Welcome to the first issue of CHI HealthTalk, the new bimonthly e-newsletter from the Colorado Health Institute (CHI). To receive future issues, you must subscribe at info@coloradohealthinstitute.org. This newsletter keeps you up to date on the latest data, reports and activities from CHI; gives you news about upcoming health-related events in the state; and provides you with other helpful resources and information about health and health care in Colorado.

Focus on the facts

• In 2003-04, 17.1 percent of Coloradans (nearly 770,000 people) reported having no private or public health coverage.
• Over three-quarters (77.8%) of Colorado’s uninsured population were working-age adults (ages 18-64 years).
• Nearly two-thirds of uninsured adults (62.9%) worked for businesses with fewer than 100 employees.

From CHI’s new data bulletin: Profile of the Uninsured in Colorado, 2004

A conversation with...
… Senator Bob Hagedorn and Representative Betty Boyd, chairs of the Health and Human Services Committees of the Colorado General Assembly.

Q: What are your top three health issues this session?
Hagedorn: Medicaid, the uninsured and innovative ways to deliver medical care to the underserved, like making better and broader use of telemedicine. Every year, Medicaid enrollment increases. We’re working to find efficiencies that will help contain costs, but also allow us the possibility of expanding services.

As far as the uninsured, we need to decide whether we want to increase the amount of people who have insurance or provide better access to safety net services. The business community will play a key role in these debates, since the majority of uninsured are working [adults].

I think telemedicine holds great promise in the delivery of health care services. We can save money and provide better access to care. There’s already a great deal going on at the local level, and I want to maximize our efforts in this area.

Boyd: Medicaid, emergency contraception and the restoration of some of the previous Medicaid cuts, especially mental health. It’s time to streamline Medicaid, and making Medicaid and CHP+ more efficient and effective is a move in the right direction. Medicaid continues to put stress on the budget and we need to make our systems work better. 

Emergency contraception can reduce the number of unwanted pregnancies, and women need better access to this form of contraception. Allowing pharmacists to prescribe emergency contraception can give women the health care options they need.

It’s also time for us to restore some of the Medicaid cuts we’ve made over the last few years. This is especially important in the areas of mental health for both adults and children. These services are vital.

Q: What will be your greatest challenge this year?
Hagedorn: Referendum C gives us a breather from several years of tough health-related cuts to the state budget. But it’s not a blank check and we have obligations to the voters. The greatest challenge will be to find the biggest bang for the small amount of bucks we have through Ref C. We need to sift through the ideas and ascertain what will work best.

Boyd: Moving the Colorado Family Care legislation through the process will be a huge challenge. I’ve worked with various constituencies over the last several months and these conversations have been productive and helped create a better bill. Streamlining Medicaid will require thoughtful deliberations and patience, but it’s a sensible way to deliver services.
 
Q: If you can accomplish one thing, what will it be?
Hagedorn: We need to address the uninsured. We’re exploring a lot of options because we can’t ignore the cost shift this population imposes on its insured counterparts. It’s unacceptable for Colorado to exceed the national uninsured rate with more than 17 percent of our citizens without health insurance. We can do better.

Boyd: I want to make real progress in improving access to affordable health care for Colorado’s under- and uninsured citizens. This may involve federally qualified health centers, the Colorado Indigent Care Program or Colorado Family Care. There are a variety of proposals on the table and more on the way. We need to figure out where our priorities lie and make our decisions accordingly.

CHI spotlight
Profile of the uninsured in Colorado, 2004
If you’re a young adult and working for a small company in the Denver metro area, you’re more likely than other residents of Colorado to be without health insurance, according to the Colorado Health Institute’s (CHI) second annual Profile of the Uninsured in Colorado.

The new CHI study shows that while Colorado’s uninsured rate has not changed significantly in the last five years, about 770,000 people (17.1%) in the state lacked health insurance in 2003-04. This figure compares to 15.7 percent nationally.

“People without health insurance often lack access to health care, have more delays in getting the care they need and are more likely to experience adverse health outcomes than people with health insurance,” says Pamela Hanes, CHI president and CEO. A large uninsured population also places a financial burden on hospitals and clinics, especially those that have a high volume of uninsured patients.

Young adults between the ages of 18 and 34 accounted for the largest proportion of uninsured Coloradans – 39.5 percent -- in 2002-04, according to U.S. Census Bureau statistics. Three-quarters of Colorado’s total uninsured adult population (ages 18-64) had jobs in the preceding year.

For more information, see our PowerPoint presentation on the uninsured or contact Jeff Bontrager at info@coloradohealthinstitute.org or 303.831.4200, ext. 205.

Safety Net Indicators and Monitoring Project
The “safety net” is an important component of Colorado’s health care system. It consists primarily of community hospitals and public and private health care clinics whose mission is provide care to low-income uninsured, Medicaid and Child Health Plan Plus (CHP+) Coloradans – roughly 25 percent of the state’s population. Supported primarily by public funds, the safety net plays a key role in meeting the health care needs of vulnerable Coloradans. 

With partial support from HealthONE Alliance, CHI has launched the Safety Net Indicator and Monitoring Project. Building on existing efforts by national, state and local organizations, the two-year project will build a database that identifies, describes and monitors Colorado’s safety net system (including physical, dental and mental health care providers) and the populations it serves. The ultimate goal is to ensure the ongoing viability of Colorado’s safety net is well-documented, and that through this documentation sound policy and program decisions can be made when corrective actions are warranted.

To accomplish this goal, CHI will identify and validate existing data, identify data gaps, collect and analyze new data as needed, develop a set of provider and population indicators to be monitored annually, and implement a multi-dimensional information dissemination strategy that transforms data into an action agenda for program management and funding purposes.

CHI will provide policymakers, funders and others with timely and relevant information through a series of publications, Web-based applications and facilitated forums. Briefings, roundtables and seminars will be timed to respond to important safety net issues as they arise.

For more information, contact Reid T. Reynolds, PhD, director for policy and research, info@coloradohealthinstitute.org, or 303.831.4200 x204

Data, data, everywhere
CHI recently launched a data section on its Web site to provide quick access to national and state databases containing health-related information on Colorado and its counties. The data section has four parts.
Online Data Links – Access to online data sources that allow you to customize Colorado statewide and county-level data.
Database Inventory – Profiles of other national and state health databases whose data can be accessed by request.
Geographic Inventory – Maps of the various regions of the state that public and private organizations use to collect data and target their work. All maps show the identified regions and their purposes, and may be printed or downloaded for presentations and reports.
County Indicators - County- and state-level data are both provided to create an overall picture of health. Information includes demographic information, access for the underserved, as well as health and health care indicators.

Try out the new features and give us your feedback at info@coloradohealthinstitute.org.

Health care data needs assessment
If Colorado's healthcare providers, policymakers and others could have all the data they need to make informed decisions, what would be most critical? A CHI survey found that childhood immunization and chronic disease rates, and minority and children's health status indicators ranked highest on the list of important indicators to have.

But, these and other valuable health data often are hard to find and, even when they are available, they're often difficult to use in the formats available, survey respondents said.

Respondents were asked to rank four domains of indicators by level of importance (extremely important to not at all important) and how accessible the data are (very accessible to not accessible). The four domains were: health status, health system, health care services and population. Among health status indicators, childhood immunization rates were ranked most often as extremely important. In the health services indicators, hospital quality data were most often ranked extremely important, yet more than one-fourth of respondents said the data are not available. Similarly, Medicaid cost data were most often ranked extremely important among health system indicators, but 23 percent said the data aren't accessible.

To read the survey findings, see Colorado Health Care Data Needs Assessment.

Upcoming events

Creating a Colorado Regional Health Information Organization (RHIO)

Mark your calendars for April 21, 8 a.m.-3:30 p.m., for “Colorado Health Care and the Promise of HIT: Making the Case for a Colorado RHIO.” This symposium for health care and community leaders will:

• Challenge the assumptions about health information technology and discuss the benefits of sharing health and health care data electronically across Colorado’s communities
• Debate the business case for health information exchange and the infrastructure needed to make a statewide interoperable information network a reality
• Share the vision of the emerging CORHIO.

The symposium will be held at the Denver Marriott West, 1717 Denver West Blvd., Golden, CO 80401. It is sponsored by CHI and the Colorado Chapter of the Healthcare Information Management and Systems Society (CHIMSS) on behalf of the CORHIO Initiative Steering Committee

Register for this event

Hot Issues in Health Care Luncheons
CHI is pleased to sponsor again this year a series of Hot Issues in Health Care (HIHC) luncheons for legislators, legislative staff and other interested parties. Legislators will receive individual invitations to each luncheon, but please mark your calendars now for the following dates. All events will take place from noon-1:30 p.m. in the Legislative Services Building, Hearing Room A, 200 E. 14th Avenue.

• Wednesday, March 29 – Quality Assurance/Transparency
• Thursday, April 20 – Safety Net: What is it? Who's in it? What need does it fill?

For more information, contact Jo Donlin, 303.831.4200, ext. 219, or info@coloradohealthinstitute.org

Long-term care advisory committee meetings
CHI is serving as facilitator for meetings of the S.B. 173 Advisory Committee on Long-term Care. This committee was appointed last summer by the General Assembly and will issue recommendations on improving long-term care in the state in summer 2006. Upcoming meetings include the following; all are scheduled from 9 a.m.-3 p.m.

• Wednesday, April 5
• Friday, May 19
• Wednesday, June 14

For locations or more information, visit http://www.coloradohealthinstitute.org/hot_issues/longtermcare.htm or contact info@coloradohealthinstitute.org.

Hot issues
Long-term care
For many people, the term “long-term care” (LTC) conjures up images of frail elderly individuals living in nursing homes. While the Colorado long-term care system does provide a variety of services to the 65+ population, it also serves a growing number of 18-64 year olds with significant physical, developmental and mental disabilities.

Colorado provides supportive and skilled nursing services in diverse settings that include nursing homes, residential care facilities, assisted living facilities, group homes, adult day health care programs, adult foster care and private residences. These institutional and community-based services represent approximately 34 percent of Colorado’s Medicaid budget. Things are changing, though, with the funding bias toward institutional care steadily eroding in favor of community-based settings and services. Colorado is a leader in consumer-directed care that empowers consumers to participate in the development of their care plans, and manage the services and the individuals who provide the services.

Colorado continues to assess and improve its LTC system. In 2005, the Colorado General Assembly established the Senate Bill (SB) 173 Long-Term Care Advisory Committee to take another look at Colorado’s long-term care services and assess both the delivery and quality of a multitude of intertwined programs. Since August 2005, the Advisory Committee has convened bi-monthly meetings and deliberated over many issues, including financing, quality management, eligibility and service delivery options. The committee will continue deliberations over the next four months and make recommendations to the General Assembly and Medicaid program on ways to further transform the state’s LTC system into one that maximizes consumer choice and promotes high-quality, consumer-directed care.

CHI is facilitating the work of the SB 173 Advisory Committee, providing data, research and analytical expertise. The next committee meeting will be February 24, 9 a.m.- 3 p.m. at The Colorado Trust, 1600 Sherman St., Denver.  All meetings are open to the public, and materials, meeting dates and other Advisory Committee information can be found on the CHI Web site at http://www.coloradohealthinstitute.org/hot_issues/longtermcare.htm.

Who's who?
With Senator Norma Anderson’s departure, the Senate Republicans not only had a legislative seat to fill, but also a leadership position. Two senators emerged – one to lead the caucus through a challenging legislative session, the other to take her seat with commitment and very short notice.

Senator Tom Wiens – new caucus chair
The Senate Republican caucus elected Senator Tom Wiens, Castle Rock, as its new caucus chairman. Weins joins the other members of the Senate Republican leadership:  Senate Minority Leader Andy McElhany, Colorado Springs, and Senate Assistant Minority Leader Steve Johnson, Fort Collins. Wiens served one term in the House in 2000 and was elected to the Senate in 2002.

With long-time interests in banking, insurance and ranching, he is CEO of New West Capital, a mortgage company and venture capital firm, and chairman of Wiens Ranch Company. He serves on several committees, including Business, Labor and Technology; Transportation; and Homeland Security and Emergency Preparedness. Wiens holds a B.S. from The American University and a MDiv. from Yale University.

A native of Colorado and father of four, Wiens serves Douglas, El Paso, Lake, Park and Teller counties. “The Senate Republicans have a lot of work to do in 2006,” he says. “We must prioritize and get to work on real issues facing real people, and the cost and availability of health care are two areas where we can improve. On these issues and many others, I look forward to working within the caucus and across the aisle to get things done for the people of Colorado.”

Senator Kathleen “Kiki” Traylor, MD
Senator Kiki Traylor seized the opportunity to represent Senate District 22 when a Senate vacancy committee asked her to fill Senator Norma Anderson’s spot after Anderson resigned in early January. 

Traylor hit the ground running with a focus on education and health care issues and a spot on the Senate Health and Human Services and Judiciary Committees. With a B.A from Stanford and an M.D. from the University of Colorado Health Sciences Center, Traylor brings her medical expertise to the legislative arena. Specializing in pediatrics, she has practiced in a variety of primary care settings while holding different leadership positions along the way.

“I’m honored to be appointed to the Senate,” says Traylor. “So far, I’ve enjoyed the process and am learning a lot. I hope I can bring something valuable to the table, particularly on health issues.”

Inside Colorado
Emergency care lacking
In the first-ever national report card on the state of emergency medicine, Colorado got a “C” from the American College of Emergency Physicians. The state ranked 51st in percentage of children 19-35 months of age who are immunized. It ranked second, however, in annual emergency visits per board-certified emergency physician.

Beyond our borders
Ohio Medicaid report
A new data brief from the Health Policy Institute of Ohio looks at the economic impacts of Medicaid cost containment measures in the state’s current biennial budget. The study turned up some surprising findings:

1. The cost containment measures could result in a $2.4 billion loss to Ohio’s economy.
2. Almost 24,000 jobs could be lost over the two-year period.
3. Ohio could lose over $12 million in state income taxes in SFY 2006 and $21 million in SFY 2007.

For more information, see http://www.healthpolicyohio.org/publications/medicaidstudy.html

Health care disparities
The 2005 National Healthcare Quality report reports that health care quality continued to improve at a modest pace across most measures last year, with patient safety showing the greatest improvement. Low-income Americans experienced the largest disparities in quality and access to care, and disparities grew for Hispanics.

The report, from the Agency for Healthcare Research and Quality, measures quality and disparities in four areas: effectiveness, patient safety, timeliness and patient centeredness. Among its findings were:

1. The diseases and populations which showed the most improvement in quality measures were diabetes, heart disease, respiratory conditions, nursing home care, and maternal and child health care.
2. The diseases and populations which showed the least improvement in quality measures were HIV and AIDS, cancer, end stage renal disease, mental health and substance abuse, and home health care.

For results on all 46 core measures, see http://www.ahrq.gov/qual/nhqr05/nhqr05.pdf.

Web watch
In case of large-scale public health emergencies, here are some useful sites.

• PandemicFlu.gov is the official U.S. government Web site for information on pandemic flu and avian influenza. (http://www.pandemicflu.gov/)
• The Colorado Department of Public Health and Environment has a fact sheet on avian flu at http://www.cdphe.state.co.us/bt/avianflu120105.pdf.
• READYColorado.com is designed to help Coloradans become prepared to respond to and recover from a wide array of disasters, both natural and human-caused.  (http://www.readycolorado.com/)

Tell CHI...
Where do you get information about health and health care policy in Colorado? info@coloradohealthinstitute.org

We'll report the responses in the next issue of CHI HealthTalk.