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Q&A: The Changing World of Colorado’s Safety Net Providers

Editor’s note: This is the second of two posts related to the health care safety net to coincide with Colorado Safety Net Clinic Week last week, August 22-26, 2011. CHI has also updated our Safety Net Primer to reflect the latest facts and figures on Colorado's safety net.

Senior research analyst Jeff Bontrager, who joined CHI in March 2005, became CHI’s director of research on coverage and access in June. As part of that role, he is responsible for monitoring the changing dynamics of Colorado’s health care safety net. A native of Denver, Jeff earned a master of science in public health from the University of Colorado Health Sciences Center, with a concentration on health care policy and health coverage issues and focusing his thesis on Colorado’s underinsured. He earned a Bachelor of Arts degree in psychology from Goshen College in Goshen, Indiana. In honor of Safety Net Week last week, we asked Jeff to update us on his work involving Colorado’s safety net system.

Question: How has Colorado’s safety net evolved and changed in the time you have been studying it as a CHI analyst?

Answer: In my six short years at CHI, I am continually impressed by how Colorado’s health care safety net manages to adapt to an ever-changing landscape. Safety net clinics are often in the position of “innovate or die” as a result of decreased resources amid increasing demand. That tends to mean Colorado’s safety net providers are often ahead of the curve on providing integrated, efficient, culturally-competent care to the hundreds of thousands of Coloradans who use their services.

Q: What trends do you see affecting Colorado’s health care safety net?

A: The best way to characterize the trends affecting Colorado’s safety would be in terms of supply and demand. There are many indications that demand for safety net services will continue to increase. For example, a downturned economy means that we have historically high numbers of enrollees in the state’s Medicaid and Child Health Plan Plus (CHP+) programs, and many of these Coloradans consider a safety net clinic to be the primary place where they seek care (in other words, their “medical home”). State and national health reform, the aging of the population and the increasing prevalence of chronic disease are also factors that influence demand.

On the supply side, providers of safety net services are forced to make tough decisions regarding whether they can expand or whether they need to pare their services when faced with state budget cuts and dwindling resources. Colorado also appears to have a maldistribution of primary care providers and specialists, with most clinicians practicing along the urban corridor of the Front Range. This creates unique challenges for Colorado’s many rural and frontier communities in attracting and retaining clinicians, especially for clinics that serve vulnerable Coloradans.

CHI is in the process of estimating health reform’s impact on potential demand for health care services and how many additional primary care clinicians will be needed as a result of the insurance expansions. Stay posted for the release of initial findings in November.

Q: What are the challenges of studying the safety net and the different providers that make up the safety net?

A: There is no standard definition of the “health care safety net,” and subsequently CHI has broadly defined it to include all sizes and shapes of health care providers that are dedicated – by mission or mandate – to serving low-income and other vulnerable Coloradans. These providers include everything from Colorado’s strong network of community health centers, to school-based clinics, homeless clinics, rural health clinics, hospital emergency departments, faith-based programs and other “community-funded” clinics. Other providers focused on securing much-needed oral health care and mental health care round out the list.

The variety of clinics creates challenges in collecting consistent data across providers. Although more safety net clinics are investing in electronic medical records and other systems, many of the smaller clinics face particular challenges with having enough staff and resources to implement these systems and optimize their reporting functionality. That said, I have been repeatedly heartened by safety net stakeholders’ willingness to engage, advise and collaborate with CHI on its projects.

Q: Tell us about the resources CHI makes available to those who are interested in learning more about the state’s safety net.

A: Anybody wanting to learn more Colorado’s health care safety net should start with CHI’s newly revised safety net primer. CHI also maintains a database of Colorado safety net clinic names and locations; as you can imagine, this list is constantly changing, but it is available upon request.  CHI is updating a map of these provider locations and it will be available soon, and there are a variety of county-level data available through CHI’s Data Center. Finally, CHI has published a number of issue briefs focused on enumerating different groups of vulnerable populations, such as our children’s and adult’s health insurance fact sheets and data supplements.

As always, I would also be happy to answer any additional questions (or point you in the right direction) by emailing