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THE MISSOURI FOUNDATION
FOR HELATH PUTS ITS MILLIONS TO WORK.
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By Bob Schaper
When people in Scotland County, Missouri, needed emergency medical
aid, it was anybody’s guess how long it would take. With only three
ambulances for the entire county—one of them nothing more than a
van without seats, and another plagued with chronic transmission
problems—patients were often in for a slow, difficult ride.
“There were times when our ambulances were all in the shop, so we’d
have to call one from another county,” says Marcia Dial, CEO of
Scotland County Memorial Hospital (SCMH), near Memphis, Missouri.
“Sometimes they’d break down in mid-route, and we’d have to call
another ambulance to that location.”
But that’s all about to change, thanks to a $488,000 grant from
the St. Louis-based Missouri Foundation for Health (MFH). With the
money, SCMH—along with ambulance districts in three surrounding
counties in Northeast Missouri—will be able to purchase two brand-new
$98,000 ambulances.
“I almost can’t tell you how thrilled we are,” Dial says. “This
is a really big deal for us.”
Dr. James R. Kimmey, president and CEO of MFH, is used to high praise
like Dial’s. But, he says, transportation grants are just one of
a number of areas in which his organization is helping to improve
health care across the state.
“We do forums where the staff and the board go out to various locations,”
Kimmey says, speaking from his organization’s headquarters at Union
Station. “There are three things we hear the most about: mental
health, dental health and transportation. And we fund in all those
areas.”
The foundation, which has assets totaling just over $1 billion,
was created after Blue Cross and Blue Shield of Missouri, then a
nonprofit corporation, proposed to transfer its assets into a for-profit
subsidiary called Right Choice in 1994. After a lengthy court battle
with the Missouri attorney general’s office a settlement was reached
in 2000, converting $400 million of Right Choice stock into MFH,
a new independent, nonprofit organization.
“Among foundations that are purely focused on health, we’re the
third largest in the country,” Kimmey says. “The attorney general
(Jay Nixon) set it up in the bylaws and charter that we should serve
the same area that Blue Cross and Blue Shield of Missouri served—84
counties and the City of St. Louis.”
"IF
WE REALLY WANT TO CHANGE HEALTHCARE IN MISSOURI, WE'VE
GOT TO BE ACTIVE ON POLICY."
Dr. James R. Kimmey
president and CEO
Missouri Foundation for Health
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From the beginning, helping the uninsured has been a priority for
the Foundation. But Kimmey says those who are underinsured or underserviced
are also a concern. “It’s a constant focus in grant-making when
we look at proposals,” he says. “Do these proposals have an impact
on the uninsured, underinsured and the underserviced population?”
Since the Foundation began releasing funds in August 2002, $46 million
has been awarded to hundreds of nonprofit organizations and governmental
entities. In 2004, Kimmey expects the grants will exceed $50 million.
“In the state as a whole, there are 575,000 folks who are uninsured
for the entire year,” he says. “And we cover 75 percent of the state’s
population; so that’s in the range of 400,000 uninsured in our area.”
Almost as bad, Kimmey points out that over a million people are
uninsured in Missouri for a portion of the year. “That represents
about a quarter of the under-65 population in the state,” he says.
Kimmey says part of the problem is state cuts in Medicaid spending—a
method of controlling the budget that he calls “not very sensible.”
“Every dollar that the state puts into Medicaid gets matched by
the federal government,” he says. “And every dollar spent on Medicaid
generates about $3 to $4 in business.”
Cost controls by corporations have increased the number of underinsured
people, too, Kimmey says. Such individuals have health insurance,
but only minimal coverage. “They’re still at risk because if they
have a serious illness, they have inadequate coverage,” he says.
Much of the Foundation’s efforts so far have been on improving health
care in the St. Louis Metropolitan Area. The largest grant awarded
to date—$ 1.5 million over three years—went to the St. Louis Department
of Health to fund its Healthy Heart program. Focusing on black residents
in North St. Louis, Healthy Heart identifies people with cardiac
problems, and attempts to change behaviors that cause heart disease.
Substance abuse treatment and prevention is also a priority at the
Foundation. Janet Popelka, coordinator of the Volunteers Offering
Innovative Community Education Services (VOICES) program at the
St. Louis office of the National Council on Alcoholism and Drug
Abuse (NCADA), says she’s grateful for MFH’s two-year grant.
“Hundreds of youth are now developing healthy life skills that will
help them resist pressures to use alcohol, tobacco and other drugs
because of (MFH’s) generous support,” Popelka says.
Farther from home, the Foundation has dedicated large chunks of
money to dental programs in rural Missouri counties. Kimmey says
Medicaid does not cover dentistry adequately, leaving rural areas
short of dentists. “We have funded dental vans that go from school
to school in southwest Missouri,” he says.
Psychiatrists, too, are few and far between in many out-state areas.
To help, MFH has funded several programs that help organizations
recruit and pay psychiatrists for rural residents.
Kimmey, who was previously St. Louis University’s vice president
for health sciences, then later chief operating officer, said he
was neither surprised nor pleased by the state of rural health care.
“There are pockets out there where primary care and medical care
is pretty good,” he says. “And there are pockets where it’s really
abysmal. We have some counties in Missouri that, from a standpoint
of health, are as bad as the worst third world countries.”
Part of the problem, Kimmey says, is the lack of recent data on
which public health officials can base funding decisions. To fix
that, MFH has dedicated five percent of its grant money to public
health policy research. “If we really want to change health care
in Missouri, we’ve got to be active on policy,” Kimmey says. “The
influence on the policy side can lead to a more lasting change.”
Kimmey says his entire career as a physician and administrator helped
prepare him for exactly the type of job he’s doing now. “It’s
very satisfying work,” he says. “No question we’re
making an impact.”
Looking forward, Kimmey says he would like to see the foundation
recognized as a major non-partisan source of good information about
health treatment in Missouri.
“And then,” he adds, “to follow that up with dollars.”
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