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Update: KS House passes KanCare expansion bill today 69-54

Hutchinson radio station KWBW host John Brennan this morning interviewed Hutchinson Regional Healthcare System President/CEO Ken Johnson, Health Fund President David Jordan, and Horizons Mental Health Center CEO Mike Garrett to explore current healthcare challenges and increase awareness and understanding of the impact Medicaid expansion would have on our communities and our state. The recording is available here – read on for some quick highlights.

[Jordan] Up to 150,000 Kansans stand to gain coverage from this policy change but it also means we’d be bringing back $1.9 million/day from the federal government to pay for it – so it would be done in a very budget-neutral way for Kansas.

[Jordan] It will protect hospitals like Ken’s [HRHS], but really a lot of the hospitals out west that depend on Hutchinson to provide that more complex care – they’re in dire straits, financially vulnerable. Half of the uncompensated care costs they have would be wiped off the books if we expand Medicaid. So it would shore them up, make those communities healthier, and really stabilize property taxes.

[Jordan] It’s also going to create jobs. KS does a lot to create jobs in communities across the state and this is really a significant policy change that’s not going to cost the state much – not a lot of economic incentives that will have to be put on the table. But it’s really about helping our neighbors be healthier.

[Brennan] Go back to what you said about stabilizing property taxes – tell me what that means.

[Jordan] If you look at the math across the state, the highest rates of uninsured people in KS are in western KS communities, rural KS communities. So you have uninsured rates as high at 18%. Those people are going to hospital emergency rooms. In order to make sure those hospitals can stay open, a lot of western KS communities are supporting those hospitals with property taxes.

Listen to the full interview for more from Ken, David, and Mike on challenges in the healthcare system and the impact of KanCare expansion on health in our state.

A new brief from KAC and UMHMF looks at how focusing on our children’s health from their earliest days provides not only the best lifetime health outcomes but also an incredible return on investment.

From access to prenatal care, to a baby’s first encounters with a doctor, Kansas’ Medicaid program provides for powerful opportunities to shape the lives of Kansas kids and their families. Healthy parents are more likely to engage with their young children, bolstering the brain development that is critical to the first year. States across the country are leveraging their respective Medicaid programs to shape the earliest years, reduce infant mortality, and transform outcomes in early childhood and beyond.

Some key points from the brief:

• Kids enrolled in Medicaid miss fewer days of school for illness, do better in school, and grow up to be healthier adults, among other positive outcomes
• States that have expanded Medicaid saw greater declines in infant mortality rates than in non-expansion states, and more pre-natal care for first-time moms
• Prioritizing the health of parents and caregivers ensures they can take care of themselves so they can best take care of their children
• Investments in early health interventions make good economic sense by preparing children to enter school ready to learn and lead healthy and successful lives

To learn more about the issues and abundant suggestions on how we can help the next generation thrive, please see the full brief here.

In 1986, the United Methodist Health Ministry Fund started with a $30 million endowment established from the sale of Wesley Hospital. Since that time, the Health Fund has turned that investment into more than $70 million in grants to improve the health and wholeness of Kansans.

The Health Fund, which serves the state of Kansas from its headquarters in Hutchinson, has supported more than 2,400 health projects since inception, helping drive progress especially on oral health, breastfeeding, and rural health issues. Now the organization is looking to the future, with plans to focus specifically on access to care, early childhood, and congregation-led community health projects through a program called Healthy Congregations.

“$70 million in grants is a major milestone, and it is the result of board members and staff who have dedicated themselves to the sound management of our assets and the strategic deployment of grants,” said David Jordan, President and CEO of the Health Fund. “We are positioned to make an even greater difference in Kansans’ health for generations to come.”

In addition to a three-year strategic plan focused on their three areas of work, the Health Fund recently released a new brand identity including a new logo, website, and messaging. “Our ability to communicate with and inspire our audiences is crucial for creating impact,” said Jordan. “We saw an opportunity to communicate our role and our work through a new look and better storytelling.”

For more information about the United Methodist Health Ministry Fund, the strategic plan, or the visual identity, visit HealthFund.org

About the Health Fund

The United Methodist Health Ministry Fund works to facilitate conversation and action to improve the health and wholeness of Kansans—especially those in rural and under-served communities. By funding programs, moving ideas to solutions, providing hands-on expertise, and convening influencers, we work to advance innovative solutions to improve Kansans’ health for generations to come. We steward a $55 million endowment, which has provided more than $70 million in grants and program support since our inception in 1986.

The announcement earlier this year that Mercy Hospital in Fort Scott would close by the end of the year was a surprise and shock to the community, which will lose several hundred jobs and more than a century of community health care legacy.

But it was not necessarily unexpected to those in the industry.

Many hospitals across Kansas, as around the country, have struggled the past decade with declining patient numbers amid rising costs.

According to the Kansas Hospital Association, of the state’s 127 hospitals spread across 91 counties, more than two-thirds had negative operating margins in a recent national study.

Read Full Story

By John Green, GateHouse Kansas

BY ANDY MARSO amarso@kcstar.com

While traveling through Kansas talking about health care, David Jordan has heard story after story about people drowning in a sea of medical bills they can’t pay.

So Jordan, the president of the United Methodist Health Ministry Fund, said he wasn’t surprised when one of the largest surveys of Missouri and Kansas health care consumers ever conducted showed that medical debt was one of their top concerns.

“One story comes to mind,” Jordan said. “In Pratt, Kansas, the owner of a property rental business, in the context of Medicaid, highlighted that oftentimes her tenants are choosing between paying their rent and paying their medical bills. They struggle with this decision and one month they might pay their medical bills and other months they might choose to pay their rent. As a result, oftentimes she has a third to half of her accounts defaulting.”

The survey of 4,274 people was commissioned by five nonprofit health foundations and conducted in 2017 by the Research Triangle Institute.

It found that 33 percent of Kansas kids and 28 percent of Kansas adults lived in a household that struggled to pay medical bills the year before. In Missouri, it was even more common, with 38 percent of kids and 34 percent of adults in households that struggled with bills.

Almost 20 percent of respondents in both states said they had faced financial consequences from medical debt, either asking family and friends for help, seeking personal loans or getting hounded by debt collectors.

The survey results come on the heels of an Urban Institute study released in December that showed that in some areas of Kansas City, about 30 percent of households have medical debt in collections.

Jordan said that can have a ripple effect on local economies by harming credit ratings while also making people less likely to seek medical care.

“Medical debt and lack of insurance is financially crippling families in Kansas and Missouri,” Jordan said.

The survey showed that about 20 percent of adults ages 19 to 64 in both states are uninsured, and about 60 percent of them are working. The uninsured rate in children, who are often eligible for Medicaid, was much lower.

Uninsured rates were slightly higher for black Kansans and Missourians than whites, but markedly higher — about 50 percent — among Hispanics.

“The stark rate of Hispanics who are uninsured has to be called out,” said Bridget McCandless, the president and CEO of the Health Care Foundation of Greater Kansas City.

Jordan and the leaders of the various health foundations have advocated for the legislatures of both states to expand Medicaid to low-income adults under the Affordable Care Act. A majority of states have expanded and Jordan said they have higher insured rates and lower rates of medical debt.

Medicaid eligibility in Kansas and Missouri is currently restricted mainly to children, the elderly, people with disabilities and pregnant women.

Legislators who oppose expansion under the ACA, commonly called Obamacare, have said Medicaid should remain a program for those populations. They also balked at the expense of funding expansion, which requires states to shoulder up to 10 percent of the costs.

Being uninsured is not the only factor in medical debt, though. The survey’s authors said some respondents who reported being insured also reported struggling to pay medical bills, though they had not broken out what percentage yet.

Sheldon Weisgrau, the director of a grant-funded program to get Kansans signed up for health insurance, said higher deductibles and co-pays mean even people covered under private insurance plans often find themselves with bills they can’t easily pay.

“Under-insurance is a huge problem,” Weisgrau said.

McCandless said nonprofit hospitals can help ease the problem in the Kansas City area.

As part of the “community benefit” they must show to keep their tax-exempt status, nonprofits are supposed to write off or write down some bills for low-income residents.

McCandless said she thought hospitals have improved their record of doing that, but “still have room to go.”

“As hospitals are making more financial decisions around their bottom lines, it is critical that we as taxpayers continue to make sure that that community benefit returns to the community,” McCandless said.

In addition to medical debt, Kansans and Missourians reported problems accessing some types of medical services.

Lack of dental insurance was a problem in both states, and so was access to mental health care.

People who couldn’t get mental health care said they either could not afford it, could not find a provider who takes their insurance, could not find a provider who had an opening or didn’t know where to find care.

Brenda Sharpe, the president and CEO of the REACH Healthcare Foundation, said she hoped those responses will push lawmakers to expand access to mental health.

“This is a hot topic in both states,” Sharpe said. “But we’ve seen very little action.”

MD News February/March 2018, Greater Kansas Edition

Consumer survey provides rich data on the magnitude of states’ access problems

RESEARCH TRIANGLE PARK, NC— With stakeholders concerned about rising costs and access to health care, a new study finds that roughly one-quarter of adults (ages 19 to 64) in both Kansas and Missouri, and one-third of children in both states, live in households carrying medical debt. Those percentages represent almost half a million people in Kansas and more than a million in Missouri.

An even greater share of the population had problems paying off medical bills in the past year. In addition, one in five lacked health insurance coverage. These findings—from the Kansas and Missouri Consumer Health Access Survey (KMHS)administered by RTI International—provide the most comprehensive data to date on health care access in Kansas and Missouri to inform policymakers and other stakeholders.

“This report confirms that medical debt and lack of insurance financially ruins hundreds of thousands of families in Kansas and Missouri,” said David Jordan, president of the United Methodist Health Ministry Fund. “These extreme levels of financial stress mean families avoid seeking healthcare when they need it and they miss more days of school and work. Lack of insurance is an issue that policymakers must address both for the welfare of families and the health of our states’ economies.”

The survey was funded by five health foundations that work in the two states: the REACH Healthcare Foundation; the Kansas Health Foundation; Health Care Foundation of Greater Kansas City; Missouri Foundation for Health; and, United Methodist Health Ministry Fund.

“It is critical in today’s changing landscape to have up-to-date information particularly on those most in need,” said Bridget McCandless, M.D., president and CEO of the Health Care Foundation of Greater Kansas City (HCF). “The data will help HCF identify where there are opportunities for improvement around access, affordability and the continuing unmet health needs of the Kansas City area.”

“Communities often need richer detail on access to health care and coverage in their communities than federal surveys can offer,” explained Thomas Duffy, senior survey research scientist at RTI and project director of KMHS. “The bi-state survey allowed the funders to capture consumer data from a larger geographic area and expand the list of survey questions to gain a deeper understanding of health challenges in all areas of the two states.”

The survey found that approximately 60 percent of working-age adults in Kansas and Missouri have a diagnosed chronic condition such as heart disease or diabetes, while one-third have a mental health diagnosis, substance abuse or addiction. Among those with chronic health care needs, significant numbers reported that they are going without needed care due to cost or lack of coverage. Among adults with a chronic condition, 19 percent in Kansas and 28 percent in Missouri did not get needed care in the past year. Among adults with a mental health diagnosis, 22 percent in Kansas and 35 percent in Missouri did not get needed mental health care or counseling.

“This survey raises awareness of health access needs in Kansas and also helps us understand the complex issues facing the state,” said Steve Coen, Kansas Health Foundation president and CEO. “Improving access to care for vulnerable populations is a critical component of our KHF work to improve the health of all Kansans.”

Barriers to dental care were reported by 40 percent of residents in both states, and among people of all racial and ethnic backgrounds and income levels. Access barriers to dental care were significantly higher for people with public coverage than private coverage and were highest for uninsured adults. More than 90 percent of uninsured adults in both states also lacked dental coverage; nearly two-thirds reported a dental access problem such as no dental visit in the past year or unmet dental care needs.

“People living in all regions of Kansas and Missouri reported difficulty accessing dental care, with gaps in care and dental insurance coverage cited across all racial and ethnic groups,” said Brenda Sharpe, president and CEO of the REACH Healthcare Foundation. “This ongoing high level of unmet need points to the urgency of pursuing innovative solutions for expanding the availability and affordability of dental care.”

The survey found these problems to be significantly more prevalent among low-income residents with family income below 138 percent of the federal poverty level. In Kansas and Missouri, roughly one-quarter of adults ages 19 to 64 reported family income under 138 percent of the federal poverty level. Of this low-income adult population, 44 percent of adults in Kansas and 33 percent in Missouri lacked health insurance. Of low-income adults with chronic conditions, 32 percent in Kansas and 52 percent in Missouri did not get needed care in the past year. Similarly, 34 percent of low-income adults in Kansas and 61 percent in Missouri with a diagnosed mental health condition did not get needed care.

Residents ages 19 through 64 in this income bracket would be potentially eligible for Medicaid coverage were either state to expand Medicaid under the Affordable Care Act.*

“The KMHS yields a robust picture of access issues affecting broad populations in the region and particularly for consumers below 138% of poverty,” Duffy explained. “The bi-state survey design revealed racial and ethnic disparities in access to care, particularly for Hispanic adults compared to white non-Hispanic adults, but more analysis would be needed to gain a full understanding of these differences.”

“Access to health insurance is fundamental to addressing racial and ethnic health disparities,” said Thomas McAuliffe, director of health policy for Missouri Foundation for Health. “This survey points us to some of the significant disparities communities of color face when entering into and obtaining services from the health care system. The charge is for substantive dialogue and more intense analysis to occur around solutions.”

Survey Methods
The Kansas and Missouri Consumer Health Access Survey (KMHS) focused on health and dental insurance coverage, unmet needs for chronic conditions, including mental health diagnoses, and unmet need for serious injury and prescription drugs. Adults residing in Kansas and Missouri were randomly selected to complete the survey through dual-frame random digit dial cellphone and landline sampling. A total of 4,274 adults and 1,159 children via an adult proxy were interviewed. The sample was adjusted using population weights so that estimates represent the non-institutionalized resident population in each state. The survey was administered between September 2017 and January 2018 by RTI International in Research Triangle Park, North Carolina.

Use the following links to download the KMHS Final Report, Methodology Report, Survey Questionnaire, and Presentation Slide Deck.

*Respondents reported family income based on the 2016 tax year. In 2016, the 138 percent federal poverty threshold income was $33,534 for a family of four. (Source: US Department of Health & Human Services, Office of the Assistant Secretary of Planning and Evaluation (2016). Computations for the 2016 Poverty Guidelines. Obtained from: https://aspe.hhs.gov/computations-2016-poverty-guidelines, March 22, 2018.)

Kearny County Hospital
Pioneer Care Advocacy Team

2017 Recipient
Janet Sevier Gilbreath Special Project Recognition Award

Kearny County Hospital and Rural Health Clinic draw patients from a 12-county area across southwest Kansas and western Colorado, an area with populations comprising at least 22 nationalities. The organization’s unique, mission-related recruiting practices have enabled it to expand its primary care provider capacity.   

The organization has instituted a multi-targeted approach to positively affect the health of residents in and around Kearny County.  In 2017 the Health Fund supported the salary of a Masters Level Social Worker enabling the Pioneer Care Advocacy Team to expand its level of care coordination services to the refugee and immigrant population that lives in and around Kearny County, specifically to the sizeable and culturally isolated Somali population.  The Care Coordination Team makes in-home visits, participates in patient rounds of acute care hospital patients and visits with emergency room patients who are triaged by medical providers as non-emergent.  All of these activities help reduce inappropriate emergency room visits while increasing appropriate clinic use.  This work played a significant part in reducing non-emergent visits to the hospital’s Emergency Room by 88% in a single year (from a monthly high of 110 visits down to 14).  In 2016, 168 persons received care coordination services; in 2017 that number expanded to 245.

Additionally, the care coordinators assist patients with Medicaid applications and accessing patient assistance funds so they can receive medications that are otherwise unaffordable.  The care coordination team makes referrals to community-based services and provides some transportation services to enable persons to access behavioral health services or other social services.  

Care Coordinators also advocate for their clients.  In one case an insurance company denied pre-authorized payment for a drug that would prevent a woman, with a history of miscarriage, from going into preterm labor at 22 weeks.  Had that initial denial not been overturned, it is very likely the mother would have delivered early and the newborn might not have survived or would have required hospitalization in a neonatal intensive care unit for many weeks.  That hospitalization would have been very costly to the payer, parents, and hospital. For an approximate $4,000 payment of medication to avoid preterm labor, the insurance payer likely prevented the expenditure of many more dollars for intensive care services. 
 
For these accomplishments and for the leadership and service provided in rural and frontier regions of Kansas, Kearny County Hospital is presented the 2017 Janet Sevier Gilbreath Special Project Recognition award for the work of its Pioneer Care Advocacy Team.

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Representing the project for Kearny County Hospital at the awards ceremony were Benjamin Anderson, CEO; Kendal Carswell, Director, Pioneer Care Advocacy Team; team members Katrina Brown, Karla Davila, Meredith Peters, Denise Robinson, Steve Sullivan, and Linzie Vanatta; Betty Greer, President, Board of Trustees; and Teresa Beaudry, Board of Trustees.

Awarded May 1, 2018

Learn more about the Janet Sevier Gilbreath award

By Amy Geiszler-Jones

• 

For the first time in its history, the United Methodist Health Ministry Fund has had a leadership change.

Kim Moore, the fund’s first president, retired at the end of January. David Jordan, former executive director of the Alliance for a Healthy Kansas, is the new president.

The United Methodist Health Ministry Fund was formed in 1986 by the Kansas West Conference, now the Great Plains Conference, of the United Methodist Church, using $30 million of the proceeds from the sale of Wesley Medical Center in Wichita. The Kansas Health Foundation was also endowed by the 1985 sale of Wesley Medical Center — at the time, a nonprofit hospital affiliated with the United Methodist Church — to the for-profit Hospital Corporation of America (HCA).

Moore had been working as an attorney for more than a decade at Kansas’ largest law firm — Foulston Siefkin, in Wichita — when he applied for the leadership job with the fund. A native Kansan and the son of a legislator, he felt he understood the needs of Kansans. He still maintains a small family farm near Longton, in Elk County.

“I was interested in a job where I could put my social consciousness to work more than I had with my legal career,” says Moore, who had specialized in employee benefits and tax-exempt organizations. “I felt both an intellectual and spiritual call to do this. I wanted to use a different set of my talents.”

Max Clayton, the fund’s board chair, noted Moore’s impact the following way in the release announcing Moore’s retirement: “The culture of the fund — its DNA, its way of operating and, one might even say, its personality — has been informed by Kim’s vision, passion and embrace of constant learning and innovation.”

Moore looks at his leadership tenure as having two halves: The first 15 years were focused on investing and growing the fund and laying the groundwork for some health initiatives, and the second half has been marked by a more strategic focus to accomplish specific health and wellness objectives for Kansans of all ages. Under his leadership, the fund provided more than $68 million in grants for more than 2,200 projects, according to fund officials.

In those first 15 years, for example, the fund helped spread Medicare-certified hospices statewide, Moore says.

New Fund President: David Jordan

David Jordan, the new United Methodist Ministry Health Fund President, has an extensive background in creating access to health care.

For almost two years, Jordan served as executive director for the Alliance for a Healthy Kansas, a coalition of more than 100 organizations whose top policy priority has been expanding KanCare. His previous experience includes serving as a project director for Community Catalyst, a leading consumer health advocacy group, where he led a national campaign to expand access to dental care, and as campaign director for Massachusetts Affordable Care Today, for which he directed a ballot campaign to bring about the state’s landmark healthcare law. The Massachusetts native is completing work on a Master of Public Administration degree at the University of Kansas.

Now the fund’s strategic philanthropy has three primary areas of focus: breast-feeding, early childhood neurological needs and health delivery systems in rural Kansas.

Using the World Health Organization’s Baby-Friendly Hospital Initiative list of maternity-care practices, the fund developed an initiative called High 5 for Mom & Baby to help Kansas hospitals better support breast-feeding, Moore says. The initiative launched in June 2012, and now about 80 percent of births in Kansas happen at hospitals that have adopted those five evidence-based maternity care practices, he says. The fund, working in conjunction with the Kansas Department of Health and Environment, is helping Kansas hospitals to adopt the complete list of 10 WHO-recommended practices as a second stage of the work, he says.

The fund’s current NeuroNurture campaign addresses early childhood toxic stress that can negatively “rewire” the brain in lasting ways and predispose the body to chronic disease later in life. For this campaign, the United Methodist Health Ministry Fund has joined with four other Kansas grant-makers — Kansas Health Foundation, Wyandotte Health Foundation, REACH Healthcare Foundation and Hutchinson Community Foundation. With the NeuroNurture campaign, early childhood advocacy groups are implementing a best-practice program of 10 home visits for parents of children ages 6 months to 2 years to give them techniques to help reduce the impact of stressors in their children’s lives.

“All young children in Kansas should have the opportunity to develop strong emotional and social characteristics,” Moore says of the initiative.

Healthcare delivery systems in rural areas continue to be important to ensure there is patient access and provider viability. The fund has formed a rural health network with eight western Kansas hospitals to create shared opportunities to learn and implement programs. The fund’s Healthy Congregations initiative supports United Methodist churches in organizing effective congregational health ministries to help community members. More than 70 communities in Kansas and Nebraska have such assets, according to the fund.