And not just any data. Extremely sensitive data.

The U.S. health system is undergoing a major technological shift right now. Some equate it to finally catching up to where the banking and airline industries have been for years: Doctors and hospitals are moving to electronic health records systems, and it’s not easy.Ìý , based in Kansas City, Mo., has grown into one of the nation’s biggest players in the field of health information technology.

Cerner’s main headquarters seems like a college campus, peppered with trees and walking paths, along with some Star Trek-like architecture.

Cerner’s headquarters, which some call “The Bunker,” are based in North Kansas City. The multi-billion dollar company started here three decades ago (Photo by Elana Gordon/KCUR).

Brian Smith oversees the part of the campus that he and many others at Cerner commonly refer to as “The Bunker.”

It’s one of the data centers that Cerner has constructed in recent years, with concrete walls built to withstand a strong tornado, armed guards and multiple security levels. It’s designed to protect what’s inside: a temperature-controlled room full of thousands of servers. There are back-up generators for back-up generators, Smith says, to be sure that this health information isn’t compromised or made inaccessible by a power outage.

This data center and Cerner’s others are responsible for health information generated by hundreds of hospital systems and doctors’ offices throughout the U.S.

This could be your data, that prescription your doctor just entered into his or her computer, that lab result that just got processed. The transactions go through here in real time.

Data storage is a big selling point for Cerner, but it’s one part of what the company does. It has software for all sorts of medical settings, and it offers other IT services, such as sending Cerner technicians into hospitals to run the systems.

These servers hold private health data at Cerner (Photo from Cerner).

Cerner started small. Founder and CEO recently told shareholders that the company started in 1979 when he and some friends were studying accounting at an iconic Kansas City park, called .

“So we probably did more day dreaming about starting a company than we did studying for the exam,” he says.Ìý“Loose Park was a beautiful place to have envisioned this.”

Today, Cerner around $17 billion. The company employs about 12,000 people, with more than half based in Kansas City. In the last two years alone, Cerner has hired 3,000 people. the company’s chief operating officer, says if you’re an engineer, you’ve got a job in Kansas City.

“In fact, someone asked me last week, they said what strategies did Cerner execute to survive the recession,” says Nill. “My answer was, ‘What recession?'”

Federal policies have spurred a lot of this growth. , with the consulting firm The Advisory Board, says in the last few years, the government has made more than $20 billion available to health providers digitize their records.

“It was a little like when the railroads were started in the late 19th and early 20th century,” Roades says. “It’s public funding that has jump-started a big, big wave of investment in these IT systems among hospitals and doctors.”

It has been a gold rush for companies like Cerner. Roades says he often hears that a hospital is spending a third of its capital on information technology.

All this federal money has fueled a lot of companies, but Cerner is one of two companies that are leading the pack.

“Our count is they’re in 15 percent of all U.S. hospitals, nearly 800 hospitals,” Jason Hess, with .

Hess says Cerner is locked in “a two horse race,” trailing the private company, Epic, based in Wisconsin. Epic has 24 percent market share for acute care hospitals with more than 200 beds to Cerner’s 21 percent in that same market, according to a recent report by Klas.ÌýEpic has also won the business of some of the largest and most prestigious academic medical centers. In fact, Cerner lost a major contract to Epic in its back yard several years ago when a big Kansas City hospital system made the switch.Ìý

Still, Cerner’s impressive has presented huge challenges. Hess says it can be difficult to recruit enough qualified engineers and maintain quality for continually evolving software. Making sure it’s user friendly is key, too.

So while this is a story about data, all this data Cerner is capturing is just the beginning of a much bigger story.

Patterson says it’s now critical to figure what to do with that data – how to analyze what a cholesterol test means, for example, in light of a patient’s medical history, or how to find the best medication for an individual.

“That’s where the cost savings will come from, is keeping you out of hospital, out of emergency room, [away from] specialists, but make you healthier,” says Patterson.

Achieving those results is the challenge that Cerner — and many other companies and providers — are racing to figure out.

This piece is part of a collaboration with , , and Kaiser Health News.

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So the city that’s home to Ìýand other health information firms seemed a natural to host something called the .

A mashup of innovation and old-school hacking (), the goal of the competition was to improve the nation’s health system and help people navigate the complexities of the Affordable Care Act.

Oh, there was a catch. They had to pull off these health care feats with an app. The top prize: $15,000.

Ten finalists Ìý²ú±ð´Ú´Ç°ù±ð a panel of five judges last week. The apps were varied. Some focused on improving personal health; others served as navigators of the federal health law; and a few made health care costs easier to find.

Liam Ryan, a 23-year-old from Dublin, Ireland, earned a runner-up prize with a program he describes as “Foursquare for health.” A user comes up with a team, perhaps of friends and family, and then competes against them on healthful behaviors. Messages pop up on the team members’ phones when someone has earned points.

“The idea is my friend went for a walk at home, got some points without me. All of a sudden I want to beat him back,” Ryan told judges, adding that he sees employers, with their growing concerns over health care costs, taking interest in a program like his.

There were a variety of apps that aimed to help navigate the Byzantine world of health care prices. What if you knew the price of that cavityÌý²ú±ð´Ú´Ç°ù±ðÌýgetting it filled?

That’s where finalist , from Seattle, comes in. “Today online, you can book and plan your dream vacation, you can research your home, you can buy a car. You can even get a Ph.D. But you can’t find out the price of your next dental exam,” McCluskey said.

McCluskey’s app locates medical services that often aren’t covered by someone’s insurance, such as dental or eye exams. The service allows users to compare options in an area based on price and a doctor’s credentials. In Chicago, one city where the app is live, McCluskey found prices ranging from $60 to $460 for an optometrist visit.

Scott Speranza was second runner-up with an app that audits medical bills. People scan bills into their phones, then the app searches for errors and savings.

The grand prize went to eLuminate Health. The company’s program focuses on outpatient surgeries and tests, such as mammograms or MRIs, where prices can vary by thousands of dollars.

Someone with traditional insurance coverage may not know — or care — whether a procedure costs $500 or $5,000. But the rise of high-deductible health plans means people may pay anywhere from $2,500 to $5,000, or more, before insurance starts footing the bill. “You’re thrust out into this system where you have no idea — you can’t do any type of shopping,” said eLuminate’s Peter Yates.

One day, Yates would like to see providers set and publicize their prices. “Just like a mechanic sets the price on an oil change,” he says. People who need a mammogram could then compare their options based on price and quality, much as they now shop for plane tickets on a site like Expedia.

Yates says the idea, which will be piloted in Kansas City this summer, has sparked the interest of medical groups that typically have less pricing leverage than large hospital systems. And while taking part may not appear to be in the interests of large providers that do well now, Yates thinks that could change.

“We really want to flip that around to more of a normal commercial model of ‘this is the thing I’m selling, here’s how much it costs,’ ” Yates said. “We want to make health care like almost any other consumer good that people buy today.”

The competition was co-sponsored by , a business incubator, and tax giant H&R Block, both based in Kansas City.

Longtime Kansas City business leader , now an assistant secretary for the U.S. Department of Health and Human Services, was one of the featured guests. “This was all impressive work,” he said.

This story is part of a collaboration that includesÌýNPR, Ìýand Kaiser Health News.

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Nixon previously said he was evaluating the issue to see what’s best for Missouri.

Speaking to a packed crowd of hospital and clinic leaders in Kansas City on Thursday, Nixon said an expansion is the right thing to do and that it makes fiscal sense. The federal government would fully subsidize an expansion during the first three years, he emphasized, with the state kicking in about 10 percent of the cost in 2020.

“It’s the smart thing to do, because if we take a pass on billions of health care dollars — dollars I should note which come out of Missourians’ paychecks when they pay their [federal] taxes — the money will go to other states,” Nixon said. “They’ll get the benefit. We’ll get the bill. That’s not smart.”

out yesterday by the Missouri Hospital Association projects Missouri would get about $8 billion dollars in federal funds during the first six years of an expansion. The state would spend an additional $300 million from its general revenue budget.

Moving forward with an expansion won’t be easy. State lawmakers have long opposed it, whether that be because of the unpopularity of the entire health law in the state, or because of worries over expanding an already large state health program.

This story is part of a reporting partnership that includes ,Ìý and Kaiser Health News.

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This story is part of a partnership with , , and Kaiser Health News.

Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov.ÌýJay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange.Ìý

Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement.ÌýTheseÌýgovernors’ moves open the door for increased federal involvement in health care in both states.

President Barack Obama’s health law has never had any easy time in this part of the country. “Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program,” Brownback said in a statement.

Missouri Gov. Jay Nixon (Photo by Alex Wong/Getty Images)

In Missouri, the law is facing an even steeper uphill battle. Last week, voters overwhelmingly approved a measure prohibiting the governor or any state agency from making any moves toward setting up an exchange without legislative approval. The also allows taxpayers to sue a state worker or agency over being involved with any part of the exchange process that’s not required by federal law, whether that be assisting a federal agency or providing resources.

A bill that would have authorized a state exchange stalled last year, and state lawmakers haven’t taken any action on one since then. They don’t convene again until January, well past some of the federal government’s key deadlines, even with the recent deadline extension.

“Based on current state law, and the federal deadline, the state-based option isn’t on the table for Missouri at this time,” said Nixon. So a federal exchange seems to be the only possibility.ÌýÌý

Some health policy experts find the situation in Missouri ironic. “We have a state that is very much committed to state rights and state control,” notes Thomas McAuliffe, with the Missouri Foundation for Health.Ìý“Yet we’re willing to just blindly cede all creation and administration of a health exchange or insurance state marketplace to the federal government.” The foundationÌýhelped fund efforts to plan an exchange.

McAuliffe doesn’t want to write everything off just yet. He thinks states like Missouri are likely to become more involved in the process, as the political dust settles. Nixon himself said in his announcement that falling back on a federal exchange isn’t ideal:Ìý“Regulating the insurance market is a power best left in the hands of the states, where we perform those duties more efficiently and effectively, and provide better service for our consumers.”

Early on, MissouriÌýmade some progress toward setting up an exchange, as had Kansas. While that’sÌýcome to a halt in both states, thereÌýare still those like Kansas insurance commissioner, Sandy Praeger, who want the state to be involved in a hybrid state-federal partnership.

Kansas Gov. Sam Brownback (Photo by Andrew Burton/Getty Images)

Praeger says that will depend on the path Brownback takes with his new legislature in the months ahead: “His concern is that they have all these new conservative Republicans that won’t want to go along with a partnership exchange,” Praeger said, “but I’m still hopeful.”

In his statement, Brownback wrote: “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could costs Kansas taxpayers millions of dollars.”

McAuliffe believesÌýthat byÌýextending the deadline for states to declare how they will run their own exchange, the HHSÌýis signaling a bit of desperation.ÌýAnd what that means, he says, is that states like Kansas and Missouri still have an opportunity to get more involved if they choose.Ìý

No matter who is in charge,Ìýthe health law calls for all of these exchanges to be up and running in a little over a year. That’s not a lot of time for either federal leaders or the health care industry to work out the details and make sure everything’s ready.

have said they plan to run their own exchanges. At least eight states have said they won’t. The rest have yet to submit plans.

This story is part of a partnership with NPR, KCUR, and Kaiser Health News.

This <a target="_blank" href="/insurance/missouri-kansas-health-insurance-exchanges/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý,ÌýÌýand Kaiser Health News.

In the southern African country of Zambia, near the capital Lusaka, there’s a phrase people whisper to each other when someone has or is rumored to have AIDS: “Kayonde yonde,” or “Slimming, slimming.” Bester Seemani says it’s the physical weight loss people there associate with the disease.

But 12 years ago, Seemani was unaware of her own physical decline as she was finishing a year and a half of work and study in hotel management in Kansas City. She was eager to go home to her 6-year-old daughter, Sue, who was still living in Zambia.

“My whole life was left back there,” says Seemani. “I was supposed to return on May 28^th. All my bags were packed.”

Bester Seemani, left, was diagnosed with HIV 12 years ago in Kansas City, altering plans to return to her daughter, Sue, right in Zambia (Photo by Elana Gordon/KCUR).

Seemani never made it back to Zambia that spring. Instead, she was hospitalized and diagnosed with HIV/AIDS. She applied for asylum to the United States in November 2000, citing the discrimination and lack of medical care she would receive if she returned to Zambia. She was granted asylum on Valentine’s Day, 2004.

This week as 25,000 delegates from around the world gather in Washington, DC for the International AIDS Conference, Seemani’s story illustrates the evolving interplay between the global AIDS pandemic and U.S. policy on the disease. Seemani is one of more than 6,000 people living with HIV/AIDS in the Kansas City region; the country she comes from has an estimated HIV prevalence rate among adults of 13.5 percent, , meaning nearly a million Zambians are HIV positive.

Diagnosed here by chance, Seemani received life-saving care, asylum and eventually U.S. citizenship. If her HIV status had been documented when she applied to come to this country on a work-study visa, she likely would have been denied entry. Up until two years ago, the U.S. banned anyone with HIV from traveling to the country. The change in that policy is what led to the International AIDS Conference taking place in D.C.

The Diagnosis

Sitting inside her cozy apartment in Kansas City, Missouri last week with her now 18-year-old daughter at her side, Seemani recounted her story.

The diagnosis had been a total shock to her. Seemani says just weeks prior to her scheduled flight back home, a good friend who hadn’t seen her in a while stopped by to say goodbye. The friend immediately noticed something was wrong: Seemani had lost so much weight.

“I had been fine,” Seemani recalls, “but someone who hasn’t seen me for a while, said ‘No, you are not OK.'”

Her friend insisted on taking Seemani to a local hospital. She stayed there for 26 days, battling high fevers and undergoing different tests and procedures. She says she had no idea why she was so ill until the day before she was to leave the hospital, when a social worker came to talk about discharge procedures and where she could access AIDS services. Her response was, “What? I have AIDS?”

“I demanded that I wanted to talk to the doctor to find out exactly what’s going on,” Seemani says. “The doctor came. He was standing really far by the door side, and he’s like, ‘Yes, you have AIDS.'”

The doctor then told her she’d be able to get medication here that wasn’t available in Zambia, medication that would help her improve to the point that she’d be able to care for her daughter. Seemani, like others in Zambia, wasn’t aware such medicine existed.

Coping With Stigma Across Continents

So despite longing to be with her family, she stayed in Kansas City. Her first challenge came up before she even left the hospital: Staff warned her not to let anyone know about her diagnosis.

“Having to come here and deal with this huge secret, it was a very big burden to carry,” says Seemani. “It’s like I’ve taken a gun and shot someone in the face, like I’m the one that’s actually caused this problem. Whereas it’s supposed to be the other way, people feeling sympathy for you because you’re the one who’s sick.”

That secrecy was very painful for Seemani’s daughter, Sue, who had to deal with the absence of her mother – and not knowing why her mother hadn’t come home.

“I just remember waiting there, and just sitting and knowing that tomorrow I’m going to the airport and my mom will be coming home,” Sue recalls. “And just being told that she’s not coming, and never being given an explanation why.”

Sue, whose father dropped out of her life when she was 2, heard relatives and friends speculate that Seemani had gotten married, had found a new family. “It was pretty hard and pretty harsh to have to deal with all of that,” Sue says.Ìý

Seemani is not sure how she contracted the virus. It may have been through sex, or through a blood transfusion she needed after giving birth to Sue. She also wonders if she got it from a traditional healer she went to, who cut her skin with razors that could have been contaminated.

Seemani was sure about one thing: the stigma around AIDS in Zambia was huge. Seemani says telling her family about her diagnosis would be more damaging to them than to her.

“My daughter would receive the same discrimination and bad treatment as though she had AIDS herself, and my sister [the] same way, as if they have the disease,” she says. “Even though they don’t have it, it affects the entire family.”

As the primary breadwinner for her family and not knowing whether the medicine would help, she also felt that confiding in her siblings would be too devastating.

“They would be completely hopeless, because I’m the person they look up to,” says Seemani.

Reuniting With Daughter, But Challenges Remain

So Seemani kept the secret to herself, confiding in just a few people, all the while getting treatment in Kansas City. She returned to work. About a year later, she had the paperwork and funds needed to bring her daughter to Kansas City.

“Even though she had been gone for three years,” Sue begins. Seemani corrects her: “Two years eight months.”

“Even though she was gone for two years eight months,” Sue says. “She was still my mom.”

The two eventually moved out of a hotel where Seemani worked and into an apartment. Seemani got a car, which she says was essential to their independence.

Even though Seemani and her daughter were finally together, life in Kansas City wasn’t easy. She still didn’t tell Sue her HIV status until it was about to come up during one of their asylum application hearings.

“I don’t think she was ever going to tell me,” says Sue. But she didn’t need to be told. Sue already knew.

“I used to do all her drug cocktails,” Sue says. “So it was basically every Sunday, I’m the one who’s sitting there going through five or seven or 12 different pill bottles, [organizing them]. It was a really easy thing to do, just dropping them in the box. And it was just a way to help out.”

Seemani says she’s been fortunate in that accessing HIV medication has never been a challenge. But side effects from the pills and the health issues associated with the disease have at times been debilitating. In 2005, the bone in her right hip , at times limiting her ability to walk, and threatening to confine her to a nursing home. She stopped taking medication for several years.

But even when she was at the peak of her health – working several jobs, going to community college, raising her daughter – Seemani lived in fear that others might find out about her HIV status.

“Because we don’t want anyone to know, we can’t mix with anyone,” Seemani says. “We really just didn’t have a life.”

Sue also had trouble: “It was also really stressful because I was 7, turning 8. And I can’t talk to anyone about it. And I go to school, and I was bullied quite a bit just for being different and not being from here. And so I was miserable.”

They were not completely alone. Seemani did get help from a volunteer with a local AIDS agency. She was also involved with an all women’s HIV support and education group. She still keeps in touch with the women.

“Sometimes it’s just helpful to sit down with other women. You all have these concerns and you just talk about things,” she says.

Sue found refuge in for kids affected by HIV. But while these outlets were essential for coping, both say they weren’t enough.

Lifting The Burden

Seemani says it was during one of her lowest points, when she just couldn’t go it alone anymore, that she had a major breakthrough. She was out of work, experiencing some serious health problems, didn’t have money for food and could barely pay the utility bills. She finally told someone from Sue’s school about her situation and asked for help. The supportive reactions made her realize she no longer had to worry about keeping her sickness a secret.

“Life just changed for the better. It became easier to talk about things, to deal with issues,” says Seemani. “That’s when we started having friends over, and now we can talk about it anywhere. Even the Zambian community [in the U.S.], everybody who knows me knows I’m positive.”

Seemani says the change gave her more strength and energy. Sue, meanwhile, began talking back to peers who made jokes about HIV. In eighth grade, she finally told a friend about her mom. In high school, she joined a group of young adults affected by HIV who traveled to schools around the country to share their experiences.

“The only way for me to feel like I could really conquer it was by getting over it, not making it less important, but getting into a place where keeping the secret wasn’t controlling my life anymore,” Sue says.

A Return Home, Hope For The Future

Seemani and Sue say it wasn’t like everything was immediately okay after they stopped keeping HIV a secret. The stress from the disease and from not having enough resources to survive has had a huge physical and psychological toll. At one point, Sue went into foster care, staying with a family friend while her mom recovered.

But this May, Sue completed her first year at Columbia University on a full scholarship. The two were also recently granted U.S. citizenship, and with that, they finally had the chance to take a trip home to Zambia over winter break.

Seemani gets the impression that the stigma around HIV in Zambia has changed since she was first diagnosed with the disease 12 years ago.

“Because so many people are sick,” says Seemani. “So almost every household, maybe they have someone who has AIDS. So it really doesn’t make sense for one family to be pointing fingers at the other family when they are dealing with it in their own family. It’s just so commonplace now that people are more accepting.”

Back in Kansas City, Seemani says life continues to have ups and downs. She’s unemployed right now, but wants to get back to work in hotel management. Her hip problem makes it difficult to walk, and she’s struggling to find treatment. Still, Seemani says she has faith that things will work out the way they’re supposed to.

“I never lose hope,” says Seemani. “I know I’m sick right now. It’s just one of those challenges that I have to go through. I know it’s going to pass, and I’ll have many more years of bright future ahead of me.”

This story is part of a reporting partnership that includesÌýKCUR,ÌýNPRÌýand Kaiser Health News.

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Which marketplace is better: a crowded one with lots of choices or a streamlined one with just a few options? Those competing ideals are the backdrop of a legal battle playing out this month in Missouri, where the state’s efforts to winnow contracts for are being challenged by one of the companies left out in the cold.

is suing the state arguing that Missouri changed the rules in the midst of a . Molina is one of five companies currently managing care for about 430,000 of the state’s Medicaid beneficiaries, who are mainly low-income children and pregnant women.Ìý

Molina’s contract was not renewed for next year. Instead Missouri awarded contracts to two insurers already active in the state and one new company.Ìý

Judge Bernhardt Drumm of Cole County circuit court could rule on the case any day now, and the dispute adds an element of uncertainty for beneficiaries, as it comes smack in the middle of open enrollment, which runs April 19 through June 16.

In Missouri’s managed care system, instead of paying doctors and health facilities directly for services, the state contracts with companies to oversee patients’ care in 54 counties.Ìý

“From the state’s point of view — and this is why it [managed care] is attractive to the state — it’s very easy for them to manage their costs,” says , a neonatologist in St. Louis and head of the state’s Medicaid oversight committee.

The state pays these insurance companies a fixed member-per-month fee. The companies negotiate rates with a network of physicians and hospitals to provide that care. They also have people who specifically help enrollees navigate the system. The model is similar to an HMO, where patients have a primary care doctor who makes referrals when needed.

“It becomes the managed care plan’s job to make sure they do a good job managing these patients, so that they don’t have their costs accelerated at a higher rate than they should, and run out of money. Cause then they’d go under,” says Walentik, who has worked with the managed care program since Missouri started it in the mid-90s, but was not involved in the state’s recent contract selection and review process

For the first time, the state has it awarded to just three, instead of granting a contract to any company that meets certain requirements. Having a cap could save the state $16 million over two years, according to officials with the state, through reduced administrative costs from having to work with fewer companies. The state also expects money to be saved from better rates that companies will be able to negotiate with providers because each company will have more members and more leverage.

Walentik says St. Louis may provide a good lesson for why less is better. When Missouri started its managed care program there in 1995, seven plans participated. “That was a disaster,” says Walentik. “There were too many plans and not enough lives. Part of way the it works in any place is you have to have a big enough population to spread the risk across the population.” She says three plans ultimately survived.

The new awards, issued in February and effective July 1, didn’t include . Molina was founded in California 30 years ago, specifically to manage healthcare for low-income people in government health programs. It has been in Missouri since 2007. The company currently manages about a fifth of enrollees in the program (including around 13,000 people in the ), and was one of currently with a contract in Missouri.

The state instead awarded a new contract to Centene’s Home State Health Plan. Based in St. Louis, the company hasn’t had a contract in Missouri for six years. The other two companies awarded contracts – Missouri Care, an Aetna health plan, and HealthCare USA, a Coventry health care plan– are already operating in the state. In March, Molina , challenging the state’s contract decisions.

“We believe the state changed the rules after proposals had been submitted and is illegally limiting the number of health plans serving Medicaid members in the state of Missouri,” says Amy Dobberteen, an attorney with Molina.

Molina wants the court to put a halt on the new contracts. The contracts total about $1.1 billion (with the federal government footing about $700 million of the bill).Ìý

Wanda Seeney, a spokesperson with the Missouri Office of Administration, said the state “conducted a competitive bid process for the managed care contract. Points were awarded for each bid based on quality; the method of performance; organizational experience; and most importantly, access to care.”Ìý

Molina didn’t score as high as the other plans on the various quality and access measuresÌý

At least one provider concurs with the state’s motives to limit contracts. “We always felt having five options was more than necessary,” says Bob Finuf, an executive with Children’s Mercy Hospital, the main children’s hospital in Kansas City. “It’s not efficient and added complexity for providers.”Ìý

The whole legal dispute comes at an inopportune time for beneficiaries. The state has already sent out information on the new contracts, and people are starting to choose plans for the coming coverage period.

“I’ve had patients tell me they’re in Harmony but are switching to HealthcareUSA,” says Walentik. “So people are making decisions already.”

As of late last week, the state had documented nearly 52,000 people enrolled in new plans, so the vast majority of the 430,000 beneficiaries still have to choose plans.

Ian McCaslin, the state’s Medicaid director, said in a court deposition that putting a hold on these new contracts would cause “turmoil” and confusion in an enrollment process that’s already underway. He said the state could also have trouble extending its current managed care contracts.

In the Kansas City area, the locally-based nonprofit insurance company, Blue Cross Blue Shield of Kansas City, also didn’t get a new contract, so the some 31,000 people who’ve been with the company are starting to choose a new plan.Ìý

“We would be happy to continue to serve this population, to continue to serve these members until things are worked out,” says Bryan Camerlinck, a financial services director for Blue Cross, who was also disappointed the company didn’t get a new contract. He says some of the insurer’s Ob-Gyn providers may not be covered on the new plans.

In St. Louis, Walentik worries about what would happen if the contracts are blocked.

“It would really put things in chaos,” says Dr. Walentik. “Because I think it takes a while to get patients educated and to get providers up and running, and it would be really hard if we had to cancel everything that’s been done and start all over again.”

Monday marked the court’s deadline for all parties to file certain evidence and briefs, so Judge Drumm could now rule at any time on whether to grant an injunction to stop the enrollment process or dismiss the case.

This story is part of a reporting partnership that includes KCUR, and Kaiser Health News.Ìý

This <a target="_blank" href="/medicaid/missouri-medicaid-managed-care-lawsuit/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The pairing is a sore point for hospital CEO who, as chair last year of the American Hospital Association, issued a urging hospitals to eliminate unhealthy food in cafeterias as one way to create a culture of wellness. Serving fast food inside Truman Medical Centers sends “an inconsistent message” to patients, staff and the community, Bluford says.

In 1992, Truman agreed to a 25-year contract with McDonald’s, at a time when the financial benefit of having a stable food service client in the hospital outweighed any potential health concerns.

But times have changed, and now other hospitals interested in replacing fast food with more healthful options may find it isn’t as easy as it seems. In Ohio, the Cleveland Clinic tried in vain to terminate its contract early with McDonald’s 10 years ago. At the time, the clinic’s lead heart surgeon (and now hospital CEO), Delos Cosgove, proposed removing all fast food vendors.

The Pizza Hut did close. But McDonald’s stayed and remains a tricky relationship for the hospital, which has since removed sugary beverages and trans fats from its campus offerings. “We’re just going to live with it,” Bill Barum, director of hospitality and retail services for the Cleveland Clinic, says. “When the contract ends, we’ll have the opportunity to re-examine the space.”

After 34 years at the Children’s Hospital of Philadelphia, McDonald’s closed its doors last September. The hospital says it wanted the extra space, but it has since added back milkshakes to the menu for sick kids, according to the hospital’s spokesperson, Julian Walsh.

Of the 14,000 McDonald’s in the United States, the company says there are 27 in hospitals. Fast food outlets like the hamburger chain can be a convenience and a comfort for patients. The food may also appeal to some patients’ picky tastes when undergoing difficult treatments.

And McDonald’s says its offerings are balanced to fit any diet. “Today, we offer more variety than ever in our menu, and we trust that our customers will make the appropriate choices for them, their families and lifestyles,” says Danya Proud, spokesperson for McDonald’s.

Some hospitals have as many as five different fast food outlets, according to the Physicians Committee for Responsible Medicine, which hospital food in 2011 at more than 100 major U.S. hospitals. The report’s top five “worst hospital environments” had at least one fast food restaurant.

“In this day and age, you would think a hospital might be proud enough, if not shamed enough, to cut or end these contracts with fast food outlets,” says Susan Levin, a dietitian with PCRM.

But even as some hospitals are looking the end the contracts, others are striking up new ones. As NPR’s The Salt blog , Chick-fil-A recently set up shop in several medical facilities, including the Texas Medical Center’s St. Luke’s Episcopal Hospital and the Medical University of South Carolina University Hospital in Charleston, S.C.

This story is part of a reporting partnership that includes ,Ìý and Kaiser Health News.

This <a target="_blank" href="/news/fast-foods-slow-exit-from-hospitals/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý,ÌýÌýand Kaiser Health News.

Free health clinics have long been places people turn to when they don’t have health insurance orÌýmoney to pay for care. But the health law’s expansion of coverage puts free clinics in uncharted territory.ÌýÌý

The Duchesne Clinic, a facility housed in an old parish school in Kansas City, Kansas, has decided to take Medicaid and private insurance if health coverage expands in the future –Ìýeven though it will mean a major transformation of the clinic (Photo by Elana Gordon/KCUR).

While the law goes before the Supreme Court this week, health providers are already gearing up for a surge in patients with insurance in 2014.

Around the country, hundreds of free clinics have been established over the last 50 years to treat patients like Patsy Duarte.

“I have no insurance, I have no other means of going to a doctor – the last time my husband went to a doctor, it was like $85 just for the visit,” says Duarte, who cannot work due to her medical conditions and whose combined income with her husband is about $15,000 a year.Ìý They are not onÌýMedicaid, because only parents with minor children are eligible.

Duarte gets her blood pressure checked at , a facility housed in an old parish school in Kansas City, Kansas. She’s been coming here for years to manage her hypertension, diabetes and other health issues. At a recent check, her blood pressure wasn’t good: 172 over 85. “That’s way too much,” she says.

The bad economy, the loss of jobs and health insurance, has meant more people like Duarte are turning to the clinic, according to director Amy Falk.

“We’ve been kind of caught in the perfect storm of you have so many people needing care that can’t get care, but at the same time, funding, you know, has been held level or in some cases decreased – so while you’d like to ramp up, this is not the economic time to do that,” Falk says.

While uninsured people can, and do, go to federally qualified community health centers and hospitals, free clinics are the only place where there’s no fear of a bill. There has always been an upside for the clinics to this arrangement: No bills means no billing systems and no heavy administrative costs.

But with the health law’s expansion of coverage, free clinics are at a crossroads: Should they stay outside the mainstream of the health system, remaining mostly dependent on donations and grants? Or should they start to accept Medicaid and other insurance?

The health law expands the reach of Medicaid beginning in 2014. That’s expected to addÌý16 million beneficiaries and some free clinics want to transform themselves to serve those newly covered people. But Nicole Lamoureaux Busby, head of the , points out that over 20 million people still won’t have coverage. And, she says, many clinics will have a role helping patients figure out the new system.

“It sounds great to have everyone be eligible between 2014 and 2019, but there’s not this magic potion or wand that’s going to get people signed up,” Lamoureaux Busby says. “Somebody’s going to have to help them. We’re going to have to explain now a very complicated system that quite frankly ignored patients in the past.”

Duchesne free clinic director Amy Falk says the clinic’s already been responding to a changing health system by trying to be more of a primary care center for patients.Ìý Falk says the clinic’s decided to take Medicaid and private insurance if health coverage expands in the future – even though it will mean a major transformation of the clinic.

“I don’t think we can stay as are. I think we have to grow within our environment,” Falk says. “It will totally change the culture and structure of this clinic, having never had to do these things and building the infrastructure one, to put in place, but just how we do our daily workflow. It will change.”

Dr. Glenn Hodges (Photo by Elana Gordon/KCUR)

One way taking Medicaid and private insurance could alter the nature of free clinics is in relationships with volunteers like Dr. Glenn Hodges, of the , in nearby Johnson County.

“I’m a medical missionary three miles from where I live, taking care of people in my neighborhood,” Hodges says.

Hodges has been a happy volunteer at the Health Partnership Clinic since he retired from the VA more than 10 years ago. This clinic will be making some more sweeping changes by applying to be a federally qualified community health center. That will include taking Medicaid and private coverage and qualifying for more federal funds.

The white-bearded Hodges – who is also a master rose gardener – says he plans to stay with the clinic. But he and most other volunteers will focus on patients who don’t have coverage. Staff will focus on those with coverage.

“The patients who are receiving free care are going to continue to be there. It’s two separate patient populations,” says Hodges. “We’ll require two separate administrative organizational structures. There’s a need for both.”

Jason Wesco (Photo by Elana Gordon/KCUR)

That attitude is great news for new Health Partnership Clinic director, Jason Wesco, who used to run a community health center. He knows he’ll still need volunteers like Hodges, as well as more paid staff to handle extra patients and a new operating system.

“I exist to help my patients get healthier and to take care of as many as I can in highest quality manner possible,” says Wesco. “How do I create a system where I can bill for services? Well, you know I just do it, just like I created a system to manage 100 volunteers. That to me is a lot harder than billing Medicaid.”

“We deliver health care to incredibly sick people, that’s hard. Billing Medicaid’s not hard.”

Still, Wesco knows this transition takes effort: planning, training staff, and adding an electronic medical records system. For clinics that go in this direction there can be bigger changes, too. Some will have to add or increase their malpractice coverage and some may need to take a role in changing state Medicaid laws.

“The bottom line is we have a growing need,” says Wesco. “And our job is to worry about all those people we don’t take care of and get resources to make sure no one goes without health care. That’s a big job and the only way I can do that adequately is to bring more resources into this organization.”

Free clinic directors say the next few years will be hard work, but they say with decades of stretching resources and caring for people with complex health problems, they’ll rise to the challenge.

This <a target="_blank" href="/medicaid/free-health-clinics/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">