Is your State ready for the Hurricane? Dr Rebekah Gee, Louisiana Commissioner of Health

Dr. Rebekah Gee – Louisiana State Health Commissioner

[Music]

Mark Masselli: This is Conversation s on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, we are seeing yet another devastating storm of
epic proportions. We haven't even begun to ade quately assess the damage of
Hurricane Harvey on Texas . A nd now a week later, we are watching a powerful
category five hurricane plow through the Caribbean and the track of the storm
that head s straight for Florida and points north .

Margaret Flinter: We ll, we are concerned about the effects of such storms on the
U.S. w e also keep in mind the smaller countries who are far more vulnerable in
many respects and will be dealing with the aftermath for years to come.

Mark Masselli: The kind of coordination re quired with these two back to back
storms is impossible to calculate and the health impacts could be enormous.

Margaret Flinter: Well, relief agencies are already stretched the capacity , t his
new assault on Florida and the East Coast will tax the system and the people
who staff them even further as regions b race for the worst. And that brings us to
our guest today, Dr. Rebekah Gee is the Secretary of the Louisiana Department
of Health.

Mark Masselli: Dr. Gee is a real leader and I am looking forward to that
conversation, and she will be talking about lessons learned from Hurricane
Katrina as well as subsequent weather events, and how that has helped them
plan a storm preparedness protocol that other states might learn from, really
looking forward to thi s timely conversation, Margaret.

Margaret Flinter: And Lori Robertson will be stopping by, the Managing Editor of
FactCheck.org.

Mark Masselli: But no matter what the topic, you can hear all of our shows by
going to www.chcradio.com . And as always if you have comments, please e - mail
us at [email protected] or find us on Facebook or Twitter, we love hearing from
you.

Margaret Flinter: We’ll get to our interview with Dr. R ebekah Gee in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

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Dr. Rebekah Gee – Louisiana State Health Commissioner

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. The
Senate Health Committee undergoing two days of hearings on Next Steps for
Health Reform , several other nation’s insurance commissioners and several
governors testifying before the bipartisan committee on ways to stabilize the
insurance marketplaces. It has been a nascent effort at seeking some bip artisan
solutions to the health reform conundrum. Many of those testifying asking for
Congress to automatically boast through the cost sharing subsidies which allow
insurers to keep premium prices and out - of - pocket cost s lower for consumers
purchasing ins urance on the exchanges. Tennessee Insurance Commissioner
Julie McPeak telling the committee the cost sharing reduction payments are not
handouts to insurance companies, there are important cost control measures and
market stabilizers. The Trump Administ ration has cut funding for advertising for
the insurance marketplaces by 90% over the last year’s budget and has
shortened the enrollment period in half. There is little time for the S enate to act
and it's uncertain if they will in time. The state insura nce commissioners have
until the end of the month to separates for next year.

It's a known fact when it comes to mental health services many Americans are
accustomed to going without or long wait times to see a behavioral specialist,
and if you are gettin g your insurance on the insurance marketplaces, you are
having an even tougher time . A pparently , a ccording to an in - depth investigation
by Health Affairs the statistics aren’t good, on average exchange plans cover just
11% of mental health providers in th eir states more than half of psychiatrists
aren’t part of a single exchange plan. And among mental health providers who
aren’t doctors less than 20% were part of any plans network. I am Marianne
O’Hare with these Healthcare Headlines.

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Mark Mass elli: We are speaking today with Dr. Rebekah Gee, the Secretary of
Louisiana Department of Health which oversees the State ’ s Public Health
Initiatives as well as Medicaid. Dr. Gee is also a practicing obstetrician,
gynecologist, having served as Director of the State ’ s Birth Outcomes. She
earned her Master ’ s in Public Health from Columbia University, her Medical
Degree from Cornell and did her residency at Brigham and Women’s Hospital in
Boston. Dr. Gee, welcome back to Conversations on Healthcare.

Dr. Rebekah Gee: Thank you, Mark.

Mark Masselli: Well, first of all, we are so pleased to see that Louisiana seems to
be out of the direct path of Hurricane Irma and was spared the worst of Hurricane
Harvey, but you have some significant experience with th e effects of massive
storm , with Hurricane Katrina never far from mind, and more recently the 2016
storm that really deluge d the Baton Rouge area . A nd I am wondering if you
could share with our listeners, what are the public health steps that you ’ ve taken

Dr. Rebekah Gee – Louisiana State Health Commissioner

and what has your state done that other states should learn from in preparing for
these incredibly potent storms?

Dr. Rebekah Gee: Sure. Well, Mark, for those who live through Hurricane
Katrina, their lives will always be punctuated by before the storm and after the
storm . You know there were many mistakes made, some of them were just
because no city of that size had endured a hurricane disaster of that proportion.
25,000 individuals had to be evacuated post storm, almost 2,000 people lost their
lives . Since then what we have done is a number of things, first and foremost,
develop ed a network. In Katrina, there was a lot of communication going in
different directions, but there was not the ability to confirm , there was not an
ability to coordinate, w e didn’t have a disaster response network. We now do.
We have a central command. I have what we call our EOC Operations Center
where we coordinate all of the healthcare activities for the S tate . W e are able to
far and advance of the storm assist facili ties with evacuation plans, make sure
that they have their generators , what they need to weather the storm or to leave
for the storm, we are able to coordinate. And we also focus on pre - storm
evacuation . S o prior to Katrina, folks hadn’t experienced that level of
devastation , take the evacuation order s as seriously now . W e really insisted
everyone leave and we have a very robust medical institution evacuation plans
that include s making sure that every facility has the ability to evacuate. So we
now have Medical Special Needs Shelters.

So prior to the storm, we would have medical staff that would show up and assist
in the general shelters so what we learned was that you have a lot of vulnerable
individuals those who are getting common community based ser vices, some of
them need a higher level of care, a nurse to care for them during the day and so
we setup Special Needs Shelters. We have a mega - shelter now in Alexandria
and we also one in Baton Rouge that we can setup and maintain and staff . A nd
so we n ow plan for that. We also have people who are assigned to sheltering
duties, assigned to medically fragile. And we also finally have a much more
robust command of the data. We use our data to know where people are on
before the storm who are fragile, we make sure that they have an evacuation
plan, we have a much better handle on where people are.

Margaret Flinter: Well, Dr. Gee, we have issues related to people having gone
without prescriptions, we cannot ignore the mental health issues. Maybe you
cou ld talk with us a little bit about what health issues you expect will a ffect the
victims of Hurricane Harvey, and how are State Health Departments helping
each other really rise to the challenges that we think we ’ re obviously going to be
seeing more of?

D r. Rebekah Gee: So I just got off the phone my Secretary Philip, Florida’s
Department of Health, and we spoke about the need to help each other out
because unfortunately with the climate changing in our globe, we expect these
events to happen. We have to expect that these things may happen with more

Dr. Rebekah Gee – Louisiana State Health Commissioner

regularity and unfortunately on the coasts, we are all in the same boat. We were
very fortunate with Harvey that the storm did not hit Louisiana so we were in a
very good position to help our brothers and sis ters in neighbor ing Texas. Around
95% of the people who came into our shelters are Texas residents and we ha d
about 1,900 Texas residents in Alexandria, 60 of those with medical needs. So
when we look at folks the most common thing that happens and we sa w this in
the flooding in the Baton Rouge area last August is that individuals leave quickly,
they leave without their prescriptions, with out durable medical equipment and so
we have now plans in place to make sure that they are able to resale their
prescr iptions even if they are not due. And we workout the ability to cross state
lines in terms of providing medical care . S o those things are fairly seamless.
Unfortunately, we get to dust off these plan s a little bit more regularly than we
would like.

Mar k Masselli: You know, I am wondering is really the sort of this focusing on
providing health services and have you seen any technology assisters out there
that might be helpful to managing populations and keeping track of them as
anything new in terms of technology that might also give some assistance in
disasters like Hurricane Harvey?

Dr. Rebekah Gee: Sure. So we ’ ve seen significant advances in healthcare
technology and purely with record keeping because the most important thing in a
storm is knowing where your vulnerable population is and having confirmation of
whether they have been able to evacuate. So we now have a single point of
entry to report medical assets and also to report medical needs. We have a
registry that identifies where every vulne rable individual is in areas that are high
risks. And so the advances in IT structure with the single data point of entry
allow us to know where people are, what their needs are. And it also allows
hospitals to report their capacities whether their gener ators are up and running,
how many beds are filled with that particular hospital so that we can plan in the
condition of an evacuation, grant management system , post - storm so that we
know where the moneys are coming in and how to distribute them. So we ar e
much more prepared from a data standpoint.

Margaret Flinter: Dr. Gee, we had f ormer Louisiana Health Official, Dr. Karen
DeSalvo on this show , s he talked about one the casualties of Katrina and how
the state rebounded from what was the loss of certainl y millions of paper and
health records, and says that it [inaudible 00:09:54] dramatic shift in your state to
the use of electronic health records. And other s talked about the impetus that
Katrina gave to really developing a more robust primary care syste m really
implementing a stronger primary care structure. I mean i f you like to share with
us a little bit about some of the progress in that area that your state undertook .

Dr. Rebekah Gee: So in the wake of Katrina, we develop ed new and robust
primary care facilities in the New Orleans area a nd I think more importantly was
the decision that Governor Edwards made which is to expand Medicaid. Here in

Dr. Rebekah Gee – Louisiana State Health Commissioner

Louisiana, we have a large number of working poor folks who one of four of them
were uninsured, no way to access primary care except for if they went to charity
facility or an emergency room. Now nearly 440,000 adults many for the first time
in their live have access to primary care and we know that over a 100,000 of
them have received preventive health serv ices, tens of thousands have gotten
colonoscopy, 19,000 women have gotten diagnostic breast imaging, 3,000 adults
being treated for diabetes, over 30,000 were treated for depression or mental
illness and that’s something that we realize post - storm when the y have lose their
home, lose everything they have worked for. That sometimes potentiates mental
illness and stress and so having a whole system of care where they have
insurance, can go to a federally qualified health center, have a medical home and
has b een a real [inaudible 00:11:19 ] for Louisiana.

Mark Masselli: We are speaking today with Dr. Rebekah Gee, the Secretary of
the Louisiana Department of Health which oversees the State ’ s Public Health
Initiative. Dr. Gee, another storm is brewing in the a rena of health policy in this
country . W e watched just the congressional leaders and the White House
attempted to repeal and replace the Affordable Care Act, other backing session
looking hopefully for a new approach. I am wondering what your thoughts ab out
that and as you mentioned Governor Edwards really stands out as a real leader
in making the expansion you talked about. Tell us about the state ’ s infrastructure
to manage 400,000, what strains have that have put on the system?

Dr. Rebekah Gee: So we have had actually very excellent results in terms of
primary care visits in the first year and half of our program. We ’ ve made sure
that our managed care companies assign every members to a primary care
practitioner . W e ’ ve done education and to make sur e that people know that they
have an opportunity to receive primary care. We are in the middle of working on
a system of care we design ed that focused on primary care, we are looking at
hospital rates and things that would potentiate our ability to incent ivize primary
care including looking at Accountable Care models. On the legislative front, I do
think this is a good time for bipartisanship. We are seeing that the federal
overhaul legislation has failed, we have seen the 11 governors including my own
J ohn Bel Edwards who assigned bipartisan letter talking about the fundamental
principles for health reform. And I am very optimistic that that the bipartisan spirit
will continue. What we ’ ve seen out of the federal proposals so far is very
disappointing , w hat they don’t address are the fundamental drivers of cost what I
see as the biggest challenge i s the overall cost of care. We spend double what
other countries that are developed spend on healthcare and we don’t have as
good as the outcome, we have poor diabetes, and we have poor obesity
numbers and our behavioral health problems are more robust.

So we are failing to deliver prevent ion care and we are failing to deliver health so
we need to deal with some of the fundamental cost drivers. One of the maj or
ones is pharmaceutical cost who right now the taxpayer has to shoulder the
burden of whatever pharmaceutical industry wants to charge for their drugs, that

Dr. Rebekah Gee – Louisiana State Health Commissioner

results frankly in lack of treatment and/or higher cost to the healthcare system,
and because the se pharmaceutical prices are just so high. So we are
addressing that, we are working with the National Governors Association on
some works that would lead to some different proposals. For some of the se
drugs that are really common, a good example is Hepa titis C where you have in
our state 70,000 people with Hepatitis C and in the Medicaid program, we only
treated 320 of them last year. People also spend a lot of money at the end of life
and for care that they might not even want. People tend to want to die at home,
but we do all sorts of very intensive things to them at the end of their life. And so
what we really need is the very robust discussion about what we can do to get
the cost of healthcare down . W hat happen ed in the Congress this year was a
re ally discussion about block granting and other mechanisms that would
fundamentally result in decrease d coverage and then millions of people losing
their healthcare. Let’s focus on the things that will bring greater value to this
discussion like how do you cover these people and cover them at a lower cost,
how do you promote healthy behaviors, and so those are all really important
discussions that I really look forward to having over the upcoming year.

Margaret Flinter: I want to look at something that I think has been a success and
cause for optimism in Louisiana and that’s the very successful public health
initiative that you ’ ve overseen as Director of the Birth Outcomes Initiative with a
goal to decrease infant mortality rates statewide, and we would be really
interested in hearing from you on some of the strategy and tactics that you
deploy to address birth outcomes.

Dr. Rebekah Gee: I am an obstetrician and continue to see patients and so I
th
would have to come up with some thing s that would the state out of the 50
grade that we got and save baby ’s life, and to help deal with health disparities
and help deal with infant mortality. So we sat on a very strategic course for
things that would work to reduce prematurity and to reduce infant mortality or t he
number of babies who die before year one. And we said about statewide by
educating hospitals, nurses, primary care clinics about what they could do, we
spearheaded healthy babies are worth a weight along with the March of Dimes
which ended – effectivel y ended the practice of elective inductions before 39
weeks in Louisiana. We have worked on getting women progesterone , women
who are high risk who have had a preterm baby before we were doing horrible at
that. We have quadrupled the number of women who get progesterone. We
also focused on women would have be health y going into the pregnancy and the
women would time their pregnancies for when they were ready. We had a 25%
drop in infant mortality in Louisiana last year that is much higher than the natio nal
average of 15% drop over that time.

Margaret Flinter: Yeah congratulations .

Dr. Rebekah Gee: We made progress. There were 92 fewer, fewer African -
American babies who died if that’s just the continued in that way and a 160

Dr. Rebekah Gee – Louisiana State Health Commissioner

overall fewer babies who died during that period . S o we are really proud of th o se
results.

Mark Masselli: I know certainly the country as a whole is looking at the
devastating impact that the opioid crisis has had causing so many accidental
deaths in this country and that coupl ed with the obesity epidemic which is
impacting the third of the nation’s children. And I believe obesity numbers maybe
somewhat higher in the south, but I wonder if you can just talk a little bit about
how you are thinking about these two chronic and com plex health problems and
any strategies that you might have cross - walked over from the greater results
that you were just discussing?

Dr. Rebekah Gee: Sure. Well, let me start with the hard one which is obesity.
We are the most obese state in the natio n. The number of obese people in our
state I feel are [inaudible 00:17:20 ] over 16 times. It's also – we have also some
of the best food in this country and in the world. People come here to eat our
food. So this is a behavior and behaviors that ’s toug h to change. So our well
a head program w as recently awarded one of the National Awards for Best
Prevention Programs of any State Health Department in the country and this
designates well spot s and community organizations, businesses that were like to
be e ncouraged and recognized for healthy behaviors and promoting healthy
behaviors, get a well spot designation. So that’s been a great success. Another
big challenge is smoking frankly, and the cost of caring for adults who smoke is
tremendously high and we still need to do a better job getting smoking rates
down. So in opioids we have had tremendous success with legislative session
because this ha s come to such ahead we first started to see at a couple of years
ago with increasing rates of what we called N eonatal Abstinence Syndrome. And
the real crisis has really just been mounting and last year for example in East
Baton Rouge we saw more overdose deaths and all motor vehicle deaths and
homicide deaths combined.

And so our legislature, our medical associ ation and our Medicaid program along
with Blue Cross Blue Shield have partnered to do some very powerful things.
One is that we set seven - day limit. We know that 80% of the people who are
addicted to heroin start on an opioid. So part of it is just decr easing the number
of people that ever get a long - term opioid prescription and have a chance to get
addicted. And we also had created a 13 - member advisory council in heroin and
opioid prevention, we strengthened our Prescription Monitoring Program, we also
made mandatory medical training for docs so that they know the impact of the
opioid epidemic and have more education on addiction. You know when I went
to medical school we didn’t get any training on addiction, addiction treatments,
you know painless tha t fits vital signs, which hold the treat pain. We didn’t think a
lot about the ramifications of our actions. We prescribed opioid s . So this is a
really a see change in terms of mandatory education and I think this will result in
much better outcome to t he people of our state.

Dr. Rebekah Gee – Louisiana State Health Commissioner

Margaret Flinter: We have been speaking to Dr. Rebekah Gee, Secretary of the
Louisiana Department of Health. You can learn more about the department’s
work by going to their website www.ldh.l a.gov or you can follow Dr. Gee on Twitter
@rebekahgeemd. Dr. Gee, thank you so much for the incredible work that you
are doing and for joining us on Conversations on Healthcare today.

Dr. Rebekah Gee: Thank you Mark and Margaret.

[Music]

Mark Massel li: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy,
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit c onsumer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what have you got for us
this week?

Lori Robertson: Many readers have asked us whether the herbicide glyphosate
causes cancer. The short answer is that there is evidence to suggest it may
cause cancer at very high doses, but not at the low doses typically found in food.
Our readers often sighted an article on www.foodbabe.com which outlines the
reports that found “alarmi ng” levels of glyphosate the most used herbicide by
volume in 2015 in various brands of cereal, cookies, chips and crackers . In
2015, the International Agency for Research on Cancer did classif y glyphosate
as “probably carcinogenic to humans ” . But in 201 6, a group of pesticide residue
experts at WHO and the United Nation also concluded that glyphosate is
“unlikely to post a carcinogenic risk to humans through their diet” . Those
conclusions aren’t as contradictory as they seem. The 2015 conclusion aims at
identifying any potential cancer hazard. But the 2016 assessment looked at
actual cancer risk of the herbicide at a specific level of exposure. Using a strict
standard from the European Food Safety Authority, a 175 - pound adult could
ingest nearly 40 mg of glyphosate a day without a risk of developing cancer.
Alternatively, a child of half that weight could ingest 20 mg of glyphosate a day,
how does that compare to the amount of glyphosate the report highlighted by
Food Ba be found in cereal and other foo d s . In order to max out an acceptable
daily intake a 175 - pound adult would have to eat more than 1,270 serving s of
cheerios a day. So yes , glyphosate i s found in some food, but experts believe
those doses of the herbicide don’t pose a cancer risk to huma n s . There is more
information about several studies on glyphosate on our website at
FactCheck.org. I am Lori Robertson, FactCheck’s Managing Editor.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political pla yers and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we will have FactCheck.org’s, Lori
Roberts on, check it out for you, here on Conversations on Healthcare.

Dr. Rebekah Gee – Louisiana State Health Commissioner

[Music]

Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives. It's a known fact
that the current gener ation of American children is more obese than any previous
generation. And at a Washington D.C. Community Health Center Unity Health
Care, a pediatrician was in a quandary over how to tackle this growing health
scourge . He began with the unique solution targeted to a teen patient whose
body mass index had already landed her in the obese category. What he did
was write a prescription for getting off the bus one stop earlier on a way to school
which made her walk the equivalent of one mile a day. Dr. Robe rt Zarr of Unity
Community Health Center understood that without motivation to move more kids
just might not do it. The patient complied with the prescription and has moved
from the obese down to the overweight category. He then decided to expand this
pr ogram by working with the D.C. Parks Department mapping out all the potential
walks and play area kids have within the city’s parks.

Dr. Robert Zarr: How to get their parking? Is parking available if someone is
going to drive? Bike racks, there is a se ction on pets park safety.

Margaret Flinter: Dr. Zarr writes park prescriptions on a special prescription pad
in English and Spanish with the words Rx for outdoor activity and a schedule slot
to ask when and where will you play outside this week?

Dr. Ro bert Zarr: I like to listen and find out what it is my patients like to do and
then gage the parks I prescribed based on their interests, based on the things
they are willing to do.

Margaret Flinter: With some 40% of his patient population grappling wit h
overweight or obesity, he wants to make the prescription for outdoor activity
adaptable for all of his patients and adaptable for pediatricians around the
country. And one day, he liked to be able to track his patients’ activities in the
parks. Rx for outdoor activity, partnering clinicians, park administrators, patients
and families to move more yield ing fitter, healthier, young people. Now, that’s a
bright idea.

[Music]

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Dr. Rebekah Gee – Louisiana State Health Commissioner

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the
Community H ealth Center.