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From YouTube: Senate Standing Committee on Health Services (2-8-23)
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A
Group
is
technically
our
first
meeting
of
the
2023
session,
even
though
we
have
met
two
times
previously
in
a
concert
with
a
house,
but
today
we
have
several
reports
we're
going
to
hear.
We
will
not
be
acting
on
any
legislation
but
very
pleased
to
have
any
everyone
here.
But
with
that,
let's
do
the
the
roll
call.
Please
Becky.
C
A
A
A
Anyone
else,
if
not,
let's
proceed
with
our
first
report
again,
our
intent
today
is
just
kind
of
bring
us
up
to
speed
on
some
things
that
we're
going
to
be
working
on
no
action
on
bills.
Today,
with
that
first
reported
on
maternal
mental
health
and
I
believe
we
have
Dr
Jeffrey,
Goldberg
and
Abby
Piper
here
for
the
presentation.
D
Good
morning,
I
thank
you
chairman
Meredith
I'm,
Dr,
Jeff
Goldberg
I'm.
Here
today,
on
behalf
of
the
Kentucky
section
of
the
American
College
of
Obstetricians
and
gynecologists,
we
represent
OB
gyns
throughout
the
state,
as
we
try
and
Advance
maternal
Health
Care
with
me
today
is
Abby
Piper
from
Piper
Smith,
our
law
being
firm.
They
help
us
Advocate
I
want
to
thank
you
for
the
opportunity
to
give
an
update
on
maternal
morbidity
and
mortality
and
some
of
the
work
that's
been
going
on.
D
Since
we
last
testified
before
the
committee
and
I'll
give
you
the
spoiler
right
up
front,
we're
going
to
be
talking
a
lot
today
about
maternal
mental
health
and
how
it
it's
it's
impacting
maternal
mortality
in
the
state
of
Kentucky.
This
is
something
that
is
really
the
the
overriding
focus
of
what
we
do:
In
Obstetrics
and
Gynecology
a
lot
of
people
think
of
a
visit
to
an
OB
GYN
as
I'm
checking
to
make
sure
the
baby's
okay-
and
some
of
that
is
true,
but
we're
really
we're
focused
on
how
do
we
keep
moms
healthy?
D
Because
if
you
want
a
healthy
baby,
you've
got
to
have
a
healthy
mom.
Unfortunately,
we've
made
tremendous
strides
over
the
last
century
if
I
can
have
the
next
slide.
Some
of
you
have
seen
this
slide
before.
If
you
go
back
a
little
over
100
years,
say
to
when
my
grandmother
was
born
in
1908,
your
chances
of
dying
from
a
pregnancy-related
complication
was
almost
one
in
a
hundred
pretty
much
everybody
knew
of
somebody
who
had
died
from
pregnancy
or
somebody
would
lost
their
mother
in
childbirth
and
fortunately,
with
modern
obstetrical
care.
D
We've
seen
dramatic
reductions
in
those
maternal
mortality
rates
over
the
last
hundred
years.
The
Advent
of
things
like
blood,
Banking
and
antibiotics
and
improved
surgical
techniques
led
the
dramatic
drops
in
the
40s
and
50s
and
by
the
time
I
went
to
medical
school
in
the
1980s.
Maternal
mortality
was
exceedingly
rare.
There
were
some
states
that
would
go
a
whole
year
without
a
single
maternal
death.
So
why
are
we
still
having
this
conversation?
Well,
unfortunately,
over
the
last
30
years
and
in
the
next
slide,
the
maternal
mortality
rate
has
been
going
back
up.
D
Now,
it's
still
nothing
like
what
it
was
when
my
grandmother
was
born,
but
we're
seeing
consistent
Rises
over
the
last
30
years.
In
spite
of
the
advances
that
we've
seen
in
medical
science,
and
in
spite
of
the
fact
that
in
the
U.S
we
spend
more
money
per
person
on
health
care
than
any
other
country,
and
unfortunately
we
are.
We
now
have
the
worst
maternal
mortality
rate
of
any
of
our
peer
developed
countries.
In
fact
we're
55th.
D
D
So
the
the
number
one
question
I
would
get
when
I
showed
people
those
slides
is.
Why
is
this
happening
and
five
years
ago?
My
answer
was
always
the
same.
We
don't
know-
and
the
reason
we
didn't
know
is
nobody
was
collecting
data
on
these
maternal
deaths,
why
they
were
happening.
What
what
could
potentially
prevent
it?
The
other
question
I
would
often
get
is,
even
though
the
rate's
going
up.
Fortunately,
maternal
deaths
are
still
relatively
rare,
so
why
are
we
focusing
on
maternal
mortality?
D
Aren't
there
other
things
we
should
be
working
on,
and
the
answer
is
because
maternal
mortality
represents
the
tip
of
the
iceberg.
It
tells
us
where
we
should
be
focusing
our
efforts
to
improve
health.
Our
best
estimate
is
that
for
every
death,
from
a
specific
condition-
they're-
probably
in
the
neighborhood
of
maybe
70
other
patients
who
had
the
same
condition
had
severe
morbidity,
fortunately
didn't
die
from
it
but
might
have,
and
even
though
it
didn't
turn
out
to
be
fatal.
D
They're
often
left
with
ongoing
severe
Health
consequences.
It
impacts
their
ability
to
take
care
of
their
infant
and
other
children.
Other
members
of
the
family
impacts
their
ability
to
work
significant
financial
toxicity.
So
when
we
talk
about
reducing
maternal
mortality,
yes
we're
talking
about
preventing
maternal
deaths
and
that's
that's
critical,
but
we're
also
really
looking
at
how
do
we
reduce
a
significant
amount
of
morbidity
morbidity
in
the
process
of
doing
so?
D
So
how
do
we
get
started
with
this?
Well,
first
of
all,
you
have
to
know
what
you're
dealing
with
if
I,
don't
know
what
the
nature
of
the
problem
is.
I
can't
come
up
with
solutions
for
it,
so
an
initial
step
is
to
form
a
maternal
mortality,
Review,
Committee
and
I'm-
mentioning
this
specifically
today,
because
I
want
to
thank
the
legislature
for
making
this
happen.
Five
years
ago,
House
Bill
167
was
passed
by
the
legislature,
enabling
the
department
for
public
health
to
create
a
maternal
mortality.
D
D
Why
is
an
mmrc
so
critical
again,
we
can't
manage
what
we're
not
measuring.
If
I
don't
know
what
we
need
to
be
dealing
with.
I
can't
change
the
nature
of
that
curve.
I
showed
you.
The
good
news
is
that
we've
demonstrated
that,
if
you
can
figure
out
what's
going
on,
you
can
in
fact
reverse
the
trend.
The
next
Slide.
D
The
best
example
of
that
in
this
country
has
been
what's
been
done
out
in
California
about
15
years
ago,
California
looked
at
the
rising
maternal
mortality
rate
said
this
is
unacceptable,
formed
in
maternal
mortality,
Review
Committee.
They
found
that
obstetrical
Hemorrhage
was
by
far
the
leading
cause
of
excess
mortality,
women
who
were
bleeding
to
death
from
delivery
or
complications
from
pregnancy.
This
wasn't
because
we
didn't
know
how
to
prevent
it
from
happening.
In
fact,
the
Medical
Science
and
the
tools
that
we
have
to
stop
leading
the
new
surgical
techniques
are
better
than
ever.
D
The
real
problem
is
that
those
techniques
weren't
being
applied
consistently
for
all
women
in
all
institutions
in
California
100
percent
of
the
time,
so
California
developed
a
checklist.
If
you
will
a
protocol
for
how
to
manage
obstetrical
Hemorrhage
both
prevention
and
management,
they
distributed
that
protocol
throughout
the
state
and,
most
importantly,
they
formed
a
support
network
involving
every
institution
in
California,
involving
obstetrical
care
and
through
those
efforts
and
the
implementation
of
those
guidelines.
They
were
not
able
to
reverse
the
increase.
D
They
actually
got
their
maternal
mortality
rate
down
to
less
than
half
of
what
we're
seeing
in
the
rest
of
the
U.S.
So
we
know
that
this
can
be
done.
Why
don't
we
just
take
what
California
did
and
apply
it
to
Kentucky?
Well,
at
the
risk
of
stating
the
obvious,
we're
not
California,
it's
very
important
that
we
be
able
to
examine
maternal
deaths
in
Kentucky,
because,
not
surprisingly,
the
nature
of
those
those
deaths
are
very
very
different
than
what
they
had
in
California.
D
D
First
of
all,
it's
important
to
note
what
wasn't
found
by
the
committee.
The
committee
was
not
finding
a
lot
of
maternal
deaths
from
obstetrical,
Hemorrhage
or
preeclampsia
or
infection,
or
any
of
the
other
conditions
that
historically
have
been
a
major
cause
of
maternal
mortality.
I
would
speculate
that
that's
probably
because
Kentucky
has
absorbed
the
Lessons
Learned
in
States,
like
California.
The
Paradigm
that's
been
put
forth
by
California
is
in
routine
use
today
around
the
state,
so
we've
tackled
a
lot
of
what
historically
have
been
major
problems.
D
What
has
been
found
is
that
maternal
mental
health
is
playing
a
major
role
in
maternal
mortality
in
Kentucky.
Again,
this
work
is
preliminary,
there's
still
a
lot
of
data
yet
to
be
analyzed,
but
there
are
some
things
that
are
important
to
share
here
today.
First
of
all,
the
committee
has
found
that
at
least
eight
and
a
half
percent
of
maternal
deaths
are
due
to
suicide,
I
say
at
least
eight
and
a
half
percent,
because
Kentucky
has
very
strict
criteria
for
what
what
qualifies
as
a
suicide
to
be
listed
on
a
death
certificate.
D
It
is
very
likely
that
many
deaths
that
were
listed
as
accidental,
particularly
those
involving
substance,
use,
probably
had
a
component
of
self-harm,
but
that's
very
difficult
to
analyze.
So
I
don't
know
if
the
real
number
should
be
10
or
15
percent
or
what
it
actually
is,
but
it's
clearly
very
significant
and
just
to
underscore
that
if
you
evaluate
the
population
of
Medicaid
patients,
who've
given
delivery
and
look
at
those
who've
required
readmission
to
the
hospital
in
the
first
three
months
after
delivery.
Historically,
we've
seen
readmissions
for
infection
or
late
onset,
preeclampsia
or
sometimes
heart
failure.
D
D
Another
Finding
from
the
committee
to
no
one's
surprise
is
that
we're
seeing
a
great
deal
of
substance
abuse
disorder,
which
again
is
a
mental
health
issue.
They
found
that
substance
use
disorder
was
a
contributing
factor
in
at
least
half
of
all
maternal
deaths.
In
fact,
it
was
possibly
a
contributing
factor
in
as
many
as
two-thirds
of
maternal
deaths,
and
this
is
mirroring
what
we're
seeing
in
the
non-pregnant
population.
D
One
of
the
assessments
done
by
the
committee
in
reviewing
cases
is
looking
to
see
if
the
death
was
potentially
preventable.
There
are
certain
conditions
in
pregnancy
that,
unfortunately,
Medical
Science
does
not
yet
know
how
to
consistently
prevent
or
effectively
treat
they're
rare,
but
they
do
happen.
So
we
probably
can't
get
to
the
point
with
today's
technology,
where
our
death
rate's
going
to
be
zero,
but
on
reviewing
these
cases,
the
mmrc
found
that
90
percent
of
the
maternal
deaths
that
they
evaluated
were
potentially
preventable.
D
D
So
now
that
we
have
this
data
coming
in,
what's
being
done.
Fortunately,
we
have
some
folks
in
the
department
for
public
health
that
are
very
dedicated
very
much.
On
top
of
this,
they
oversee
the
activities
of
the
mmrc
they're
responsible
for
taking
this
information
and
coming
up
with
action
plans
in
the
interest
of
time,
I'm
not
going
to
go
through
everything
that
they're
doing
about
this
I
would
refer
you
to
the
chfs
website.
D
Pqcs
are
Cooperative
groups
that
are
found
throughout
the
country.
They
are
formed
with
multiple
stakeholders
who
work
to
improve
maternal
and
neonatal
care,
and
it
concludes
Health
Providers
at
all
levels.
It
includes
Health
Care
institutions
that
provide
obstetrical
care.
It
includes
insurers.
It
includes
professional
societies
like
ACOG
National
societies
like
the
March
of
Dimes,
although
it's
a
national
program,
that's
overseen
by
the
CDC,
it's
done
at
the
state
level,
so
each
state
has
to
set
up
its
own
pqc
and
we've
had
one
since
October
2019.
D
I
would
encourage
you
to
take
a
look
at
the
work
that
they've
been
doing,
particularly
around
maternal
mental
health,
including
substance
abuse.
Their
website
is
kentuckypqc.org
again
I'm
not
going
to
go
through
all
the
details,
but
I
would
encourage
you
to
take
a
look
at
that.
It's
a
very
robust
program.
They
have
Zoom
web
conferences
every
other
month
on
these
topics.
There's
a
conference
call
every
other
week
assisting
institutions
and
implementing
recommendations.
So
it's
been
very
active.
The
next
slide.
D
Now,
when
you
see
this
data
again,
I
think
some
of
it
is
very
compelling
that
we
need
to
do
something.
We
need
to
do
something
quickly,
but
it's
important
that
we
step
back
and
and
be
careful
about
what
exactly
we
we
do
number
one.
We
need
to
make
sure
that
any
efforts
we're
undertaking
is
something
that's
directed
by
an
analysis
of
the
data,
there's
only
so
much
bandwidth
for
interventions.
D
We
want
to
make
sure
that
everything
that
we're
doing
is
evidence-based,
meaning
that
there's
clinical
studies
that
demonstrate
that
it's
actually
effective,
there's
often
a
temptation
to
implement
ideas
that
sound
good
and,
unfortunately,
the
history
of
medicine
is
replete
with
ideas
that
sounded
good,
but
then,
when
rigorously
tested
turned
out
not
to
be
effective
or
in
some
cases,
even
harmful.
The
other
thing
that
we
want
to
avoid
doing
is
trying
to
throw
rules
at
the
problem.
D
It's
very
often
that
we'll
look
at
something
and
realize
that
problems
are
occurring
because
people
aren't
doing
something
they're
supposed
to
or
they
are
doing
something
they're
not
supposed
to,
and
we
create
a
rule
that
says:
don't
do
that
and
then
we
say:
okay,
we're
done
and
unfortunately
that
doesn't
really
solve
the
problem.
There
are
Exceptions.
There
are
some
rules
that
are
truly
impactful,
for
example,
the
law
that
says
you
have
to
wear
a
seat
belt
when
you're
driving
a
car
has
saved
a
lot
of
lives,
but
that's
really
the
exception.
D
What
we
really
want
to
focus
on
is
not
making
more
rules
but
improving
the
system
in
which
we
deliver
care.
The
ideas
as
I
give
a
lot
of
these
talks.
I
tell
people
we're
not
trying
to
get
people
to
follow
the
rules,
we're
trying
to
get
people
to
want
to
follow
the
rules
and
that's
a
complex
Endeavor,
but
that's
the
only
way
that
you
can
move
the
needle
one
of
the
programs
that
the
Kentucky
pqc
has
at
its
disposal
as
we're.
D
Trying
to
improve
these
numbers
comes
from
an
organization
called
The
Alliance
for
Innovation
on
maternal
health
or
aim
aim
is
a
National
Organization
that
was
formed
by
ACOG
and
has
22
partners.
It's
a
national
level
program
to
reduce
maternal
morbidity
and
mortality.
But
even
though
it's
a
nationwide
program,
it's
implemented
at
the
state
level,
every
state
has
to
apply
to
participate
in
the
aim
program.
There
are
certain
requirements
for
just
for
participation,
including
having
an
mmrc
and
having
a
pqc,
and
now
that
Kentucky
has
those
things
we
are
now
in
AIM,
State
and
again.
D
D
One
of
the
many
tools
that
aim
puts
at
our
disposal
is
what
are
called
patient
safety
bundles
again,
there's
there's
no
lack
of
science
as
to
how
to
deal
with
very
various
problems
like
preventing
death
from
Hemorrhage
or
a
death
from
infection.
The
difficulty
has
been:
how
do
we
get
institutions
to
apply
all
of
these
effective
things
with
every
patient
in
every
location,
one
hundred
percent
of
the
time?
D
That's
where
the
gaps
are
and
that's
why
we're
seeing
the
maternal
mortality
that
I've
showed
you
one
of
the
analogies
I
use
is,
if
you
imagine,
a
landing
checklist
for
an
airplane.
It's
not!
Okay.
If
you
just
do
most
of
the
things
on
the
checklist,
you
don't
get
points
for
doing
some
of
it.
If
you
don't
do
everything
on
the
checklist,
but
every
airplane,
every
flight
you're
going
to
see
airplanes
crashing
it's
the
same
in
health
care.
D
We
need
to
make
sure
that
everybody
gets
exactly
what
they're
supposed
to
be
getting
a
hundred
percent
of
the
time.
So
aim
has
developed
what
we
call
safety
bundles.
This
is
groups
of
care
plans
that
are
appropriate
for
every
patient
for
various
conditions.
The
first
ones
that
were
developed
for
were
for
some
of
the
historically
more
common
problems
like
Hemorrhage
or
infection,
or
dealing
with
preeclampsia.
Again,
those
are
not
things
that
we're
seeing
as
much
of
a
problem
with
in
Kentucky.
D
Fortunately,
we
have
newer
aim,
bundles
that
you
see
at
the
bottom
of
the
screen,
including
perinatal
mental
health
and
substance
use
disorder,
and
that
last
one
is
going
to
be
the
primary
focus
of
Kentucky's
pqc
as
we
move
forward
again.
If
you
want
to
see
some
of
the
details
of
what
goes
into
these
bundles
I,
encourage
you
to
check
out
the
saferbirth.org
website
the
nice
thing
about
having
these
bundles
available
is
we
don't
have
to
reinvent
the
wheel,
the
science?
D
What
needs
to
be
done
has
already
been
established,
the
materials
that
you
need
to
do
it
are
available
to
us
the
action
plan,
for
how
do
you
get
this
consistently
implemented
through
all
the
institutions
throughout
your
state?
How
do
you
work
through
your
pqc
to
make
sure
that
these
things
are
happening?
That
roadmap
has
already
been
developed,
so
the
folks
at
the
department
for
public
health
don't
have
to
redo
that
work.
D
They
just
have
to
take
it
and
run
with
it
through
our
pqc
I
threw
this
poster
up
there,
just
as
an
example
of
some
of
the
many
materials
that
are
available.
This
is
a
poster.
That's
designed
for
health
care
providers
who
are
not
Obstetricians.
This
might
go
up,
for
example,
in
a
in
a
triage
room
or
an
ER
or
a
Family
Practice
Clinic,
and
it's
a
reminder
checklist.
D
If
you
will
of
some
of
the
warning
signs
to
check
for
problems
related
to
pregnancy
or
or
postpartum,
that
could
potentially
be
fatal
things
that
we
don't
want
to
miss
and
included
on
that
list
are
symptoms
of
postpartum
depression.
So
there
are
many
many
materials
like
this
available
and
are
being
pushed
out
by
the
department
for
Public
Health.
D
So
what
can
you
do
to
help?
Well,
first
of
all,
you've
already
done
a
lot
of
it.
Just
creating
the
mmrc
has
been
a
very
critical
step.
None
of
the
work
that's
going
on
now
could
be
happening
without
that
data
from
the
mmrc
and
it's
going
to
continue
to
yield
significant
data
going
forward
so
again
for
those
of
you
that
were
involved
in
that
effort.
I
can't
thank
you
enough.
D
Just
having
this
hearing
today
and
addressing
this
problem
and
raising
awareness
is
also
a
major
step.
I
would
note
that
what
we're
doing
now
is
happening
on
a
voluntary
basis,
we're
very
fortunate
that
we
have
Personnel
in
the
department
for
public
health
who
are
doing
a
phenomenal
job
of
instituting
these
programs
they're
very
dedicated
people,
they're,
very
talented,
but
they're
not
doing
it
because
they're
fulfilling
a
statutory
requirement,
they're
doing
it,
because
it's
the
right
thing
to
do,
but
our
state's
participation
in
the
aim
program
is
voluntary.
D
D
Participation
in
these
programs
should
be
mandatory,
not
voluntary,
and
we
need
to
make
sure
that
we're
giving
the
department
for
public
health,
the
resources
and
the
support
that
they
need
to
carry
out
these
programs.
So
with
that
I'll
stop
and
take
any
questions.
I
want
to.
Thank
you
again
for
your
time
this
morning,
I
have
to
answer
any
questions.
A
Thank
you
doctor
and
for
the
first
comment
I
would
have
my
question.
Would
comment
is
I
just
want
to
commend?
You
you're
become
a
committee
rock
star
because
you
kept
this
to
20
minutes
like
I
asked
you
to.
A
F
I
do
have
a
question,
sir.
Thank
you
very
much
and
thank
you
for
a
very
interesting
presentation.
Have
we
looked
at
maternal
mortality
through?
Have
we
broken
it
down
to
see
if
we
have
what
the
degree
of
racial
disparity
in
this
state
is.
D
Not
through
me,
the
department
for
public
health
has
that
information,
but
they're
also,
you
know,
they're
very
careful
about
making
sure
that
they
they're
releasing
accurate
data.
So
it's
definitely
being
looked
at.
There's
a
strong
focus
on
social
determinants
of
Health,
including
income
levels,
racial
disparities
and
so
forth.
So
absolutely
that
data
is
being
looked
at,
but
again
I
want
to
emphasize
we're
very
early
on
in
this
process.
Although
five
years
might
seem
like
a
lot
of
time,
it
takes
a
certain
amount
of
time
to
assemble
that
committee.
C
One
of
my
constituents
is
here
today,
Meredith
strayhorn,
and-
and
thank
you
for
being
here
what
I
wanted
to
ask
you
Dr
Goldberg,
when
you
suggested
that
improving
the
system
of
care
there
was
a
house
bill,
filed
the
first
of
this
year
by
our
majority
caucus
with
Jason
nemes,
and
then
I
filed
a
companion
bill
to
that
yesterday
on
expanding
birthing,
centers
and
I
see
that
as
a
yes
and
that,
yes,
we
have
wonderful
Hospital
opportunity
with
great
outcomes,
but
we
also
could
see
great
outcomes
and
have
seen
throughout
the
nation
in
birthing
Centers.
D
Absolutely
basically,
every
facility
or
program
that
is
involved
in
providing
health
care
for
pregnant
women
needs
to
be
part
of
this
process.
If
you
look
at
Who's
involved
in
the
pqc,
it's
Healthcare
professionals
at
all
levels,
institutions
at
all
levels,
again:
insurers,
National
organizations
and
including
both
professional
midwives
and
certified
nurse
midwives.
Everybody
has
to
be
at
the
table.
Birthing
centers
are
a
component
of
obstetrical
care
in
the
United
States.
D
They
are
an
option
for
where
to
give
birth
and
they
absolutely
need
to
be
part
of
the
process
of
making
sure
that
we
are
bringing
all
the
tools
necessary
to
help
prevent
morbidity
and
mortality.
So
if
Kentucky
does
have
a
new
birthing
center,
they
will
absolutely
be
invited
to
be
part
of
the
pqc
and-
and
we
hope
will
be
a
big
component
of
these
efforts.
C
I'm,
the
sixth
of
12,
my
mom,
is
the
third
of
17.
and
I'm,
a
mom
of
six
and
and
a
Nana
of
five,
so
I
did
get
to
see
the
nurse
midwives
in
practice
on
the
fourth
of
our
grandchildren
born
only
a
year
and
a
half
ago,
so
very
excited
for
this
holistic
approach
and
the
perinatial
quality
collaborative
great
work.
Thank
you.
A
G
Dr
Goldberg
I,
don't
know
if
I
have
a
question
in
this
or
not,
but
but
I,
certainly
in
taking
a
look
at
at
the
data
and
the
information
that
you
presented,
I
just
kind
of
want.
To
sum
this
up,
at
least
for
me,
we're
seeing
increased
maternal
mental
health
issues
and,
and
we
go
on
and
talk,
ask
the
if
the
legislature
will
support
this
and
obviously
that
that
is
what
our
people
elect
us
for
is
to
serve
serve
our
constituents.
G
But
I
want
to
dive
a
little
bit
deeper
into
this,
and
you
know
we
talk
about
8.5
percent.
The
mortality
can
be
related
to
Suicide.
Then
we
go
on
to
talk
about
how
two-thirds
of
those
deaths
or
two-thirds
of
the
deaths
related
to
maternal
Mental
Health
are
are
actually
associated
with
substance
abuse
disorder
and
for
me,
as
a
physician
as
well.
That
takes
me
to
a
different
area,
because
one
of
the
comments
I
I've
often
made
is
that
mentally
mentally
healthy
people
make
poor
decisions
and
substance
abuse
disorder.
G
The
entrance
into
the
substance,
abuse
disorder
I,
don't
want
to
equate
poor
mental
health
with
the
entry
or
the
pathway
into
substance,
abuse,
disorder
and
and
I
I
think
sometimes
in
our
society.
We
do
that
and
I
don't
I,
don't
want
to
do
that.
I
know
there
are
some
people
who
do
who
who
enter
through
that
portal,
but
I
also
don't
want
to
make
excuses
for
people
who
make
poor
decisions
and
I
know
this
won't
play
very
well.
But
that's
not
what
I
got?
G
That's
not
why
I
got
elected
I,
don't
want
us
to
miss
the
boat
and
and
hold
our
our
providers
and
our
healthcare
system
responsible
for
some
of
the
poor
decisions
that
people
make.
We
can
do
what
we
can
do
on
our
side
as
a
provider
or
the
people
who
run
mental
who
who
run
Health
institutions
to
help
people,
but
somehow
we've
got
to
really
address
the
continual
poor
decisions
and
and
the
poor
environments
that
people
find
themselves
in
without
a
very
good
support
system
and
I.
G
G
We
hold
another
system
accountable,
but
another
system
is
responsible,
so
I
I
guess
I
would
quickly
I,
just
I
just
quickly
want
to
make
that
make
that
distinction
so
that
we
can
adequately
attack
this
problem,
because,
as
long
as
we
hold
our
Health
Care
system
responsible
for
decisions
that
that
we
have
no
control
for
for
decisions
that
other
people
make
for
which
we
have
no
control
over
we're
not
going
to
get
a
handle
on
this
it
we
can
spend
all
the
money
we
want
to
spend,
but
we
just
won't
get
a
handle
on
it
and
I
guess.
E
D
Just
so,
everybody
knows
I'm,
actually,
a
cancer
specialist
I'm,
a
gynecologic
oncologist
I'm,
not
an
expert
in
substance,
use
disorder,
but
there's
no
question
a
big
chunk
of
our
time
is:
is
spent
convincing
people
to
take
the
treatments,
that's
best
for
them
and
that's
really
the
art
of
medicine.
There's
the
science
I
can
tell
you
what
the
best
treatment
is
for
your
cancer,
but
convincing
you
to
take.
D
It
is
another
story
or
helping
you
to
make
decisions
when
their
choices
to
be
made,
so
unfortunately
I,
don't
think
Dr
Senator
Meredith
is
going
to
allow
us
the
time
to
have
that
conversation.
But
but
yes,
you
do
raise
an
interesting
point,
which
is
we
follow
the
data
we're
looking
at
what
what
are
the
causes
of
maternal
mortality
in
Kentucky?
Which
of
those
causes
are
preventable
which
again
90
percent
of
the
time
it
is,
and
then
we
start
asking
how
do
we
do
that?
D
There
is
a
component
of
what
was
the
etiology
of
it
because
yes,
we'd
rather
prevent
a
problem
in
the
first
place
than
have
to
manage
it
once
it
occurs,
but
either
way
we
can't
ignore
the
fact
that
there's
a
large
number
of
deaths
that
are
due
to
mental
health
conditions,
whether
it's
depression,
pre-existing,
depression,
postpartum,
depression,
substance,
use
disorder.
All
of
these
things
are
are
potentially
preventable
deaths.
H
And
Senator
Douglas,
if
I
may
you
know,
obviously
we
want
healthy,
mommies,
healthy
babies,
and
so
you
know
any
of
those
layers
that
kind
of
overlap
into
that
work.
We'd
be
happy
to
talk
more
about.
A
Certainly
a
great
presentation
today-
and
this
is
not
the
only
time
we'll
be
having
this
dialogue
with
you
through
the
session
and
probably
over
the
next
two
or
three
years-
probably
everything
you
said
today.
What
impressed
me
the
most
was
the
fact
that
ninety
percent
of
these
deaths
are
preventable,
and
that
certainly
is
a
challenge
for
us.
So
appreciate
your
presentation
today.
Look
forward
to
our
continued
Dialogue
on
this
and
I'm
sure
committee
members.
Will
we
be
talking
about
this
in
more
detail
so
again
appreciate
you
being
here.
Thank
you.
Thank.
H
A
Can
move
on
our
Medicaid
annual
report
is
the
next
presentation
we
have
and
we
have
commissioner
Lisa
Lee,
another
committee
rock
star.
A
The
reason
we
asked
commissioner
Lee
to
be
here
today,
she's
going
to
present
a
Medicaid
entry
report,
which
is
a
new
report
for
us
and
just
reminded
the
Committees
that
before
we
reconstituted
this
committee
to
become
Health
Services,
we
had
a
separate
statutory
committee,
Medicaid
oversight,
which
would
hear
those
reports
and
take
appropriate
action
when
we
could
so
now.
This
has
been
incorporated
into
our
responsibility.
A
So
since
this
is
a
new
report
which
you
will
be
receiving,
and
hopefully
our
annual
basis
in
the
future,
I
want
to
conventionally
to
kind
of
give
you
an
overview
of
this
and
talk
about
what
we
can
expect
in
future.
So,
commissioner,
leafy,
would
identify
yourself
for
the
record
and
please
proceed
good.
I
Morning,
I
am
Lisa
Lee
I'm,
the
commissioner
for
the
Kentucky
Department
for
Medicaid
services,
I'm
very
happy
to
be
here
to
talk
about
the
Medicaid
annual
report.
The
Medicaid
annual
report
is
not
a
unique
idea.
Many
state
agencies
have
Medicaid
annual
reports
that
they
present
each
year.
They
even
have
websites
that
they
post
those
reports
on.
So
what
we
did
in
the
department
is,
we
went
out
and
looked
at
several
of
those
reports
to
try
to
see
what.
How
could
we
develop
a
Medicaid
annual
report
for
Kentucky?
What
information
would
be
useful?
I
So
this
is
the
very
first
comprehensive
report,
but
most
of
the
data
in
this
report
is
available
in
other
places.
We've
just
compiled
it
in
one
area
to
try
to
give
individuals
just
a
big
broad
overview
of
what's
going
on
in
the
Medicaid
Program.
We
have
created
it
to
share
information.
We
want
this
first
annual
report,
which
is
2020
it's
a
little
dated,
but
it
did
take
us
a
while
to
pull
the
information
together,
but
the
good
news
is
now
that
we
have
this
first
annual
report.
I
I
The
table
of
contents
tells
you
pretty
much
everything.
That's
in
the
report.
We
did
have
to
do
some
technical
notes.
We
found
this
I
think
in
Louisiana's
annual
report,
because
the
Medicaid
Program
is
so
complex.
We
have
to
have
some
information
in
there
so
that
individuals
know
kind
of
what
they're
looking
at
so,
for
example,
if
you
pull
information
based
on
a
paid
date
of
service
versus
the
date,
the
service
was
actually
actually
delivered,
you're
going
to
get
two
different
reports,
so
some
of
that
information
is
in
the
technical
notes.
I
The
background
information
just
gives
you
a
historical
overview
of
the
Medicaid
Program.
In
general,
we
have
an
agency
overview
of
the
department
and
where
it
stands
within
the
Cabinet
for
Health
and
Family
Services,
we
have
a
listing
of
all
of
our
technical
advisory
groups.
We
have
about
22
technical
advisory
groups.
That
report
and
work
with
the
department
for
Medicaid
services
and
they
report
up
to
a
Medicaid
advisory
Council.
I
This
is
a
little
bit
unique
for
Kentucky.
Typically
State
agencies,
State
Medicaid
agencies
have
a
Medicaid
advisory
Council
and
they
have
a
variety
of
Representatives
on
that
Council,
including
legislators
in
Kentucky's.
Howard
works
just
a
little
bit
differently
with
those
22
advisory
groups.
We
also
talk
a
little
bit
about
the
Public
Health
Emergency
due
to
covet,
because
when
we
started
the
report
in
2020,
we
had
to
incorporate
some
of
that
information
in
there.
I
We
have
the
2020
year
in
review
just
talking
about
how
many
individuals
were
enrolled
in
the
program
where
they
were
at
and
just
we
have
some
programmatic
changes
policy
changes
that
we
implemented
in
2020.
So
as
we
go
forward
in
2021
and
22
you'll
see
other
policy
changes
that
we
made,
such
as
Senate
bill
50
with
the
single
Pharmacy
benefit
manager
and
some
of
the
impacts
that
had
on
the
program.
We
have
a
breakdown
of
Eligibility
by
County.
We
also
have
a
five-year
county-wide
change
in
eligibility.
I
That
is
very
telling
we
talk
a
little
bit
about
our
Medicaid
providers
and
if
you
look
at
the
report,
you'll
see,
for
example,
we
have
listed
886
Hospitals
now
we
know
we
don't
have
886
hospitals
in
Kentucky,
but
we
do
count
out
of
state
providers.
So
a
lot
of
our
surrounding
states.
We
have
hospitals.
I
We
show
outline
a
little
bit
of
the
services
that
we
provided.
Some
of
the
top
diagnosis
codes
and
top
procedure
codes.
We
break
this
out
by
fee
for
service,
which
mainly
includes
individuals
who
are
in
home
and
community-based
waivers
or
in
long-term
care
facilities.
We
also
have
a
breakout
of
Managed
Care
Organization
Services,
because
Managed
Care
organizations
serve
about
90
percent
of
the
Medicaid
population
in
Kentucky
we
have
some
key
prescription
statistics
in
the
report.
I
A
little
overview
of
the
finance,
including
state
budget
and
federal
dollars
that
come
into
the
program
and
of
course
it
wouldn't
be
state
government
without
an
acronym.
So
we
do
have
a
very
comprehensive
acronym
list
in
the
back
of
the
report
and
then
the
five-year
County
enrollment
changes
that
I
spoke
about
earlier,
and
then
we
also
have
a
list
of
the
top
providers
who
are
delivering
services
to
the
Medicaid
members
in
Kentucky.
I
Some
of
the
notable
content
is
the
enrollment
by
County,
with
an
outline
of
percentage
of
who
receives
services
and
the
total
dollar
amount
paid
per
County.
So
you
can
look
at
this
report
and
see
in
a
county
how
many
individuals
were
enrolled
in
Medicaid
in
that
county
and
of
those
individuals
who
actually
received
a
Medicaid
service
that
was
paid
for
during
that
reporting
year.
We
have
the
five-year
enrollment
Trend
by
County,
so
you
can
see
individual
shifting
in
the
between
the
counties.
If
they're
the
county
enrollment
in
Medicaid
is
either
increasing
or
decreasing.
I
Again
we
have
the
child
versus
the
adult
comparison
related
to
diagnosis,
codes
and
procedure
codes.
We
do
compare
the
fee
for
service
and
manage
care
members
as
far
as
diagnosis
procedure,
codes
and
medication,
and
when
you
look
at
these
charts,
you
can
definitely
see
a
stark
difference
in
the
Medicaid
fee-for-service
population
versus
Managed,
Care
members
and
the
services
that
they
receive.
We
also
have
the
enrollment
by
Managed
Care
organizations
where
enrollees
are
choosing
to
get
their
service
from
the
Managed
Care
organizations
and
then
again
the
number
of
providers,
including
out
of
state.
I
This
map
is
also
included
in
our
report.
This
is
a
report
of
since,
and
you
can
see
since
2016
enrollment
has
increased
in
our
Medicaid
population
by
about
34.9
percent.
This
is
a
report
by
County.
As
you
can
see,
the
red
Counties
have
more
individuals
enrolled
than
those
counties
shaded
in
blue
or
brown,
so
our
enrollment
demographics.
You
can
look
at
this
and
see.
Half
of
our
enrollees
are
female
and
male.
We
have
a
pretty
good
breakdown.
I
We
have
about
37
percent
of
our
children,
our
enrollment,
our
children,
elderly
count,
Pro,
6.8
percent
and
adults
are
56..
The
adult
population
would
include
a
blind
individual's
disabled
and
pregnant
women.
You
can
see
from
our
race
and
ethnicity.
Demographics
about
11
percent
are
African-American.
20
percent
are
other
or
chose
not
to
choose
the
this
not
chose
not
to
select
that
demographic
on
their
application
and
again
that
is
something
that
is
not
mandatory
in
the
Medicaid
Program.
I
When
you
apply
for
Medicaid,
it
is
not
mandatory
that
you
check
race
or
ethnicity,
so
we
have
a
little
breakout
here
by
payments
and
enrollment
by
age
group.
You
can
see
that
while
elderly
individuals
account
for
about
six
percent
of
our
population,
they
account
for
about
50
15
of
the
payments
same
way.
If
you
go
down
the
chart,
you
can
see
that
the
adult
labor
population,
which
again,
are
those
individuals
in
home
and
community-based
waivers
long-term
care
facilities
about
one
percent
of
our
population,
but
they
account
for
about
10
percent
of
the
costs.
I
Now
can
we
can
compare
that
with
the
members
and
payments
ranked
by
payments?
This
demonstrates
that
of
all
of
our
members,
if
you
group
them,
for
example,
if
you
look
at
the
the
gray
shaded
area,
those
are
high,
utilizers
mid
high
utilizers,
and
it
shows
that
about
20
percent
of
our
population
accounts
for
over
84
percent
of
our
costs
in
the
Medicaid
Program.
I
So
you
can
see
that
the
approximately
half
of
our
program
in
that
bottom
dark
blue
box
50
accounts
for
about
3.9
percent
of
air
payments
in
Medicaid,
so
to
break
this
down
a
little
bit.
I
think
that
this
is
one
of
the
great
things
about
getting
this
information
and
getting
it
in
a
comprehensive
document
that
you
can
look
at.
So
when
we
started
looking
at
this
information
we
said,
can
we
see,
for
example,
who
are
those
high
cost
utilizers?
I
So
we
notice
that
we
have
23
members
in
the
Medicaid
Program
out
of
the
1.5
million
that
we
served
in
2020.
23
of
those
individuals.
We
paid
over
one
million
dollars
during
that
year
for
their
services,
so
we
wanted
to
see
what's
happening.
What
are
the,
who
are,
these
individuals
and
I
have
been
in
Medicaid
for
over
20
years,
so
I'm
automatically
assumed
that
I
knew
this
would
be
waiver,
individuals
or
individuals
in
long-term
care.
It
was
not.
These
are
individuals.
We
had
some
NICU
babies
in
there
several
NICU
babies.
We
had
some
hemophiliacs.
I
What
region
were
they
in?
What
hospital
did
they
deliver
in?
Is
one
Hospital
doing
better
than
the
other?
And
what
can
we
learn
from
that
information?
Because
if
you
look
in
the
report,
you
can
see
that
one
of
the
top
diagnosis
codes
procedure
codes
that
we
do
is
we
deliver
babies.
We
pay
to
have
babies,
delivered
Medicaid
pays
for
over
half
of
the
children
born
in
this
state,
so
combining
those
two
reports
together.
That
would
be
to
me
a
really
good
question
to
ask
is:
what's
happening
in
the
Medicaid
Program
with
maternal
mortality.
I
I
So
if
you
go
down
through
this
report
again,
you
can
see
that
we
had
638
411
members
that
we
spent
less
than
one
thousand
dollars
per
year
on
in
2020.,
so
again,
just
good
information
to
know
to
kind
of
help
focus
our
attention
on
where
we
should
be
looking
at
policies
for
the
Medicaid
Program
as
we
go
forward
so
again
going
forward.
We
want
to
use
this
2020
report
as
a
benchmark.
We
can
produce
future
iterations
I
think
at
a
little
bit
quicker
speed.
I
We
want
to
distribute
this
information
to
individuals
and
organizations
who
are
interested
in
the
Medicaid
Program
and
to
whom
we
talk
on
a
daily
basis.
We
want
to
this
information
to
drive
those
conversations
around
Health
Care
policy,
and
we
want
to
definitely
promote
transparency.
So
again,
this
is
just
the
first
iteration
of
the
Medicaid
report
very
interested
in
what
this
committee
thinks.
What
you
would
like
to
see
in
future
iterations
of
the
report
as
we
go
forward,
would
it
be
very
helpful
to
have
a
breakdown
or
some
information
of
emergency
room
visits?
I
For
example,
what
are
the
diagnosis,
codes
or
procedure
codes
in
emergency
rooms
so
again
very
interested
in
this
committee?
What
you
would
like
to
see
in
future
iterations
and
how
we
can
best
use
this
information
to
drive
those
those
positive
policies
that
drive
air
health
care
and
I'm
happy
to
answer
any
questions
or
have
a
discussion
about
anything
in
the
report.
Commissioner,.
A
Lee
I
appreciate
you
taking
the
initiative
on
this:
a
wealth
of
information
and
I'm
I'm
not
going
to
entertain
questions
from
our
committee,
because
this
is
a
draft.
I
can
Envision
that
this
summer
and
during
the
interim
session
we
could
probably
hold
a
single
meeting
just
on
this
subject,
which
I
would
encourage
us
to
do
so.
Committee
members
I'd:
ask
you
to
kind
of
develop
your
questions,
we'll
feed
them
to
commissioner
Lee.
We
can
get
in
this
deeper
dive
in
this
this
summer,
but
I
think
this
is
a
great
report.
A
You
know
the
only
question
I
would
have,
and
you
kind
of
touched
on
this.
A
little
bit
is:
how
can
we
use
this
report
to
truly
Drive
policy
decisions?
And
you
know
what
comes
to
mind
for
many
on
this
committee?
Is
the
decision
to
extend
Medicaid
benefits
for
hearing
vision
and
dental
when
that
really
wasn't
embraced
by
our
legislature?
A
It
wasn't
embraced
by
Medicaid
oversight
and
I,
don't
think
Health
and
Welfare
either,
and
why
did
that
become
a
priority
when
we
really
thought
that
it
should
go
to
increased
payments
to
Providers
or
add
more
people
that
looking
for
care
in
the
waiver
program?
So
how
do
we
use
this
document
to
drive
policy?
And
how
do
we
develop
this
symbiotic
relationship
where
we
make
these
decisions
jointly,
rather
than
just
you
know,
literally
like
we
was
done
with
the
decision
to
add
additional
Medicaid
benefits.
I
And
I
think
this
is
the
first
step
in
great
conversations
that
we
can
have
based
on
actual
data.
I.
Think
the
previous
presentation
too,
some
of
the
takeaways
that
I
got
was
definitely
using
data
to
inform
our
decisions
as
we
move
forward
and
look
forward
to
working
with
this
committee
as
we
develop
a
healthier
Kentucky,
because
we
are
definitely
all
here
for
the
same
reason
and
that's
to
improve
the
lives
of
those
we
serve
and
Senator
funky
frommeyer
have
to
say
I'm
the
youngest
of
13,
so
I
think
I
have
you
beat.
A
Well,
it's
not
a
competition.
Ladies
okay
appreciate
your
presentation.
We
will
talk
more
about
this
during
and
on
this
summer,
and
one
of
the
commitments
I
made
to
this
committee
is
this:
train
runs
on
schedule.
We
arrive
on
schedule
so
appreciate
your
time
and
with
that
we'll
move
on
to
our
next
agenda
item,
which
is
our
minority
Health
Equity
report.
J
A
This
is
my
seventh
session
I.
Don't
know
that
we've
ever
had
a
report
on
this
particular
report
before
and
that's
why
I
want
to
give
for
the
committee,
because
then,
as
we're
formulating
policy,
you
wouldn't
want
to
know
where
our
weak
weaknesses
are
more
areas.
Improvement
are
so
if
you
would
kind
of
give
us
a
brief
overview
as
to
what
this
report
does
and
absolutely
what
it
tells
us.
J
So
Vivian
Leslie
Bibbs,
director
of
The
Office
of
Health
Equity
for
the
Department
for
Public
Health,
so
I'm
glad
to
present
this
report.
This
is
the
first
time
I've
actually
had
an
opportunity
to
present
the
minority
health
status
report.
I
think
it
contains
a
wealth
of
information
and
I
hope,
I
hope
you
think
so
too,
and
then
at
the
end,
I'll
ask
you
what
you
the
same
thing
that
commissioner
Lee
asked.
What
can
we
do
to
make
the
report
better
next
slide?
J
So
the
minority
health
status
report
is
mandated
by
Statute
it's
in
odd
numbered
years,
so
I'll
be
presenting
the
2021
report
to
you.
It
includes
everything
from
our
Kentucky
behavioral
risk
factor
study.
We
get
data
from
the
Census,
the
ACs
and
any
other
measures
of
population
Health.
We
get
that
across
the
information
from
the
cabinet
and
information
from
our
individual
departments
within
Public
Health
next
slide.
J
So
what
the
minority
health
status
report
does
is
to
really
highlight
the
disparities
that
we're
seeing
across
the
state
and
impacting
kentuckians
and
their
health
outcomes.
It's
a
resource
that
we
hope
communities
use
to
start
conversations
around
what
they
can
do
to
address
some
of
the
minority
and
vulnerable
populations
that
we're
seeing
and
then
really
talk
about.
Those
social
determinants
of
health
and
I
was
really
intrigued
by
the
first
presentation.
Looking
at
that
91
percent
that's
preventable.
Some
of
that
is
the
social
determinants
of
Health.
J
Some
of
that
is
the
environment
that
our
moms
live
in
their
social
and
cultural
norms,
those
things
that,
when
they
walk
in
the
door,
we
sometimes
don't
think
about
that
are
impacting
the
health
of
mom
and
baby.
The
document
also
provides
data
to
support
the
2021
State
strategic
plan
in
the
Department
of
Public
Health.
J
So
what
we
really
talk
about
in
the
report
is
kind
of
distinguishing
between
Health
disparities
and
health
inequities.
Sometimes
people
get
those
confused,
so
we
know
that
disparate
Health
outcomes
have
been
linked
to
cultural
and
linguistic
barriers,
access
to
Services,
you
all
can
read
that
finances
personal
biases
and
then
systemic
and
institutional
barriers
that
sometimes
we
don't
often
think
about
that
are
impacting
moms
and
babies
and
other
folks
in
Kentucky.
J
J
So
what's
actually
in
the
report,
so
it's
broken
down
into
demographics,
social
risk
factors,
the
health
risk
factors
and
then
Health
outcomes,
and
then,
after
that,
we
list
recommendations,
the
strengths
and
limitations
of
the
report
itself
and
any
conclusions
that
we
have
drawn
from
the
report.
J
So
just
to
give
you
a
hint
of
what's
in
the
report.
As
far
as
the
demographics
we
break
down
where
the
majority
population
86.7
percent
of
white
and
then
eight
percent
of
the
population
black,
and
then
we
also
give
the
information
of
where
those
populations
reside.
Where
do
our
minority
populations
reside?
J
And
then
we
also
look
at
Social
risk
factors,
especially
Aces,
we're
most
interested
in
those
adverse
childhood
experiences,
and
we
recognize
that
Kentucky
is
right
at
the
top
of
at
least
having
four
or
more
Aces
that
are
impacting
health
and
and
for
kentuckians,
and
then
we're
also
looking
at
some
of
that
economic
data.
We're
looking
at
that
minorities
are
most
likely
renters
than
homeowners,
and
that
may
be
important
for
some
communities
to
know
as
they're
working
on
economic
development
issues
and
trying
to
provide
stable
housing
for
folks
next
slide.
J
Some
of
the
other
health
risk
factor
information.
We
look
at
obesity.
We
look
at
also
our
disabled
population,
which
we
sometimes
forget
that
they
have
health
issues
too.
35.1
percent
of
our
disabled
adults
have
some
type
of
cognitive
or
mobility
issue
compared
to
26.7
percent
of
the
of
the
national
average.
J
And
then
for
health
outcomes,
we
list
some
of
those,
especially
with
diabetes.
We
look
at
cancer
for
the
cancer
registry
next
slide,
please
and
then
getting
to
the
meat
of
it.
What's
the
usefulness
of
this
data,
we
want
it
to
be
starting
conversations
as
I
said
earlier,
but
we
also
want
it
to
be
a
point
of
collaboration
and
Partnerships.
We
can't
do
this
by
ourselves.
We
need
everyone
to
address
some
of
these
issues
and
understand
the
relationship
between
socioeconomic
status,
the
intersection
of
those
how
literacy
levels
and
environment
and
policies
and
procedures
impact
Health.
J
It
also
lets
us
think
about
how
these
intertwine
and
exacerbate
the
situation
and
then,
when
we
think
about
stratifying
by
race,
sex,
age
and
other
categories,
how
it
CR,
how
that's
Amplified
and
creates
a
hardship
for
many
of
kentuckians.
J
So
what
do
we
do
to
achieve?
Health
Equity?
Well,
we
need
to
address
those
social
determinants
of
health
and
think
about
population-based
interventions,
evidence-based
interventions,
targeted
methods
that
focus
on
the
greatest
areas
of
unmet
need
and
we
need
to
understand
the
root
causes
of
Health
inequities.
All
of
those
isms
ableism
sexism,
racism.
All
of
those
things
that
perpetuate
Health
disparities
next
slide.
J
So
this
is
a
slide
I
like
it's
talking
about
where
we,
where
we
were
where
we
started
and
where
we
need
to
be
so.
We
often
focused
on
that
Downstream,
where
we
just
address
the
health
outcomes
and
to
me
that's
just
putting
a
Band-Aid
on
things.
I
used
to
do
clinical
medicine
for
a
while
and
I
used
to
see
people
come
in
and
we'd
repeat
the
same
conversation
over
and
over
and
we'd
send
them
out
again
and
we'd
come
back
and
I
said:
I've
got
to
do
something
about
that.
J
We
need
to
start
thinking
about
those
social
determinants
of
health,
and
then
we
need
to
think
about
some
of
those
Upstream
things.
What's
the
real
issue,
that's
impacting
folks.
Is
it
some
of
those
structural
and
institutional
things?
Is
it
policies
and
processes
that
are
impacting
certain
populations
over
another?
So
that's
where
this
report
kind
of
puts
that
question
out
there.
What
do
we
need
to
do
to
move
forward
and
I?
J
So,
in
summary,
we
address
these
Health
inequities,
so
we
don't
keep
perpetuating
some
of
the
things
that
we
keep
seeing
in
these
reports
over
the
years.
We
look
at
some
unjust
circumstances.
We
look
at
things
that
may
be
put
into
place
that
are
impacting
one
population
over
the
other
that
might
need
to
be
eliminated,
and
the
bottom
line
is
that
everybody
deserves
the
best
health,
regardless
of
your
ZIP
code,
regardless
of
where
you
live
right,
regardless
of
where
you're
in
Eastern
Kentucky,
Western,
Kentucky,
Central
and
Kentucky
I'm
a
proponent
that
everybody
deserves.
G
I
I,
just
I
just
want
to
thank
thank
Miss
Bibbs
for
for
this
presentation.
I
think
the
information
that
you're
presenting
is
is
outstanding
and
I
really
look
forward
to
working
with
you
more
in
the
future.
Thank.
K
Carroll,
thank
you
Mr,
chairman
and
just
real
quickly.
Can
you
talk
a
little
bit
more
about
with
with
these
inequities?
What
are
the
areas
that
we
can
affect?
The
most
is
it?
Is
it
an
access
issue?
Is
it
an
educational
issue
on
these
Services?
Is
it?
What
is
it.
J
K
And
if
you
all
broken
this
down
geographically
to
to
like,
like
with
what
was
done
with
the
the
Medicaid
report,
to
help
us
to
understand,
are
there
parts
of
the
state
that
have
more
struggles
in
this
area
than
other
parts.
J
Tell
you
Senator
when
we
saw
that
the
most
was
with
the
when
the
pandemic
hit
and
people
finding
access
to
get
to
vaccination
sites
trying
to
get
to
a
provider
trying
to
find
out
where
they
needed
to
go.
We
found
out
that
Transportation
was
a
very
big
barrier
for
that
and
also
put
making
sure
that
we
had
facilities
within
those
communities
to
provide
that
service,
so
that
really
kind
of
tore
the
Band-Aid
off.
So
to
speak
as
to
where
we
really
need
to
focus
some
of
our
issues
in
in
Appalachia
and
also
in
Western
Kentucky.
A
Chairman,
thank
you.
Senator
Carroll
and
I
appreciate
that
remark
about
not
being
Appalachian
West
Kentucky,
but
we
have
a
tendency
up
here
to
look
at
Urban
versus
rural.
We
know
we
have
those
Healthcare
deserts
within
our
urban
areas
as
well,
so
I
think
that's
kind
of
that
universal
view
that
you're
talking
about
is
how
can
we
make
sure
everybody's
got
a
Level
Playing
Field
to
address
all
these
issues,
so
I
appreciate
this
and
really
look
forward
to
presentation
this
summer.
A
We'll
certainly
invite
you
back
and
take
a
deeper
dive
on
this,
but
appreciate
your
presentation
today.
Folks,
the
last
time
we
have
an
agenda
are
several
block
grants.
These
are
six
months,
Dash
reports
it's
for
informational
purposes
only.
We
will
hear
this
again
when
we
receive
annual
reports.
So
if
there
are
no
questions
comments,
this
committee
stands
adjourned.