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.”
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