By Sally McMahon

The Health Enterprises Network Health Policy Forum is a group of healthcare executives and professionals who meet regularly to hear about key issues and legislation related to the region’s health-related economy.

The Forum, held virtually in early May, was sponsored by Circulo Health, a new company based in Columbus, Ohio focused on bringing innovation to Medicaid Managed Care. Tom McMahon, JD/MBA, the go-to-market leader at Circulo Health, said we should focus on, “How are we – the broader ecosystem of providers, payors, public officials and advocates – looking attechnology, looking fortechnology, buildingtechnology assets and finding ways to safely/reliably deploy technology to better serve the Medicaid population? And how are we using technology to reduce staffing burdens and find economic efficiencies in the system?”

The forum featured Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services (CHFS). Friedlander has spent 35 years in public service, most of them with CHFS. He served previously as CHFS deputy secretary in the administration of Gov. Steve Beshear, a position in which he helped lead and manage successful implementation of the Affordable Care Act and transformation of Kentucky’s healthcare delivery system. Most recently, he served as chief resilience officer for the Louisville Metro Office of Resilience and Community Services.

Scope of Work

Friedlander summarized the scope and mission of CHFS, which employs more than 8,000 people across the commonwealth. Friedlander said that close to 1.6 million people in Kentucky receive healthcare coverage through Medicaid, or one in three Kentuckians. About 6,000 Kentuckians receive assistance through the Supplemental Nutrition Assistance Program (SNAP), many receive childcare and over two million meals are served through the senior meals program. There has been an increased need for services in behavioral health and substance abuse during the pandemic.

A large focus at CHFS has been on public health, especially in the past 18 months. Friedlander said, “When you compare Kentucky to the nation or the region, we are punching above our weight in terms of vaccinations, testing, low positivity rates–all things you want to see in a public health response.”

Medicaid Update

During the COVID-19 state of emergency, individuals younger than 65 without medical insurance can request temporary coverage under Kentucky Medicaid presumptive eligibility. 

Friedlander said, “This presumptive eligibility is at a level unusual for a state. We may be the only state providing it at the state level.” Close to 100,000 people receive coverage through the presumptive eligibility program and Friedlander said, “Now that we have an open federal healthcare exchange, we are going to transition as many folks over to exchanges as we can.”

Pandemic Response

The Cabinet has developed and nurtured partnerships during the pandemic with the Kentucky Hospital Association, long-term care associations, and hospitals such as Norton Healthcare, UofL and UK. Friedlander said, “We need to continue and build upon those partnerships so we can move the health needle in Kentucky. It’s a shame that we have one in three Kentuckians receiving coverage through Medicaid and an $18 billion Cabinet and we still struggle to move the health needle.”

Inspired by his time on Mayor Greg Fischer’s administration, Friedlander said, “We talked about individuals and communities living to their full potential in the Fischer administration and now we are bringing that vision to the Cabinet.” Four pillars guiding the Cabinet are equity (racial equity, rural vs. urban), resilience (trauma and secondary trauma), structural economic support and health and wellness.

Structural Economic Support

Friedlander referenced the economic impact of programs such as the WIC Program, a nutrition program for new mothers and infants. Friedlander said, “WIC has done a study that said for each dollar that goes into the community it generates $9 of economic activity. These programs make a huge difference in the local community.”  

As for Medicaid, Friedlander said, “Without Medicaid our entire system would collapse. When you consider Medicaid expansion, for every 20 cents Kentucky spends, we get 80 cents back from Federal government.” Friedlander considers that an intelligent way to bring additional federal dollars to the state.

Lessons Learned

Friedlander said they have learned to work differently during the pandemic. During the pandemic 90 percent of Cabinet employees worked from home. He said, “We are working much more efficiently than we ever have. In February 2020, we had a call line with 4,000 calls a day with wait times of 10-12 minutes. Now we answer 10,000 calls a day with call wait times of 1-2 minutes. We didn’t do much different, but it’s just that we are more efficient and effective from home.”

The big lesson learned during the pandemic related to the strength of community. Friedlander said, “Through a pandemic, any time something impacts one of us in the community, it really does impact us all. We need to think about from resilience perspective. When you have a community, it is the weakest part of the community where the chain breaks. It is important to understand how to strengthen that.”