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SEPT. 4, 2017

TALKING ABOUT POOR HEALTH AS AN OBSTACLE TO PROGRESS IN APPALACHIA, AND WHAT TO DO ABOUT IT

By Melissa Patrick
Institute for Rural Journalism and Community Issues

JOHNSON CITY, Tenn. -- Appalachia faces many hurdles when it comes to economic development and creating a healthy workforce, including education barriers, addiction issues, stigma and overall poor health.

Those were the conclusions of a 13-member panel convened to discuss the findings of two new Appalachian Regional Commission reports that found Appalachian health continues to fall behind the rest of the nation, and how that affects economic development.

"Without a healthy workforce, the economic prospects in the region are greatly diminished," declared Julie Marshall, an ARC economist and a principal investigator for the "Health Disparities in Appalachia" report.

The second report, "Diseases of Despair," looked at deaths from overdose, suicide and alcohol-related liver diseases in Appalachian and found them to be 37 percent higher than the rest of the nation: Overdose deaths were 65 percent higher, suicide deaths were 20 percent higher, and alcoholic liver-disease deaths were 8 percent higher.

Michael Meit, lead author of the study, reminded the panel that it's important to look beyond poverty as the only reason for these high rates, pointing out that some Appalachian states, like Mississippi and Georgia, have high poverty levels, but lower death rates for these measures.

Meeting in Johnson City, Tenn., the panel said addiction -- to opioids, alcohol, methamphetamine and cocaine -- is a major workforce issue in the region.

Dan Eldridge, the mayor of surrounding Washington County, said he had recently talked to a company looking to bring more than 600 jobs to his area, and spent most of the time talking about the region's workforce. And when he asked why, they told him that among other things, one of their selection criteria was access to a drug-free workforce and "this region of the country does not have a good reputation."

Eldridge said he thought one contributor to the problem is that high-school students who aren't college-bound don't have any plans for the future, and their drug use seems to increase after they graduate.

Randy Wykoff, dean of the East Tennessee State University College of Public Health, said it's time to bring people together from different sectors -- health-care providers, the criminal-justice system, advocacy groups and people with substance-use disorders -- to "rethink this whole thing." He said it's time to quit putting people in jails who need rehabilitation and treatment.

Successes and strategies

Eldridge said his county has a program that teaches employees how to recognize personal or work-related problems and encourages employers to implement employee-assistance programs to address them.

Mike Caudill, CEO of the Mountain Comprehensive Health Corp., a federally qualified health center in Whitesburg, Ky., pointed to its "Farmacy" program as one of their many successes.

The grant-funded program gives qualifying individuals a "prescription" for fresh fruits and vegetables at their local farmers' market. Caudill noted that one of their participants lowered his A1C, a test for blood sugar, from 14 to 6.2 in just eight months. A normal A1C is between 4 and 5.6.

"In the midst of all this bad news, somebody has to speak life into what is possible," said Jared Arnett, executive director of Shaping Our Appalachian Region, a bipartisan effort to revitalize and diversify Eastern Kentucky's economy.

Arnett said technology can open doors for new economic opportunities, expand entrepreneurship, provide access to health-care specialists through telemedicine, and offer more opportunities for education and workforce training.

Other ideas to improve the workforce included creating multi-sector partnerships, involving community members in decision making, taking advantage of the region's high rate of social associations, including health considerations in all government policies, and better coordinating local educational systems with the region's workforce needs.

Written by Al Cross Posted at 9/02/2017 12:29:00 PM

Sep 1, 2017 

To fight the opioid epidemic, Kentucky doctors, legislators and health-insurance companies are working to limit the prescription of painkillers.

The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”

At the annual convention of the Kentucky Medical Association, a University of Kentucky trauma surgeon told other physicians how he and his colleagues got a wake-up call about the problem and “how they were able to halve the amount of opiates given to trauma patients without increasing their pain levels,” the Lexington Herald-Leader reports in an editorial.

Dr. Phillip K. Chang, now UK’s chief medical officer, had what he calls an “eye-opening moment” in 2013, when a young man he treated for injuries in a vehicle crash became addicted to the painkiller he had prescribed. He says many physicians have had similar epiphanies, and addiction “could happen to our family, our neighbors, ourselves.”

Dr. Phillip K ChangDr. Phillip K ChangTopics related to the opioid epidemic dominated the KMA’s weekend convention. Journalist Sam Quinones discussed his book, Dreamland, about the 30-year history of the epidemic.

“We believe it is important to know the issue from a historical perspective,” KMA President Nancy Swikert said in a press release. “Knowing how we got to where we are on this issue will help us address it going forward.” She said this was the first time the annual meeting “has had breakout groups to address an important public-health issue.”

The Herald-Leader gives a capsule history: “Two developments of the 1990s spurred this crisis: Pain was added as a vital sign by the hospital accrediting commission. And the pharmaceutical industry targeted physicians with aggressive and misleading marketing of opioids, flooding Kentucky with powerful painkillers, many of which were diverted into the black market.” Meanwhile, the federal Medicare and Medicaid centers began asking patients about pain control, “creating a financial incentive to over-prescribe painkillers.”

Chang told Kentucky Health News and WKYT-TV last year that the UK trauma team adopted a protocol to treat acute pain (as opposed to chronic pain): Use a non-narcotic first, and only prescribe a narcotic if the non-narcotic doesn’t relieve the patient’s pain. “Rather than eliminating pain, Chang aims to keep pain ‘tolerable’ — a standard that Medicare should adopt,” the Herald-leader editorial said.

Chang told the Herald-Leader last week that UK patients are “super receptive” when educated about the risk of opioids. He said the trauma team is integrating art, music and touch therapies into treating acute pain, and has achieved the same level of pain relief with half the amount of painkillers. “Such success among trauma patients certainly could be replicated in other populations,” the editorial said.

The 2017 General Assembly imposed a three-day limit on most opioid prescriptions for acute pain. Change told the Herald-Leader that the law is “a game-changer,” and the newspaper said the law “creates opportunities for doctors to educate their patients about non-addictive options.”

Insurance companies can play a role, too. Anthem Blue Cross and Blue Shield announced last week that prescribed opioids for its members in Kentucky dropped 12 percent in the past year. The insurer said it limits to seven days its coverage of opioids for patients newly starting opioids, requires prior authorization by a health-care provider, and directs patients most at risk for opioid-use disorder to one pharmacy.

All those steps have helped reduced opioid prescriptions, the company said in a press release. “The primary goal of the quantity limits was to prevent inadvertent addiction and opioid-use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines,” it said. In March, the CDC recommended that opioid prescriptions last three to seven days, and that prescribers should avoid high doses and warn patients of the risk.

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” Deb Moessner, president of Anthem Blue Cross and Blue Shield in Kentucky, said in the release. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

The CDC reported in July county-by-county figures for dispensing of opioids in 2015 and 2010. The amount in Kentucky went down, but some counties went up, and the figures are available from Kentucky Health News at www.uky.edu/comminfostudies/irjci/OpioidVitalSigns2017Kytable.xlsx.

Lisa King of The Sentinel-News in Shelbyville used the data as the basis for a story saying that opioid prescriptions declined 20 percent over the five-year period, and also looking at some other counties. But in interviews with pharmacists, she also found a possible reason that the number could now be going up. She wrote:

“Raschelle Cox at Shelbyville Pharmacy said that even though prescription numbers may be down, there are still a lot being written. ‘In the two years that I’ve been here, I haven’t noticed any decrease,’ she said.

Cox added that . . . there are a couple of medications used to treat neuropathy from diabetic nerve pain, that people have been using instead of opiates, that have just recently been declared as narcotics. ‘Now Gabapentin is controlled as of July 1,’ she said. ‘We sell a lot of it.’ Roanya Rice, director of the North District Health Department, said a trend is also underway of using drugs other than narcotics.”

From Kentucky Health News

FRIDAY, AUGUST 25, 2017

Dozens of counties, mostly in rural areas, were at risk of having no individual private insurance options in 2018 after companies like Anthem Blue Cross and Blue Shield pulled out of the markets. But a few insurance companies have filled gaps in coverage, and now there are no areas in the U.S. without coverage.

Paulding County, Ohio, was the very last bare county in the country until CareSource committed to offering coverage in 2018 to the 380 customers who need it, Dylan Scott reports for Vox. CareSource also filled coverage gaps for next year in other bare counties in Ohio and Indiana this summer.

Bloomberg insurance map aug 25 2017 Bloomberg insurance map aug 25 2017


Click here for the interactive county-by-county Bloomberg map; https://www.bloomberg.com/graphics/health-insurance-marketplaces-for-2018/


This summer there were dozens of counties that had no individual insurance options for 2018. President Trump threatened not to pay insurers the federal cost-sharing payments that make it possible for them to offer low-cost plans to the poorest citizens. Because of that and the general uncertainty surrounding Congressional Republicans' fight to repeal and/or replace the Patient Protection and Affordable Care Act, some insurers decided it would be safer to withdraw from markets that depended heavily on federally subsidized plans. That left some areas with no coverage options.

But insurers like CareSource and Centene saw an opportunity in the bare coverage areas and have stepped in to fill the gap. Both are niche insurers that specialize in managing Medicaid programs for the poor. "This isn't a perfect solution, especially for people who don't receive subsidies and therefore aren't protected from premium increases in a monopolized market," Scott writes. "It's also possible that Trump does something in the next few weeks to disrupt the market again — insurers have until the end of September before they are truly locked into selling plans in 2018."

Scott writes that the country should now focus on counties that have only one insurer in 2018. He's not worried so much about insurers with monopolies charging outrageous prices, but more about customers not being able to shop around for plans that fit their needs.

Written by Heather Chapman

Posted at 8/25/2017 11:41:00 AM

 

 


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