Kentucky can win under federal health care reform

rules allow us to create a health system aimed at state's needs

August 9, 2010 

At issue | Aug. 2 Tom Eblen column, "Spelling out how health law will help"

The Patient Protection and Affordable Care Act of 2010 offers significant opportunities for Kentuckians to receive high-quality, affordable health care. We are a small, rural, relatively poor, conservative state where change is often resisted, rather than embraced, thus it is likely that implementing the new law in our state will be challenging and difficult.

I am concerned that resistance — coupled with insufficient vision and knowledge of what is possible — may lead us to squander this opportunity.

The new law offers many financial incentives to assist in transformation of our health care delivery system.

If we use the new money and resources to try to solve persistent problems with the same old ways of doing things, we are not likely to see improvement in the quality or cost of health care.

Thus, it is important that our health policy-makers, legislators and citizens are up to date on promising health care initiatives currently under way in many states and counties across the country.

One such initiative is the Patient-Centered Health Home for delivery of integrated, primary care. Forty-four other states have initiated demonstration projects to test this new model in various forms. The preliminary findings for cost savings and improved quality of care are impressive enough that the federal organization overseeing Medicaid and Medicare has recently released a call to states to participate in a three-year pilot program.

In this model, every patient has a designated doctor or nurse clinician to coordinate care across various specialists and services. It is a collaborative, rather than authoritarian, approach; health professionals work in multidisciplinary teams and patients and families are included as partners when making decisions and setting up treatment plans.

While we have many dedicated health professionals and pockets of great success in overcoming barriers to health in Kentucky, overall the status quo is not working very well for us.

Kentuckians are more likely to have cancer, diabetes, mental and physical disability with poorer outcomes than people who live in most other states. The reasons — environmental, psycho-social, cultural and/or biologic — are complex and poorly understood, and frankly irrelevant at this juncture.

We can blame individuals or government, pharmaceuticals or TV. But in truth, this is our problem. All of us are vulnerable to early death, injury and illnesses that in many cases could be prevented or treated more successfully.

We have a window of opportunity to make real and lasting changes to improve the system that we all rely on. To access and use wisely the funds and resources the new law offers, we need informed leadership, commitment and vision — not just in Frankfort, but in every community and county across the state.

Yes, there is a lack of specificity in some of the law's provisions, but this flexibility can be beneficial because it allows states to tailor the provisions with the methods and means we choose to meet our unique needs. This makes the need for local leadership and involvement of citizens in the implementation of the law even more important.

I realize some of our citizens oppose the legislation, and some will use their time and energy to block its implementation. Yet, I feel certain that the vast majority want a health care delivery system that is safer, cheaper, less fragmented, easier to access, less frightening and more conducive to healing.

When I hear someone claim we have the best system in the world, I assume they have not experienced a major illness or injury in the last decade.

Today the reported cases of deaths due to hospital-acquired infection, injury and medical error are the equivalent of several major jet liners crashing every week. If the deaths caused by our broken health system were as obvious as those of a poorly engineered airplane or inefficient airline, I know the citizens would be demanding change and reform.

Go to,, the Web site of the Friedell Committee for Health System Transformation. Here you can access resources to learn about the characteristics of high functioning health care systems, the values Kentuckians have identified to guide reform in our state and the role of citizens and communities in changing our health system.

Let us work together to create the very best health care system for ourselves, our families and generations to come — not just because there is a new law, but because it is the right thing to do and the system has been broken for a very long time.

Judy Myers, a Louisville registered nurse, is co-chair of the work group on the Patient-Centered Health Home, part of the Friedell Committee for Health System Transformation.

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