RED FLAGS

Community Health Coordination

Unsustainable growth of health-care costs and poor health outcomes call us to reevaluate ways to improve the community's health. When care coordination is fragmented, individuals struggle to understand access points and how to self-manage their conditions, which further drives poor health outcomes. In Springfield, there is little coordination across the full continuum of care (from the hospital to the home), especially when individuals need medical, behavioral and/or oral health services. There is little coordination between health-care providers and social service agencies that can address issues like hunger, shelter, transportation, and other ancillary needs. Greater investment in collaboration is needed to ensure all individuals understand how to manage their health and are connected to the appropriate resources; thus, ultimately improving the community's health.

To coordinate care in an effective manner, data-sharing investments are essential. Not unlike other national attempts, Missouri tried to build a data-sharing platform for providers to exchange patient information, but the effort has faced many roadblocks. If providers and employers are to take more responsibility to improving the community's health, data must be shared and frequently analyzed to determine what indicators can be changed.

Community Health Outcomes

When compared to Missouri and the United States, Springfield consistently ranks poorly, indicating that it is an unhealthy place to live. Recognizing that community health is determined by several interrelated factors, Springfield should focus on health and wellness services in a coordinated care model to reduce individual and economic costs and improve health outcomes. This is a low-cost, high-impact way to improve health and change behaviors in a sustainable way.

Health outcomes are somewhat driven by those who have health insurance and access to care. Prior to the enactment of Missouri's Health Exchanges, approximately 17 percent of Springfield citizens were uninsured. Since then, 38 percent more citizens have enrolled in coverage, increasing access to care. Health systems, employers and community health agencies should be more incentivized to collaborate, providing greater health and wellness services that help improve our community's health outcomes.

Behavioral Health

About 25 percent of the population experiences a behavioral health disorder each year, and these individuals are likely to enter primary medical care services with a co-morbid physical health condition. About 6 percent of the population experiences a serious mental illness in a given year, and co-occurring health conditions are even more devastating among this group. Those with serious mental illness die an average of 25 years younger, account for 60 percent of chronic disease incidences and cost employers an average of $80—$100 billion annually, according to the American Hospital Association. Greene County is home to an estimated 18,800 adults with untreated serious mental illness, with total estimated costs of $124.5 million. These costs include direct medical expenses, incarceration and criminal justice involvement, disability payments, lost wages, and reduced productivity. Actuarial analysis indicates other troubling red flags, including 13 deaths by suicide, 2,321 incarcerations and 3,051 cases of adult unemployment, all due to untreated mental illness. Because Medicaid has not been expanded in Missouri, 37,260 individuals were dropped from coverage in 2014, further decreasing access to critical behavioral health services among a population at very high risk. The Health Care Foundation of Greater Kansas City reports as the number of behavioral health providers and psychiatric beds decline due to shrinking reimbursements and budget cuts, many adults and children face limited access options.

Because behavioral health conditions co-occur with chronic disease and this combination can substantially worsen associated health outcomes, Springfield should integrate and co-locate behavioral health services with health-care and other community services. Communities that have pursued this model have experienced significant improvements in physical and behavioral health outcomes and employer-related costs.