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The Senate Health & Welfare Committee today heard testimony from numerous Kentucky health care providers about their many concerns and issues relating to Kentucky's new to Medicaid managed care environment.

Denying and delaying prior authorizations for medications, a lack of transparency in the system, inadequate reimbursement rates, denial of claims and complications with multiple formularies were all cited as issues that the three new Medicaid Managed Care Organizations (MCOs)
must address. These issues have one common goal in that they threaten to restrict patient access to quality care.  If not addressed, these issues have the long term potential to hurt patients and drive up healthcare costs.

The patient/provider relationship must be protected in this process and patient access cannot be jeopardized in efforts to conserve costs.

Do you have a personal story about the new managed care system? Let us know by calling the Kentucky Medicaid Managed Care Story Bank Hotline at 1-888-825-5592 or by filling out the following form on the KVH website: http://kyvoicesforhealth.com/form_view.php?form_id=7&from_cms=true

You can also educate your legislators on these important issues by calling the Kentucky Legislative Hotline at: 1-800-372-7181

The major health policy story of 2011 was Kentucky’s switch to Medicaid managed care—a move that will impact more than 540,000 Kentuckians.  But much more is on the way, and it will have a major impact on the rest of Kentuckians as soon we will begin seeing more reforms as a result of the Affordable Care Act (ACA).

As the ACA is implemented, it is important that patient access to care is not jeopardized. That is why Kentucky Voices for Health (KVH) has designated several focus areas to help guide the way policymakers, consumers and health care providers interact with the healthcare system.   These include consumer engagement in the development of new health exchanges (“a shopping mall for individual and small business health plans”), increasing access to preventative services, greater transparency in regards to coverage and costs, and most importantly, maintaining access to quality care.

The public must become more educated and engaged in order to take advantage of the new opportunities and greater amount of health-related information available to them. Standardizing the language used by plans and insurance companies is important for consumers to be smart, active purchasers of health coverage.  Individuals also need to be more aware of their personal health information and the care they are receiving in order to have a complete understanding of what they are paying for.  Health information technology is a tool that both patients and providers should use to improve care coordination and consumer engagement.

Individuals and employers are the real payors through the premiums paid to insurance companies.  That is why the Medical Loss Ratio (MLR) is so important to consumers by requiring that 80% of all premiums paid be used for medical services and quality improvement and not on marketing, administrative fees, commissions, and executive salaries.  It is important that the MLR be retained with strong consumer protections and rebates to ensure accountability to all of us who pay for care. 

Health reform will result in significant changes in the Commonwealth and will present many interesting challenges to our policymakers as they build health insurance exchanges that will make it easier for individuals to shop for coverage.  In addition, Medicaid will be expanded to cover additional Kentuckians with incomes up to 133% of the federal poverty level—making more than 250,000 additional Kentuckians eligible for Medicaid.  The bottom line is that for implementation to be successful in making coverage more affordable, it is important for all Kentuckians to be covered--including the currently estimated 604,000 Kentuckians who have no health insurance.

So health reform is not just a political endeavor, nor is it just about insurance companies, hospitals, clinicians. It is about me, you, our employers, and our communities.  I once heard the quote, “"Health starts where people live, learn, labor, play and pray." What are you doing to live a healthier lifestyle? How are you engaged in the care that you are receiving? Do you know the actual costs of the health care services you are receiving?  Is the service/procedure necessary for improving your quality of life?  These are all questions that we need to be asking. 

The concept of value-based health care purchasing is that buyers (you, me, and our employers) should hold providers and plans accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the money spent towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the delivery of high quality care.

Health reforms must promote fairness and provide security to families while allowing consumers and small businesses to buy affordable coverage and compare health plans. All stakeholders win in a value-based purchasing model with active consumer engagement.

Preventing an illness from ever happening is still the most effective medicine available. Vaccines are a perfect example of this; saving millions of lives each year and nearly eradicating many deadly diseases.

That’s why Kentucky Voices for Health (KVH) commends the Kentucky Cabinet for Health & Family Services (CHFS) for taking steps to protect Kentucky children by updating the childhood immunization requirements and promoting the Vaccines for Children (VFC) Program. It is also why parents are encouraged to adhere to the Centers for Disease Control and Prevention’s (CDC) recommended immunization schedule for their children.

Two of our top priorities, children’s health and prevention, form an important intersection when it comes to immunizations, one of the easiest and most effective ways to prevent diseases in children. For too long, Kentucky has ranked below CDC recommended immunization rates—we’re currently at 69% but should be above 90%—and has needed a shot in the arm to improve in this critical area of public health.

The new immunization requirements, which include many familiar sounding vaccines like PCV for children up to five, and MCV and Tdap vaccines for sixth-graders, will help boost the states immunization rates and ensure that all Kentucky children have access to these important vaccines. This is particularly important for those without health insurance as these vaccines are now available at local health departments through the state’s VFC program which helps families by providing free vaccines to doctors who serve eligible children.

But ultimately, it is up to parents to ensure their children are properly immunized. Thus it is critical for parents to understand the importance, safety and efficacy of vaccines when it comes to protecting their children. Unfortunately, according to a recent study by the University of Michigan, 10% of parents nationwide are now following an alternative vaccination schedule instead of that which is recommended by the CDC. The study also concluded even more parents would consider a switch to an alternative schedule. This is a dangerous precedent that must be addressed through proper education and patient consultation with their care providers.

Anne Schuchat, M.D., director of CDC’s National Center for Immunization & Respiratory Diseases, summed it up nicely in a recent CDC press release, “as recent outbreaks of measles and whooping cough have shown, vaccine-preventable diseases are still around us, and it is important that health care providers, community groups, and state programs support parents in assuring that children are protected from vaccine-preventable diseases.”

For more information on Kentucky’s vaccine program and the Vaccines for Children program, visit: http://www.chfs.ky.gov/dph/epi/Immunization+Program.htm.

Kentucky Voices for Health is a coalition of over 250 health care organizations and individuals who believes that the best health care solutions are found when everyone works together to build them. Healthy families create healthy economies. So we're working step by step to build a healthier Kentucky for everyone.

Resources to Help You Be a Better Caregiver 

Carolyn M. Clancy, M.D., Director of the Agency for Healthcare Research and Quality (AHRQ), offers brief, easy-to-understand advice columns for consumers to help navigate the health care system.  In her latest column, Dr. Clancy describes resources that can help you be a better caregiver to a parent, spouse, child or other loved one.    

To read Dr. Clancy's latest column, go to: http://www.ahrq.gov/consumer/cc/cc070511.htm.