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APRIL 19, 2015
Kentucky re-bidding Medicaid managed care contracts to address complaints of patients, advocates and health-care providers
By Melissa Patrick
Kentucky Health News
State officials are re-bidding Medicaid managed-care contracts that cover more than 1.1 million Kentuckians. The news came as a delight and surprise to many health-care providers and patient advocates.
“I was both stunned and thrilled by the announcement. I did not know it was coming,” Sheila Schuster, a Louisville mental-health advocate, told Tom Loftus of The Courier-Journal. “A number of the changes that they say will be part of the new contracts are things those of us in the behavioral health community have brought up time and time again.”
Kentucky changed to Medicaid managed care from a traditional fee-for-service model in 2011 to fill a projected budget overrun of $166 million. Health Secretary Audrey Haynes said in a news release that doing so has "saved Kentucky taxpayers more than $1.3 billion in state and federal funds" and had also improved the delivery of health care to the Medicaid population.
"However, after several years of experience, we determined it was time to retool, rebid and strengthen the contracts to appropriately address concerns expressed by advocates and healthcare providers," Haynes said.
The transition to managed care has been met with consistent complaints from both patients and providers, despite efforts of the cabinet to work through the issues and keep the channels of communication open between providers, the cabinet and the managed-care organizations.
Two passionately debated bills in the recent legislative session challenged some practices of the current MCOs: one seeking an appeals process for denial of payments and the other removing a cap of "triage fees" for emergency-room services that MCOs later deem not to be emergencies.
Both issues have been challenging to the financial health of rural hospitals. State Auditor Adam Edelen addressed many such issues in a recent report on the financial health of rural hospitals.
“We are pleased to see the cabinet taking steps to improve and strengthen managed care contracts, many of which we recommended in our recent report on the financial strength of rural hospitals,”Edelen told Insider Louisville.
Some requirements for the new contracts include: required statewide coverage; standardized rules among the MCOs; improved administrative processes; increased oversight of claim denials; continued expansion of behavioral health services; incentives for MCOs to work with Medicaid patients to decrease emergency-room use and improve their health; and increased penalties to assure contract compliance. Click here for the Cabinet for Health and Family Services' complete Request for Proposal.
“I’d like to say that they heard the voice of the people,” Schuster told Insider Louisville.“If you look at the Medicaid Advisory Council, those meeting are every two months and it’s the same litany of complaints and concerns every darned time with no response. The only thing I can think of is it’s a gesture by this outgoing administration to get things right so that regardless of who comes in next year, there are strong contracts in place. I applaud them for it, and I’m stunned.”
The current contracts with Anthem, Aetna's Coventry Cares, Humana's CareSource , Passport and Wellcare expire on June 30, 2015 and proposals for the new contracts are due by May 5. The statewide contracts will be awarded to multiple MCOs for a one-year period with four, one-year renewal option, according to the news release.
Posted by Melissa Patrick
Donnie Thomas said he remembers the first time he experienced multiple sclerosis symptoms like it was yesterday.
“I was 30,” he said. “I’d been to the driving-range over the weekend and when I came back the following week my hand was numb, it was just kind of a funny feeling.”
Thomas, a Winchester native, visited his family doctor and was prescribed two-weeks worth of Celebrex, an anti-inflammatory drug.
“The feeling didn’t go away,” he said. “So I went back and (my doctor) told me there may be something else going on.”
His doctor referred him to a neurologist who performed brain scans and MRIs that revealed Thomas had lesions on his brain.
A spinal tap confirmed Thomas has relapsing-remitting multiple sclerosis, the most common type of the autoimmune disease that causes the body to attack the insulating membranes (myelin) that coat nerves in the brain and spinal cord.
MS can cause numbness, weakness, vision trouble, balance problems and other symptoms, depending on which parts of the central nervous system are affected.
RRMS patients experience attacks that cause new or worsening symptoms, which are followed by remission periods where the disease does not progress.
For Thomas, who is now 45, the numbness was the only indication of the disease, and until 2010, he remained active, playing softball, tennis and golf and working full-time with nearly perfect attendance at Catalent Pharma Solutions, where he has worked for 22 years.
“Since 2010, I’ve slowed down some,” he said. “My walking has been affected.”
Despite taking a variety of medications, the MS affected Thomas’ right leg, making it difficult for him to walk and stand. He used a cane and a power scooter when it was necessary, especially at work. By the end of 2014, his condition worsened and walking became even more difficult.
For nine years, Thomas took an injectable drug called Avonex and has tried nearly every oral medication for MS.
“None of it seemed to work,” he said.
Around three years ago, Thomas heard about an innovative drug that could essentially stop MS in its tracks.
“My neurologist and I had been talking about this drug for a couple of years,” he said. “I first learned about it when it was just in the clinical trials.”
Thomas’ neurologist, Cary Twymann of St. Joseph Neurology Associates, was involved in the clinical trials of Lemtrada, a disease-modifying therapy for people with relapsing forms of MS.
Because Thomas hadn’t experienced success with other MS treatments, Twymann targeted Lemtrada for Thomas as soon as it was approved by the Food and Drug Administration.
“I didn’t have any positive results from other medications I was on,” Thomas said. “The Avonex was keeping me stable, but the side effects pretty much wiped me out a couple of days a week. I didn’t tolerate the oral medications as far as the side-effects, either. They upset my stomach and just made me feel terrible.”
Lemtrada gained FDA approval in November 2014, and Thomas began treatments March 2.
Lemtrada was originally used to treat B-cell chronic lymphocytic leukemia, and is designed to target immune cells.
Thomas said the drug works by attacking a cell-surface protein called CD52, which is found on T and B cells. In the process of “blowing up” the cells, it attacks cells thought to cause MS, Thomas said.
“What the hope is that since my body has been under attack from the MS for so many years, when the new T cells and B cells come back, they won’t be affected by the MS, and they will slowly start to heal my body, and my body will heal itself over time,” he said.
Thomas is the first MS patient in Kentucky to receive the drug, and one of the first 100 people in the United States to use Lemtrada, which he said has the potential to change the course of the rest of his life.
Thomas received intravenous infusions of Lemtrada on an outpatient-basis for five consecutive days, and will receive treatments again for three consecutive days in February 2016.
If all goes as planned, the drug will prevent Thomas’ MS from progressing.
His biggest concern was potential side effects that range from things like thyroid conditions or bleeding disorders to less-serious side effects like rashes, headaches, vomiting, fungal infections and joint pain.
Thomas’ immune system has been compromised, so he also runs the risk of contracting other illnesses more easily. He’ll also need monthly blood work for the next five years to monitor his thyroid levels and cell counts.
“Those are risks I was willing to take,” he said. “My nurse sat down with Melissa and me for several hours and told us about the possible side effects. But, amazingly, I haven’t had any.”
Thomas belongs to a Facebook group for other Lemtrada patients, and said their results have been similar.
“I haven’t read about one bad result,” he said. “Anybody that I’ve seen on the Lemtrada page, it’s been nothing but positive results. That’s why they call it a game-changer.”
Thomas said he was told not to expect any results until 4-6 months after his first treatment, but he has already experienced relief thanks to the drug.
“When I went to the hospital to get my first treatment, I had to be taken in by a wheelchair,” he said. “I had been off work or working from home for three to four weeks before I had my first treatment. I went in in a wheelchair on Monday and by my last treatment on Friday, I was able to walk out of the hospital by myself.”
Thomas’ wife of 22 years, Melissa, said she can see improvements as well.
By Whitney Leggett
The Winchester Sun
THURSDAY, APRIL 02, 2015
Researchers in the United Kingdom reported that an ancient cure might help kill the superbug MRSA, Justin Wm. Moyer reports for The Washington Post. The leading cause of superbugs, organisms that are resistant to some—if not all—antibiotics, like methicillin-resistant Staphylococcus aureus, or MRSA, is the overuse of antibiotics. Scientists have been charged to fight these infections through "technological" means.
But researchers have recently found that MRSA is "vulnerable to an ancient remedy" made of garlic, some onion or leek, copper, wine and oxgall—or cow’s bile. Garlic and copper continue to be thought of as having antibiotic or antimicrobial properties. “We were absolutely blown away by just how effective the combination of ingredients was,” Freya Harrison, one of the researchers from the University of Nottingham, told the BBC, Moyer reports.
The remedy, noted as eye salve, was found in a manuscript written in Old English from the 10th century called "Bald's Leechbook," a well-respected physician's desk reference from that time, Moyer reports. He also notes that not every remedy in the manuscript is credible, like this one from the translation of an Eastern Algo-Saxonist: “In case a man be a lunatic; take skin of a mereswine or porpoise, work it into a whip, swinge the man therewith, soon he will be well. Amen.”
The Centers for Disease Control and Prevention estimated MRSA contributed to the deaths of more than 5,000 people in the United States in 2013, Moyer reports, writing that "some say it could eventually kill more people than cancer."
The research will be presented at the upcoming Annual Conference of the Society for General Microbiology in Birmingham. Moyer notes that the abstract for the conference cautions that "oxgall was no cure-all." Christina Lee, an associate professor in Viking studies at the University of Nottingham, told Moyer "that it was the combination of ingredients that proved effective against MRSA—which shows that people living in medieval times were not as barbaric as popularly thought."
Written by Melissa Patrick Posted at 4/02/2015
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
THELEVISALAZER.COM - APRIL 2, 2015 -
SOMERSET, KY — Eastern Kentucky PRIDE announced today that Justin Sensabaugh has joined to its Board of Directors. He will volunteer his time and expertise to direct PRIDE, a nonprofit organization that promotes environmental cleanup and education in 42 counties of southern and eastern Kentucky.
Sensabaugh is an Operations Superintendent for Kentucky American Water, an investor-owned water utility that serves nearly half-million Kentuckians. Sensabaugh manages the company’s Northern Operations, which includes the town of Owenton and a 20-million-gallons-per-day water treatment plant serving Owenton and Lexington.
Sensabaugh has been with Kentucky American Water for seven years and has worked in the water and wastewater field for 17 years. He holds several state certifications in water and wastewater, has an Associate of Arts degree from Somerset Community College, and is currently working on his Bachelor’s degree at Midway College.
“My wife, Leah, and I are both originally from London, Ky., and our extended family still lives there,” Sensabaugh said. “Being from London, I am familiar with Eastern Kentucky and the counties PRIDE serves.”
“I have a personal connection to PRIDE, having volunteered for the Laurel Lake cleanup in the past,” he added. “I have witnessed PRIDE in the Laurel County area help with different environmental projects and initiatives over the years. Being a good steward to the environment is important to me.”
“Kentucky American Water has a connection to PRIDE mainly due to our vision ‘Clean Water for Life,’ and one of our core values ‘Environmental Leadership,’” Sensabaugh explained. “Kentucky American Water also has a long- standing relationship with Bluegrass PRIDE, currently Bluegrass GreenSource, which was modeled after Eastern Kentucky PRIDE.”
“We are pleased to welcome Justin to the Board of Directors,” said Tammie Wilson, PRIDE President/Chief Executive Officer.
“As a native of this region, Justin understands that a clean, healthy environment is closely tied to our overall quality of life,” she said. “His extensive training and experience with water and wastewater issues will be helpful as we assist communities to improve their water quality and wastewater service.”
“Dedicated, skilled board members are essential to the success of a small nonprofit, so I appreciate Justin’s commitment to PRIDE and the support shown by Kentucky American Water,” Wilson added.
The PRIDE Board of Directors meets bimonthly to establish guidelines for PRIDE programs and approve the organization’s budget. Nine board members are volunteers who bring particular expertise to fulfilling the PRIDE mission. One staff member, the President/Chief Executive Officer also serves on the board.
PRIDE promotes “Personal Responsibility In a Desirable Environment” by encouraging and equipping communities to improve water quality, clean up solid waste problems and promote environmental education. PRIDE was founded in 1997 by Congressman Hal Rogers (KY-5) and the late James Bickford, who was the Kentucky Secretary for Natural Resources and Environmental Protection.
“The annual PRIDE Spring Cleanup is underway, and our theme this year is, ‘Take PRIDE, Company’s Coming,” Wilson said. “A great way to welcome spring and tourists is to make sure our incredible landscape looks its best. You can do your part by picking up litter near your home, church, business or favorite spot. If you need trash bags, gloves or safety vests, then call our toll-free number.”
The toll-free number for PRIDE is 888-577-4339. The PRIDE web site is www.kypride.org.