►
From YouTube: Medicaid Oversight and Advisory Committee (8-11-22)
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
Morning,
we're
calling
our
third
meeting
the
medicaid
oversight
and
advisory
committee,
meaning
to
order
before
we
get
into
our
former
agenda.
I'd
like
to
take
a
moment
just
to
remember
those
folks
in
eastern
kentucky
who
have
lost
their
lives.
So
if
you
would,
please
join
with
me
in
a
moment
of
silent
prayer
for
those
folks.
A
A
You
know
miss
johnson,
I'm
always
reminded
of
the
first
lesson
I
learned
when
I
came
to
senate
in
2017
and
good
friend,
centers
and
steve
west,
and
he
told
me
you
know
every
legislation
we
pass
has
unintended
consequences,
and
that
certainly
is
is
true
and
that's
one
of
the
reasons
I
want
to
hear
you
to
hear
today
because
you
know,
I
think
that
certainly
there's
good
intent
behind
these
mandated
staffing
ratios.
But
we
don't
stop
to
really
understand
the
impact
it
could
potentially
have
on
our
citizens
and
our
providers.
F
Thank
you,
chairman
meredith.
I
think
you
stole
my
my
main
line.
So
thank
you
again.
My
name
is
betsy
johnson,
I'm
the
president
of
the
kentucky
association
of
healthcare
facilities.
We
represent
skilled
nursing
facilities,
personal
care
communities
and
assisted
living
communities
across
the
commonwealth
with
me
is
emily
weber
she's
our
communications
director,
and
she
will
tell
me
if
I'm
saying
something
wrong:
it's
always
an
honor
to
come
before
this
committee
and
especially
to
talk
about
something
as
important
as
president
biden's
proposal
for
minimum
staff,
mandates,
minimum
staff
ratio
mandates
and
skilled
nursing
facilities.
F
Yes,
let
you,
okay,
there's
a
lot
of
words
on
the
slide,
so
I'm
gonna
try
to
go
through
it
so
to
make
sense
of
it.
We
try
to
make
it
as
simple
as
possible,
but
this
is
complicated
information
in
april
of
22,
the
centers
for
medicare
and
medicaid
services
released
the
proposed
medicare
payment
rule.
F
F
The
proposed
rule
included
also
recruit
included
a
request
for
information
seeking
input
on
establishing
minimum
staffing
requirements
for
long-term
care
facilities.
Again,
thousands
of
comments
were
submitted
on
the
proposed
minimum
staffing
requirements
and
cms
acknowledged
that
they
were
continuing
to
re
review.
Those
comments
cms
stated
that,
based
on
the
comments
that
they
have
reviewed,
many
individuals
commented
on
the
overall
approach
for
establishing
these
staffing
standards,
recommendations
for
implementing
a
minimum
staffing
requirement
and
factors
that
should
be
considered,
such
as
payment
cost
and
barriers
and
input
on
forthcoming
staffing
studies.
F
Additionally,
cms
will
be
conducting
on-site
visits
between
august
and
october
of
this
year
in
skilled
nursing
facilities,
50
site
visits
in
a
mix
of
states
from
all
regions
from
mid-august
to
end
of
october
will
happen
and
25
site
visits
from
january
to
march
of
2023
to
happen,
president
biden
has
made
it
very
clear
that
he
wants
to
implement
this
within
a
year,
so
they're
seeking
information.
Currently
so
there's
a
lot.
We
don't
know
yet,
because
cms
is
still
studying
this
issue.
F
However,
on
the
next
slide,
I
will
address
what
our
best
estimates
on
of
the
impact
on
the
minimum
staffing
requirements
will
be,
but
today
we
do
know
that
that
federal
regulations
require
that
total
nursing
staff
hours
per
patient
day
are
I'm
sorry
that
so
licensed
nursing
services
are
required.
24
hours
a
day
with
a
registered
nurse
on
staff
for
at
least
eight
consecutive
hours
a
day,
seven
days
a
week.
This
equates
to
0.30
staffing
hours
per
resident
day.
F
So
again,
there
are
already
minimum
standards
within
federal
law,
kentucky
reported,
3.78,
total
nursing
staff
hours,
which
included
registered
nurses,
licensed
practical
nurses
and
nurse
aides
per
patient
day
from
the
nursing
home.
Compare
website.
As
of
june
30
2022
cms
calculates
the
total
by
taking
the
total
nursing
hours
reported
by
the
kentucky
facilities
by
the
total
patient
days,
with
those
facilities
to
yield
total
nursing
staff
hours
per
patient
day.
F
So
again,
you
will
see
that
kentucky
staffing
hours
from
june
30th
2022
is
a
total
of
3.78,
which
is
above
the
national
average.
In
that
number,
it
includes
.74
hours
per
patient
day
for
our
registered
nurses
.87
per
patient
day
for
licensed
practical
nurses
and
2.17
hours
per
patient
day
for
nurse
aides.
F
F
A
recent
survey
was
done
of
skilled
nursing
facilities
and
responses
show
that
98
of
skilled
nursing
facilities
are
experiencing
difficulty
hiring
staff.
So
our
next
question
becomes:
where
are
the
people
people,
and
this
goes
to?
We
talked
about
costs,
but
now
we
talk
about
the
barriers
to
hiring
these
individuals
and
I'm
always
honored
to
come
before
this
committee
and
share
the
stories
of
my
members.
However,
I
I
firmly
believe
is
much
more
impactful.
G
So
for
us,
as
a
non-profit,
when
we
talk
about
many
minimum
staffing,
it
is
a
concern,
most
importantly,
because
we
are
just
like
any
other
long-term
care
facility
right
now,
we're
struggling
to
find
staff
as
it
is
today.
We,
our
challenge,
obviously,
is
the
increase
in
wages
and
just
the
numerical
number
of
folks
that
have
and
folks
are
not
being
replaced
with
new
folks
entering
the
industry.
So
for
us
the
concern
is:
where
are
the
people
going
to
come
from?
I
think
for
our
team.
It's
just
going
to
add
another
layer
of
pressure.
G
G
If
there
is
a
minimum
staffing
requirement,
we
will
adhere
to
that.
It
is
concerning,
because
it's
one
more
thing,
one
more
metric
that
we
will
have
to
focus
on
and
again
for
us.
The
biggest
concern
is:
where
are
these
individuals?
Gonna
come
from?
Our
industry
has
lost
so
many
folks
they've
from
the
pandemic.
We
were
beat
up
and
we,
the
war
that
we
fought
in
long-term
care,
and
it's
still
not
over
during
this
pandemic.
G
In
my
mind,
is
unlike
many
other
environments
out
there,
and
so
I
believe
that
covered
fatigue
is
real
again,
it's
going
to
be.
Where
are
these
people
going
to
come
from,
and
how
are
we
going
to
have
the
resources
to
pay
them?
Because
if
there's
going
to
be
a
staffing
mandate,
we're
going
to
have
to
have
help
from
from
somebody
to
funnel
us
a
workforce?
We
just
we're
depleted.
The
pipeline
is
depleted
and
I'm
all
about
a
minimum
staffing
ratio.
G
If
that's
what
we,
if
that's
a
regulation,
that
we
have
to
follow,
of
course
we're
going
to
follow
it
just
like
we
do
all
the
other
regulations
in
this
industry.
However,
we
can't
do
it
in
the
current
environment.
We
just
the
people,
aren't
there.
So
we've
got
to
have
the
people
in
that
pipeline
in
order
to
meet
this
minimum
or
we're
all
going
to
fail.
C
C
C
And
the
only
way
to
keep
those
ratios
is
I
had
to
increase
my
my
cost
of
labor
by
48
this
year.
That's
just
since
the
month
of
february.
That's
when
we
instituted
across
the
board
wage
increases
as
well
as
some
other
retention
thing.
It
wasn't
strictly
wages,
but
it
was
mostly
wages
and-
and
I
am
averaging
118
000
net
loss
each
and
every
month
of
this
of
this
year.
F
So,
on
slide
five,
I
think
this
graph
is
pretty
straightforward.
You
received
from
february
2020
to
the
most
recent
data
available.
Nursing
facilities
have
lost
4
347
jobs
during
the
pandemic.
F
Although
this
week
the
bureau
of
labor
statistics
reported
that
nursing
homes
were
seeing
an
estimate,
estimated
3,
700,
300,
3
700
jump
and
new
hires
nationally.
The
sector
has
seen
the
loss
of
nearly
229
000
caregivers
or
more
than
14
percent
of
the
workforce.
Since
february
2020,
based
on
the
current
number
numbers,
the
model
indicates:
workforce
levels
may
not
return
to
pre-pandemic
staffing
levels
until
2026
and
remember
president
biden's
goal
is
to
implement
these
minimums
within
a
year.
F
Four
years
is
a
long
time
to
wait.
Our
people
are
worn
out,
they're
exhausted.
I
think
you
probably
sensed
that
from
both
karen
and
david's
videos
on
slide,
six
you'll
see
that
all
sectors
of
senior
services-
and
these
are
kentucky
specific
numbers
which
includes
alpc
and
skilled
nursing
facilities,
the
graph
from
january
2020-
and
this
is
based
on
a
quarter
basis.
So
we
do
attribute
this
to
covid.
F
Those
numbers
have
dropped
significantly
too,
and
so
across
all
senior
services
in
kentucky
we're
down
5505
jobs.
So
then
the
next
slide
again
it's
pretty
self-explanatory.
You
know
we
we
work
closely
with
our
healthcare
partners,
the
hospital
association
and
other
groups
on
workforce
issues,
but
you'll
see
in
the
slide
skill.
F
And
you
know
you
have
to
limit
emissions,
and
that
means
for
lower
revenues
coming
into
the
building,
as
david
mckenzie
explains
so
well,
our
staff
and
providers
are
facing
burnout.
Mental
health
issues,
post-traumatic
stress
disorder
from
coven
people
are
retiring,
like
I've
never
seen
before
people
that
have
been
with
our
association
for
years.
Our
leaders
are
leaving
child
care,
has
always
been
a
struggle
and
continues
to
be
a
struggle.
F
We
have
transportation
challenges
in
both
rural
and
urban
settings
and,
of
course,
we
compete
with
non-health
care
sectors
that
can
pay
more
because
we
are
so
dependent
on
medicaid
for
reimbursement
and
what
we
need.
So
again,
these
are
issues.
I
know
that
that
the
general
assembly
has
talked
about
in
recent
years
and
our
association
is
always
happy
to
to
continue
those
conversations,
but
a
loan
forgiveness
program
such
as
was
passed
last
session,
tax
credits,
affordable
housing,
child
care,
assistance,
mental
health
assistance,
easier
pipelines
into
long-term
care
professions.
F
A
I've
always
appreciate
the
challenges
of
your
industry
and
chronic
treatment.
I
don't
think
that
we've
ever
given
the
general
public's
ever
given
the
respect
that
the
industry
should
have
you
do
a
tremendous
job
and
folks
who
have
been
in
the
business
a
long
time
and
they
truly
are
angels
walking
on
the
face
of
the
earth.
I
was
glad
to
hear
in
your
first
video
presentation
that
there
is
support
for
minimum
staffing
requirements.
I
think
something
we
all
support.
A
I
guess
in
theory
the
the
idea
staffing
ratio
would
be
one
to
one,
but
we
know
that
that's
not
realistic
and
very
proud
to
see
that
that
your
industry's
standard
is
higher
than
the
national
average.
But
do
you
have
some
idea
of
what
a
an
ideal
staffing
ratio
should
be?
Is
3.7
adequate
or
is
4.1
really
what
should
be.
F
And
that's
an
excellent
question:
I
don't
have
a
magic
number
and
I
do
think
it
depends
on
the
the
facility
or
the
community
and
based
on
census.
I
mean
I
I'm
always
concerned
when
the
government
does
a
one-size-fits-all
type
of
regulation,
because
for
those
of
you
who
have
ever
been
in
a
skilled
nursing
facility,
I
know
dr
alvarado
has
you
know
it?
F
It
differs
and
it's
complex
and
based
on
acuity
of
the
of
the
resident
based
on
the
size
and
shape
of
the
building,
and
I
always
say
I
mean
I've
been
in
a
lot
of
skilled
nursing
facilities
in
kentucky
and
once
you've
been
in
one
you've
been
in
one,
because
they're
they're
laid
out
differently.
The
the
workforce
is
different,
so
I'm
not
sure
that
there's
a
magic
number
and
you're
right.
F
F
There
has
to
be
support
with
that,
whether
that's
financial
support
or
some
solutions
to
open
up
the
workforce
pipeline
to
bring
people
into
skilled
nursing
facilities,
because
it's
not
from
lack
of
trying,
I
mean
we,
I
mean:
we've
had
a
presentation
recently
where
we
talked
about
the
costs
of
gone
for
geo-fencing
and
and
advertising
and
retention
bonuses,
and
I
mean
emily,
sits
on
with
on
the
chambers
talent
pipeline.
She
meets
with
them
almost
weekly
and
we're
talking
we're
having
these
discussions.
A
A
The
reason
I
asked
the
previous
question
is
kind
of
leading
was
you
know,
maybe,
as
legislators
and
industry
leaders,
we
need
to
talk
about
what
that
ideal.
Staffing
ratio
is
and
develop
like
a
five-year
plan
as
to
how
do
we
get
there,
rather
than
just
throw
it
out
there,
because
all
the
issues
you've
identified
certainly
are
real
in
their
challenges.
I
think
we
all
want
to
improve
the
the
quality
of
care
in
all
of
our
facilities,
and
this
is
one
way
to
do
it,
but
we
have
to
do
it
as
a
partnership.
H
Thank
you,
mr
chairman
and
betsy.
Thank
you
all
for
the
presentation
and
just
a
quick
comment
and
then
a
question.
I
I
think
it's
important
to
remember
also
that
the
effects
that
our
long-term
care
facilities
are
feeling
in
their
reaction
having
to
increase,
pay,
there's
a
trickle-down
effect
to
that
to
other
types
of
providers.
H
It's
running
a
day
programs.
You
know
we
have
had
to
increase
our
pay
for
cnas
tremendously.
We
were
about
to
lose
our
cnas
to
long-term
care
facilities
because
they
have
increased
their
pay
so
much
to
keep
staff
and
for
for
us
to
stay
open.
I
had
to
do
the
same.
So
it's
not
just
that
industry
that
this
affects.
There
are
other
types
that
are
related
that
this
impacts
also.
So
I
would
ask
that
we
also
think
about
those
things
as
we
move
forward.
H
My
question
is:
have
you
all
been
able
to
conduct
any
type
of
studies
on
your
staffing
to
to
determine
pre-covid
with
with
the
staff
that
left?
Who
are
they
and
where
are
they
was
most
of
it
due
to
retirements?
Was
it
moving
into
other
healthcare
areas?
Hospitals,
do
you
all
have
any
data
on
that?
Are
you
actively
pursuing
that.
F
And
actually
emily
did
a
survey
during
cove
and
we're
actually
putting
a
new
survey
out,
but
maybe
I'll
have
her
speak
to
what
she
found
with
that.
Yes,.
C
So
we
have
done
a
few
surveys
based
on.
C
We
have
done
a
few
surveys
to
our
members
based
on
their
workforce
shortages
prior
to
covid
in
the
midst
of
covid,
and
then
we
are
currently
in
the
process
of
of
getting
one
out
now
to
see
what
what
their
workforce
shortages
look
like,
and
we
have
seen
many
different
factors,
those
that
you
have
mentioned,
that
they
you
know
that
there
are
retirements
from
long-term
care,
but
also
they're
they're,
moving
away
from
from
the
healthcare
industry.
C
Overall,
there
are
remote
jobs
available,
there
are,
you
know,
new
opportunities
and-
and
they
just
have
felt
so
burnt
out
that
they
have
decided
to
pursue
other
options.
There
are
also
you
know,
the
the
the
coveted
stress
and
burnout
child
care
issues
trying
to
think
of
all
the
different
factors.
F
Transportation
but
emily's
right,
I
mean
you
know
it
was
the
two
years
that
we
were
dealing
with
in
the
part
of
the
time
of
the
lockdown.
You
know,
there's
a
there's,
a
breaking
point
for
healthcare
workers.
F
I
mean
we're
seeing
it
in
other
sectors
away
too,
but
I
think
what
I
would
like
the
committee
to
realize
is
that
skill,
nursing
facilities
were
very
unique
is
because
we
truly
were
locked
down,
so
the
staff
not
only
were
the
caregivers,
but
they
took
on
the
family
role
too,
because
the
family
was
not
able
to
enter
the
building
and
not
because
the
skilled
nursing
facility
made
that
choice,
but
because
the
government
did
and
not
that
it
wasn't
the
right
choice,
but
it
caused
a
ripple
effect
of
stress
and
post-traumatic
stress,
disorder
and
and-
and
you
know
at
certain
points
during
covid,
skilled
nursing
facilities
had
the
most
significant
loss
of
life
and
we
also
lost
a
lot
of
health
care
workers
during
that
time.
F
So
I
hope
that
answers
your
question,
but
I
also
senator
care.
If
you
don't
mind,
I
understand
your
struggles,
because
you
know
healthcare
unfortunately
becomes
a.
You
know,
there's
a
tiered
to
it,
and
you
know
hospitals
can
always
pay
more
than
we
can
and
it
sounds
like
we
possibly
can
pay
more
than
a
a
day
center,
so
that
causes
inequities
in
the
system
and
and
it's
usually
based
on
reimbursement
models,
because,
of
course,
hospitals
can
receive
commercial
insurance,
which
pays
more
than
what
we
receive
in
medicaid
good.
H
H
I
would
challenge
your
association
to
start
thinking
about
within
the
industry,
the
possibilities
of
building
or
including
child
care
facilities
as
part
of
the
long-term
care
facility,
and
I've
heard
people
talk
about
this
before,
but
what
a
great
model
to
have
kids
there
on
site
to
spend
time
with
the
seniors
and
as
we
move
through
and
you
know
we
have
the
task
force
now
for
early
childhood
education
in
the
state,
and
I
would
ask
you
all
to
think
about
that,
and
we
may
ask
you
to
come
present
before
that
task.
H
Force
completes
and-
and
I
think
all
business
and
industry
when
within
the
commonwealth
needs
to
start
thinking
along
those
lines
about
providing
on-site
child
care.
And
then
we
as
a
state
need
to
be
thinking
about
the
regulations
on
how
we
can
adjust
regulations
to
make
those
things
happens
to
to
solve
some
of
these
problems.
So
please,
I
challenge
you
to
start
thinking
along
those
lines
and
maybe
pull
together
some
some
information
from
some
of
your
centers
to
see
what
those
barriers
would
be.
F
And
I
agree
with
you
and
during
coven
when
they
shut
down
the
daycares,
we
were
having
those
conversations
with
the
cabinet,
but
you
know:
can
we
can
we
send
the
you
know
just
limited
to
the
staff
to
centers
with
on
the
campus
of
the
facility
and
those
were
interesting
conversations,
but
they
need
to
continue
as
well.
H
It
would
take
some
regulatory
changes
because
you
with
the
different
age
groups
and
and
and
trying
to
keep
separate
so
it,
but
it's
something
we
can
look
at
we're,
trying
to
just
open
the
book
up
on
child
care
and
rewrite
it
to
make
it
fit
where
we
are
and
allow
us
to
move
forward
as
a
state
right.
Thank
you,
mr
chairman.
A
Thank
you,
senator
central
alvarado
and
then
we'll
finish
with
representative
wilner.
So
please.
B
A
B
Mr
chairman,
so
obviously
this
is.
I
live
this
every
day,
I'll
be
later
on
seeing
patients
later
on
today.
So
this
is
a
real
issue.
I
don't
think
you
know
I
a
lot
of
our
medical
providers
in
hospitals.
Don't
spend
any
time
in
nursing.
Homes
often
have
no
idea.
They
think
that
they
operate
like
a
hospital
would
and
the
same
rules
applies
in
a
hospital.
B
It's
much
stricter
in
a
nursing
home
as
far
as
rules
for
providing
care
for
folks,
people
think
you
can
regulate
somebody's
diet
and
you
can't
people
it's
like
an
apartment.
They
can
eat
whatever
they
want.
So
I'll
have
a
patient
in
a
hospital
with
heart
failure.
They
have
30
pounds
of
fluid
removed,
they
cut
as
they're
being
wheeled.
In
order
me
a
pizza
and
you're,
like
that's
just
going
to
put
the
fluid
back,
oh
well,
you
know,
I
can't
restrict
them.
If
I
do,
I
am
abusing
that
patient
in
a
hospital
setting.
B
I've
often
said
if
you
want
to
get
the
attention
of
the
medical
community.
Attention
of
legislators
is
for
a
bunch
of
nursing
homes
to
lock
arms
and
say
you
know
what
we
can't
take
any
new
patients
for
a
while
two
or
three
months
and
see
what
happens
to
the
health
care
system
in
the
state
of
kentucky
or
in
the
country
for
that
matter,
because
our
hospitals
would
back
up
with
patients
have
nowhere
to
send
them.
Families
would
be
out
crying
saying:
I
can't
take
care
of
mom
or
dad
they're
too
sick.
I
can't
handle
it.
B
I
gotta
go
work,
I
gotta
have
them
go
somewhere?
Well,
we
have
no
room.
You
know
why,
because
we've
imposed
nursing
regulations-
and
I
gotta
have
a
certain
ration
of
how
to
shut
down
a
bunch
of
beds.
If
that
happened,
everyone
here
would
wake
up
and
say
we
got
a
major
problem
on
our
hands.
We
got
to
do
something
all
we're
doing
is
kind
of
just
riding
along.
We
hear
these
reports,
everybody
says:
oh
yeah,
there's
a
problem
with
shortage
of
st,
but
we
live
it.
I
I
live
it.
B
I
see
it
every
day
and
it's
coming
very
very
soon,
where
you're
going
to
have
facilities
that
are
major
employers
in
our
communities,
that
don't
a
lot
of
those
folks
will
be
suddenly
unemployed.
All
these
folks
will
be
shifted
somewhere
else.
Many
counties
out
of
state,
perhaps
to
some
other
place
because
we
have
nowhere
close
by
for
them
to
be
closer
to
their
families.
B
Nursing
you
know,
reg
the
the
ratios.
It
sounds
great.
You
know
something
that
legislators
can
say.
I'm
gonna
hang
my
hat
on
that
we
got
something
done
we
fixed
something
it
you
can
say:
everybody's
gonna
have
10
pink
flamingos
or
green
flamingos
in
their
front
yard.
We
can't
find
any
well.
You
got
to
have
them
where
you
got
to
shut
down
you're
going
to
just
shut
places.
B
Down
is
what
you're
going
to
do
so
we
can
impose
these
and
say
you're
going
to
find
them
as
though
these
are
people
we
can
just
pop
out
of
a
gumball
machine.
You
can't
these
are
individuals
who
choose
where
they
want
to
work
and
if
they
don't
want
to
work
in
that
setting,
we
can't
force
them
to
work
in
the
setting.
B
And,
frankly,
there's
just
we
know,
there's
a
massive
nursing
shortage.
States
like
california
have
imposed
this,
and
I
know
the
nursing
associations
here
have
come
out
later
saying.
This
is
a
bad
move
mistake
you
shouldn't,
have
done
it
and
somewhere
along
the
way
as
government.
We
just
don't
trust
the
people
that
provide
the
care
in
this
field
to
do
the
right
thing,
and
that's
how
I
view
it.
That's
how
so
much
of
health
care
is
anymore.
Is
that
are
we
seeing
these
kind
of?
B
B
When
you
talk
about
burnout,
that
adds
to
the
burnout,
because,
when
you're
providing
that
care-
and
that
becomes
your
life
bet
from
you
know,
12
hours
I
mean
there's
assistant
don's
there
who
are
doing
the
director
of
nursing
work
and
now
we're
having
to
do
so
all
day.
Long
they're,
director
of
nursing,
overseeing
the
daytime
nurses
and
there's
no
one
to
do
the
night
shift.
They
work
night
shift
all
night
and
then
on
morning
they
come
back
on
and
they're
working
all
day
again
to
oversee
they're.
B
Doing
36
48
hour
shifts
in
a
row
to
provide
the
care
because
there's
no
one
else
to
provide
it
and
they
frankly
care
about
the
people
in
those
beds
and
when
we're
saying
you're
not
doing
a
good
enough
job,
you
need
to
just
find
more
people
that
do
it,
there's
no
one
else
out
there.
Folks
I
mean
that's,
that's
the
reality
of
what
we're
facing
and
until
these
facilities
have
to
shut
down.
B
I
fear
that
we're
not
going
to
pay
attention
and
no
one's
gonna
notice,
because
the
warnings
have
been
coming
for
a
long
time
and
it's
about
to
hit
the
fan.
Unfortunately,
so
I
know
it's
not
just
the
money,
I
mean
something
because
they
just
bring
us
more
dough
again,
there's
no
one
to
hire
for
these
roles,
and
I
I
often
I
often
say
we
just
we.
B
I
think
it's
a
lack
of
trust
for
the
people
that
provide
the
care,
because
they
think
that
somehow
we
have
a
nefarious
purpose
to
hurt
the
people
that
are
there
and
we
just
frankly,
do
not
I'd
invite
any
of
you
to
spend
24
hours
in
nursing
home
and
see
the
care.
That's
provided
often
what
the
staff
have
to
go
through.
B
I
mean
they're
they're,
I
know
nurses
who
were
hit
by
someone
had
their
job
broken
went,
had
it
fused
and
as
soon
as
they
can
come
back
to
provide
that
same
individual
who
broke
their
jaw,
the
care
that
they
provided.
So
I
go
on
a
rant,
mr
chairman,
and
I'm
sorry
for
that,
but
this
is
very
personal.
I
know
I've
had
discussions
with
reporters
about
this
topic
a
few
years
ago,
a
really
irresponsible
and
lazy
reporter.
B
Frankly,
who
wanted
to
talk
about
this,
and
I
gave
him
the
reasons
why
I
think
this
is
probably
not
a
good
idea,
and
the
report
was
more
about
the
nursing
homes
that
I
worked
at
in
their
rankings
and
he
wasn't
even
concerned
about
the
topic
at
hand.
But
this
has
been
a
discussion.
I've
been
willing
to
talk
with
anybody
about.
You
know
to
trust
the
people
that
are
out
there
to
do
the
right
thing.
I
mean
we.
We
want
to
have
as
many
nurses
as
possible
provide
as
much
care.
It's
a
true
struggle.
B
It's
been
a
struggle
for
a
long
time.
The
more
regs
you
put
on
the
harder
it
is
a
veterans,
nursing
home
tom,
I
think
of
the
one
in
wilmore
thompson
hood.
They
have
lots
of
beds
that
are
laying
empty.
Why?
Because
federal
regulations
apply
to
them
and
they
can't
find
the
nurses,
and
so
they
just
veterans
lie
in
hospitals.
The
va
looking
for
a
place
to
go
have
nowhere
to
go
because
we
can't
provide
the
nurses
because
of
the
ratio
issues
that
we
have
at
those
hospitals
at
that
facility.
Thank
you,
mr
chairman.
F
Chairman
meredith
megan,
we
pray
for
the
flood
victims,
let
your
manner
which
had
to
evacuate
because
of
the
flood
we
heard
from
their
regional
vice
president,
and
she
said
that
to
dr
alvarado's
point,
who
these
caregivers
are.
So
these
are
people
who
lost
their
homes
or
cars
and
some
family
members,
but
they
were
in
the
facility
taking
care
of
making
sure
those
elders
were
safely
evacuated
and
then
help
with
them
back.
So
you
know
these
are
unique
individuals.
A
C
You,
mr
chairman,
and
thank
you
for
the
presentation
it's
overwhelming
and
it's
daunting
the
challenges
we're
facing,
and
I
you
know
I'm
hear
so
often
about
the
health
care
force
dwindling,
because
people
are
leaving-
and
I
I
this
I
get
my
question.
F
And
I
agree
with
you
representative:
you
know
that
it
it.
If
you
saw
the
the
chart,
we're
mostly
nurse
a-dependent,
the
high.
You
know
we
have
lpns,
we
have
rns,
but
most
of
the
caregivers
drug
caregivers
are
nurse
aides
and
I'm
sure
it's
very
stressful
when
they
have
several
call
lights
going
on
and
they
can't
get
to
the
residence
and
time
because,
as
dr
alvarado
point
out,
these
people
are
there
because
they
want
to
be
there
right.
F
So,
if
you're
going
to
show
up
to
work
every
day,
you're
going
to
want
to
do
a
good
job
and
if
you're,
if
you
can't,
because
there
are
not
enough
people,
it's
going
to
cause
stress
it's
going
to
cause
burnout,
I
mean
all
of
us
in
all
of
our
jobs.
If
we
have
too
much
on
our
plate,
we're
going
to
get
burned
out
and
that's
true,
but
that
goes
back
to
the
question.
F
Where
are
the
people,
though
I
mean
if
you
and
I
you
know,
I
would
like
to
work
with
the
general
assembly
about
opening
up
the
pipeline.
I
know
representative
moser
is
very
passionate
about
this.
You
know
look
at
how
we
train
our
nurse
aides.
Look
at
how
we
have
them
tested.
I
mean
we're.
F
This
is
where
I
want
to
be,
but
if
there's
one
barrier
after
one
another
barrier,
they're
going
to
go
elsewhere
because
there's
there's
jobs
that
are
easier
to
get
to
I
mean
you
don't
have
we
have
to
have
background
checks,
we
you
know,
there's
you
have
to
be
tested
for
competency
and
you
can
unfortunately
go
work
at
a
fast
food
restaurant
a
lot
easier,
but
we
need
people
who
want
to
care
care
for
people.
So
I
agree
with
what
you're
saying
in
a
perfect
world,
like
senator
meredith
said
we
would
have
one-on-one.
A
Appreciate
your
presentation,
as
always-
and
you
know-
we've
limited
this
predominantly
to
talking
about
staffing,
which
I
know
makes
75
80
of
your
expense.
But
I
assume
you're
feeling
great
financial
pressures
because
of
the
increase
in
inflation
over
the
last
few
months,
and
we
don't
have
time
to
discuss
this
morning.
But
I
would
encourage
you
possibly
to
share
that
information
with
committee
members
as
well
as
how
that's
impacting
I
imagine.
The
food
budgets
have
just
gone
out
the
the
wazoo,
but
we'll
be
curious.
How
that's
impacting
you
as
well
but
appreciate
your
attendance
this
morning.
A
Your
testimony
is
always
very
educational
for
us
and
knowing
that
you
have
our
support.
Thank.
A
I
I
also
want
to
thank
many
of
you
for
making
time
to
meet
with
me
individually
before
the
meeting
I'd
be
lying.
If
I
didn't
say,
I
was
a
little
bit
anxious
for
this
morning's
conversation
and
being
able
to
look
at
some
friendly
faces
across
the
way,
hopefully
reduces
that
a
little
bit.
So
thank
you
for
for
taking
the
time
to
really
provide
direction
for
what
you
wanted
to
hear
about
this
morning.
Things
you
may
or
may
not
have
been
hearing
about
from
a
united
healthcare
perspective,
really
helped
us
feel
more
prepared.
I
I
also
want
to
say
that
it's
an
honor
to
be
on
this
morning's
agenda.
I
want
to
recognize
that
it's
national
health
center
week,
and
just
after
me
on
this,
this
agenda
is
molly
lewis
and
some
members
of
her
team
from
kpca
they've
been
wonderful
partners
for
us
at
unitedhealthcare.
In
fact,
they
serve
many
of
our
patients
throughout
the
commonwealth.
I
I
know
they've
been
incredibly
busy,
especially
in
eastern
kentucky,
with
the
community
health
centers
and
fqs
in
that
part
of
the
state,
but
throughout
the
state,
and
it's
been
an
ongoing
great
partnership,
so
molly
to
you
and
your
team
much
gratitude
and
I
hope
you're
finding
ways
to
celebrate
everyone
this
week
and
also
recognize.
What's
the
ongoing
tragedy
in
eastern
kentucky
as
a
as
a
state
partner,
we're
assisting
to
provide
some
resources
out
there.
I
will
tell
you
our
clinical
teams
that
have
had
relationships
case
management
relationships
with
members
in
that.
J
I
Of
the
state
immediately
went
into
action
trying
to
call
their
members.
As
we
all
know,
cell
phone
signals
were
really
challenging
and
getting
a
hold
of
those
people
was
very
challenging
again.
Thank
much
gratitude
to
kpca
for
lending
some
support
and
helping
us
track
down
and
make
sure
members
were
safe,
had
the
medications
and
the
durable
medical
equipment
et
cetera
that
they
they
need.
I
I
Honestly,
I
could
probably
spend
a
full
day
talking
to
you
about
the
various
programs
we've
deployed
throughout
the
commonwealth
to
address
members
health.
Obviously,
you
did
not
want
a
commercial
or
a
full
library
or
inventory
of
what
those
programs
are.
So
we
just
selected
a
handful
of
the
things
that
we
see
most
frequently
in
our
medicaid
population.
Today
we
have
quite
a
few
maternity
patients
in
our
membership,
and
we've
got
a
variety
of
programs
to
meet
those
members
where
they
are.
I
I
wanted
to
highlight
just
a
handful
of
the
programs.
We
have
a
program
called
healthy,
first
steps.
It
encourages
mothers
both
through
education
in
terms
of
prenatal
care,
but
also
provides
rewards
for
when
they
see
their
provider.
We
know
how
important
prenatal
care
is
throughout
the
duration
of
a
pregnancy,
and
so
they
get
a
reward
for
every
scheduled
visit
that
they
do
attend,
including
postpartum
visits.
I
Well,
hop
and
text
for
baby
are
two
programs
that
we
have
found
to
be
quite
quite
successful.
They're,
both
app-based
and
web-based
models
again
provides
a
lot
of
education.
Wellhop
in
particular,
is
a
great
cohort
model,
so
mothers
are
connected
with
other
mothers
at
the
same
gestational
state
of
their
pregnancy.
For
that
peer
support,
we
also
provide
direct
peer
support
for
mothers
that
do
have
sud
and
ou
treat
oud
treatments,
which
is
fantastic
for
them
to
see
a
success
story
see
a
mother
on
the
other
side.
I
I
I
I
I
I
In
some
cases
there
may
be
needs
for
urgent
after-hours
care.
A
pcp
may
not
be
available
have
that
after
hours,
phone
line
or
after
hours,
office
visits,
and
yet
it
doesn't
necessarily
require
emergency
room
level
care.
So
we
make
our
members
aware
of
both
telehealth
doctor
chat,
features
and
in-home
doctor
visits
as
well,
and
for
those
where
this
becomes
a
routine
pattern
where
they
continue
to
present
at
the
er
oftentimes.
We
will
engage
them
in
an
ongoing
case
management
effort
as
well.
So
they
also
have
one
of
our
nurses
that
they
can
call.
I
I
I
would
tell
you-
I
am
really
proud
of
our
network
team
in
18
months
with
the
state
operational
here
getting
to
95
medical
network
access
96
for
behavioral
health
94
across
dental.
This
has
been
a
lot
a
lot
of
work
individually
meeting
with
providers
and
making
those
network
agreements
happen.
We
do
have
broad
statewide
access.
All
acute
care
hospitals
in
the
state
are
contracted
for
medical
services.
I
I
There
are
challenges
that
I
would
recognize
in
specialties
in
certain
geographies
there's
a
couple
of
things
our
team
does
to
address
those.
We
arrange
for
care
with
the
next
closest
provider
to
that
member.
We
can
use
single
case
agreements
if
someone
is
not
in
our
network
and,
as
has
been
thoroughly
discussed,
coming
out
of
the
coved
19
pandemic,
there
are
challenges
in
getting
appointments.
So,
while
everyone
may
show
you
this
map
that
shows
90,
plus
access
availability
for
our
network
providers,
there
are
times
when
someone
struggles.
I
I
I
We
support
members
making
those
appointments
for
them.
Our
member
services
team
is
really
adept
at
trying
to
not
give
the
member
more
work
to
do,
especially
for
medicaid
members.
When
I
listen
in
on
those
member
services
calls
and
the
supervisors
sort
of
reviewing
them
and
providing
feedback
to
our
front
line
staff.
One
of
the
number
one
things
they
talk
about
is:
did
you
leave
the
member
with
extra
work
to
do
when
you
hung
up
the
phone?
And,
if
so,
why?
I
And
this
is
one
of
those
instances
where
we
don't
leave
the
member
with
that
extra
work
to
do.
We
will
continue
to
call
the
provider's
office
schedule
the
appointment,
reach
back
out
to
the
member
and
let
them
know
that
it's
been
done.
Medicaid
members
don't
need
more
work
to
do
in
that
way
in
their
lives.
K
Thank
you
krista
good
day,
everyone,
dr
lisa
cook.
Thank
you.
I
am
have
been
the
behavioral
health
executive
director
for
united
care
community
plan
of
kentucky,
and
I
want
to
thank
the
chairman,
chairman
meredith
and
our
co-chair
for
the
opportunity
to
present
today,
as
well
as
all
the
committee
members.
K
We
also
want
to
look
at
quality
of
services
to
ensure
that
the
services
that
are
being
provided
to
our
members
are
qualitative
and
they're
they're
working
towards
the
outcomes
that
the
members
desire
for
their
recovery,
and
so
when
we
think
about
that,
we
move
into
what
we
call
continuity
of
care,
and
so
with
that,
our
quality
focus
is
continuous
improvement
around
looking
at
data
and
data
analytics
reviewing
the
data
and
data
analytics.
When
we
look
at
providers
we're
looking
at
what's
what's
the
best
practices?
K
K
We
utilize
asam
clinical
guidelines
as
we
address
the
substance,
use
care
for
our
members,
and
then
we
have
complex
case
management.
Our
focus
here
is
making
sure
that
we
assess
our
members
needs
through
care
management
services.
We
coordinate
with
our
members
to
support
them
for
community
tenure,
as
well
as
provide
information
if
they
need
those
areas
of
social
determinants
of
health
addressed.
We
provide
referrals
to
make
sure
we
connect
with
them
and
work
on
behalf
of
their
members
to
ensure
that
those
issues
are
addressed
as
much
as
we
can.
We
have
something
in
our
model.
K
That's
called
a
recovery
resiliency
program
and
that
program
is
specifically
around
addressing
peer
support,
so
we
ensure
that
we
address
recovery
and
resiliency
in
every
phase
of
our
members
care,
because
we
understand
that's
an
important
part
of
their
progress
in
recovery.
So
we
look
at
continuing
care
with
clinical.
K
We
look
at
quality,
but
also
look
at
collaboration,
and
so
our
goal,
when
we
came
into
the
market
a
year
ago,
was
to
build
relationships
and
partnerships,
our
providers,
and
so
we
do
that
through
our
care
management
program,
building
partnerships
for
our
members,
but
also
bridging
those
relationships
with
our
providers
as
well,
in
education
and
partnership,
and
so
in
education.
How
do
we
do
that?
I
mentioned
earlier
our
recovery
and
resiliency
manager.
Her
role
is
to
go
across
the
commonwealth
and
identify
areas
where
we
see
peer.
K
Equally,
we,
our
utilization
management
teams.
From
the
time
we
engage
with
our
providers,
we're
fostering
education
on
that
process,
ensuring
that
we
are
working
together
collaboratively
while
they're
in
care
our
provider
relations
team
also
provides
education
on
a
recurring
meeting
that
they
have
with
their
with
the
providers
across
the
state
to
make
sure
that
there's
any
questions,
how
to
navigate
the
space
of
working
with
the
united
healthcare
but
they're,
actually
giving
education
and
then
our
care
management
teams
equally
are
providing
education
to
the
members.
What
are
your
benefits?
We're
going
to
talk
about
that?
K
What
are
the
programs
that
they
can
enroll
in
we're
going
to
share
that
with
them
our
care
management
teams
as
well,
and
then?
How
do
we
support
them?
In
a
recovery
so
we're
looking
at
education
through
all
those
different
lenses
and
then
partnership.
K
Equally,
we
just
launched
in
this
year
one
of
our
programs,
one
of
our
clinical
interventions
in
partnership
with
some
of
our
residential
facilities,
is
called
reducing
admissions
through
collaborative
interventions.
We
call
that
program
racy.
So
what
that
really
is
is
that
we
look
at
their
clinical
leadership,
their
doctors,
their
clinicians,
their
peer
support
specialists.
Our
case
managers
we
bring
in
our
clinical
team
and
we
wrap
around
that
member,
and
we
see
those
members
who
have
like
more
than
three
admissions
or
more
in
that
facility.
We
wrap
around
that
member.
K
We
try
to
strategize
with
that
member
to
figure
out
intervention,
so
they
have
community
stability
again.
Our
goal
is
to
reduce
the
missions
that
they're
having
ensure
that
they're
stable
in
the
community
and
then.
Finally,
as
we
look
at
partnering
with
our
providers
behavioral
providers
in
this
last
year,
the
first
year
we
focused
on
collecting
data
that
was
important
for
us
to
understand
how
our
providers
are
providing
services
and
now
we're
able
to
use
that
data
and
talk
about
value-based
payment
arrangements.
E
Thank
you,
dr
cook.
Thank
you
to
the
chairs
to
the
committee
we're
grateful
for
the
opportunity
to
talk
about
our
programs
here.
I'm
greg
irby,
I'm
the
chief
operating
officer
for
united
healthcare's
community
plan
of
kentucky,
and
I'm
happy
to
be
here
today
and
I'm
honored
to
speak
about
health
equity.
E
E
I
think,
as
we
start
a
conversation
about
health
equity,
it's
important
for
us
to
acknowledge
that
we
cannot
positively
impact
health
equity
without
understanding
the
unique
needs
experienced
by
each
individual
member,
and
so
that's
where
we'll
start.
Our
conversation
today
for
some
members,
their
first
entrance
into
healthcare
is
through
our
member
services
line,
and
so,
when
they're
connected
to
one
of
our
agents,
we're
going
to
solve
their
immediate
needs,
we're
going
to
address
those.
E
E
We
will
refer
members
to
those
community
partners.
We
can
receive
information
back
from
the
community
partners
about
a
successful
connection,
but
we're
also
going
to
follow
up
with
the
members
to
make
sure
that
they
receive
the
services
that
they
need
through
this
screening
program.
We've
identified
needs
like
food
insecurity
that
can
be
such
a
hardship
for
a
family
we've
identified
those
needs
and
we've
been
able
to
successfully
connect
people
to
food
banks
and
food
pantries
to
make
sure
that
they
know
where
their
next
meal
is
coming
from.
E
One
of
our
partnerships
that
we're
really
proud
of
and
that
we're
excited
about
is
our
partnership.
With
goodwill
over
the
last
several
months,
we've
sponsored
goodwill's
rise
and
expungement
classes
and
clinics,
and
through
that
more
than
1100
participants
have
attended
and
nearly
900
of
those
have
received
expungement
services.
E
What
that
means
for
these
900
people
is
that
they're
free
to
re-enter
society,
they're
free
to
re-engage
their
community
to
start
contributing
to
start
receiving
services
and
accessing
services.
Without
that
additional
barrier-
and
so
we're
very
proud
of
that
more
than
more
than
900
are
in
the
process
right
now
of
getting
those
services
as
well.
E
E
So
what
we
can
see
from
this
is
that
both
rural
and
urban
communities
are
benefiting
from
access
to
health,
telehealth
telehealth.
It
really
does
eliminate
barriers
to
care
things
like
child
care.
Rigid
work
schedules
transportation.
Those
can
often
be
an
impediment
to
receiving
the
services
that
people
need,
but
telehealth
eliminates
those
barriers
and
supports
health
equity.
In
that
way,
when
we
look
at
telehealth
through
a
health
equity
lens,
it
really
is
a
game
changer,
because
it
changes
the
expectation
for
the
member,
rather
than
expecting
the
patient
to
work
through
barriers
to
access
care.
E
As
you
can
imagine,
this
type
of
access
is
dependent
on
broadband
access
and
we're
happy
to
know
that
over
95
of
the
commonwealth
has
access
to
broadband
services
because
of
investments
that
have
been
made
in
this
commonwealth
for
members
that
don't
have
the
appropriate
technology
or
the
appropriate
mobile
devices
to
access.
We
can
refer
them
to
one
of
our
community
partners,
who's
ready
to
support
and
meet
that
gap
as
well.
E
One
of
our
studies
that
we
found
is
that
access
to
telehealth
services
increased
behavioral
health
appointment,
compliance
by
26
percent
and
we
believe
that's
because
it
eliminates
the
barriers
to
care.
So
again,
I
I
appreciate
the
time
to
talk
about
our
program,
I'll
transition
back
to
christa,
who
will
talk
a
little
bit
more
about
rural
healthcare.
I
I
We
leverage
data
which,
as
dr
cook
articulated,
we
are
about
18
months
in
so
we
are
excited
to
finally
be
at
a
point
where
we
have
a
more
robust
data
set,
but
we
share
those
data
insights
with
key
stakeholders,
members
providers,
community
partners
and
together
we
convene
groups
to
identify
what
are
the
key
issues
in
this
particular
community
and
what
are
objectives
that
we
can
stack,
hands
and
work
together.
So
we
set
measurable
market
specific
goals
and
then
we
really
try
to
address
a
holistic
approach,
so
it
might
not
be
a
one-size-fits-all
thing.
I
It
might
be
data
sharing,
it
might
be
value-based
care
agreements,
it
might
be
expanding
or
amplifying
what
a
community
is
already
doing
in
terms
of
building
walking
or
biking
paths.
Again,
our
approach
is
to
be
out
in
the
community
working
in
partnership
with
folks
that
are
already
doing
great
work
there
and
figuring
out
what
we
can
do,
how
we
can
contribute
and
how
we
can
amplify
investment
and
good
momentum
already
in
place.
I
But
what
does
that
look
like
in
practice?
I
wanted
to
give
you
guys
a
couple
of
examples
of
community
grants
we
have
made.
We
invested
about
a
million
dollars
with
the
university
of
kentucky
the
dental
program,
specifically
to
reduce
the
rates
of
oral
cancer
and
improve
oral
health
care
in
eastern
kentucky.
I
I
I
This
is
putting
in
telehealth
equipment
and
resources
into
pathways
facilities
so
that
3
000
children
served
across
a
10
county
service
area.
Could
access
more
specialty,
behavioral
health
that
they
required
and
would
otherwise
not
have
access
to.
I
So
I
want
to
thank
you
for
your
time.
I
also
want
to
make
sure
that
all
of
you
understand
that
we
are
here.
We
want
to
be
good
partners,
we
want
to
identify
any
issues
that
may
come
up
and
we
would
welcome
you
to
call
any
one
of
us
at
any
time.
If
you
or
one
of
your
constituents
are
aware
of
of
any
challenges,
we
want
to
make
sure
we're
working
through
those
with
you
in
partnership.
So
thank
you
for
your
time.
I
Today
we
are
really
honored
that
you
gave
us
the
mic
for
a
bit
to
talk
about
what
united
healthcare
is
doing
in
the
commonwealth,
and
we
would
welcome
your
questions.
A
Thank
you.
Thank
you
for
your
presentation.
I
don't
know
if
you-
and
I
talked
about
this
before,
but
one
of
the
reasons
that
we're
asking
our
mcos
makes
presentations
is
the
decade
that
we've
been
under
managed
care.
We
really
haven't
done
a
very
good
job
in
terms
of
moving
the
needle
and
improving
the
health
of
our
population.
A
A
We're
looking
to
significantly
move
up
on
that
bar
improve
the
herald
population
and
again
that's
one
of
the
reasons
we
have
you
here
today.
I
would
ask
you
and
it's
a
very
broad
question,
but
what
do
you
see
as
the
number
one
impediment
to
improving
the
health
and
population
of
kentucky.
I
Senator
meredith,
it
is
a
great
question
and
one
that
I
have
been
on
the
hunt
to
answer
since
arriving
about
six
months
ago.
I
again,
I
don't
know
that
it's
a
one-size-fits-all
answer
to
that
question.
I
think
it
is
local
community-based
in
terms
of
what
are
the
barriers
for
folks,
health
outcomes
in
each
community
and
what
we've
been
actively
doing
is
trying
to
get
out
into
the
community
whether
it's
meeting
with
community
partners
with
providers
to
more
understand
what
are
today's
barriers
and
what?
What's
our
part
in
doing
something
about
it?
I
Is
it
access
to
care?
Is
it
access
to
other
determinants
of
health
like
food
access,
transportation,
healthy
spaces
to
exercise
those
things
are
things
that
you
don't
often
see
on
a
spreadsheet
per
se,
but
you
need
to
see
by
being
out
in
the
community
working
with
others,
so
we
are
still
at
it.
Learning
learning
more
every
day
about
each
of
the
communities,
we're
engaged
with.
A
Well,
thank
you
for
that
answer.
Senator
carol,
you
have
the
first
question
pass:
senator
alvarado.
Will
you
speak
passionately
on
this
one
as
well.
B
K
B
So
I'll
tell
you,
you
have
the
most
soothing
clinical
voice.
Honestly,
I
I
mean
we've
heard
a
lot
of
testimony.
If
I
ever
have
any
mental
health
needs,
I
may
give
you
a
call.
I
mean
really,
I'm
I'm
not
leave.
B
It's
it's
really
soothing
voice
and
I
admire
that.
That's
it's
important
for
providers
to
have,
particularly
in
behavioral
health
space.
I
appreciate
the
response
on
the
local
we've
been
talking
about
how
to
revamp
medicaid
there's
been
some
discussion.
Some
states
do
just
that
is
that
they
have
a
collaborative
care
organization
rather
than
a
managed
care
organization
in
which
insurance
companies
work,
with
local
health
departments,
to
address
very
local
issues
and
very
local
needs,
which
I
think
is
of
crucial
importance,
because
I
think
the
response
I
mean,
there's
there's
generic
responses.
B
We
all
know
substance
use
disorder.
Mental
health
is
a
huge
issue
in
the
state
tobacco
uses.
Still
obesity
rates
and
exercise
issues
are
the
biggest
things
that
would
probably
have
the
biggest
impacts
on
getting
our
state
healthy.
If
we
can
get
people
to
change
behaviors
in
that
regard,
to
improve
their
mobility
substance
use
continues
to
be.
You
know
a
pariah
really
for
the
entire
country
and
for
our
state
in
particular,
but
there
might
be
particular
nuances.
B
So
I'm
encouraged
to
hear
that
you're
trying
to
leverage
data
to
get
down
to
the
very
granular
local
level.
I
think
that's
needed.
The
other
question:
I
have
it's
kind
of
a
same
topic
when
we
talk
about
network
adequacies.
You
know
you're
talking
a
little
bit
about
the
er
and
why
people
use
the
er
more.
I
mean
it's
a
primary
care.
Doc.
People
use
it
because
it's
open.
B
B
So
if
you
try
to
contact
somebody,
it's
not
a
convenient
arrow
I'll
go
when
it
is
convenient,
I'm
going
because
it's
open
and
that's
frankly
the
reason
why
and
I've
often
I
think
I've
told
you
all
I've
told
every
mco
group
someone
he's
invested
in
an
er
kiosk
of
some
sort,
you're
talking
about
using
that
for
behavioral
health
purposes,
to
put
that
in
an
emergency
room
to
say:
hey,
if
you
have
our
insurance
and
you
know
you
can
wait
four
or
five
hours
to
be
seen
for
a
cold
or
for
a
routine
non-emergent
situation
in
er.
B
You
have
to
sit
and
wait,
or
you
can
be
seen
right
there
and
someone
can
log
in
and
they
can
be
seen
quickly
and
out.
They
go
with
treatment.
I
think
would
make
a
lot
of
sense
would
save
a
lot
of
money
for
everybody
for
the
system
and
it
would
be
a
lot
more
expeditious
for
patients
to
get
their
care
if
they're
going
to
go
to
the
er
anyway
to
be
seen.
B
The
other
question
is
on
the
adequacy
issue.
I
mean,
I
know
you
said
the
appointment.
Availability
is
great.
I
was
texting
some
folks,
I
know.
Do
you
base
on
the
availability,
for
that
is
it
based
on
who
the
person
wants
to
see
or
just
having
a
provider
to
see,
because
I
think
I
often
will
ask
hey.
Okay,
you
have
a
huge
clinic,
it's
owned
by
a
hospital
system.
They've
got
lots
of
providers,
someone
calls
up
with
united
healthcare
and
you
know
medicaid,
and
they
want
to
be
seen.
B
How
quickly
can
you
get
them
in
they
say?
Well,
who
do
they
want
to
see
if
they
want
to
see
the
doc
they're
going
to
be
waiting
months
to
be
seen
for
a
initial
appointment?
Even
if
it's
not
an
emergent
months
to
be
seen
if
they're
willing
to
see
the
nurse
practitioner
we
can
get
them
in
within
the
week,
is
what
they're
saying
so?
Are
you
judging
that,
based
on
who
the
person
wants
to
see
or
just
availability
to
any
provider.
I
That's
a
really
great
question
and
I
I'm
gonna
actually
defer
to
greg
our
chief
operating
officer,
who's,
probably
closer
to
those
audits
that
we
perform.
E
B
And
I
I'll
tell
you
I've,
I
just
know
in
what
I
do.
Obviously
a
lot
of
folks
will
say:
hey:
they
need
to
be
seen
by
a
gi
doctor
someone's
really
struggling
and
they
need
a
specialty
appointment
and
they
can't
find
anybody.
You
know
it's
not
necessarily
the
of
you
all.
I
think
it's
just
of
the
system
in
general,
what
we're
encountering
now
with
shortages
and
they
think
well
alvarado,
will
know
someone
because
he's
kind
of
connected
and
I'll
call
the
guys.
B
So
that's
why
often
I
see
these
statistics
from
a
lot
of
our
presenters
and
and
it's
not
often
what
I
see
on
the
ground
I
mean
because
I'm
I'm
you
know,
I
know
a
lot
of
folks.
I
struggle
to
find
someone
to
see
some
of
these
folks
quickly
and
when
they're
asking
me
for
help
to
help
them.
Do
that
so
I'd
just
be
interested,
I
mean
the
primary
care
situation
might
be
quicker
and
again,
if
it's
just
a
hey,
I'm
willing
to
see
anybody
you
probably
can
get
in.
B
I
Thank
you
happy
to
follow
up
with
you
on
that
as
well.
It's
not
a.
I
would
share
it's,
not
a
kentucky
specific
issue
in
terms
of
healthcare
workforce.
Our
earlier
presenters
talked
about
that
as
well.
We
see
it
across
most
of
the
markets
we
serve
today,
which
is
why
we
try
to
continue
to
innovate
on.
How
do
you
expand
the
capacity
of
the
workforce
that
we
have
today?
I
Are
things
like
telehealth,
a
natural
expander
of
the
assets
that
we
have,
and
we
continue
to
invest
in
things
like
scholarships,
especially
for
those
that
might
be
underrepresented
in
the
healthcare
workforce.
Today,
we've
invested
quite
a
bit
in
scholarships
to
support
folks
through
schools.
We
think
that's
also
a
component
of
our
health
equity
response.
So
thank
you
for
your
question.
A
L
Thank
you,
mr
chairman,
christa,
I
think
you've
heard
me
say
this
before,
but
looking
around
the
room,
there's
only
a
couple
of
us
that
were
here
in
2008
to
2011
when
managed
care
was
implemented
and
continued
gooch
and
myself
were
were
here
and
heard
the
promises
made
by
the
by
the
administration
and
the
mcos
that
you
know
that
the
managed
care
would
improve
patient
outcomes
and
we
would
the
mcos
would
make
money
by
improved
or
healthier
healthier
recipients,
and
you
know
that
they,
I
guess
the
promise
was
to
be
proactive
rather
than
reactive
and
and
again
get
make
sure
that
that
population
was
was
healthier.
L
Somehow
that
went
by
the
wayside
and-
and
we
went
through
a
period
of
time
when
mcos
primarily
concentrated
on
provider
reimbursements,
and
we
had
a
lot
of
issues
there
and
I
haven't
heard
any
complaints
on
that
recently.
So
hopefully
we've
moved
past
that
I
guess
my
my
observation
from
where
I
sit.
Probably
the
number
one
issue
we
have
with
the
medicaid
population
is
communicating
with
them.
We
talk
about
95
percent
of
the
state
having
access
to
the
internet,
but
you
know
just
not
everybody.
L
The
phone
calls
that
I
got
that
people
just
simply
could
not
negotiate
the
that
that
process
they
just
couldn't
do
it,
and
so
I
think
that's
that's
a
big
part
of
the
issue
and
I
guess
my
question
is
and
and
what
are
are
you
doing
anything
to
improve
on
those
the
communication
with
the
with
the
your
your
population.
I
Yeah
it's,
it
is
a
challenge
in
terms
of
having
good
contact
information
for
our
members
when
we
receive
an
assigned
member
from
the
state
when
we
identify
a
member
that
needs
our
support.
I
One
of
the
things
that
occurs
is
our
clinical
staff
and
our
non-clinical
staff
does
multiple
outreach
attempts
both
telephonically
via
mail,
and
then
they
would
get
they
get
pretty
scrappy.
I
would
say
they
will
go
into
claims
and
look
for
you
know
what
pharmacies
has
the
member
been
to?
What
physician
offices
have?
Has
the
member
been
to
and
start
calling
those
offices
and
asking
if
they
have
any
contact
information
on
the
member?
I
So
there
it's
a
challenge
and
one
that
our
team
takes
on
with
full
speed,
uncovering
any
resource
possible
to
get
a
hold
of
members
that
need
our
support.
I
would
I
would
share
the
sentiment
of
the
prior
presenters
as
well.
You
know
oftentimes
people,
don't
think
of
a
health
insurance
company
or
as
a
as
a
payer
in
the
same
capacity
as
as
providers,
but
I
would
say
that
I'm
really
honored
for
the
folks
that
work
on
my
team
they
are
mission
driven.
I
Our
mission
is
to
help
people
live,
healthier,
lives
and
at
those
points
of
frustration
when
they
know
a
member
needs,
help
and
they're
having
a
hard
time
getting
to
them.
I
know
they
have
to
dig
deep
in
that.
Well
of
why
am
I
doing
this
job
and
and
really
stay
focused?
So
I
appreciate
the
question.
L
Mr,
mr
chairman,
one
one
final
comment
and
chris:
I
think
your
numbers
were
better
than
this,
but
back
in
september
last
year
there
was
a.
I
saw,
a
statistic
that
only
27
percent
of
the
medicaid
population
had
received
a
covet
vaccination,
and
you
know
I
don't
believe
in
mandating
that,
but
still
27
percent,
when
one
in
three
kentuckians
receives
medicaid.
L
That's
over
a
million
people
that
are
unvaccinated,
and
I
asked
the
question
you
know
how
many
of
our
folks
that
are
in
icu
are
medicaid
recipient,
unvaccinated,
medicaid
recipients
and
I
think
that's
kind
of
an
indication.
I
I
M
Mr
chairman,
and
thank
you
so
much
for
your
presentation,
this
has
been
very
helpful
to
to
understand
all
that
you
have
going
on.
You
know
we're
we're
all
here.
I
think
everyone
on
this
committee
is
here
with
the
end
goal
of
improving
kentuckian's
health
and
we
look
at
all
aspects.
M
So
on
slide
four,
you
talk
a
lot
about
the
initiatives
that
you're
you're
undertaking,
and
I
mean
it
all
sounds
amazing.
As
a
former
neonatal
intensive
karen
flight
nurse,
I
I
mean
I
have
worked
directly
with
this
population.
I
work
a
lot
on
substance,
use
issues,
mental
health
issues
and
it's
exciting.
M
I
Yeah,
that's
a
great
question:
when
I'm
happy
you
asked
we
do
employ
community
health
workers
they're
a
critical
part
of
our
outreach
and
oftentimes.
We
find
them
to
be
the
most
approachable
at
first
for
a
member
they're
not
intimidated,
they
don't
have
a
sort
of
white
coat
syndrome
necessarily
and
they
can
help
identify
those
most
critical
cases
that
then
really
do
need
to
connect
with
one
of
our
nursing
professionals.
I
The
other
thing
we
have
done-
and
I
could
have
mentioned
in
our
rural
healthcare
and
community
investments
fund-
is
we've
worked
with
the
uk
center
for
excellence
in
rural
health
and
sponsored
chw
interns
every
summer
out
in
hazard.
I
got
to
spend
time
out
there.
Last
month
we
decided
we
didn't
want
to
just
write
the
check
as
a
part
of
their
internship,
but
we
hosted
as
a
part
of
that
a
professional
development
day
and
so
spent
time
with
those
students
talking
about
professional
brand.
I
M
That's
very
exciting
and
if
I
may
just
comment
quickly,
it
would
be
interesting
to
see
you
know
as
you
increase
this
program
really
how
robustly
the
uptake
is
on
individuals
who
are
getting
trained
and
certified
as
community
health
workers,
and
then
I
had
one
more
if
I
may
and
I'll
make
it
quick.
I
there
were
some
questions
about
barriers
to
utilization.
We
talked
about
network
ad
adequacy
and
you've.
M
You've
been
doing
the
audit,
for
you,
said
about
18
months
and
collecting
data
are
you
so
so
we
see
on
slide
six
the
availability
of
access?
What
sorts
of
increases
are
you
seeing
in
the
actual
utilization
of
services,
yeah.
M
M
Yeah
I
I
mean,
I
think
that
that's
an
interesting
question.
You
know
it's
great
to
see
that
all
of
the
resources
are
available,
but
if
people
once
again,
you
know
back
to
the
community
health
worker
issue.
If,
if
folks
are
not
accessing
care,
it
there's,
you
know,
I
mean
we're
we're
missing
the
the
boat
here,
so
I
I
think
if
we
could
see
what
the
utilization
of
services
is
in
implementing
some
of
these
great
programs,
I
mean
obviously
you're
looking
at
this,
because.
J
M
An
expense
that
you
know
is,
is
you
know
unnecessary
if
it's
not
working,
and
you
know,
I
think
it
gets
to
the
point
of
that
some
folks
made
about
in
increasing
expanding
medicaid
and
not
really
seeing
any
movement
in
our
in
our
health
outcomes.
So
you
know
if
we
can
dig
down
a
little
bit
more
on
some
of
this
issue
that
would
be
really
helpful
and
and
on
the
provider
reimbursement.
M
I
am
still
hearing
from
providers
that
it's
an
issue,
so
I'm
not
picking
on
anyone.
I
just
you
know-
and
I
have
conversations
with
the
cabinet
about
this-
so
hopefully
they're.
You
know
having
conversations
with
the
the
involved
parties.
So
all
right
thanks.
Thank
you.
I
A
It's
one
that
you
and
I
talked
about
in
our
conference
call
timely
resolution
of
payment
disputes
and
sometimes
those
who
can
run
down
to
hundreds
of
thousands
of
dollars
and
it
may
not
mean
a
lot
to
a
huge
corporation.
But
if
it's
any
smaller
entity,
it's
it's
their
lifeline
and
I
hope
you've
looked
into
that
and
we
have
some
resolution
for
that
specific
issue.
But
if
not,
I'm
sure
we'll
talk.
Yes,.
I
A
Appreciate
that
and
I'll
just
finish
with,
I
think
you've
had
a
very
nice
presentation
this
morning,
but
I'll
be
quite
canon
with
you
out
of
five
areas.
I
asked
you
a
dress.
I
think
you
adequately
addressed
four
as
meatloaf
said
two
out
of
three
ain't
bad,
so
I
guess
maybe
four
out
of
five
is
not
bad,
but
I
really
don't
think
you
addressed
question
number
five,
but
that's
something
we
can
have
the
additional
discussion
on
in
the
future,
but
appreciate
you
being
here
this
morning
appreciate
your
testimony
and
thank
you
look.
I
A
J
Good
morning,
I'm
molly
lewis,
with
the
kentucky
primary
care
association,
I'm
currently
filling
in
as
interim
ceo
and
I'm
honored
to
be
here.
Thank
you
for
inviting
us
senator
meredith
and
representative
elliott.
I
with
me
today
is
dr
john
landis
who's,
the
dental
director
at
health,
first
of
the
bluegrass
in
lexington
and
tara
stanfield
who's,
the
director
of
integration
at
health
first
of
bluegrass,
and
we
brought
them
because
I
think
that
it
helps
to
shape
for
you
all
to
understand
what
they're
experiencing
and
the
level
of
care
that
they're
delivering.
J
So
and
thank
you
krista
for
your
kind
remarks.
We
have
a
great
partnership
with
the
managed
care
organizations
and
with
the
department
for
medicaid
services,
and
it
continues
to
improve.
We
know
that
it's
a
lot
more
than
just
medicaid,
but
most
all
branches
of
the
cabinet
are
on
speed,
dial
and
have
been
very
helpful.
J
So
it's
not
all,
not
all
kentuckians
access,
this
type
of
primary
care,
but
it
is
a
significant
population
and
we
know
about
health
that
about
90
of
it
is
social
determinants
of
health
and
really
understanding
what
I
like
to
think
about
is
life
and
what
patients
need
in
order
to
improve
their
health.
J
One
of
the
ways
that
we
serve
our
members
is
through
the
opportunity
to
perform
a
supported
provider
network.
So
when
christa
mentioned
network
advocacy,
part
of
it
is
the
primary
care
center
association,
primary
care
associations
network,
because
we
have
members
that
includes
over
30
community
health
centers,
which
you
all
might
know
of
as
federally
qualified
health,
centers
or
lookalikes,
and
over
about
over
60
rural
health
clinics,
which
are
also
in
underserved
areas
and
have
to
deliver
a
comprehensive,
integrated
health
care
approach,
we're
in
over
300
schools
and
about
40
public
school
districts.
J
So
it
it
is
in
the
nooks
and
crannies
of
our
communities.
Evidence
shows
that
patients
who
access
primary
care
have
better
health
and
lower
health
care
costs.
So
the
point
is:
how
do
we
get
patients
in
the
door
and
taken
care
of?
How
do
we
avoid
unnecessary
visits
to
the
emergency
room?
How
do
patients
know
who
to
call
and
how
to
get
what
they
need?
J
We
believe
that
the
value
of
care
that
our
members
provide
us
is
a
significant
testament
to
the
benefits
of
this
model
of
care.
That's
coordinated,
integrated
and
comprehensive,
and
so
I'd
like
to
turn
it
over
to
dr
landis
and
tara,
to
tell
you
all
a
little
bit
about
a
really
impressive
program
that
they
have
at
their
federally
qualified
health
center
in
the
lexington
area.
That
includes
community
health
workers,
doctors,
dentists,
health
care
providers,
nurse
assistants,
the
whole
gamut
and
how
they
work
together
to
deliver
effective
care.
N
N
N
We
have
two
that
are
embedded
into
homeless,
shelters
in
town
and
we
have
10
full
primary
care
clinics
that
are
embedded
into
fayette
county
public
schools
in
underserved
areas.
Each
of
those
clinics,
the
homeless
sites
and
the
school-based
clinics
all
have
a
full-time
nurse
practitioner
have
a
full-time
therapist,
a
behavioral
health
therapist.
We
rotate
dental
and
psychiatry
through
those
clinics
as
well
and
they're.
Just
really
super
cool.
When
you
get
to
go
see
them
most
are
in
elementary
school.
N
N
We
have
behavioral
health
services,
including
psychiatry,
and
we
have
a
ton
of
services
aimed
at
reducing
barriers
to
care.
So
you
hear
people
talk
about
social
determinants
of
health,
all
the
time
at
the
front
of
that
are
our
community
health
workers.
We
have
a
fantastic
team
that
pretty
much
work
miracles
on
the
daily
for
patients
and
we're
really
excited
about
our
model.
N
I
know
you
guys
have
a
special
interest
in
hearing
more
about
dental,
so
we
wanted
to
really
highlight
that
service
at
our
clinic
today
and
then
wanted
to
just
tell
you
a
couple
of
examples
of
how
it
works,
because
I
just
think
like,
like
my
parents
still
don't
know
what
I
do
like
when
they
ask
me
what
my
job
is.
They've
had
a
hard
time.
N
The
whole
time,
because
I'm
a
therapist
too
so
that
was
confusing,
but
but
this
really
confuses
people,
and
when
I
interview
people
and
I
try
to
explain
them
about
the
job,
when
I
interview
a
therapist
and
say,
look
I'm
going
to
place
you
on
a
primary
care
unit,
working
with
at
least
four
or
five
doctors
and
you're
their
partner
and
if
anything
outside
of
their
scope
comes
up.
It's
for
you
and
they'll
say:
well,
that's
not
how
normal
behavioral
health
work
works.
N
Like
usually
somebody
schedules
an
appointment
and
has
somebody
telling
them
they
need
to
schedule
the
appointment.
It's
not
just
somebody
that
just
walks
in
the
door
for
a
sore
throat
and
starts
to
cry
because
they're
deeply
depressed
and
not
talked
to
anybody
with
their
primary
care
doctor
for
five
years
and
the
primary
care
doctor
is
able
to
say.
Oh,
let
me
go
out
here
and
get
somebody
that
specializes
in
this
and
then
that
intervention
is
going
to
happen
right
there
on
the
medical
side
with
the
medical
team.
N
That's
just
not
the
way
people
are
used
to
working
in
my
line
of
work.
So,
even
when
I
try
to
explain
it
to
them,
it's
not
until
after
somebody's
been
there
three
or
four
months
they
say.
Oh
now
I
get
how
this
all
works
and
how
these
people
all
work
together.
So
we'll
tell
you
some
examples
of
that
and
dr
landis
is
going
to
share
a
little
bit
about
our
dental
program.
D
Thank
you,
tara
and
thank
you,
mr
chairman,
for
the
opportunity
to
speak
here
today.
My
name
is
john
landis.
I
am
the
chief
dental
officer
at
health.
First
bluegrass,
it's
been
a
privilege
of
mine.
My
background
includes
25
years
as
a
dental
medicaid
provider
here
in
kentucky
12
of
those
years
were
in
harlan
county
with
a
private
practice.
D
So
the
majority
of
the
patients
that
have
been
served
over
those
25
years
have
been
patients
with
medicaid
and
mr
chairman,
as
you
know,
kentucky
does
have
a
good
history
with
oral
health
resources.
Kentucky
was
the
first
state
in
the
nation
to
have
a
fluoride
in
every
county
in
the
state,
so
we
do
know
that
there's
resources
available
with
oral
health
in
line
with
some
of
the
conversation
today.
D
D
D
We
know
that
elective
services
were
discontinued
for
some
time,
so
treatment
plans
were
kind
of
kicked
down
the
road.
So
as
a
result
of
that,
what
we're
seeing
now
and
we're
playing
catch-up
is
that
there
has
been
an
increase
in
urgent
needs,
an
increase
in
walk-in
patients,
an
increase
in
extractions,
because
some
of
those
treatment
plans
that
may
have
been
restorative
care
may
have
turned
into
extractions.
D
So
what
we
do
we're
fortunate
to
have
resources
to
be
able
to
follow
up,
make
sure
these
patients
don't
follow
through
the
crack
that
we
work
with
the
patients.
We
work
with
the
schools
to
follow
up,
to
assist
with
transportation,
to
assist
with
language
barriers,
to
make
sure
that
we
complete
those
treatment
plans.
D
D
A
D
One
is
dental
hygienist,
communicate
with
our
women's
health
team,
educating,
expectant
mothers,
preventing
baby
bottle
tooth
decay,
building
trust
early
and
reducing
future
costs,
improving
the
overall
health.
With
a
team-based
approach,
we
did
pilot
a
communi
community
health
worker,
embed
it
within
a
dental
team.
D
So
what?
What
did
that?
Look
like
one
example
is
that
we
we
have
a
a
teenager
that
was
present
for
a
dental
visit
and
it
was
identified
that
that
teenager
had
suicidal
thoughts
had
symptoms
of
depression
and
we
were
able
to
provide
the
resources
needed
for
this
patient
and
that
originated
from
a
dental
visit.
D
N
We,
the
behavioral
health
people,
love
working
with
the
dental
team
several
times
the
dentists
have
identified
patients
and
and
sent
them
our
way
or
when
we've
had
our
our
team
co-located
with
them
in
ways
that
I
would
have
never
thought
a
patient
would
make
it
to
yet
they
they
had
an
example
post
hardcore
pandemic
times.
I'm
not
sure
what
we
call
what
space
we're
in
at
any
time.
N
We
had
an
example
where
a
young
person,
a
college
kid
came
in
to
the
dentist
dentist,
goes
and
finds
a
community
health
worker
and
says
something's,
not
right
this
kid.
I've
seen
this
kid,
since
they
were
young
they've
had
immaculate
teeth,
they
take
care
of
their
teeth
and
it's
got
six
cavities
that
something's
not
going
right.
I
don't
really
know
what
to
do.
That's
not
what
I
do
so
much.
Community
health
worker
goes
starts
talking
to
the
kid
kid
says.
N
N
Let
me
walk
you
downstairs
where
we
have
a
whole
bunch
of
therapists
and
psychiatrists
and
let's
get
you
hooked
up
with
them
and
it
worked
out,
and
so
we
got
that
kid
wrapped
in
the
hardest
challenge.
For
me
in
thinking
about
coming
here
today
and
talking
to
you
guys
about
our
model
was
like
what
what
are
good
examples,
because
there's
so
many
it's
all
day
long,
it's
every
day.
That
kind
of
thing
is
happening
where
we're
able
to
identify
people
who
just
wouldn't
wouldn't
go,
especially
on
the
behavioral
health
side.
N
It
makes
a
huge
difference
and
the
amount
of
information
we
have
via
er
reports
or
all
of
those
kind
of
it's
just
a
whole
different
kind
of
ball
game
and
being
able
to
treat
our
patients.
But
the
story
that
stood
out
to
me.
A
lot
is
we
had
a
family
majority
of
the
family
were
our
patients,
adults
and
kids.
We
had
a
family
a
little
while
back
that
had
a
terrible
car
accident,
the
youngest
child
past
older
brother
was
sitting
next
to
her
and
had
some
injuries
but
survived.
N
We
get
the
er
report.
The
primary
care
team
gets
the
er
report,
they
schedule
a
follow-up
because
everybody
sustained
some
injuries.
The
kid
comes
in
seeing
the
primary
care
doctor
and
really
turns
into
probably
in
all
my
years
of
doing,
behavioral
health
work,
maybe
the
most
just
acute
pain,
emotional
pain.
I've
ever
seen
in
this
kid's,
just
feeling
of
guilt,
big
brother
guilt,
that
this
is
happening
for
their
family
and
the
primary
care
pediatrician
immediately
reaches
out
to
our
behavioral
health
consultant.
N
Who's
standing
right
in
the
pod,
just
waiting,
behavioral
health
consultant,
gets
involved
with
the
kid
and
starts
working
with
them
pretty
heavily
because
we
know
with
trauma
those
first
couple
of
days
and
first
couple
of
weeks
after
a
traumatic
event
will
kind.
You
will
naturally
set
your
own
way
of
explaining
what
happened
and
young
people.
Anybody
can
set
that
real
wrong.
N
But
he
kept
on
having
problems
and
he
mostly
was
having
problems
at
school.
He
would
kind
of
do
okay
when
he
got
home
and
meanwhile
the
family's
falling
apart,
just
as
I'm
a
parent,
I
can
only
imagine
what
that
would
be
like
for
the
parents
trying
to
support
the
children
and
he
kept
just
exploding
at
school
and
to
the
point
they're
afraid
he's
going
to
like
get
start
getting
in
trouble.
N
Like
I
just
sat
in
the
classroom
and
I
felt
so
closed
in
and
he
said
what,
if
I
called
the
school
and
asked
them
if
we
can
send
the
community
health
worker
who
was
used
to
the
family
and
working
with
them
a
lot
of
that
time
and
send
her
out
and
maybe
sometimes
when
you're
feeling
that
way,
she
can
just
walk
you
around
the
track
or
walk
you
up
and
down
the
halls
or
whatever,
and
the
kid
is
a
middle
schooler.
So
I
I
kind
of
thought
it's
not
going
to
do
that.
N
He
says
yes,
anything,
yes,
so
she
starts
doing
a
couple
times
a
week
in
the
beginning,
the
community
health
worker,
the
conversation.
She
would
tell
me
that
she
and
this
little
boy
were
having
were
amazing
and
then
it
bridged
to
a
week
at
a
time
and
then
she'd
only
go
every
couple
of
weeks,
but
I
just
think
this
from
a
primary
character.
N
You
just
don't
expect
that
when
you
go
to
primary
care
to
be
able
to
have
those
kind
of
services
wrapped
around
and
I
couldn't
be
more
proud
of
what
we've
done
and
where
I
think
we
can
go
and
and
just
of
all
the
people
that
we
get
to
help.
So
thank
you
for
letting
us
talk
to
you
about
it
a
little
bit
today
and
we'd
love
to
take
any
questions
or
if
you
ever
have
questions
in
the
future
about
it.
N
I'd
like
I'm
sold,
you
can
tell
I've
drank
the
kool-aid
of
integrated
care,
but
in
the
future,
if
you
have
questions
or
anything
we
would
we
would
love
to
hear
them.
A
A
How
much
is
that
costing
our
commonwealth
because
of
that
shortage,
and
I
don't
think
we
ever
asked
the
basic
question
is
why
now
I
know
there's
a
shortage
of
personnel
everywhere
and
primary
care
has
been
there
for
decades,
but
it
doesn't
answer.
The
primary
question
is:
why
can't
we
recruit
healthcare
professionals
to
rural
communities.
J
We're
about
to
start
a
community
health
center
learning
center
in
north
eastern
kentucky,
where
there
are
opportunities
for
residency
programs,
because
we've
learned
that
grow
your
own
is
a
really
good
model
and
that
people
who
are
invested
in
communities
and
are
educated
and
committed
to
their
neighbors
are
really
good
providers.
And
so
we
need
to
provide
ways
to
support
that
growth
and
workforce.
We
will
not
have
enough
primary
care
providers
to
meet
the
need
or
the
growing
need
unless
we
start
thinking
about
the
training
and
the
opportunities
to
enhance
this
workforce
with.
J
That
being
said,
I
think
that
the
primary
care
model,
what
has
previously
been
described
before
managed
care
and
before
it
became
the
neighborhood
approach
of
a
assists
of
health
care,
became
more
integrated
and
more
comprehensive.
J
The
workforce
required.
I
mean
the
reimbursement
requires
a
face-to-face
with
a
doctor
nurse
practitioner
pa,
but
what
we've
learned
is
that,
in
order
to
have
integrated
comprehensive
care
a
lot
of
times,
everybody
there's
a
there's
more
diversity
and
who
can
meet
those
needs
and
having
appropriate,
planned
care
that
involves
community
health
workers
and
which
obviously
costs
a
lot
less
money
than
doctors
and
nurses,
or
to
have
peer
support
specialists,
people
who
are
actually
in
recovery,
helping
somebody
sustain
their
own
recovery.
J
There
are
other
ways
that
it
doesn't
have
to
be
a
doctor
and
nurse
all
the
time,
because
that's
asking
too
much
and
it
creates
burnout,
and
we
it's
really
hard
to
retain
that
type
of
workforce
and
it's
not
really
the
most
cost
effective
or
the
most
appropriate.
So
I
think
that
it's
great
that
we're
able
to
think
outside
of
the
box
there's
also
some
types
of
care
that
can
be
done
at
the
school
or
it
can
be
done
over
the
phone
or
by
a
visit
or
visiting
the
area
development
district
senior
center.
M
Yes,
thank
you,
mr
chairman,
and
thank
you
very
much
for
your
presentation.
Thank
you
so
much
for
your
work.
I
think
we
I've
been
sold
on
the
integrated
care
model,
for
I
don't
even
know
how
many
years
now
I
mean
it's
just
it
makes
complete
sense,
and
when
I
was
the
director
of
drug
control
policy
and
working
on
substance
use
disorders,
we
always
said
you
know
to
to
destigmatize
substance
use
disorders.
We
need
treatment
to
be
just
a
part
of
primary
care,
so
I'm
I'm
interested
in
a
lot
of
this.
M
But
what
are
the?
Are
there
challenges
in
providing
the
this
integrated
care
in
billing?
Do
you
have
you
know?
Oftentimes
reimbursements
are
really
compartmentalized
and
I'm
wondering
about
the
funding
model
and
what
your
challenges
are.
N
I
would
say
from
just
from
the
integrated
care
side
the
biggest
challenge
that
stands
out
and
I'm
sure
our
cfo
would
prefer
to
answer
the
question.
Then
let
me-
but
I
would
think,
would
be
the
two
visits
on
the
same
day
problem
that
we
run
into
so
that
whole
model,
where
the
therapist
is
just
kind
of
there
ready,
yeah
and
there's
always
plenty
to
do
most
of
the
time.
It's
you
know
whoever
got
to
that
patient
first
so
that
so
that's
a
challenge
for
us
for
sure.
M
Right
and
and
that's
problematic,
because
if
an
individual
comes
in
for
a
dental
issue
and
a
mental
health
or
behavioral
health
issue
is
identified,
you
can't
even
treat
them,
so
you
can
you're
not
going
to
get
reimbursed
right,
but
you
know
so
I
I
mean
that
is
a
big
problem.
I
you
know,
I
don't
know.
If
that's,
I
think
it's
probably
a
federal
issue
and
you
know
with
cpt
codes
and
and
all
that
goes
into
the
reimbursement
model,
but
certainly
there's
something
that
we
can
do
to
to
work
on
that.
M
So
I'd
I'd,
love
to
kind
of
dig
down
on
that
issue
too.
J
Thank
you.
We
would
love
to
come
and
work
with
you
on
that.
We
actually
have
some
good
ideas.
There
are
also
opportunities
for
us
to
show
that
sometimes
it
does
really
work.
J
So
there
there
is
some
innovation
and
we
we
think
we
found
some
flexibility,
but
we
we
have
some
other
ideas
too,
also
with
the
treatment
plan
for
oral
health
being
able
to
treat
more
than
one
quadrant
every
month.
You
know
those
types
of
things.
J
B
You,
sir,
so
this
is.
This
is
team
based
care,
which
is
what
you
know.
I
know
the
doctors
have
been
talking
about
this
for
at
least
since
I've
been
practicing
medicine
almost
27
years
or
so,
which
is
great,
it's
a
dream
for
most
docs
and
they
want
to
do
this.
We
used
to
be
able
to
do
these
things
in
the
office
where
I
actually
had
a
counselor
in
the
office,
because
I
found
that
we
had
to
refer
so
many
people
out.
We
kept
it.
B
The
difficult
part
of
that
is
like
you,
just
like
you
just
stated,
is.
If
I
saw
if
someone
comes
in
for
a
well
visit,
they're
coming
in
for
that
code,
I
have
to
address
a
bunch
of
stuff
now
for
government
and
for
insurance,
and
I've
got
to
fill
it
out
if
they
say
you
know
doc,
while
I'm
here,
can
you
look
at
my
knee
or
hey?
I've
got
a
tooth
or
some
other
issue
the
response.
Now
it
used
to
say
yeah.
Sure,
of
course,
let
me
address
it.
I
put
a
modifier.
B
You
get
reimbursed
a
little
bit
extra
for
doing
that
extra
acute
visit
and
doing
the
the
well
visit
the
same
time.
Now
I
got
to
say
yes,
sorry,
let
me
do
the
well
visit
make
an
appointment
for
next
week,
so
I
can
look
at
you
for
your
knee
too.
Why?
Because
government
needs
to
have
that
data
collection
we
heard
about
earlier.
B
They
got
to
collect
the
data,
see
what's
an
acute
visit,
what's
a
well
visit
what's
ever
and
they
have
to
separate
all
that
stuff
and
it's
become
nonsense
and
a
lot
of
it's
federal,
that's
coming
down.
This
is
a
much
you
know,
give
somebody
a
global
fee
and
say:
look
address
all
these
things
at
once.
People
can
take
off
of
work
once
to
come
in
for
everything
at
that
same
time,
instead
of
and
take
off
multiple
visits,
it's
kind
of
a
ridiculous.
So
I
commend
you.
This
is
great.
B
B
Eighty
percent,
I
mean,
I
think
eighty
percent
of
the
physicians
will
practice
within
an
80
mile
radius
of
where
they
do
their
residency.
If
I'm
a
med
student
and
I
go
to
oregon
and
do
my
residency,
there
odds
are
I'm
going
to
stay
in
oregon,
I'm
not
coming
back
to
kentucky,
so
we
need
residency
positions
of
all
types,
but
particularly
for
psychiatry
for
primary
care.
Two
of
the
things
I'm
going
to
ask
you
really
quickly.
You
mentioned
that
you
guys
have
your
own
psychiatrists,
that
perks
my
interest.
We
have
a
major
shortage.
I'm
curious!
B
You
don't
have
to
answer
it
yet
how
many
psychiatrists
you
guys
employ
within
your
system
and
secondly,
I'm
looking
at
your
handout
and
it's
a
very
important
topic
for
me
on
the
workforce
development
on
the
bottom.
Under
the
financial
perks
malpractice
benefits
through
the
federal
tort
claims
act
program.
Maybe
you
could
expand
on.
Why
that's
important.
Has
that
helped?
You
attract
other
providers
because
I've
been
claiming
we
have
a
hard
time
getting
docs
that
come
into
states.
N
Have
one
full-time
adult
psychiatrists
and
one
very
part-time
child
psychiatrist?
I
will
say
that
the
current
the
psychiatry
problem
is
a
huge
problem
for
us.
We
have
several
psychiatric
nurse
practitioners
that
work
alongside
of
them
and
the
way
that
we
have
made
it
work
with
seeing
as
many
patients
as
we
have
is
oftentimes.
N
Once
our
psych
team
can
stabilize
a
patient,
we
can
pass
that
care
back
down
to
primary
care
and
they're
comfortable
with
some
patients.
Some
never
some
need
to
be
with
a
psychiatrist,
but
some
are
okay,
but
we're
trying
to
hire
for
a
child's
psychiatrist.
Right
now-
and
I
have
I
mean
it's
over-
it
feels
over
I'm
not
throwing
in
the
towel,
but
it's
it's
hard.
B
J
Okay,
so
federal
tort
claims
act
is
a
beautiful
structure
when
it
works.
It
creates
a
sense
of
immunity
for
a
public
workforce
of
health
care
providers,
and
it
also
helps,
especially,
as
we
know
like
ob,
gyns
and
pediatricians.
Just
the
liability
can
be
cost
prohibitive,
but
it
is
limited
to
our
community
health
centers,
which
are
the
federally
qualified
health
centers
that
actually
receive
a
330
grant.
J
So
we
have
25
of
the
26
of
those
in
here
in
kentucky
that
benefit
from
it
and
it
one
thing
that
we
have
been
talking
a
lot
about,
especially
during
the
flood
response
is
our
members
are
very
collegial,
and
our
community
health
centers
federally
qualified
health
centers
in
areas
that
have
not
been
impacted
have
been
desperate
to
assist
those
that
are
impacted,
but
the
ftca
does
not
travel
it
does
the
portability
is
a
problem,
but
that's
a
federal
issue.
J
I
know
that
you
have
lots
of
prob,
we
were
talking
to
them,
but
I
do
think
that
maybe,
in
times
of
emergency,
some
of
the
good
samaritan
rules
that
are
currently
in
place
could
maybe
be
expanded
so
that
we
do
have
a
more
portable
workforce
of
individuals
who
are
trained
in
this
delivery
model
and,
as
we
know,
from
kovid
they're
essential
providers
that
we
have
not.
We
don't
miss
work
and
these
providers
not
me
personally,
but
the
providers
that
we
support.
J
B
Part
of
that
benefit
is
that
part
of
what
that
act
has.
Is
that
if
you
have
an
issue
or
a
claim
you're
going
to
file
against
the
provider,
it
goes
to
the
federal
court
system,
which
has
a
much
easier
dismissive.
I
mean
if
you
get
a
frivolous
lawsuit
before
that
a
judge
can
easily
just
throw
it
out
in
kentucky.
B
So
we
have
to
change
that
to
give
ourselves
the
authority
to
do
that
and
implement
some
of
the
good
things
that
that
act
has
to
provide
for
providers
here
in
kentucky.
If
we
can
get
it
done.
So
I
commend
you,
I'm
glad
that
you
put
it
on
there.
It's
very
important
that
we
consider
to
keep
that
front
and
center,
because
that's
again,
it's
an
important
thing
and
again,
if
it
limits
people
from
volunteering
to
help
people
in
a
situation
like
we
have
right
now
for
fear
of
liability.
J
A
Thank
you
for
presentation
very
enlightening,
very
educational.
I
always
welcome
you
folks
here
and
look
forward
to
our
continued
relationship
and
working
with
you.
We.
A
Great
presentations
today,
good
meeting
our
next
one,
is
for
your
calendar,
thursday
september
15th,
at
10
o'clock
a.m.
For
the
business
we
will
stand
adjourned.
Thank
you.