Wednesday, August 27, 2014

Health-board smoking bans that Supreme Court struck down are still being obeyed: 'Everybody loves it,' advocate says

By Melissa Patrick
Kentucky Health News

Three counties in Kentucky with unenforceable smoking bans continue to be smoke-free by the people’s choice.

Clark, Madison and Woodford counties have smoking bans that can’t be enforced because they are regulations of county health boards, which the Kentucky Supreme Court ruled in June do not have the power to ban smoking in public places. But officials in each county reported that most of the establishments in these counties continue to be smoke-free by choice.

“We are finding, in general, public spaces and restaurants are still complying with regulations as if it is still enforceable,” said Christie Green, public-information officer for the Madison County Health Department. “It seems as if the general public prefers this.”

In Versailles, the city council “hadn’t heard from one single tax-payer who is opposed to it,” recently resigned city council member Sonny Jones said in an interview before his resignation.

Scott Lockard, director of public health in Clark County, said likewise. “The community has remained smoke free. The public has demanded this, ” he said, and as far as he was aware “No businesses have gone backward in this.”

That doesn’t surprise Ellen Hahn, director for the Kentucky Center for Smoke-Free Policy and the state’s leading smoking-ban advocate. “When communities go smoke free, everybody loves it,” she said.

The anti-smoking regulations can’t be enforced, advocates said. “If enforced, a lawsuit might result,” Lockard said. “We have no active enforcement right now in Clark County.”

The court ruled in a case from Bullitt County, where a local judge had blocked enforcement.

Each of the other counties is handling the issue somewhat differently.

Woodford County, out of “respect for the cities” of Midway and Versailles, will let them determine whether they want to reinstate their previously enacted smoking bans before the county fiscal court makes a decision for the unincorporated area of the county, County Attorney Alan George said, “because the bulk of the affected business is in the city.”

Midway passed a new anti-smoking ordinance Aug. 18 and Versailles plans to hold its first reading on one Sept. 2.

Madison County plans second reading and passage of its smoking ordinance for Sept. 9. Berea is scheduled to do likewise Sept. 2.

Clark County has “no forward actions” or “no ordinance drafted” at this time, Lockard said. Asked if officials are waiting on the Nov. 4 election to move forward, he said that “no one had come out and said the election will play a role,” but he noted that the Winchester mayor and the county judge-executive have opponents.

The Supreme Court ruling was a great disappointment to smoke-free advocates. Betsy Janes, coordinator for Smoke Free Kentucky, said several health boards had been ready to implement smoke-free regulations, but were waiting on the Supreme Court. These plans obviously have had to change.

“It was a major blow, but the good thing is that it is very clear who has the authority to do this now,” Janes said. “Fifty-five percent of Kentuckians want to be smoke free. We are losing 1000 Kentuckians a year to second hand smoke,” based on research that has determined its effects.

While Hahn said the decision was a “step backwards for Kentucky,” she also said her center is “busier than ever” working with fiscal courts to create smoke-free laws on the local level. She said there are 35 city or county ordinances in effect, covering 31 percent of Kentuckians.

The Kentucky Chamber of Commerce supports statewide smoking ban, which has never come to a vote in either chamber of the legislature.

“Twenty-four other states have statewide smoke-free laws and we want to not be the last to join them,” said Ashli Watts, the chamber’s public-affairs manager.

While Clark County is not pursuing a smoke-free ordinance now, the health department is actively educating the public about the benefits of such laws and plans to be a strong advocate to get something passed, Lockard said.

“We are finding overwhelming positive response to smoke-free,” he said. “The Board of Health and health department will work in any way possible to get a law on the books.”

Lockard also voiced his hope that school boards will pass smoke-free policies in schools, which he said should be attainable because no legislation is needed.

“There are 174 school districts in Kentucky and less than 40 of them have smoke-free policies on their campuses,” Lockard said. “If we could have all schools smoke-free, that would have a major impact on our communities.”

Lockard reflected on what Tom Frieden, director of the federal Centers for Disease Control and Prevention, said in his recent visit to Kentucky, that the most important changes Kentuckians need to make to improve their health are to stop smoking, decrease secondhand smoke exposure, and to exercise.

Tuesday, August 26, 2014

Logan Co. schools work to keep kids and bus drivers hydrated during hot, humid days; here are tips for dealing with heat

With temperatures soaring into the high 90s and the heat index over 100, the new Logan County school superintendent made sure the students and bus drivers were well hydrated last week, O.J. Stapleton reports for the Russellville News Democrat & Leader.

Dr. Kevin Hub and other members of the central office staff delivered bottled water to all schools for students who would be riding buses in the extreme heat, Stapleton writes.

“I think it’s important to recognize that it’s hot and we do not have air conditioning on our school buses,” Hub told Stapleton. “That makes it hard on our drivers and students. This just falls under the category of ‘a good thing to do’ when it comes to taking care of our students and staff.” He said the gesture was appreciated by both the staff and students.

Signs and symptoms of heat exhaustion, according to the Centers for Disease Control and Prevention, are heavy sweating; weakness; cold pale clammy skin; fast, weak pulse; nausea or vomiting; and fainting. The CDC suggests that if someone has these symptoms they should be moved to a cooler location, lie down and loosen their clothing, apply wet, cool cloths to as much of the body as possible, be offered sips of water and seek medical attention immediately vomiting occurs and continues.

The CDC reports the signs and symptoms of heat stroke, a much more serious condition, as: body temperatures above 103 degree Fahrenheit; hot, red, dry or moist skin; rapid and strong pulse; and possible unconsciousness. These symptoms require immediate medical attention. Call 911 immediately, move the person to a cooler environment, reduce the person's body temperature with cool cloths or even a bath and do NOT give fluids.

Prevention is the best way to avoid these heat-related illnesses, Stapleton reports. He offers some suggestions below on how to protect yourself during these extreme temperatures.

Here are some suggestions to prevent heat stroke:
  • Drink more fluids, regardless of your activity level.
  • Avoid alcoholic beverages and high-sugar beverages as they can cause you to lose more body fluid.
  • Don't wait until you are thirsty to drink.
  • Seek the advice of your doctor if you have fluid restrictions or are on water pills.
  • Avoid very cold drinks as they can cause stomach cramps.
  • Stay indoors in an air-conditioned place if possible.
  • Go to the mall or the library for some air-conditioned relief if you do not have home access.
  • Seek a heat-relief shelter in your area. Contact your local health department for information.
  • Fans do not prevent heat-related illness when the temperatures are in the high 90s.
  • Take a cool shower or bath.
  • Wear lightweight, light-colored, loose-fitting clothes.
  • NEVER leave anyone in a closed, parked vehicle.
Every person is at risk of heat-related illnesses in these extreme temperatures, but some people are at greater risk and need to be checked on regularly, Stapleton writes. High risk adults should be checked on at least twice daily and monitored for signs of heat exhaustion or heat stroke. Infants and children need more frequent watching.

Those at high risk of heat-related illness are:
  • Infants and young children
  • People aged 65 or older
  • People who are ill, especially with heart disease or high blood pressure.
Some advice for being outdoors in the heat:
  • Limit your outdoor activities to the morning and evening hours.
  • Minimize your outdoor exercise.
  • Drink two to four glasses of cool, non-alcoholic fluids each hour if you exercise.
  • Drink sports beverages to replace the salt and minerals you lose in sweat. Consult your doctor about the use of sports drinks if you are on a low-salt diet.
  • Rest often in shady areas.
  • Wear a wide-brimmed hat, sunglasses, and sunscreen.

W. Ky. elementaries use Baptist Health grants to join national program to fight childhood obesity; results encouraging

Two more West Kentucky schools have joined Project Fit America, a fitness program that targets childhood obesity, to help its students become more fit, reports The Paducah Sun.

East Calloway County and Calvert City elementary schools are the seventh and eighth schools in the area to win a $16,500 grant from Baptist Health Paducah for indoor and outdoor fitness equipment, teacher training and curriculum material, all included with the Project Fit America program.

"We believe as educators it is our responsibility to help our young population begin healthy lifestyles that will follow them into adulthood," Kathy Crouch, East Calloway principal, told the Sun.

Kentucky ranks eighth in child obesity, and U.S. adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

Benton Elementary, which joined the program only last year, has already documented improvement in students' fitness, showing a a 27 percent increase in cardiovascular endurance, 18 percent increase in upper body strength, 12 percent increase in abdominal strength and a 38 percent increase in students who could perform pull-ups.

Project Fit America is a national non-profit group that has worked with nearly 900 schools in 45 states to motivate students, parents and faculty to choose fitness over sedentary lifestyle habits. (Read More. This article is behind a pay wall.)

Monday, August 25, 2014

Beshear cites examples of health reform's benefits, while McConnell keeps up criticism, at Farm Bureau's ham breakfast

By Al Cross
Kentucky Health News

Democratic Gov. Steve Beshear and Republican U.S. Sen. Mitch McConnell squared off on health-care reform for the second straight year at the Kentucky Farm Bureau Federation's annual Country Ham Breakfast at the Kentucky State Fair last week.

Beshear, who spoke first, noted that a year earlier he had called for politicians to stop "partisan bickering" about the law and told Kentuckians that they didn't have to "like the president or the Congress" to investigate its benefits. "Over half a million Kentuckians took my advice," he said. "Young and old, black and white, singles, families, Democrats, Republicans, city folks, country folks -- you went looking for the facts, and what you found was high-quality, low-cost health insurance."

Beshear noted that Kentucky is second in the nation in the estimated reduction of uninsured population, and gave the reductions in four counties: Christian, from 17 percent to 12 percent; Montgomery, from 18 to 9.5; Laurel, from 18;7 to 10.1; and heavily Republican Monroe, from 21 to 11.5.

He also cited two individual examples: Casey County farmers Frank and Renee McAninch, who couldn't afford insurance but now pay nothing, who skipped doctor visits, ignored health concerns and paid "outrageous out-of-pocket costs;" and Joe Paul Mattingly of Marion County, a state Farm Bureau director who found "cheaper, better insurance" on the state health-insurance exchange.

Beshear said Frank McAninch had skin cancer removed, and Mattingly is not receiving a subsidy but is paying 20 percent less for coverage than before. "As Joe Paul said, he chose to be part of the solution, not part of the problem," Beshear said, adding that critics of the law should do likewise.

McConnell was having none of it. Noting that Beshear didn't use the word "Obamacare," the senator said, "He just doesn't want to say it, and I don't blame him."

McConnell delivered his usual litany about the law -- its cuts in payments to health-care providers, its taxes on medical devices and insurance policies, and the higher premiums, co-payments and deductibles being paid by many people.

Citing a study by the Congressional Budget Office, McConnell said Obamacare “will cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

As for the Medicaid expansion that is responsible for about three-fourths of the 521,000 people with Kynect coverage, McConnell said, "I do worry about our state government and its ability to meet these commitments in the future."

Beshear has cited studies predicting that the expansion will pay for itself by expanding the health-care industry and creating jobs. Republicans have said they don't believe those predictions but generally have been unwilling to say that the expansion should be ended, which would leave hundreds of thousands of people without coverage. McConnell has said his criticism of the law is "not connected" to the state insurance exchange.

Sunday, August 24, 2014

Montgomery County board OKs free meals at most schools

In a microcosm of discussions taking place all over Kentucky and much of America, a divided Montgomery County Board of Education decided Aug. 19 to offer free meals to all children in the county's elementary schools and its Early Learning Center.

By another 3-2 vote, the board defeated a motion to offer free meals at those schools and the county's intermediate school, one of the two options recommended by the district's food-services director.

It did not vote on a much more expensive option of offering free meals at all the county's schools, including Montgomery County High School, or on the other recommended option, to offer the meals at only one elementary and the Early Learning Center. Board Member Sharon Smith-Breiner, who supported the program generally, said she couldn't support singling out one elementary, Tom Marshall reports for the Mount Sterling Advocate.

Board Member Kenny Gulley, who opposed all the options, "told fellow board members that he couldn’t support the decision because it provides free meals to students whose parents have been deemed capable of paying and there is no evidence that they are not being fed," Marshall reports.

Board Member Alice Anderson, who voted yes on both motions, "responded that at least this way the board can ensure that they are fed," Marshall writes. "Smith-Breiner cited as one of the advantages of the move being the potential to boost the school attendance rate and test-score improvement."

Under guidelines of the federal National School Lunch Program, the district must commit for a period for four years with the ability to opt out," Marshall notes. "Food services director Julie Tuttle . . . said the board can reevaluate the success of the program next April."

Friday, August 22, 2014

KET will look Monday night at why lack of sleep is bad for your health, and offer advice on improving sleep quality

We live in a country where a third of adults report that they get less than six hours of sleep a night, which doesn't seem like a big deal until you consider the health risks that are associated with insufficient sleep.

The next edition of KET's "Health Three60" will explore these risks and advise how to improve your sleep quality. The program, "Sleepless in Kentucky," will air Monday at 10 p.m. ET.

Host Renee Shaw and guests will explore links between sleep deprivation and weight gain, diabetes, heart disease, cancer, skin issues, anxiety, concentration skills and impaired motor abilities. They will also look into how screen time (TVs and computers) affects sleep.

The show will discuss sleep apnea, treatments and what to expect in a sleep study. These issues will be examined by Jay McGuire, manager of the University of Louisville Physicians Sleep Center, and Dr. Egambaram Senthilvel, pediatric sleep specialist with University of Louisville Physicians.

The program will also examine how to improve sleeping habits by changing our sleep culture, including discussion about what can be done in schools and the workplace.

Other guests will include Dr. Phillip W. Bale of Glasgow Primary Care; Dr. Barbara Phillips, professor and medical director of the University of Kentucky Sleep Laboratory; and Dr. Mohamed A. Saad, director of the University of Louisville Physicians Sleep Center.

The series is funded in part by the Foundation for a Healthy Kentucky. (Read more.)

Owensboro commissioners drop pre-existing bars from draft of smoking-ban ordinance

The Owensboro City Commission compromised to gain the support of all five members to vote for a smoking ban, which will come up for a vote on Sept. 2, Steve Vied reports for the Owensboro Messenger-Inquirer.

The original draft of the ordinance eliminated smoking in all public places in the city, and was favored narrowly. The compromise allows smoking to continue in establishments that are already in operation and don't allow entry to anyone under 18, thus exempting bars, as a county ordinance does.

"New bars that open after the ordinance goes into effect, whether they allow customers under 18 or not, will not be permitted to have smoking," Mayor Ron Payne said.

"Thank you so much," said Ashley Oberst, an employee of Rocky's Bar and Grill at Ninth and Crittenden streets. "It means more than you know."

"I'm not here to make choices for adults," Commissioner Jeff Sanford said, but if smoking "is around kids, I can't support it."

Payne told the audience at a meeting, "First and foremost, this commission wants to act in unison. We did not want a split vote. No. 2, we have listened to you. You made some good points that we have considered. We all have wrestled with this. This is a toughie. I have three younger brothers, all gone, two from lung cancer."

The new version also deleted regulation of electronic cigarettes. (Read morethis article is behind a paywall)

Thursday, August 21, 2014

Grimes and McConnell lay out differences on health reform

By Al Cross and Megan Ingros
Kentucky Health News

U.S. Sen. Mitch McConnell kept attacking federal health-care reform and challenger Alison Lundergan Grimes gave her strongest defense of it yet as the candidates held the closest thing to a debate Wednesday, Aug. 20, at Kentucky Farm Bureau headquarters in Louisville.

Grimes was the most detailed she has been in a public discussion about health-care reform. Grimes indicated that she supports Kynect, the state health-insurance exchange, created by Gov. Steve Beshear and funded by Obamacare, where people sign up for Medicaid or buy insurance.

“For the first time ever, because of our governor, 500,000 Kentuckians are able to go to the doctor, their kids get checkups before school, and many of them are farm families in rural Kentucky,” she said. “The law isn’t perfect but we have to work to fix it. . . . We have to work to streamline the Affordable Care Act, to make sure there aren’t over-burdensome regulations on our businesses, especially our small businesses.”

Grimes endorsed President Obama’s delay in the law’s employer mandate and suggested that he should also live up to his promise that “If you like your doctor, you can keep it.”

She actually appeared to be referring to keeping old insurance policies, because her next words were, “We should be working to extend that grandfathering clause so we live up to that promise that Washington politicians made to Kentuckians. . . . It requires a senator, though, who doesn’t want to repeal root and branch the access to health care that Kentuckians just got for the first time.”

McConnell answered, “She won’t use the words, but she supports Obamacare, he single worst piece of legislation that’s been passed in the last half-century.”  He said Obamacare is going to cost jobs and it “ought to be pulled out root and branch and we ought to start over.”

McConnell said what should have been done is “truly national competition among health-insurance companies to keep prices down and quality up,” as well as “a national medical malpractice standard to bring some sanity to the litigation lottery that’s confronting every health-care provider in America; and thirdly, we need to allow small businesses to form groups for the purpose of more purchasing power on the open market.”

Citing a study by the Congressional Budget Office, McConnell said the law will only cover 10 million of the 40 million people who were uninsured, and will “cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

McConnell said Kentucky will not be able to afford its expansion of the Medicaid program, which covers about three-fourths of the newly insured. “She applauds it,” he said. “It’s fine for the governor because the first three years the federal government will pick up 100 percent of the tab, but after that, the state’s going to be in serious financial problems.”

Beshear has cited studies showing that the Medicaid expansion will pay for itself by expanding the health-care industry and creating jobs, but Republicans say they are skeptical of that.

A video of the debate is available on the Farm Bureau website, www.kyfb.com, until Sept 20. The specific site is http://new.livestream.com/accounts/7542430/events/3309694.

Wednesday, August 20, 2014

Hopkinsville paper gives detailed description of federally mandated changes in Christian County school lunches

Five years ago Christian County Public Schools served a dessert with every meal, white rolls, and vegetables with plenty of salt, Margarita Cambest reports for the Kentucky New Era in Hopkinsville.

Shift to 2014: Dessert is considered an occasional treat, fruit is a staple, the rolls are whole grain and there are vegetables galore, with a lot less salt.  Students are adjusting to these changes as school meal programs shift to comply with new federal guidelines, Cambest reports.

“They want to be healthy, but they don’t always want to eat healthy,” Sandra McIntosh, the schools' food service coordinator, told Cambest. “This makes it easier.”

The Healthy, Hunger-free Kids Act, which passed in 2010, initially required schools in the federal meal program to decrease fat and sodium and increase whole grains. This year, strict sodium and calorie limits have taken effect. McIntosh told Cambest that this was the first major change in the program's law in 30 years.

Specifically, fruits and vegetables must be offered, with a choice between two meats, two vegetables and two fruits at each meal, Cambest writes. Whole grains have replaced white bread, and only fat-free or low-fat milk may be served, including chocolate milk. Calorie limits vary between grades, but all students must take at least one serving of fruit or vegetable at breakfast and one of each at lunch.

So what does a typical meal look like?  The New Era sampled lunch at Hopkinsville Middle School and reported a menu of breaded and baked chicken (with or without barbecue sauce), a cheeseburger on a whole-grain bun, or a chef's salad. Green beans, mashed potatoes with gravy, or veggies with low-fat ranch dressing were served on the side, and a choice of a banana or mandarin orange slices rounded out the meal.

“A lot of times, kids aren’t offered this kind of variety at home,” schools spokeswoman Heather Lancaster told Cambest.

This year, all Christian County public-school students are eligible for free meals under the federal Community Eligibility Program, which applies to schools that serve mostly low-income students. The middle school and the district's two high schools were the last in the district to be added to the program, Cambest reports. In the first 10 days of school, the three schools served 1,690 more breakfasts and 595 more lunches than in the same period last year. (Read more; this article is behind a paywall)

Monday, August 18, 2014

Doctors of osteopathy are an increasing answer to the doctor shortage, as more osteopathic medical schools open

Doctors of osteopathy could be part of the solution to Kentucky's well-documented primary care doctor shortage, Laurel Black reports for The Paducah Sun.

"The American Association of Medical Colleges predicts that a growing population of aging people, health insurance expansion, and a freeze on Medicare funding for residency training positions will lead to a physician shortage of more than 90,000 by 2020," Black reports.

Rural areas are expected to be most affected by the shortage of physicians, especially in the area of primary care, Black writes. Kentucky is already experiencing this problem. A presentation at the 2013 Kentucky Rural Medical Educators Conference said Kentucky had a 1,287:1 primary care physician-to-citizen ratio, 557 short of the national average.


Despite this "looming doctor shortage," little attention has been given to osteopathic medicine as a possible solution, Black writes. But enrollment in osteopathic medicine, "which puts a focus on primary care and works to place its doctors in under-served regions," is growing.

"There are a lot of osteopathic schools. It's definitely a growing field," Griffin Bicking, a doctor of osteopathy and a vascular surgeon at Baptist Health Paducah, told Black.

"Graduates in osteopathic medicine have increased by more than 250 percent between 1980 and 2005, according to a study by the medical colleges' association. In 1980, there were 14 schools with fewer than 5,000 students in America; there are now 30 schools with more than 30,000 students," Black reports. "It's estimated that today nearly 30 percent of all medical school graduates are estimated to be doctors of osteopathy," or D.O.s.

The University of Pikeville's Kentucky College of Osteopathic Medicine has graduated more than 800 physicians since its inception in 1997, with 60 percent of these graduates serving primarily in rural healthcare facilities in Eastern Kentucky and other regions of Appalachia, according to its website.

New or relatively new osteopathic medical schools near Kentucky are in Harrogate, Tenn.; Lewisburg, West Virginia; and Blacksburg, Va.  Other adjoining states with such schools include Ohio, Illinois, Indiana and Missouri.

Black reports that the stigma associated with D.O.s is fading as people seek a more holistic approach to their health. She also notes that the most notable difference between D.O.s and a doctor with traditional training is a required 300 to 500 hours of training in osteopathic manipulative treatment. This training, known as OMT, involves the movement of patient's bones and muscles to treat illness and injury and is part of the controversy surrounding D.O.s, Black reports.

However, more than half of D.O.s "used OMT on less than 5 percent of their patients," according to a study reported in Academic Medicine, the journal of the medical colleges' association, Black writes.

"Curriculum-wise, it's pretty much the same," Bradley Albertson, an internist and pediatrician at Mercy Primary Care in Benton, told Black of osteopathic medicine, which also requires four years of training followed by an internship and a residency. "The differences are more political and social."

Albertson opted for a non-osteopathic residency after attending a college of osteopathy for medical school, telling Black it "would add legitimacy to his practice."

And while osteopathic schools try to push primary care, D.O.s can go into any field a traditional doctor can, and it usually pays more to specialize, Black writes.

Albertson told Black that he is not sure that osteopathic schools will be the solution to the predicted patient-doctor gap and suggest it will take a "variety of solutions," including giving nurse practitioners more privileges.

Sunday, August 17, 2014

Busy Woodford County girl is one of 20 youth ambassadors in national campaign against childhood obesity

Genna Ringler of Woodford County has been named to the youth advisory board of the Alliance for a Healthier Generation, a national anti-childhood obesity group, John McGary reports for The Woodford Sun.

Geena Ringler, Alliance for a Healthier Generation
youth ambassador (Woodford Sun photo)
"I  see a lot of kids at my school every day.  They want to be healthier, but they don't know how, so I'm hoping that when I serve on the board, and even after that, that I show them ways that they can lead a healthier lifestyle," Ringler told McGary.

The 12-year-old's life is already full.  She peer-tutors children with special needs, teaches special-needs children to swim, runs cross-country, is on the local swim team and enjoys bicycling, McGary reports.  She has also led a fundraiser that generated nearly $2,800 for the Muscular Dystrophy Association, to honor a friend and classmate who passed away.

She applied for the ambassador position in Febuary, was selected in May and was off in July for training in Utah, where she met the 19 other selected ambassadors, received media and interview training, and consulted with the adult ambassadors to develop goals for her project.

"I didn't know that it wasn't just playing video games," she told McGary, referring to the causes of childhood obesity. "It's so much more.  It's your economic background and how your parents raise you ... and all that kind of stuff."

Ringler told McGary that childhood obesity is an epidemic and that "it takes a lot of people to help change one person's lifestyle and I thought that one more person could help make a difference." (Read more) Kentucky ranks eighth nationally in child obesity.

Friday, August 15, 2014

Women leading Ky. Health: With less than 16 months left, Haynes tries to 'bake in' health reform, managed care, more

This is the last in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

How does a person create lasting change in an ever-changing political environment? “Bake it in,” says Audrey Tayse Haynes.

Secretary Audrey Haynes
As secretary for the Cabinet for Health and Family Services since 2012, Haynes has led the state's efforts to implement the federal health-reform law, dealt with the controlled chaos that was the transition to managed-care Medicaid and faced controversies in the social-services system. Now, with less than 16 months left in Gov. Steve Beshear's administration, she wants to make big improvements in the state’s behavioral-health system.

“We want to get as much (done) as we can get and we want to get it baked in,” Haynes said, “so hopefully the next person that comes will be as enthusiastic about building on the foundation that we have laid.”

Haynes brought more than 25 years of leadership experience to her job, including appointments under three earlier governors. From 1997 to 2001, she was deputy assistant to President Bill Clinton and director of the Office for Women’s Initiatives and Outreach, then special assistant to Vice President Al Gore and chief of staff for Tipper Gore. For the next decade, she was senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C.
  
She says her personal style of leadership – “collaboration, inclusion and transparency” – took her staff a while to get used to, but is paying off with results.

“I’m all about forcing people to work together and trying to figure it out because you get a better product,” she said. “We don’t sign things around here unless it’s been vetted through the agency that it is going to impact. It took a while for people to get used to that.”

At her recommendation, Beshear named Carrie Banahan to run the state insurance exchange, Kynect, which has enrolled 521,000 people and become the nation’s model of how to run a successful exchange.
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“We all collaborate and all work together,” Banahan said in a separate interview. “Audrey has comprised a good team in the cabinet and we support her 100 percent.”

“I couldn’t get a better boss,” Public Health Commissioner Stephanie Mayfield said in a separate interview.  “She is genuinely concerned about not just her employees, but the health of the public.”

Haynes said the expanded access to coverage under health reform will improve the health of Kentuckians and the state's health statistics, something employers consider when choosing sites.

“Kentucky has worked so long and hard on building a better, more educated citizenry, so that we (can) recruit more industry and have a stronger economic development base. I believe that is important,” she said. “But equally as important is that we have healthy employees. … I do believe that our state will see many, many benefits from this.

Health reform has been the most controversial domestic issue of the last few years, but for many people in the health-care industry, there has been more tooth-gnashing over the managed-care Medicaid system that began several months before Haynes became secretary.

Managed care, in which insurance-company subsidiaries get a certain sum per patient and increase their profits by controlling costs, “has not been a walk in the park to implement,” Haynes acknowledged. Providers have complained about slow payment and rejection of claims, and one managed-care firm left Kentucky, saying the state gave it misleading financial information.

She said all involved had to “stop, take a breath and stop screaming long enough to sit down and honestly work through the problems. . . . We have just forced people to the table month in and month out to work out these issues.”

Haynes began collaboration with providers and managed-care firms, and held public forums for all stakeholders to ask questions and get answers. It recently started a second round of forums, and she says things are much calmer now, almost three years after managed care began.

“Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” she said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act.”

The next big frontier in managed care is integrating behavioral health with physical health, she said. Noting that more behavioral-health providers are now eligible to receive Medicaid reimbursements, she said that increases accountability toward better outcomes for such patients.

Haynes has little more than a  year left to “bake it in,” because Beshear cannot seek re-election. She acknowledges that the changes in health care are “turning people’s worlds upside down.”

“There are a lot of changes going on, and they are not going to be able to just move on a dime,” she said. “So we have to be able to push, cajole, be patient, teach and then repeat all of that constantly.”