Kentucky has three accountable care organizations, a health-reform linchpin, but they remain to be identified

The "accountable care organization" is one of the hallmarks of the federal health-care reform law, with doctors and providers encouraged to team up to give coordinated care and be paid financial incentives to do so.

While being heavily promoted, they were recently likened to "unicorns" because "no one has ever seen one." That's what William Hazel, Virginia secretary for health and human services, at the Howard L. Bost Memorial Health Policy Forum in Somerset in September.

But now a new study has emerged indicating ACOs are popping up all over the country and that there are three in Kentucky, two part of a hospital system and the other part of an independent physician association. A spokesman at Leavitt Partners, which conducted the study, would not disclose the names of the Kentucky ACOs.

To get their count, "Leavitt Partners examined news releases, media reports, trade groups and conducted interviews and considered a health system to be an ACO if it either self-identified as one or was 'adopting the tenets of accountable care,'" reports Jenny Gold with Kaiser Health News.

Of the 164 ACO entities identified nationwide, 99 were sponsored by hospital systems, 38 by physician groups and 27 by insurers. Nationwide, 41 states had ACOs, "though there were vast regional differences. Poor and rural regions were found to have little ACO growth," Gold reports. In the Southeast and Appalachian regions of the country, there are few ACOs forming.

The findings run counter to what was discussed at a recent meeting of the Friedell Committee, whose members said there are no existing ACOs in Kentucky, though they did acknowledge ACOs would have a hard time developing in rural areas: "If you know anything at all about ACOs, you know they're driving by volume," said Cris Miller, a partner in the Louisville accounting firm of Mountjoy Chilton Medley. "We're going to have a few in Louisville, probably as many as three in Lexington. Maybe have one in Bowling Green, one in Paducah. But I can promise you we will not have one in Pikeville, we will not have one in Somerset. There's not enough population."

The discrepancy might have to do with the definition of ACO. The report notes that while the term ACO has been recently adopted, its tenets are not new and organizations have been using the health care delivery model for years, just not calling it accountable care. "The study authors determined that their findings suggested a trend toward 'proclaiming oneself as an ACO with only modest changes to the care process' and not a total redesign," Gold reports. (Read more)

18 Kentucky children died from child abuse or neglect last year, down from 33 in 2009, but report is incomplete, critics say

A report by the the Cabinet for Health and Family Services shows 18 Kentucky children died from abuse or neglect in the past fiscal year, down from 33 the year before. Ten were part of families that had been involved with state social service officers, reports Deborah Yetter of The Courier-Journal.

The report is required by state law, but was a much shorter version than it has been in years past. This year's document was 15 pages long, compared to the 29-page report from last year and "provides limited information and omits much of the detail of past annual reports," Yetter writes.

Terry Brooks, executive director of Kentucky Youth Advocates, said the drop in deaths is good news, but called the scaled-down version of the report "a failure," saying it made it difficult to compare findings from past years. It was also three months late in being released.

"They are scrambling to get it out three months late," he said. "At a time when this issue needs some transparency and more visibility, they have given us the Reader's Digest version."

Lawmakers have scheduled a meeting Dec. 19 to talk to cabinet officials about the issue of child abuse deaths and to review the report, the latest sign the issue is starting to attract more attention. Earlier this week, Gov. Steve Beshear ordered the release of records of abuse in which children died, but the cabinet immediately filed a motion saying it needed more time.

In 2009, a federal government report found Kentucky had the highest rate of child abuse deaths with 41 deaths based on 2007 data — the most recent at the time — from the U.S. Department of Health and Human Services. In 2010, Kentucky dropped to 19th place with 22 deaths based on the 2008 data. The 2009 numbers showed Kentucky ranked fourth. (Read more)

Kentucky ranks 36th for tobacco prevention spending; many states have made cuts

Though it received $389 million in tobacco-settlement funds in fiscal year 2012, and ranks first or second in tobacco use, Kentucky spent just $2.2 million of that on prevention of tobacco use. The figures rank Kentucky 36th in the nation for helping its residents stop smoking or using smokeless tobacco.

The findings come from a report called "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later," which was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society and other non-profit groups. The "promise" in the settlement among cigarette makers and state attorneys general was not specific, but strongly implied.

The report found that the Centers for Disease Control and Prevention recommend Kentucky spend $57.2 million each year to establish a comprehensive tobacco prevention program. But while Kentucky does not come close to that figure, most states don't either and have cut tobacco prevention spending even more in 2012 in the face of budget deficits, The Associated Press reports.

"There are no easy cuts anymore. There's the old expression, tried and true, it's not fat anymore, we're talking about bone," said Debra Miller, director of health policy for the Council of State Governments. "All revenue is looked at as revenue for the highest priority programs ... They aren't ignoring the whole idea of tobacco cessation and the public health issues, the budgets are just such a problem right now."

States have cut their funding 12 percent this year, putting it at its lowest level since 1999, AP reports.

Kentucky is one of 33 states that is spending less than a quarter of the amount recommended by the CDC. Only Alaska is meeting or exceeding the recommendation. Connecticut, Nevada, New Hampshire, Ohio and the District of Columbia did not put any funds into tobacco prevention in 2012. Kentucky cut its tobacco prevention spending by $400,000 from fiscal year 2011. In the past four years, states have cut funding by 36 percent.

About 46 million Americans smoke, while more than 3 percent of American adults use smokeless tobacco, according to the CDC. A recent poll found Kentucky has the highest smoking rate in the country, with 29 percent of people surveyed in a Gallup-Healthways Well-Being Index poll answering "yes" to the question. To find county-specific smoking rates, click here. (Read more)

Kentucky and most other states continue to delay action on health-insurance exchanges, despite Jan. 1, 2013 deadline

Though states must be able to prove whether or not they're ready to run a state insurance exchange by Jan. 1, 2013, many, including Kentucky, have not made any moves toward setting one up.

Kentucky officials have said they are waiting for more guidance to come from the federal level before anything can be decided, but there were indications that the administration of Gov. Steve Beshear might have been delaying action until last month's gubernatorial election. If Kentucky were to set up its own exchange, a move would likely have to be made in the 2012 General Assembly.

Jason Millman of Politico Pro writes an easy-to-understand summary of the complex issue and what it will mean for the American public: "Set to open in January 2014, exchanges will offer a marketplace where individuals and small businesses in each state can shop for health coverage. The exchanges, which offer subsidized coverage to lower- and middle-income individuals, will absorb more than half of the law's projected expansion of health coverage to 32 million people."

Some Republican-dominated states are waiting to see if the U.S. Supreme Court will rule the federal health-care reform law or its individual mandate unconstitutional, but a ruling is not expected until June at the earliest. "If that's when they start to work on an exchange, they will certainly be challenged to have a state-based exchange in 2014," said Steve Larsen, who oversees exchange development for the U.S. Department of Health and Human Services.

Wisconsin state Sen. Frank Larsee, chairman of the insurance committee, plans to wait even longer — opting to wait until after the 2012 presidential election. "Exchanges really aren't required until 2014, so we have plenty of time after November 2012," he said, not addressing the Jan. 2013 deadline.

So far, just 13 states have passed legislation to form an exchange. (Read more)

The common 'fat gene' can be overcome with a little exercise

Even if they've inherited "the fat gene," people don't have to be overweight if they have a relatively small amount of physical activity, such as walking their dog, a study has found. (Getty Images photo)

The research, published this month in the journal of PLoS Medicine, reviewed dozens of studies about the fat mass and obesity-associated gene, which is very common. "By most estimates, about 65 percent of people of European and African descent and perhaps 44 percent of Asians carry some version of the FTO gene," reports Tara Parker-Pope of The New York Times.

But physical activity, even a small amount, may counter the effects of the gene, reducing reduced the effect of the FTO by 30 percent. "While that still leaves 70 percent of the potentially fat-encouraging effect of the gene intact, the consequences of physical activity on the workings of this single gene seem to be substantial enough to perhaps allow someone who otherwise would become seriously overweight to maintain a normal waistline," Parker-Pope reports.

Scientists are still stumped by how the FTO encourages weight gain, but know the gene is particularly active in the the regions of the brain "that regulate the balance of energy intake and expenditure," said Dr. Lu Qi, assistant professor in the department of nutrition at the Harvard School of Public Health. "The loss of energy balance is the basis of development of obesity."

Physical activity, though, my counteract that. "Biologically, it is possible these two factors, genes and physical activity, may interact in affecting energy balance," Qi said. And exercise might affect how the FTO gene works, influencing "whether it expresses certain proteins or remains quiet," Parker-Pope reports.

Though researchers are being cautiously optimistic, they hope the implications of the findings will be encouraging. "Often people feel that obesity runs in the family or that obesity is in their genes, and therefore feel they have no control over their weight issues," said Dr. Ruth Loos, a program leader at the Institute of Metabolic Science in Cambridge, England. "Our study shows that physical activity plays a role in weight control, even in those who are genetically predisposed." (Read more)

Get tested, get treatment, Bluegrass HIV Coalition encourages

Today is World AIDS Day and health advocates are asking Kentuckians to get tested and get treatment.

Hundreds of Kentuckians are diagnosed with AIDS each year, reports Mary Meehan of the Lexington Herald-Leader. Minority populations are hit particularly hard, with black men nearly 10 times more likely to die of AIDS than non-Hispanic white men. Black women are almost 23 more times more likely to die from the infections, compared to non-Hispanic white women.

Though people are still dying, AIDS is not a widely-discussed disease, in part because of its past association with homosexual activity. Mark Johnson, member of the Bluegrass HIV Coalition, said AIDS can be hard for people to talk about.

In addition, the infection is often seen as treatable, in part because of people like Magic Johnson, who has had the infection more than 20 years but is still in good health. What people don't see "is the often expensive regimen of drugs that is needed to keep the worst of the disease at bay, the side effects of those medicines or the ultimate end of what is still an incurable disease," Meehan reports. (Read more)

County data paint specific pictures of health; Ashland paper is one of first to pick up on it and do a story

More progress is needed to make sure children from low-income families are going to the dentist is just one of the findings of the 2011 Kentucky Kids Count County Data, released by Kentucky Youth Advocates.

The data paint a detailed portrait of each county's health for Kentucky's children, showing results of prenatal care, the percentage of mothers smoking during pregnancy, rates of preterm birth and low birthweight, breastfeeding, the number of children enrolled in Kentucky Children's Health Insurance Program and Medicaid, early-childhood obesity rates, asthma hospitalizations, and access to recreational facilities.

Statewide, the numbers show nearly one of every four children lived in poverty between 2005 and 2009, a 10 percent increase from 2000. The rates of preterm births and low-birthweight babies also increased. Overall, however, the numbers show improvement, particularly when it comes to children being covered by state or federal insurance. The number of children enrolled in KCHIP increased by 45 percent and in Medicaid more than 50 percent.

That data is supported by a reported released Tuesday by Georgetown University, which found the number of children without health insurance has dropped by 1 million nationwide in the past three years, Kelli Kennedy of The Associated Press reports. (Read more)

For an example of how to localize the data, click here. Mike James of The Independent in Ashland used it to assess the health status of children in Greenup, Carter and Boyd counties. He also spoke to a local school district and found officials will use the findings to bolster "requests for competitive grants that fund ... programs and ... identify gaps in services," he reports.