Ta b l e o f C o n t e n t s
James Comer & Chris McDaniel
E x p e r i e n c e M at t e r s
Healthcare is Kentucky’s second largest budget item by function. The next Governor of Kentucky
will inherit the largest expansion of Medicaid in history and the single worst piece of legislation in
modern history with Obamacare. Kentucky must get its fiscal house in order and healthcare is a
good place to start.
Commissioner James Comer understands the issues that face our healthcare system and how to
address the budget issues surrounding the drastic changes that have occurred in healthcare in the
last 5 years. Prior to being elected as Kentucky’s Commissioner of Agriculture, Comer served on the
Kentucky State House Health and Welfare Committee. His vast knowledge of the healthcare issues
facing Kentucky has garnered support and endorsements from hundreds of doctors, healthcare
executives, and medical professionals across Kentucky.
As the current Chairman of the Kentucky Senate Appropriations and Revenue Committee, Senator
Chris McDaniel oversees every expenditure in the state budget. He has fought against wasteful
spending and understands where opportunities for efficiency lie within the budget. McDaniel also led
the effort to pass crucial legislation to fight Kentucky’s heroin epidemic in the 2015 session of the
General Assembly.
Over the past year, Commissioner Comer and Senator McDaniel have sought input from hundreds
of doctors and healthcare professionals about the issues that face Kentucky’s healthcare system.
The “Comer/McDaniel Plan for a Healthier Kentucky” is the culmination of the many hours spent
meeting with the people on the frontline of healthcare issues in Kentucky. Bold leadership is more
than generic talking points and buzz words. Bold leadership is critical thinking and offering detailed
solutions. Kentuckians deserve nothing less.
4
Introduction
5
Kentucky has unacceptable statistics regarding the health status of its citizens, and
a significant contributing factor is the unacceptably low average household income:
The Comer/McDaniel Plan to improve the health of Kentuckians
8
Kentucky’s rural health care system is fragile and in peril:
The Comer/McDaniel Plan to save and support Kentucky’s rural health system
11
The cost of healthcare is of great concern to Kentuckians:
The Comer/McDaniel Commitment to helping Kentuckians address the costs of healthcare
12
The Commonwealth’s healthcare bureaucracy must be improved to be more efficient,
responsive, and to provide more organizational and fiscal accountability:
The Comer/McDaniel Plan regarding overhaul of the state government bureaucracy
in healthcare
15
The Commonwealth’s “Medicaid Managed Care System” must be fixed and paid for:
The Comer/McDaniel Plan to address Medicaid
19
Provider Taxes and DSH program:
The Comer/McDaniel position on provider taxes and DSH program
19
Medical Professional Liability:
The Comer/McDaniel position on Medical Professional Liability
20
Healthcare Workforce:
The Comer/McDaniel plan for assuring Kentucky has a 21st Century healthcare workforce
20
Long Term Care:
The Comer/McDaniel Commitment to Long Term Care
21
Mental Health:
The Comer/McDaniel Commitment to Mental Health Care
I n t r o d u ct i o n
Kentucky spends over $28.4 billion annually on healthcare which accounts for 16-18% of
Kentucky’s Gross Domestic Product and healthcare spending continues to grow each year,
usually outpacing the overall economy. But even with those expenditures, the health status
of Kentuckians falls near the bottom compared to all other states in many categories. And the
number of Kentuckians being added to Medicaid has rapidly increased, creating an unsustainable
increase in costs to taxpayers. Therefore, healthcare will be a major focus of the Comer/
McDaniel Administration. While the health of our citizens is far more than just a “business,” we
will identify all the major issues and address them in a business-like manner, including defining
the priority issues, completing research, understanding the issues, engaging appropriate experts
from across the state and beyond, developing plans with timelines, budgets, and metrics
for performance and outcomes measurement, and working with legislators and others for
successful implementation. We will be committed to improving the health of Kentuckians while
being responsible for sound fiscal management of taxpayer assets.
We have identified the following major areas of focus within the healthcare sector for the Comer/
McDaniel Administration. The following is our position and plan for each area of focus. Obviously,
this document will be dynamic and fluid, being adjusted as we proceed through the campaign
and in the early months of our administration. It will be based on continued learning of additional
facts, challenges, and opportunities, while listening to the public we serve. A.KENTUCKY HAS UNACCEPTABLE STATISTICS REGARDING
THE HEALTH STATUS OF ITS CITIZENS. A SIGNIFICANT
CONTRIBUTING FACTOR IS THE LOW AVERAGE HOUSEHOLD
INCOME OF KENTUCKIANS.
1. Kentuckians’ poor health statistics
n KY ranks 47th in overall health conditions of its citizens
• Cancer deaths: 50th
• Smoking: 49th
• Drug Deaths: 48th (Heroin overdose deaths up 20% since 2012) • Obesity: 46th
67% of KY adults are overweight; 31% obese. 37% of KY children ages 10-17 are overweight
or obese. Overweight/obesity increases an individual’s risk of chronic diseases including heart
disease, stroke, diabetes, and certain cancers.
• Cardiovascular Deaths: 43rd
• Diabetes: 38th (35% higher than national average)
• Annual dental visits 44th • Teen Births 46%
• Inadequate prenatal care 34%
2. Kentuckians’ low incomes
n KY ranks 47th in median household income and 46th in per capita income.
n KY ranks 50th for children in poverty (32% in poverty; National average is 20%)
3. Research has shown a strong link between lower income and poorer health.
n 2
5% of KY’s population is on Medicaid (National average: 8-10%), with a total cost of over
$8 billion, and rising rapidly
• Approx. 1,073,000 people (including 440,000 children, of which 75,000 are chronically ill)
• 375,000 added to Medicaid in 2014 as result of Affordable Care Act (Obamacare) and Gov.
Beshear’s expansion of Medicaid
• It’s estimated that over 60,000 KY children are uninsured even though they are eligible for
Medicaid or KCHIP
n Kentucky leads the nation in child abuse and neglect death rates. In 2013, KY had 17,000 cases
of child abuse reported, and averages 25-30 deaths per year. Children who survive abuse often
are left with lifetime debilitating injuries. Research also shows that a child living in poverty is 22
times more likely to be abused. Thus addressing poverty is a key to preventing child abuse
n Kentucky has the highest rate of preventable hospital admissions in the nation. These are mostly
comprised of patients who have chronic disease conditions, such as respiratory ailments, heart
disease, and diabetes... chronic conditions for which appropriate treatment can avoid costly
hospital stays
4 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 5
Comer/McDaniel Plan to improve health of Kentuckians
e) W
e will have our applicable Cabinets work with providers, insurance companies, and others
to improve access for all Kentuckians to physical health resources as well as mental, dental,
and vision health resources. We will also seek ways to promote integration of physical,
mental, dental, and vision healthcare services in all healthcare offerings by insurance
carriers, employer self-insured plans, and the Medicaid program, to achieve efficiencies in
care delivery and lower costs.
f) A
s called for in the state health plan, Cabinet for Health and Family Services (CHFS) will
work with the Commonwealth’s two regional perinatal centers for the highest levels of
neonatal care (the two children’s hospitals), Kentucky’s medical schools, and other pediatric
care providers to develop an improved and coordinated system throughout Kentucky for
caring for our smallest and most vulnerable children: our infants needing the highest level
of specialty neonatal care. These patients are also often Medicaid/KCHIP recipients and
thus, are major costs for that program. Thus, better coordination of care will save taxpayers
Action Item A1: We must, and we will, create more jobs to increase median household incomes
in Kentucky, thus decreasing the need for families to be on Medicaid and, making KY less of a
“welfare state.”
Action Item A2: We must, and we will, within the first 180 days of our administration, create a
“Strategic Plan for a Healthier Kentucky” which will include input from experts across Kentucky,
and will include specific, actionable plans with timetables to significantly improve the health of
Kentuckians over the next decade. Such a plan will include (but not be limited to):
a) C
hild Abuse: Child abuse is 100% preventable. It is unacceptable for Kentucky to rank 50th
in child abuse and death rates. The Comer/McDaniel Administration will make prevention and
early detection/intervention of child abuse and neglect a priority. Our state agencies will work
closely with legislators and the outstanding private organizations in the state to coordinate a
statewide effort to improve Kentucky’s statistics and to move us from “worst to first”.
money as well as saving the lives of Kentucky babies.
b) W
e will create initiatives within the Department of Insurance to facilitate insurance plans
which reward healthier life style habits (incentives to reduce smoking, obesity, etc.), increase
prevention and wellness programs and participation, early detection and intervention (e.g.
cancer screenings, heart disease, etc.), and better manage chronic diseases (e.g. respiratory
ailments, diabetes, heart disease, etc.), ensure coverage for and require medical homes
(primary care physicians) annual physical exams, and programs to assure treatment and
monitoring of patients with chronic disease (e.g. chronic health management programs).
c) W
e will support legislation and appropriate regulations to prevent access to illegal drugs, to
fight heroin and opioid abuse, meth production and use, prescription drug abuse, and other
abuses of drugs, and to improve access to substance abuse addition education, treatment,
and coverage for those with substance abuse problems.
g) C
HFS and the Medicaid Program will also work with the Commonwealth’s two children’s
hospitals, our medical schools, and other pediatric providers across Kentucky, to develop
better access to and coordination of specialty care services for children across the state,
including cardiology, diabetes, pulmonary, and other areas of specialty care. Public/private
partnerships, as well as telemedicine and new technology, will be encouraged
and facilitated.
We will support efforts to address the increasing rate of infants born with neonatal abstinence
syndrome (NAS).
We will support legislation to toughen criminal penalties for drug traffickers. These efforts will require
coordination among multiple cabinets and departments:
d) N
ew initiatives between Cabinets of Education and CHFS to use social media and health
information technology to better educate Kentuckians about prevention, wellness, early
intervention, and how best to get access to healthcare, and to better understand and take
advantage of the health care coverage they already have, especially about health education,
prevention and early detection/intervention.
6 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 7
B.KENTUCKY’S RURAL HEALTH CARE SYSTEM IS FRAGILE
AND IN PERIL
n 45% of Kentuckians get their hospital care from KY’s 66 rural hospitals.
n 6
8% of KY’s rural hospitals are below national average in financial strength and 34% are
considered to be in “poor financial health.” Of those in poor health, approx. 60% of their patients
are on Medicaid and Medicare with most being low income and/or elderly.
Comer/McDaniel Plan to save and support Kentucky’s
rural health system:
Action Item B 1: We endorse the recent “Special Report on the Financial Strength of Kentucky’s
Rural Hospitals” by Adam Edelen, Auditor of Public Accounts, and commit to begin immediately to
implement its recommendations, including:
•
sing a provider-endorsed financial assessment tool to regularly monitor the fiscal strength of
U
rural hospitals.
•
Convene a work group, reporting directly to the Cabinet, to:
• Examine new models for rural healthcare delivery to ensure quality of care and continued
and better access to care in rural Kentucky, and develop recommendations to ensure those
providers have the flexibility to adjust their business models for 21st century health care
delivery. This may include proposed changes to Certificate of Need/Licensure regulations
to allow more flexibility in how to use or transition existing assets (licensed beds or other
resources) to other uses which better meet the needs of those served and to adapt to the
rapidly changing health care landscape.
• Determine need and feasibility of an emergency capital pool for use in providing short-term
loans, transition incentives, financing for equipment and technology advances, and other
needs.
• Track changes in numbers and types of providers across all regions, especially those who
take low income/Medicaid patients, and make recommendations to improve access to
medical services.
• Make recommendations to improve access to care in remote areas that have inadequate
primary care or specialty providers, through telemedicine or other strategies. Likewise, make
recommendations on improving access to care by specific strategies regarding emergency
and non-emergency transportation, the role health departments should play, healthcare, and
workforce issues, etc.
8 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 9
C. THE COST OF HEALTHCARE IS OF GREAT CONCERN
TO KENTUCKIANS
n Healthcare costs make up 16-18% of the state’s economy and continue to increase.
n The costs of the state’s Medicaid program has rapidly grown at unsustainable rates.
n 30% of recently polled KY adults said the cost of healthcare was of great concern to them.
n 2
2% of KY adults indicate they delay needed medical care due to costs and 31% have trouble
paying medical bills.
Comer/McDaniel Commitment to helping Kentuckians
address the rising costs of healthcare:
Healthcare costs continue to be of great concern to Kentuckians as well as the entire nation. The entire
healthcare industry is undergoing rapid change, with much of the focus on ways to reduce costs. Over
the next decade, providers and insurers expect our nation’s healthcare system to evolve away from a
volume-driven, “fee-for-service” payment system which rewards over-utilization, to more of a valuedriven system which rewards providers for keeping people healthy and reducing costs.
The Comer/McDaniel Administration will work with providers and insurers, and those responsible
for managing the state’s Medicaid program, to move expeditiously toward this new healthcare
environment.
The Comer/McDaniel Administration will bring the public and private sectors together to develop
and implement in Kentucky innovative and state of the art initiatives to increase coordination of
delivery of services, expanded use of health information technology, chronic disease management
prevention and management, to improve health outcomes. Further, we will develop new payment
and service delivery models in the context of the evolving changes in healthcare payment models
from volume-based fee for service to a value-based payment environment to pay/reward providers
for keeping citizens health rather than being incented to create more volume of episodes of service,
and to ultimately reduce the cost of healthcare.
10 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 11
D.THE COMMONWEALTH’S HEALTHCARE BUREAUCRACY
MUST BE IMPROVED TO BE MORE EFFICIENT, RESPONSIVE,
AND TO PROVIDE MORE ORGANIZATIONAL AND FISCAL
ACCOUNTABILITY
The Cabinet for Health and Family Services (CHFS) has become a huge, complex bureaucracy, with
over 8,000 employees in 32 separate agencies, divisions, advisory commissions/councils/boards, and
with a total budget of over $10.5 billion, all under the auspices of one Cabinet Secretary appointed by
the Governor. Moreover, the Medicaid program is a huge and growing expenditure of the state (over
$ 8 billion), with tremendous challenges. It must be given exclusive attention by professionals with
extensive and successful experience in these complex areas of public policy and expense.
Comer/McDaniel Plan regarding overhaul of the state
government bureaucracy in healthcare:
Action Item D 1: The Comer/McDaniel administration will promptly and seriously consider whether
to split the current Cabinet for Health and Family Services (CHFS) into two departments under one
Cabinet, one to oversee the huge Medicaid program and get it under control, and another for all other
Health and Family services programs.
Action Item D 2: The Commissioner (or Cabinet Secretary) will be from the “provider community,”
and someone who has had significant operational experience in the healthcare environment,
including managed care.
Action Item D 3: Certificate of Need:
The Comer/McDaniel administration will be pro free-market competition and anti-regulation. Providers
have traditionally been financially incentivized to build capacity and then over-utilize that capacity,
which increases costs of healthcare to consumers, employers, and taxpayers (via over utilization of
Medicaid, Medicare). Kentucky is one of 37 with a certificate of need (CON) program, administered
in conjunction with statewide health planning, to ensure that major expenditures in expanding
healthcare capacity are really needed by Kentuckians. Also, CON helps protect “safety net” providers
(often in rural settings) from being threatened by proprietary providers “cherry-picking” paying
patients. We also recognize that the healthcare landscape is constantly evolving from the historic
volume-driven “fee for service” payment system to more of a value-based system which will
dramatically alter financial incentives to providers.
12 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel administration will support retaining the CON program and require all providers
to follow the same rules in order to assure a level playing field and to protect the public. We will
take action. We will continually review the state health planning process as well as the current CON
process to determine if they are meeting their intended purposes and to streamline those processes
whenever feasible.
We will also closely monitor the changing healthcare environment to determine if any changes need
to be made to either the state health planning process or the CON process to assure that both are
contemporary and handled in a business-like “best practice” manner, compared to other “CON
states”. We will modernize, as appropriate, the CON process to facilitate the evolution of providers
being paid on the basis of keeping people healthy (“value”) rather than volume (“fee for service”),
to facilitate providers who develop a full continuum of care alone or in partnership with others, to
improve quality and patient safety, and to improve access to care.
Given the rapid changes in health care, and in order to meet the needs of local patient populations
and providers, we will explore expanding the concept of “flexible beds” to allow the type of bed
designation (e.g. acute vs. skilled nursing) to follow patient needs without requiring transfer,
especially in rural areas, thus improving access and allowing patients to stay close to home.
The Comer/McDaniel Plan for a Healthier Kentucky 13
E.THE COMMONWEALTH’S
“MEDICAID MANAGED CARE”
SYSTEM MUST BE FIXED AND
PAID FOR
The cost escalations to the Commonwealth are
unsustainable.
1. As previously cited:
n 25% of KY’s population is on Medicaid
(National average: 8-10%); Approx. 1,046,000
people.
• Of those, 440,000 are children, with
75,000 chronically ill, accounting for $434
million in Medicaid claims.
n 375,000 added to Medicaid in 2014 as result
of Obamacare and Gov. Beshear’s expansion
of Medicaid, at additional cost of $2.5 billion,
but no plan on how to pay for the expansion
after the 100% reimbursement from federal
government begins to phase down in 2017
from 100% of expansion costs initially, to
95% in 2017, and to 90% by 2020.
2.In 2015, the total cost of KY’s Medicaid program is
projected to be over $ 8 billion.
3.When the state moved to the current “managed
care” system for Medicaid in 2012, it did so too
hurriedly and thus has created huge problems for
providers and has not achieved its potential or
mandate (cost savings, improved health status of
Kentuckians). According to a report in late 2014
14 The Comer/McDaniel Plan for a Healthier Kentucky
by Citi Research, through the first nine months
of 2014, Kentucky MCOs generated over $444
million, a profit margin of 10.6%, compared to
a 3-5% margin that most Medicaid MCO plans
target nationally and what Kentucky expected.
4.The lack of standardization among the MCOs with
respect to credentialing of providers, formularies,
prior authorizations, appeals processes and the
like, are increasing the administrative costs of
hospitals and other providers, and are creating
unnecessary and inappropriate barriers to
patients and providers.
5.Per the Special Report on the Financial Strength
of Kentucky’s Rural Hospitals” by Adam Edelen,
Auditor of Public Accounts:
a) “Weaknesses in the contracts
between CHFS and MCOs appear to
be hindering improvements from being
made to the managed care system
in the Commonwealth, and are likely
contributing factors to the declining fiscal
health of many providers.”
b) Administrative burdens on hospitals have
increased since the implementation of
Medicaid managed care.
c) Hospitals indicate MCO policies
regarding Emergency Room (ER) visits
are causing a significant financial burden
(and thus, inevitably, an access barrier to
Medicaid recipients).
The Comer/McDaniel Plan for a Healthier Kentucky 15
Comer McDaniel Plan to address Medicaid:
Action Item E 1: As previously stated, The Commissioner (or Cabinet Secretary) for Medicaid will
be from the “provider community,” someone who has had significant operational experience in the
healthcare environment, including managed care.
Action Item E 2: The Comer/McDaniel administration will make substantial changes to the Medicaid
Managed Care program to improve real coordination/management of care to Medicaid recipients, to
address legitimate concerns of providers, and to better oversee the performance of the Medicaid
Managed Care Organizations (MCOs), and to better manage the costs to the Commonwealth,
including a specific plan to address the reduction of the federal subsidies for Medicaid which begin
in 2017. We will develop a plan which will pay for the expanded Medicaid costs by (a) decreasing
unnecessary utilization of services through true managed care/coordination of care, and (b) carefully
monitoring eligibility to assure that only those who meet the criteria receive and/or stay on Medicaid.
Specific changes anticipated by the Comer Administration include:
(1) How to move the Kentucky Medicaid managed care toward payment for “value” instead
of “volume”; that is, how to move to a payment system to incentivize both the MCOs
and providers to work collaboratively to actually improve the health status of Medicaid
beneficiaries and to keep people healthy rather than the current system which still rewards
volume in many ways. This major initiative will require much inclusive planning and a new
environment of collaboration by the Cabinet, the MCOs, and providers. The money saved by
better management of care resources and reduction in unnecessary utilization of resources
will be key to accomplishing the necessary savings to help pay for the increased financial
burden on the state by the Medicaid program.
(2) A
system to ensure Medicaid recipients initially and continue to meet appropriate eligibility
criteria. It is anticipated that re-enrollment will be required at least every two years.
(3) L
ikewise, CHFS/Medicaid program will initiate programs to better ensure Medicaid
beneficiaries understand their coverage and are appropriately utilizing the services.
Emphasis will be placed on assuring that beneficiaries have a “medical home” and are
getting appropriate primary care to include prevention services (e.g. immunizations, checkups, etc.), early diagnosis and intervention when indicated, and appropriate treatment of
chronic diseases. This will improve the health of those beneficiaries as well as save the
taxpayers money in the long run.
(4) D
evelop specific programs and plans to reduce the number of preventable hospital
re-admissions of Medicaid patients.
16 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 17
(5) Regarding MCO’s:
•
•
•
•
•
evelop an independent appeal process to
D
challenge inappropriate MCO denials of coverage
and payment.
Develop a process to require MCOs to recognize
a valid patient assignment of benefits allowing
providers to represent patients in the appeals
process, including a fair hearing.
Require MCOs to use nationally recognized criteria
for determining medical necessity of hospitalization
or treatment.
Require MCOs to comply with federally approved
Medicaid State Plan policies which require hospital
ERs to determine if an emergency or nonemergency condition exists.
MCOs will be audited by the Commonwealth on a
regular basis to determine adherence to contract
criteria, applicable policies and regulations, provider
and beneficiary relations, and profits.
(6) F
urthermore, the Medicaid program will adopt the
recommendations of the State Auditor’s report
(referenced above), including:
•
•
•
•
•
•
•
•
Improve relations with providers.
Establish a uniform credentialing/re-credentialing
process for MCOs.
Report, or require providers to report, any changes
in provider certification status to MCOs in a
reasonable time frame.
Require MCOs to publish preauthorization criteria
and formulary schedules within a certain timeframe.
MCO contractual penalties be strengthened, such
as listing specific penalties and establishing criteria
for applying penalties.
CHFS require MCOs to report provider grievances/
appeals monthly so it can determine that conflicts
are resolved appropriately and timely.
CHFS update MCO contractual language to
strengthen behavioral health integration and
wellness program requirements.
CHFS will expand quality reporting, utilizing
recognized national reporting organizations and/
or criteria.
18 The Comer/McDaniel Plan for a Healthier Kentucky
•
HFS will establish contractual restrictions on
C
triage fee caps to avoid overuse of the caps as well
as provisions to permit the use of triage fees in
instances when providers refuse to participate in
certain cost savings, utilization management, and
wellness programs.
CHFS will incorporate policies in its MCO contracts
that will further enhance its ER SMART initiative.
•
(7) T
aking care of our own: We will work with
Kentucky healthcare providers, especially those
along border counties and with Kentucky providers
of the highest levels of care, to maximize keeping
patients in Kentucky unless the patient’s health
condition or urgency of care dictates the need
to be treated outside Kentucky. This will provide
these patients with better access to care closer
to home, and for those patients in the Medicaid
program, will save the Commonwealth’s
taxpayers money.
(8) Medically complex children on Medicaid:
Over 440,000 Kentucky children are on Medicaid, of
which at least 75,000 are chronically ill. (The most
common and costly type of chronic pediatric patient:
Chronic Pulmonary disease (COPD) with 67,000
patients at a cost of $32 M in 2013. Other top
chronic conditions of pediatric Medicaid patients:
cancer, diabetes, cerebral palsy, congenital heart
conditions.)
The Comer/McDaniel Administration will work with
Kentucky’s providers of pediatric care, especially
the two children’s hospitals and physicians/other
providers who provide specialty care to children,
F. PROVIDER TAXES AND DSH PROGRAM
Kentucky hospitals pay $183 Million annually in provider taxes which generates more than $600
million each year to support the Medicaid program. A portion of this tax is used as the state match to
access federal Medicaid “disproportionate share” funds which are allocated to Kentucky’s hospitals
(which care for a “disproportionate share of Medicaid and/or indigent patients) to help offset losses
incurred because Medicaid pays, on average, only 80% of actual costs to treat Medicaid patients.
The Medicaid shortfall is expected to rise with the Medicaid expansion, up to $400 million annually.
Federal Medicaid DSH funds are slated to be cut under the Affordable Care Act beginning in 2017.
The Comer/McDaniel position on Provider Taxes
and DSH Program:
We will work to provide Kentucky hospitals with continued access to the federal DSH funds and will
oppose any action to reduce hospital DSH funding.
G.MEDICAL PROFESSIONAL LIABILITY
Medical liability insurance costs are lower in surrounding states that have enacted liability reforms.
Kentucky is ranked 38th worse among all states on elements related to the litigation environment,
such as damages and jury fairness. Frivolous lawsuits are a major factor driving increased medical
liability premiums as well as the practice of defensive medicine which increases the costs of
healthcare. About 20 states use medical review panels to identify and eliminate meritless cases and
encourage early settlement of valid cases without going through the court process. This benefits
injured patients by getting claims settled faster and a high percentage of the money going to the
injured individual rather than the legal system. Review panels have been shown to lower health care
costs and lower liability insurance rates by as much as 20%.
The Comer/McDaniel position on Medical Professional Liability:
We will actively promote the enactment of legislation establishing medical screening panels for the
review of all medical liability claims in Kentucky.
to meet the opportunities and requirements of
this expected federal legislation. This will that
ensure these “special needs children” get the care
that they require in the most appropriate settings
closest to home, and to hopefully also achieve
efficiencies in costs for the Medicaid program.
The Comer/McDaniel Plan for a Healthier Kentucky 19
H.HEALTHCARE WORKFORCE
Having a sufficient supply and appropriate distribution of healthcare workforce throughout the
Commonwealth is a fundamental necessity in providing all Kentuckians with access to quality
healthcare and, thus, to improving the health status of Kentuckians. This includes physicians
(especially primary care), physician extenders, nurses, pharmacists, and allied health practitioners.
Additionally, the local hospital and/or healthcare facilities are often a major employer for Kentucky
communities
The Comer/McDaniel Administration Plan to Ensure a
21st Century Healthcare Workforce for Kentucky:
We will work with the Cabinet for Education and Workforce, Council on Post-Secondary Education,
and the Cabinet for Health and Family Services to collaboratively develop a “Comprehensive Plan
for Kentucky’s Healthcare Workforce of the 21st Century” to ensure a sufficient quantity and
distribution of appropriately trained healthcare workforce to meet the projected needs of Kentucky
and to improve the health status of Kentuckians. Emphasis will be placed on plans to attract and
assist students from Kentucky to enter into healthcare professions and to keep them in Kentucky
following training, and to incent graduates to provide services in those areas of Kentucky needing
more healthcare workers, especially rural Kentucky. Emphasis will also be placed on partnerships
and collaborations, including the Commonwealth’s public universities as well as private educational
and training institutions.
I.LONG TERM CARE
As the expected life span increases, and as “Baby Boomers” reach retirement age and beyond,
the need for long term beds is increasing, as is the desire to receive services while staying in their
homes. Likewise, these needs are increasing for our citizens with major disabilities. With the
expansion of Kentucky’s Medicaid program, more of these Kentuckians are qualifying for Medicaid,
which, in turn, creates additional cost for our state.
administration is committed to removing barriers and encouraging providers to operate across our
great state. Our administration will aggressively pursue legislation to create medical review panels to
reduce frivolous lawsuits, which drive up the cost of care and divert precious resources from actually
providing care. CHFS will review regulations and develop sustainable models to enable services to
be provided in the community. Regardless of where services are received, the funding should follow
the person and not inhibit their access to care.
J.MENTAL HEALTH
There is a shortage of mental health providers and facilities, both in-patient and out-patient. The wide
disparities and geographic gaps in the distribution of existing providers make access a critical issue.
While state and federal laws mandate parity in the access to mental health services, the reality is that
true parity does not exist in Kentucky.
THE COMER/MCDANIEL COMMITTMENT on Mental Health:
We understand the importance of adequate access to mental health services and true parity. We
are committed to giving mental health providers, advocates and other stakeholders a place at the
table as we discuss policies for addressing mental health issues. We acknowledge the complexities
involved in dealing with these issues and know it is imperative there be a collaborative effort
with maximum involvement from experts and those in the field. CHFS will review the policies of
each Medicaid MCO for compliance with their contract on these issues and access to treatment.
Inappropriate denials for treatment will not be tolerated. CHFS will promote the integration of
behavioral and physical health through financial incentives, which will save money, improve the
delivery of care and enhance the quality of life for patients. In addition, CHFS will create policies that
will lead to a robust continuum of care to address the gap between primary mental health services
and in-patient care. As we develop policies, the main focus will be to remove barriers and promote
seamless access to services through the state.
All too often our citizens find they must travel beyond their communities to find an available long
term care bed or the services they need to stay in their homes are not available. Long term care
companies have left our state because we have done nothing to prevent frivolous lawsuits. In
addition, Kentucky has not been progressive in attracting businesses to operate in all parts of our
state to provide services these vulnerable citizens need in order to stay at home.
THE COMER/MCDANIEL COMMITTMENT on Long Term Care:
We are committed to including long term care providers, advocates and other stakeholders in
discussions about policy and in finding solutions to the long term care issues facing our state. Our
primary goal is to allow older Kentuckians and those with disabilities to receive needed services
in their community whether they are living in their homes or in a residential facility. We believe
Kentuckians deserve the ability to choose where they want to receive these services and our
20 The Comer/McDaniel Plan for a Healthier Kentucky
The Comer/McDaniel Plan for a Healthier Kentucky 21
references
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
Centers for Medicare and Medicaid Services: State Innovation Models
Kentucky State Health Plan 2013 – 2015
Kentucky Office of Health Policy: Health Facility and Services Utilization Reports
Children’s Hospital Association: proposed “Advancing Care for Exceptional Kids Act of 2015”
Kentucky Department of Medicaid Services: “Cost of Medicaid Expansion”
Citi: “Managed Care Weekend Update” (week ending November 29, 2014)
Every Child Matters Education Fund (Child Death Rates)
Partnership to Eliminate Child Abuse
Kentucky Hospital Association
United Health Foundation: America’s Health Rankings 2014
The Leadership Institute: Telemedicine
Kentucky Cabinet for Health and Family Services: Pediatric Health Statistics
Watchdog.org (Medicaid expansion)
CN/2 (Medicaid expansion)
WHAS 11 (Medicaid expenses)
Medicaid.gov
KentuckyHealthFacts.org
Foundation for a Healthy Kentucky: Kentucky Health Issues Poll 2012, 2013, 2014
Foundation for a Healthy Kentucky: 2012 Kentucky Parent Survey
Foundation for a Healthy Kentucky: “Place Matters: Health Disparities in the Commonwealth”
Kentucky Cabinet for Health and Family Services: Analysis of the Affordable Care Act, Medicaid
Expansion in Kentucky
22) The Special Report on the Financial Strength of Kentucky’s Rural Hospitals, Adam Edelen,
Auditor of Public Accounts (March 2015)
22 The Comer/McDaniel Plan for a Healthier Kentucky
Paid for by Comer for Governor