When it comes to health outcomes in the 11-county Kansas City metropolitan area, there’s good news and there’s bad news.

That’s the takeaway from a regional health assessment released Wednesday by the REACH Healthcare Foundation in Merriam, Kansas, which aims to improve health care for the poor and medically underserved.

The good news: Except for obesity and diabetes, health outcome trends in the metro area are improving.

Largely because of the Affordable Care Act, more people have health insurance. Preventable hospitalizations are down. Chronic conditions like heart disease, stroke, respiratory disease and diabetes are being managed better. Rates for most of the leading causes of death have declined.

The bad news: These positive outcomes don’t extend to everyone. As measured by disease incidence and mortality, medically vulnerable populations – in particular the poor and minorities – are doing less well.

“These positive trends aren’t as strong for racial and ethnic minorities, so this is an area of concern,” says Pattie Mansur, a REACH spokeswoman. “One example is preventable hospitalizations.”

Preventable hospitalizations for both acute and chronic conditions declined in every county, according to the report. But, “when viewed by race rather than geography, we see improvement in both categories only for whites,” it states. “Preventable hospitalizations are still rising for blacks with chronic conditions, and for Asians and Hispanics in both categories.”

“Clearly your socioeconomic status or your race or ethnicity has an impact on whether you’re participating in these positive outcomes or not,” says Dean Katerndahl, one of the authors of the report, which was prepared for REACH by the Mid-America Regional Council.

Overall, the report concludes that the region is doing a good job of addressing health outcomes, but “its record in addressing health disparities may become a bigger issue in the future as vulnerable populations grow.”

“Disparities persist across geography, race and ethnicity and income – possibly the biggest health challenge the region faces,” the report’s executive summary states.

“Obviously, we need to do a better job of focusing on those who are most vulnerable,” Katerndahl says.
The report, which updates earlier assessments of regional health in 2010 and 2013, says that poverty in the region is increasing, giving rise to greater numbers of medically vulnerable people.

“When you have increases in poverty, you’re going to see poor health outcomes,” Mansur says.

Poverty is one indicator of medical vulnerability, the report notes. Others are age – especially the very old and very young, who are more susceptible to adverse health conditions; being a member of a racial or ethnic minority, which correlates with higher poverty rates and poorer access to health care; and belonging to a catchall group that includes those with limited English proficiency, undocumented immigrants, the less educated, the disabled and people without health insurance.

The number of people without health insurance, however, is declining. The report says that the Affordable Care Act (ACA), often referred to as Obamacare, “has had a significant impact in lowering uninsured rates in all counties.”

“It’s only a first step,” says Mid-America Regional Council economist Frank Lenk, another of the report’s authors, referring to the ACA.

“Clearly the idea is that, by having better access to doctors on a more regular basis, problems can be found more quickly and interventions can occur at the stage where an ounce of prevention is worth a pound of cure.”
But Lenk says there’s still a high degree of correlation between health and wealth, “and that’s a large part of what’s showing up in the disparities.”

Another disparity is geographical: Many area residents, particularly those who live in rural counties, have limited access to health care providers, according to the report.

For example, there’s one primary care physician for every 906 people in Johnson County, an affluent bedroom community on the Kansas side of the state line. There’s just one for every 4,015 people in largely rural Cass County on the Missouri side.

Similarly, there’s one mental health provider for every 475 people in Johnson County. There’s just one for every 1,766 people in Cass County.

“This issue of disparities is a really nagging problem that we haven't effectively addressed yet,” Katerndahl says.
“And as we become more diverse and face income inequality and things like that, it's going to be a bigger problem. And so we need to figure out how to address it.”

Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR