Welcome to CHI HealthTalk, the bimonthly e-newsletter from the Colorado Health Institute (CHI). Please subscribe, unsubscribe or give us feedback at info@coloradohealthinstitute.org. 

Focus on the facts

From the 2005 Colorado Physician Workforce Survey: Technical Notes and Key Findings (forthcoming from CHI)

A conversation with...
...Barbara O'Brien, Colorado lieutenant governor.

Barbara O'Brien, 55, became Colorado’s lieutenant governor in January 2007. She spent the previous 15 years working on behalf of Colorado's children as president of the Colorado Children's Campaign. She has led major policy initiatives to improve the health, education and safety of all Colorado children, and provided recommendations to policymakers and community leaders on ways they could improve the lives of children in their own communities.

Q: What health care issues do you think you'll be spending the most time on during your first years as lieutenant governor?
O’Brien: We know what we want to accomplish in the next four years; some of it we can do right away and some things will take much longer. The first is to get the childhood immunization rate up to 90%; it’s around 83% now. This effort is important for public health, but it also brings a child in to see a health care provider, which gets the child and the parent off to a good start in taking care of the child’s health.

Second is redefining health reform as “wellness” and not just health insurance. If we are to insure our uninsured people, we can’t afford to have an overweight, diabetic population; we need healthy people who are less expensive to insure. Colorado is starting from a good place in this; we’re not overweight and we are fit, but the trend lines are going in the wrong direction. Employers can do a lot through small actions such as giving their employees pedometers. It’s critical, too, that neighborhoods have bike paths and places to walk. Schools need to keep P.E. in the curriculum.

Q: What are some of the big issues that should frame the debate over reforming the state's health care system?
O’Brien: We are confident that the 208 Commission will come up with good recommendations on how to structure financing for affordable health insurance for everyone. Who pays what? How do we keep employers in the market and also enable individuals to buy their own health insurance? We’re also interested in efficiencies and cost savings in Medicaid and are looking at how it operates. We’d like to encourage more flexible funding and get the money out of silos that can’t be tapped. We also want to address the mental health component of illness – how to treat root causes, how to head off problems early and keep people out of emergency rooms.

Farther down the road, we plan to address the issue of what is affordable health insurance. We are a small-business state so many individuals have to buy their own insurance policies. We should investigate how to provide reasonable benefits without pricing individuals out of the market. In addition, you can have insurance but still not have access to health care, so we want to address provider network capacity, reimbursement rates and rural access. If you have insurance but no pediatrician in your county, the insurance may not do your family a lot of good. Technology, particularly telemedicine, can play a bigger role in providing health care to rural areas.

Q: The Colorado Health Institute has a large project on monitoring the state's health care safety net. What role do you think the safety net plays in Colorado, and do you think it's adequate to meet the needs of vulnerable Coloradans? What new roles do you see for safety net clinics and the state in helping clinics overcome barriers?
O’Brien: Colorado’s safety net clinics and providers have done a heroic job in a tight fiscal environment. They picked up the slack when the 2002 and 2003 state and local budgets were cut. For children, school-based health clinics could play a more important role, but many schools and districts lack them. The state can fund these clinics to some extent, but there are tradeoffs – we have to restore cuts to higher education, we have urgent transportation needs. The key is finding serious incentives for efficiencies, even small changes such as reducing the number of pages parents have to fill out to apply for public coverage and then how long it takes to process these forms. Every little bit counts.

Q: CHI also has a project on the health workforce. What do you see as the greatest need in the state regarding health professionals? Does the administration plan to address health workforce issues? If so, what would you focus on?
O’Brien: I’ve heard over and over that health professional shortages in rural areas are getting worse, particularly in nursing, and that nursing schools can’t hire enough faculty. The state has to get funding for community colleges and higher education up to a decent level, then community colleges will be in a better position to respond to the demand for training programs.

Q: What other health care issues are you thinking about or planning to act on?
O’Brien: Coming from the nonprofit world, I understand the power and creativity of partnering with nonprofits and foundations. They’re able to try pilot programs and experiment with new ways of doing things. If state government can learn from them and from their research, that partnership will lead to some interesting things in health care. I met just today (4-5-07) with four major health foundations on children’s health care access and why kids aren’t enrolled in public plans. We’re excited about what we can do together. The Department of Health Care Policy and Financing is working hard to streamline its infrastructure so that expanding health care coverage will be efficient. If we bump up the number of enrollment applications before the system can handle a surge, it will discourage parents from trying again. The infrastructure is as important as outreach efforts.

As someone who has worked on health care reform for 20 years, I’m encouraged by the health bills coming through the legislature this session; Governor Ritter has already signed bills that will reduce prescription drug costs through multi-state purchasing and a preferred drug list. Also, the 208 Commission is developing good proposals for health care reform. A lot of work over many years by the health policy community is coming to fruition, and it is an honor to be part of it.

CHI spotlight
Pharmacist survey data file available
CHI has released the public use database (PUF) from its survey of Colorado pharmacists. Part of CHI's Health Workforce Database Project, this new PUF contains data from more than 2,200 pharmacists who responded to an October 2005 survey. It is the third in a series; an RN and Physician PUF are already available on the CHI Web site (see link below).

Survey questionnaires were sent to the 5,738 individuals who held an active license to practice as a pharmacist in Colorado. Of these, 31 percent had a contact address outside of Colorado. About 39 percent of those who were mailed a survey form returned them.

Unlike CHI’s data files of registered nurses and physicians, the pharmacist file includes a variable that accounts for non-respondents and allows CHI to weight data survey responses accordingly. A weighted database allows users to generalize findings from the survey respondents to all pharmacists holding an active license in the state.

The Colorado Trust, as part of its Health Professions Initiative, funded CHI to build and maintain a Colorado Health Professions Workforce database. Data from a cross-section of health professions, including medicine, nursing, dentistry, pharmacy, mental health and allied health, are being collected to create a series of public use databases and workforce indicators to monitor supply and demand factors over time.

All the data files can be downloaded from the CHI Web site at http://www.coloradohealthinstitute.org/hot_issues/healthprofessionsdatabase.htm.

CHI staff member honored
Jo Donlin, CHI’s senior policy analyst, was among local leaders selected recently for the Denver Business Journal’s 11th annual “Forty under 40” recognition.

A special section in the March 2 Journal and a public event on March 16 honored 40 young leaders under the age of 40 who were selected for business leadership, recognition of accomplishments and community involvement.

Donlin joined CHI in January 2005. She serves in both CHI’s communications and policy and research units, and is a primary liaison between CHI and the legislature on issues of health policy.

She is on the board of directors for Craig Hospital and the Rocky Mountain Spinal Injury System Consumer Advisory Board and volunteers with the University of Colorado Health Sciences Center Physical Therapy Program. A Colorado College graduate, Donlin previously worked with the National Conference of State Legislatures.

New CHI publications
In 2006, CHI was asked to develop a baseline policy analysis from which decisionmakers could look to the future based on an understanding of what has been tried in the past. Staff interviewed health policy experts and opinion leaders who have witnessed firsthand health reform efforts in Colorado over the past 16 years. The result was Health Care Vision 2007 and Beyond, an examination of trends in the private health care market; small group insurance reforms; impact of the tobacco settlement and Amendment 35; and Colorado’s publicly financed health programs.

For more: http://www.coloradohealthinstitute.org/documents/HealthCareVision2007.pdf

Upcoming events

Colorado Safety Net Symposium
May 4, 2007, Denver Marriott West, Golden, Colorado

Registration is open for the Colorado Safety Net Symposium, a unique event that will bring together safety net providers, community leaders and policymakers at all levels to focus on strengthening health care access for vulnerable Coloradans.

Symposium attendees will have the opportunity to:

• Celebrate success stories and learn what's working as communities strive to provide physical, dental and mental health care access to vulnerable populations;
• Share and discuss the challenges and opportunities available to serve Coloradans who are uninsured, underinsured or enrolled in publicly financed health care programs;
• Participate in interactive problem-solving;
• Explore issues critical to the future sustainability of Colorado's health care safety net; and
• Get better acquainted with their colleagues from across the state and the role each plays in ensuring the safety net continues to be a vital and sustainable network of providers.

Reduced-price rooms are available at the Denver Marriott West until April 20.
Conference registration is $20 through April 26 and $40 afterwards.

The symposium is part of the Colorado Health Institute’s (CHI) Safety Net Indicators and Monitoring Project. Co-sponsors include the Colorado Community Health Network, the Colorado Rural Health Center, ClinicNet and the Colorado Hospital Association.

For more information and to register: http://www.coloradohealthinstitute.org/eBlast/SafetyNet/SafetyNet_agenda.html

Hot issues
Health Information Technology
While Colorado pursues health care reform through the work of the 208 Commission, another important initiative is advancing adoption of electronic health records and implementation of a statewide system for health information exchange (HIE). 

Colorado’s efforts recently took a big step forward with the formal incorporation of the Colorado Regional Health Information Organization (CORHIO) as a new nonprofit organization. An initial board of directors has been seated, with Kaiser Permanente President Donna Lynne serving as chair (see Who's Who). The board will provide the leadership needed to implement and sustain CORHIO as a statewide HIE service organization. Because privacy and security is such an important issue in HIE development, CORHIO will be establishing data exchange policies and practices over the next year and disseminating technology standards, while promoting investment strategies and governance policies to guide the exchange of clinical and other health data in the state.

CORHIO began two years ago as a statewide coalition of individuals, health care providers, agencies, organizations and community leaders who forged a common statewide vision and consensus for how HIE could be implemented to improve health care quality and cost-effectiveness. Colorado became one of a handful of states to receive a five-year $5 million federal contract to build a technical prototype for how to exchange clinical health data between different types of hardware and software systems.  Last year, it was one of nine states tapped to identify promising state models and inform national efforts to achieve consensus on standardsfor state-level HIE. 

The Colorado Health Institute’s Lynn Dierker, director for community initiatives, has facilitated discussions about CORHIO. While she continues in a part-time role as CORHIO’s interim director, this spring she will become project director for the State Health Information Exchange Consensus Project, an effort sponsored by the Office of the National Coordinator for Health Information Technology. States that are leaders in health information exchange will identify credentials that state-level HIE organizations will need as they take on distinct information management roles and functions. 

In the Colorado General Assembly, SB 196 would create an advisory committee to develop a long-range plan for HIT. The plan would include the use of electronic medical records, computerized clinical support systems, computerized physician order entry, regional data sharing interchanges, data privacy and security measures, and other methods of incorporating information technology to achieve greater cost-effectiveness and better patient outcomes.

Who's who?
In each issue of CHI HealthTalk, we introduce you to individuals who are making a difference in health and health care in Colorado.

Donna Lynne, Regional President, Kaiser Permanente
Donna Lynne, DrPH, is president of Kaiser Permanente Colorado, which cares for more than 480,000 people in the Denver/Boulder and Colorado Springs areas. Dr. Lynne joined Kaiser Permanente in 2005, bringing more than 20 years of health care experience, including seven years as executive vice president and chief operating officer of the nonprofit Group Health Incorporated in New York.

As a senior vice president for New York City's Health and Hospitals Corporation (HHC), she led administration, personnel and operational functions there prior to joining GHI. She also led successful labor relations efforts at HHC and negotiated affiliation agreements with academic medical centers. Dr. Lynne has a strong background in labor relations with the mayor's office in New York. In addition, she spent two years as executive director of the New York Business Group on Health, a nonprofit business and health care coalition with 250 members, including large and small businesses, government, unions, health care providers and insurance companies.

She has the distinction of recently being elected the first president of the Colorado Regional Health Information Organization (CORHIO), described in the article above. Besides CORHIO, Donna serves on a number of boards including: Colorado Concern, Colorado Economic Futures Panel, ColoradoFIRST, Colorado Forum, Colorado Succeeds, Kempe Foundation, Saint Joseph Hospital Foundation and Metro State College Foundation. She is also on the executive committee and board of directors of the Denver Metro Chamber of Commerce, and the board of advisors of the University of Colorado at Denver Business School.

Inside Colorado

State community health center group hits quarter century mark
The Colorado Community Health Network (CCHN) is celebrating its 25th anniversary with a special publication, 25 Years of Good Medicine for Colorado Community Health Centers. The report looks at CCHN’s history and the people behind the efforts to unite the state’s independent, community-owned, nonprofit or public health centers. Today, 15 centers serve nearly 400,000 – one in every 12 – Coloradans.

For more: http://www.cchn.org/CCHN_25th_Anniversary_Book.pdf

Alzheimer’s rates rising in Colorado
The national Alzheimer’s Association recently released Every 72 seconds someone in America develops Alzheimer’s, a publication of facts and figures about Alzheimer’s. The report looks at the prevalence, mortality rates, the costs and other issues and includes data tables with information on individual states. The publication estimates a 47 percent increase in the number of Coloradans age 65+ with Alzheimer’s disease between 2000 and 2010, with 72,000 afflicted. Only Alaska had a comparable rate.

For more: http://www.alz.org/national/documents/Report_2007FactsAndFigures.pdf

Primary care shortages
About 56 million Americans, including more than 900,000 Coloradans, are “medically disenfranchised,” that is, “at great risk of not having a ‘medical home’ to address their basic health needs,” according to a new report. Access Denied, published by the National Association of Community Health Centers and the Robert Graham Center, notes that “even those lucky enough to have good health insurance face a large and growing shortage of primary health care options.” The biggest gaps are in Alabama, Alaska, Florida, Kansas, Mississippi, Missouri, Oregon, South Carolina and Utah, where the report states that at least two in five residents are considered medically disenfranchised.

For more: http://www.nachc.com/research/Files/Access_Denied.pdf

Beyond our borders

Aging Americans and their health status
The State of Aging and Health in America 2007 is a recently released report from the Centers for Disease Control and Prevention that presents the most current national data available on 15 key health indicators for older adults. The “State-by-State Report Card” provides comparable information for each of the 50 states and the District of Columbia. It is designed to enable states to see how they compare on a set of indicators relative to other states. The only indicator where Colorado ranked first was in the percentage of residents receiving flu vaccines in 2004 (78.8%). West Virginia and Mississippi had more “worst” scores than other states.

New York reducing hospital/nursing home surplus
The Commission on Health Care Facilities in the 21st Century recently issued recommendations to restructure the hospital and nursing home systems in New York State and reduce excess capacity. The recommendations affect one-quarter of all hospitals in the state and will reduce approximately 4,200 hospital beds statewide, around 7 percent of current supply. Nearly 50 hospitals will be restructured and nine will be closed. In addition, approximately 3,000 nursing home beds will be eliminated, almost 3 percent of the state’s supply, and home and community-based alternatives to nursing home placements created. About one-third of the recommendations reflect voluntary initiatives developed by providers with the commission’s encouragement and assistance.

For more: http://www.nyhealthcarecommission.org/final_report.htm

Web watch

HIT resources

• Colorado Regional Health Information Organization (CORHIO) – the latest on efforts to develop and implement a statewide health information exchange system in Colorado. http://www.corhio.org
• State Health Information Exchange Consensus Project (previously the State RHIO Consensus Project) – a federal effort to develop best practices and document successful models for regional health information organizations (RHIOs) in the areas of governance, structure, financing and health information exchange policies. http://www.staterhio.org/

CHI HealthTalk Contributors
Writers: Sherry Freeland Walker, Lynn Dierker
Design: Kindle Fahlenkamp-Morell
Photo of Jo Donlin courtesy of Vectra Bank Colorado

Submit ideas for future HealthTalk issues to info@coloradohealthinstitute.org.