Women leading Ky. Health

This is the last in a series of stories about four high-ranking female state officials who have guided the state’s embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

How does a person create lasting change in an ever-changing political environment? “Bake it in,” says Audrey Tayse Haynes.

As secretary for the Cabinet for Health and Family Services since 2012, Haynes has led the state’s efforts to implement the federal health-reform law, dealt with the controlled chaos that was thetransition to managed-care Medicaid and faced controversies in the social-services system. Now, with less than 16 months left in Gov. Steve Beshear’s administration, she wants to make big improvements in the state’s behavioral-health system.
“We want to get as much (done) as we can get and we want to get it baked in,” Haynes said, “so hopefully the next person that comes will be as enthusiastic about building on the foundation that we have laid.”
Haynes brought more than 25 years of leadership experience to her job, including appointments under three earlier governors. From 1997 to 2001, she was deputy assistant to President Bill Clinton and director of the Office for Women’s Initiatives and Outreach, then special assistant to Vice President Al Gore and chief of staff for Tipper Gore. For the next decade, she was senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C.
She says her personal style of leadership – “collaboration, inclusion and transparency” – took her staff a while to get used to, but is paying off with results.
“I’m all about forcing people to work together and trying to figure it out because you get a better product,” she said. “We don’t sign things around here unless it’s been vetted through the agency that it is going to impact. It took a while for people to get used to that.”
At her recommendation, Beshear named Carrie Banahan to run the state insurance exchange, Kynect, which has enrolled 521,000 people and become the nation’s model of how to run a successful exchange.
“We all collaborate and all work together,” Banahan said in a separate interview. “Audrey has comprised a good team in the cabinet and we support her 100 percent.”
“I couldn’t get a better boss,” Public Health Commissioner Stephanie Mayfield said in a separate interview.  “She is genuinely concerned about not just her employees, but the health of the public.”
Haynes said the expanded access to coverage under health reform will improve the health of Kentuckians and the state’s health statistics, something employers consider when choosing sites.
“Kentucky has worked so long and hard on building a better, more educated citizenry, so that we (can) recruit more industry and have a stronger economic development base. I believe that is important,” she said. “But equally as important is that we have healthy employees. … I do believe that our state will see many, many benefits from this.
Health reform has been the most controversial domestic issue of the last few years, but for many people in the health-care industry, there has been more tooth-gnashing over the managed-care Medicaid system that began several months before Haynes became secretary.
Managed care, in which insurance-company subsidiaries get a certain sum per patient and increase their profits by controlling costs, “has not been a walk in the park to implement,” Haynes acknowledged. Providers have complained about slow payment and rejection of claims, and one managed-care firm left Kentucky, saying the state gave it misleading financial information.
She said all involved had to “stop, take a breath and stop screaming long enough to sit down and honestly work through the problems. . . . We have just forced people to the table month in and month out to work out these issues.”
Haynes began collaboration with providers and managed-care firms, and held public forums for all stakeholders to ask questions and get answers. It recently started a second round of forums, and she says things are much calmer now, almost three years after managed care began.

“Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” she said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act.”
The next big frontier in managed care is integrating behavioral health with physical health, she said. Noting that more behavioral-health providers are now eligible to receive Medicaid reimbursements, she said that increases accountability toward better outcomes for such patients.
Haynes has little more than a  year left to “bake it in,” because Beshear cannot seek re-election. She acknowledges that the changes in healthcare are “turning people’s worlds upside down.”
“There are a lot of changes going on, and they are not going to be able to just move on a dime,” she said. “So we have to be able to push, cajole, be patient, teach and then repeat all of that constantly.”