Missouri deserves more direct health care. Here’s how we do it | Opinion

Recent data confirms what many Missouri families already know all too well: Our health care system is failing us. A September 2024 survey by the Missouri Foundation for Health found that half of all Missouri adults have dealt with medical debt in the past five years. Even more alarming, 40% currently owe money to medical providers, with one in 10 Missourians carrying over $5,000 in medical debt. And given the median household income in Missouri is about $68,000 per year, that is a crippling amount of debt.

These aren’t just statistics. They represent real families making impossible choices: cutting back on groceries to pay hospital bills, depleting savings accounts meant for college funds, or, most dangerous, skipping necessary care altogether.

Meanwhile, 19 of Missouri’s 57 rural hospitals are at risk of closure because of serious financial problems. For communities where a hospital closure means the difference between a 10-minute or a 90-minute drive for emergency care, this isn’t just an inconvenience — it’s potentially life-threatening.

Even more troubling is that these problems persist despite Medicaid expansion. While Missouri’s expanding Medicaid in 2021 aimed to alleviate the financial burden for more of the state’s residents, approximately 1 in 5 state residents still report going without health coverage. Why? Because having insurance in our current system doesn’t guarantee affordable care.

The reality is that we’ve been trying to fix a fundamentally broken system with incremental changes and half-measures. The truth is that Missouri doesn’t need another round of health care reform — it needs a complete rebuild.

At Nomi Health, we’ve discovered that the most effective way to lower costs and improve access is surprisingly straightforward: eliminate administrative waste and create direct relationships between those who need care and those who provide it. And other companies can do the same.

By equipping employers with more usable data and creating direct access to health care services and medications, we’ve seen costs decrease up to 30% while improving access to quality care. For Missouri’s rural communities, where health care access hangs by a thread, direct payment models offer rural hospitals something they desperately need: stable, predictable income to keep their doors open.

Complex billing, payment systems

This direct approach works because it addresses the root cause of our health care dysfunction: an extraordinarily complex billing and payment system that wastes 40 cents of every health care dollar on administration, paperwork and nonmedical overhead, as reported by independent researchers at the Kaiser Family Foundation. That’s real money being siphoned away from actual patient care.

For employers, who often blindly pay some of the largest bills in their budgets without understanding where the money goes, direct contracting offers something invaluable — transparency. They gain visibility into their health care spending and the ability to ensure their employees are getting quality care at reasonable prices.

This is no small matter, as employee health care benefits are often the second-largest line item on an employer’s profit and loss statement after wages. Missouri has a unique opportunity to lead this health care transformation.

Missouri has already taken important first steps by passing legislation supporting direct health care models. In 2015, House Bill 769 established the framework for Direct Primary Care in the state, allowing for medical retainer agreements between physicians and patients. Additionally, the Centers for Medicare and Medicaid Services has implemented initiatives such as Direct Contracting and Primary Care First in the greater Kansas City region. These programs create pathways for direct provider-patient relationships and give health care providers opportunities to take on risk and earn rewards while reducing administrative burden. With current legislative momentum and Medicare- and Medicaid-driven programs creating favorable conditions, the state is perfectly positioned to become a laboratory for health care innovation.

But the revolution in health care won’t come from Jefferson City or Washington, D.C., alone. It will come from employers, providers and communities working together to build something better.

Missouri families deserve a health care system that works for them, not one that drives them into debt. Rural communities deserve hospitals that stay open. And Missouri employers deserve to know what they’re paying for.

By embracing direct health care models, Missouri can cut the medical debt burden that’s crushing families, stabilize rural hospitals with reliable payment systems, ensure that insurance actually translates to affordable access, and redirect health care dollars from administration to actual medicine

The time for incremental change has passed. The emergency is here. And a direct approach to health care is the cure.