Thursday, August 14, 2014

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson
This is the third 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

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”