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Health Fund Staff Blog

April 18, 2016
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Rural Options--The Very Last Option--Innovate

Kim MooreThe last approach I want to discuss for developing and maintaining rural services is innovation. As will be apparent, innovation may make use of parts of the other three, but it likely starts with and aims toward a different goal than the other three. Innovation could be about keeping a hospital in the community, for example, but I would suggest that real innovation starts with a different aim than keeping hospital services or K-12 or a public health department. It starts with more fundamental questions such as: how do we develop the health services necessary for a vital community or how will we educate our children (and adults) to maintain a vital community?  In the type of innovation I am suggesting, there is no pre-set determination that a community needs the normal K-12 structure, hospital or other traditional agency to provide the services a community needs  (or to have a vital economic life). Rather, there is an openness to development of the right agency and set of services within the available resources—that may be the traditional agency with many changes but it also might be something very different. [read full post]

March 29, 2016
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Rural Options--Third Installment: Merge and Consolidate

The library at Chaparral High School was full of adults sitting around tables on this particular night in late 2015. Two women were dressed up in Halloween garb appropriate for the season. Jody Gragg from Via Christi Wichita greeted me and quietly explained the goals and structure of the meeting that evening. Representatives of Harper Hospital District #5 and Anthony Medical Center (both located in Harper County) were meeting to continue discussions of a possible merger or other affiliation of the two hospitals. Other Harper County communities were represented and active in the discussion. The meeting was led by a former elementary school teacher who proved herself masterful at understanding the currents and undercurrents in the room. I was impressed by the work coming out of small groups that evening. Instead of a sense of impending loss, there were great expectations of benefits and new possibilities in a shared hospital. [read full post]

February 15, 2016
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Rural Options--Second Installment: Affiliate and Modify

In an Issue Brief issued in December, the Kansas Health Institute discussed “Cross-Jurisdictional Public Health Sharing Arrangement in Kansas.”  Existing public health departments—generally single county in Kansas—come together by agreement to share services or administrative functions. These arrangements are not prescribed by any higher authority but are developed to achieve cost savings, efficiencies and perhaps expanded services. Sometimes the arrangements result in division of services—one county health department delivers environmental protection services for the entire group of counties or emergency preparedness for all members, including grant application preparation (a constant in the lives of public health departments). Although noting challenges to such arrangements, KHI concluded, “cross-jurisdictional sharing arrangements can be excellent tools for health departments looking to improve current services or acquire new ones, while maximizing the use of their resources.” [read full post]

January 22, 2016
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Rural Options--First Installment: Preserve and Protect

In 1965 I went with my father, mother and the then Superintendent of Public Instruction for Elk County, Ethel Yantis, to Topeka on a hasty trip. Just ahead of the statutory deadline for unification plans, Dad and the Superintendent were filing a paper, authorized by the relevant school boards, to remove Longton Public Schools from the Elk County unification plan and Elk City Public Schools from the Montgomery County unification plan. The two arch enemies across county lines (Lions and Red Devils) were putting their school fortunes together rather than have them controlled by Howard and Independence.

There appear to be four general approaches (sometimes used in tandem) for responding to the issue of rural decline: 1) preserve and protect; 2) modify and affiliate; 3) regionalize/consolidate; 4) innovate.

My Elk County story illustrates a combination of 1 and 3. The great desire to preserve a traditional school system with some K-12 structures in the community led to the Longton/Elk City action. Together these two historic rivals could preserve schools in both communities. But preserve and protect frequently has costs which are not readily apparent. [read full post]

December 21, 2015
Christmas Card
Keep Christ in Christmas...Or Maybe Not

The bumper sticker clearly read on a car in Wichita: 'Let’s Keep Christ in Christmas.'  It brought back several memories of childhood and prompted a bit of potential Christmas season theology. For those of you too young to remember, 'Let’s Keep Christ in Christmas' was a song of the 1950s or perhaps early 1960s. It reflected the sense of Christian struggle to avoid the commercialization and secularization of Christmas amid the decades of anti-communism.

I also associate a man named Elmer Childress, rightly or wrongly, with this song. Elmer Childress (his bio is on the web) was a gospel singer (even sang once with The Stamps Quartet) and became a Wichita television personality. He and his family sang throughout Kansas, again in that 1950-1960 period, and came at least once to the Longton Methodist Church (pre-United). My bad memory of that event involves my Dad who was a very talented musician who enjoyed performing. This frequently lead to his making me perform (when I didn’t want to) and eventually making his grandchildren perform (when they didn’t want to). This tendency hit its high (or low) point after the Childress event when he asked Elmer Childress to stay and listen to his very talented son (probably a first grader—okay somewhat older) sing and to give Dad Childress’ appraisal of my talent. Well, he did and I wasn’t. [read full post]

December 8, 2015
KanCare Logo
KanCare Expansion - Right on the Money

Today I joined with leaders of the state's other five health foundations in delivering an open letter calling on Governor Brownback and members of the Kansas Legislature to engage in serious consideration and open debate about expansion of KanCare, in light of new research showing potential savings for the Kansas budget.

"The potential benefit to the state budget alone indicates that legislators can no longer afford to simply say 'no' to KanCare expansion. We call upon legislators to give KanCare expansion serious consideration and an open debate, allowing diverse opinions a chance to be heard in committee and on chamber floors," reads the letter signed by the six foundations comprising Kansas Grantmakers in Health (KGIH), an informal group sharing a commitment to improving the health of Kansans.

The letter cited a new analysis by Manatt Health Solutions commissioned by KGIH which found with KanCare expansion and the favorable federal funding match offered, Kansas could expect to save much of what it currently spends for providing critical services to the uninsured.

More than 150,000 Kansans would benefit from KanCare expansion, and more than three-quarters of these Kansans work at least one job or are in families which do. They are the working poor, working jobs that don't offer health insurance or that pay too little to make insurance affordable. [read full post]

October 28, 2015
Deductible rise chart 2010-2015
Heading to Zero?

The recent release of the 2014 Kansas Statistical Abstract won't make front page news. Nerd that I am, of course I had to take a look.

My personal long-term reason to check the Abstract is to watch the trends related to rural Kansas. As a child of Elk County in southeast Kansas and raised by the penultimate community booster (my father, Everett Moore), I remain interested in what is happening in frontier and rural Kansas - particularly my own corner of near-southeast Kansas. The truth is, I keep hoping to find some evidence that the decades-long decline of rural Kansas is ending. Regrettably, this edition of the Abstract provides no encouragement along those lines.

One of the fundamental indicators of the health of an area is the growth or decline of its population. Twenty-one of Kansas' 105 counties declined by more than 10% in the 2000-2010 decade (Elk County was down 11.6%). [read full post]

September 24, 2015
Deductible rise chart 2010-2015
Health Care Still Costs Too Much

The annual survey of employers done by Kaiser Family Foundation/Health Research & Education Trust indicates that annual premiums for employer-sponsored, family health coverage reached $17,545 in 2015, up four percent from 2014. The average annual single premium is $6,251. Workers' wages increased 1.9% while inflation declined by 0.2%, and some experts believe the growth in health care costs for employers is part of the reason that wages grow so slowly. There is no indication in this survey that the Affordable Care Act has caused a dramatic rise in insurance premiums, although we know that some of the taxes imbedded in the ACA have been passed on as increased premiums and increased coverage (benefits) have been included in premium increases. Still, the rate of premium increase for family coverage during the last five years was the same rate as from 2005-2010 (27%) and significantly less than the growth rate of 2000-2005 (69%). This makes it hard to argue that the ACA has been especially harmful to "costs" or premiums.

What is astounding to me from the survey is the shifting of cost from employers to employees. Since 2010, the deductible for all workers with single coverage is up 67%. [read full post]

August 21, 2015
Cover Kansas Logo
From the Frontlines of Health Insurance Coverage

Yesterday it was my privilege to meet with navigators and program administrators supported by grants from United Methodist Health Ministry Fund working full-time since last fall/winter to assistant Kansans in securing health insurance coverage through the health insurance marketplace. All of these navigators are part of the Cover Kansas program which supported 165 navigators (most of them unpaid, part-time volunteers) around our state during this last open enrollment period ending in March. Debbie Berndsen and her staff at Cover Kansas (a program of Kansas Association for the Medically Underserved) answer technical questions, cut-through the marketplace processes when possible and encourage these navigators. The system is solid in operation but certainly not at the scale needed. [read full post]

August 12, 2015
Communication Inequalilty
The New Kid and Communication Inequality - by Aaron Walker

Since this is my first blog post on the TMWoT blog (and hopefully not my last), I thought it might be good to give a bit of an introduction. I am the new Vice President for Strategic Development for the Health Ministry Fund and I have had the good fortune to work with Kim (our President, the primary blogger here), Katie, Kristine, and Jeff since January. I enjoy writing a great deal so was very excited when Kim asked me if I would like to be a part of the blog. But what to write about?

I came here after more than 10 years in child welfare where I sat, entrenched, on the other side of the funding table. Though both agencies are considered part of the non-profit realm I had no idea how different the world could be from this side of the table. In my (old) world, wondering from whence funding would be available was not quite a daily consideration… almost though. Now I work for a public charity, a non-profit with a completely different funding structure and thus with a very different outlook. [read full post]

July 24, 2015
Clergy Health Graphic
Are Clergy Unhealthy? Why? What to Do?

Since United Methodist Health Ministry Fund started 28 years ago, there has been expressed interest in the Fund addressing clergy health because of unique problems facing that group.

In recent years, the Fund has moved to address the apparent core problem of clergy health: as a group, clergy have many health indicators which are worse than those of the general public. This situation of United Methodist clergy is highlighted in the report of the 2015 Clergy Health Study conducted by the Center for Health of the General Board of Pension and Health Benefits (UMC). Although there are factors suggesting clergy as a group have some health advantages over the general public, very important indicators suggest clergy--at least United Methodist clergy--face high health challenges. [read full post]

July 15, 2015
Illustration
Fictional Science - It's Everywhere

The summer 2015 edition of Trust by the Pew Charitable Trusts contains a fascinating report on a survey determining the difference of opinion between scientists and the general public. A Deep Divide (by Guy Gugliotta) discusses a wide divergence of positions between U.S. adults and members of the American Association for the Advancement of Science (the world's largest scientific society).

A key issue in today's polarized society is the apparent failure of some political leaders to challenge popular beliefs when they are clearly non-scientific. In fact, there seems to be a tendency to feed the frenzy instead of leading toward solid thinking. [read full post]

May 28, 2015
Is Smaller Ever Better?
Is Small Ever Better?

A few days ago, a nonprofit executive said in my presence that a particular person's perspective was not all that important because he ran a smaller nonprofit than the speaker. The clear indication was that less ability was necessary to run a smaller operation than a larger one and this individual's experience would not be as valuable as the experiences of a manager in a larger operation. I suspect this type of thinking is widespread.

I am personally sensitive to "big is better" thinking. I grew up in a small town (population 400) in a low-population rural county (5000) and graduated with 11 others from a high school with 45 students. I then attended a small liberal arts college (700 students). My law career was slightly exceptional for my life in that I joined the largest law firm in Kansas; of course, "largest in Kansas" was not all that large -- then 30 lawyers. I have served as president of a small asset ($58 million) health philanthropy for 28 years. Small is sort of my thing. Some might say I have preferred to be a "large duck in a small pond..." [read full post]

April 2, 2015
Hospital Closed Sign
Closing Rural Hospitals

Kansas Health News Service reported this week that two southeast Kansas hospitals—Mercy in Independence and Fort Scott—might close. These hospitals are in relatively sizeable communities compared with many hospital sites in Kansas. The Independence and Fort Scott hospitals are prospective-payment hospitals. They receive fee for service payments, not cost-based reimbursement from Medicare and Medicaid, so volume which pays for care is critical to their survival. Hospitals receiving fee for service payments have been particularly hard hit by the failure to expand Medicaid in Kansas. The Affordable Care Act implemented lower reimbursement for Medicare payments but envisioned less charity care, with Medicaid expansion reducing the uninsured rate and costs to providers. The ability of states to separately decide about a Medicaid expansion—per the US Supreme Court decision—has resulted in hospitals receiving only the negative reimbursement side of the ACA.  Kansas remains a no Medicaid expansion state.
 
National Rural Health Association states that 48 rural hospitals have closed since 2010 and 280 more are in trouble. Can Kansas create one or more new provider models and improve the financial viability of existing critical access hospitals fast enough to save our rural health systems? [read full post]

March 23, 2015
Minding the Money
Who's Minding the Money?

In a nonprofit organization, there are three correct answers: staff members, external auditor/reviewer and governing board. Each one of these three players exercises a critical role in making sure that money is properly received, spent and accounted for. A weakness or laxity in any one of the three is a reason for special concern and action by the other two.

Four times in my 28 years at the Health Ministry Fund I have experienced the failure of this system to the point that the very life of the organization is threatened. In only one of those four situations was actual misappropriation of funds by an insider a significant part of the resulting financial quagmire. In three of those situations, the facts are so similar as to almost create a roadmap for financial ruin. [read full post]

March 16, 2015
Kansas Flag
Expand Medicaid in Kansas

A Medicaid expansion will be good for struggling low income families, health care providers seeking to stretch ever more limited payment dollars, and the overall Kansas economy.

The current Medicaid program is too restricted in coverage to provide access for thousands of hard-working Kansas families without employer coverage and for other Kansans facing difficult circumstances like partial disability. The only adults in Kansas with Medicaid coverage are parents below 33% of the federal poverty index, pregnant women and a very few disabled persons. [read full post]

March 10, 2015
Caring
When Cures Are Insufficient
I was privileged to hear Dr. Donna Meier at our annual Grantmakers in Health conference last week. She is the director of the Center to Advance Palliative Care (www.capc.org). From the experiences of the Health Ministry Fund in successfully promoting the spread of Medicare certified hospices across Kansas more than 20 years ago, I came to her presentation expecting to get confirmation of much I already knew. Instead, she improved and changed my understanding of palliative care as a major force in bringing healing with quality into our health care system for many consumers and their families. [read full post]

February 23, 2015
Dental Operatory
Better Dental Care:
Dental Assistants-Hygienists-Dental Practitioners-Dentists

In remote regions of Alaska, a "demonstration project" is showing how to improve oral health delivery. Started due to the impossibility of securing permanent, consistent dental care for residents of scattered, small villages, a new member of the dental team was developed: the Dental Health Aide Therapist (DHAT). Overcoming strenuous objections and legal fights instituted by the American Dental Association and its on-the-ground affiliate, the Alaska Dental Association, a wedge of care and service now reaches residents traditionally afflicted by bad oral health and infrequent, long-distant service.

In Kansas, for five years the Kansas Dental Project has been working to secure the needed state legislation to authorize a similar new dental team member. States including Kansas use a labyrinth of professional practice laws to decide through licensing who can and who can't perform certain tasks: barbering, lawyering, medicine, dentistry, etc. These laws in Kansas recognize three people who can perform dental activities in the mouths of its citizens: dental assistants, hygienists, and dentists. The result of the Kansas practice law is that you don't have any "dental treatment" legally occurring in the mouth of a Kansan unless one of approximately 1,500 licensed practicing dentists is doing it. [read full post]

February 9, 2015
Aquaduct
The Elusive Concept of Sustainability
Many grantmakers would say that a key tactical understanding for them is “making long-term change with short-term money.” These funders—and the Health Ministry Fund is one—intend  to support a project for a period of two to five years; the project will be expected to sustain itself after the grant period. Frequently, there are public guidelines containing the indicia of this tactical understanding: “No on-going operating grants,”  “Maximum grant term of five years,” and “Renewals are the exception.” Almost always, those same grantmakers do make repeated renewals in one or more parts of their portfolio. For example, many funders believe that advocacy organizations have to be an exception to the “no on-going funding” rule because those organizations cannot develop a natural funding constituency (other people who care enough about the cause to donate or any source of earned revenue from the organization’s work).  

There are a lot of things wrong with the short-term money/long-term benefit idea, especially as applied by funders and understood by grantees. The first problem is that it so seldom works in many contexts. [read full post]

January 26, 2015
Puzzle Pieces
Putting the Mind Back Into the Body
A great article appeared in the Wall Street Journal ("Tot Therapy: Psychiatrists Join Up With Pediatricians,") reporting how a large pediatric practice in the Bronx had successfully integrated behavioral health into its practice. The benefits to consumers were many and the effectiveness of treatment was being demonstrated. The health problems are being addressed wholistically, recognizing that physical and behavioral health issues co-occur and influence each other.

It is a strange fact of our American health care system that some health conditions are segregated out for treatment. Almost always due to historical accident, we find some body parts not welcome for service in the traditional medical settings of physicians' offices and hospitals. [read full post]

January 21, 2015
Farm Work
One Area of Growth in Rural Areas
Those of us who grew up in rural areas--even though that was decades ago in my case--retain a mind picture of a hard-working population living a large part of its life outdoors. Rightly or wrongly, we remember a generally healthy group of people. Policymakers likely have similar views and may believe the rural population is healthier than the general American population. The truth for 2015 is that rural populations frequently have similar characteristics in terms of health with urban populations and the suburban population is the healthiest demographic group.

It is counter-intuitive to believe that the places which produce food for America can lack access to nutritious foods. It boggles the mind that places with wide-open, uncrowded spaces lack opportunities for physical exercise. None of that squares at all with the lingering perceptions of rural life which many of us have. But it is the reality! [read full post]

January 5, 2015
Mother and Baby
2015 Newborns--the Right Start is Breastfeeding
The first babies of 2015 are pictured in the local newspaper and, in some communities, special gifts are provided by and through the local hospital to the family lucky enough to have that first-born of the year (maybe to compensate for missing the tax deduction for last year). I wish the stories asked the parents one more question beyond the minutes and hours of the birthing experience and the weight and height of the newborn. It is a question that will determine much about the future health of that baby: will you be breastfeeding for at least six months? [read full post]

December 29, 2014
Circles of Hope
Hope Grows in Circles
For almost four years, I have been part of a local project called Circles of Hope. It is a fairly complicated structure to explain, and the terminology is prone to misunderstanding, but the impact is clear and immense. The start of a new year with all its possibilities and resolutions to make seems like a good time to talk about transformation -- and that is what Circles of Hope is all about.

In Circles of Hope, two groups separated by class (middle income and persons of limited resources) start learning separately about the issues of poverty and class division. Those with limited resources have highly structured sessions on budgeting, class differences, community resources, self-awareness, planning, and more. After the series of lessons, those with limited resources decide if they want to continue as leaders of Circles; if they do, the select prepared persons of middle income as allies to join their individual circle (one leader or co-leaders, if spouses). Meeting at least once a month, and often more frequently, the Circle members all set goals to work on -- with accountability to the group and access to the group's ideas. [read full post]

December 22, 2014
The Nativity
Christmas Presence
As a child, I was lucky to have two grandmothers living close to me. Both had lost their husbands (my grandfathers) at what is now a young age (late 50s, early 60s—when I was in first grade). My mother's mother, Grandmother Cox, lived in Longton where I did. I stayed with her a lot on Saturday evenings and other times when my folks were gone for the evening. She was short and heavy-set, cooked at the school, and was a barrel of fun. Christmas at her house was filled with games, all kinds of delicious home-cooked food, inexpensive but age-appropriate gifts, and lots of relatives, especially my cousins. We went to her house for Christmas Eve and sometimes back for Christmas Day evening.

My Grandmother Moore was a different story. [read full post]

December 8, 2014
Board Members
Nonprofit Boards
Our board was with us two days last week for committee meetings, full board meeting and retirement events for Virginia Elliott, Vice-President for Programs here at United Methodist Health Ministry Fund. Part of the board work was considering new board members and developing a recruitment plan to secure the skills, connections and passion we want in those new members. There is surely nothing I can say which has not been said dozens of times about nonprofit boards but, to my way of thinking, what has been said has not sunk in enough for many, many nonprofits. This justifies saying some of it again.

Good boards are a joint project for the chief executive officer and board leadership. Often, when I hear nonprofit executives complain about their boards, I have minimal sympathy because the executives have operated with a "hands-off" mentality and get what their zero board development effort merits: an unengaged board or, worse, a problem board. Nonprofit executives are responsible for providing board education opportunities, encouraging board self-assessment at regular intervals, maintaining appropriate inter-personal connections with board members and trolling for good prospects for board membership to present to the board. Working with the board chair, executives should attempt to see that each board meeting has three elements: important decisions needing the collegial thinking of the board, interesting information about the field of endeavor or board operations, and inspirational, uplifting moments reflecting the organization's positive mission. Too many nonprofit board meetings are "whine-ins" about what is not available financially, the difficult clients served, the failure of board members to perform fundraising, the heavy hand of government, etc.
[read full post]

December 1, 2014
Investments
Investment Worries...for Foundations, Pensioners, Small Investors
We have been living in an investment climate since 2008 which is either a near-term "new normal" or an aberration of sorts. At three investment committees that I participate in, the word has been virtually consistent since the 2008 debacle -- "expect returns below the historical norm for the next 5-10 years." While advisors have been providing this sobering line, the US stock market has been soaring. Meanwhile, the fixed income market has been dealing with interest rates at historic lows, creating concern that increased rates will "sometime soon" hit fixed income with significant principal losses. [I personally felt this had to happen at least four years ago and have missed out on lots of good fixed income returns as rates ratcheted down toward zero.]

At an investment conference last week, five of my directors and I heard over and over again that the "endowment model" is being questioned, although the speakers uniformly supported its continuance -- it is their livelihood, after all. Apparently, to the investment community, the "endowment model" is a diversified portfolio of investments from different asset classes which tamps down volatility -- movement in returns and values -- because the various asset classes do not move in tandem under the vast majority of market conditions.

But there are several apparent problems with the "endowment model."
[read full post]

November 24, 2014
Health Insurance
It Was a Short Conversation
The young clergyman thanked me for the Fund's role in bringing information about insurance availability on the health insurance exchange to his community. I remembered that he had asked a lot of questions of the speaker and had presumed he was a critic of the Affordable Care Act looking for the problems. But that was not the case this time.

He explaned that in his denomination (not United Methodist), local churches are not required to purchase health insurance for their pastors. For years, he, his wife and two children had not been able to secure affordable health insurance. They had worried that a medical issue -- a normal childhood accident, for example -- would cause them enormous financial problems. After hearing more about the health insurance exchange, he went online and was able to secure coverage for his family at an affordable price due to the group rating of products there and the subsidies. A load had been lifted from their lives. But he can't tell this story to his congregation because they are firmly against ObamaCare. I have tried to be careful in the telling so that somehow this example of appreciation for the ACA does not get back to them. [read full post]

November 17, 2014
Missed Opportunities
Missed Opportunities
In March, the Secretary of Education announced a report from the Office of Civil Rights which determined that 8,000 public preschoolers were suspended at least once in 2011-2012 - most frequently, boys and black children.

This confirmed 2005 research by Yale's Walter Gilliam, who found that pre-K students were being expelled (not suspended) at a higher rate than K-12 students. The Kansas preschool expulsion rate was less than 4 per thousand, but still higher than the rate of K-12 expulsions. These suspensions and expulsions are not high absolute numbers but certainly reflect a problem (and also an opportunity).

Research in brain development and new understanding of the interplay of nature and nurture provide great hope for addressing emotional and behavioral problems in infants, toddlers, and preschoolers with low-cost, practical interventions. The issue of the social and emotional health of our youngest children has been on the back burner far too long. [read full post]

October 20, 2014
Smiling Girl
The Fight for Fluoridation
In 1998, I had no idea there was any issue about community water fluoridation. That was the year the Health Ministry Fund adopted a new focus for grants to improve the oral health of Kansans. Our research told us the key to improving oral health in Kansas is to adjust fluoride levels in community water to offer optimal benefits for healthy teeth. Simple and effective.

I was right about the effective part. There is not any real issue about the safety and efficacy of community water fluoridation.

I was wrong about the simple part. [read full post]

October 13, 2014
ER
Rural Health Care: Whither Thou Goest...
Recently I attended the National Rural Health Association's conference on Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs). With these Medicare/Medicaid payment designations, the providers receive "cost-based reimbursement" proportional with their Medicare/Medicaid volume instead of fee-for-service. My rural friends will want me to let you know they don't really get reimbursed for their costs (what they spend). This CAH/RHC payment structure is why we still have hospitals and physicians in much of frontier and decidedly rural Kansas and America. Fifty-eight percent of Kansas hospitals are CAHs (76 in number).

In spite of this more generous reimbursement, rural health care is under stress in much of America and in Kansas. NRHA spokespersons summarized the problem with some dismal financial statistics. 283 CAHs are vulnerable to closure now. Forty-one percent of CAHs operate at a financial loss, and CAHs overall have an average 0.7% operating margin. Twenty-seven rural hospitals closed in the last 19 months. To maintain and improve rural health care delivery, it will take new reimbursement and operational models and cooperation from the many key players to revitalize the rural health structures necessary for the 21st century. [read full post]

October 6, 2014
Reality
Reality Still Exists? Facts or Fiction about the ACA
I remain committed to the idea that the world is actually what we see, feel, touch, smell and hear (although my audio function may not be sufficient for total clarity). This reality can be quantified with representations such as numbers and words. Misperceptions can be corrected with the scientific method, the historical method and similar observational and intellectual activities built upon shared principles and careful application. I believe that, subject to sensory and brain limitations, there is a shared reality which can be described and experienced.

This is increasingly a minority operational view in Kansas and America. We are particularly assaulted with this problem in the political season when history is rewritten, causation and association are blurred beyond recognition, and myths of non-mythic proportions (I am tempted to say “prevarications”) are shared to stimulate the appropriate base and move the undecided. [read full post]

September 29, 2014
Compass
Getting Ready to Enroll Thousands
The second open enrollment period for insurance through the health exchanges created under the Affordable Care Act is coming. From mid-November through mid-February, Kansans without health insurance (and having a few other qualifications) can look to the federal "marketplace" for coverage options and possible subsidies to make coverage affordable. However, for many of those approaching the insurance marketplaces, the real-life impact of terms such as deductible, co-payment, networks, and co-insurance may not be clear. Understanding the basics of health insurance (health insurance literacy) and having a knowledgeable, trusted guide to help families and individuals navigate the many options and choices is critical to gaining effective and affordable coverage. [read full post]

September 22, 2014
Medical Care
Legacy Providers
Last week, while attending the Governance Institute (a conference for hospital executive staff and trustees), I was introduced to a new term in health care: Legacy Providers. Ken Kaufman of Kaufman Hall consultants describes existing physician practices and hospitals with this term, as compared to the new competitors in health care such as CVS, Walgreens and Walmart. Many of us are familiar with what Ken was discussing, and although these and similar big businesses have not yet significantly developed health clinics in Kansas beyond urban areas, they are coming - and, for better or worse, changing the way health care is delivered. [read full post]

September 15, 2014
Passing the Baton
Boomer Succession
We are well into the long-dreaded (and perhaps long-awaited, for some) period in which nonprofit leadership transitions are happening all around us. In many nonprofits, a leadership transition is a potential disaster, but handled adeptly, the succession process can bring opportunity for many organizations to move in new directions, adopt new practices and create more impact. The outcome, for better or worse, depends on several key factors. [read full post]

September 8, 2014
Bills
Grocery Bills and Medical Bills
Health care in America is very expensive, and although many people have been protected from the full impact of rising costs by insurance, for many reasons underinsurance is a growing problem, putting families' financial resources at risk and often contributing to bankruptcy. But isn't health care just one more bill, like paying for groceries? Can't people just shop around and decide how much health care they're able or willing to pay for? Or is there something different about health care costs? [read full post]


September 1, 2014

Community Gardens

Recently, I visited two community gardens - facilitated by Hiawatha United Methodist Church and Grace United Methodist Church, Emporia. Both had received start-up grant support from the Health Fund through our Healthy Congregations program. They represent a growing interest in community gardening in Kansas communities and throughout the nation. [read full post]