►
Description
This stream will be taking place at the 2021 Kentucky State Fair located in the Louisville, KY.
A
A
B
B
Thank
you,
representative
frazier,
president
of
the
room.
Thank
you,
representative
marzian.
Thank
you,
representative,
prunty,
president,
in
the
room.
Thank
you,
representative,
rayburn,
president,
in
the
room.
Thank
you
representative.
Raymond,
president,
in
the
room.
Thank
you,
representative.
Riley.
A
A
All
right
very
good,
so
we
have
a
quorum
or
established
to
do
business.
First,
I
want
to
remind
everybody
who's
participating
remotely.
Everyone
should
be
muted
unless
they're
actively
speaking
in
the
meeting,
and
please
use
the
chat
feature
to
notify
staff.
If
you
want
to
be
recognized
for
any
questions
or
comments
during
the
meeting,
we've
got
a
very
busy
agenda.
Normally,
we
would
take
up
a
lot
of
our
regulations,
I'm
going
to
wait
till
later,
because
we
have
an
active
breakfast
going
on.
A
I
know
there's
some
that
may
want
to
still
attend
part
of
that,
so
we're
going
to
start
off
right
away
with
first
thing
is
approval
of
the
minutes.
We've
got
the
minutes
before
us
from
the
july
21
2021
meeting
motion
on
the
minutes.
We
have
a
motion.
Is
there
a
second
give
a
second
all
those
in
favor,
please
signify
by
saying
aye
aye
anybody
opposed
right.
The
minutes
have
been
approved.
A
I
Thank
you.
Well,
the
last
time
I
appeared
before
this
group.
It
was
in
capacity
of
working
in
health,
welfare,
education,
workforce
initiatives,
and
you
know
I
wanted
to
I've,
had
a
lot
of
questions
in
my
transition
over
to
app
harvest
about
how
do
you
go
from
health,
health
and
welfare
to
app
harvest?
And
the
question
for
me
is
very
simple:
this
is
an
incredible
opportunity.
We
believe
at
harvest
brings
incredible
opportunity
to
kentucky
through
education,
community
social
investment
and
through
employment.
So
we
wanted
to
take
the
time
to
share
with
this
committee.
I
Some
of
the
work
app
harvest
is
up
to
and
what
we
plan
to
do
and
would
love
to
look
forward
to
questions.
I
know
we
have
20
minutes,
so
I
will
go
through
the
information
fairly
quickly
romell
and
I
will
tag
team
a
little
bit
on
efforts
that
are
underway
in
kentucky
so
app
harvest.
Our
mission
is
to
build
a
resilient
food
system
for
america
in
appalachia
from
the
heart
of
appalachia.
I
We
have
had
a
number
of
recent
events
that
have
really
shown
some
light
on
the
issues
that
we
have
with
environment:
agriculture
with
our
food
supply.
Our
food
production,
we
must
start
rapidly
building
controlled
environment
agriculture
inside
to
secure
future
food
production,
the
world's
going
to
need
at
least
50
50
more
food
by
2050,
but
about
70
percent
of
all
fresh
water
currently
is
already
dedicated
to
agriculture
and
farming.
In
the
traditional
realm,
coven
19
also
exposed
unstable
nature
of
america's
food
system.
I
We
had
shortages
around
the
country
and
around
the
world,
grocery
store
shelves
were
empty
and
in
in
the
united
states
it's
shown
a
light
on
our
reliance
upon
imports,
particularly
of
the
foods
that
that
app
harvest
grows.
The
vine
crops,
tomatoes,
those
sorts
of
products,
69
of
all
fresh
vine
crops
sold
in
the
u.s
in
2018,
were
imported.
I
App
harvest
has
proposed
establishing
a
new
local
supply
chain.
You
know,
of
course,
one
of
the
challenges
that
we
face
in
the
united
states
is
food
insecurity
and
people
being
able
to
have
access
to
fresh
foods
through
a
new
local
supply
chain.
We
we
farm
in
an
ecologically
responsible
way,
it's
locally
supported
and
it's
very
predictable.
I
We
wanted
to
talk,
though,
about
to
this
group,
in
particular
our
our
solutions
for
environmental
and
social
issues
with
app
harvest.
We
we
do
have
a
winning
approach
to
labor
at
app
harvest.
We
have
a
living
wage
13
an
hour,
fully
paid
health,
dental
and
vision
benefits
and
that's
of
particular
interest.
I
know
to
this
group,
as
you
consider
you
know,
health
issues
and
health
outcomes
in
the
state
of
kentucky.
I
We
also
provide
401k
in
stock
options.
We
have
a
highly
efficient
farming
system,
we
use
90
percent,
less
water
than
conventional
agriculture
and
we
use
100
recycled
rainwater.
We
also
are
free
of
harsh
chemicals
and
pesticides.
We
use
an
integrated
pest
management
system
that
really
introduces
good
pests
to
take
care
of
bad
pests.
I
We
don't
produce
any
agricultural
runoff,
there's
less
food
waste
and
we're
very
climate
resilient.
You
know
we
were
in
operation
in
our
first
harvest
during
the
ice
storms
in
february,
ramel
was
there
and
there
were
no
issues
with
continuing
production
and
continuing
harvesting
during
the
ice
storms.
I
think
it
was
a
bit
of
a
challenge
getting
people
there
in
the
ice
storm,
but.
I
I
We
have
a
10-acre
rainwater
retention
pond,
we
produce
30
30
times
more
yield
than
traditional
open
field
agriculture,
but
I
do
want
to
make
the
point
with
this
group,
and
we
also
appeared
before
the
agriculture
committee,
that
we
do
not
compete
with
traditional
farming.
We
do
not
farm
row
crops,
our
products
do
not
and
end
up
on
the
shelves
with
traditional
farming
products.
I
We
have
thousands
of
projected
jobs
in
the
next
couple
of
years
right
here
in
kentucky,
we
have
currently
four
facilities
under
construction
and
we
have
our
flagship
facility
in
moorhead,
that
is
a
60
acre
tomato
farm
and
we
employ
currently
about
300
people
there
and
we'll
talk
about
that
a
little
bit
later.
But
we
are
investing
about
a
billion
dollars
in
the
appalachian
region,
in
particular
in
eastern
kentucky
areas,
through
development
and
through
high
school
container
farm
education
program.
I
One
of
the
things
that
I
wanted
to
point
out-
and
I
actually
pointed
this
out
to
our
leadership
team.
This
group
is
very
familiar.
This
leadership
team
is
very
familiar
with
the
medicaid
levels
of
medicaid
dependence
in
the
commonwealth
of
kentucky.
As
of
the
end
of
july,
we
had
1.557
million
people
enrolled
in
the
medicaid
services
and
it's
very
hard
to
sustain
that
level
of
medicaid
through
many
years.
I
We
have
moved
from
about
four
people,
I
think
carmel
was
was
one
of
them
and
amy
samples
in
the
audience
with
us
was
another
one
of
the
original
few
to
about
336
joining
in
2021
for
a
total
of
about
500
employees
in
the
past
year
and
a
half
expanded
economic
impact
that
you
might
be
interested
in
across
the
state.
The
the
green
shaded
areas
show
that
we
have
one
to
five
companies
that
we
do
business
with
the
light.
Green
is
six
to
ten
companies.
I
The
sort
of
yellow
is
31
companies
and
the
red
is
91
companies.
Those
are
all
counties
that
we
have
impacted
because
there
are
supply
chain
providers
in
those
counties.
So
not
only
is
it,
you
know
we're
excited
about
our
industry,
but
we're
excited
about
partnering
with
other
industries
across
the
state
to
provide
additional
economic
opportunity
and
growth.
I
We
can
be
the
leader
we
think
in
ensuring
kentucky's
america's
food
supply
chain,
in
particular
in
addressing
food
insecurity
right
here
in
our
home
state,
we're
focusing
on
eastern
kentucky
and
appalachia.
We
do
partner
with
food
banks
and
with
other
programs
to
help
provide
food
to
families
in
need.
We
have
supporting
industry,
so
it's
not
just
about
app
harvest
and
control
environment
agriculture.
I
We
do
have
providers
of
diffused
glass,
steel
led
lights,
technology
robotics,
so
it's
more
than
just
coming
in
at
an
entry
level
position.
These
are
positions
that
really
will
take
additional
training,
we're
partnering
with
universities
and
we're
very
excited
about
advanced
technology.
As
part
of
our
farming
techniques,
we
are
working
to
possibly
develop
a
research
facility.
We've
been
in
discussions
with
state
leadership
and
with
the
university
of
kentucky
eastern
kentucky
university
and
morehead
state.
I
We
have
a
very
close
connection
with
the
netherlands
and
that's
something
else
that
we
would
really
like
to
explore.
How
do
we
capitalize
on
that
with
state
leadership,
and
then
I
want
to
also
talk
about
our
rural
urban
connection
and
to
do
that.
I'd
like
to
ask
ramel
bradley
to
speak
on
just
some
of
the
initiatives
that
have
been
underway.
J
Thank
you,
christy,
the
urban
rural
connection,
so
economic
and
food
insecurities
look
the
same.
Even
when
we
look
at
different
geographic
locations.
The
city
of
louisville
is
the
largest
food
desert
in
our
state.
Median
household
incomes
for
low-income
communities
such
as
louisville
and
eastern
kentucky
are
still
nearly
the
same.
J
I
So
funding
our
future
we're
we're
looking
at
ways
to
leverage
resources
as
well
to
help
offset
poor
health
outcomes
to
provide
access
to.
You
know
locally
sourced
healthy
food
to
address
rural
and
urban
food
deserts,
and
there
are
areas
of
funding
that
we'd
be
happy
to
explore.
With
this
committee
in
more
depth,
the
american
rescue
plan
act.
I
I
So
our
new
crop
of
tomatoes
are
being
planted
as
we
speak.
We
have
new
farm
development
and
accelerated
timeline,
so
we
have
a
plan
to
build
12
facilities
by
2025
in
the
central
appalachian
region
and
surrounding
areas.
We
have
four
that
are
underway,
two
are
being
built
currently
in
richmond
and
berea,
and
two
have
broken
ground
in
pulaski,
somerset
and
also
an
expansion
in
our
moorhead
area.
I
J
I
A
Well,
thank
you
very
much
and
if
everybody
can
tell
by
the
agenda
that
we've
got
today,
the
kind
of
the
theme
that
we
have
is
looking
at
our
health
metrics
as
a
state.
I
know
we're
in
a
time
of
covid
and
a
lot
of
focus
on
that,
but
a
lot
of
other
things
that
are
also
killing
kentuckians
and
causing
a
lot
of
chronic
disease
states,
and
I
think,
when
app
harvested
requested,
they
wanted
to
present.
A
A
I
know
how
small
of
a
country
that
is
and
from
what
I
understand
that
the
biggest
agricultural
producer
for
europe-
and
so
maybe
you
could
talk
about
how,
in
a
very
small
amount
of
space,
what
they've
done
really
to
maintain
a
lot
of
again
fresh
fruits,
vegetables,
that
we
can
do
and
obviously
we're
much
more
larger
in
landmass.
But
how
much
we
can
accommodate
how
big
of
an
area
can
we
serve
beyond
just
the
borders
of
kentucky
through
this
model?.
I
Well,
we
think
it's
pretty
limitless.
We
think
kentucky
has
an
opportunity
right
now,
like
no
other,
we're
very,
very
excited
about
that
opportunity.
To
give
you
some
perspective,
the
netherlands
would
actually
fit
in
the
area
of
eastern
kentucky
and
they
are
the
number
two
number
two
exporter
of
fresh
produce
in
the
world.
So
we
do
believe
that
you
know
and
their
model
what
they
what
they
do.
Is
they
build
campuses,
so
they
build
campuses
that
have
not
just
greenhouses,
but
they
also
have
the
supporting
industry
right
there
on
site
you've
been
there.
J
K
I
just
want
to
thank
you
for
your
presentation
and
for
what
you're
bringing
to
kentucky
when
I
learned
about
app
harvest.
I
said
you
know
this
is
really
something
that
we
need
to
hear
about,
especially
in
health
and
welfare.
We
know
how
directly
good
nutrition
affects
our
health,
our
health
outcomes
and,
as
chairman
alvarado
said,
we're
going
to
hear
about
kentucky's,
poor
health
metrics.
K
We
really
are
committed
to
finding
ways
to
improve
those
health.
Those
health
metrics
and
I
really
feel
like
app
harvest,
will
play
a
huge
part
in
this.
I'm
very
excited.
I
really
don't
have
a
question.
I
love
your
presentation.
I
love
what
you're
bringing
to
kentucky
and
certainly,
if
there's
anything
that
we
can
do
to
to
help
app
harvest
grow
and
bring
healthy
nutrition
to
kentuckians.
I
think
that's
what
we
need
to
to
do
and
create
that
partnership.
So
thank
you.
A
Thank
you,
and
just
on
that
rural
urban
connection,
I
mean
we
know
that
there's
areas
of
louisville
right
here
that
are
diff
you
know,
west
end
of
louisville
has
some
difficult
areas
economically.
This
would
be
a
tremendous
amount,
we're
talking
about
doing
that.
That's
a
tremendous
idea,
so
I
would
commend
you
on
that.
Look
forward
to
seeing
that
come
to
fruition.
We've
got
a
few
questions.
First
person
we've
got
is
senator
meredith.
C
J
C
I
There
is
senator
meredith.
I
can
always
count
on
you
to
ask
me
for
data,
so
we
will
definitely
get
that
for
you.
There
is
information
that
talks
about
what
specifically
you
know,
goes
into
like
it's
a
certain
area
away
from
grocery
stores,
and
then
we
can
find
out
what
the
per
capita
food
desert
situation
is
for
louisville,
but
for
the
greater
state
as
well.
G
Thank
you,
mr
chair,
welcome,
christy
a
different
view
and
when
I
was
a
young
man,
my
first
job
was
taking
care
of
a
hundred
thousand
tomato
plants
for
35
dollars
a
week,
so
I've
suckered
and
tied
tomato
plants
from
may
all
the
way
through
july,
4th
before
on
my
knees,
but
my
question
to
you
is:
are
you
using
a
hybrid,
are
you
growing
them
hydroponically
roots
up
roots
down
in
the
dirt,
and
what
what
hybrid
are
you
using?
Are
you?
Is
it
a
variety?
Is
it
from
uk
or
who.
J
Well,
we're
growing
hydroponically
we're
using
no
soil,
we're
growing
our
our
plants
vertically,
it's
drip
irrigated
closed
loop
system.
We
have
a
10
acre
retention
pond
in
which
we
collect
all
of
our
rainwater
from
our
roof
2.76
million
square
feet,
so
we
use
all
recycled
100
percent
recycled
rainwater.
We
use
90
percent,
less
water
and
with
precision
irrigation.
J
I
J
L
I
A
B
J
Yeah
so
currently
we
have
partnered
with
six
different
high
schools
in
eastern
kentucky.
Our
first
pilot
was
in
pikeville
and
and
out
of,
I
believe,
the
120
counties,
pikeville
shelby
valley,
high
school.
There
was
three
without
ag
teachers
or
ag
programs,
so
I
volunteered
to
teach
the
students
and
our
and
our
first
cohort,
but
ultimately,
what
we
have
is
a
40-foot
shipping
container
that's
been
recycled
into
a
hydroponic
system,
led
lightings,
bluetooth,
irrigation
systems
that
the
students
can
control
on
their
iphone.
J
We
had
students
waking
up
at
6am
to
meet
me
in
a
farm
to
grow
fresh
produce
they
partnered
with
restaurants
in
their
local
communities.
They
did
a
tedx
event
where
they
highlighted
the
salad
that
they
grew
themselves
and
it's
been
a
tremendous
feeling
and
ultimately
has
made
a
huge
difference
in
not
only
the
students
lives,
but
the
communities-
and
you
know
it's
just
amazing
feeling
to
do
the
right
thing
and
grow
healthy
food.
B
G
I
So,
with
the
partnership
with
master
nardi,
they
are
our
distributor,
so
they
purchase
all
of
our
products
and
they
distribute
them.
Wherever
the
need
is
a
lot
of
our
tomatoes,
you
can
find
them.
I
have
found
them
in
lawrenceburg
every
now
and
then,
but
they
do
end
up
on
the
large
grocery
store
shelves.
B
I
The
same
we,
it
is
it's
a
very
high
quality
product,
but
we
are
priced
competitively
because
we
we
our
primary
goal.
Is
we
import
a
great
number
of
our
tomatoes
from
mexico
currently
and
they
are
picked
before
they
have
the
chance
to
have
all
the
nutrients
absorbed.
They're
green
they're
trucked
for
several
days,
sometimes
a
week
and
more,
and
so
we
are
priced
competitively
with
those
tomatoes
for
the
purpose
of
disrupting
that
market.
A
E
More
of
a
comment
than
the
question
I
just
want
to.
Thank
you
all
for
your
your
investment
in
eastern
kentucky
and
you
rock
castle
county
high
schools
is
one
of
the
partners
that
you
all
have
done
with,
and
I
know
they're
super
excited
just
thank
you
for
your
investment
in
madison
county
and
super
excited
about
what
charles
future
holds.
L
Yes,
thank
you.
While
you
all
are
here,
I
want
to
say
I
believe
in
this
program.
I
hope
it
works
and
I
think
it
will
work,
but
I
think
we
need
to
acknowledge
the
recent
news
right
that
there
have
been
growing
pains
in
the
business
32
million
loss
recently
posted
partly
due
to
low
quality
tomatoes.
So
I
wanted
to
ask
you
about
that:
how
you're
going
to
improve
quality
and
and
keep
growing
the
business
and
then
something
caught?
My
ear
about
good
kids
grow
up
on
farms.
Good
kids
grow
up
everywhere,
including
all
over
louisville.
I
Sure,
yes,
we
so
this
is
our.
First
year
of
operations
we
opened
in
october
of
2020
hired
during
covet.
You
know
everything
was
happening
during
challenging
challenging
times.
We
had
some
operational
lessons
learned
in
the
harvesting
season
that
you
know
and
the
that
paired
with.
We
were
very
optimistic
and
maybe
set
the
bar
a
little
high.
I
We
have
definitely
had
some
training
challenges
with
with
people
who
have
come
in
who
haven't
you
know
we
had
to
do
some
training
additional
training
as
far
as
harvesting
techniques
and
some
other
operational
pieces
go.
So
we
did
have
a
very
challenging
second
quarter.
Third
quarter,
we
will
not
have
significant
earnings,
because
it's
our
tear
out
it's
when
we
tear
out
the
crops
we
don't
grow
during
the
time
when
traditional
tomato
season
is
producing
during
the
summer
months,
we've
replanted
and
we
expect
a
very
healthy
quarter.
I
A
All
right,
thank
you.
Any
other
questions.
Remember
the
committee
before
we
move
on
again.
Thank
you
all
for
your
presentation.
Appreciate
it.
Mr
bradley
go
big
blue.
Thank
you
for
your
time
on
the
team.
We
appreciate
your
time
as
well
and
thank
you
all
for
your
commitment.
This
is
exciting.
I
I
get
excited
about
thinking.
A
This
is
helping
both
and
I've
been
talking
my
extension
office
when
I
go
to
council
meetings
about
how
we're
trying
to
tap
into
that
farming
and
agriculture
can
be
fun
not
only
for
rural,
but
also
for
urban
communities
and
really
energizing
people
who
want
to
see
that
happen.
A
lot
a
lot
of
our
kids
and
youth,
don't
even
know
where
food
comes
from
and
to
watch
it
being
produced
and
then
seeing
it
moved
into.
Restaurants.
Locally
is
exciting
to
see.
So.
Thank
you
for
your
presentation.
A
We
appreciate
it
look
forward
to
the
work,
maybe
having
you
guys,
come
back
in
the
future.
Give
us
an
update
on
what's
going
on
all
right.
Next
on
the
agenda,
we've
got
kentucky
health
metrics
update
on
chronic
diseases.
We've
asked
dr
connie
white
who's.
The
deputy
commissioner
for
clinical
services
for
the
department
for
public
health
to
give
us
an
update,
and
hopefully
dr
white,
are
you
on
remotely.
H
H
Okay,
well
I'll
go
ahead
and
get
started
just
with
some
overview.
We're
going
to
look
at
a
lot
of
data
that
comes
from
kentucky
berfus.
I'm
sure
many
of
you
that
have
been
on
the
committee
have
heard
of
berfus.
That
is
the
that
is
housed
in
the
department
for
public
health,
and
it
is
a
telephone
survey
that
the
cdc
has
sponsored
since
1985..
H
It's
where
we
do
call
folks
and
we
do
a
statistically
significant
raking,
epidemiologic
voodoo.
They
have
all
the
words
that
I
don't
quite
understand,
but
they
sample
a
significant
number
of
people
to.
Let
us
know
what
are
the
health
outcomes
in
the
state
of
kentucky
and
the
first
slide
when
we
get
it
up
is
america's
health
rankings,
and
that's
just
is
I
wanted
to
give
you
just
an
overview
of
where
kentucky
is
in
that
group
and
a
lot
of
this
data
comes
from
our
berfus
data.
A
H
A
H
That
that's
great,
thank
you.
So
the
the
the
second
slide
just
shows
you,
the
the
chronic
disease
states
in
kentucky-
and
I
just
pulled
a
few.
I
pulled
things
that
we
were
going
to
talk
about
today:
asthma,
cardiovascular
disease,
copd,
oh
great,
there's
the
slide:
copd
diabetes,
hypertension,
obesity
and
preventable
hospitalizations.
H
These
were
the
ones
that
I
just
pulled
off
at
the
top
of
my
head.
This
morning,
going
back,
I
looked
at
a
smoking,
we're
49th
in
the
nation
for
smoking
and
we're
49th
for
multiple
chronic
conditions,
as
as
both
our
co-chairs
know.
Since
they've
worked
in
healthcare,
people
don't
have
the
luxury
of
just
having
one
chronic
condition.
Most
people
have
more
than
one
and
we
are
very
high
in
the
nation
for
people
with
chronic
conditions.
H
So
the
next
slide,
I'm
just
going
to
ask
you
to
fasten
your
seat
belts,
we're
going
to
do
a
quick
journey
through
some
of
our
chronic
disease
programs
in
the
state
of
kentucky
at
the
department
of
public
health.
So
you
can
be
aware
of
some
of
the
strategies
that
we're
us
working
on
in
the
in
the
state.
H
So
we'll
look
at
heart,
disease
and
stroke
tobacco,
physical
activity,
nutrition,
which
fits
in
quite
well
with
the
presentation
that
ramallah
and
christie
just
gave
diabetes
and
asthma
and
then
we'll
talk
about
cancer
at
the
end.
So
the
next
slide
just
gives
you
some
basic
statistics
about
heart
disease
in
kentucky.
I
don't
think
this
is
probably
a
surprise
to
many
of
you
about
one
in
five
people
in
kentucky
report
to
berfus
that
they
have
heart
disease
or
I'm
sorry,
one
out
of
five
deaths
in
kentucky
or
heart
disease.
H
If
you'll
just
hit
the
click,
there's
the
strategies
will
show
up
next,
so
we're
looking
at
several
strategies
that
I
think
are
important
for
your
group
to
know
about.
We
are
working
with
some
high
blood
pressure
awareness
programs,
where
we
are
getting
blood
pressure,
cuffs
to
teams
and
getting
different
programs
to
look
at
this.
One
of
the
programs
that
I
think
is
very
interesting
is
a
blood
pressure
program.
H
We
have
on
some
river
boats
stock
that
are
that
dock
in
paducah
and
they
are
looking
at
their
diet
on
the
river
boats
and
looking
at
watching
and
monitoring
their
own
blood
pressures,
and
we've
had
some
really
good
success
with
that
program.
We're
looking
at
the
heart
disease
and
stroke
task
force,
which
is
over
350
strong.
H
This
is
co-chaired
by
dr
carrie
remmel
from
university
of
louisville
and
dr
nathan
custer
from
baptist
lexington,
and
this
team
has
been
meeting
since
for
for
many
years,
and
out
of
that
came
our
secret
program,
which
is
the
stroke,
encounter
quality,
improvement
program
and
carrie.
I'm
sorry,
kara
moore,
is
from
the
university
of
louisville.
Neurology
is
the
chair
of
that
that
group
started
in
2009.
All
volunteer,
we
lost
our
grant
to
support
that,
but
those
two
people
kept
meeting.
H
We
now
have
40
hospitals
from
16
that
are
working
with
c-qip
and
with
c-qip
and
our
diabetes
provided
sorry
wrong
disease.
Our
high
blood
pressure
and
stroke
task
force
has
put
enough
of
a
good
foundation
of
work
in
kentucky
that
we
were
able,
in
the
state
of
kentucky
to
get
a
coverdale
stroke
program
grant
that'll
be
based
at
the
university
of
kentucky,
but
it
will
allow?
U
k?
H
So
it's
a
very
broad
group
of
people
that
have
met
routinely
and
have
greatly
improved
their
care.
The
care
collaborative
that's
listed.
There
is
a
very
interesting
program,
and
this
is
a
lay
program
where
you
get
a
layperson
to
take
someone's
blood
pressure,
and
then
they
chart
it
on
a
little
card
that
you
keep
in
your
wallet.
That
is
put
you
in
the
red,
yellow
or
green
category.
H
People
can
understand
if
their
blood
pressure
is
in
the
red,
they
know
that's
bad
and
then
that
lay
person
gives
them
some
very
simple.
Behavioral
changes
that
they
can
make
and
have
them
come
back
in
three
months
and
look:
are
they
still
in
the
red
or
are
they
in
yellow
or
have
they
gotten
to
green?
Are
they
staying
in
the
green?
It
has
been
remarkable.
The
number
of
people
whose
blood
pressure
has
come
down
and
people
who
have
actually
gotten
off
medications
just
by
making
those
simple,
behavioral
changes.
H
It's
a
program
that
we're
very
proud
of-
and
it
has
has
been
very
successful
and
we're
we're
spreading
that
we've
even
taken
that
program
and
modified
it
for
people
with
disabilities,
and
we
have
seen
an
improvement
in
outcomes
for
hypertension
in
people
with
disabilities
and
their
caregivers
and
from
looking
at
our
data.
It
explains
why
it's
very
important
that
we
focus
on
this
population.
H
The
next
slide
talks
to
you
about
our
tobacco
prevention
and
cessation
program.
We
have,
we
are,
as
you
saw
earlier,
49th
in
the
country
for
smoking,
so
about
one
in
four
kentuckian
smoke.
We
have
a
nine
percent
smoking
in
our
schools
and
twenty
six
percent
of
our
high
schoolers
report
that
they
have
vaped
it's
very
hard
anymore,
to
find
someone
who
just
smokes
cigarette
in
the
younger
group.
It's
usually
smoking
and
vaping.
At
the
same
time
they
go
together.
H
We
have
in
the
united
states
almost
a
half,
a
million
people
die
every
year
of
tobacco-related
causes
and
in
kentucky
that
death
rate
is
almost
9
000
people
a
year.
The
next
click
will
show
you
what
our
strategies
look
like
in
our
tobacco
program.
So
we've
got.
We
are
we
support
100
tobacco-free
schools
and
have
a
lot
of
media
campaigns
for
for
the
youth.
We
have
the
quit
line,
which
is
a
very
successful
program
where
we
will
either
do
phone
or
online
chat
with
a
counselor.
H
If
you
qualify,
we
have
free
nicotine
replacement
therapy
that
we
can
send
to
people.
We
have
it
in
spanish,
we
have
it
in
english
and
then
the
my
life.
My
quit
program
is
modeled
after
the
quit
now,
except
it's
particularly
aimed
at
adolescence,
and
you
can
phone
online
chat
or
text,
and
we
are
working
very
hard
with
a
lot
of
electronic
health
programs.
Electronic
health
records
that
there
will
be
a
button
on
your
ehr,
that
you
can
click
and
it
will
automatically
refer
the
patient,
that's
in
front
of
you
to
the
quit
line.
H
H
The
next
slide
show,
or
the
next
click
shows
you
some
of
our
strategies.
So
we
are
looking
at
working
very
hard
in
early
education,
working
with
a
select
group
of
early
childhood
education
programs,
we're
looking
at
menus.
These
kids
get
fed
and
they're
they're,
very
young
kids,
developing
their
tastes
for
foods,
and,
if
you
are,
if
your
kitchen
is
a
hot
plate
and
your
menu
is
peanut
butter,
sandwiches
and
bananas,
that's
not
the
kind
of
food
we
want
our
younger
people
to
eat.
H
But
if
you
don't
help,
people
understand
nutrition
and
give
them
some
menus
that
they
can
prepare
in
a
small
kitchen.
They
need
that
assistance,
we're
helping
them
to
understand
how
to
do
this,
and
as
we
do
this
in
our
pilot
projects,
we
can
spread
that
out
through
the
state,
also
working
with
screen
time
and
helping
the
parents
to
understand
the
play
time
on
the
screen
and
the
importance
of
play
time
out
time.
H
Aside
and
physical
activity
look
we're
working
with
our
maternal
child
health
division
and
with
baby
friendly
hospitals,
because
we
know
breast
fed
babies
have
less
obesity
and
we're
looking
at
guidelines
for
food,
pantries
and
food
banks.
We're
very
pleased
that
a
lot
of
our
food
banks
during
the
most
recent
crisis
have
actually
been
packing
foods
for
people
with
diabetes
and
trying
to
pack
things
that
are
not
all
processed
foods
and
and
things
that
can
actually
be
healthy
when
they
get
those
those
food
bank
parcels
and
then
really
working
very
hard.
H
And
many
of
you
have
probably
participated
in
your
local
communities
with
walk
bike
paths
to
make
sure
that
people
have
a
place
to
walk,
because
it's
one
thing
to
tell
people
they
need
to
be
physically
active
and
if
they
don't
have
a
safe
place
to
do
it
and
they
aren't
in
a
safe
area,
then
they're
not
going
to
do
it.
We
have
to
make
the
healthy
choice
the
easy
choice.
H
The
next
slide
gets
into
our
diabetes
and
prevention
and
control
program.
You
all
know-
and
you
have
heard
and
been
very
supportive,
financially
of
diabetes,
education
in
our
state,
and
so
we
are
high
with
13.3
percent
of
our
adults
report.
They
have
diabetes
and
the
estimate-
and
this
is
just
an
estimate-
is
that
11
of
kentuckians
have
pre-diabetes
it's
the
sixth
leading
cause
of
death
in
the
state.
The
the
the
buzzwords
for
for
our
prevention
group
is
that
diabetes
is
common.
H
It's
serious,
it's
costly
and
it's
manageable,
so
we
know
that
it
cost
a
great
deal
of
money,
both
in
medical
costs
and
lost
time
from
work,
and
we
know
that
it's
manageable
and
preventable
with
the
dpp.
The
diabetes
prevention
program
that
I
know
y'all
have
heard
about.
That's
been
presented
this
committee.
H
It
is
a
over
50
effective
if
people
will
stay
with
the
diabetes
prevention
program
over
50
effective
to
preventing
them
from
developing
diabetes,
and
that
is
where
all
of
our
work
needs
to
go
for
the
type
2
diabetic
and
then
the
dsmes
is
a
program
that
teaches
people
how
to
control
their
diabetes
and
not
let
their
diabetes
control
them.
We
at
the
state
have
applied
for
we.
We
have
an
oversight
for
diabetes,
educators,
all
across
our
different
health
departments,
we're
collecting
data
and
showing
hemoglobin
a1cs
and
people's
total
weights
going
down.
H
We
have
a
very
active
kentucky
diabetes
network
that
involves
all
different
folks
that
touch
the
diabetes
world
and
dr
moshe
gundam
from
the
university
of
louisville.
Division
of
endocrinology
is
the
chair
of
that
board.
So
the
next
slide
just
tells
you
that
we're
we're
trying
to
increase
dpp
and
increase
dsmes
as
much
as
we
can
and
trying
to
include
the
workflow
of
getting
people
to
understand
how
they
can
put
that
into
the
workflow
as
providers.
H
I
know
the
two
of
you
know
that
it's
just
you
know,
don't
give
me
one
more
thing
to
do
so
we're
trying
to
find
ways.
We
can
help
people
get
this
in
the
workflow.
With
some
project,
pilots
we've
got
with
some
fqhcs
that
have
been
very
successful.
The
next
slide
talks
about
our
asthma
management
program.
H
In
kentucky
we
do
have
we
we're
it's
one
of
the
things
we're
22nd
on.
That's
that's
not
the
highest
number
we
would
like
to
be,
but
we
do
have
about
seven
percent
of
adults
over
that
have
make
over
fifty
thousand
dollars
have
asthma,
but
if
you
are
lower
income
because
of
a
whole
host
of
things,
asthma
triggers
poor
housing
access
to
care
being
consistent
with
medication.
We
see
this
is
a
a
higher
problem
in
the
african-american
population,
as
well
as
our
low-income
population.
H
And
I
just
went
blank
on
the
name:
infinite
campus
infinitive
campus
tells
us
that
it
is
the
leading
cause
of
chronic
disease
in
kentucky
children
in
public
schools.
So
we're
working
to
be
sure
that
people
are
in
the
professional
world
know
about
diabetes
about
asthma
guidelines.
We
do
educational
training
for
asthma,
our
asthma
educator
institute.
H
We
work
with
schools.
We
are
very
pleased
that
we
are
now
instituting
the
stock
albuterol
policy
to
to
prevent
any
loss
of
life
from
asthma
in
our
school
systems
and
working
very
hard
with
community
health
workers
and
and
others
in
the
health
care
system.
Try
to
prevent
asthma
triggers
for
children.
H
The
next
slide,
I'm
just
going
to
real
quickly
mention
community
health
workers,
because
I
know
our
next
talk
is
going
to
be
about
that
they
serve
this
underserved
population
with
chronic
disease.
We
at
the
department
of
public
health
found
that
to
be
a
critical
way
for
us
to
improve
our
health
outcomes.
We
can't
doctor
our
way
out
of
this.
There
are
too
many
things
going
on
in
people's
lives
and
our
health
care.
H
My
work
for
20
years
as
a
healthcare
provider
can't
turn
that
around
without
a
whole
lot
of
other
other
hands
in
the
in
the
till.
To
try
to
make
this
work
I
listed
where
community
health
workers
are
employed.
We
have
a
huge
collaboration
that
has
been
meeting
for
several
years,
all
across
the
state
and
we
now
certified
community
health
workers,
and
we
do
offer
continuing
education
program
because
part
of
their
certification
means
that
they
need
to
get
continuing
education
credits
and
we
are
providing
that
for
them.
H
The
next
slide
just
goes
over,
and-
and
you
can
read
this
about
the
data
for
kentucky
cancer-
we
talked
about
being
number
one
for
cancer
incidence,
mortality
and
our
strategies
real
briefly
here.
The
next
slide
just
that
we
are
working
on
preventable
and
screenable
cancers,
smoking
cessation,
because
tobacco
affects
so
many
different
types
of
cancers,
colorectal
breasts
and
cervical
cancer
screening
for
low
income
and
underinsured
women
and
men,
and
then
nav
supporting
research
for
childhood
cancer.
H
So
the
next
slide
just
shows
you,
the
three
programs
I'm
going
to
briefly
mention
that
are
part
of
the
department
for
public
health.
Looking
at
colon,
breast
and
cervical
and
pediatric
cancer,
the
next
slide
shows
a
program.
You
are
probably
familiar
with,
because
your
group
funded
our
colon
cancer
prevention
and
screening.
So
the
next
slide
shows
you
that
kentucky
has
improved
the
screening
from
35
to
70
percent,
but
even
with
that
great
work,
and
that
has
been
great
work
by
a
whole
host
of
people.
H
We
are
still
fourth
in
the
country
for
mortality
and
second,
for
incidents
of
colon
cancer.
So
the
next
slide
shows
that
we
have
a
colon
cancer
screening
and
prevention
program
that
is
working
across
the
state
to
tr
working
with
kentucky
cancer
link
working
with
our
kentucky
cancer
programs
to
inform
people
of
the
need
for
screening
and
to
with
the
kentucky
cancer
link
is
helping
to
connect
people
and
navigate
them
to
prevention,
and
this
is
something
that
can
be
paid
for
through
the
funding
that
you
provide
us.
H
Next
is
the
women's
express
and
cervical
cancer
screening
program
that
you
are
also
very
familiar
with
there's
some
data
that
you
can
see
that
talks
about
breast
cancer
is,
it
is
the
most
commonly
diagnosed
cancer
in
women
and
we
we
have
an
incident
and
mortality
rate
higher
than
the
rest
of
the
united
states
on
cervical
cancer.
When
I
do
talks
about
women's
health,
I
mentioned
cervical
cancer
people
look
at
me
and
go
people
don't
die
of
cervical
cancer
anymore?
H
Well,
yes,
they
do
and
we
have
one
of
the
highest
cervical
cancer
rates
in
the
st
we
have
the
highest
in
the
st
in
the
in
the
nation.
We
have
about
80
70
to
80
women
a
year
die
of
cervical
cancer.
That's
around
one
woman
a
week
dying
of
cervical
cancer,
so
the
next
slide
shows
our
strategies
as
we,
with
your
help,
go
into
public
health
transformation.
H
And
then
our
last
program
is
the
pediatric
cancer
research
trust
fund
that
you
generously
funded.
We
know
that
childhood
cancer
4.5
higher
in
kentucky
than
the
rest
of
the
us,
and
we
do
not
understand
but
brain
and
central
nervous
system,
tumor
cancers
have
overtaken
leukemia
as
the
leading
cause
of
cancer-related
death
of
children.
I
don't
have
a
strategy
listed
here.
I
don't
believe
I
don't
think
I
put
that
slide
in
because
it's
a
list
of
all
the
programs
that
the
the
trust
fund
is
working
on.
H
What
we
have
done
with
with
your
help
is
to
have
developed
a
board
that
actually
working
with
subject
matter.
Experts
are
looking
at
every
application
for
grants
for
funding
for
pediatric
research,
and
then
the
board
routinely
goes
over.
Those
applications
goes
over
their
progress
reports
throughout
the
year
and
helps
to
connect
other
people
that
have
an
interest
in
pediatric
cancer.
The
remaining
slides
that
you
have
in
your
packet
that
you
can
see.
Oh,
I
did
put
that
in
there
sorry.
H
I
just
said
that
next
slide
and
then
so
these
last
few
slides
just
show
you
where
kentucky
ranks
for
new
cancers,
and
that's
us
on
the
very
top
line,
and
you
can
see
the
green
line,
shows
you
the
u.s
rate
and
the
top
blue
line
is
kentucky.
The
next
slide
shows
the
rate
of
cancer
deaths
in
the
u.s.
The
green
line
is
the
average
and
the
top
line
there
is
kentucky
cancer
death
rates.
The
next
slide
shows
you
the
top
10
rates
of
new
cancers
in
kentucky
and
for
female
breast
cancer.
H
As
I
said,
is
number
one.
Prostate
is
number
two,
but
the
next
slide
shows
you
that
the
rates
of
cancer
deaths-
and
this
is
where
we
see
lung
and
bronchus
cancer
as
the
number
one
cause
of
death.
It's
not
breast
cancer
for
men
and
women.
It
is
long
so,
as
I
said,
that's
a
snapshot.
I
wanted
to
try
to
give
you
as
much
information
and
hope
that
I
could
make
you
interested
enough
to
ask
me
back
so
we
can
discuss
any
of
those
specific
topic
areas
and
I
am
prepared
for
questions.
A
Thank
you,
dr
white.
We
appreciate
that
and,
as
always,
a
lot
of
information
we
know
to
cover
and
everybody's
got
a
tight
agenda,
so
I
appreciate
you
getting
that
done
in
time,
and
this
is
always
just
to
remind
us
that
you
know,
amidst
all
the
other
things
that
we
talk
about,
you
know,
what's
kind
of
still.
The
number
one
killer
for
us
is
heart
disease.
What
causes
that
is
our
tobacco
rates,
and
you
know
I
one
question.
A
I
think
I've
often
we've
tried
to
get
tobacco
policies
in
our
state
in
the
past
and
there's
been
some
resistance
to
getting.
Some
of
those
done
is:
is
tobacco
smoke
recognized?
Officially
I
mean
we
know
that
it's
a
carcinogen,
obviously,
and
I'm
curious
in
terms
of
the
labeling
of
that
as
a
carcinogen-
is
that
a
state
function
a
federal
function
in
terms
of
things
like
asbestos,
which
we
know
also
can
cause
certain
types
of
cancer.
Benzene
lead,
which
we
know,
causes
all
kinds
of
anemia
and
chronic
problems.
A
We've
got
all
kinds
of
stipulations
around
the
use
of
those
inside
buildings
and
paint,
and
you
can't
store
benzene,
obviously
open.
You
can't
put
mercury
and
arsenic
which
are
all
legal
products,
but
you
can't
put
them
out
in
the
air
for
people
to
inhale
it's
best.
It's
the
same
thing
is
tobacco
considered
we
have
rules
around
those.
I
don't
know
that
it's
been
state
laws.
It
may
have
been
regulations
that
come
from
the
cabinet
from
or
from
the
federal
side
of
things
tobacco
smoke
is
there
carcinogen.
H
Well,
that's
a
great
question
and
it's
certainly
something
we
can
do
at
a
statewide
level.
We
do
have
some
some
smoke-free
indoor-smoke-free
policies
in
some
of
our
communities
and
many
of
us
who
live
in
those
communities
forget
that
there's
a
large
swath
of
our
state.
Where
that
isn't,
I
I
go
into
a
restaurant
and
someone
lights
up
a
cigarette
and
it's
been
a
long
time
since
I've
actually
seen
someone
light
up
a
cigarette,
because
I
stay
in
the
louisville
lexington
frankfurt
area,
which
is
where
I
live
and
work.
H
So
I
think
that
is
something
that
that
can
be
entertained
as
as
state
law.
It's
certainly
something
our
prevention
and
the
cessation
and
prevention
program
would
be
thrilled
to
get
into.
We've
worked
very
hard
to
get
this
out
of
school
systems
in
and
off
of
campuses
and
field
trips.
So
I
think
we
we
as
a
state
can
choose
to
do
that
because,
but
it
because
it
is
killing
our
people.
K
Thank
you,
mr
chair,
and
thank
you,
dr
white,
for
this
presentation.
It's
it's
always
enlightening
to
to
hear
you
talk
about
these
issues
and,
as
dr
alvarado
said,
it
is
a
good
reminder
to
all
of
us
that
kentucky
has
some
real
health
issues
and-
and
we
know
some
of
the
preventative
models-
and
you
know
we
really
need
to.
We
need
to
implement
more
of
those
prevention
initiatives
here
in
kentucky.
K
Certainly,
we
know
how
to
prevent
many
cancers.
I
think
it's
important.
As
you
said,
many
of
these
strategies
revolve
around
education
and
that's
key
for
patients
and
and
citizens
to
really
understand
kind
of
what
we're
dealing
with
and
and
understanding
your
own
family
history
and
your
own
genetic
predisposition
and
lifestyle
changes
that
really
do
make
a
difference,
and
so
that's
really
why
we
wanted
to
talk
about
this
today.
Is
you
know
we
have?
K
We
had
the
great
discussion
from
app
harvest
about
nutrition
and
and
the
role
that
that
plays
in
our
health
and
certainly
taking
a
deep
dive
on
some
of
these
issues.
I
think
that
you
know
we
just
need
to
hear
this
from
time
to
time
to
to
really
reiterate
that
there
are
some
things
that
we
can
do
and
we
need
to
do
and
we
need
to
put
resources
behind.
K
So
thank
you
for
your
presentation.
Thank
you
for
your
work
on
the
community
health
worker
initiative
as
well,
and
we've
got
a
lot
of
people
who
are
going
to
talk
about
that
because
I
think
that's
really
an
up-and-coming.
You
know
it's
been
around
a
while
people.
Don't
really
know
that,
but
I
think
it's
something
that
we
need
to
take
a
real
look
at,
because
when
we're
talking
about
these
social
determinants
of
health,
they
are
real
and
you're
right.
Not
physicians.
Don't
have
the
time
to
deal
with
this.
K
A
Also,
to
put
it
in
perspective,
when
we
always
the
statistic
is
the
same:
8
900
deaths
related
to
tobacco.
I
mean
we
throw
that
number
like
it's
nothing,
we're
worried
about,
obviously,
a
massive
pandemic
and
how
many
lives
that's
consumed
annually
that
consumes
more
lives
than
our
entire
pandemic
has
every
year.
So,
if
we're
worried
about
the
amount
of
deaths
we
have
from
a
virus,
tobacco
is
taking
more
kentucky
lives
every
year.
As
a
result
of
that,
we've
got
several
questions.
First
is
senator
meredith.
C
Well,
thank
you,
chairman
eli,
and
just
a
couple
of
quick
questions.
If
I
could
please,
on
your
slide
six
physical
activity
and
nutrition
program,
one
of
the
strategies
you
mentioned
is
healthy
food
service
guidelines
for
food
banks.
Can
you
elaborate
on
that?
Just
a
little
bit
is
what
that
might
look
like
and
what
what
we
hope
to
accomplish
by
that.
H
Well,
we're
we're
looking
at
what
is
put
or
put
in
those
boxes
that
people
get
and
we're
trying
to
make
sure
that
when
we
request
things
when
people
donate
that
we're
getting
fruits
and
vegetables
that
we're
not
just
getting
all
cans
of-
and
I
don't
want
to
use
a
brand
name
because
that
would
be
inappropriate
but
canned
spaghetti-
can
things
with
high
salt
high
low
low
nutrition?
If
we
get
those,
and
so
can
we
spread
those
out
so
that
one
box
doesn't
have
all
of
that
high
salt?
H
C
F
Thank
you,
mr
chair,
dr
dr
earl
white.
Thank
you
very
much
for
the
presentation.
Your
first
slide
in
your
last
couple
of
slides,
I
sort
of
knew
about
the
the
first
slab,
the
second
sl
last
lads
sort
of
struck
me,
but
and
not
to
too
great
or
the
what's
going
on
in
the
state,
not
from
a
legislative
point
of
view,
but
also
from
the
medical
community,
as
well
as
the
public
health
department.
F
It
seems
like
the
second
slab
in
terms
of
the
america's
health
ranking
to
where
we
rank
we're.
Always
there
we
never
get
out
of
that
that
bottom
ranking
what
fundamental
change
needs
to
happen
from
the
medical
community
from
from
the
legislative
perspective,
to
make
this
dynamic
change,
because
we
it's
it's
like.
If
we're
like
a
hamster
and
a
and
a
on
a
wheel,
we
work
and
work.
We
get
off
we're
still
stuck
in
the
cage.
F
I
haven't
gone
anywhere
so
and
that,
like
I
said,
I
don't
want
to
degrade
anything
we've
been
going
on
in
terms
of
programs
because
they've
been
very
good,
but
something
needs
to
hit
hit.
The
road
is
there
anything
that
you
know
of
from
a
collaborative
cooperative
way
to
change
a
fundamental
dynamic
to
get
us
out
of
these
rankings.
H
H
Sorry,
I
think
I
just
muted
myself.
I
had
something
laying
on
my
screen
on
my
keyboard.
There's
a
slide
that
I
should
have
included
that
if
I'm
allowed
I'll
I'll
send
to
you
from
the
university
of
wisconsin
county
health
rankings
and
it
breaks
down
health
outcomes
by
percentage
and
it
talks
about.
In
my
whole,
life
was
medical
care
working
hours
and
hours
a
day,
and
I
found
out
that
only
twenty
percent
of
health
outcomes
is
medical
care.
Thirty
percent
is
health
behavior,
so
you
have
to
work
on
tobacco
diet
exercise
alcohol
use.
H
H
So
the
reason
that
there's
not
one
answer
to
your
question
is:
there
are
a
bunch
of
questions,
so
there
are
a
bunch
of
answers
and
it
has
to
be
done
in
all
of
these
different
fields
and
the
problem
with
public
health
is
we're
not
a
heart
transplant
or
a
new
super
duper
drug.
We're
physical
activity,
nutrition-
that's
not
very
sexy,
and
people
just
really
don't
want
to
do
that.
So
how
do
you
sell
that
to
people?
How
do
you
get
people
to
say?
H
Well,
everybody
in
the
family's
got
the
sugar,
so
I'm
going
to
have
it
too?
Well,
no,
and
sometimes
we
can
break
through,
and
people
get
that
aha
moment
and
there's
a
change.
So
that's
a
long
non-answer
to
your
question.
I
apologize,
but
I
think
we
have
to
continue
to
do
these.
Pilots
learn
what
works,
learn
what
doesn't
work
and
when
we
learn
something
that
works,
then
we
spread
it
out
and
that
that
has
to
do
with
funding
and
how
much
that
we
can.
H
We
can
spread
these
different
success
stories
to
other
communities
and
what
might
work
in
fulton
might
not
work
in
falmouth,
so
we
and
we
have
to
continue
to
tweak
them
and
make
a
plan
that
will
work
and
find
that
trusted
local
individual
in
that
community.
That
can
push
that
out.
It
can't
be
connie
white
from
frankfort.
It
has
to
be
at
the
local
level.
People
understand
this
is
going
to
make
their
people
better
and
that's
what
we
have
to
work
on.
F
And
I
know
it's
a
difficult
question
to
answer.
I
didn't
want
to
put
you
on
the
spot
and
I
know
it's
a
multifaceted
approach
and
takes
a
really
holistic
mindset,
which
I
want
to
ask
you.
My
next
question,
if
you
don't
mind,
mr
chairman,
is
that
you're
we're
looking
at
all
the
physical
side
and
so
forth?
Where
does
a
mental
health
come
into
this
perspective
because
you
talked
about,
like
I
said,
taken
from
various
aspects
from
a
holistic
point
of
view,
and
I
want
to
know
exactly
how
is
that?
H
You're
you
hit
it
right
on
the
head.
The
the
mental
health
aspect
probably
is
an
umbrella
over
all
of
this,
I
I
worked
for
20
years.
As
a
gynecologist
and
a
friend
of
mine
said
I
was
a
gynecologist.
I
spent
more
of
my
time
in
my
office
talking
to
people
about
their
their
their
emotional
feelings
about
themselves,
and
I
did
about
about
physical
medicine.
H
It
felt
like
some
days
so
if
people
are
in
a
state
where
they
are
whether
they're
in
a
state
because
of
a
situation
like
income,
I
mean
I
had
patients
that
would
take
their
blood
pressure
medicine
one
month
and
their
diabetes
medicine
one
month
in
their
heart
disease,
medicine
one
month,
because
they
could
only
afford
one
month
at
a
time
of
medication.
So,
if
you're
facing
that
you're
facing
putting
food
on
the
table,
all
of
those
issues
that
are
part
of
those
social
determinants
of
health
that
the
chair
moser
was
talking
about.
H
That's
going
to
put
most
all
of
us
in
a
state
of
how
do
I
cope
with
this
so
until
we
can
help
people
with
those
coping
skills?
That's
part
of
the
diabetes
self-management,
education
and
support
is
tel,
showing
people
that
they
can
manage
this
chronic
disease,
and
they
can
live
with
this
in
a
way
that
is
healthy.
All
of
those
things
are
so
critical
and
that's
part
of
every
program
that
we
try
to
do
and
that
you're
right.
H
That
is
a
tough
nut
to
crack,
and
that
has
to
be
something
that
we
approach
in
every
every
program
that
we
we
put
forward,
but
giving
people
the
information,
so
they
understand
they
can
control
it.
I
think
when
people
feel
like
they
have
control,
we
did
a
copd
program
with
community
health
workers
and
after
they
taught
the
patients
how
to
take
care
of
themselves.
H
F
Well,
I'm
anticipating
that
we'll
be
continuing
to
move
the
needle
from
a
mental
health
standpoint
through
the
leadership
of
the
co-chairs,
as
well
as
representative
bentley,
and
on
the
severe
mental
health
illness
task
force.
We
have
so
I'm
looking
forward
to
trying
to
do
this,
and
hopefully
we
can
work
with
your
department
and
to
combine
the
fiscal
aspect
and
the
middle
aspect
of
keep
moving
the
needle,
so
we
can
get
out
of
the
bottom
rankings.
Thank
you,
mr
chair.
Thank.
A
A
C
B
Noticed
vaping
in
schools
has
always
been
a
huge
concern
of
ours,
the
last
few
years,
and
it's
just
seen
such
a
market
increase.
What
are
you?
I
notice
that
the
the
the
tendency
looks
like
it's
about
one
out
of
every
four
in
schools,
24
25
and
then
that
same
percentage
is
smoking
as
adults,
so
that
correlation
is
striking,
that
what
are
you
all?
What
are
you
seeing
there?
Can
you
comment
on
that
real
briefly,.
H
The
the
my
life,
my
choice,
my
life,
my
I
threw
my
I
threw
my
slides
on
the
floor
as
I
got
through
talking
about
them,
so
I
don't
have
them
in
front
of
me,
but
that's
a
program
geared
toward
adolescence
and
really
geared
to
try
to
work
with
vaping
because
and
educating
parents,
because
they
don't
understand,
and
you
can
hide
vaping
really
well,
there's
there
could
be
people
vaping
in
this
room
right
now.
We
wouldn't
really
know
it.
H
G
Thank
you,
mr
chairman.
Thank
you,
dr
white
and
your
expertise.
I
have
this
question.
I
want
to
formulate-
and
I
kind
of
agree
with
representative
fleming-
I'm
tired
of
being
in
the
bottom
numbers,
but
on
cervical
cancer
kentucky
has
the
highest
rate
in
the
united
states,
cervical
cancer,
back
in
the
70s.
G
L
G
N
G
G
H
Well,
certainly,
the
more
sexual
partners,
you
have,
the
higher
your
risk
of
being
exposed
to
hpv,
and
so,
if
we
can
prevent
that
transmission,
you're
absolutely
right,
and
I
think
that's
certainly
the
first
line
that
anyone
would
teach
any
any
young
adolescent.
If
they
ask
that
question.
Unfortunately,
they
usually
ask
the
questions.
After
the
fact,
when
things
have
already
happened,
we
we
have
made
great
strides
in
cervical
cancer.
I
looked
and
the
year
I
was
born
1954.
H
A
E
H
The
county,
the
american
health
rankings
every
year
when
they
put
out
their
new
report,
always
addressed
that
who
went
up
and
who
went
down
and
by
how
much
and
what
you're
gonna
find
is
your
top
ten
are
gonna,
be
the
same
top
ten.
It's
going
to
be
your
colorados
and
your
hawaiis
and
your
massachusetts
and
vermont
and
places
where,
quite
frankly,
the
there's
a
better
income,
there's
better
employment,
there's
better
living
conditions
and
all
of
those
those
social
determinants
of
health
help
keep
those
people
at
the
top.
H
H
E
H
I
don't
think
we
see
anything
drastic
happen
at
this.
I
think
we,
if
we
would
have
to
look
back
over
several
years
and
see
if
someone
gradually
started
moving
up
and
if
somebody
moves
up
that
means
somebody's
moving
down
because
of
the
way
the
rankings
go.
But
I
can't
answer
that
question.
If
there's
somebody
that
has
started
in
the
in
the
seller
and
worked
their
way
up
even
to
the
mid-range
we
have
in
some
areas,
but
overall,
no.
E
Quick
comment-
and
I
know
10
years
ago,
kentucky
looked,
you
know,
switched
to
the
mco
model
and
I
know
that's
that's
not
over
all
of
our
health
care,
but
you
know
we
were
told
that
it
would
save
the
state
money
and
improve
health
outcomes,
and
here
we
are
10.
10
years
later,
48
49
44
46
46
50th,
I'm
open
to
looking
into
whatever.
We
need
to
do
to
to
improve
this,
and
I
thank
you
for
your
work,
dr
white.
Thank
you,
mr
chairman.
E
E
A
L
Thank
you,
vaping
sure,
is
a
problem.
I've
seen
vaping
on
the
house
floor
it.
It
sounds
like
we're
all
talking
around
how
sick
we
all
are,
and
we
know
that
the
sicker
we
are
the
more
it
costs
we're
talking
about.
Can
we
take
drastic
action?
Perhaps
the
desire
is
building
to
do
that.
So
if
we
were
to
stop
nibbling
at
this,
what
would
it
take?
Should
cigarettes
cost
twelve
dollars
a
pack?
What
would
it
take
to
cut
cancer
in
half
in
kentucky.
H
That's
the
question
you're
asking
me:
I
think
anything
we
can
do
to
put
to
make
the
healthy
choice
the
easy
choice
and,
by
contrast
to
make
the
unhealthy
choice
hard
a
barrier
to
that
unhealthy
choice.
I
think
we
would
see
health
improvements
and
more
information
for
people
to
understand
the
outcomes.
L
E
Thank
you,
dr
white,
for
your
presentation
with
covid
we've
kind
of
noticed
in
hospitals.
I
think
over
2020,
the
78
percent
of
all
hospital
admissions
with
covid
were
obesity
related
and
then
just
looking
at
slide.
2
it.
You
know:
hypertension,
diabetes,
copd,
cardiovascular,
that's
all
obesity
related.
E
Has
the
cabinet
or
the
the
department
thought
about,
in
addition
to
pushing
vaccinations
as
as
hard
as
they
are
and,
as
you
know,
should
be
doing
that
kind
of
a
holistic
health
approach
to
this,
because
I
do
feel
like
right
now:
people
are
paying
more
attention
to
their
own
personal
health
care
and
a
lot
of
people
think
well.
If
they've
got
the
vaccination
or
if
they've
had
coveted,
they're,
okay
and
they're
obese,
has
there
been
any
thought
of
a
more
holistic
approach
to
this.
H
I
think
right
now,
we've
put
most
of
our
efforts
into
making
sure
that
people
that
miss
their
cancer
screenings
miss
their
their
chronic
disease.
Checkups
miss
their
other
vaccinations
to
childhood
vaccinations.
That's
been
our
biggest
push
in
in
the
healthcare
arena
right
now,
but
certainly
making
sure
that
people
understand
that
the
unhealthier
they
are
the
highest.
That
risk
is-
and
I
think
that's
an
excellent
suggestion
that
we
can
take
back
and
see
if
we
can
put
some
some
numbers
to
that
of
what
you're
talking
about.
C
Thank
you,
miss
chairman.
This
is
a
brief
one
on
your
slide
of
chronic
disease
status
and
certainly
no
surprises
here
other
than,
and
maybe
it's
because
a
word
fits
on
the
disease
spectrum.
But
I'm
surprised
we
haven't
had
any
discussion
about
alzheimer's
and
dementia,
and
most
of
these
things
are
contributing
factors
to
that.
Just
want
to
make
sure
that's
on
the
radar.
Is
it
on
the
radar.
H
It's
on
the
radar
in
this
it,
the
the
alzheimer's
association,
comes
to
our
berfus
group
and-
and
we
have
bertha's
questions
about
not
only
about
alzheimer's
but
about
caregivers.
That's
a
big
big
push
for
the
national
alzheimer's
foundation.
We
don't
have
any
grant
funding
right
now,
so
we're
not
doing
any
active
research
or
active
work
in
the
alzheimer's
world.
H
C
A
Thank
you
senator
thank
dr
white
as
always
thank
you
for
your
willingness
to
come
and
testify
and
provide
us
some
an
update.
It
always
prompts
a
lot
of
questions.
Obviously
a
lot
of
concerns
we
want
to
improve
our
rankings.
We
commented,
I
think,
at
our
last
meeting
about
our
mco
partners
who
are
supposed
to
help
in
this
regard,
and
we
really
haven't
seen
much
change
in
the
last
10
to
12
years
in
that
regard,
so
just
trying
to
find
ways
to
get
you
know.
As
doctors,
we
know
we
can
often
advise
people
what
to
do.
A
They
don't
always
agree
with
us
or
want
to
do
what
we
ask
them
to
do,
what
we
think
is
best
for
them
and
the
way
we
can
you
know
get
folks
to
make
those
changes
sometimes
is
very
gradual.
The
process,
but
it's
often
just
re-educating
re-educating,
our
code
of
ethics-
requires
us
not
to
denigrate
not
to
humiliate
not
to
embarrass
not
to
anything,
just
break
down
barriers
re-educate
trying
to
get
them
to
get
to
the
best
conclusions
for
their
for
their
own
health.
A
So
we
thank
you
for
your
work
that
you're
doing
I
know.
Sometimes
it's
often
not
appreciated,
but
I
want
to
know
that
I
appreciate
you
and
the
efforts
you
make
in
the
department
of
public
health.
So
thank
you.
Thank
you.
All
right.
We've
got
two
more
presentations,
so
next
we've
got
primary
care
services
and
community
health
workers.
It's
one
of
the
topics
we
had
dr
white
had
presented.
We've
got
several
folks
that
are
here
either
remotely
or
in
person.
So
I'm
going
to
ask
all
of
you.
A
I
think
everybody
was
given
kind
of
20
minutes
and
I
know
how
we
are
in
the
health
world.
We
often
tell
stories,
and
you
know
we-
we
sometimes
are
not
even
aware
of
how
long
we
take
so
I'm
going
to
ask
you
please
be
mindful
of
the
time
to
communicate.
We
have
about
a
20
minute
presentation.
I
think
we've
got
john
inman
and
teresa
cooper
and
pam
spradling
are
here.
A
O
Good
to
go:
okay
thanks,
I'm
john
imminent
from
the
kentucky
primary
care
association.
We
appreciate
the
opportunity
to
testify
this
morning
in
front
of
you,
some
of
the
issues
that
you
brought
forward.
You
know
the
robust
discussion
about
a
holistic
approach
to
health
person-centered
health
care:
how
to
engage
the
patients
in
their
own
health
care
with
the
primary
care
association.
It's
one
of
our
main
missions.
O
We
try
to
offer
a
variety
of
services
and
we're
actually
mandated
our
members
are
fqhcs
and
rhcs.
We
offer
behavioral
health,
physical,
health,
dental.
We
do
a
lot
of
outreach
programs,
we
do
school
clinics
and
we
really
try
to
take
into
account
the
health,
the
true
health
of
our
patient
when
we
prescribe
those
treatments.
O
Those
are
important
things
at
the
at
the
very
core
of
it.
To
get
those
patients
engaged
in
our
health
care,
we're
big
advocates
of
a
value-based
payment
system,
you
know
get
the
providers
engaged
in
that
health
care
and
and
bringing
about
positive
health
outcomes
and
being
responsible
for
the
care
that
you
provide
to
those
patients.
O
First,
on
our
agenda,
we
have
wayne
linscott
he's
the
ceo
of
health.
First
bluegrass
he's
in
lexington
he's
going
to
kind
of
give
a
brief
overview
of
kind
of
the
variety
of
services
they
offer
to
talk
about
that
person-centered
care
and
then
we're
going
to
lead
into
some
testimony
about
the
community
health
workers,
how
they've
used
them,
and
then
we
have
two
other
guests:
pam
spradling
from
big
sandy
community
health
center
and
then
remotely.
We
also
have
tammy
colette
she's
from
mountain,
comprehensive
healthcare
and
seeded.
P
I
am
on
good
morning
everybody.
I
found
myself
wanting
to
jump
into
the
conversation
when
dr
white
was
presenting
hearing
some
of
those
questions,
so
we're
really
excited
to
be
here
today
to
talk
about
our
health
center
federally
qualified
health
centers,
the
work
we
do,
how
we're
a
little
bit
different.
So
I
do
want
to
say
that,
since
we
have
such
a
limited
amount
of
time,
you
know
any
of
those
questions
from
the
food
bank
question
to
behavior
change
to
affect
healthy
behaviors.
P
All
the
way
to
the
the
payment
incentives,
like
john
talked
about
we'd
love,
to
have
you
out
to
one
of
our
sites
to
talk
about
that,
but
since
we're
short
on
time,
I'm
going
to
introduce
tara,
copper,
stanfield
she's,
our
chief
integrated
care
officer
and
she's,
going
to
be
talking
to
you
today
about
community
health
workers.
She
has
many
areas
of
expertise,
but
specifically
she's
an
expert
in
behavioral
health
substance,
use,
disorder,
treatment,
social
supports
and
integrated
care,
so
just
to
speak
really
briefly
about
health.
P
First,
we
are
a
federally
qualified
health
center,
a
non-profit
health
care
provider
serving
fayette
county
and
the
surrounding
counties
we
operate.
16
sites
and
employ
260
employees,
so
just
big
picture
overview.
Any
of
these
topics.
If
you
all
are
interested
again,
we
can
talk
about
them,
but
we
operate
under
an
integrated
care
model,
including
behavioral
health,
dental,
medical
and
pharmacy
services.
The
sites
at
where
we
provide
services
are
kind
of
the
primary
care
centers
that
you
would
imagine.
P
We
operate
mobile
units
and
actually
have
co-located
clinics
in
schools
and
homeless.
Shelters
as
been
has
been
discussed
today.
Covet
has
impact
operations,
access
and
safety
have
been
at
the
top
of
our
priority.
I
did
want
to
talk
a
little
bit
about
projected
targets
for
us
as
an
organization
we
just
submitted
our
federal
grant
application
so
we're
looking
at
serving
27
000
patients
for
75
000
visits
by
the
end
of
our
project
period.
P
I'm
going
to
turn
it
over
to
tara.
I
do
want
to
say
we
definitely
see
the
value
in
community
health
workers
for
patients
and
our
organization,
dr
white
and
several
of
you
have
commented
on
some
of
those
benefits
and
we
do
see
the
long-term
benefit
to
the
health
system,
as
that
position
continues
to
be
professionalized
and
potentially
reimbursement
changes
are
made
for
that
particular
service.
So
I'm
going
to
turn
it
over
to
tara
to
talk
about
how
community
health
workers
are
operating,
kind
of
from
an
operational
perspective
and
a
clinical
perspective.
M
M
So
it's
been
a
wild
couple
of
years,
but
I
genuinely
feel
like
the
work
I've
got
to
be
a
part
of
for
the
last
four
years
has
been
the
most
clinically
valuable
and
rewarding
work
that
I've
ever
got
to
do
and
throughout
my
career,
our
our
model
looks
like
a
mixture
of
on
each
of
our
teams.
Real,
really,
I
think,
if
you
think
of
it
as
our
core
philosophy,
is
that
we're
providing
the
right
service
at
the
right
time?
We
talk
about
that
all
the
time.
M
There's
a
million
reasons
why
people
don't
go
to
specialty
behavioral
health
there's
a
million
reasons
why
people
are
don't
know
where
to
go
when
it
comes
to
resources
and
they
said,
and
they
said,
and
they
said,
and
they
let
conditions
worsen,
whether
those
be
behavioral,
whether
it
be
substance
use
whether
it
be
resource
needs
that
they
have,
they
don't
go
back
to
school
because
they
don't
know
how
to
get
back
into
school.
They
don't
go
for
job
interviews
because
they
don't
have
the
right
clothes.
M
All
of
those
things
that
we
know
that
our
patients
are
facing
where
they
do
go,
though,
is
primary
care.
If
you
get
sick
enough,
you
go
to
your
primary
care
doctor,
and
so
our
model
is
about
being
good
enough,
that
when
somebody
shows
up
in
our
primary
care
side
or
in
our
dental
side
and
identifies
a
problem,
we
screen
hard.
We
screen
very
hard
and
the
primary
care
docs
through
their
relationships
with
patients,
also
know
what's
going
on
with
their
patients.
M
So
when
they
show
up
in
those
moments
and
something
is
identified,
the
power
of
our
model
is
that
on
demand
right
then,
and
there,
in
the
same
clinic
in
the
same
visit
room
side
by
side
with
their
doctor,
that
they
trust
a
behavioral
health
consultant
or
community
health
worker,
depending
on
what
the
need
is
oftentimes
both
are
tagged
and
joined
that
doc
and
provide
whatever
intervention
it
is
needed
right.
Then
we
know
that
most
behavior
change
happens
when
the
moment
is
hot,
when
the
pain
is
the
hardest.
M
We
feel
like
we
make
much
better
gains,
also
treating
substance
use,
including
mat
in
that
model,
out
of
primary
care
and
out
of
the
you
know,
specialty
clinic
the
suboxone
clinic
model
that
people
hear
about
all
the
time
and
have
all
kinds
of
feelings
about
based
on
the
history
of
that
we
want
to
do
it
right
there
at
the
doctor's
office.
With
the
same
doctor
that
treats
their
sore
throat
and
we're
really
loving
the
model,
the
next
slide,
I
know
community
health
workers
were
a
hot
topic
for
you
guys.
M
We
love
the
community
health
workers.
When
I
started
working
with
the
primary
care
teams,
I
thought
I
would
get
to
be
a
big
hero
for
bringing
a
therapist
on
to
take
away
some
of
those
conversations
that
I
know
slow
down
the
doc's
day.
But
honestly,
the
community
health
worker
has
been
in
a
lot
of
ways.
M
The
fan
favorite
for
the
docs
because
they've
been
treating
you
know,
kids
with
asthma
that
live
in
an
apartment,
that's
eat
up
with
mold
and
they're,
just
going
to
put
a
band-aid
on
it
because
they
know
this
thing's
going
on,
but
don't
know
what
to
do
with
it.
This
is
an
example
where
they
tag
the
community
health
worker,
community
health
workers
able
to
go,
and
maybe
work
with
the
landlord
and
work
something
out
or
maybe
find
a
different
place
for
that
person
to
live.
M
They
do
things
like
work
on
electric
got
turned
off
in
somebody's
house,
they're,
going
to
work
on
getting
that
term
back
on.
For
them
we
have,
they
will
go
to
the
grocery
and
help
somebody
with
diabetes
shop,
make
a
healthy
food
decisions
and
do
education
there
on
site.
We
had
it.
We've
had
several
situations
where
that
elderly
folks,
who
need
to
exercise
lower
their
a1c,
they're,
nervous
and
scared
to
death
to
go
to
a
gym,
that's
something
unfamiliar
to
them.
Even
if
it's
at
the
ymca,
where
there's
free
programming
makes
them
afraid,
makes
them
nervous.
M
We
have
the
community
health
worker
who
they
know,
go
there
meet
them.
There
get
them
used
to
it,
and
we've
seen
great
gains
that
way.
The
community
health
workers
have
been
phenomenal
on
helping
people
get
social
security
cards.
Birth
certificates
driver's
license.
If
you
don't
have
those
things
you're
in
a
bad
way
when
it
comes
to
getting
resources
and
getting
back
on
your
feet,
the
most
top
things
they
do
day
in
and
day
out,
every
single
day
are
transportation,
housing
and
food
insecurity.
M
That's
a
constant
thing
for
them
on
all
the
days,
but
they
get
involved
in
in
things
that
I'm
always
excited
to
hear
about
what
they've
got
going
on
and
what
they're
finding
out
in
the
community
I'll
tell
you
a
little.
We
did
it.
We
built
our
model,
you
can
go
to
the
next
slide.
We
built
our
model
a
little
differently
than
you
might
see
in
other
clinics.
We
have
required
a
bachelor's
degree
and
some
experience
in
health
and
human
services
up
until
this
point.
M
The
reason
that
we
did
that
in
my
past
my
past
life,
I
worked
a
lot
in
substance.
Use
was
involved
in
some
of
the
first
pure
training.
Template
builds
in
in
the
lexington
area
to
get
the
peers
up
and
running
loved
piers
loved.
That
model
found
that
you've
got
to
have
really
good
supervisors
to
support
those
peers,
because
it's
a
different
kind
of
work.
M
My
example,
always
in
that
world
was
it's
like
driving
a
you
know,
a
lamborghini
it'll
get
places
that
nobody
else
can
go
appear.
Somebody
with
that
relatable
experience.
They
can
do
things
the
doctor
can't
do
they
do
things
that
therapists
can't
do,
but
they
better
have
a
good
driver
or
they'll
crash
extra
hard.
M
The
lamborghini's
fast
right,
and
so
what
we
wanted
to
do
is
really
build
a
strong
foundation
with
people
with
a
lot
of
experience,
get
all
that
up
and
running
and
then
open
the
floodgates
to
be
able
to
provide
jobs
to
people
who
don't
have
a
bachelor's
degree
who
have
that
related
experience,
but
don't
have
experience
working
on
a
clinical
team
and
really
make
sure
we
can
support
them
and
we're.
Finally,
to
that
point
I
feel
excited
about
it,
I'm
excited
about
what
the
future
will
hold
for
us.
Thank
you.
O
Q
I
thank
you
for
the
opportunity
today
to
talk
about
community
health
workers
and
and
the
difference
that
they
can
make
in
the
lives
of
patients
in
the
viability
of
individual
health
care
centers
and
in
our
overall
health
care
system.
In
kentucky
at
big
sandy
healthcare
we've
employed
chw
since
2017.
Q
they
coordinate
care
for
patients
with
chronic
conditions
and
then
other
other
patients
as
well,
who
have
resource
needs
related
to
social
determinants
of
health
through
home
visits,
clinic
visits,
telehealth
and
phone
calls.
The
chws
provide
patients
with
health,
education,
navigation
services
and
linkages
to
community
resources
to
help
alleviate
those
barriers
they
have
that
are
relate
related
to
social
determinants.
Q
Q
These
are
some
of
the
biggies
that
we
deal
with,
but
every
day
we
never
know
what
our
patients
are,
what
their
issue
is
going
to
be
and
what
kind
of
need
they
may
have
since
2017,
big
sandy
healthcare
has
also
been
part
of
a
research
project
through
marshall
university
school
of
medicine.
You'll
hear
a
little
bit
more
about
that,
I'm
sure
when
mountain
com
talks
in
a
few
minutes.
During
this
time
our
chws
have
worked
with
over
800
patients
at
big
sandy
we've
been
we've
seen
statistically
significant
improvements
in
clinical
indicators
among
our
patients.
Q
Q
Between
january
2019
and
june
2020,
the
marshall
university
cohort
reduced
the
total
number
of
ed
visits
among
enrolled
patients
by
93
percent
and
reduced
total
hospitalizations
by
82
percent
for
the
patient.
This
means
better
health
outcomes
and
increased
quality
of
life
for
insurance
companies.
It
means
cost
savings
due
to
reduced
utilization
of
health
care
services,
reduce
medication
requirements
and
reduce
costly
complications
from
chronic
disease.
Q
Much
capacity
has
been
built
around
chws
in
kentucky
over
the
past
decade.
You
heard
dr
white
talk
about
some
of
that
earlier
on,
and
I
was
I
was
thankful
and
glad
to
be
part
of
that.
That
effort
in
the
early
days
and
throughout
the
the
course
of
that
kdph
convened
the
chw
advisory
work
group,
which
still
meets
quarterly
to
advance
the
chw
profession
in
kentucky
the
kentucky
association
of
community
health
workers
was
was
formed
in
2016
to
advocate
for
and
promote
chws
in
the
state.
Q
The
association
views
chw's.
As
the
missing
link
between
the
health
care
provider
and
the
patient,
this
relationship
plays
a
key
role
in
improving
the
health
of
our
communities.
And
again,
you
talked
to
you
heard
tara
talk
about
that
that
trusting
relationship
that
the
community
health
worker
develops
with
the
patient
that
is,
quite
frankly,
very
different
from
the
relationship
that
that
most
providers
are
able
to
develop
with
a
patient.
Q
If
you
question
that,
I
would
ask
you
when
was
the
last
time
you
saw
what
your
patient
has
in
the
refrigerator.
When
was
the
last
time
you
saw
the
inside
of
your
patient's
home.
When
was
the
last
time
you
knew
who
lived
in
your
patient's
home
and
the
dynamic
of
the
environment
of
your
patient's
home.
Q
They
must
complete
10
hours
of
state
approved
continuing
education
units
each
year.
In
order
for
the
chw
model
to
make
to
remain
viable
in
kentucky,
we
must
have
a
sustainable
stream
of
revenue,
while
most
chw
programs
are
implemented
with
grant
funding.
We
know
we
must
facilitate
payment
models
in
order
to
continue
this
important
work
and
improve
the
health
and
lives
of
the
people
we
serve.
O
Thank
you
pam,
and
I
I
think
one
of
the
things
that
pam
and
I
talked
about
in
our
initial
conversation
before
the
the
meeting
was
the
you
know.
You
touched
on
a
little
bit
the
granular
level
that
the
chws
get
involved
in
their
in
their
patients
lives.
I
almost
said
they're
like
a
healthcare
life,
coach,
they'll,
actually.
O
Q
Q
So
hey,
you
know,
but
it's
a
very
complicated
system
of
health
care
that
we
have
and
involves
many
facets
of
many
organizations,
and
you
know
from
payers
to
providers
and
specialist
providers
and
on
down
the
line,
so
the
community
health
worker
can
help
the
patient
navigate
that
not
only
by
telling
them
how
to
do
it.
But
you
know
a
lot
of
times.
Q
Our
patients
have
been
told
how
to
do
that
a
million
times
and
then,
when
they
get
there,
it's
like
what
what
was
I
supposed
to
do,
but
our
chws
actually
go
with
our
patients
to
those
visits
they
can
go
to
lexington
to
uk
for
a
specialty
visit
with
a
patient
or
to
huntington.
You
know
for
a
visit
with
a
patient
so
just
having
that
person
there,
especially
if
they
don't
have
any
family
support
or
caregiver
support.
Just
having
that
chw
there
to
provide
that
support.
A
K
Thank
you.
Thank
you,
mr
chairman,
and
thank
you
very
much
for
your
presentation.
I
don't
know
if
we
still
have
tammy
culler
to
talk
about
mountain
comprehensive
briefly,
but
before
we
do
that,
I
I
have
a
quick
question
about,
and
you
know
I
I
love
this
program,
I'm
very
supportive,
but
what
is
the
current
billable?
Is
this
a
billable
service
is
what's
the
funding
mechanism.
Q
Technically,
as
far
as
as
community
health
workers
go
and
the
services
they
provide,
there's
there's
no
billable
service
per
se.
However,
we're
able
to
build,
for
instance,
medicare
for
chronic
care
management
and
as
long
as
our
community
health
workers
are
working
under
direct
supervision
of
a
provider,
then
we
are
eligible
to
bill
medicare
for
ccm,
unfortunately,
for
for
fqhcs
the
reimbursement
is
lower
than
it
is
for
just
a
traditional
primary
care
organization.
So
that's
a
little
bit
of
a
deterrent
for
us.
I
mean
we're
glad
to
have
whatever
money.
Q
Medicare
will
provide
for
us,
obviously
to
be
able
to
continue
our
programming,
but
you
know
other
health
organizations
have
the
ability
to
bill
for
up
to
60
minutes
of
service
for
for
a
patient
per
month,
we're
only
eligible
to
bill
one-time
20-minute
service
per
month
per
patient.
So
we'd
certainly
like
to
see
that
that
expanded,
but
yeah,
the
the
only
other
funding
mechanisms
that
we
have
right
now
other
than
grants
are,
if
we're
providing
certain
evidence-based
health
education
programs
like
dpp
through
our
programs,
and
so
if
our.
K
O
B
B
I
was
boots
on
the
ground
with
the
program
at
the
beginning,
so
we
have
a
patient
with
an
a1c
of
14..
This
patient
has
been
in
and
out
of
the
hospital
multiple
times
in
clinic
in
er.
I'm
sorry
inpatient
in
er
repeatedly
his
provider
had
got
to
the
point
where
he
said.
I
can't
do
anything
else
to
help
him
everything
that
we
tell
him
to
do
fails.
So
that's
when
we
brought
the
community
health
worker
in
the
community,
health
worker
goes
out
to
the
patient's
home
and
discovers
the
patient
cannot
read
or
write.
B
This
is
not
something
that's
ever
been
shared
with
anybody
at
any
time
during
any
of
his
hospitalizations
er
visits
in
office
visits,
so
he
had
no
clue
how
to
even
dose
his
insulin
because
he
can't
read
or
write
so.
The
community
health
worker
worked
with
this
patient
to
develop
a
plan
through
his
care
plan,
with
the
provider
of
how
to
understand
dosing
insulin,
how
to
read
a
clock,
so
he
would
be
able
to
keep
up
with
the
times
how
to
with
shapes
and
pictures.
B
C
C
If
our
mcos
are
charged
with
improving
the
health
of
our
population,
which
obviously
I
don't
think
they
have
done
the
last
10
years.
It
certainly
is
their
advantage
to
employ
these
folks
because
the
benefits
are
going
to
accrue
not
only
to
the
patient
and
the
providers
but
to
the
insurance
companies
directly.
C
So
the
money's
there,
particularly
if
you
have
a
capital
right
today,
our
mcos-
do
insurance
companies,
regardless
of
what
the
payment
model
is.
The
benefit
accrues
to
them
by
having
a
healthier
population.
So
the
funding
is
there
and
I
think
that's
where
we
need
to
start
with
is
get
these
folks
to
step
up
and
say
yes,
we're
going
to
do
this,
or
we
will
provide
funding
to
do
this
because
again,
they're
going
to
be
the
ultimate
beneficiary
of
this
position,
but
I
think
it's
a
good
one
and
one
we
need
to
have
continued
discussion
on.
R
R
Q
Just
the
training,
that's
provided
by
the
appalachian
kentucky
healthcare
access
network,
there's
a
40-hour
training
that
we
put
all
of
our
children
through
they
get
just
the
kind
of
the
basics
in
chronic
disease.
So
they
have
some
talking
points
to
talk
with
patients
about
that
communication
and
just
learning.
You
know
those
public
health
protocols.
Q
We
we
don't
require
that
they
have
a
any
kind
of
medical
background
as
far
as
a
cna,
a
cma
or
anything
like
that
they
have
to
have
a
high
school
diploma
and
some
of
our
current
chws
do
have
a
cna
cma.
We
have
a
social
worker
who
works
with
us.
She
has
bachelor's
degree
in
social
work,
so
you
know
we.
We
certainly
look
at
that
and
consider
that
a
you
know
a
plus,
because
she
has
that
background
in
that
education,
but
it
is
not
required.
A
Well,
thank
you
all
very
much
and
we've
got
one
more
presentation
to
go.
We
appreciate
this.
This
is
a
topic
of
interest
for
all
of
us
we've.
You
know,
and
it's
it's
good
to
get
a
bit
more
info
on
it
and
something
we
need
to
consider
covering.
I
know
a
lot
of
our
mcos
somebody.
Saving
twenty
thousand
dollars
must
call
it,
I
would
argue,
probably
is
higher
than
that.
Every
hospitalization
that
you
prevent
is
a
lot
of
money
saved.
A
A
You
know
community
health
workers
rather
all
kinds
of
models
they
can
use
to
help
do
that
they
got
to
start
getting
innovative
because
again,
we're
not
seeing
any
movement
in
the
traditional
way
of
how
they've
managed
things
we've
got
to
start
having
ways
to
reimburse
this
to
save
more
money
in
the
back
end,
it's
always
hard
when
it
comes
to
health
care
and
any
aspect
of
government.
Anything
you
talk
about.
A
An
ounce
of
prevention
is
worth
a
pound
of
cure
and
we
argue
that
all
the
time-
and
it's
just
tough
to
have
people
trust
that
or
believe
it,
so
we
have
to
keep
pushing
the
more
results
we
get
the
more
argument
we
have.
So
thank
you
all
for
doing
that.
Thank
you
for
your
work
during
these
tough
times
as
well.
We
do
appreciate
that.
A
The
last
group
on
the
agenda
we
have
at
least
as
far
as
presentations
is
the
health
care
issues
facing
kentucky's
hospitals
and
their
patients.
We
have
nancy
galvani
here
with
the
kentucky
hospital
association
also
but
warman
and
melanie
moak.
If
you
all,
could
come
forward
and
introduce
yourselves
to
the
record.
I'd
appreciate
that.
N
Thank
you,
chairman
alvarado,
and
chairwoman
moser,
I'm
nancy
galvani,
president
of
kentucky
hospital
association
with
me
today,
is
bud.
Warman
he's
our
vice
president
for
remember,
engagement
and
he's
also
a
former
hospital
ceo.
You
ran
the
highlands
regional
medical
center
for
meadow
many
years
and
we
have
melanie
mock
our
vice
president
for
information
services
and
they're
with
me
today
to
help
answer
any
questions
you
may
have
at
the
end
of
my
testimony.
N
So
again,
thank
you
for
being
here
today,
while
our
hospitals
continue
to
cope
with
rising
covet
hospitalizations
from
the
delta
variant
and
the
fallout
of
the
coveted
pandemic,
including
a
tidal
wave
of
sud
patients,
we're
facing
other
significant
challenge
challenges,
and
we
want
to
make
you
aware
of
those
today
at
the
outset.
I
know
everyone's
interested
in
talking
about
what's
going
on
with
covid,
so
I'd
like
to
address
the
stress,
our
hospitals
are
facing
right
now
from
the
flood
of
admissions
from
coven
19
patients
suffering
from
the
delta
variant.
N
N
N
The
constraint
in
doing
so
is
the
inability
to
staff
the
additional
beds.
Hospitals
across
the
country
are
facing
a
nursing
shortage.
We
were
doing
that
before
the
pandemic,
and
now
that
situation
has
just
gotten
more
worse,
because
the
pandemic
has
put
that
in
that
stress
into
full
view,
our
staff
is
burned
out,
they're
tired,
they
have
mental
distress,
they're
having
to
work
longer
shifts
taking
on
more
patients
that
has
led
to
retirements
to
resignations,
and
so
we
are
really
lacking
inexperienced
nursing
staff
and
they
are
not
easily
replaced.
N
We
have
hospitals
that
are
burning
through
their
financial
reserves
to
hire
a
very
small
pool
of
traveling
nurses
that
everyone
in
the
nation
is
competing
to
get
we're.
Having
to
pay
national
rates
of
pay,
not
a
kentucky
rate
of
pay,
and
so
our
hospitals,
both
large
and
small,
which
did
not
have
adequate
provider
relief
funds
that
you
know
were
paid
out
last
year
are
having
to
compete
now
with
hospitals
in
new
york
and
california
that
have
a
lot
more
higher
rates
than
kentucky
hospitals
do
competing
for
those
same
limited
nurses.
N
The
latest
indications
from
federal
authorities
are
that
the
delta
variant
will
peak
over
the
next
few
weeks
and
then
recede
over
the
coming
months.
But
in
the
meantime,
there's
no
quick
answer
to
the
shortage
of
our
skilled
nursing
staff,
making
sure
that
our
patients
are
receiving
the
treatment
they
need
in
a
timely
manner
is
the
guiding
star
for
our
hospitals
but
there's
another
serious
problem,
which
all
too
frequently
interferes
with
our
ability
to
serve
our
patients
that
are
also
your
constituents
across
the
state.
N
Hospitals
are
discovering
that
many
times
when
we
call
the
ambulance
simply
doesn't
come.
Patients
who
have
suffered
from
strokes,
severe
burns
or
even
suicide.
Attempts
are
languishing
for
hours
and
sometimes
days
in
a
hospital
emergency
room
waiting
for
transport
to
the
appropriate
level
of
care.
There
have
even
been
fatalities
because
the
ambulance
didn't
come,
and
let
me
be
clear:
we
are
not
here
to
bash
the
ambulance
services.
N
Our
purpose
today
is
to
outline
a
growing
problem
and
to
make
you
aware
of
the
efforts
to
address
this.
If
we
can't
do
it
on
our
own,
we
may
need
to
ask
your
assistance
in
resolving
this
problem,
because
our
patients,
who
again
are
your
constituents,
cannot
be
ignored
when
minutes
count
in
the
saving
of
someone's
life.
N
N
N
N
These
are
not
isolated
cases.
There
are
quite
literally
scores
of
stories
from
all
around
the
state
we
have
surveyed
our
hospitals
and
the
problem
of
patient
transport
was
virtually
everywhere
in
the
state.
Kha
has
been
engaged
in
talks
with
the
kentucky
board
of
ems
or
k-beams,
which
governs
ambulance
services.
N
N
We
have
also
reached
out
to
other
stakeholders,
and
we
found
that
there
are
many
other
stakeholders
that
have
the
same
problem
and
that
involves
the
long-term
care
groups,
mental
health
groups
and
even
hospice
providers
all
of
our
collective
patients.
Your
constituents
are
facing
this
gross
reality
on
a
continuing
basis.
N
We
would
like
to
turn
now
to
another
topic
of
urgent
importance,
and
one
of
the
worst
outcomes
of
the
covet
pandemic
is
the
effect
it
has
had
on
the
mental
health
situation
in
kentucky
other
than
the
deaths
from
covet
itself.
Nothing
has
been
worse
than
the
impact
on
our
people's
mental
health.
We
have
seen
a
dramatic
rise
in
the
use
of
opioids
and
other
drugs,
as
the
pandemic
has
ground
on.
N
I
want
to
let
you
know
that
over
the
last
year,
more
than
50
percent
of
the
visits
to
hospital
emergency
departments
have
involved
sud
and
behavioral
health
issues.
1
million
ed
visits
were
tied
to
these
issues
and
we
wanted
to
make
everyone
aware
that
back
in
2018
kha
established
a
statewide
opioid
stewardship
program.
We
call
it
sos.
N
For
short,
we
have
partnered
with
the
cabinet
for
health
and
family
services
and
we
are
funded
through
their
kentucky
opioid
response
effort,
and
the
goal
of
this
program
is
to
lower
the
amount
of
opiates
that
are
prescribed
in
the
hospital
setting,
and
so
we've
been
working
with
our
physicians,
we've
been
providing
ongoing
training
and
we
have
sought
to
make
prescribing
an
opioid.
The
last
thing
you
do,
instead
of
the
first
thing
you
do
where
other
drugs
can
be
substituted.
N
We
are
now
expanding
that
has
been
so
successful
that
we
are
now
expanding
that
program
onto
into
the
outpatient
arena,
and
we
have
a
pilot
program
that
we're
starting
in
eastern
kentucky,
with
appalachian
regional
health
care
in
looking
at
working
in
their
outpatient
clinics
and
also
because
of
the
concern
about
people
coming
to
our
hospital
emergency
rooms
that
are
more
addicted.
We
are
also
going
to
be
working
with
the
cabinet
to
develop
a
program
to
help
more
hospitals,
implement
ed
bridge
clinics
to
get
addicted
individuals
more
immediately
into
treatment.
N
N
Two
other
things
that
we
want
to
touch
upon
before
our
time
expires
are
the
new
federal
transparency
law
that
our
hospitals
are
working
to
comply
with
and
give
you
a
very
brief
update
on
the
hospital
rate,
improvement
program
or
a
trip
which
all
of
you
supported,
and
we
thank
you
for
that.
In
the
last
legislative
session.
N
The
new
rules
are
going
to
require
hospitals
to
post
their
standard
charges
on
a
public
website
and
that's
the
charge
for
each
individual
item
of
service
that
a
hospital
provides,
of
course,
that
can
be
very
confusing.
It's
not
very
consumer
friendly
to
try
to
go
on
a
website
and
look
up
every
supply
and
figure
out
what
their
cost
is
going
to
be
and,
of
course,
charges
don't
really
reflect
what
anybody
pays,
and
we
also
want
to
point
out
that
in
2002
the
rand
group,
which
is
a
national
think
tank
group
did
a
study
in
it.
N
N
We
certainly
want
to
make
useful
information
available
to
consumers
and
that's
why
our
hospitals
are
working
to
make
on
their
websites
an
online
price
estimator
for
hundreds
of
outpatient,
non-emergency
shoppable
services,
for
example.
If
you
needed
an
mri
or
you
need
elective
surgery,
we
want
people
to
be
able
to
go
on
put
in
their
information
and
get
an
estimate
of
what
they
are
likely
to
pay.
Also,
last
year
there
was
a
federal
legislation
that
passed.
N
It
was
called
the
no
surprises
act
to
address
surprise
billing,
which
actually
has
not
been
a
huge
problem
in
our
state.
Nonetheless,
we
work
very
closely
with
senator
mcconnell
on
that
legislation
and
basically,
what
that
legislation
does
is
say
that
for
out
of
network
providers
the
patient's
held
harmless,
they
only
have
to
pay
their
in-network
cost
sharing
and
then
any
dispute
between
the
actual
reimbursement
between
the
out-of-network
provider
and
the
insurer.
They
just
negotiate
that
and
if,
of
course
it
doesn't
work
out,
it
goes
to
arbitration.
It
was
very
similar.
N
I
think
dr
alvarado
to
the
model
that
you
had,
but
as
part
of
that
no
surprises
act,
there
was
a
transparency
provision
put
in
it
and
under
that
transparency,
provision
which
will
go
into
effect
next
year.
Health
care
providers,
hospitals
and
health
care
providers
will
be
required
to
send
a
good
faith
estimate
of
expected
charges
for
whatever
the
service
is,
with
the
expected
expected
billing
and
diagnostic
code
to
the
patient's
health
plan.
The
patient's
health
plan
will
accumulate
that
information
and
then
produce
what
is
known
as
an
advanced
eob
back
to
the
patient.
N
So
then
they
will
have
something
customized
to
them
and
they
will
know
based
upon
their
health
plan,
what
they're
expected
out
of
costs
are
going
to
be,
and
so
again
we
are
still
in
the
process
of
finding
out
what
the
regulations
are
going
to
be
but
wanted
to.
Let
you
know
that
that
is
being
done
at
the
federal
level.
N
N
As
you
may
recall,
we
have
to
get
that
program
approved
every
year
by
cms
and
right
now
we
are
in
the
negotiating
phase,
not
us,
but
the
cabinet
for
health
and
family
services,
which
has
been
a
great
partner,
is
in
the
question
and
answer
phase
right
now
with
cms.
So
we
are
very
hopeful
that
that
program
is
going
to
get
approved
for
another
year,
but
it
hasn't
been
yet.
N
I
will
say
that
going
forward,
we
are
going
to
have
quality
metrics
tied
to
that
program
where
hospitals
will
have
to
meet
certain
outcome
measures,
and
so
we
are
happy
to
come
back
at
a
future
meeting
and
talk
to
you
more
about
what
we
are
going
to
be
doing
in
the
quality
area
that
is
related
to
this
program
and
I'll.
Stop
there
and
happy
to
take
any
questions.
A
Great,
thank
you
all,
and
I
appreciate
you
guys.
I
mean
that
we're
getting
tight
on
the
time.
I
think
they
need
the
room
by
11
for
another
meeting.
I
think
so.
The
one
thing
I
did
want
to
cover
really
quickly,
obviously
for
vaccinations,
we
encourage
everybody,
anybody
who's,
watching
this
go
out
and
get
vaccinated.
A
If
there's
concerns
about
it,
I've
taken
personal
calls
from
people
the
state
capitol
with
questions
around
it
feel
free
to
reach
out
to
me,
either
by
email,
be
happy
to
discuss
kind
of
the
ins
and
outs
of
what
we
know
about
current
vaccinations.
But
please
get
vaccinated
regards
to
staffing
very
important
topic
right
now.
Obviously
we
know
a
supreme
court
decision
has
come
down.
The
governor
is
kind
of
saying,
hey
your
legislature,
you're,
going
to
call
the
shots
on
all
these
things.
We've
got
some
ideas
on
things
that
need
to
be
done.
A
We
know
what
other
states
have
done
in
the
space
of
trying
to
recruit
and
retain
nursing
staff.
I
think
we've
we've
had
some
discussions.
The
discussion
is
what
arkansas
has
recently
done:
129
million
dollars
they've
put
towards
recruitment.
I
think
nine
thousand
dollars
per
license
bet
for
hospitals,
2
500,
for
nursing
home
beds
for
the
same
issue,
because
the
nursing
homes
are
struggling
as
well.
We've
got,
I
mean
if
people
don't
think
I
mean
right
now.
If
you're
a
nurse
and
you're
available,
you
can
go
out
and
travel
you
can
make
more
than
most.
A
Doctors
are
making
per
hour.
Frankly,
as
far
as
because
the
demand
is
that
high
for
icus-
and
I
know
that
the
crunch
is
critical-
a
lot
of
states
a
year
ago
saw
this
coming
and
I
think
I've
been
making
preparations
for
that
from
what
I
did.
You
all
have
an
opportunity
to
talk
to
the
administration
about
this
issue
a
year
ago
and
kind
of
raise
the
concerns
this
might
be
coming.
A
N
N
A
And
I
think
we
may
be
late
to
the
dance
we're
going.
We
have
to
start
considering
those
things
if
you've
got
some
that
you'd
like
to
put
in
some
language
we'd
like
that
now,
because
we're
starting
to
formulate
plans
for
what
needs
to
happen
for
the
state
going
forward,
especially
with
this
huge
surge
that
we're
having
the
burnout
of
providers
is
not
just
from
covid
people.
Think
it
is,
it's
kind
of,
I
think
the
straw
that
broke
the
camel's
back.
There's
been
a
lot
of
things
that
have
gotten
us
to
this
point.
A
Liability
is
one
issue
really
it's
the
bureaucracy
of
government,
the
bureaucracy
of
insurance
companies,
where
you're
spending
more
time
whatever's
on
this
piece
of
paper
or
in
your
computer,
is
what
matters
more
than
you
actually
taking
care
of
a
patient,
and
it's
got
every
provider
up
to
here
and
I'm
you
know
one
of
those
as
well.
It's
just
gotten
to
the
point
where
that's
more
burdensome,
you
don't
sign
up
for
that.
A
You
sign
up
to
take
care
of
people,
and
the
folks
that
are
in
that
are
getting
to
the
point
where
kobe
came
around
nurses
would
stay
home
with
their
kids.
They'd
say
you
know
what
I'm
not
going
back
or
I'm
retiring
early
or
lots
of
reasons,
and
so
we've
lost
a
lot
of
our
workforce.
Other
states
are
poaching
that
workforce
from
us
right
now.
We've
got
to
do
something
pretty
quickly
if
we're
hoping
to
keep
a
lot
of
that
staff
present.
A
The
other
thing
I
wanted
to
talk
about
and
and
something
that's
been,
I
know
you
guys
were
talking
about
other
issues-
monoclonal
antibodies.
We
know
there's
been
a
discussion
on
that
regeneron,
which
is
something
that
leads
to
give
iv
which
we
can
now
give
subcutaneously,
which
can
be
given
by
probably
non-medical
personnel
like,
like
an
insulin,
shot
to
have
the
same
effect.
A
We
can't
give
it
when
people
are
sick
enough
to
be
in
a
hospital,
so
you
get
admitted
with
covid
your
oxygen's
low,
you're,
no
longer
a
candidate
for
regeneron,
but
we've
got
tons
of
it
from
what
I
hear
all
over
the
state
and
all
over
the
country.
For
that
matter,
some
states
are
taking
it
upon
themselves
to
offer
locations
specifically
where
people
can
go
and
if
they've
got
positive,
coveted
before
they
get
to
that
state,
where
they're
having
to
be
hospitalized
to
come
in
and
get
a
treatment
of
that
it
reduces
hospitalizations
by
70
percent.
A
Would
that
be
something
the
kha
can
help
us
with?
I
mean
we're
looking
at
maybe
putting
some
kind
of
a
proposal
together
for
the
state
as
well
to
kind
of
roll.
This
out
we're
going
to
have
to
have
regional
locations
somewhere,
people
can
get
that
administered
and
hopefully
keep
them
from
being
admitted
to
the
hospital.
Is
that
something
you
all
can
help
with?
As
far
as
logistics.
N
Yes,
we
can,
and
actually
we
are
already
surveying
our
hospitals.
We
know
a
number
of
our
hospitals
are
actually
operating
these
regeneron
outpatient
sites,
so
we
thought
we
would
start
by
finding
out
how
many
hospitals
are
already
doing
it
and
then
maybe
see
where
there's
gaps
in
the
need,
as
you
say,
for
a
regional
center.
C
It
truly
has
been
inspirational
and
again
we
don't
give
those
folks
enough
credit
specific
to
your
issue
about
the
ambient
service.
Just
to
let
you
know
our
last
medicaid
oversight
committee
meeting,
they
testified
to
talk
about
this
very
issue
and
particularly
the
rural
communities.
They
say
they
have
enough
ambulances
bringing
shortage
of
personnel
just
like
we
all
have,
and
they
seem
sincere
in
their
commitment
to
work
on
this.
C
I
think
the
legislation
we
passed
this
last
session
to
give
them
a
provider
tax
which
helps
increase
the
funding,
has
helped
a
lot
but
they're
not
there
yet,
and
I
just
want
to
encourage
you
to
keep
talking
to
those
folks,
as
I
think
we
will
as
well.
We
want
to
see
a
solution
to
this.
I'm
not
sure
hospitals
getting
into
the
business
is
going
to
help
it.
C
It's
sort
of
like
the
traveling
nurse
situation,
if
there's
only
so
many
people
out
there
and
we
get
in
competition
to
just
job
set
the
price
without
increasing
the
the
the
base
number
of
employees.
We
have
so
there's
there's
issues
all
around
this
and
just
let
you
know,
I
hear
you
hear
your
problem.
I
know
those
weights
how
difficult
they
are
on
the
patients
and
family
members,
but
we
need
to
make
sure
we're
working
jointly
on
this
and
just
appreciate
the
work
you've
done
on
this
so
far,.
N
A
N
Hospitals
calling
me
just,
we
need
a
solution
and
we've
been
studying
this
for
a
year.
This
is
not
something
that
just
happened
yesterday
we
were
getting
calls.
This
has
been
a
a
problem,
but
growing
all
across
the
state
and
bud
is
here
today,
bud
of
course
experienced
it
also
when
he
was
at
highlands
and
he's
been,
you
know
leading
a
task
force
that
has
been
multi-disciplinary,
that
has
included
the
ambulance
providers
as
part
of
the
task
force,
and
we've
been
studying
this
for
a
year.
C
I've
been
retired
since
2013
and
I
had
that
problem
back
in
2013,
so
I
know
it's
a
standing
problem,
but
I
think
the
conversations
I've
had
with
the
folks
that
you've
got
their
attention
and
they
want
to
work
on
a
solution.
So
let's
just
try
to
do
that
if
at
all
possible,
but
absolutely
thank
you.
I
understand
the
problem.
Thank
you,
mr
chair.
Thank
you.
Senator
carroll.
C
B
You,
mr
chairman,
and
just
quickly
along
those
lines,
have
hospitals,
attempted
partnerships
to
supplement
staffing
and
ambulance
service
during
this
emergency
crisis
period,
and
and
I'm
assuming
there
would
be
regulations
that
would
affect
that.
That
would
have
to
be
changed
in
order
to
to
facilitate
that
happening.
So.
N
You
make
a
good
point
and
something
that's
I
think
important
to
understand.
You
know
the
cabinet
for
health
and
family
services
has
no
say
over
ambulance
services,
they
regulate
every
other
health
service,
but
they
don't
regulate
ambulance
services,
that's
the
kentucky
board
of
ems,
and
there
are
regulations
in
terms
of
you
know
how
the
ambulances
have
to
be
staffed.
You
know
who
can
ride
the
ambulance,
like
nurses
can't
run
the
ambulance,
so
you
know
the
cabinet
really
has
their
hands
tied.
They
can't
do
anything
to
help
the
situation.
N
B
G
G
G
G
It
takes
months,
and
I
way
I
understand
from
the
doctors
they
could
do
that
in
one
form
and
speed
up
that
process.
So
I
would
like
for
you
to
look
into
that
and
not
only
that
I
get
upset
well,
everybody
knows
I'm
from
eastern
kentucky
and
I'm
kind
of
hillbilly.
That
way,
but
I
get
upset
when
I
pass
bills
and
they
never
get
implemented
house
bill.
G
314
is
a
casper
bill
that
says
if
a
lady
comes
in
and
she's
addicted
to
opioids
that
that's
reported
by
the
hospital
through
the
casper
system,
so
that
we
prevent
neonatal
asset
syndrome,
babies
and
they
cost
us
a
hundred
thousand
dollars
a
year,
each
one
of
them.
So
we
could
save
10
10
times.
100
is
pretty
easy
to
figure
it
out.
R
Thank
you,
mr
chairman,
and
thank
you
for
the
presentation
and
highlighting
some
of
these
really
critical
issues.
I'll
tell
you
what
I'm
hearing
about
ambulance
services
and
I'm
so
glad
that
you
brought
this
up.
I'm
hearing
that
there
are
challenges
traveling
from
out
of
state
and
that
there
can
be
barriers
county
to
county
that
seem
to
be
between
the
different
ambulance
providers.
R
And
then
maybe
I
don't
know
if
it's
more
alarming
as
alarming.
I'm
hearing
that
patients
are
being
told
that
ambulance
providers
do
not
need
to
provide
services
for
behavioral
health
or
mental
health
services.
In
some
cases,
just
we
don't
provide
those
services
and
that,
in
other
cases,
people
sometimes
in
a
severe
mental
health
crisis
are
being
transported
to
facilities,
hospital
facilities
that
don't
have
mental
health
units.
N
Yes,
absolutely
hospitals
are
reporting,
all
of
that
hospitals
have
called
and
been
told
by
the
ambulance
provider.
We
don't
transport
behavioral
health
period.
Others
say
you
have
to
call
the
sheriff.
You
have
to
get
a
court
order
and
then
you
have
to
wait,
however
long
that
takes
in
the
meantime
you're
correct.
K
Thank
you,
mr
chair,
and
thank
you
very
much
for
your
presentation
and
highlighting
all
these
really
critical
points.
I
I
won't
belabor
any
of
them.
I
I
just
appreciate
your
work,
especially
on
the
opioid
steward
stewardship,
but
on
the
question
of
what
can
we
do
right
now
about
the
ambulance
issue?
I
know
that
I
or
I've
heard
that
the
board
of
ems,
or
maybe
just
ambulance
services,
really
are
struggling
with
staffing,
and
I
know
that
some
regs
were
relaxed
to
allow
nurses
to
ride
along
with
ambulance
services.
K
N
N
Another
was
to
allow
hospital
to
call
any
ambulance
in
the
state,
because,
right
now
you
you're
really
only
allowed
to
call
the
local
ambulance
that
has
the
license
for
your
county
and
if
they
won't
come,
you
know
you're
kind
of
what
are
you
going
to
do
so
I
think
yes,
there
could
be
some
things
that
are
done.
The
other
thing
I'd
just
like
to
mention
that
we
think
would
help
the
situation
and
you
may
have
heard,
because
you
know
that,
falsely
that
we
are
asking
for
ambulance
services
to
come
out
of
certificate
of
need.
N
That
is
not
what
we
are
asking
for.
We
have
made
the
cabinet
aware
of
this
problem
and
we
support
certificate
of
need.
However,
we
believe
that
ambulance
services
could
still
stay
under
certificate
of
need,
but
be
put
in
the
more
streamlined,
faster
process
for
review.
Instead
of
a
formal
review,
put
put
them
in
a
non-substantive
review
level
of
review,
which
is
still
state
oversight,
but
it
is
a
faster
process.
It
is
a
more
streamlined
process
and
it
so
it
allows
where
there
are
unmet
needs,
for
you
know
somebody
to
address
that.
K
R
Thank
you,
chairman
alvarado
and
chairwoman
moser.
Thank
you
for
an
amazing
presentation.
This
is
a
question.
I've
been
asking
myself
and-
and
I
honestly
hesitate
to
ask
it
publicly,
but
I
think
we
need
to
to
start
asking
as
we
go
into
the
height
of
this
delta
search,
and
we
know
our
facilities
are
at
capacity.
R
R
Triaging,
you
know
I
work
in
the
er
we
triage
and
you
know,
as
of
now,
we
take
critically
ill
first,
if
we
can
save
them,
I
mean
those
are
typical,
typical
rules
of
triage.
If
you
can
save
somebody,
you
take
them
first,
I
mean,
as
we
become
more
and
more
overwhelmed,
do
we
consider
taking
those
patients
who
have
chosen
to
be
vaccinated
and
triage
them
over
those
who
have
made
the
choice?
Not
to
that's
my
question.
It's
a
real
ethical
question.
A
Yeah
I'll
tell
you
I'm
a
primary
care,
doc
who's
done
a
lot
of
hospital
work.
I
don't
ever
look
at
a
patient
and
say:
did
you
do
what
I
asked
you
to
do
before
before
I
offer
you
treatment
or
I'm
going
to
put
you
as
a
second
class
person
behind
someone
else.
I
don't
know
of
any
health
care
provider
how
the
kha
wants
to
respond
to
that.
As
a
doctor.
For
me,
that's
unethical
to
start
saying:
did
you
do
what
I
tell
you
to
do
beforehand
or
not?
A
Did
you
do
what
I
recommended
or
not
as
doctors,
we
get
people
you
know
in
medicine,
I
give
advice
all
the
time.
People
choose
not
to
follow
the
advice
and
if
they
don't
said
well,
if
you
had
listened
to
what
I
had
you're
going
to
have
to
wait
in
line
behind
someone
else,
we
take
people
as
they
come
in
so
as
they
come
in
and
need
urgency,
we
triage
that's
up
to
the
provider
who's.
Seeing
those
folks,
I
don't
do.
A
I
don't
think
we
make
decisions
on
whether
or
not
they
get
health
care
first
based
on
their
decisions
in
the
past.
That's
my
approach,
that's
kind
of
an
unethical
thing
to
do.
I
don't
know
how
the
kh
would
like
to
approach,
but
I
would
think
that
every
provider
individual
would
make
that
decision.
I
don't
think
we
do
that
as
a
system
yeah.
N
N
Of
that,
of
course,
you
know
and
the
hospitals
are
cooperating.
If,
if
hospitals
are
you
know
out
of
ventilators
or
whatever,
you
know
we're
working
together
to
move
the
patient
to
a
facility,
you
know
that
does
have
adequate
space.
So
I
don't
think
we're
at
the
point
where
we're
having
to
prioritize
who's,
getting
care
we're
working
together
to
make
sure
people
can
get
to
to
care,
and
if
one
hospital
is
full
well,
who
has
an
open
bed,
and
where
can
we
transfer
that
patient.
R
Thank
you
very
much.
I
am
I
I
honestly
and
dr
alvarado.
I
agree
with
you
wholeheartedly.
I
think
the
ethics
of
prioritizing
patients
based
on
their
past
behavior
is
is
wrong.
I
mean
I
don't
ask,
I
don't
care,
I
don't
want
to
know,
but
if
we
get
to
the
point
honestly
where
our
health
care
system
is
so
overrun
that
we
don't
have
capacity,
when
do
we
start
thinking
about
those
decisions,
I.
A
Don't
think
we
can
do
that
unless
we
violate
our
own
ethics
as
providers
as
physicians.
We
can't
I
mean
that's,
that's
not
that
we
don't
you
know.
I
don't
think
we
can
do
that.
Thank
you
all
very
much.
I
appreciate
it
we're
out
of
time.
I
know
there's
another
group
waiting
for
this
room,
so
thank
you
all
for
your
presentation,
we'll
be
having
lots
more
discussions
here
in
the
next
few
weeks
really
quickly.
We
have
a
lots
of
referred
administrative
regulations
for
the
committee.
Hopefully
you've
all
had
a
chance
to
review
these.
A
A
D
Yes,
I
will
thank
you,
sir.
My
name
is
todd
trapp,
I'm
the
assistant
director
of
the
division
of
family
support,
I'm.
I
appreciate
y'all
letting
me
talk
to
you
today
about
community
services
bart
grant
the
cabinet
for
health
and
family
services
department
for
community-based
services
is
a
state
agency
designated
by
the
governor
to
administer
a
community
services
block
grant
otherwise
known
as
csbg
in
the
commonwealth
of
kentucky,
the
u.s
department
for
health
and
human
services
office
of
community
services
provides
the
federal
block
grant
funds.
D
D
D
D
A
A
Seeing
done
you
have
a
motion
to
accept,
is
there
a
second?
You
have
a
second
all,
those
in
favor,
please
signify
by
saying
aye
aye.
Anyone
approved
very
good.
The
black
crime
has
been
approved.
Thank
you
very
much.
Thank
you
all
for
your
patience.
It
was
a
very
lengthy
meeting.
Our
next
ijc
meeting
will
be
on
wednesday
september,
the
22nd
at
1
pm
in
our
usual
location.