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State News

Missouri

Missouri has taken several steps to improve the efficiency and quality of its healthcare system through care coordination. For example, the state has two health home initiatives—one focused on primary care and the other on behavioral health. Missouri's Primary Care Health Home strives to provide intensive care coordination and care management as well as address social determinants of health for medically complex populations. The Community Mental Health Center (CMHC) Healthcare Home strives to integrate care for chronic health conditions into the CMHC setting. 

To combat provider shortages, Missouri created a new class of mid-level healthcare provider authorized to practice in underserved areas in 2014. However, early research has surfaced concerns over the providers’ ability to deliver high-quality care. 

Like many states, Missouri has done little to combat excess prices, eliminate waste in the system and improve affordability. Although Missouri has collected inpatient and outpatient charge and utilization data since 1993, there is no consumer website available to facilitate comparisons between providers and facilities. The state has introduced, but not passed, legislation to increase price transparency and has no protections against surprise medical bills as of 2019. 

Missouri ranked 32 out of 47 states plus DC, with a score of 28.9 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.


Missouri | Dec 14, 2023 | Report | Drug Costs

Missouri Becomes 50th State to Launch Statewide Prescription Monitoring Program

Missouri has launched a statewide prescription drug monitoring program, reports the Columbia
Missourian
. The program requires pharmacies to document when they dispense prescribed
Schedule II, III, or IV controlled substances to patients and make dispensation information for
such substances available to prescribers, dispensers, and healthcare providers. Prescription
drug monitoring programs are recognized as an effective way to improve patient safety, reduce
low-value care and decrease health care costs related to inappropriate prescribing and drug
related injuries.


Missouri | Aug 4, 2023 | Report | Population Health

Missouri Releases Maternal Mortality Report; Finds Maternal Mortality Has Increased

The 2020 Maternal Mortality in Missouri report revealed an increase in maternal mortality rates,
with 32 people dying per 100,000 live births, up from about 25 per 100,000 from 2017 to 2019,
according to St. Louis Public Radio. The leading causes of death in Missouri’s pregnant and
postpartum women were overdoses, suicides, and other mental health problems. Most new
mothers died between 43 days and one year after they gave birth, with the highest rate of
mortality was among women who had a Medicaid-covered pregnancy. The report examined
deaths between 2018 and 2020, prior to the state expanding postpartum Medicaid coverage – in
2023, the state legislature voted to extend Medicaid coverage for new mothers up to twelve
months following birth, a move providers hope will result in fewer postpartum deaths.


Missouri | Dec 15, 2022 | Report | Health Costs

The High Price of Healthcare in Missouri: Confronting Crushing Costs

Even with insurance, many Missourians face challenges affording healthcare, reports the Missouri Foundation for Health. Nine percent of Missourians remain uninsured and three-in-five Missouri adults struggle to afford healthcare due to high costs. These challenges are disproportionately shouldered by households that include a person with a disability.


Missouri | Jun 29, 2021 | News Story | Affordability Consumer Voices

Woman Hit with Nearly $2,000 Unexpected Bill for Colon Cancer Screening

A popular home test to screen for colon cancer has come with an unexpected bill for some people - leading to fears they may put off life-saving treatment, reports CBS News. While experts say Cologuard is a good screening tool, some users have faced a high bill, like Missouri resident Lianne Bryant did when she received a bill of $1,900 from the hospital that performed her subsequent colonoscopy, due to her positive Cologuard result. Under the Affordable Care Act, only routine screening tests are covered, and because Bryant's Cologuard result was positive, her colonoscopy was coded as a diagnostic test, which was not fully covered by her insurance. She would have been fully covered had she not used Cologuard first. Experts worry that when people find out their colonoscopies might not be covered, they won't get them. 


Missouri | Feb 19, 2020 | News Story | Affordability

Health Museum Creates On-Line Guide to Free or Low-Cost Care in Missouri

A children’s health education museum in St. Louis has created an on-line community guide to over 100 health services in an effort to help Missouri residents find free or low cost care, according to the St. Louis Post Dispatch. Users can search by type of service needed (such as prescription assistance, vision or emotional health) or can search by location within several state regions and counties. “While a visit to the museum can help motivate children and adults to strive for healthier lives, we recognize there are a number of families throughout Missouri who struggle to afford medical care and other health services,” said Shannon Laine, museum CEO. “By creating the community guide, we aim to help those in need by offering a one-stop resource for those looking to access healthcare organizations, programs and resources at a discounted rate.”


Missouri | Nov 13, 2019 | News Story

Missouri's Refusal to Treat Mental Health like a Physical Condition Means Patients Wait Months

As the need for mental health treatment in Missouri grows, patient advocates say the state’s refusal to enforce mental health parity may worsen barriers to access, according to KCUR. Missouri remains one of the last holdouts in the battle against the federal Mental Health Parity and Addiction Equity Act, which requires insurers to cover mental healthcare no differently than treatment for physical conditions. The federal government intended for states to enforce the law, passed in 2008, but Missouri officials insist they lack the authority. Every other state, except for Oklahoma, actively upholds the law.


Missouri | Nov 13, 2019 | News Story

Missouri's Refusal to Treat Mental Health like a Physical Condition Means Patients Wait Months

As the need for mental health treatment in Missouri grows, patient advocates say the state’s refusal to enforce mental health parity may worsen barriers to access, according to KCUR. Missouri remains one of the last holdouts in the battle against the federal Mental Health Parity and Addiction Equity Act, which requires insurers to cover mental healthcare no differently than treatment for physical conditions. The federal government intended for states to enforce the law, passed in 2008, but Missouri officials insist they lack the authority. Every other state, except for Oklahoma, actively upholds the law.


Missouri | Oct 2, 2019 | News Story | Rural Healthcare

Immersion Program Prepares Students to Alleviate Rural Provider Shortages

The University of Missouri has created a week-long immersion program designed to inspire future doctors, pharmacists and nurses to practice in rural communities, reports KCUR. Program participants meet with local leaders and healthcare providers, as well as tour local businesses, to understand the role of a healthcare provider in the community at large. This program is different from the university’s other rural healthcare recruitment initiatives because it focuses on giving students a picture of life in a small town.


Missouri | Sep 26, 2019 | Report | Consolidation

A New Report Says Springfield, MO Has Something Close to a Healthcare Monopoly

A nationwide study measuring 112 U.S. metropolitan areas for the degree of concentration in their hospital markets ranked Springfield, Missouri the most concentrated of them all, reports the Springfield News-Leader. In Springfield, the increase in concentration has a lot to do with healthcare systems buying up smaller doctors' offices. While consolidation is linked to higher healthcare prices, the report authors note that Springfield's prices are relatively low, at 6 percent below the national median. The lower prices may be a reflection of Springfield's generally low wages and overall cost of living.


Missouri | Sep 5, 2019 | News Story | Rural Healthcare

Missouri Gets $5 Million to Address Growing Primary Care Doctor Shortage

The University of Missouri is one of five institutions nationwide to receive nearly $5 million in federal funds to address the looming shortage of primary care physicians, reports the St. Louis Post Dispatch. Most of the money will go toward the expansion of programs already in progress to recruit college students from rural areas to pursue rural medicine; while also exposing more medical school students to doctors in small-town clinics instead of specialists at large teaching hospitals. A smaller portion of the money will fund the development of a new family medicine residency program at the Bothwell Regional Health Center in rural Sedalia.


Missouri | Aug 17, 2019 | News Story | Health Costs Consumer Voices

For Many People in Medical Debt, a Trip to the Emergency Room Leads to the Courtroom

Poplar Bluff Regional Medical Center has filed more than 1,100 lawsuits for unpaid bills in a rural corner of Southeast Missouri, where emergency medical care has become a standoff between hospitals and patients, according to The Washington Post. Three nearby hospitals closed for financial reasons in the past few years, leaving Poplar Bluff Regional as the last full-service hospital to care for five rural counties, treating more than 50,000 patients each year. As a result, the hospitals’ uncompensated care costs have risen from about $60 million to $84 million. Community residents are similarly at-risk of financial ruin. Over 35 percent have unpaid medical debt on their credit report, about double the national rate. The resulting lawsuits have become so routine that some people derisively refer to it as the “follow-up appointment.” 


Missouri | May 13, 2019 | News Story | Drug Costs

Lawsuit: Sick People in Missouri, Kansas Paid Higher Prices for Generic Drugs Due to Price-Fixing

Missouri and Kansas have joined 41 other states and Puerto Rico in a lawsuit accusing generic drug makers of conspiring to manipulate and drive up prices for more than 100 generic drugs, reports KCUR. The lawsuit, filed in federal court in Connecticut, alleges that generic drug giant Teva Pharmaceuticals significantly raised prices on more than 100 generic drugs beginning in July 2013 and colluded with competing companies to carve up markets and raise prices on at least 86 of those drugs. Missouri’s Attorney General called the alleged conspiracy “one of the most damaging and far-reaching price fixing schemes in modern history, with certain companies inflating prices by nearly 1,000%.”


Missouri | Apr 20, 2019 | News Story | Affordability

Patients Fed Up with Fee-For-Service Doctors are Finding a Way around the Insurance Industry

Patients in the Kansas City region who are fed up with the bureaucracy of the health insurance industry are ditching the copays and high deductibles for a different way to get primary care, reports KCUR. Instead of using the traditional system, patients are turning to “direct primary care” clinics consisting of doctors who offer membership-based healthcare services, rather than accepting insurance. At one clinic, patients pay a monthly fee for unlimited routine visits and direct phone/email communication with their provider. Although their services are limited to primary care, these clinics offer a lifeline for patients who cannot afford the high cost of health insurance.


Missouri | Mar 8, 2019 | News Story | Medical Harm

Three Kansas City Area Hospitals Get Dinged by Medicare for High Complication Rates

Three Kansas City-area hospitals are among 17 in Missouri and seven in Kansas that are being penalized by Medicare this year for high infection and patient-injury rates, reports KCUR. Truman Medical Centers, Research Medical Center and Belton Medical Center will see their Medicare payments reduced by one percent because of high rates of complications, as part of the Affordable Care Act’s effort to improve patient care. The article lists the 24 Missouri and Kansas hospitals that have been penalized this year (out of 800 general hospitals nationwide).


Missouri | Jan 14, 2019 | News Story | Surprise Medical Bills

Air Ambulance Billing, Collections Draw Concern from State Regulator

Air ambulance companies in Missouri use the practice of balance billing to stick patients with bills for tens of thousands of dollars, reports Missouri Business Alert. The findings come from a new report from the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). The DIFP estimates that air ambulance providers charged a total of $25.7 million for their services in Missouri in 2017. Of that amount, patients could have been balance-billed up to $12.4 million, which comes out to $20,000 per passenger. The report also cites “vigorous collection efforts,” including wage garnishments and liens, by some air ambulance companies. 


Missouri | Nov 13, 2018 | Report | Medical Harm

Only a Few St. Louis Hospitals Receive Top Safety Rating in New Report

A handful of St. Louis area hospitals received a high rating for patient safety in a report from the medical watchdog nonprofit, the Leapfrog Group, according to St. Louis Public Radio. The St. Louis-area hospitals that received “A” ratings include Mercy hospitals in Festus and St. Louis, St. Anthony’s in Alton, St. Joseph’s in Breese and St. Elizabeth’s in O’Fallon, Illinois. No hospitals in St. Louis received an “F,” but two hospitals, St. Alexius and Christian Hospital Northeast, received “D” grades. According to Leapfrog, characteristics of patients in a hospital service area do not affect rankings.  


Missouri | Nov 12, 2018 | News Story | Rural Healthcare

St. Louis Archdiocese Will Open its First Rural Health Clinic in Washington County

The Archdiocese of St. Louis plans to open its first health clinic early next year in Washington County, in an effort to improve rural healthcare, reports the St. Louis Post Dispatch. The free clinic will offer primary care, chronic disease management, mental healthcare and social services — including housing and employment resources — for people without health insurance. Washington County is one of the poorest in the state, with a poverty rate of 22 percent. The county has the highest percentage of uninsured adults in the St. Louis region (at 17 percent) and ranks 109th out of 115 Missouri counties in health outcomes, including longevity and quality of life.


Missouri | Aug 16, 2018 | Report | Rural Healthcare

Primary Care Physicians: Missouri Workforce Update

Missouri’s primary care provider landscape has changed considerably over the past few years, with an increased number of physicians throughout the state—particularly in rural areas. However, shortages remain and are anticipated to continue into the future, which will require diligent efforts to maintain and increase the state’s supply. A recent report by Missouri Hospital Association discusses Missouri’s current and future primary care workforce needs and highlights successful strategies to improve recruitment and retention. 


Missouri | Aug 15, 2018 | Report

How Effective are Medicaid MCOs at Managing Care in Missouri?

Statewide expansion of Medicaid managed care in May 2017 resulted in 240,000 Missourians being shifted from traditional Medicaid to coverage from one of three for-profit corporations. But despite the rapid growth of managed Medicaid delivery models in the U.S. and Missouri, limited evidence exists on the actual effectiveness of MCOs to deliver efficiencies and cost savings while improving health outcomes for enrollees. A new report by the Missouri Hospital Association evaluates recent trends in hospital utilization for the Medicaid managed care population compared to other Missouri Medicaid patients and describes observed differences regarding clinical, behavioral and sociodemographic risk factors. The study found that observed differences in hospital utilization for MO HealthNet beneficiaries can be explained by higher rates of clinical, behavioral and social complexity among fee-for service enrollees. Although Medicaid managed care patients have significantly lower clinical and behavioral risk factors, they have higher rates of emergency department utilization and inpatient readmissions, compared to the fee-for-service population.


Missouri | Jun 29, 2018 | News Story

For Missouri Heart Attack Patients, the Nearest Hospital Isn't Always the Best

The Missouri Department of Health and Senior Services has designated nine hospitals in St. Louis County (and 14 throughout the rest of the state) as priority heart attack centers to ensure that the highest-risk patients have best chance of recovery, according to St. Louis Public Radio. The recent designation is a part of a longstanding effort to develop a Time-Critical Diagnosis System (already in place for other time-sensitive health issues such as trauma and strokes), which directs emergency responders to facilities that are both nearby and well-equipped to meet the patient’s needs. Prior to the system’s introduction, emergency responders were required to transport patients to the nearest hospital, regardless of its ability to effectively treat certain conditions.


Missouri | Jun 11, 2018 | News Story

Trouble Paying Medical Bills? Large Survey Shows it’s Common in Kansas and Missouri

One of the largest surveys of Missouri and Kansas healthcare consumers ever conducted shows that medical debt is a top concern, according to The Kansas City Star. The survey found that 33 percent of Kansas children and 28 percent of Kansas adults lived in a household that struggled to pay medical bills in the last year. In Missouri, difficulty paying medical bills was even more common, with 38 percent of kids and 34 percent of adults living in struggling households. Almost 20 percent of respondents in both states said they had faced financial consequences from medical debt, either asking family and friends for help, seeking personal loans or getting hounded by debt collectors. These results support findings from an earlier study conducted by the Urban Institute.


Missouri | Jun 6, 2018 | News Story | Surprise Medical Bills

Missouri OKs Law to Combat Anthem's Controversial ER Policy. Will it Help?

Missouri passed a law designed to circumvent a controversial policy enforced last year by Anthem, allowing the company to deny medical claims when a consumer goes to an emergency department for care deemed non-emergent, according to the Springfield News-Leader. The new law, which goes into effect Aug. 28, 2018, aims to protect patients by reinforcing the “prudent layperson” standard, which suggests that patients should not be penalized for seeking emergency care for reasons that are rational given an average knowledge of health and medicine. Additionally, a licensed physician will be required to examine the medical file before a claim can be denied, which will prevent a computer from determining how claims are processed by billing code. Despite the law, Anthem is likely to continue enforcing its controversial policy in Missouri.


Missouri | Apr 23, 2018 | News Story | Health Costs

More Missourians Facing Hefty Air Ambulance Bills

Increasing reports of Missourians forced to pay high air-ambulance bills have prompted a state-level investigation of insurer and air-ambulance providers’ negotiations, reports the St. Louis Post Dispatch. The problem, according representatives of the insurance industry, is that air ambulance providers' considerable market power eliminates the incentive for them to join insurers’ networks. When insurers refuse to pay for out-of-network services, high prices are ultimately passed to the consumer. Senator Jill Schupp is working to pass legislation to protect consumers from surprise bills after emergencies; however, due to the way air ambulances are regulated, changes to state law would likely prove ineffective in protecting consumers from these types of air ambulance bills. Additionally, the director of Missouri’s Department of Health and Senior Services has called on his colleagues at the Department of Social Services and Department of Insurance to see what role, if any, state agencies can play in assisting families. Faced with similar consumer complaints, North Dakota took steps last year to inform patients about which air ambulance companies are in-network with the state’s largest insurance providers. Providers are required to share the information with patients, and the state’s insurance commissioner also maintains a consumer-friendly guide that identifies carriers that are part of a network and those that are not.


Missouri | Mar 21, 2018 | News Story | Price Transparency

New Missouri Health Data Resource Unveiled

The Missouri Foundation for Health and Missouri Hospital Association jointly announced the release of a new tool that allows community health improvement stakeholders and the public to identify health factors and outcomes at the local level. ExploreMOhealth.org enables users to access the state's county health dataset, in addition to ZIP code-level health data and analysis. This resource will help Missouri hospitals and public health professionals develop more targeted, data-driven approaches to deliver better value. The user-friendly format also allows private citizens to easily identify their county's top health concerns and pressing social issues.


Missouri | Feb 15, 2018 | Report

Kansas and Missouri Cost Containment Initiatives Report

A new report by the Health Care Foundation of Greater Kansas City analyzes the results of five local initiatives aiming to improve patients' healthcare experience, lower the cost of care per person and improve health outcomes and access to care. Multi-stakeholder collaboration, building relationships with the target audience and achieving buy-in from organizational leadership were identified as key factors contributing to the initiatives' success. Challenges included barriers to data collection and educating and training staff. These initiatives highlight the potential for collaborative, patient-centered efforts to reduce unnecessary ER use and preventable hospitalizations and provide important insights to help inform Kansas and Missouri lawmakers as they explore strategies to reduce healthcare costs. 


Missouri | Nov 8, 2017 | News Story

A Hospital Without Patients: The Cutting Edge of Healthcare is Tucked Off a St. Louis Highway Exit. And it's Eerily Quiet.

The St. Louis-based Mercy Virtual Care Center, a virtual hospital where specialists remotely care for patients at a distance, may provide a glimpse into the future of healthcare delivery, reports Politico. Using advanced technology, Mercy Virtual is able to detect irregularities in hospitalized patients even before the bedside nurses notice the symptoms. The technology has decreased physician burnout, hospital infections and readmissions, in addition to reducing the number of days that patients spend on ventilators. 


Missouri | Jul 10, 2017 | News Story | Health Costs

Anthem Asks Missourians to Think Twice Before Going to the Emergency Room

Anthem Blue Cross Blue Shield, one of Missouri’s largest insurers, no longer covers emergency room visits that it deems unnecessary, reports KRCU Southeast Missouri Public Radio. The policy aims to save costs and direct patients to primary care physicians and urgent care clinics for non-emergent medical conditions. But doctors warn that patients may not seek emergency treatment when they really need it, if they fear a large bill.


Missouri | Jun 28, 2017 | News Story | Drug Costs

MORx Program Changes to Affect Over 60,000 Missourians

Beginning July 1, MORx – a program that helps Missouri seniors afford prescription drug costs – will cease coverage for over 60,000 individuals, increasing the amount they will have to pay for prescription medications, reports The Rolla Daily News. While the change will not affect “dual-eligibles” enrolled in both Medicare and Medicaid, others will be forced to make difficult trade-offs that potentially put their health at risk.


Missouri | Feb 8, 2017 | News Story

Saint Luke’s Partners With UnitedHealthcare to Cut Costs

Saint Luke’s Health System and UnitedHealthcare have launched an accountable care program to reduce healthcare costs and improve quality, according to Kansas City Business Journal. The program helps providers identify high-risk patients and increase care coordination efforts, including sharing patient records. As an incentive, if providers reduce the cost of a patient’s care and meet health outcome expectations, they split the savings with the Centers for Medicare and Medicaid Services.


Missouri | Oct 3, 2016 | News Story

Partnerships and New Strategies Expand Missouri’s Show Me Healthy Housing Network

Missouri’ Foundation for Health’s pilot program Show Me Healthy Housing continues to expand in size and scope. The program gave its first program-related investment of $1.5 million to Corporation for Supportive Housing (CSH). The Show Me Healthy Housing program offers permanent, affordable supportive housing for people with disabilities, serious health conditions, and histories of homelessness. The philosophy of supportive housing showed great promise in reducing Medicaid costs and improving health outcomes.


Missouri | May 27, 2016 | News Story | Rate Review

Bill Provides for Missouri Agency Review of ACA Rate Hikes

Missouri approved a bill which includes a provision giving the state agency authority to review any proposed rate increase before it affects consumers who buy insurance through the ACA marketplace, according to News-Leader. The notification also gives consumers the chance to comment on the rate hike proposals. The Missouri Health Insurance Rate Transparency Act allows the agency to determine reasonable rate increases and request a change if the increase is unreasonable.


Missouri | May 25, 2016 | News Story | Consolidation

Missouri Blocks Proposed Aetna-Humana Merger from Insurance Market

The Missouri Department of Insurance issued an order prohibiting the proposed Aetna-Humana merged company from selling plans in the individual, small group and all group and some individual Medicare Advantage markets, according to Healthcare Finance. Missouri is the first state to take steps to limit the merged company from competing in the local insurance market.


Missouri | May 10, 2016 | News Story | Rate Review

Coalition Cheers Health Insurance Rate Review Bill Passage

Both chambers of the Missouri legislature overwhelmingly passed a health insurance rate review bill, according to The Missouri Times. The advancement was cheered by Missouri Health Care for All, who believe the bill will bring more transparency to insurance premiums. The law gives the Missouri Department of Insurance, Financial Institutions and Professional Registration a chance to determine if a rate hike is unreasonable ahead of time, notify the insurer and request a change. If the insurer moves forward with a rate that has been deemed unreasonable, the agency can make the determination public. But it cannot reject those increases, according to St. Louis Public Radio.


Missouri | Feb 3, 2016 | News Story | Price Transparency

Missouri Hospital Association Launches New Pricing Tool; Local Hospitals Mostly Absent

Focus on Hospitals, the Missouri Hospital Association’s consumer-focused website, offers pricing data for participating Missouri hospitals. The launch of pricing data is concurrent with a complete revision of Missouri’s hospital quality transparency program.  In reality, only 80% of hospitals in the state are participating, according to the Kansas City Business Journal.


Missouri | Jul 1, 2015 | News Story | Rural Healthcare

Obamacare Subsidies' Impact on Rural Missouri

This article by Mid-Missouri Public Radio describes the impact of the ACA on rural residents of the state, who tend to be a little older, sicker and poorer than their urban counterparts, a combination that previously put health insurance out of reach for many.


Missouri | Jun 1, 2015 | News Story | Rate Review

Missouri Consumer Group to Review Health Plan Rate Hikes

St. Louis Post-Dispatch: Missouri is one of the few states that does not allow its insurance regulators to review and approve health plan prices before they can be sold. As a result, local health advocates are planning for the first time to conduct that review themselves.


Missouri | Apr 30, 2015 | Report

Report Cites Iowa in Making Case for Medicaid Expansion

Iowa and Missouri share a border, but the states have taken very different approaches to Medicaid expansion, according to the Cedar Rapids Gazette.  Iowa has expanded it while Missouri has not, costing that state's hospitals money and harming the quality of life for its residents, according to a Families USA report.  The report estimated that if Missouri had extended Medicaid in 2014 it would have saved an estimated $385 million in uncompensated care costs by 2022.


Missouri | Aug 11, 2014 | News Story | Rate Review

Record Settlement Highlights State’s Lack of Rate Review Authority

The Missouri Department of Insurance announced  that it had reached a settlement with the Anthem BlueCross BlueShield of Missouri family of insurers to return a record $7.8 million to some consumers for charging them more for “substantially equivalent health plans” sold to other Missouri consumers. Missouri is the only state where oversight agencies can only protect health insurance consumers by conducting these market conduct reviews “after the fact.”


Missouri | Aug 15, 2012 | Report | Health Costs

Bending the Healthcare Cost Curve in Missouri

In an effort to inform state-level discussion of healthcare savings opportunities, Missouri Foundation for Health funded a report that estimates the impact of six scenarios that could help contain escalating costs in Missouri while improving quality. The scenarios include: implementing mandatory managed care for dual eligibles; adopting bundled payment methods; enabling a robust insurance exchange; promoting shared decision making and palliative care; care coordination and disease management; and broadening the scope of practice of primary care practitioners.