KHC Employer Co-Chair Leaves a Lasting Legacy

Eight years ago, I met Dr. Diana Han at a newly formed business coalition called the Greater Louisville Employer Health Advisory Committee. To my surprise and delight, Dr. Han was a primary care physician who was practicing advanced primary care, despite not having the infrastructure needed to provide whole-person care. And, she had the benchmark quality data to demonstrate that her processes were improving the prevention and management of chronic diseases. We were thrilled to find a local physician practicing patient-centered care at that time. After that initial introduction, the business coalition was absorbed by the KHC, and Dr. Han became the Global Medical Director for GE Appliances. We knew the KHC would benefit from her new role – but we didn’t realize truly how much our organization, and the community, would benefit from her passion, intelligence, and innovation.

While at GE Appliances, Dr. Han became a nationally sought-after speaker for her insight and vision for driving better health and healthcare within the workplace. She thinks about health and all of its complexities by addressing and optimizing systems that can drive better outcomes and quality of life for her workers and the business. Her passion for employee health and benefits made her a perfect fit to serve as the KHC Employer Co-Chairperson since 2017.

This month, Dr. Han left GE Appliances to pursue a new challenge and will no longer serve as Co-Chair of the KHC, although I’m sure she will continue to be a close friend to our organization and our efforts. We wish her the best in her new position and continue to root for her in all of her endeavors.

One of the most distinctive qualities about Dr. Han is her expectation that everyone receives equitable, exceptional (and I mean exceptional) care with optimal outcomes at an affordable price. It is this expectation for excellence that has helped the KHC advance its work to drive improvements to healthcare value and community health, especially around mental health and substance use disorder.

In addition to her knowledge and expertise, Dr. Han has played a key role in fundraising and is a passionate advocate for community collaboration. It cannot be overstated how much the KHC has grown in terms of scope of work, staffing, and fundraising with her as a Co-Chair over the last four years. Dr. Han has been a key visionary leader within the KHC, and I could not be more grateful for her partnership over the years. I have no doubt that she will make a big impact in her next role and that the KHC will continue to build on the legacy of her work to drive better health and healthcare in our community and state. 

Don’t Hesitate to Vaccinate

(Note: This guest blog post was written by Michael Kuduk, M.D., Pediatric Hospitalist)

I would like this to be the first blog post you have seen recently which does not mention COVID-19. However, issues surrounding COVID-19 have permeated every aspect of health care, none more so than vaccination, as many entities are holding hope that an effective vaccine will bring an end to the pandemic. Even if we can develop a safe, effective vaccine, there are no guarantees that the pandemic will end, especially if a significant percentage of the public opts not to receive the vaccine. Yet again, vaccine hesitancy and refusal suddenly have appeared in the national spotlight. Now might be a good time to reflect on what vaccines are capable of doing, as well as what they cannot accomplish.

I started my residency in 1989. During my intern year at Texas Children’s Hospital, at any given point in time there were two to three patients in the pediatric intensive care unit being treated for acute bacterial meningitis, and another twenty to thirty on the pediatric floors finishing up intravenous treatment. Acquired hearing loss was common in survivors, and, unfortunately, deaths from meningitis happened all too frequently. Our attending physicians made a special effort to train us to detect the early signs and symptoms of bacterial meningitis in all of our patient encounters. Especially terrifying were night time phone calls with moms of children who had high fever. Spinal taps were universal in patients with fever who appeared ill, and far too many were positive.

By the time my residency ended in 1992, everything had changed. The number of cases of bacterial meningitis we were seeing had dropped dramatically. In addition, other (at the time) common life threatening illnesses such as epiglottitis, orbital cellulitis, and many bone and soft tissue infections dramatically decreased. It seemed as much of what I was trained to diagnose and treat suddenly vanished. The reason – the HiB vaccine.

HiB, short for Hemophilus influenza type B, was the bacterial culprit behind many of these illnesses. Early HiB vaccines were pioneered in the mid 1980’s, and were used primarily in older children. In 1990, the vaccine was licensed for use in two month olds. Here’s what happened to HiB illness, per the CDC:

So – a single vaccine was able to completely change the face of pediatric infectious disease. Over the next fifteen years, vaccines would be introduced against major strains of Streptococcus pneumonia, as well as against Neisseria meningitidis, the other two major causes of bacterial meningitis. Now, bacterial meningitis is an unusual disease, and most middle of the night fevers end up being from viral infections. Pediatrics changed dramatically, almost overnight.

The HiB vaccine is safe and incredibly effective. Developing it was a lengthy process, taking almost ten years from start to finish, and dramatic improvement in disease did not occur until the vaccine became widely used in infants. Unfortunately, the world does not have ten years to wait for a COVID-19 vaccine. Fortunately, dramatic advances in molecular biology, genome sequencing, and computing power have drastically shortened the time needed for vaccine development. At this point, widespread COVID-19 vaccine availability for mid-2021 is a very realistic goal. While there are significant political and societal pressures to rush a vaccine to market, doing so with a vaccine which is not totally safe will undermine public confidence in vaccines in general, and will result in the increase of diseases which otherwise would be well controlled by vaccination, such as measles. Shortly after the initial polio vaccine was introduced in 1955, a manufacturing error occurred where live virus was included in what was supposed to have been a killed-virus vaccine. As a result, 10 people died and 170 were paralyzed. The world cannot afford to experience a similar incident with COVID-19.

During my years of private practice, I told this story to countless families who were hesitant to vaccinate their children. I was able to counter the theoretical fears which they found on line with my practical, real world advice. My world is different because of vaccines, in a very positive way. I can only hope that the vaccines in development for COVID-19 have the same effect.

A Snapshot of Viral Hepatitis in Kentucky, 2020

(Note: This guest blog post was written by Barbra Cave, PhD, APRN, Assistant Professor, University of Louisville)

Before SARS-CoV-2, the virus causing COVID-19, was at the forefront of our minds, three other viruses had had the attention of Kentucky’s public health officials and healthcare providers. As important as it is to address COVID-19 and the potential for significant, severe morbidity and mortality, it is also important to remember Kentucky’s other outbreaks.

In 2017, Louisville experienced an outbreak of hepatitis A that eventually spread state-wide that was not associated with contaminated food (Foster et al., 2018). Cases of hepatitis B have been increasing in rural areas, including Kentucky, Tennessee, and West Virginia since 2009 (Harris et al., 2016). Coinciding with the injection drug and hepatitis C epidemics, Kentucky ranked #3 in acute hepatitis B infection (CDC, 2019). With viral hepatitis seeming to flourish across the state, it is important to understand the main differences between the viruses and what we can do to address them.

NameVirus FamilyTypeTransmission
Hepatitis A VirusPicornaviridaeRNAFecal-oral (dirty hands touching things we put our mouth on) and parenteral (sexual contact, injecting drugs with shared equipment)
Hepatitis B Virus HepadnaviridaeDNAParenteral (sexual, mother-to-baby, contaminated tattoos, injecting drugs with shared equipment)
Hepatitis C Virus FalviviridaeRNAParenteral (mother-to-baby, contaminated tattoos, injecting drugs with shared equipment, sexual transmission may occur with men who have sex with other men or if someone has HIV)

Despite similarities in their common names, hepatitis A, B, and C come from distinct genetic backgrounds and virus families. However, each may cause a similar set of symptoms when someone is initially infected. The symptoms of a new viral hepatitis infection may include:

  • Fever
  • Abdominal pain
  • Nausea/vomiting
  • Diarrhea
  • Loss of appetite
  • Light colored stools
  • No symptoms at all 

The best approach to addressing hepatitis A and B is prevention through vaccination (Nelson et al., 2020). The 2017 hepatitis A outbreak was brought under control through increased hand hygiene access/awareness and mass vaccination efforts targeting key populations: healthcare workers, incarcerated persons, and homeless persons. Food service workers should be routinely vaccinated for hepatitis A. There is no specific treatment or cure for hepatitis A infection. Few people require hospitalization or die from hepatitis A infection; however, the risk for bad outcomes is increased when hepatitis B, C, or alcoholic hepatitis is present. Kentucky’s hepatitis A outbreak ended in July 2019 (KDPH, 2019).

Kentucky began recommending the hepatitis B vaccine at birth in 1991 and testing all pregnant women for hepatitis B infection in 1998 (KCHFS, 2017). Healthcare workers and those with high likelihood of blood exposure are encouraged to receive the vaccine series as part of their employment. Nonetheless, there remains a large number of young and middle-aged adults vulnerable to hepatitis B infection due to lack of vaccination and lack of awareness of how the disease is spread (Harris et al., 2016). If hepatitis B develops into a long-term infection, medications are available to treat the disease. Hepatitis B infections are associated with the development of cirrhosis (advanced liver disease) and hepatocellular carcinoma (liver cancer) (CDC, 2020). Unfortunately, many vulnerable adults do not receive hepatitis B testing and risk continued spread of the disease through sexual transmission and substance use (Harris et al., 2016).

Hepatitis C virus has no vaccine for prevention; however, it can be easily treated and cured with direct-acting antiviral medications. Most hepatitis C infections (80%) are associated with intranasal or injection drug use. The risk of having hepatitis C from substance use exists even if the episode of drug use occurred just once decades ago, or is part of someone’s daily life. Other sources of hepatitis C infection may stem from blood transfusions received prior to 1992, history of military service, or history of incarceration (AASLD, 2018).

As of January 2020, the CDC, USPSTF, and the American Association for the Study of Liver Disease and Infectious Disease Society of America updated hepatitis C testing guidelines to reflect universal testing of all adults at least once, and pregnant women with each pregnancy (AASLD, 2018; Shillie et al., 2020; USPTSF, 2020). It is easy to test for hepatitis C infection. If discovered, patients can be treated across Kentucky from primary care providers, addiction care providers, infectious disease specialists, gastroenterologists, or hepatologists. It is becoming increasingly easy to find someone to treat hepatitis C, and programs are underway in Kentucky to train non-specialists to manage the infection (Patrick, 2019). There are no longer rules preventing someone with ongoing/active substance use disorder from being treated right away.

In summary, Kentucky has endured simultaneous outbreaks of viral hepatitis over the past decade. We appear to have overcome hepatitis A, but remain especially vulnerable to hepatitis B and C propagation. Preventing hepatitis A and B is best through vaccination. When that is not possible or was not completed, screening, diagnosing, and treating viral hepatitis will help lead to case reduction and eventual elimination. Harm reduction strategies such as syringe exchange programs and provision of straight-forward disease transmission education are key to mitigating the spread of viral hepatitis. Although addressing the COVID-19 pandemic is a priority, we cannot forget to address the ongoing battles against hepatitis B and C in the context of the ongoing injection drug epidemic in our region.

References:

AASLD-IDSA HCV Guidance Panel (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases, 67(10), 1477–1492. doi: 10.1093/cid/ciy585

Centers for Disease Control (CDC) (2019). Surveillance for Viral Hepatitis- United States, 2017. Retrieved from https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm

Centers for Disease Control (CDC) (2020). Hepatitis B information. Retrieved from https://www.cdc.gov/hepatitis/hbv/index.htm

Foster, M., Ramachandran, S., Myatt, K., Donovan, D., Bohm, S., …& Jorgensen, C. (2018). Hepatitis A virus outbreaks associated with drug use and homelessness – California, Kentucky, Michigan, and Utah, 2017. MMWR. Morbidity and Mortality Weekly Report67(43), 1208–1210. doi: 10.15585/mmwr.mm6743a3

Harris, A. M., Iqbal, K., Schillie, S., Britton, J., Kainer, M. A., Tressler, S., & Vellozzi, C. (2016). Increases in acute hepatitis B virus infections – Kentucky, Tennessee, and West Virginia, 2006-2013. MMWR. Morbidity and Mortality Weekly Report65(3), 47–50. doi: 10.15585/mmwr.mm6503a2

Kentucky Cabinet for Health and Family Services (KCHFS). (2017). Perinatal hepatitis B. Retrieved from https://chfs.ky.gov/agencies/dph/dehp/idb/Pages/perinatal-hepatitis-b.aspx

Kentucky Department for Public Health (KDPH). (2019). Acute hepatitis A outbreak weekly report. Retrieved from https://chfs.ky.gov/agencies/dph/dehp/idb/HepADocuments/AHAO19W26.pdf

Nelson, N.P., Weng, M.K., Hofmeister, M.G., Moore, K.L., Doshani, … & Harris, A.M. (2020). Prevention of hepatitis A virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(5); 1-38. doi: 10.15585/mmwr.rr6905a1

Patrick, M. (2019, August). Conference speakers call for a more aggressive approach to eliminate hepatitis; Ky leads the nation in both hepatitis A and C. Kentucky Health News. Retrieved from http://ci.uky.edu/kentuckyhealthnews/2019/08/05/conference-speakers-call-for-a-more-aggressive-approach-to-eliminate-hepatitis-ky-leads-the-nation-in-both-hepatitis-a-and-c/

Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A. B. (2020). CDC Recommendations for Hepatitis C Screening Among Adults – United States, 2020. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports69(2), 1–17. https://doi.org/10.15585/mmwr.rr6902a1

US Preventive Services Task Force (USPSTF) (2020). Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association, 323(10):970–975. doi:10.1001/jama.2020.1123

Statement From the Officers, Executive Committee, and Staff of the Kentuckiana Health Collaborative

The tragic and senseless killings of Breonna Taylor, George Floyd, Ahmaud Arbery, and numerous others have punctuated the prominence of structural racism in the United States. Racism and prejudice are embedded into the culture, institutions, and policies of our society and have resulted in the repression, marginalization, and death of countless Black Americans. The Kentuckiana Health Collaborative (KHC) stands together with those seeking change and calling for the dismantling of these inequitable systems.

Structural racism against racial and ethnic minorities is a public health crisis. While health disparities have long been recognized as a public health concern, the continued display of discrimination and brutality against people of color calls for swift and decisive action to address health inequities and the effects of structural racism on health and well-being.

For nearly two decades, the KHC has worked to promote a better healthcare system where costs are reasonable, outcomes are exceptional, medical errors are minimal, and all patients are respected by providers that are energized and engaged in mission-driven work. Structural racism is present in the healthcare system. We are committed to working with the community to engage businesses and multiple healthcare stakeholders to create a healthcare system where your life expectancy and health outcomes are not determined by the color of your skin.

As a community, we must do more than acknowledge that Black Lives Matter; we must be willing to do the hard work to dismantle a culture and system of racism to make our community a safer and healthier place to live, play, pray, and work for all.

KHC Develops COVID-19 Data Dashboard for Kentuckiana

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

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

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

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

KHC Releases COVID-19 Testing Employer Resource Guide

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

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

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

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

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

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

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

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

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

 

Stephanie Clouser 

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

Emily Divino 

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

Natalie Middaugh  

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

 

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

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

Kentuckiana Health Collaborative Releases Community Measurement Reports, Collects Data on Opioid Prescribing

The Kentuckiana Health Collaborative is pleased to release the 2018 Community Measurement Reports, which also includes opioid prescribing data as part of the KHC’s partnership with the Kentucky Opioid Response Effort (KORE).

For the last 15 years, the KHC has led the way in healthcare quality measurement and transparency through Consolidated Measurement Reports, which allows for comparison to local and state averages and benchmark scores on the quality of care patients receive on a variety of ambulatory care indicators. The KHC is the only organization that combines Commercial, Medicaid, and Medicare Advantage data for quality reporting. The data also allows us to see where we have improved – or not – as a community in these key indicators of quality healthcare.

For the second year, the measures on the reports include all of the 2019 Kentucky Core Healthcare Measures Set for which there was available data and features a highlight of where the community performs well and where there are gaps in care. To access the full reports, click here.

OPIOID PRESCRIBING DATA SHOWS REGION AROUND THE NATIONAL AVERAGE

This year’s Community Measurement Reports feature two new measures related to opioid prescribing: Use of Opioids from Multiple Providers and Use of Opioids at High Dosage. The first measure looks at the proportion of patients who are getting opioids from multiple prescribers, multiple pharmacies, or both. Use of Opioids at High Dosage looks at the number of patients who received prescription opioids at a high dosage for great than or equal to 15 days during the year.

The information was collected as part of the KHC’s partnership with the Kentucky Opioid Response Effort (KORE), in which the KHC has partnered with national data leaders to explore opioid use trends for Kentucky’s residents. In November, 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. The results were discussed in a November webinar. If interested in learning more detail about this data and key takeways, a recording of our November webinar can be viewed here.

When we look at the KHC Community Measurement Report measures for opioid-related care, similar to the IBM Watson data, Kentucky and Kentuckiana fall near national averages.

Kentucky data shows opioid prescribing similar to national averages.

WEBINAR PLANNED FOR MAY 21

For more information on the opioid measures, as well as all the results of the 2019 Community Measurement Reports, register for a complementary KHC Webinar on May 21. The event will include an overview of these reports, the data, and a chance to ask the KHC questions. You can find more information about the webinar here.

Pain Symposium Kickstarts Employer Conversation on Advancing Comprehensive, Integrative, Evidence-Based Pain Management

At the peak of the opioid crisis in 2017, the Kentuckiana Health Collaborative identified substance use disorders and mental health as one of our top organizational priorities. Since then we have convened our community partners to develop several resources and educational opportunities to aid in addressing the crisis. Through this work, it became increasingly clear that as our national, state, and local communities have taken great strides in supporting from the prevention, treatment, and recovery from opioid misuse and opioid use disorders, there has been an increasing need to address the closely related issue of pain management. On April 22, stakeholders from across Kentuckiana came together virtually to explore the complex relationship between pain and opioids, opportunities and challenges for pain management in our current system, and what employers can do to begin driving improvement.

Striking a Balance  

The relationship between pain and opioids is multifaceted and has been long developing. The implications of inappropriate opioid use are apparent; however, opioids are also an incredibly effective method of treating pain in some clinical situations. Travis Rieder, PhD, Director of the Master of Bioethics degree program and Research Scholar at the Johns Hopkins Berman Institute of Bioethics, kicked off the day’s conversation by exploring this dilemma through his own experience as a trauma patient. Rieder’s story highlighted the conflict between undertreating pain as a result of fear and overprescribing opioids when trying to relieve pain. In his presentation, Rieder followed the polarizing history that our country has had with opioids over the past century – ebbing and flowing between periods of widespread use, then addiction, then abstinence, all the while perpetuating the harmful stigma that surrounds the drug. By using our history as a lesson, Dr. Rieder advocated that now is the time to resolve our attitude towards opioids and find a balance between prohibition and liberal use.

Stories such as Dr. Rieder’s highlight how opioids can be a valuable tool in the pain management “toolbox,” although they should not always be considered a first-line option. Appropriate prescribing and tapering practices must be implemented, alongside a compassionate, patient-centered approach that considers the biological, psychological, and social factors that contribute to pain.

Transforming the System

To manage pain, an individualized, multidisciplinary, and multimodal approach is demonstrated to be the most effective. Despite this, its implementation is often challenged by cultural and systemic barriers. Amy Goldstein, Director of the Alliance to Advance Comprehensive, Integrative Pain Management (AACIPM), led a panel of local providers to explore the biopsychosocial model of pain and what is necessary to make individualized, multidisciplinary, and multimodal pain management a reality. Danesh Mazloomdoost, MD, Founder of Wellward Regenerative Medicine shared the biology of pain management. Larry Benz, President and CEO of Confluent Health, highlighted the functional outcomes of pain management and promising advance in pain neuroscience. Molly Rutherford, MD, MPH, FASAM, Founder, Bluegrass Family Wellness, PLLC, shared her experience as a primary care physician and member of the Pain Management Best Practices Inter-Agency Task Force. Collectively, these providers painted a picture of what pain management should look like and what needs to happen to bridge the gap.

At the national level, there is a movement geared towards making comprehensive, integrative pain management a reality, and several organizations have done so with demonstrated positive outcomes. At the symposium, Goldstein presented on the AACIPM movement, a multi-stakeholder collaborative including purchasers, public and private payers, providers, people with pain, researchers, government, federal medicine, policy experts, patient/and caregiver advocates, and more. The work focuses on connecting the dots in shared interest to improve access to quality, safe, evidence-based, individualized pain care that is oriented to the whole person. As part of AACIPM, Goldstein was​ joined by Kavitha Reddy, MD, FACEP, ABoIM and Christine Goertz, DC, PhD to share how their organizations have implemented this approach to pain care. Dr. Reddy, who serves as the Whole Health System Clinical Director at VA St. Louis Healthcare System and National Whole Health Champion, Veterans Health Administration, shared the VA’s whole health system model of care and the impact the transformational effort is making on Veterans in VHA. Dr. Goertz, a Professor of Musculoskeletal Research at Duke University School of Medicine shared a model for spine care across a continuum of services, ranging from evidence-based patient education to state-of-the-art surgical techniques.

Making the Employer Case

The morning was spent with a clinical focus and set the stage for the afternoon’s employer-focused discussion. Randa Deaton, President and CEO of the Kentuckiana Health Collaborative, introduced the role of employers as key healthcare stakeholders, emphasizing how employers can re-position themselves to leverage best practices and take action to reduce costs, eliminate inappropriate care, and improve health outcomes. Erin Peterson, MPH, Researcher at the Integrated Benefits Institute (IBI) supported the benefits of such approaches by sharing IBI’s research on the impact of employee health on business outcomes and strategies on how the two interests can be aligned. IBI’s research on opioids and pain revealed that opioid use, whether appropriate or inappropriate, is a large driver of employee absence. However, their findings also revealed that three out of five employees used opioids to treat pain without misusing them, underscoring the larger issue of pain management in the workforce. Peterson’s guidance for employers centered on leveraging partner expertise, raising workforce awareness, preventing opioid abuse, and ensuring employee access to substance use disorder treatment.

With a clear understanding of the employer role in addressing these issues and the business impact of not doing so, the conversation moved towards using claims data and benefit design as a way for employers to act. Last 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. At the Pain Symposium, IBM Watson Health team members Katherine Haverty, MS Pharmacology, and Norah Mulvaney-Day, PhD, presented an update to these key metrics, revealing trends in the data from 2016-2018 and top strategies for each stakeholder type to improve pain and substance abuse management.

Taking Next Steps

As part of an ongoing relationship with the Kentucky Opioid Response Effort (KORE), the Kentuckiana Health Collaborative has developed a number of new resources for employers to continue catalyzing the improvement of prevention, treatment, and recovery of opioid misuse and opioid use disorder as well as the treatment of acute and chronic pain.

The “Opioids and the Workplace” toolkit has been re-released in an online, interactive version and can be found here. Additionally, the toolkit has been updated to provide best practice data analytic and healthcare benefit design recommendations for employers in advancing comprehensive, integrative, pain management. With these updates, employers can first first and foremost learn the basics of pain and information on why do we experience pain, how pain should be treated, and why it isn’t being treated appropriately. Employers will also learn what medical and pharmacy analytics they can evaluate in order to better understand how pain is being addressed among their health plan members. The updated benefit design recommendations will guide employers on what pain management modalities should be included in their health plan, along with what design considerations employers should make when including them. Last but not least, the KHC has developed a data analytics worksheet for employers to utilize alongside toolkit’s data analytics recommendations. This worksheet allows employers to input their own data and compare it alongside both Kentucky and national benchmarks.

For more information on the Pain Symposium, including speaker presentations, click here. For more information on the KHC’s Opioids and the Workplace initiative, click here or contact nmiddaugh@khcollaborative.org.

 

 

 

 

 

 

Dr. Teresa Couts Leaves Kentuckiana Health Collaborative After a Decade of Exemplary Leadership

KHC Co-Directors Teresa Couts and Randa Deaton

Dr. Teresa Couts and I have served together over the last decade as the Co-Directors of the Kentuckiana Health Collaborative (KHC) and Co-Directors of the UAW/Ford Community Healthcare Initiative (CHI). Teresa and I were often seen together and worked closely, as the nature of our work was joint in nature between the United Auto Workers (UAW) and Ford Motor Company. People confused us often, and we learned to answer to one another’s names. We even wondered if we should blend our names into “TerAnda” or “RandEsa.” We settled on “TerAnda.” Our dynamic duo ended on April 1, 2020, as Teresa transitioned back to Ford’s Kentucky Truck Plant for her next career move, albeit a bit delayed due to COVID-19.

Dr. Teresa Couts began her career with UAW/Ford Motor Company in 1995, serving in a variety of positions throughout her career. Teresa and I first began working together in the late ‘90s in Ford’s training department. For those of you who know Teresa, it will be unsurprising to hear that she emerged as a strong leader and a popular, effective, and engaging trainer. After I moved into a new role as the Director of the Family Center, Teresa became a board member of the center, so our work continued to cross paths in the early 2000s. In 2011, Dr. Teresa Couts became the third and final UAW Director of the UAW/Ford CHI, with me as the Corporate Director of the UAW/Ford CHI program.

The UAW/Ford Community Healthcare Initiative began forming and convening the Kentuckiana Health Collaborative (KHC) in 2001 and closed on March 31, 2020 after nearly 20 years of community health service to Greater Louisville. Teresa was responsible for convening and leading key healthcare stakeholders to collaborate on healthcare improvements focused on measurement, transparency, and transformation. Dr. Couts handled all of the KHC’s finances and membership along with many other key operational and leadership responsibilities. In her role, she was honored as a Medistar Healthcare Leadership Nominee in 2019 by Medical News, received the Leadership Award with the National Alliance of Healthcare Purchaser Coalitions in 2018, and received Louisville’s Commitment to Compassion Award by Insider Louisville in 2017. On March 11, 2020, the KHC honored Teresa with a “Leading by Example” award recognizing her years of dedicated service and leadership.

Teresa is known for her commitment to excellence, strength, resiliency, work ethic, leadership, uncanny memory, and “better than Google maps” skills. Her role cannot and will not be fulfilled by anyone, and I want to thank her on behalf of the entire KHC team for her exemplary leadership. Teresa will be greatly missed by the KHC staff, board, members, community, and certainly by me. Her early morning starts, willingness to do anything needed to get the job done, excitement about yummy vegan food, passion for sports and politics, beautiful smile, quick wit, and unconditional friendship will be missed. I thank Teresa for her partnership and friendship over the years. As Co-Directors, Teresa and I are proud of our accomplishments together, and the growth of the KHC will be part of Teresa’s lasting legacy.

As Teresa and I abandon “TerAnda” and reclaim our respective names, we will learn to adapt to our new and separate, yet familiar, roles. When office work returns to “normal,” we will notice the office a bit dimmer without Teresa’s light. I wish Teresa continued success in her next career chapter and look forward to the day we can connect again in person for some amazing food, drinks, family updates, and new and old stories that only old co-workers can appreciate.