Impact Center for Health Policy
University of Missouri
Healthy lives, Healthy communities
News Briefs 3 | Supreme Court Ruling 8 | MOHEC Conference: Healthy lives, Healthy Communities 10 Summit 2012 16 | Health Policy Forum 17 | Healthy Community Initiative’s Dr. Casey Williams 18
Summer 2012
From the Director
Dear Colleagues and Friends,
What a summer! From the extended triple digit heat wave that gripped our state, to the intense fervor leading up to the Supreme Court’s health care decision, to the tightening of budgets in state and local governments, no one has been immune to the stressors of modern times. But even in all of these heated situations, I am continually inspired and humbled to see how Missourians have stepped up, responded, and continued to work toward better health and health care in the state. At CHP, we know that with the Supreme Court’s decision, our work is only beginning. There is such a great need to share information. In this edition of Impact, we’re sharing some of that work, as well as that of our partners. This includes the Missouri Health Equity Collaborative’s (MOHEC) health equity conference, “Healthy Lives, Healthy Communities,” described on page 10. At the conference, leading
health equity speakers, including Thomas LaVeist, PhD, and Dr. Darrell Kirch, provided rousing presentations and much inspiration to attendees to show how we can improve our community’s health by addressing the needs of all groups. In this edition, we also highlight our Missouri Health Policy Forum (see page 17), which is a free service we host for all players in the health care industry, such as providers (all types), payers, state agencies, and advocates. Finally, we share a conversation with Dr. Casey Williams, who works on the University of Missouri’s Healthy Communities Initiative (see page 18). These stories are a few highlights of the work being done this spring and summer, and I welcome your thoughts and feedback. Email us at chp@missouri. edu or send a tweet to @chpmissouri. As we look forward to fall, I thank everyone for their collective work. I know even under pressure, great things can happen.
Karen Edison, MD Center Director
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News Briefs
Impact Vol. 8, Issue 2 Published by the Center for Health Policy Karen Edison, MD Director LaRita Emanuel, MBA Administrative Associate Fiscal/Human Resources Stan Hudson, MA Associate Director Amy Lake, MS Project Director Nick Butler Project Director Candy Fincher Office Support Staff III Suzanne Hansford-Bowles, MA Senior Grant Writer Dave Zellmer Project Development Specialist Ioana Staiculescu, MPH Research Specialist Amy Dunaway, MPH, MA Stanford Griffith Jon Stemmle, MA Editors Contributors: Alex Denning, Shraddha Sankhe Photography from the Center for Health Policy, MU Health Care, MorgueFile and Deposit Stock. Impact is published twice a year by the University of Missouri Center for Health Policy. The University is an affirmative action, equal opportunity employer.
In Brief //health literacy// New Health Literacy Quality Improvement Program approved by ABIM, ABFP and ABP
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octors and health care providers seeking to improve patients’ satisfaction scores and treatment outcomes can now spend one day with CHP and learn the keys for achieving both. CHP’s Health Literacy Quality Improvement Program, launched in 2011, provides hands-on training. This program teaches the fundamentals of health literacy and clear communication for health care providers and gives them the tools and action steps to incorporate those skills into their practices. Recently, the training for maintenance of certification credits has been approved by the American Board of Internal Medicine and the American Board of Family Practice as well as the American Board of Pediatrics. “The program employs a universal precautions approach to miscommunication and misunderstanding,” said CHP Associate Director Stan Hudson. “Clear communication will be more pivotal as payment reform moves to episodebased reimbursement mechanisms. Now that the program is approved for credit, more providers will be able to maximize their already busy schedules by gaining credit while learning and working on a critical priority area.”
Participants in the program spend one day with CHP staffers and trainers in Columbia and develop their own practice plans that can be implemented upon their return home. An evaluation plan is also included in the implementation plan in order to monitor participants’ progress and successes. Data analysis and coaching are provided throughout the duration of the program and are included in the program tuition. Dates for upcoming day-long training sessions are posted on the CHP web site. Details are online at http://healthpolicy.missouri. edu.
//Health equity//
MOHEC conference focuses on healthier Missourians
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ccess to good health opportunities in all Missouri communities was foremost on the minds of the speakers and attendees of the Missouri Health Equity Collaborative (MOHEC)’s “Healthy Lives, Healthy Communities” conference on April 27 at the Hilton Continued on page 4
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News Briefs Continued from page 3
City; David Campbell, MD, MEd, Institute for Family Medicine, St. Louis; and Samantha Marquard, MSN, MPH, APRN FNP-C, Institute for Family Medicine, St. Louis.
Garden Inn Conference Center in Columbia. Leading health equity researchers and practitioners headlined the event, including Thomas LaVeist, PhD, director, Johns Hopkins Center for Health Disparities Solutions, and Darrell Kirch, MD, president and CEO, Association of American Medical Colleges (AAMC). “All of our featured speakers and panelists were outstanding,” said Nancie McAnaugh, former MOHEC project director. “With over 130 attendees, we were thrilled to raise the issue of access to good health for all Missourians and look forward to continuing our work in the coming months.” Breakout sessions included: •
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Racial and Ethnic Health Disparities with Sarah Gehlert, PhD, Brown School of Social Work, Washington University, St. Louis, and Katherine Mathews, MD, MPH, MBA, Casa De Salud, St. Louis. Behavioral Health and Health Care Access in Vulnerable Populations with Jeff Lubsen, Good Samaritan Project, Kansas City; Joe Parks, MD, Missouri Department of Mental Health, Jefferson City; and Paul Thomlinson, Burrell Center Inc., Springfield. Newcomer and Immigrant Health Disparities with Steve Jeanetta, PhD, University of Missouri, Columbia; Cathy Anderson, Jewish Vocational Services, Kansas
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LGBT Health Disparities with Sherrill Wayland, MSW, SAGE Metro St. Louis; William Snook, MS, Ed, Kansas City Health Department, Kansas City; and Jane McElroy, PhD, University of Missouri, Columbia.
Students and health professionals from around the state also presented a collection of research posters related to health equity and health disparities. The conference was sponsored by MOHEC, Missouri Foundation for Health, MU School of Medicine, MU Sinclair School of Nursing, MU Office of Continuing Medical Education, Missouri Hospital Association, Missouri Primary Care Association, MU Institute for Clinical and Translational Science (MU-iCATS), MU Master of Public Health Program, MU School of Social Work, Primaris, and the U.S. Department of Health and Human Services. Presentations are available online at healthpolicy.missouri.edu.
MOHEC’s health analysis work featured in New Orleans
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HP Research Specialist Ioana Staiculescu presented two posters at the Fifth Health Disparities Conference: Achieving Health Equity Through Access,
Ioana Staiculescu
Advocacy, Treatment and Policy Development at Xavier University of Louisiana College of Pharmacy’s Center for Minority Health and Health Disparities Research and Education in New Orleans, LA. Staiculescu’s posters were from CHP’s Missouri Health Equity Collaborative’s latest research, “Disparities in Access to Health Care Services: Perspectives from Refugee and Immigrant Patients,” and “Access to Health Care Services: Perspectives from Patients with Mental Health Illness.” “It was an energizing conference,” said Staiculescu. “There were many dynamic speakers including Dr. Thomas LaVeist who presented at our MOHEC health equity conference in April, and I had a number of attendees ask some great questions about our research projects and what we were seeing in terms of health disparities in Missouri.”
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News Briefs Continued from page 4
assistance, guidance, and information on best practices to support and accelerate provider’s efforts to become meaningful users of certified EHR technology. To learn more about MOHIT, visit http://ehrhelp.missouri.edu.
living in rural areas through telehealth technologies.
//Health care reform// The high health care costs of a small group
M //Health information technology// Meaningful money: More than 2,000 providers in Missouri receive $150M Under EHR Incentive //Telehealth// Programs Heartland Telehealth n June, the Missouri Health Information Technology (MOHIT) presentation at ATA, Regional Assistance Center launches new site
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announced that 2,107 Missouri health care providers received $150,359,246 in payments under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). “This is a great achievement,” said Nancie McAnaugh, former MOHIT project director, “and a testament to providers’ hard work and commitment around implementing electronic health records. Missouri was an early leader in achieving its goals around meaningful use and we are thrilled to be able to help providers in the Show-Me State get their best return on investment.” MOHIT is an independent, non-profit organization, providing technical
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he Heartland Telehealth Resource Center’s (HTRC) work was presented at the American Telemedicine Association’s Annual Conference in San Jose, CA. Jon Stemmle, director of the MU Health Communication Research Center, presented “Telehealth Adoption: Using Media to Gain Public Awareness,” and shared the results of the HTRC’s direct to consumer marketing efforts. Recently, the HTRC’s marketing work also expanded to include the launch of a new web site, www.HeartlandTRC. org. The new site includes resources for health care providers new to telehealth, resources on paying for telehealth technologies, and social media links. The HTRC serves Kansas, Missouri and Oklahoma, and seeks to expand access to health care for all Americans
ost Americans don’t actually cost very much in terms of health care spending dollars. A recent report from the Agency for Health care Research and Quality (AHRQ) found that a mere one percent of the U.S. population accounted for almost a quarter of all health care spending in 2009. What was total health care spending that year? $1.26 trillion. “This report hopefully clears up some misconceptions on health care spending,” said CHP Director Karen Edison, MD. “We know that only one percent of folks in poor health account for a lot of services. They tend not to be children or young adults, and they often have complex conditions that require expensive treatments. Instead of pointing fingers, we have an opportunity to look at ways to reduce costs and improve care. From a policy perspective, having this information is very helpful in making programmatic or policy decisions.” For the individuals at the top of the nation’s health care spending pool, the report states that these patients tend to be white (77.6%), female (59%) and older (42.9%). On average, each person in this top one percent costs over $90,000 a year in health care costs. Read the report at http://1.usa.gov/
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News Briefs //Cultural Humility/ Diversity// A commitment to diversity: University of Missouri Health System partners with IIH
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he importance of diversity and cultural humility among Missouri’s health care workforce was reaffirmed by committed partners this spring when the National Conference for Community & Justice of Metropolitan St. Louis (NCCJSTL) provided the Inclusion Institute for Health Care (IIH) training for MU health care staff and providers. The IIH is a powerful, three-day immersion-style residential training workshop suitable for health care providers, health system leaders, teachers and others. “This was a wonderful opportunity for our health care system,” said CHP Director Karen Edison, MD. “The Office of Medical Education (OME), the Center for Health Policy and many others have worked behind the scenes and we were so proud to be able to assist in bringing this valuable training to our frontline health care workers. Diversity is a key to the future success of our health care system, our state and our nation. Having been through the training, I know how intense and time-worthy it is. The training definitely improves my own care of patients and has crossed over into everything I do at the Center.” Additional funding, however, was needed before University staff and providers could be sent to the program.
Working through its partnerships and grants, OME generously contributed $10,000 from the Caring for Missourians grant, while five different departments from the medical school, as well as the hospital and Dean’s Office, committed a combined $14,700. “This training is a step in the right direction,” said Edison, “and a true testament to the collaborative work of OME, CHP, the UM Health System and all of our partners.” Learn more about IIH at http://www.iistl.org.
//New Resources//
County Health Rankings data released
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ow healthy is Missouri? New data from County Health Rankings, a project of the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation (RWJF), show that St. Charles County ranks number one in the state for its overall health
Follow CHP on Twitter @CHPMissouri 6 | Impact | Summer 2012
outcomes, while Pemiscott County ranks last (115th). (See how the MU Healthy Community Initiative project is using the CHR data on page 18). The rankings are a state equivalent of an annual checkup. All 50 states and almost all counties are assessed on the same health, well-being and economic standards that determine the overall level of a population’s health are and how long the people from that community can expect to live. New to this year’s rankings are data measurements that account for the number of fast food restaurants in a county and levels of physical inactivity among residents. Premature death trend graphics are also new to this year’s data sets. “The County Health Rankings show us that much of what influences our health happens outside of the doctor’s office. In fact, where we live, learn, work and play has a big role in determining how healthy we are and how long we live,” said Risa LavizzoMourey, MD, MBA, president and CEO of RWJF in a press release. “The good news is that businesses, health care providers, government, consumers and community leaders are already joining forces in communities across the nation to change some of the gaps that the Rankings highlight.” Learn more at
http://countyhealthrankings.org.
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Resources for effective, patient-centered health care
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inding one’s way through the health care system can be confusing and challenging. A diagnosis doesn’t necessarily mean one treatment, but many. How do patients know what the best treatment is for them, their families, and their overall quality of life? The Agency for Health care Research and Quality (AHRQ) has released new materials on effective, patient-centered health care to help. Now, patients can learn about their treatment options, ways of discussing their health with their doctor(s), and how other patients have tackled similar health conditions to decide on their best course of treatment. The resources include condition guides, summaries and tools for physicians, and patient decision aids on particular illnesses. All are available through www. Ef fectiveHealthCare. AHRQ.gov. These resources can also be accessed at http://MOHEC.org.
20 percent of Missourians are currently battling high blood pressure. While stress and genetics play a role, food choices do as well. The reason food matters so much? Salt. Many Americans have tried to reduce their salt intake by limiting the use of salt in home cooked meals, but still consume far more than the recommended amount (2,300 mg/day for healthy individuals which is equal to a teaspoon, or 1,500 mg/day or less for those at high risk for high blood pressure). Processed and restaurant foods make up the majority of our salt intake. As part of the Million Hearts Campaign, DHSS has released a sodium brief for health care workers and providers. The resource can be downloaded for patients and colleagues. View it online at http://health.missouri.gov.
//CHP News//
Join MOHEC this fall for a health equity regional meeting near you. MOHEC will hold meetings in Columbia, St. Louis, Springfield, Sikeston and Kansas City. Details at http://mohec.org
McAnaugh to become COO of LeadingAge Missouri
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Health care providers urged to help patients shake the salt habit
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ccording to data from the Missouri Department of Health and Senior Services (DHSS), approximately
HP Project Director Nancie McAnaugh has accepted a new position as Chief Operating Officer of LeadingAge Missouri, based in Jefferson City. Her new role began in August. Since the winter of 2011, Nancie has led CHP’s Missouri Health Equity Collaborative (MOHEC) and Missouri Health Information Technology (MOHIT) Regional Assistance Center projects. Her valuable contributions and insights have been borne out through the Healthy Lives, Healthy Community conference, and a myriad of Jump Start and Advanced Practice webinars, to name but a few. We thank her for her many contributions to CHP and to the health and well-being of Missourians. Best of luck, Nancie! �
Stay up to date with CHP E-News! Sign up for monthly e-newsletters: http://healthpolicy.missouri.edu
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Supreme Court Decision
A final rule from the Supreme Court
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ong anticipated and hotly debated, the Supreme Court of the United States released its ruling on the Affordable Care Act (ACA) on June 28. In a 5-4 decision, the Court upheld the majority of the law, including the controversial individual mandate. While the outcome was loved and loathed by groups on both sides of the political aisle, the vote came down to conservative Chief Justice John Roberts, who decided to support the law. Finding that the individual mandate was not truly a mandate, but a tax, it was allowed to remain in the law.
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Health care upheld U.S. Supreme Court finds most of health care law constitutional Said CHP Director Karen Edison, MD, “This is a major moment in the health and wellbeing of all Americans. Now that the decision has been released, we know that real work of health care implementation begins.” But among the law’s implementation provisions, one will not be enacted. In reviewing the case, the Court found no problem with the ACA’s focus on expanding Medicaid to more enrollees. However, the Court did not support the ACA’s penalty for states that do not comply with Medicaid expansion regulations.
That penalty would have meant withholding all of the state’s federal Medicaid funding, which the Court found to be coercive. The Court’s final decision is now public, and additional plain language resources are available on the individual mandate and Medicaid expansion decisions. Details at: http://healthpolicy. missouri.edu. �
Presentations
Presentations & Publications Check out some of the presentations made by CHP staff during the last few months. Feb. 16 EHR Jumpstart Series: To Be Electric, or Not To Be, Webinar, Nancie McAnaugh Feb. 25 Health Literacy MOC Workshop, Columbia, MO, Stan Hudson, Karen Edison, David Fleming, Jim Campbell, Diane Smith, Ioana Staiulesu, Nick Butler and Dave Zellmer Mar. 1 Clear Understanding Training via MTN, Presentation, Xavier University of Louisiana College of Pharmacy - Fifth Health Disparities Conference, New Orleans, LA, Nancie McAnaugh, Steve Jeanetta, Karen Edison, Ioana Staiculescu, Caress Dean and Stan Hudson Mar. 1 Health Literacy in Communities, Presentation, Xavier University of Louisiana College of Pharmacy- Fifth Health Disparities Conference, New Orleans, LA, Nancie McAnaugh, Steve Jeanetta, Karen Edison, Ioana Staiculescu, Caress Dean and Stan Hudson Mar. 6 Disparities in Access to Health Care Services: Perspectives from Refugee and Immigrant Patients, Webinar, Nancie McAnaugh Mar. 7 Access to Health Care Services: Perspectives from Patients with Mental Health Issues, Webinar, Nancie McAnaugh Mar. 7 Moving Forward with E-Prescribe: Requirements, State Law & Meaningful Use, Presentation, 2012 American Academy of Dermatology Annual Meeting, San Diego, CA, Karen Edison Mar. 15 EHR Jumpstart Series: Selecting an EHR, Presentation, 2012 American Academy of Dermatology Annual Meeting, ADAM Group, San Diego, CA, Karen Edison Mar. 16 Educate your patients and improve outcomes, Presentation, Lake of the Ozarks Senior Resource Group, Laurie, MO, Stan Hudson Mar. 16 Health Literacy Presentation, 2012 American Academy of Dermatology Annual Meeting Therapeutic Safety Group, San Diego, CA, Karen Edison Mar. 18 Health Literacy and Seniors, Presentation, 2012 Kentucky Health Literacy Summit, Lexington, KY, Stan Hudson, Karen Edison, James Campbell, David Fleming, Diane Smith, Kimberly Hoffman, Dena Higbee, Nick Butler and Ioana Staiculescu Mar. 19 Patient Education-Health Literacy, Presentation, 2012 Kentucky Health Literacy Summit, Lexington, KY, Stan Hudson, Karen Edison, David Fleming, James Campbell, Diane Smith and Ioana Staiculescu Mar. 23 Using Simulated Visits to Enhance Health Literacy, Workshop, Poplar Bluff Regional Medical Center, Poplar Bluff, MO, Stan Hudson Mar. 23 A Health Literacy Practice Improvement Toolkit for Physicians, Workshop, Poplar Bluff Regional Medical Center, Poplar Bluff, MO, Stan Hudson Mar. 27 Health Literacy Coaching for staff, Training, Columbia, MO, Nick Butler Mar 28 Health Literacy Coaching for staff, Presentation, MU School of Nursing, Nursing in Communities class, Columbia, MO, Nick Butler April 6 One Health One Medicine One Community Network (Missouri CommUNITY Partnership), Presentation, Mizzou Advantage Poster Session, Columbia, MO, Karen Edison, Amy Lake, Steve Jeanetta, Molly Vetter-Smith, Stan Hudson, Sharon Grass, Joseph LeMaster and Melissa Maras April 11 Meaningful Use Stage 2: What’s Next?, Webinar, Nancie McAnaugh April 13 Health Literacy: Improving Patient-Provider Communication, Presentation, 2012 Missouri Speech-Language-Hearing Association (MSHA) Convention, Osage Beach, MO, Diane Smith and Stan Hudson April 19 EHR Jumpstart Series: Buying an EHR, Webinar, Nancie McAnaugh April 20 Empowering Patients to Meet Health Literacy Challenges, Presentation, 7th Annual Family Medicine Update, Columbia, MO, Stan Hudson Continued on page 19 Center for Health Policy | 9
Now Recruiting:
Health
Equity Race, Ethnicity, Mental Health Conditions, Immigrant Health and LGBT Health Discussed at the Center For Health Policy’s Healthy Lives, Healthy Communities Conference By Shraddha Sankhe The United States spends almost $2.3 trillion annually on health care . But health does not begin in a doctor’s office or a hospital. It begins where we live, learn, work and play. There have been efforts to reduce health disparities in United States, but they have not been sufficient. How are health disparities experienced in Missouri? How can health disparities be eliminated? What strategies can be used to reduce health care disparities in diverse communities with ever-tightening budgets? To discuss these questions, the Center for Health Policy (CHP) hosted “Healthy Lives, Healthy Communities: Building Health Equity in Missouri One Community at a Time,” on Friday, April 27 in Columbia. More than 130 health care administrators, providers and researchers attended the conference to discuss building and Continued on page 11
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Top row: CHP conference organizers and staffers; Second row, left: poster presenters, right: attendees. Third row, left: posters from the poster presentations on urban alternative schools, right: Dr. Thomas LaVeist with CHP Director Karen Edison, MD and former Project Director Nancie McAnaugh. Fourth row: Dr. Darrell Kirch. Fifth row: Attendees of the conference listen to panelists.
Healthy Lives, Healthy Communities Conference Continued from page 10 Left: Presenters on the Newcomer and Immigrant Disparities panel Dr. Dave Campbell and Samantha Marquard. Middle: LGBT Panel presenters Dr. Jane McElroy, Sherrill Wayland and Bill Snook. Right: Racial and Ethnic Disparities Panel presenters Dr. Katherine Mathews and Dr. Sara Gehlert.
improving health equity in communities of Missouri. The conference covered racial and ethnic health disparities, newcomer and immigrant health disparities, health disparities among individuals with mental health conditions and LGBT health disparities. Nine poster presentations from across the state were also showcased at the conference.
Health Disparities Keynote Darrell Kirch, MD
Opening the conference, keynote speaker Darrell Kirch, MD, CEO of the Association of American Medical Colleges (AAMC), reminisced on his early memories of Missouri and briefed attendees on the history of health care in the United States. His presentation, “Can America Achieve Health Equity” dealt with diverse issues ranging from respect, to access to good health care in the country to the overall results of the current health industry. “People come from all over the world to get health care from United States,” he stated. “But I am yet to meet anybody who has come to the United States for their health care insurance. Great interventions, flawed systems.”
Kirch’s presentation highlighted the role that academic medical centers can play in addressing health disparities. Specifically, he spoke of the AAMC’s national efforts to eliminate the problem by: • Advancing health care equity; • Diversifying medicine; • Reducing health disparities; and • Conducting research on the impact of diversity. “When I was a medical student, the academic medical system was extremely hierarchical,” Kirch said, going on to express concerns over various complicated steps that a medical student had to go through in a system where scope was limited. In fact, he noted there was little diversity in the medical student population which did not meet the needs of the patient community. Kirch also described the AAMC’s objectives for overhauling all the academic medical centers in the United States by attracting, sustaining and transforming the system for an improved representation of the America’s diverse communities. Kirch elaborated upon three key points. The first involved identifying excellence among the vast pool of talented students
aspiring to study medicine as a career. The second step was to create a culture and environment to help the students to thrive and excel in medical colleges. Kirch emphasized his third strategy of sustaining excellent health care system with the joining of the student and medical system forces, saying science and technological innovations could transform health care system, especially the care provided to the diverse patient communities. “I’m here to recruit you to help promote health equity in the United States,” said Kirch in conversation with the crowd. He received a loud round of applause as he concluded his keynote speech as he stated, “Health is about more than health care.”
Racial & Ethnic Disparities Sessions
Sarah Gehlert, PhD, director of the Center for Interdisciplinary Health Disparities Research (CIHDR) at Washington University in St. Louis, led the conversation about disparity challenges seen among breast cancer patients in Missouri. Her presentation, Continued from page 12
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Healthy Lives, Healthy Communities Conference Continued from page 11
Left: Thomas LaVeist, PhD, from the Johns Hopkins Bloomberg School of Public Health illustrates the social determinants of health with the Titanic disaster as an example. Right: University students and professionals were among the exhibitors during the poster presentations. Here Faustine Williams presents, “Spatial Cluster of Female Breast Cancer in Missouri.”
“Addressing Health Disparities in Breast Cancer Using a Team Science Approach,” explored mortality rates of women due to breast cancer in Missouri and United States, including the factors that increase a person’s risk of breast cancer. Gehlert shared the research she started in Chicago with a group of transdisciplinary investigators who were examining the ways in which a person’s social environment changed his or her biology. In the study, Gehlert and her colleagues discovered how mere social interactions could increase the body’s stress response, and that this long-term increased stress response was predictive of triple negative cancer, a particularly deadly form that African American women die from more frequently than white women. Using that research, Gehlert is currently working with partners in North St. Louis to better support high
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risk women, providing services such as mammograms, tutoring, and HIV screening.
[T]hat’s how we came out with this needs assessment grant,” she said. “Our whole goal is hearing from all people in the community, hearing about all the things that impact health.”
Katherine Mathews, MD, MPH, MBA, addressed the crowd after Gehlert and continued the discussion on increasing access to health care. She Behavioral Health and emphasized her personal experiences Health Care Access in in working with Casa De Salud, a Vulnerable Populations health clinic serving the uninsured Session and underinsured. Casa De Salud focuses on providing health care to Jeff Lubsen, organizer of the LGBTnew immigrants and refugees in the Affirmative Therapists Guild of St. Louis area who encounter barriers Greater Kansas City, stated that there of access to receive care, Mathews is a necessity to review some basic said, and currently is conducting terminology to avoid gender or sexual needs assessments with funding microagressions. He explained how from Missouri Foundation for Health ‘microaggression’ is a term coined in to better understand their clients the 1970s to describe connotations and challenges faced. Explaining that are hostile, derogatory or the networks and partnerships that negative due to intentional or Casa de Salud had in place, Mathews unintentional, verbal, nonverbal, explained how “We’ve got power, behavioral, or environmental we’ve got influence but where’s the authority for what we’re doing?... Continued on page 13
Healthy Lives, Healthy Communities Conference Continued from page 12
Top left: Eduardo Crespi (second from right) and the Centro Latino group. Top right: Erica Campbell, student. Bottom: Members of the DHSS MICA Department Andrew Hunter and Becca Mickels.
perceptions of LGBT community. In his presentation, “The Impact of Sexual and Gender Microaggressions on LGBT Accessibility to Health care,” Lubsen explained the various areas of disparity, including misunderstood identities of people belonging to LGBT community in Kansas City. Because of the lack of knowledge among medical practitioners regarding LGBT terminology and social behavior, Lubsen explained that the disparities in health care access, including the increased risk of sexually transmissible infections and substance abuse, are heightened. Lubsen suggested that what health care providers can do to shrink health disparities in vulnerable LGBT communities is to consider a person’s sexual orientation as part of his or her identity. Further, the providers should understand how that identity influences his or her health—whether that individual is in a relationship or not. Lubsen strongly advised health
Paul Thomlinson, PhD, Burrell Center Inc., stated that there was disparity in mental health care access to more than half rural population in Missouri. His presentation, “Rurality and Mental Health Equity,” discussed issues such as the social stigma, lack of technical assistance in rural areas, mistrust of health professionals and focus on cure rather than prevention. He proposed strategies to raise health equity in rural areas by adopting awareness programs to improve relations between the public and health professionals. He also mentioned that awareness about medicines and treatments in behavioral health sciences would minimize perceived stigma related to mental health conditions.
practitioners to avoid prejudgments in order to work for greater health and health equity.
Luncheon Keynote Speaker Thomas LaVeist
Joe Parks, MD, from the Missouri Department of Mental Health, presented on “Health Disparities Associated with Serious Mental Illness (SMI).” Parks said preventable diseases like diabetes, obesity and substance abuse heighten the risk of SMI as they are left mostly untreated in most cases.
To animate the prevalence of inequality in American society, Thomas LaVeist, PhD, asked attendees to think about the Titanic passengers. LaVeist, director of the Hopkins Center for Health Disparities Solutions, showed a graph grouping Titanic survivors who were classified according to their first-, second- or third-class tickets. All but four first class passengers survived the Titanic, he said to make his point. In his presentation, “Making Progress in Understanding the Causes of Health Inequalities,” he explained how the social class of Titanic survivors was interlinked with the social class of people receiving health care in 2012.
He also identified factors that led to health disparities in people with mental illness and discussed possible solutions to the problem. For example, a CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study showed that more than 60 percent of hypertension patients and 80 percent of high blood pressure patients were not receiving treatments because of their often-ignored mental illness problems. “Inadequate care is probably more expensive,” he said.
“Racial status determines the way in which you ‘experience’ America,” said LaVeist. He added that it was, in fact, income, and not race or ethnicity that Continued on page 14
Healthy Lives, Healthy Communities Conference Continued from page 13
MU’s Jenna Jordan presents presents, “Smoking, and demographics within the diverse SGM community,” during the Healthy Lives, Healthy Communities Conference in April.
led to health inequalities in the country. Citing how more African American men in United States are perceived to be in prison than college, LaVeist quantified the figure. There were 310,000 African American men in prison in 2006, he said. But there were 480,000 African American men in colleges the same year. LaVeist pointed out that the difference of 170,000 was largely ignored by the society and the media. “Disparities in health have a lot more to do with the zip code of where you live,” said LaVeist. “Health, wealth, criminal justice and education are four great race disparities that directly affect health equity.” To improve the state of health equality, he explained, it is important to move beyond race and ethnicity.
Newcomer and Immigrant Health Disparities Session
To understand the problem of access from the point of view of an immigrant or
refugee, Steve Jeanetta, PhD, University of Missouri, presented, “Newcomer and Immigrant Health Disparities: Perspectives from Newcomer Patients about Accessing the Health Care System.” Jeanetta examined the diverse positive and negative experiences of immigrants and refugees coming from countries such as Somalia, Iraq, Sudan, and Mexico who then settled in Kansas City and Cassville/Monett. He explained how the newcomer groups felt threatened by expensive treatments, experienced confusion over insurance coverage, and perceived bias over their ethnicities. However, many of the disparities triggered by language, culture, and access to health care facilities can be resolved. Jeanetta recommended using trained interpreters, flexible medical treatments, and awareness of the issues among health care providers to help reduce the disparities. Cathy Anderson, Jewish Vocational
Services (JVS) of Kansas City, continued on the subject of health care disparities experienced by refugee and immigrant groups with her presentation “JVS: Creating a Cultural Bridge.” JVS provides assistance to Limited-English Proficient (LEP) groups such as Cuban, Russian, Burmese and Afghan refugees. Anderson highlighted the common differences between the terms, ‘refugee’ and ‘immigrant.’ A refugee is a person born outside of United States who seeks protection on the grounds that he or she fears prosecution in his/ her home country. An immigrant on the other hand, is a foreign-born person admitted to live permanently in America if he/she has status which is acquired by employment, family-sponsorship or by visa lottery. David Campbell, MD, and Samantha Marquard, MSN, MPH, APRN FNP-C, represented the Institute Continued on page 15
Watch video clips from the conference at:
youtube.com/healthpolicymu 14 | Impact | Summer 2012
Healthy Lives, Healthy Communities Conference Continued from page 14
CHP Graduate Research Assistant Caress Dean, Project Director Nancie McAnaugh and Research Specialist Ioana Staiculescu.
for Family Medicine (IFM). IFM sets up small, cost effective health clinics in St. Louis catering to culturally sensitive and vulnerable groups of new arrivals, immigrants and refugees. Children, women and senior citizens are the organization’s primary focus.
health risk. Wayland said that services like housing, transportation, long-term care must be provided to assist with the unique needs faced by LGBT older adults. “LGBT older adults represent the past and the future as they create a legacy for generations to come,” she added.
Campbell and Marquard each described their personal experiences working with these populations, including strategies to reduce health disparities for people from diverse backgrounds. Campbell emphasized the responsibility of health care providers to understand patients’ cultural and social backgrounds. “Simple treatments are often new and [are] significant treatments for clients who have not seen a provider for a long time or ever,” Marquard said.
Continuing the discussion, William Snook, MS, Ed, presented the fundamental terminologies and disparities among LGBT community in Kansas City. Based on his work for the Kansas City Health Department, Snook elaborated upon the working definitions of sexual orientation, gender identity and the difference between the two.
LGBT Health Disparities Session
Sherrill Wayland, MSW, SAGE Metro St. Louis, captivated the crowd’s attention with her talk on “The Aging and Health Report: Disparities and Resilience among LGBT Older Adults.” Among these LGBT older adults, the disparities included higher rates of disability, mental problems, and social isolation. Wayland said there were factors like smoking and drinking, which put them at a higher
Snook explained that most areas related to LGBT health lack research altogether or the research has been conducted unevenly, with more research on gay men and lesbians and less on bisexual or transgender individuals. Jane McElroy, PhD, University of Missouri, concluded the session presenting her findings from her research with MU colleague Kevin Everett, PhD. In her talk entitled, “Out, Proud and Healthy Project: Sexual and Gender Minority (SGM) health behaviors and access to care,” McElroy stated that
the SGM community was less likely to opt for a health insurance, get medical or surgical treatment and take medicines. She added that the SGM community was more likely to smoke, drink or show symptoms of depression. By the conclusion of the conference, organizers and presenters agreed that while existing research and resources are useful to address many disparities, there are significant gaps. More robust measures are needed to improve our understanding and resolve the complicated interrelationships between race, ethnicity, and socioeconomic status that contribute to health care disparities.
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Check out presentations online: http://medicine. missouri.edu/policy/ projects-healthequity. html
Center for Health Policy | 15
Join us this fall for the Tenth Annual Missouri Health Policy Summit, Critical Crossroads: Keeping Missouri Healthy Without Breaking the Bank on Friday, October 26, 2012 at the Stoney Creek Inn in Columbia. Featured speakers include:
Jay Angoff Senior Advisor, U.S. Department of Health and Human Services and Acting Regional Director, Region 7 Angoff
Joe Flower Health Care and Technology Futurist Glen Nowak Senior Advisor to the Director, National Center for Immunization and Respiratory Diseases Additional panelists will discuss the impact of federal health care reform on Missouri and innovation in health care delivery and payments. Continuing education credits are available.
Flower
Presented by MU Center for Health Policy, Missouri Foundation for Health, Missouri Hospital Association, Missouri State Medical Association, University of Missouri Health Care, MU School of Medicine, Primaris, Smith/Patterson Lecture Series and MU School of Social Work. Details and registration for the 2012 Summit can be found online at http://healthpolicy.missouri.edu.
Nowak
Follow the summit on Twitter! #summit12
16 | Impact | Summer 2012
Health Policy Forum
Spotlight on Missouri Health Policy Forum:
A Conversation with Project Development Specialist Dave Zellmer By Shraddha Sankhe Finding a fair and balanced way to discuss issues related to health care, insurance payments and the 2010 health care law has been difficult for many organizations. The Center for Health Policy (CHP) has long recognized the importance of providing a nonpartisan space for open dialogue on health care issues, and created the Missouri Health Policy Forum (MHPF) in 2008, to serve that role. The forum is comprised of a diverse group of health care stakeholders from across the state who come together quarterly to discuss health care and health care reforms in a nonpartisan environment. Dave Zellmer, CHP project development specialist says, “So much of what is discussed in health care today can be influenced by the political climate, especially in an election year like this one. We saw a need to consider health policy issues outside of the typical budget cycle and political theater.” The Forum is responsive to the emerging issues about the latest health news in the state and country. Consequences of legislative and regulatory changes in healthcare are among
some of the key issues discussed in the Forum. The Forum also helps CHP collect beneficial collaborative information about innovations in various projects in health care across the state. Participants in the February 2012 quarterly meeting discussed a list of potential proposals recently submitted for the Centers for Medicaid and Medicare Services’ Innovation Grant.
See the list of organizations currently involved with Missouri Health Policy Forum or for more information about the Forum visit http://healthpolicy.missouri.edu.
Many issues discussed in the quarterly Forum are the basis for health care in the state for years to come. “When you add in the current issues, including health reform, it starts to become clear just how important the work we do really is. Collaborative relationships and new ideas seem to spring from each of our Forum meetings,” says Zellmer.
To date, the MHPF has more than 166 members, including 120 organizations, from across the state. Members include health policy leaders, state agencies, health care systems, the insurance industry, consumer groups, the pharmaceutical industry, health care consultants, and academic health centers. Zellmer says, “The variation among them makes for engaging conversation on key health care issues impacting everyone in our state.” Moreover, Zellmer explains, the MHPF creates networking opportunities for professionals and organizations, alike. “In addition, the Forum gives us the opportunity to share our resources and keep the health care community up-to-date on the projects the Center is involved in. The Forum is a completely voluntary group. We welcome all the participation involved,” he says. If you or your organization would like to get involved with the Forum or receive email updates about quarterly meetings, contact Dave Zellmer (zellmerd@missouri.edu).
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Center for Health Policy | 17
Healthy Community Initiative
Affiliate Spotlight:
Casey Williams, MD Improving Missouri’s Health through the Healthy Community Initiative By Alex Denning Casey Williams, MD
In the current U.S. health care system, the priority is on when the individual becomes sick. When a patient comes to the hospital or clinic, health care providers will try to fix the problem and send them on their way. But what causes the individual to become sick? Could this illness be prevented? Dr. Casey Williams, a research fellow and clinical instructor, is working with others in University of Missouri’s Family Community Medicine Department to find answer to these questions. With funding from University of Missouri and the University of Missouri Health System, a project called the “Healthy Community Initiative” seeks unique and innovative ways to approach the growing health problems in Missouri. The Healthy Community Initiative is aimed at improving the health of an individual community in Missouri. This project will use community-based interventions that will focus on factors that predispose people to illness such as their environment, access to
clinical care, or social support. After implementing these interventions in an individual county, the team will determine which interventions were effective in improving health outcomes. To get a better insight into the project, I sat down with Dr. Williams to discuss the “Healthy Community Initiative.” Interviewer: Why is this project unique and innovative? Dr. Williams: It’s unique because traditionally health systems don’t do a whole lot of community interventions on the factors outside of the health care system that affect health. I’ve been involved in some community-based projects that are based on clinic care, like helping people improve their self-management of diabetes. But this project is different in that it affects the aspects of daily living that predispose people to make certain choices about their health. And traditionally, health systems do not venture into this territory, which is sort of the “upstream”
approach to health and health care. Health care reform is trying to keep people out of the hospital. But we need to take it three or four steps further and keep them from getting sick. And that’s hard to do in an environment that almost guarantees that you become sick. The Healthy Community Initiative team has incorporated the Robert Wood Johnson Foundation’s County Health Rankings as a means of selecting and examining potential counties to work with and is using this source as a starting place for how to define a healthy community. Many different factors are put into this data set including, morbidities, mortalities, access to clinical care, built environment, and social and economic factors. These different factors have different weights, which play a role in the overall score that a county gets. This score is then compared other counties throughout the state and a ranking is formed (1 being the best). Interviewer: Are any measures in the County Health Rankings Continued on page 19
18 | Impact | Summer 2012
Healthy Community Initiative Continued from page 18
Affiliate spotlight: Dr. Williams more important for the “Healthy Community Initiative” than others? Dr. Williams: No, not at this point. Right now we are looking at this as a whole. What we are trying to do with this Healthy Community Initiative project is to figure out which ones [measures] we can focus on once we get through the process of selecting a community. We will eventually make a list of evidenced-based practice for each of these individual measures. We hope to make a larger impact, [and] we are focusing on where we
can have the most impact for the limited amount of resources we have. [We are also looking at] which interventions have worked in the past for other communities, and what we might be able to do that might have evidence behind it. Using and building evidence is important to the project, Dr. Williams explains because through the Healthy Community Initiative, the project team will be creating methods of best practices that will allow other communities to replicate
the process to improve their county’s health. By creating communities that have environments that will reduce the predisposition of illness, Dr. Williams believes that these healthy communities will help create, “access to health rather than access to health care.” If you have questions about the project, contact Dr. Casey Williams. �
Presentations & PUBLICATIONS Continued from page 9
April 27 April 28 May 3 May 17 June 6 June 7 June 14 June 21 July 24
Health Literacy Presentation, The Consequences of Low Birth Weight Babies, Missouri Bootheel Healthy Start Regional Consortium, Miner, MO, Nick Butler CK4 Interprofessional Education on Health Literacy: Session Development and Evaluation, Presentation, 45t STFM Annual Spring Conference, Seattle, WA, James Campbell; Sherri Ulbrich; Carla Dyer; Stan Hudson Health Literacy & Worker Safety Presentation, Mid America Safety, Health and Environmental Conference & Expo, Lake of the Ozarks, MO, Stan Hudson EHR Jumpstart Series: Implementing an EHR, Webinar, Nancie McAnaugh Climate Change and Health, Presentation, Adapting to Climate Change: Gaining the Advantage, Columbia, MO, Karen Edison The Health Impacts of Climate Change, Presentation, Adapting to Climate Change: Gaining the Advantage, Columbia, MO, Nancie McAnaugh What You Don’t Know About Privacy and Security Can Hurt You, Webinar, Nancie McAnaugh EHR Jumpstart Series: Utilizing an EHR, Webinar, Nancie McAnaugh Health Care Access in the Community: Perspectives from Refugee and Immigrant Patients, Presentation, 2012 Community Development Society International Conference, Charleston, SC, Steve Jeanetta, Nancie McAnaugh, Karen Edison, Ioana Staiculescu, Caress Dean and Stan Hudson
Publications “Using the PEOP conceptual model as an analyzing framework for health literacy,” Diane Smith and Stan Hudson. Journal of Communication In Healthcare, Volume 5, Number 1, April 2012 , pp. 3-11(9). Center for Health Policy | 19
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