disease Control and Prevention

“The National Alliance is fortunate to have the participation of these industry experts as we continue to lead and leverage efforts to promote transparency, reward and recognize value and performance, improve health and access to care, and facilitate alternative payment methodologies,” said Michael Thompson, National Alliance President and CEO.

Annual Forum

Convening employers, policymakers, business coalition leaders and other healthcare stakeholders, the National Alliance will host its Annual Forum, November 11-13, 2019 at the Marriott Wardman Park in Washington. Registration and sponsorship information can be found here.

About National Alliance of Healthcare Purchaser Coalitions

The National Alliance of Healthcare Purchaser Coalitions is the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value across the country. Our members represent more than 12,000 employers/purchasers and 45 million Americans spending over $300 billion annually on healthcare. To learn more, visit nationalalliancehealth.org or connect with us on Twitter or LinkedIn.

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

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

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

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

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

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

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

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

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

To learn more about getting involved, email 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.