Ky. Faces Obstacles on its Roadmap Toward Improved Health

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LEXINGTON HERALD-LEADER | OP-ED | MAY 5, 2015

Kentuckians are generally unhealthy, but with so many problems, where do we begin?

Last year, the state established a set of priorities to help improve health. The priorities include basic but important goals, such as reducing smoking, obesity, cancer deaths, heart disease and other important public health priorities.

The seven goals are set out in a program called kyhealthnow.

But we know — from working on the front lines of medical care — that there are many barriers within the health care system to achieving these goals. Through meetings and individual discussions with physicians, as well as a recent survey of physicians, the Kentucky Medical Association has identified specific barriers that must be addressed before we, as a state, can get healthy.

Take, for instance, the No. 1 public-health issue in our state — smoking. We continue to lead the nation in the percentage of residents who smoke, with more than 30 percent of Kentuckians participating in this unfortunate habit.

Smoking also contributes to other health conditions on the kyhealthnow list, such as cancer deaths and heart disease.

It seems logical that we should do everything we can to help those who want to quit smoking do exactly that.

But patients often find that the health system contains many unnecessary roadblocks. For instance:

  • Insurers often fail to cover medication related to smoking cessation and fail to cover smoking cessation counseling. Whether on health or cost terms, I am at a loss to understand that.
  • Reducing cancer deaths: According to feedback from physicians, many insurers require preauthorization for cancer screening services — including those for breast, colon and lung cancers.
  • Reducing obesity: Some patients for whom physicians determined bariatric surgery was medically necessary were denied the procedure by insurers. In addition, we all know that getting children moving will go a long way in helping to reduce the obesity problem.

But the managed care organizations that serve Kentucky, as well as some private insurers, won’t pay for a sports physical if a child has had a regular physical within that 12-month period, despite the separate physical required by the school.

  • Reducing drug overdoses: Only 13 percent of physicians responding to the KMA survey indicated availability of adequate drug addiction treatment in their areas.

In addition to those burdens, the state and federal government, along with private insurers, are requiring a great deal of data to be provided by the medical community and used to pinpoint ways that these public health issues can be addressed.

Unfortunately, they all require different data, have different ways of measuring, and have become so burdensome that those on the front lines of treating patients — as well as the patients themselves — often find such data meaningless.

The state should be applauded for setting its goals. Now, we should take this opportunity to build a system for Kentucky that achieves these goals.

Uniform criteria and incentives should be established so that everyone knows what must be done. Unnecessary red tape should be cut. And barriers that send the wrong message (such as refusing to pay for smoking-cessation drugs) should be torn down.

As the saying goes, “If not now, when?”

Dr. David J. Bensema is chief information officer at Baptist Health Kentucky and president of the Kentucky Medical Association.