GROW KC Healthcare August 2013

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HEALTHCARE

KC C H A M B E R N E W S L E T T E R

Presented by Blue KC

PRESIDENT & CEO'S

POINT OF VIEW Wellness is everybody’s job – including business. As employers, we provide insurance benefits. As individuals and employees, we control more than 70 percent of the factors that influence our health. As a country, we have a serious problem with obesity. Although I like the moniker “Big KC,” I’d prefer the “Big” not be a literal description.

That’s why, every August, we devote a special edition of Grow to the issues of healthcare and wellness. We’re also engaged in a very serious health initiative with Blue Cross and Blue Shield of Kansas City (Blue KC) – our Not So Big KC challenge. In Phase I, Mayor Sly James and I competed to see who could get healthier, based on a combination of weight loss, cholesterol, glucose and other like numbers. Phase II just finished, with 25 CEOs and government officials dedicating themselves to wellness.

Our two governors are also drawing attention to the problem of obesity, using their bully pulpits to encourage healthier lifestyles among residents of Kansas and Missouri.

Last November, right after Thanksgiving, Kansas Governor Sam Brownback announced his “Weight Loss Challenge,” with more than 5,000 Kansans participating. Together the group lost a total of 22 tons. The challenge ran for four months, with 1,000+ teams of five competing against a team from the governor’s office.

Missouri Governor Jay Nixon, meanwhile, launched “100 Missouri Miles,” challenging Missourians to complete 100 miles of outdoor physical activity by the end of the year, preferably on one of the state’s many trails. Governor Nixon and his wife have both taken up the challenge. At press time, the First Lady was leading with 60 miles walked.

To the north of us, Iowa Governor Terry Branstad is getting national attention for his announced goal to make Iowa the healthiest state in the nation by 2016 as measured by the Gallup-Healthways Well-Being Index. It’s a community-based, business-led, government-endorsed statewide effort, and it is pretty impressive. In the first year Iowa moved from 19th to 16th on the Well-Being Index.

As I mentioned earlier, your KC Chamber is also committed to wellness and a healthy “Big KC.” We are hard at work with Blue KC, planning the next phase of our wellness partnership – so stay tuned!

I know we’d all like to lose the distinction of being one of the fattest cities in the nation.

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JAMES A. HEETER

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CO N T E N T S 4

Blue KC: 75 Years Young: Kansas City's First Health Insurance Company

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Working for a Healthier Kansas City: The State of Health in our Community

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Beyond Access: Healthcare Reform Starts At Home

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Staying Active in Kansas City

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Addressing Kansas City’s Food & Play Deserts

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What Implementation of the ACA Means for Businesses

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Safety Net Clinics Adjusting with the ACA 4

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Making Your Way Through the Marketplace

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Local Leaders Join Forces for Not So Big KC

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10 Above: Chiefs Sports Lab powered by Blue KC hosts school field trips where students learn the importance of physical activity, eating right, and injury prevention. Located inside Arrowhead Stadium, the Chiefs Sports Lab powered by Blue KC features hands-on and interactive computer activities for children of all ages.

On the cover: Kansas City Missouri Mayor Sly James, Blue Cross and Blue Shield of Kansas City President and CEO David Gentile, and KC Chamber President and CEO Jim Heeter are inspiring Kansas Citians to take steps to take control of their own health and wellness.

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Blue KC:

75 Years Young Kansas City’s First Health Insurance Company

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lue Cross and Blue Shield of Kansas City (Blue KC) has been serving customers’ health insurance needs since 1938, when an employee from Wolfermann’s Bakery convinced her boss he should provide health insurance to his workforce. That employee, Betty “Grace” Jackson, and Wolfermann’s Bakery became the first customers of Blue KC. Originally called “Blue Cross of Kansas City,” the company was started by local physicians, hospitals and individuals, and provided hospital services with seven network hospitals.

The company grew quickly, and by the end of 1938 served 14,000 members. In 1943, Kansas City Blue Shield was formed to provide members with a prepayment plan for physician services. Blue Shield grew quickly, as well, and in 1950 it was the first Blue plan to introduce extended benefits to individuals not covered by an employer. That practice continues today, and is one of the fastest growing markets Blue KC serves.

In the 1960s, Blue Shield introduced a Medicare program to serve the health insurance needs of a growing senior citizen market. Finally, in 1982, Blue Cross of Kansas City and Kansas City Blue Shield united to become Blue Cross and Blue Shield David Gentile of Kansas City. Since that President and Chief Executive Officer time, the company has Blue Cross and Blue Shield of Kansas City continued to grow and

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currently serves more than one million customers here in Kansas City, as well as across the country, providing a variety of innovative employer and individual health plans and comprehensive wellness programs.

Mission Driven As we mark our 75th anniversary this year, I’m proud to be at the helm of an organization with such a rich history. As the only local, not-for-profit commercial health insurance company in Kansas City, Blue KC’s commitment to the community runs deep. Our longstanding mission to: "use our role as the area’s leading health insurer to provide affordable access to healthcare and to improve the health and wellness of our members” drives the more than 1,000 employees at Blue KC to continually work to provide excellent service and a variety of affordable plans and programs to fit the community’s changing health insurance needs.

Our efforts have not gone unnoticed. In 2012 and 2013, Blue KC was honored to receive J.D. Power and Associates’ ranking for “Highest Member Satisfaction among Commercial Health Plans in the Heartland Region.”

Community-centric The culture of our organization includes a sense of service, and desire to give back by investing time and dollars to keep area neighborhoods and school districts strong and children healthy. Annually, Blue KC provides substantial financial resources to a variety of community organizations and initiatives serving this objective. Programs around this effort include assisting area safety net health organizations to be able to serve

more people; providing financial assistance to member school districts so they may enhance the learning experiences of their students; and providing programs in the community that educate and encourage residents to live healthier lifestyles.

In addition, employees collectively volunteer thousands of hours of their time to help a variety of community initiatives, and Blue KC’s executives hold leadership positions on the boards of many local organizations. At Blue KC, the giving comes from all levels, and makes a difference for Kansas City’s residents.

A New Era Thinking about the changes set into motion since the passage of the Affordable Care Act, it’s noteworthy that of the three imperatives driving the healthcare industry – achieving an appropriate access, quality and cost balance – the focus of the ACA was to address access. Accordingly, effective January 1, 2014, up to 32 million additional Americans will have access. On the quality and cost fronts, the ACA does far less and essentially leaves finding a remedy to the private sector – if this challenge is not met, legislators likely will take steps to act.

About 80 percent of all healthcare spending is generated by about 25 percent of the population who are burdened by one or more chronic health conditions.

Clearly, to make progress on cost more focus must be placed on keeping people well and helping those with chronic conditions manage them more effectively. To do so, payment systems that incentivize physicians and hospital systems to focus on volume rather than patient outcomes must change and better coordination among physicians of patient care must take center stage for improved patient outcomes and quality to take hold.

That’s why the next generation of healthcare must be built around wellness and a greater sense of accountability on all of our parts. Providers must ensure quality outcomes; employers need to encourage employees to take advantage of wellness programs offered; and individuals must understand that good health begins with them. As Kansas City’s wellness leader, Blue KC is doing its part by providing benefits, programs and education to help people make the right decisions

regarding their health. But we cannot do it alone.

Blue KC’s Strategy Blue KC’s strategy is built upon this wellness framework. The company has ramped up its already significant provider collaboration activities, and is currently working with Kansas City’s hospitals and medical community on a shared approach to align reimbursement strategies to reduce cost and improve quality for patients. Blue KC helped bring the first patient centered medical home program to Kansas City, a concept of care in which the patient and physician collaborate in the care approach for that patient to bring the best possible outcome. The success of our pilot program served as the catalyst for our rapid growth of the program to now include about 50 percent of all primary care physicians in our area.

In addition, providing value-based benefit designs are an essential part of the plan, as they bring cost-effective care while enhancing the quality of care customers expect. Last, but certainly not least, Blue KC is putting a laser focus on its retail market and consumerism. Estimated to grow the fastest once health care reform really comes into play in 2014, the retail market promises big opportunities, as well as big challenges for Blue KC.

Thank You I would like to thank you for being part of our 75year history. I am proud to be a member of a team of over 1,000 employees serving this great city.

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Working for a Heal K

ansas City and its surrounding areas have a lot to be proud of, including numerous rankings among all U.S. cities as one of the best places to raise a family, based on affordability, opportunity, schools and safety.

According to the 2013 County Health Rankings, compiled by the Robert Wood Johnson Foundation, Kansas and Missouri has some work to do in order to create a healthier place to live, work and play. County Health Rankings show the health status of nearly every county in the nation and illustrate that much of what affects health occurs outside the doctor’s office. The Rankings help counties understand what influences the health of residents and the impact on their life expectancy.

Unfortunately, when it comes to the health of area residents, Kansas City does not fare as well. Communities in the metropolitan area, particularly within Wyandotte and Jackson counties, exhibit much poorer health, when compared to national benchmarks. However, even counties like Clay and Johnson with higher overall health rankings have areas to work on. Targeting major health risks, like childhood obesity, unsafe sex, excessive alcohol consumption and high blood pressure, is important in order to improve overall health but also

to reduce the number of premature deaths.

The County Health Rankings report released in March found that rates of premature deaths in counties across the country are at the lowest level in 20 years.

However, people in the unhealthiest counties are dying too early at more than twice the rates of those in the healthiest counties.

Understanding the relative importance of health risk factors will impact premature death, which is defined as the number of people per 100,000 residents who will die before the age of 75. The national benchmark is 5,317. Overall premature deaths in Kansas are 6,871 and in Missouri are 7,827. When comparing counties in the two states, Wyandotte and Jackson are well above the national average with 10,125 and 8,902 premature deaths, respectively.

Looking at health overall, nationally 10 percent of adults report they have generally poor or fair health.

In Wyandotte County, 20 percent of residents reported poor or fair health, while 15 percent of residents in Jackson County reported poor or fair health. Compare these to 8 percent and 14 percent in Johnson and Clay counties, respectively. These statistics translate into ATCHISON 30%

Obesity in KC: a big problem

HOLT 31%

UNHEALTHY

Percentage of obese adults reporting a BMI ≼ 30 National average: 25%

HEALTHY

In the Blue KC service area, all but one county report obesity rates above the national average, making our community more susceptible to heart disease, diabetes, and other obesityrelated diseases

County Obesity Rates:

NODAWAY 31%

HARRISON 32% GENTRY 31%

ANDREW 31% DEKALB 32%

PLATTE 28%

35%-39%

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DAVIESS 32%

WYANDOTTE 38% JACKSON 33%

CASS

33%

BATES 30%

RAY 32%

CARROLL 31%

LAFAYETTE 31%

JOHNSON 34%

HENRY 32%

ST. CLAIR 31% VERNON 34%

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GRUNDY 29%

CLAY 28%

25%-29% 30%-34%

MERCER 32%

LIVINGSTON 28% CALDWELL BUCHANAN CLINTON 35% 37% 31%

JOHNSON 24%

20%-24%

WORTH 30%

SALINE 31%

PETTIS 29%

BENTON 32%

lthier Kansas City an increased percentage of reported poor physical and mental health days among residents, which translates into decreased worker productivity and increased absenteeism, which is costly for employers.

Additionally, excessive drinking levels among Kansas City residents (Clay, Jackson, Johnson and Wyandotte counties) are more than double that of national benchmarks. Meaning more than 15 percent of residents in these four counties report either binge drinking or drinking heavily, versus 7 percent nationally.

Other factors to consider in overall health status are teen birth rates and sexually transmitted infections.

Well above national levels, teen birth rates are four times higher in Kansas City and sexually transmitted infection rates are more than 6-8 times higher than the national average.

Compounding the already relatively poor health of residents in the Kansas City area, the report shows a lower percentage of people on Medicare get the critical health screenings they need. In particular, diabetes and mammography screenings are lower in our area than nationally. These screenings can catch significant health problems before they become life threatening. We imagine the number of people going without suggested screenings increases in the uninsured population which represents nearly a quarter of Wyandotte and Jackson county residents under the age of 65. Nationally, 11 percent of people under 65 years old are uninsured.

Cumulatively, these benchmarks, and many more available on the 2013 County Health Rankings website, make Kansas City counties less than healthy communities. Many are based on lifestyle choices, such as lack of physical activity, drinking, unsafe sexual activity and poor healthcare decisions. Additionally, obesity plays a significant role in Kansas City’s health status.

Obesity is at epidemic proportions among adults and children, both nationwide and in our area. In 2012, the Centers for Disease Control and Prevention released nationwide state obesity rankings, placing Missouri and Kansas among the most overweight and obese states in the nation, with as many as one in three children in the two states classified as overweight or obese.

Thirty-eight percent of Jackson, 28 percent of Clay and 33 percent of Wyandotte residents are considered

obese – with a Body Mass Index greater than 30 – compared to a national average of 25 percent. Johnson County comes in just under the national average with 24 percent of residents considered obese.

As a result of these rising obesity rates, chronic health conditions, such as heart disease, Type 2 diabetes and cancer, are also growing among adults and children.

Additionally, asthma, hypertension, depression and anxiety, all obesity-related conditions, are affecting many children in our community.

While alarming today, these statistics only get worse over time. If future predictions hold true, over the next 25 years the obesity rate for U.S. youth ages 6-19 will increase from 18 percent to 31 percent. In this same timeframe, the percent of adults overweight or obese will rise precipitously. Direct costs for treating obesity and its related health conditions, currently $150 billion annually, will also increase substantially in future years.

Stemming the Tide No one factor causes unhealthy communities, just as no one action will turn the tide around. Negative health influences may exist within families, such as sedentary behavior, poor diet choices and socioeconomic status.

Yet factors within our communities themselves may also give rise to unhealthy trends: lack of access to playgrounds; unsafe streets; food deserts and lack of access to fresh, healthy foods.

The benchmarks cited are sobering, but lifestyle changes can prevent these projections from becoming reality. In order to help make Kansas City a healthier community all stakeholders, including policy makers, community organizations, healthcare industry players, school administrators, business leaders and others will need to engage and work in collaboration to stem the tide.

No matter where you live, or which community you call home, we can all do something to make our families and ourselves healthier. Through our common efforts toward a healthier community, we can bring about uncommon results, and turn Kansas City into a healthier community.

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The 2013 County Health Rankings are available at countyhealthrankings.org.

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Beyond Access: Healthcare Reform Starts At Home T o achieve success in driving great outcomes for patients as they navigate their way through the healthcare system, industry participants are challenged to achieve an appropriate balance among access, quality and cost imperatives. While the challenges have remained consistent for decades, the solutions have gotten increasingly more complicated over time. While there is no silver-bullet solution that will solve all three at once, various organizations are working on multiple solutions to improve outcomes across the board.

The Affordable Care Act (ACA) will expand healthcare coverage for up to 32 million Americans through subsidies, Medicaid expansion and individual and employer mandates. The ACA does not, however, address cost and quality in a similarly sweeping way. Therefore, the quality and cost elements are now center stage among healthcare industry participants.

Achieving the right balance among cost and quality imperatives has long been a challenge for the United States healthcare system. According to the World Health Organization, in the United States, we spend a higher portion of gross domestic product on healthcare, but rank 37 out of 191 countries for performance. Clearly, this is an undesirable distinction, which must change.

Solutions to improve quality and reduce cost As the Kansas City area’s leading health insurance provider, Blue KC is looking for solutions that reduce cost while improving

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quality. In 2012, Blue KC produced initial results from its pilot Patient Centered Medical Homes (PCMH) program.

The PCMH model represents a transformation in the way primary care is delivered and coordinated.

A PCMH practice serves as a patient’s healthcare home base, providing an individualized care plan and connecting each individual with a full team of health professionals, including the physician and practice team members. The PCMH team may also include any number of healthcare providers, including, but not limited to, specialists, dieticians, pharmacists and physical therapists. The overall goal is for primary care physicians to work with patients to lower chronic disease risks and manage costs by focusing on preventive care and disease management.

“At Blue KC, we believe primary care physicians are in the best position to manage the delivery of the highest quality of care while decreasing personal healthcare costs. We continuously work to enhance provider collaboration through our PCMH model,” said David Gentile, President and Chief Executive Officer of Blue KC. The Blue KC pilot program featured approximately 25,000 members and 13 primary care offices from 2009 to 2011, and showcased improved clinical outcomes, including: • Preventable* hospital admissions decreased 11.1 percent among the pilot practices year over year.

• Preventable* hospital re-admission rates decreased 34.7 percent among the pilot practices year over year.

• Immunization rates for pediatric patients improved between 2009 and 2011 by 4.3 percent for the PCMH pediatric practice.

Based on these and other findings, the pilot was deemed a success and today more than 107 practices, 502 Kansas City and St. Joseph primary care physicians and 200,000 patients are engaged in a collaborative effort with Blue KC to transform the way healthcare is delivered.

Blue KC also recently implemented an innovative way to pay hospitals. The collaborative value reimbursement program focuses on collaboration between *As defined by 3M's methodology for potential preventable admissions and readmissions rates, not actual.

the patient, provider, hospital and insurance company, where the shared goals of increased quality of care and decreased costs are paramount.

Buoyed by the success of its Patient Centered Medical Home program, Blue KC expects the collaborative value reimbursement program will offer measurable results and put Kansas City hospitals at the forefront of a new way of thinking about patient care.

While the Patient Centered Medical Home program relies heavily on primary care physicians to manage the care of a defined population, the collaborative value reimbursement program with hospitals and their employed physicians will bring the fully integrated care delivery system to bear on controlling costs and improving quality. Hospital systems have the added benefit of incorporating specialty care and additional ancillary services like radiology and ambulatory surgical centers in a cohesive team to foster enhanced communication and improved care coordination.

“With the Patient Centered Medical Home initiative, we’ve seen positive results in both outcomes and cost.

We’re excited about advancing the ideas and applying them to the integrated delivery system that hospitals provide,” said Gentile. “With the collaborative effort of a hospital’s integrated delivery system, we stand to see even better results in terms of enhanced care, member access and lower costs.”

Supporting those on the frontline to improve care Blue KC is also working with researchers to improve patient care and reduce healthcare costs through Health Outcomes Research Grants. In 2013, four $50,000 grants were presented.

Recognizing a Deadly Infection Dr. Steven Simpson describes severe sepsis as “the worst possible outcome of infection.” Unfortunately, severe sepsis is a growing problem in the United States, with the number of cases doubling about every 8.5 years. Simpson, professor of medicine and director of fellowship training, division of pulmonary and critical care at KU Medical Center, believes his program can greatly reduce this trend.

The program will work with four area hospitals and, with the help of a web-based tool, teach physicians,

nurses and other hospital staff to recognize, diagnose and treat severe sepsis.

Treating Asthma Patients Long Distance Rural areas are relatively underserved by asthma specialists – not comforting news for asthma patients living in Kansas and Missouri, which are largely rural states. A research program developed by Dr. Jay Portnoy, section chief – allergy, asthma and immunology at Children’s Mercy Hospitals and Clinics, will utilize computer technology - or “telemedicine” - to enable Kansas City asthma specialists to diagnose and treat children in Wichita and St. Joseph to see if young patients seen via telemedicine do just as well as patients who drive several hours to Kansas City to receive face-to-face care.

Managing Heart Failure Patients at Home African Americans experience heart failure at young ages, compared with other ethnic groups, which often results in early and repetitive hospitalizations. And notably, African Americans also have a strong family legacy, being especially close and helping other family members.

What if this legacy could be used to improve heart failure patients’ health care and reduce repeat hospitalizations? That’s the focus of the research program from Ubolrat Piamjariyakul, RN PhD, a research associate professor at the University of Kansas Medical Center.

Her team has developed an innovative healthcare delivery practice model that will train family members in heart failure home care management.

Developing Better Patient Handoffs Phone calls, pages, interruptions and background noise can all cause communication breakdowns, which can adversely affect patient handoffs – the transfer of responsibility for a patient’s care from one healthcare worker to another.

Developing a tool that could greatly minimize miscommunications is the focus of the research program underway by Dr. Robert Riss, associate director of medical student education and a Pediatric Hospitalist at Children’s Mercy Hospitals and Clinics.

Information about the Blue KC Health Outcomes Research Grants, including eligibility, review criteria and application procedures, can be found on the Kansas City Area Life Sciences Institute’s website at www.kclifesciences.org.

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Staying Active in

Kansas City

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ansas City is a great place to live, work and raise a family. With a variety of ways to get active and stay healthy, our community offers activities for people of all ages.

It’s difficult to find a weekend in the spring, summer or fall that isn’t full of opportunities for families and individuals to get out of the house and get active, whether it’s a 5k, a farmer’s market or a bicycle ride.

Yet, even with a full schedule of events, Kansas City is still behind the curve when it comes to health and wellness. That may explain why, in 2012, the Center for Disease Control ranked Missouri as the tenth and Kansas as the eleventh most overweight and obese states in America. Thirty percent of adults in Kansas and Missouri are overweight or obese.

Many places in the Greater Kansas City area are food deserts, have gaps in fresh produce and a lack of access to safe and healthy physical activity. Fortunately, a few organizations around town have made it their mission to close the gaps and make our community healthier and more vibrant.

Initiatives such as KC Healthy Kids support efforts to advocate healthy eating and active living opportunities in Kansas City neighborhoods. The KC Healthy Kids organization is currently established in the Ivanhoe and Rosedale

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communities. Both neighborhoods face many challenges that make healthy eating and active lifestyles difficult. KC Healthy Kids is working to establish healthy grocery stores, community gardening and safe and accessible sites for physical activity.

The City of Kansas City, Mo. is also hard at work making the city safe and accessible by adopting an ordinance to increase bicycle routes and lanes. In April, Kansas City public workers started installing signs designating 352 lane-miles of bicycle routes throughout the city.

Officials say when the project is completed the city will have 600 miles of on-street bicycle lanes and 230 miles of shared-use trails.

Jackson County jumped on board when County Executive Mike Sanders proposed the Intermodal Transportation Concept. This plan suggests stretching transit, rail, trail and bus routes linking downtown with Missouri suburbs.

It would include new express bus service to cities and add additional hiking and biking paths.

If passed, this proposal would increase connectivity and access within the city.

Kansas City is on the move. With hard work and dedication to the cause, we can go from being one of the fattest to one of the fittest, active and engaged cities in America.

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Addressing Kansas City’s

Food & Play Deserts

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n the Kansas City metro area, there are several communities where it is much easier to purchase hamburgers and fries than fresh fruits and vegetables.

In some instances there are not only obstacles blocking access to healthy foods, but also a lack of parks, playgrounds or safe streets and neighborhoods for physical activity. These areas are considered deserts for healthy food and recreation. Food and play deserts in our community contribute to detrimental health problems like malnutrition, obesity and diabetes. Providing better access to healthy foods and safe environments to exercise can greatly improve quality of life across the metro area.

According to the USDA, the definition of a food desert is an area with “limited access to affordable and nutritious food, particularly such an area composed of predominantly lower income neighborhoods and communities.” Food deserts may be near fast food restaurants and convenience stores that provide high calorie meals and packaged foods, but far away from grocery stores or farmers’ markets that provide items like fresh produce, eggs and milk. A lack of transportation exacerbates the problem. There are several food deserts across the Kansas City metro—most notably in Jackson County, but also in the Northland, as well as Johnson and Wyandotte Counties.

Farmers’ markets help diminish food deserts by bringing local produce to urban areas. In the Kansas City metro area, residents can visit farmers’ markets in the River Market, Overland Park, Merriam, Parkville, the Crossroads, Liberty, Zona Rosa and Brookside.

In addition, Truman Medical Center hosts a Healthy

Harvest Produce Market every Wednesday on Hospital Hill that features healthy food, recipes and dieticians offering nutrition education.

Along with tackling food deserts, it is important to devise solutions to play deserts. Play deserts are defined as “areas with a large number of children and limited access to safe outdoor play areas—a problem that is worse in low-income areas.” To address the issue of play deserts, communities must find ways to boost safety, as well as invest in parks and playgrounds that allow youth and families to get active. For example, Blue KC, the Housing Authority of Kansas City and the Public Housing Residential Council teamed up with KaBOOM! at the end of last year to build a much-needed playground on Vine Street. We must focus on increasing opportunities for youth to stay active and support paths toward healthier lifestyles.

There are a number of ways to get involved and boost access to healthy food and safe exercise in Kansas City.

Several organizations in Kansas City are working to integrate urban agriculture and eliminate food deserts, including the Greater Kansas City Food Coalition, Cultivate KC and Kansas City Community Gardens. You can get involved by volunteering with one of these organizations, or offering to donate your time as a volunteer at a community garden or local farmers’ market.

It is important the Kansas City area increases access to healthy, affordable and local food, while also providing residents with safe places to engage in physical activity.

It enriches the lives of everyone in our community, and helps residents live up to their healthiest potential.

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The ACA and Challenges for Businesses

WHAT IMPLEMENTATION

OF THE ACA MEANS FOR BUSINESSES

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One of the biggest changes coming from the Affordable Care Act is directed at midsize and small group employers.

The first ever federal mandate to offer coverage or benefits to employees or risk a penalty was originally scheduled for implementation next year, but has since been postponed until 2015. Although this is welcome news in the business community, many business owners have questions about the best way to plan for providing healthcare benefits to their employees in 2014 and beyond.

In 2015, businesses with 50 or more full-time equivalent employees must begin offering all full-time employees essential benefits that are both affordable and offer adequate coverage, otherwise they will potentially face penalties. Carolyn Watley, President of CBIZ Benefits & Insurance Services of Kansas City, says, “The first and biggest change for businesses is being able to identify how many full-time workers are on staff. While a 40-hour workweek is standard for a full-time employee, through the ACA, businesses will have to offer affordable options to anyone working at least 30 hours a week.” With the change in definition, many companies will have more employees eligible for coverage, which means more dollars invested in them.

Watley advises that the next challenge for employers is figuring out who to offer coverage to as many companies have variable hour employees, including restaurants, schools and grocers to name a few. For companies in this situation, the government offers a look back option, which grants employers the ability to review employees’ hours from three months ago and beyond, then determine who met the 30 hour definition during that time. “Depending on the look back period, anyone who worked 30 or more hours per week over that former period is deemed full-time for that same period of time moving forward,” says Watley. Special provisions are available for certain circumstances – and this idea certainly raises a fair share of questions.

Key Considerations The employer mandate for midsize and small group businesses is confusing, but business owners should consider the following list of factors when determining how to best provide health insurance for their employees. First, remember that this mandate by itself does not mean companies are going to start or stop offering coverage. Providing healthcare benefits remains a valuable recruitment and retention tool for many companies.

As a result, many employers will continue their offerings because of the larger scale benefits.

Watley advises that businesses should evaluate the Affordable Care Act mandate’s influence on their operations: • What You’re Currently Offering. Take time to review what your business is currently doing, how much you are spending and to whom you are already offering coverage. After examining your environment, ask yourself if you would be making changes

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regardless of the ACA. Then ask yourself, “With the new rules, what exactly am I required to do?”

Additional Taxes and Fees. Get a handle on additional required taxes and fees. Remember, some are already built into premiums and some are required for employers to submit. Understand how those costs will impact your business.

Current Eligibility Requirements. Review your current eligibility requirements and what changes you may wish to make to remain compliant. For example, you may need to change your eligibility to employees working 30 or more hours in order to avoid potential penalties.

New Benefit Requirements. Ensure your plan has the new benefit requirements in place. Pay special attention to changes, such as the requirement that employees’ wait periods can be no longer than 90 days.

Common Questions from Local Businesses The most common questions Watley receives include: This certainly isn’t an easy subject to tackle. Watley encourages each business to work with a broker consultant for guidance through the complex process.

The November 6 Business Class luncheon, presented

by Watley and Blue KC, will provide the most current information available on this topic.

Register online in the calendar at www.kcchamber.com to attend.

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What are the penalties?

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Do I have to offer coverage?

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What are the projected additional costs for all provisions of ACA?

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Will it be delayed or repealed?

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How my company is specifically impacted?

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How can I avoid penalties?

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What can I do to keep my costs the same?

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Can I change my renewal date?

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Additional Reporting Requirements. It’s important to review all of the reporting requirements to ensure your plan adjusts accordingly. If you are already in a fully insured contract, your insurance will take care of many of these changes having to do with the summary of benefits and coverage. If you are self funded, you’ll be responsible to ensure these requirements are met. To help, CBIZ created a three-page healthcare reform checklist to ensure companies don’t miss any steps.

Open Enrollment Considerations Watley suggests that open enrollment will be a

significant undertaking. “It will be important to think about communicating healthcare reform basics to your employee population. Start off with basic education: This is what it is, this is what it is about, this is what it does, this is our plan, its offerings and what is available to you.”

Thinking about Penalties Watley relays it is important to carefully review and understand the two applicable penalties, worth either $2,000 or $3,000 per employee.

• If a business with more than 50 full-time equivalent employees neglects to offer any coverage,

Safety Net Clinics Adj The Affordable Care Act (ACA) is changing almost everything we know about health insurance. As the 2014 implementation date approaches, businesses and organizations are struggling with how to continue to operate under new rules and regulations. For several Kansas City safety net clinics, which provide healthcare services primarily to the uninsured today, this means implementing changes to its business models in order to continue to serve patients who will likely be eligible for subsidies to help pay for health insurance coverage in 2014. The implementation of the ACA means they now must expand their care to both uninsured and insured individuals.

Adding the ability to provide services to insured individuals opens the clinics up to third party reimbursement from Medicare, Medicaid and insurance companies which completely alters their business plans. A shift is necessary to provide continuity to patients who have been visiting safety net clinics for years.

“Safety net clinics have established a medical home for patients. To patients, we are their doctor,” said Liz Cessor, CEO of Cabot Westside Health and Dental

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Center. “That is why newly insured patients will want to continue to come back even after they are insured.”

Cabot Westside Health and Dental Center is a safety net provider in Jackson County that is undergoing some major changes of its own. Cabot is in negotiations to merge with Samuel Rodgers Health Center, a federally qualified health center with eight locations in the greater Kansas City area. The potential merger would not only improve Cabot’s patient quality care to its current uninsured patients but would also expand its care to insured patients.

Merging with Samuel Rodgers would “enable Cabot patients to have access to expanded services,” said Cessor. “Sam Rogers provides a lot of services that Cabot is unable to offer and those are services that our patients would not be able to afford in the private sector.”

Merging is just one of the ways clinics have been adjusting to the changing health care industry.

KC Care Clinic, one of the country’s largest free and charitable clinics, is preparing for perhaps the most significant change of any clinic in the area. After having

the business owner may face a $2,000 penalty for every employee, minus the first 30 employees.

• If a business with more than 50 full-time equivalent employees neglects to offer adequate and affordable coverage, the owner can be penalized $3,000 per credited employee. Affordable is defined as the cost of single coverage that is no more than 9.5 percent of income. To meet this standard, owners would ensure the employee contribution for single coverage is no greater than 9.5 percent of the income of the lowest paid employee.

“Penalties are only triggered if an employee goes to

the Marketplace (formerly called the Exchange), qualifies for a subsidy and reports working for a company that is not offering coverage and/or not offering adequate and affordable coverage,” Watley says. “Therefore, it’s important for companies to evaluate how many employees may qualify for a subsidy, which is described as someone making 100-400 percent of the poverty rate.”

CBIZ is a professional services company, providing a comprehensive range of business services, products and solutions that help our clients grow and succeed by better managing their finances and employees.

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- This article reflects the status of the Affordable Care Act as of the GrowKC publication date of July 22, 2013.

djusting with the ACA made major changes in November of 2012 and changing its name from The Kansas City Free Health Clinic to KC Care Clinic, it continues to be proactive in order to keep serving its patients. KC Care’s business model shift will use volunteers and paid providers to deliver care to both uninsured and insured patients.

Implementing this hybrid business model, applying for Medicare and Medicaid numbers, moving towards Patient Centered Medical Home certification, and several other initiatives are major adjustments. Though a strenuous process, these changes will ensure more holistic care for KC Care’s patients.

“We are adjusting to our patient’s needs. With most of our current patients set to receive some form of insurance coverage in 2014, the change is necessary to keep our service level where it has been for over 107 years,” said Sheridan Wood, CEO of KC Care Clinic. “Despite our many changes, our goal remains the same. No one will be denied care due to their inability to pay.”

Although several fundamental changes are occurring for these and other KC safety net clinics – one thing isn’t

changing, and that is the need for philanthropic involvement, volunteers, and donations. “We are going to need support now more than ever to keep our doors open and to keep patients healthy,” Cessor said. Though the changes in the industry seem immediate, Wood understands this is a lengthy process. “Reform is good, but it will take us a while to really understand what this means.

The need for support from our community will continue for many years.”

Not only are these organizations leaning on the community during this transition period, but they are also leaning on one another. “Something that is unusual about the safety net community in Kansas City is that all the safety net providers work really well together. That is not true in other cities,” Wood said. “We all are trying to make the safety net community as strong as it can be.

Someone asked one of the federally qualified health centers after our name change if we are now in competition with one another and we all just looked at each other and laughed. We have too many people to take care of. We are only as strong as our weakest link.”

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Making your way through

the marketplace Approximately 300,000 people in Kansas City and the surrounding area are currently uninsured. The Affordable Care Act (ACA) will not only guarantee them access to health insurance but require they enroll (or otherwise pay a penalty). The ACA implements new rules for insurance companies and expands health insurance coverage to include most Americans, regardless of a variety of factors including pre-existing conditions and age.

Starting on January 1, 2014, these rules will take effect and enable those who do not have access to employer or public coverage to shop for health insurance that fits their specific needs and budget. Think of it as an online marketplace to help simplify the experience of shopping for health insurance.

What is a Marketplace?

The Marketplace, previously referred to as the Exchange, is a one-stop shop where consumers can compare insurance options based on price, benefits, quality and other important features offered within each of the Qualified Health Plans (QHP). The Internet-based service will also facilitate the application for premium and out-ofpocket expense assistance from the government, often referred to as subsidies.

All states will be required to have two options to serve individuals and small business employers. For individuals, the Marketplace will offer the opportunity to shop among various levels of coverage offered by multiple carriers. Small businesses with fewer than 50 full-time employees will have the opportunity to purchase health insurance for their employees through Small Business Health Operations Program, often referred to as SHOP. SHOP will let employers set a coverage contribution level for their employees, then allow employees to pick from available plans. States can choose to establish a single marketplace serving both individuals and small business-

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es, or provide coverage through separate entities. Regardless of what states choose, the vast majority of people now covered by employer plans will not see a change.

States have three options in deciding how their Marketplace is developed: creating their own health insurance Marketplace, setting one up in partnership with the federal government, or leaving it to the federal government. Kansas and Missouri have both elected for the latter—leaving it to the federal government to establish marketplaces on their behalf. For consumers, the benefits should be the same no matter who runs the Marketplace.

How does it work?

Health plans that are sold through the Marketplace and SHOP must pass federal requirements to become a qualified health plan or QHP. By enforcing the QHP requirements, individuals and businesses can be assured that the plans are comprehensive and competitive. Additionally, participating QHPs will be required to offer four levels of value: Bronze, Silver, Gold and Platinum, and range from lower quality but more affordable, to higher quality and more expensive.

To help low- to moderate-income individuals purchase coverage through the Marketplace, individuals will receive income-based subsidies. In order to receive these subsidies, individuals must apply for government assistance through one of two forms based on eligibility requirements: Advanced Premium Tax Credit or Cost-Sharing Subsidy.

Small businesses will also receive tax credits to help them afford coverage for their employees. Small businesses with 25 or fewer employees may be eligible for a tax credit of up to 50 percent of their healthcare expenses. Additionally, the average employee salary must be below $50,000 and the employer must pay at least 50

percent of the cost of healthcare for employees.

Consumers will have the opportunity to shop the Marketplace for six months beginning October 1, 2013, through March 31, 2014. Once consumers have made a decision on the best option for them, enrollment for QHPs and government assistance sold on the Marketplace must be completed through an online application.

Where can you find help?

Brokers, who are available today, are likely best positioned to effectively assist consumers and have been actively engaged in learning about the new rules and products since the law was passed in 2010. Brokers are Marketplace certified and retain active licenses to sell individual and small group health insurance policies on and off the Marketplace.

Another option, aside from brokers, are navigators.

The ACA requires each state health insurance Marketplace to establish a “navigator� program that will help eligible individuals learn about health insurance options.

Navigators will be assigned by the federal government and support individuals in their decision-making process to get enrolled. Because navigators are not obligated to be actively licensed, they cannot legally recommend any particular plan or carrier. Rather, they are there to educate and assist applicants as needed. The government has yet to identify its navigators and with only a couple of months until open enrollment begins, the government will need to hire and train its navigators on a variety of processes and products in order to effectively work with consumers on the Marketplace.

Regardless, it is ultimately up to the consumer to seek assistance from individuals with the expertise to help them determine the best path. To maximize the likelihood of making good judgments during this time of rapid change, individuals and businesses will be well served to start the conversation now in order to be prepared when the Marketplace opens in October.

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- This article reflects the status of the Affordable Care Act as of the GrowKC publication date of July 22, 2013.

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Local leaders Join Forc

It’s been likened to a marathon, rather than a sprint.

How apropos that the Not So Big KC challenge be compared to the pinnacle of a runner’s list of events. The challenge, after all, is laying the foundation for growth in Kansas City’s health and wellness initiatives.

What started with Jim Heeter and Mayor Sly James has expanded to include some of the most well-known names in Kansas City business and leadership. Twenty-five participants joined the healthy competition; to improve or maintain their own health from February through July. Through their participation in the challenge, they’re setting an example to affect change in our community.

Challenge participants and KC Chamber Board Members Greg Graves and Eric Morgenstern ditched their desk chairs for walking meetings with employees.

Jeanette Prenger proves that you can juggle closing deals with classes at the gym and Matt Condon provides the hard numbers that demonstrate how the health of

employees affects a company’s bottom line. Clyde McQueen, Rick Kahle, Bob Berkebile, Robert Cowan, Jeff Provost, Danny O’Neill, Jonathan Kemper, David Janus, Carolyn Watley, Roshann Parris, Terry Bassham, Frank Ellis, Russ Welsh, Troy Schulte, Ron Shaffer, and Ed Eilert are among those doing their part to make health and wellness a priority.

“We’re extremely pleased to have these individuals join our pledge to personal and community health,” said Jim Heeter. “When the Mayor and I began this journey, we hoped it would inspire others. Clearly it has. The bottom line is it is good for the bottom line. Healthy people have higher productivity, better morale, fewer missed days of work and lower insurance claims. We hope the example our colleagues are setting as ambassadors for health will inspire people in the workplace and the greater community.”

David Gentile, president and chief executive officer

24 business and community leaders joined KC Chamber president and CEO Jim Heeter, KCMO Mayor Sly James, and Blue KC president and CEO David Gentile on a journey to wellness. Participants gathered in February to launch Phase II of the Not So Big KC Challenge.

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rces for Not So Big KC of Blue Cross and Blue Shield of Kansas City (Blue KC), is on-board and supports the leaders as they improve or maintain healthy lifestyles. The insurance provider offered each participant the following over the sixmonth challenge: • A health assessment paired with a health educator to review results and set realistic goals.

• A Fitbit to track and monitor daily health behaviors such as steps, distance, calories and sleep.

• Full access to the Blue KC gym.

• Emails every two weeks with healthy tips designed to educate and motivate.

• Event registration for the 2013 Heart Walk.

• An optional goal setting meeting with a Blue KC Fitness and Wellness Specialist.

• An optional beginning and mid-term visit with a Blue KC personal trainer and nutritionist.

• An optional meeting with HR staff and a member of the Blue KC A Healthier You team to develop new ideas to create a healthier workplace.

“Blue KC is committed to improving the health and wellness of the individuals and families living and working in the communities we serve,” said Gentile. “Not So Big KC is one example of how Blue KC is actively taking a role to help others achieve lifelong health. I applaud these business and community leaders for their commitment to the program. Together we can make the health of Kansas City a top priority.”

While the challenge includes hard work and dedication, the participants have enjoyed themselves over the past six months at community walk and runs, and a kickoff reception that provided contenders access to everything from healthy food samples and exercise tips, to relaxation techniques and massage from sponsors like Hitch Fit, which offers personal training services along with nutrition guidance, and Your Wellness Connection, one of the nation’s most successful healing centers focusing on integrative healing disciplines.

Because time is of a premium for these participants, tracking their success was low maintenance and high

tech. Each was monitored by a Fitbit. The Fitbit wirelessly monitored daily health behaviors such as number of steps, exercise, food, sleep, weight and body fat.

The culmination of the challenge was marked with a luncheon, honoring the participants, and a keynote address by special guest Will Wynn, the former mayor of Austin, Texas.

During his two terms in office, Wynn led Austin through a transformation. He created awareness around the cost of avoidable healthcare spending, promoted the prevention of chronic diseases and better health and established Austin as a healthy place to live, work and play.

According to Wynn’s website, Austin was one of eight original grantees from the Center for Disease Control’s Steps to a Healthier U.S. program. The initiative in Austin emphasized reducing the burden of diabetes, overweight, obesity and asthma and addressed risk factors such as physical inactivity, poor nutrition and tobacco use, particularly in at-risk populations.

In 2004 he established the Mayor’s Fitness Council, which coordinated the involvement of citizen advocates, businesses, schools, the faith community and health leaders to support the implementation of evidence-based strategies and programs driving positive change and healthy lifestyles. The Council developed the Austin Fitness Index as a monitoring tool.

Since launching his efforts, Austin’s healthcare costs and sick time has decreased, while health screenings and productivity has increased.

Wynn applauded Kansas City leaders for taking an interest in and setting an example for community wellness and challenged them to build on the momentum.

“Improving our community’s health is certainly a priority,” said Mayor Sly James. “But it’s a marathon, not a sprint. We’re glad to have business leaders support the cause and look forward to tipping the scales in a positive direction where Kansas City’s health is concerned.”

While the Not So Big KC participants have crossed the finish line, the race isn’t over. Stand by for the passing of the baton. It’s your turn, Kansas City.

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Union Station 30 W Pershing Road Suite 301 Kansas City, Missouri 64108 For membership information, call (816) 221-2424 or email info@kcchamber.com GROW KC Business is produced by the Greater Kansas City Chamber of Commerce Marketing Department for Chamber Management Services, LLC (a wholly owned subsidiary of the KC Chamber). Information in this publication is carefully compiled to ensure accuracy.

However, neither the KC Chamber nor CMS assume responsibility for accuracy. Contents are copyrighted by the Greater Kansas City Chamber of Commerce.

Design solutions for GROW KC Business provided by KC Chamber member Ridpath Creative Partners, LLC, www.ridpathcreative.com.

THIS IS

MARGARET BREWER.

SHE HAS

SEVEN LOVELY

GRANDKIDS. Not today, of course. Today, little Maggie is 10 years old and full of potential.

But if she doesn’t get nutritious food and safe play areas while she’s young, Maggie will struggle with obesity, Type 2 diabetes and depression, and she may never get to see the next generation of her family grow and thrive.

At Blue Cross and Blue Shield of Kansas City, we’re working hard to make sure kids like Maggie and local families get the knowledge and resources they need to live healthy, fulfilling lives. But we can’t do it alone; we need your help.

Learn what you can do to fight childhood obesity in Kansas City. Download the Blue KC Childhood Obesity Report at:

BeWellKC.BlueKC.com

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.

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