PROGRESS > building a EDUCATION > COMMUNITY healthier > saint louis rhc a report on the integrity of saint louis’ health care safety net 03 saint louis regional health commission report PROGRESS > building a EDUCATION > COMMUNITY healthier > saint louis rhc a report on the integrity of saint louis’ health care safety net 03 saint louis regional health commission report 2 table of contents saint louis regional health commission TABLE OF CONTENTS acknowledgments4 vi. other determinants of health 212 A. Factors Which Influence Health Status 213 i. executive summary 8 B. RHC Support of Community Initiatives 214 216 ii. introduction to the rhc 18 C. RHC Community Response to Date A. History Leading to the RHC 18 vii. discussion of health reporting in st. louis city 19 B. The Work of the RHC and Results to Date and saint louis county 218 C. The Mission and Role of the RHC 20 A. Importance of Health Status Reporting 218 D. The Initial Focus of the RHC 21 B. Current Measurement and Reporting in St. Louis 219 E. RHC Schedule of Events for 2003-2004 22 C. Provider Impressions of Health Status Measurement and Reporting 220 F. Importance of Community Participation 23 D. Health Status Reporting in Other Communities 220 G. Purpose of this Report 24 E. Proposal for Health Status Reporting 221 221 iii. health outcomes in st. louis city & county 26 F. Selection of Proposed Health Indicators 27 A. Sources and Methodology viii. next steps for the community & 29 B. Summary of Findings how to get involved 226 C. Reporting of Indicators 34 glossary 230 iv. the integrity of the health care safety net in the region 128 references 232 A. Organization of the health care safety net in St. Louis city and Saint Louis County 133 appendices 239 B. Safety net primary care services 136 1. ST. LOUIS REGIONAL HEALTH COMMISSION’S SURVEY 240 C. Safety net subspecialty care services 147 METHODOLOGY AND RESPONDENT LIST D. Dental services (in development) 150 2. ST. LOUIS REGIONAL HEALTH COMMISSION WORKPLAN 244 E. Pharmacy services (in development) 153 3. ST. LOUIS REGIONAL HEALTH COMMISSION ROSTERS 261 F. Mental health services (in development) 158 AS OF MARCH 2003 174 G. The financing of the safety net system (in development) 4. CALL TO ACTION UPDATE: THE ST. LOUIS REGIONAL HEALTH 264 COMMISSION RESPONSE TO COMMUNITY RECOMMENDATIONS v. barriers to accessing the health care system 192 5. SAFETY NET AFTER-HOURS RESOURCES 270 A. System Barriers 195 6. RESOLUTION TO RECOMMEND THE PROTECTION 272 B. Financial Barriers 199 OF STATE FUNDS TO MISSOURI MEDICAID PROGRAM C. Cultural Barriers 207 table of contents saint louis regional health commission 3 appendices (Continued) 7. 330 LEGISLATION 274 8. METHODOLOGIES USED TO ESTIMATE SOURCES 275 AND USES OF FUNDS FOR PRIMARY AND SPECIALTY CARE — ST. LOUIS CITY AND COUNTY 9. ESTIMATE OF NUMBER OF NON-ELDERLY, 286 UNINSURED PERSONS IN ST. LOUIS CITY AND COUNTY 10. CULTURAL AND LINGUISTIC BARRIERS FOR NEW AMERICANS 294 11. MEASUREMENT IN OTHER COMMUNITIES 304 4 acknowledgments saint louis regional health commission ACKNOWLEDGMENTS The creation of this report has been a community-wide effort. Halfar for their tireless work on Section III of this report. We also thank the Saint Louis County Department of Health and the State of Missouri for assis- The St. Louis Regional Health Commission would like to acknowledge the tance in this effort. dedication and commitment of its nineteen Commissioners and fifty Advisory Board members, as well as the City of St. Louis, Saint Louis County, the State In addition, we also acknowledge Greg Vadner, Margie Mueller, and the staff of of Missouri, community organizations and community members in making this the Missouri Division of Medical Services (DMS) for the considerable time and effort possible. assistance spent assisting with the development of the estimates included in the Financing of the Safety Net section of this report. In particular, a large debt of gratitude is owed to the staff members of area safety net providers, as listed in Appendix 1 of this report, who took considerable time We would also like to acknowledge community-based organizations and to answer survey questions regarding the provision of safety net medical care. members who assisted us in our research or reviewed this document, including We are also indebted to those who assisted in developing survey tools and gath- Metropolitan Congregations United, Citizens for Missouri’s Children, Bi-State ering primary data, including the Missouri Department of Mental Health Eastern Development Agency (Metro), City of St. Louis Planning and Urban Design Region, the International Institute, and the City of St. Louis Mental Health Agency, Saint Louis County Department of Planning, RegionWise, the Mental Board of Trustees. We are also grateful to the St. Louis College of Pharmacy for Health Association of Greater St. Louis, St. Louis 2004, the United Way of collaborating on a survey of area safety net pharmacies. Greater St. Louis, Coro Leadership Center of St. Louis and Diann Bomkamp. We also thank area health-related institutions that provided considerable assis- The RHC would also like to recognize its community partners that work to tance in data collection, analysis, or review, including: the staffs of BJC Health improve collaboration in community health, including the St. Louis Healthy System, Washington University School of Medicine, Saint Louis County Heart Association, the St. Louis Lead Prevention Coalition and the St. Louis Department of Health, Missouri Hospital Association, Sisters of Mercy Health Regional Asthma Consortium. System, Saint Louis ConnectCare, and numerous divisions within the Missouri The RHC also would like to thank the staffs at TOKY Branding + Design and Department of Health and Senior Services. In addition, we are grateful to the DigiJones Graphics for superior service in the creation of this report. Saint Louis University School of Public Health and the Episcopal-Presbyterian Charitable Health and Medical Trust, for sharing research on barriers to accessing Lastly, the RHC would like to thank its funders, including: Sisters of Mercy the health care system that was invaluable to the creation of Section V of this Health Systems, SSM Health Systems, the City of St. Louis, Saint Louis County, report. the State of Missouri, and Civic Progress. We especially thank the City of St. Louis Department of Health for the generous Together, we will build a healthier St. Louis. loan of full-time staff resources to complete the work in reporting the health status Thank You, of our community, and in particular acknowledge Louise Quesada and Allan The St. Louis Regional Health Commission, March 2003 acknowledgments saint louis regional health commission 5 st. louis regional health commission past commissioners Peter Sortino Sister Betty Brucker, FSM Ancelmo Lopes Congressman William Lacy Clay, Jr. Chairman Executive Director, Catholic President & CEO, U.S. House of Representatives, President, St. Louis 2004 Community Services/The St. Louis ConnectCare 1st District, Missouri Archbishop’s Commission on Jacquelynn A. Meeks, DrPH* Robert Massie, DDS Larry Fields, M.D. Community Health Vice Chair Chief Executive Officer, Former President & CEO, Director, Saint Louis County Deborah Cooper Family Care Health Center Saint Louis ConnectCare Department of Health Chief Program Officer, Beverly Roche Robert Fruend, Jr. Missouri Foundation for Health Steven Lipstein Finance Director, City of Jennings William Peck, M.D. Treasurer James P. Crane, MD* Will Ross, MD Executive Vice Chancellor President & CEO, Associate Vice Chancellor for Associate Dean and Director for Medical Affairs and Dean, BJC HealthCare Clinical Affairs, Washington of the Office of Diversity Programs, Washington University University School of Medicine Melba R. Moore, MS* Washington University School of Medicine Secretary James Buford School of Medicine Dana (Katherine) Martin Commissioner of Health, City President & CEO; Urban League Corinne A. Walentik, MD, MPH Former Director, of St. Louis, Department of Health of Metropolitan St. Louis Professor of Pediatrics/Division Department of Social Services Reverend B.T. Rice Betty Jean Kerr of Neonatal-Perinatal Medicine, State of Missouri Executive Committee Member Chief Executive Officer, Saint Louis University/Cardinal Sharon Rohrbach, R.N. Pastor, New Horizon People’s Health Centers Glennon Hospital Executive Director, Seven Day Christian Church Scott Lakin Robert Fruend, Jr. (Ex Offico) Nurses for Newborns E. Andrew Balas, MD, PhD Director, Chief Executive Officer, Dean, Saint Louis University Department of Insurance, St. Louis Regional School of Public Health State of Missouri Health Commission Ron Levy President & CEO, SSM Health Care St. Louis * Workgroup Chairperson As of March 2003 6 acknowledgments saint louis regional health commission provider services advisory board Corinne Walentik, MD, MPH Lisa M. Heisserer, LCSW Deborah W. Kiel, MSN, RN, CS Katie Plax, MD Professor of Pediatrics/Division of Unity Health Hospice Clinical Assistant Professor, Adolescent Center, Neonatal-Perinatal Medicine, Saint University of Missouri - St. Louis St. Louis Children’s Hospital David Heitman Louis University/Cardinal Glennon Executive Director, Care Partners Jerry Linder, MBA, CPA Carolyn J. Pryor-Luster, MD Children’s Hospital CEO and CFO, Serenity Women’s Healthcare, Inc. Mildred Jamison Erol Amon, MD, JD Community Care Plus Executive Director, Faith Village Sharon Rohrbach, RN Professor & Director, Saint Louis Mark