2. Missouri Foundation for Health
Robert Hughes, PhD
President & CEO

3. Mission
To improve the health and well-being of individuals and communities most in need.

4. About Us
Missouri Foundation for Health is a resource for the region, working with communities and nonprofits to generate and accelerate positive changes in health. As a catalyst for change, the Foundation improves the health of Missourians through partnership, experience, knowledge, and funding.

5. The Foundation serves 84 Missouri counties and the city of St. Louis.
Where We Work
The Foundation serves 84 Missouri counties and the city of St. Louis.

6. How We Work
As a catalyst for change, we take on important, challenging health issues.
Promoting health insurance coverage
Fostering healthy schools and communities
Reducing infant mortality

7. How We Work
Opportunity Fund Through our Opportunity Fund we’re offering the chance for visionary thinkers to tell us their best ideas with the hope of making them a reality.
You can click on the words Opportunity Fund, and it will take you to the website where the OF page is, if you want to show your audience.

8. How We Work We collaborate and partner:
Innovative Solutions to Food Insecurity
MFH worked with Incarnate Word Foundation to engage the St. Louis community to address problems of food access, hunger, and insecurity.
Excellence in Mental Health Act
Our partnership with the Department of Mental Health supported the Coalition for Community Behavioral Healthcare to assist DMH in the development of the Missouri planning grant for the Excellence in Mental Health Act.

9. How We Work
As a resource for the region, we offer expertise in research and policy analysis.
Health Equity Series
We issue publications on health disparities for specific Missouri populations.
Medicaid Basics
We educate consumers on all things Medicaid, including eligibility, services, and delivery systems so that they are familiar with the MO Healthnet program and empowered to take control of their health and make informed decisions about health care.

10. How We Work We are strengthening Missouri’s health sector: Advocacy
Leadership

11. Mirror, Mirror… Reflections on U.S. Health and Health Care in 2017
Missouri Foundation for Health
Mirror, Mirror… Reflections on U.S. Health and Health Care in 2017

12. Health Care in the United States
Health Care Spending as a Percentage Of GDP
1980–2013
Despite poorer outcomes, the U.S. is spending more on healthcare as a percentage of GDP than peer countries.

13. Health Care in the United States
U.S Other Countries
Infant Mortality Rates in the U.S. and Average Of 16 Peer Countries
1960–2009
- Infant mortality rate has been widely regarded as a reliable proxy for population health.
- In the late 70s the U.S. infant mortality rate began to decline at a slower rate than that of peer countries

14. Health Care in the United States
Cause of Death
Mortality Rate
(per 100,000)
Cardiovascular disease
155.7
133.6
Respiratory disease
34.3
21.0
Infectious disease
15.4
7.7
Perinatal conditions
7.1
3.7
Intentional Injuries
17.3
11.4
The U.S. has higher mortality rates across a number of different causes of death
U.S Other Countries

15. Health Care in the United States
Expectancy vs. Health Expenditure Over Time
1970–2014
Source- Forbes
If we look at how that same data translates to a per-capita view, we see that the U.S. is spending more money and living shorter lives than other developed nations.

16. America’s Health Rankings, 2016
Health in Missouri
America’s Health Rankings, 2016
based on:
Behaviors
Community and environment
Policy
Clinical care

17. Health in Missouri
The Commonwealth Fund’s Scorecard on State Health System Performance ranks Missouri 36th overall
Missouri is toward the bottom in a number of areas:
21st: Prevention and treatment
28th: Health equity
33rd: Access and affordability
38th: Avoidable hospital use and cost of care
40th: Healthy lives
21st – Prevention and treatment (quality of care provided in hospitals, nursing homes, doctors’ offices, and patients’ homes)
28th – Health Equity (low-income people and those who belong to racial and ethnic minorities)
33rd – Access and affordability (being able to get—and afford—health care when you need it, rates of insurance)
38th - Avoidable hospital use and cost of care (rates of potentially avoidable and expensive hospital care, the average cost of an individual employer-based health insurance premium and average annual spending per Medicare beneficiary) MO experienced a significant reduction from 2012 to 2015.
40th – Healthy Lives (rates of smoking, premature death, obesity, etc.)

18. Inadequacy of the Health System
Our health care system is built on a conception of “health” as treatment for short-term, acute illness as opposed to chronic illness or life-long wellness.

19. Inadequacy of the Health System
System would be more effective in making people healthier if it was organized to simultaneously promote population health, treat major episodes of illness and injury, effectively address chronic diseases, and care of patients at the end of life.
Example: “Projected Coding Intensity in Medicare Advantage Could Increase Medicare Spending by $200 Billion Over Ten Years”
Inclusion of diagnosis in the payment system creates a strong incentive for MA plans to report as many diagnosis as they can legitimately support (incentives not present in traditional Medicare)
We need to move to a focus on lifelong wellness
alter the occupational structure of delivery
Create new roles and teams that are designed to meet patient needs
Team based care has been found to improve health outcomes and reduce costs
leverage appropriate technology

20. Inadequacy of the Health System
Our workforce is not based on population health needs
We have complex payment systems with inconsistent incentives
Our service delivery system is fragmented

21. Public Concerns About Health Care
Americans’ Priority Health Concerns
Rank
Priority 1
Lowering the amount individuals pay for health care
(67%) 2
Lowering the cost of prescription drugs
(61%) 3
Dealing with the prescription painkiller addiction epidemic
(45%) 4
Repealing the 2010 health care law
(37%) 5
Decreasing the role of the federal government in health care
(35%) 6
Decreasing how much the federal government spends on health care over time
While at a slower rate than what was originally predicted, medical care as a share of GDP continues to increase.

22. Public Concerns About Health Care
Projections For Medical Care as a Share of GDP
2008 Projection
2010 Projection
2015 Projection
While at a slower rate than what was originally predicted, medical care as a share of GDP continues to increase.

23. Public Concerns About Health Care
$16,834
69% Total Premium Increase
Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage
2004–2014
$9,950
$12,011
81% Worker Contribution Increase
$7,289
Average healthcare premiums have increased for employers, and over time more of the burden has been shifted to employees. There is reason to believe this trend will continue. (looking for graph)
$4,823
$2,661
2004
2014
Worker Contribution Employer Contribution

24. Deep Divides and Misunderstandings
More Americans Now Have a Favorable View of the Health Care Law than Have an Unfavorable View
Favorable Unfavorable Don’t know/Refused

25. Deep Divides and Misunderstandings

26. U.S. Health and Health Care in Brief
The U.S. is falling behind peer countries
Missouri is below average among states
Our health system struggling to transform to meet the needs of the population
The public is concerned about affordability
Our country is deeply divided on how to move forward

27. Where We Are Today There is significant uncertainty about the future
Unprecedented changes have been proposed for Medicaid beyond ACA
The public is insufficiently aware of what these changes are and what they would mean for their health and health care

28. Robert Hughes, PhD
President & CEO
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