The 5th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 18, 2009, at 1:00 PM, in Room 129 of the Capitol Annex. Senator Julie Denton, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Senators Julian M. Carroll, Perry B. Clark, Joey Pendleton, Katie Kratz Stine, and Jack Westwood; Representatives Jim Glenn, Brent Housman, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Tim Moore, Darryl T. Owens, Ruth Ann Palumbo, and Addia Wuchner.
Guests: Marty White and Bill Doll for the Kentucky Medical Association; Don Putnam for the Parent Group of Oakwood; and Jan Gould for the Kentucky Retail Federation.
LRC Staff: DeeAnn Mansfield, CSA; Miriam Fordham, Ben Payne, Jonathan Scott, Amanda Dunn, and Cindy Smith.
The minutes of the October 21, 2009 meeting were approved without objection.
The first item on the agenda was a Legislative Review of the FFY 2010 Community Mental Health Services Block Grant. There was a motion by Representative Owens, seconded by Senator Carroll and adopted by voice vote to approve the FFY 2010 Community Mental Health Services Block Grant.
The next item on the agenda was a Legislative Review of the SFY 2010 Substance Abuse Prevention and Treatment Block Grant. There was a motion by Representative Owens, seconded by Senator Carroll, and adopted by voice vote to approve the SFY 2010 Substance Abuse Prevention and Treatment Block Grant.
The next item on the agenda was a presentation regarding a model of health care delivery by Kenneth L. Brigham, MD, Associate Vice President, Health Affairs, Director, Predictive Health Institute, Vice Chair for Research, Department of Medicine, Director, CTRLung, Associate Director for Research, McKelvey Lung Transplant Center. Dr. Brigham said the Center for Health Discovery and Well Being has a new approach to sustaining health. They have a unique environment (non-clinical atmosphere, customer oriented, high tech – high touch), a translational interaction (research findings & participant biomarkers) and have a “predictive health partner” concept. In regard to the health partner concept, Dr. Brigham said that time constraints in usual medical care settings do not permit adequate education, motivation, and other interactions for optimal outcomes. Health coaches have improved management of diabetes and hypertension. Wellness coaches help healthy people improve weight, fitness and general health. “Health partners” partner with participants to optimize healthy lifestyle choices and behaviors. Health partners do not deliver medical care. They conduct surveys and complete more than 50 different laboratory tests for known biomarkers, as well as research biomarkers. They also complete health assessment reports, which are a compilation of results from assessments, which include instructions about how to interpret them. In regard to Health Action Planning, Dr. Brigham said they collaborate with their predictive health partner, maintain participant empowerment & engagement in goal setting and discuss what this means for the participant. Dr. Brigham also shared data with the committee relative to age, body mass index, blood pressure, vitamin D concentrations, and heart attack risks of the participants.
Senator Denton asked about the deficiency of vitamin D in some participants. Dr. Brigham said it could be due to dietary data, the use of sunscreen, and staying out of the sun completely.
Senator Denton asked if the cost of the participant’s health care is looked at intervals of 6 months or one year down the road. Dr. Brigham said they are looking at relationships between risk status and data. They are also viewing a lot of epidemiologic data.
Senator Denton asked about the cost per year per participant. Dr. Brigham said the cost is $2,500 per year, but that cost is subsidized by the university.
Representative Glenn asked what other sources of vitamin D are. Dr. Brigham said good sources are found in green, leafy vegetables. He also noted that obesity risks are associated with a decrease in vitamin D.
Representative Glenn asked if other states are using this program. Dr. Brigham said there are no other programs exactly like their program.
Senator Stine asked if this program is changing how things are taught in medical school and if there is a holistic approach being used. Dr. Brigham said to some degree it is changing and includes more attention to the whole person and to health and wellness.
Senator Stine asked if insurance companies or employers are buying into paying for this concept. Dr. Brigham said they are not yet, but there are a couple looking into it as a possible pilot project.
Representative Lee noted that we are a nation that treats diseases instead of preventing them. He wanted to know how to motivate people who are in entitlement programs, such as Medicaid, to be part of a pilot project, that will stay well, and if incentives will be offered. He noted that people’s lifestyles need to be changed and there needs to be a focus on wellness and prevention. Dr. Brigham said that there has to be an individual component, with focus on how individuals behave. If there is a culture change, behaviors will change.
Representative Wuchner noted that by 2018, 50 percent of Kentuckians will be overweight. She added that adding physical activity to every child’s day in school could make these statistics change.
Representative Owens asked when there will be data to indicate a cost savings. Dr. Brigham said data will not be available for about 3 years.
Senator Pendleton added that health and wellness of staff in doctor’s offices and hospitals would be a good starting point, as well as starting with kids in schools.
Representative Moore agreed that there is a need for change and noted that people are lacking the will to change. Dr. Brigham said that more information is needed in order to focus on the things that work.
Representative Meeks asked how they got the information for the study. Dr. Brigham said they are collecting data on socio-economic status, dietary history, environment, among other things.
Representative Housman entertained a thought about a study group of younger people, since usually by the time children reach the age of 18, bad habits are already in place. Dr. Brigham commented that there is currently a study being done of college freshman at Emory University and he noted that starting young is the key.
Representative Housman asked for a presentation from Kentucky’s higher education universities on what they are doing, as well as what is being done at the pediatric level in Kentucky. Senator Denton said that Kentucky schools have testified before and they will be back again. She noted that Dr. Brigham was asked to testify because the wellness program is so different and there is not another program of its kind anywhere.
The last item on the agenda was a presentation on the Underwood and Lee Clinic and Brigham ICF/MR Group Homes by Donovan Fornwalt, Director of Governmental Affairs, Council on Mental Retardation; Carol Mueller, President, Central State Bingham ICF/MR Family Group; Matt Holder, MD, MBA, CEO, Underwood and Lee Clinic; and Henry Hood, DMD, Director of Clinics and Research, Underwood and Lee Clinic. Mr. Fornwalt made introductory comments for the panel. Ms. Mueller updated the committee on the state of the Central State Bingham Center Family Group. She noted that next spring they will be breaking ground for six new four-bedroom homes and a comprehensive clinic. She discussed changes that have been happening at the Bingham Center over the past ten years, the change in employees, as well as the change in resident population. She said the Brigham Center is a violent, volatile place where staff and resident injuries are frequent. She noted that due to the circumstances at the Bingham Center, the Family Group has lost faith in state operation. She stressed that they would like support for a public-private partnership for the new Brigham relocation project.
Next, Dr. Hood and Dr. Holder presented information on the Underwood and Lee Clinic. They said The Underwood and Lee Clinic is a teaching clinic delivering comprehensive dental services to approximately nine-hundred patients with neurodevelopment disorders and intellectual disabilities, from over forty-five Kentucky counties. Many of their patients travel great distances to come to their clinic. Some families travel as much as five hours each way to bring their loved ones to them and they are grateful for the services provided to them. Dental care has been identified all across the country as the single greatest unmet need for Americans with intellectual disabilities. The quantity of oral disease treatment at the Underwood and Lee Clinic is significant and the severity of that disease is significant, as well. The access problem for people with neurodevelopment disorders is a teaching problem.
Survey results concluded that 51 percent of dental graduates and 81 percent of medical graduates have not treated a patient with a neurodevelopment disorder; and 75 percent admit feeling inadequately trained to do so. The clinical care challenges are formidable and they are working hard to try to solve this teaching problem. They noted that they have a very well-developed predoctoral and postdoctoral teaching component at the Underwood and Lee Clinic. All senior dental students are required to complete a sixteen-hour rotation through our clinic during their fourth year of training. Additionally, all thirty-five dental hygiene students are required to complete a sixteen-hour rotation at the clinic, as well.
They are also providing clinicians and teachers from anywhere in the United States an opportunity to enroll in their new Developmental Dentistry Mini-Residency program. They have focused research efforts on solving the clinical problems that are the obstacles to the delivery of the standard of care to our patients.
In regard to their research, it has been published in book chapters and monographs in the United States, Germany, Great Britain and Japan. Their research program won seven research awards in its first five years in existence. They are currently developing three separate research manuscripts examining everything from early detection of gastroesophageal reflux disease in this population to the Medicaid costs associated with untreated oral disease.
The Underwood and Lee Clinic saves the Commonwealth money (greater than 100 percent annual return on investment) with decreased utilization of emergency services, decreased polypharmacy (over-medication), decreased end-stage dental care costs, decreased operating room costs ( $1.5 million/year), and providing services to Bingham residents, resulting in 25 percent savings.
Representative Lee noted that the work Drs. Holder and Hood do is very critical. He said if the economy had not been so bad, there would be four clinics by now. He hopes to be able to continue to maintain the system everyone has worked so hard to achieve.
Dr. Hood thanked everyone who had worked so hard to help them get where they are today. He said that it takes a team effort and that people can get better when the health care team works together and with their families.
Representative Lee asked everyone to remember that these individuals deserved to live in residential settings and supports need to be in their counties so they do not have to drive so many hours to get the medical attention that they need.
The meeting was adjourned at 3:15 p.m.