Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract

Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the Lexington Herald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.

With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.

The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided.  Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."

ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)

Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.

Managed-care firm blames state for problems leading to impending end of contract with ARH hospitals

In the face of a lawsuit that alleges it did not pay claims promptly, Coventry Health and Life Insurance Co. blamed the state for problems that have surfaced since managed care was implemented. Coventry has canceled its contract with Appalachian Regional Healthcare, which has sued the company as well as Kentucky Spirit Health Plan Inc., reports Nola Sizemore for the Harlan Daily Enterprise.

"The current crisis would have never occurred except for the commonwealth's failure to make timely and reasonable decisions on three major issues," Coventry Executive Vice President Timothy Nolan said in a letter to ARH President Jerry W. Haynes. The issues are "a failure to implement a risk adjustment methodology, failure to find a solution to the supplemental hospital payment issue and errors in the original data book and failure to ensure all MCOs meet the same robust standards for network adequacy," Sizemore reports. MCOs are managed-care organizations.

Conventry Health and Kentucky Spirit are two of three MCOs chosen to manage the state's Medicaid program. Since they took over Nov. 1, there have been repeated complaints about delayed payments, as well as burdensome rules requiring doctors to get pre-authorization from the companies before they can provide care.

ARH treats about 25,000 Medicaid patients at its eight hospitals. In the past six months, nearly 11,000 Medicaid visits have been made at the Harlan facility alone, with 7,800 of them covered by Coventry, said Mark Bell, community and patient advocate. This will "present a complex and serious crisis for everyone," he said. (Read more)

Convenience, not expense, is making us avoid eating fruits, vegetables and other non-processed foods

A lack of convenience, not a high price, is the major obstacle to getting people to eat more fruit and vegetables, a study published in the journal Public Health Nutrition has found. The study analyzed the fruit and vegetable consumption in six low-income, mostly minority neighborhoods in Chicago.

"Participants who agreed that they had 'convenient access to quality' produce were more than twice as likely to eat the FDA-recommended amounts of fruits and vegetables," Sarah Kliff reports for The Washington Post. "Those who reported high cost as a barrier to the consumption of produce ended up eating just as much as those who didn't." (Post photo above by Barbara Damrosch)

The study seems to support New York Times columnist Mark Bittman's assertion that Americans are skipping nutritious food because it takes much more work to prepare, not because it's too expensive. "It's cooking that's the real challenge," he writes in a September 2011 column. "The core problem is that cooking is defined as work, and fast food is both a pleasure and a crutch." (Times photo by Daniel Borris)

Contributing to the problem, Bittman argues, is the addictive qualities of fast food and processed food: physically addictive, as a study by the Scripps Research Institute shows, and mentally addictive. Bittman cites David A. Kessler, former commissioner of the Food and Drug Administration and author of The End of Overeating, who said manufacturers created food that was "energy-dense, highly stimulating and went down easy. They put it on every street corner and made it mobile, and they made it socially acceptable to eat anytime and anyplace. They created a food carnival, and that's where we live. And if you're used to self-stimulation every 15 minutes, well, you can't run into the kitchen to satisfy that urge."

The answer is in changing mindsets, Bittman writes, and getting "people to see cooking as a joy rather than a burden, or at least as part of a normal life." That takes education and changing the environment, which, he points out, has been done with tobacco. Cultural change can happen by celebrating whole foods, he writes. Political action would mean limiting "the marketing of junk; forcing its makers to pay the true costs of production; recognizing that advertising for fast food is not the exercise of free speech but behavior manipulation of addictive substances; and making certain that real food is affordable and available to everyone. The political challenge is the more difficult one, but it cannot be ignored." (Read more)

Kentucky is 43rd among the states in health rankings report

Kentucky is near the bottom of the list in a ranking that determines which states are the healthiest. It came in 43rd, up from 44th last year.

Kentucky's low ranking is attributed to its unusually high numbers of people who smoke, are obese, die of cancer and are hospitalized for preventable reasons, according to America's Health Rankings, funded by the United Health Foundation.

"As it has for the last decade, Mississippi was ranked 50th on this year's list, which was topped by Vermont at No. 1," Louisville's Business First reports.

"Kentucky's rank of 43rd is a reminder that, while are making progress, as Kentuckians we still have much to do to keep ill health from holding us down," said Susan Zepeda, president/CEO of the Foundation for a Healthy Kentucky. "The good news is there are many concerned civic leaders working to reduce rates of smoking and obesity in the state and keep young people from starting to smoke."

Highlights of the report show:

• While smoking has decreased from 30.5 percent to 24.8 percent of Kentucky adults in the past 10 years, 822,000 still smoke. Recently, Kentucky ranked 36th in the nation for its smoking cessation efforts.

• Almost 1.1 million Kentuckians are obese, 353,000 more than 10 years ago.

• Diabetes decreased from 11.5 percent to 10 percent of the populations in the past year, but there are still 322,000 adults in Kentucky with diabetes.

• In the past five years, the percentage of people without health insurance increased from 13 percent to 15.4 percent.

• In the past 10 years, the percentage of children living in poverty increased from 15.2 percent to 24.7 percent.

As for the entire country, overall health has not improved this year over 2010. "Between 1990 and 2000, the overall health of the nation ... improved by an average of 1.6 percent each year. After 2000, however, the upward trend slowed to 0.5 percent annually," until this year, Health.com reports.

"Physical activity, nutrition, and tobacco: If we could get people focused on those three, we could take a huge bite out of the chronic-disease epidemic," said Georges Benjamin, the executive director of American Public Health Association. "This is not an infinite list of things that people have to address."

America's Health Rankings has been assessing health data for the past 22 years, making it the longest-running health assessment report in the country. For its methodology, researchers look at four groups of health determinants: behaviors, such as smoking and obesity rates; community and environment, such as children living in poverty, violent crime and infectious disease; public and health policies, such as lack of health insurance and public health funding; and clinic care, such as prenatal care, the number of primary care physician and preventable hospitalization rates.

Each of these four determinants are intimately connected with one other, researchers contend. "For example, an initiative that addresses tobacco cessation requires not only efforts on the part of the individual but also support from the community in the form of public and health policies that promote non-smoking and the availability of effective counseling and care at clinics," the report reads.

Data sources include the Centers for Disease Control and Prevention; American Medical Association; Federal Bureau of Investigation; U.S. Census Bureau; and National Center for Health Statistics.

Kentucky Youth Advocates gets $100,000 to push for income-tax policies aimed at helping the poor improve their health

Kentucky Youth Advocates is one of 12 coalitions nationwide to receive a "Roadmaps to Health" grant from the Robert Wood Johnson Foundation. The non-profit children's advocacy organization will receive $100,000 for two years to build statewide support for tax policies that would help low-income families keep more of their income to pay for doctor visits, healthier diets and weight-loss or smoking-cessation services.

The 12 grantees were selected from more than 300 initial applicants. "Kentucky Youth Advocates has long been a proponent of improving economic policies for families, and promoting child health throughout the state," said Tara Grieshop-Goodwin, deputy director of the coalition. "We know income can impact health, and we are excited to ahve the opportunity to combine our economic well-being efforts with our health work and look forward to fostering partnerships between advocates from both disciplines throughout the state." (Read more)

Last year, 17.4 percent of Kentuckians lived in poverty and 17.5 percent did not have health insurance

More than one in six Kentuckians lived in poverty last year and almost exactly the same number didn't have health insurance, preliminary U.S. Census numbers show.

The state's poverty rate was 17.4 percent and the uninsured rate was 17.5 percent. Nationwide, 15.1 percent of Americans lived in poverty and 16.3 percent were without health insurance in 2010, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

To be considered to be living below the poverty line, a family of four must earn less than $22,314 each year.

About 640,000 Kentuckians do not have health insurance. Those numbers have risen as employers have stopped offering coverage to employees, said Jason Bailey, director of the Kentucky Center for Economic Policy. In 2000, 65 percent of Kentuckians had employer-based insurance, but in 2010 only 57 percent did.

Medicaid, which provides coverage for the country's poor and disabled, covered almost 1 in 5 Kentuckians in 2010, up from 1 in 10 in 2000, Bailey said. "The percent of children covered by Medicaid in Kentucky rose 6 percentage points since 2007-08, to 40 percent, keeping the number of uninsured children low," Spears reports. (Read more)