December 4, 2014 Meeting

Meeting Agenda – December 4, 2014  3:30-5:00

Location: CFO

I.   Welcome – Greg Burris & Gail Smart

II.  Update on Poverty Simulations

III. Panel Presentation: Health Care

  • Introductions & Moderator – Mike Peters
  • Panelists:
    • Kevin Gipson, Springfield-Greene County Health Dept.
    • Larry Halverson – CoxHealth
    • Jay Guffey – Mercy
    • Brooks Miller – Jordan Valley Community Health Center

IV. Questions and Discussion

V.  Adjourn

December 4, 2014 Meeting Minutes

Greg Burris, Springfield City Manager                                     Mark Struckhoff, Council of Churches

Gail Smart, City Center Christian Outreach                             Maura Taylor, Health Commission

Nate Bibens, The Network

Scott Brady, CPO Board of Directors                                       Guest:

Rob Dixon, Springfield Area Chamber of Commerce                Asher Allman, MSU Graduate Student

Brendan Griesemer, City of Springfield

John Horton, Rotary Clubs of Springfield                                 Mike Peters, Moderator

David Jayne, Central Assembly of God

Mary Kromrey, Healthy Living Alliance                                    Panel Members:

Traci Louvier, Tuthill Vacuum & Blower System                       Kevin Gipson, Springfield-Greene Co. Health Dept

Morey Mechlin, Care to Learn                                                Larry Halverson, CoxHealth

Debi Meeds, United Way of the Ozarks                                  Jay Guffey, Mercy

Rob Nelson, Marlin Company                                                 Brooks Miller, Jordan Valley Community Health Ctr.

John Oke-Thomas, Minorities in Business                              Mary Ellison, WIC Coord. Springfield-Greene Co.

Mary Ann Rojas, City of Springfield                                        Health Dept.

Cora Scott, City of Springfield                                                Staff:

Larry Spilker, Buckhorn, Inc.                                                  Janet Dankert, CPO

Dr. Mike Stout, Missouri State University                               Trent Sims, CPO

Myra Massey, CPO

 

Co-Chair Gail Smart welcomed everyone to the meeting and thanked them for attending. Co-Chair Greg Burris asked Carl Rosenkranz for a status report on Poverty Simulations.

Carl provided the following report with efforts of the Commission in bold:

Upcoming simulations:

January 26th 9-11am at Central Assembly with Central Assembly

February 10th 11am-1pm at MSU with MSU Education Department

February 13th 9-11am at Truman Elementary with SPS teachers

March 17th 10am-noon location to be determined with Springfield Chamber of Commerce

                March 26th 8-10am at First Baptist Church with Downtown Rotary Club

                April 20th 9:30am-11:30am at North Point Church with North Point Church (possibly)

                April 23rd 10am-noon location to be determined with Center City Christian Outreach

Groups OACAC is trying to schedule:

Enactus

Sparta School District

Craig Peterson

Completed simulations because of efforts from the Commission:

April 3rd with the Commission

May 13th with Greene County Health Department and Jordan Valley

May 21st with Greene County Health Department and Jordan Valley

September 22nd with Junior League

October 16th 9-11am at Missouri Career Center with the Library

October 20th 9-11am at Missouri Career Center with the Library

October 29th 9-11am at Cox North Fountain Plaza Room with CoxHealth Certified Application

Counselors

November 3rd 6-8pm with MSU Mike Stout

November 12th 9-11am at OACAC with 417 Magazine

November 18th 3:30-5:30pm at Missouri Career Center with Springfield Chamber of Commerce The

Network

Meghan is now telling newly interested groups that they are booked until March 2015 and that simulations need to be scheduled during regular business hours (8:00am-5:00pm) Monday-Friday. Volunteers are needed for each simulation. Due to a change in schedule, there is now one opening in January. Please let Meghan Visser, Program Development Specialist at OACAC, know if you are interested in assisting or know someone who would like to volunteer. Her phone number is 417-873-3372 or e-mail at mvisser@oacac-caa.org.

Cora Scott introduced Mike Peters as Moderator for today’s panel discussion about Health Care and poverty. Mike has been with the Mercy Health System since 1990 and is now its Vice-President of Government Relations state-wide. Prior to that he was an on-air radio and television personality for KWTO and KOLR. Cora asked him to introduce the panelists.

Kevin Gipson has been with the Springfield-Greene County Health Department more than twenty years and is now the Director of the Department; Dr. Larry Halverson is a family practice physician in Springfield and has been affiliated with the Cox Family Residency Program for over twenty years; Jay Guffey is Senior Vice-President and Chief Operating Officer for Mercy Hospital in Springfield; Brooks Miller is President and CEO of Jordan Valley Community Health Center; Mary Ellison has been with the Health Department since 1998 and has been Coordinator of the WIC Program since 2008.

Before beginning the discussion, Mike asked Greg to give a brief explanation of the mission of the Impacting Poverty Commission (IPC): The role of IPC is to determine why poverty trends are increasing in our community and create strategies to drive those trends in the opposite direction.

Discussion: What are significant issues faced by the under-resourced in the Springfield area for health care?

The following points were made by one or all of the panelists:

  • No insurance and little or no access to health care other than the emergency rooms of hospitals;
  • Use of emergency rooms as primary care drives up health care costs and tests are run because without a primary care physician there is no way to form a patient/doctor relationship for records and for follow-up assessment;
  • Medicaid assessments are flawed. Maximum income levels to qualify are very low, leaving most of the working poor without access;
  • Mental health care needs are not being met and there are not enough beds in the area or in Missouri and surrounding states;
  • Health care, including those on Medicaid or Medicare, needs to be planned for optimum benefit; people at poverty level have problems planning ahead because day-to-day needs are overwhelming and they can deal only with immediate needs;
  • Those between the ages of 21 and 65 (Medicare eligibility) are offered few opportunities for health care;
  • Little assistance with prescription medicine is available;
  • Oral health care is often non-existent or what does exist has waiting lists;
  • Under-resourced need case management along with emergency room services; Medicaid patients would benefit as well;
  • Most poverty is generational and will take several generations to change.

Discussion: Who bears the cost of health care for the under-resourced and how does the cost of providing this care affect the rest of the population?

  • Everyone bears the cost to cover uncompensated emergency care for the under-resourced, from insurance rates to taxes paid to the federal government; hospital administrators have challenges in meeting needs in order to keep hospitals open; uncompensated or under-compensated care “at cost” totaled $78M last year at Mercy Hospital in Springfield alone.

Greg’s question of what could be accomplished with just 1/10 of that amount generated interesting and thought provoking comments from panelists:

  • With 1% of the population spending 22% of health care dollars and 5% spending 50%, the current system is too expensive to continue indefinitely; technology has out-stripped our ability to pay; cost of medical care in the U.S. is double that of other nations;
  • Larry referred to “The Hot Spotters,” a study by Dr. Jeffery Brenner, of medical care in Camden NJ that focused on “frequent flyers.” (Read the report in the January 24, 2011 issue of The New Yorker.) He found that 1% of the 100,000 people who made use of Camden’s medical facilities accounted for 30% of its costs; model could be replicated;
  • Change the model of how care is provided making it easier for the under-resourced to take better care of themselves; focus on the high utilizers through care management and care coordination; find a way to work with OACAC, WIC, and other organizations to provide better care to the under-resourced;
  • To develop fully functional adults, change focus to prevention of illnesses through early detection and education rather than focusing on treating illnesses; the U.S. invests the least (approximately 15%-20%) in the population that can return the most, 0-18 years of age.

Discussion: What is the role of health care providers in solving the issue of poverty?

  • Develop a system that encourages people to take more responsibility for their own health;
  • Invest more in preventative care; the State of Missouri is 50th in the nation in prevention dollars, spending only $5.84 per capita for public health care; health care in the U.S. costs twice as much as other nations and has seen a 3.8% increase this year, yet the U.S. is 37th in the world in terms of health;
  • Case management is needed to ease under-resourced into preventative care; what seems a small matter to us, may seem difficult for them;
  • Springfield-Greene Co. Health Department’s WIC program has developed a nurse-family partnership program for at-risk mothers, pairing them with a nurse to provide case management through pregnancy and delivery and through age two for the infant; 3,000 births in Greene Co. per year with about half under Medicaid;
  • Catholic Charities’ program, LifeHouse, houses homeless pregnant mothers through delivery and up to one year at least, providing comprehensive services to become self-sustaining, saving approximately $100,000 in a lifetime per birth; partnerships have developed (Jordan Valley) in the recent past, providing pre-natal care for mothers on Medicaid and decreasing days in NICU dramatically.

Discussion: What are some additional preventive programs in the community that can, or are, addressing health issues that will save money in the future?

  • The Health Department piloted a program in the Weller neighborhood, sending people door-to-door to screen people for high blood pressure and to refer them for further screening and medical care,
  • Transportation for medical treatment is a problem for many; go where they live, take screenings to locations where people already congregate such as churches or Crosslines; make provisions, other than ER, for people who are working 8:00-5:00 and cannot seek medical treatment for themselves or family members during traditional hours;
  • Niche treatment is good, but continuous treatment requires doctor to patient relationships.

Rob Dixon asked if there are trends toward certain health risks in the under-resourced population.

  • Studies show when people’s income and social status increase, the status of their health improves as well; statistics have shown smoking is a major concern among this population, along with accompanying illnesses such as coronary heart disease, COPD, etc.; diabetes and obesity are also prevalent issues.

General consensus:

  • An evaluation needs to be done on where the War on Poverty dollars have been spent, what is working, and what is not working, and reallocate funds where they would do the most good. Attacking one disease or one aspect of healthcare will not solve the problem. Understand it at a deeper level. When do we do certain tests, overdo tests, overdo meds, etc.
  • Medical institutions are now being held accountable for the care that is delivered in terms of readmissions. The U.S. medical population does a lot of things well; it just has to be done the right way, do it conservatively, and do more with preventive care. In this population it is about managing and getting involved and engaging them; help them get to the right places for the care they need, not necessarily the most expensive.

Morey asked why ER prices have to be charged for everyone who comes in; why an ear infection must be charged at the same rate as a heart attack.

  • Emergency room services are the most expensive option for health care; Hospitals have an ethical responsibility to treat anyone who enters ER; because these patients frequently have no history on file, many tests must be run that would not be required if a primary care physician were involved (having a chart on a patient is much different than a relationship between a patient and a primary care physician).

Greg asked the panel what actions they would recommended for the community as a whole.

  • Find a way to meet folks where they congregate;
  • Create a high utilizer program similar to the one in Camden, NJ;
  • Look at the entire community to find the root of growing healthy people;
  • Invest in preventive healthcare for the community as a whole, encouraging better health for everyone; it isn’t just the poor who smoke or are over-weight; it is the population in general that have growing health concerns;
  • Invest in building relationships with pregnant women to encourage healthy mothers and healthy births.

Brooks summarized the issue this way, “We have become a culture that wants it all, and wants it now. We cannot separate the two populations, expecting something of them (the under-resourced) and not expect it of ourselves.”

Mike thanked the panel members for coming to the meeting to talk about the problems with poverty as they see them in their organizations.

Meeting adjourned.

The date for the next meeting will be announced.