The Missouri Foundation for Health recently tightened up its strategy and focused on new priorities, said president and CEO Robert Hughes.
Under the foundation’s new strategic plan, the first priority is to get more people health insurance coverage. The second is infant mortality, third is oral health and fourth is childhood obesity.
The foundation awards about $40 million annually to address these and other health issues.
“We think each one is a critical issue to improving the health of the St. Louis region and the whole region we serve,” he said.
Missouri has a 6.3 percent infant mortality rate, which is below the nation’s 6.7 percent rate. However, Missouri’s infant mortality rate for African Americans is more than twice that, with 13.3 percent.
St. Louis’ rate is also almost twice the state’s rate with 11.9 percent. Hughes said the foundation goes where people are most vulnerable, according to the data.
“These are problems that many people have been working on for awhile,” Hughes said. “Despite the good work, when you look at the data over a long period of time, we just haven’t made the progress that we need to make. So we are optimistic that we can begin to make that happen.”
Supporting organizations that are training and sending more physicians in underserved areas is another way the foundation is addressing the issue.
Lack of health insurance is another part of the problem. However, even those with insurance have to deal with confusing bills and obscure processes for charging patients.
Recently, the Obama administration released information on how much hospitals are charging for services, as part of efforts to make the health care system more accountable. The study looked at the top 100 most frequently billed discharges at 3,000 U.S. hospitals and found significant differences in what St. Louis hospitals are charging patients.
Looking at that study, Hughes said there weren’t any surprises for him. The figures represented both information about what Medicare paid as well as what the hospitals charge, “which is kind of like the list price if you go to an auto dealership,” he said.
“Unfortunately, the people who were most at a disadvantage were the people who don’t have health insurance,” Hughes said. “People who have health insurance have a third party who negotiates with the hospital.”
Medicare has a lot of bargaining power as well, he said, and it pays much less than list price.
“Who loses out in this system?” he said. “It underscores that our basic way for paying for health care in this country, as almost everyone acknowledges, really needs to change. Some of that is beginning to happen.”
Over time, the incentives in a predominately fee-per-service system lead to higher prices, he said. Through some experimentation in pilot projects and ongoing assessment, the country will have to figure out how these different paying processes for health care affect both cost and quality, he said.
“Ultimately what we as a society want to pay for is higher quality of health care – higher value for our dollar,” he said. “That’s going to take a while.”
Patients who don’t have health care can ask to negotiate their bill for services with a hospital representative. However, that’s hard to do on the back end, he said.
Hughes said he’s excited about the roll out of the state health insurance exchange, which is part of the federal Affordable Care Act. The exchange offers all residents an online marketplace for buying private health insurance plans. Under the health care law, the federal government will create exchanges for states that don’t create their own – and that includes Missouri. Enrollment begins in October.
Some Missourians are eligible for subsidies to offset the cost of the insurance. Subsidies are available to those earning between 100 and 400 percent of the Federal Poverty Level (FPL).
Currently 19.3 percent of St. Louis city’s population and 11 percent of St. Louis County’s population are uninsured and under age 65. More than 40 percent of those individuals are eligible for some kind of subsidy.
Having a heavy hand in preventative care is another way the foundation can keep patients out of the hospitals.
Last year, the foundation gave $1 million awards to four food banks, including one in St. Louis, to promote access to healthy food. This builds into the foundation’s work on childhood obesity.
He offers simple advice for parents with overweight children.
“Being physically active is number one,” he said. “Small changes are worth while, whether in food or healthy activity. If you can make just one of the meals a healthier meal, if you can get out and walk in the neighborhood, those things all add up and make a difference.”
