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story.lead_photo.caption Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, speaks during a COVID-19 briefing Tuesday, July 14, 2020. Photo by Beaumont Enterprise (Beaumont) / News Tribune.

Document: Commonwealth Fund 2020 Scorecard on State Health Performance


Data show Missouri's health slid downhill in recent years.

Early last week, the Commonwealth Fund released its annual Scorecard on State Health System Performance. Missouri dropped seven spots to 48th (which is fourth from the bottom).

The scorecard looks at all 50 states and the District of Columbia. It looks at data from the most recent year with complete records. For the 2020 scorecard, that data came from 2018, although some preliminary data from 2019 was included, according to the report.

Preliminary data may have an effect on the final outcome of the reports. (When the 2019 report was released, Missouri was ranked 43rd in the nation in health, but improved to 41st as more comprehensive information arrived.)

The state has been sliding down the health rankings for several decades, according to Dr. Randall Williams, director of Missouri Department of Health and Senior Services. Although, state health leaders lean more on the United Health Foundation's state rankings, which may be found at

The nonprofit organizations look at the same types of metrics when measuring health outcomes, Williams said. However, Commonwealth Fund looks at about a dozen more than United Health.

Regardless of the report you choose to look at, either shows Missouri falling behind other states.

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The foundation's website provides a chart that shows where each state stood over each of the past 30 years, Williams points out. The data provides information about the trend.

Missouri was 24th in 1990.

"We're now 39 — and that number has gone down (about) every year since that time," he said. "It's been declining for 30 years."

The Commonwealth Fund — a private foundation that aims to promote a high-performing health care system that achieves better access, improved quality and greater efficiency — produces the scorecard every year to give a snapshot of how states are doing in terms of improving the health of their citizens. Its report may be found at

The report contains links to highlights for each state.

Missouri, it shows, improved in a number of areas. The state reduced the number of home-health patients who suffered with limited mobility. It made more anti-psychotic medication available for nursing home residents. It got more adults treatment for mental illness.

However, there was a surge in the percentage of children who are overweight or obese, public health funding remained the lowest in the country and potentially avoidable emergency department visits jumped.

Four years ago, when Williams arrived, about the entire state government was idling, he said, including his own department.

Staff just wanted to blend in, he said. They didn't want to stand out. They certainly didn't want to make mistakes.

"Being a surgeon, one of my first priorities was to change the culture — realizing that all actions have risks and benefits," Williams said. "In surgery, you have to act — you have to do things."

DHSS has completely changed its culture to one of action, he continued. Alongside that, the department has created "subject matter expertise" through training and education.

Outcomes have improved, he said.

The COVID-19 pandemic made apparent another much-needed change over the past four years — an integrative, intergovernmental approach to challenges the state faces — Williams said.

A crisis, he said, is a "lousy time" to make introductions.

When Gov. Mike Parson took office in mid-2018, he established a system in which all his Cabinet members would meet regularly (every week if possible) and would collaborate with organizations like the Missouri Hospital Association, Williams said.

Until the pandemic started, state health officials met every month with all 100 county health department administrators. Those meetings have transitioned to the virtual environment.

When Williams testified about COVID-19 before the Missouri House of Representatives on March 2, he was confident the state would fare well because Parson had established a culture of bidirectional communication.

"The governor and I are in a phone conversation every Saturday morning with every infectious disease doctor in the state," he said. "We very much developed a culture here of working closely with our health departments hospitals and health care providers."

Williams and Parson conducted 126 statewide calls involving mayors, county executives and clergy from March through June, Williams said.

Those collaborations may be helping the state turn a corner on health rankings, Williams said.

He pointed out that in 2019 Missouri made significant gains in a number of areas. In 2018, more than 1,100 deaths in the state were attributed to opioid overdose.

"This is the first year we've had a decrease in opioid deaths," he said. "We had a decrease of 5 percent."

That was done by focusing on communities where opioid deaths are most common — in the St. Louis area, where 75 percent of deaths occur, he said.

DHSS mined data to determine where efforts are most needed. It received grants to assist in the effort to reduce overdose deaths. It expanded access to Naloxone — considered an "opioid antagonist," that reverses opioid overdoses — and authorized pharmacists to distribute it without a prescription.

The state established a Community Resource Response Team in St. Louis to reduce overdose deaths and homicides. The mobile command unit travels to sites of overdoses to arrange for follow-up services for survivors.

"We have markedly increased treatment," Williams said. "We passed the Universal Narcan (Naloxone) Law. And we passed the Good Samaritan Law."

Something else the state has been purposeful about is maternal mortality, Williams said.

In Missouri, a review board looks at all cases in which a pregnant woman dies. It is required to submit a report about the deaths each year.

When Williams arrived in 2017, the board was still reviewing cases from 2011, he said.

"We now review all maternal deaths in real time. We have about 80 in Missouri every year," Williams said.

The No. 1 thing pregnant women are dying from is hypertension. Opioids also oftentimes contribute to the deaths, he said.

"In Missouri, from 2018 to 2019, using the United Health Foundation rankings, we went from 46th in the country to 38th," Williams said. "Which is the largest jump in the country for women's health."

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