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
Source: Profile of the Uninsured in Colorado, An Update for 2005, Colorado Health Institute, November 2006.
A conversation with...
...Karen Donkle, director, Bent County Family Medical Center, and administrator, Bent County Nursing Service
Q: The Bent County Family Medical Center was the result of a merger. Can you explain its evolution?
Donkle: We had two county clinics competing for the same patients -- Bent County Rural Health Center and the Family Medical Center. There were two boards, duplicative services and neither one was financially sustainable. In September 2006, we merged into one entity – Bent County Family Medical. We are a full clinic and a designated rural health clinic. This merger made a lot of sense because we can target our services and serve the population more effectively. We also work closely with the Bent County Nursing Service, which is our county public health department. I wear two hats – director of Bent County Family Medical (BCFM) and administrator of Bent County Nursing Service. The nursing service has 13 employees and BCFM has four plus a contracted nurse practitioner one day a week and a doctor two afternoons a week. I’m a nurse practitioner and see most of our patients.
Q: As a certified rural health clinic, BCFM serves seven southeastern counties, Baca, Bent, Crowley, Kiowa, Las Animas, Otero and Pueblo. How many miles and people does this represent, what services do you provide, and how does the staff serve them successfully?
Donkle: We provide full clinic services including primary care and different preventive services such as well-child visits, vaccinations and some ob/gyn screenings. I have a memorandum of understanding with a couple of doctors who provide pediatrics and ob/gyn services when we need them. I split my time by seeing patients in the morning and focusing on administrative duties in the afternoon. On Wednesdays, we send a mobile clinic van out to our communities in Bent and other surrounding counties. We’ve been strategic in how we select the communities we visit. We don’t want to step on any toes where a clinic might already exist. We band together and make it work with other partners. For instance, the nurse practitioner in Kiowa County is pregnant and had to go on bed rest, so we’re doing our best to serve her area. When a crisis occurs, we face problems together and get them solved.
Q: As you travel around your area, what do you see as the major health issues facing your clients and your staff?
Donkle: Our population is predominantly elders. We see a lot of hypertension, diabetes and high cholesterol. I coordinate a program in our health department called STAR – screening, treatment, assessment and resources. With a grant from the Colorado Department of Public Health and Environment for cardiovascular, cancer and pulmonary disease prevention, we established this program to help folks better manage their conditions. I try to enroll as many people as I can so they can be monitored, but also live healthier lives.
Q: As the number of uninsured continue to grow, how will you continue to serve this population and others? What does the future look like?
Donkle: Right now, about 45 percent of our clients are uninsured or underinsured. My underinsured can’t pay their co-pays or high-deductibles so they come to us. If I enroll an uninsured patient into the STAR program, the grant that established STAR will allow the patient $250 worth of services. That funding is then transferred to BCFM to cover an individual’s costs. That’s a big help. We do get Medicare, Medicaid and private insurance clients.
Every day, we see 10-12 new clients. To be honest, I’m not fully sure where they’re coming from. I’m optimistic that the merger will prove to be a success and we’ll be financially stable when our grant runs out in June 2008. In BCFM and the Bent County Nursing Service, I have an independent staff. They hold their own and we get the job done.
CHI spotlight
CHI evaluation highlights
The results of CHI’s first outside evaluation, carried out late last year as part of our first five-year business plan, point to many successes for a young organization as well as areas for improvement.
CHI’s founding foundations – The Colorado Trust, Caring for Colorado and Rose Community Foundation – asked constituents to respond to an online survey. About 58 percent of the approximately 250 individuals who received a personal letter asking them to take part responded. In addition, 17 key constituents were interviewed in a more open-ended format by consultant Tom David.
“For a new organization that has only been fully operational for two-and-one-half years, we are gratified at the survey findings,” said CHI President and CEO Pamela Hanes. “I am pleased to share the summary results with our readers. I want to assure the community we heard that there are places we could be doing better, and our 2007 workplan has incorporated strategies to reach an even broader audience of individuals and organizations with our information clearinghouse and policy analysis resources.”
New on the CHI Web site
CHI continues to add new resources to our Web site. Visit frequently for new publications and data additions. Here are some of our latest additions:
- Our new update on Colorado’s uninsured population examines risk factors for being uninsured, including income, age and race.
- The 4th Biennial Hot Issues in Health Care Legislative Conference, held in November 2006 after the mid-term election, featured presentations and discussions focused on the state-of-the-state with regard to health and health care in Colorado, the private health insurance market, publicly financed coverage and state and local innovations in expanding access to health care at the community level. View the agenda and presentations.
- See the Database Descriptions area for updates or new national and state data sources available and the Interactive Data Sites area for new resources that you can query for Colorado-specific information.
- CHI has several new issue briefs to provide you with background and trend information on health care spending in Colorado, dual eligibles, the state’s high-risk insurance pool, Colorado’s children’s insurance status and long-term care.
- Forthcoming: A more detailed paper on Colorado’s uninsured children will be available on the CHI Web site in late February.
Upcoming events
Colorado Safety Net Symposium
As part of its Safety Net Indicators and Monitoring Project, CHI will host a symposium in late April or early May on Colorado’s health care safety net system and the providers that serve the state’s most vulnerable residents. Co-sponsors include the Colorado Hospital Association, the Colorado Community Health Network, ClinicNet, the Colorado Health Foundation and the Colorado Rural Health Center.
The purpose of the symposium is to bring together Colorado’s safety net providers, community leaders and state policymakers to better understand the full range of services and providers that comprise the safety net and engage participants in problem-solving around the policy issues facing the safety net.
If you’re part of or interested in the state’s health safety net, drop us a line and we’ll make sure you get notified about the date, time and location of the symposium.
Rural Health Policy Institute
February 26-28, Washington, D.C.
For more: http://www.nrharural.org/conferences/sub/PI.html
Association of Maternal and Child Health Programs Annual Conference
“Healthy Communities”
March 3-7, 2007 Arlington, Virginia
For more: http://www.amchp.org/news/2007/callforabstracts.php
Association for Community Health Improvement Annual Conference
March 7-9, 2007, New Orleans, Louisiana
For more: http://www.communityhlth.org/communityhlth/conference/annual07.html
Hot issues
2005 physicians workforce survey data available; RN data updated
The Colorado Health Institute (CHI) has released the public use data file (PUF) from its 2005 workforce survey of licensed Colorado physicians. This is the second public use file to be released from CHI’s Health Workforce Database Project funded by The Colorado Trust. The project is designed to inform policymakers and the philanthropic community about workforce issues related to the supply, retention and demand for health professionals in Colorado.
In March 2005, physicians whose Colorado licenses were up for renewal received a workforce survey form with their license renewal materials. A total of 16,138 physicians renewed their license to practice medicine in Colorado, with about 20 percent having a contact address outside the state. CHI received survey responses from 48 percent of those who renewed their licenses – 7,715 physicians.
The public use data file now available on the CHI Web site contains record-level data from the survey, with identifying information suppressed. A brief describing survey administration methods and key findings is in production.
In addition, CHI has updated the public use data file for the 2005 Registered Nurse Survey as more data has been made available since its September 2006 release.
For more on physicians: See Web watch below.
HIT efforts heating up
The initiative to build a statewide interoperable health information exchange network, known as the Colorado Health Information Organization (CORHIO), is gaining momentum.
In December 2006, the Steering Committee voted to incorporate CORHIO as a 501(c)3 nonprofit organization early in 2007. In light of that action, the committee approved a slate of nominees to sit on CORHIO’s start-up board of directors. This initial slate of candidates includes high-level community leaders with experience in different areas of health care.
The Privacy and Security Project, one area of development essential for CORHIO operations, recently completed its second phase of work and released the Interim Analysis of Solutions Report. This extensive report describes how CORHIO and its partner health care organizations can address various barriers to electronic health information exchange posed by privacy and security needs and requirements. The next phase of the project involves developing a plan for implementing these privacy and security solutions over the next 12-18 months.
Governor Bill Ritter included health information exchange in his “Colorado Promise,” saying he will encourage work under way to modernize the state’s health information infrastructure and push for public-private partnerships to promote the use of technology to reduce medical errors. Colorado policymakers are also expressing support for building electronic health information exchange and CORHIO as a way to improve health care quality and cost-effectiveness.
Please visit www.corhio.org to download the latest Privacy and Security report and to read more.
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.
 Irene Ibarra, President and CEO, The Colorado Trust
A new year brings new leadership to one of Colorado’s largest health foundations. Irene Ibarra is the new president and CEO of The Colorado Trust, following a career at The California Endowment, the nation’s 12th largest foundation. Ibarra returns to Colorado having served in Governor Roy Romer’s cabinet and as an appointee of Mayor Federico Pena.
Bringing her extensive experience with health care issues and the nonprofit and philanthropic sectors, Ibarra will continue the tradition of strong leadership and commitment established by outgoing president and CEO John Moran, Jr. She earned her J.D. from the University of Washington, and also holds a master of public administration and a master of social work from the University of Denver.
“I’m eager to build on The Trust’s achievements to advance the health and well-being of the people of Colorado, and I greatly look forward to getting to know The Trust’s extended family – from grantees and partners to all the many individuals and organizations that share our mission,” Ibarra said.
For more: http://coloradotrust.org/repository/newsreleases/pdfs/2006/NR-NewCEO-Ibarra-9-2006.pdf
 Nancy Spence, Senate Assistant Minority Leader
The Senate Republican caucus has elected Senator Nancy Spence as its new assistant minority leader.
Spence brings nearly 10 years of experience to the position, having first been elected to the House of Representatives in 1998, where she chaired the Education Committee for four years. In 2004, she was elected to the Senate from District 27, which covers portions of Arapahoe County. Spence serves on the Senate Education and Transportation Committees.
Spence began her career in public service as a member of the Cherry Creek School District Board of Education. With a history of community service, she also serves on the Craig Hospital Board of Directors. In the past few years, Spence’s legislative work and volunteerism have been recognized by the Colorado Civil Justice League, the University of Colorado Health Sciences Center, the Colorado Home Builders Association and the Colorado Dental Association.
Along with other legislative leaders, Senator Spence is eager to find solutions to Colorado’s most pressing health care issues. “We are concerned about waiting for the legislature’s commission on health care to come back with findings on where Colorado should go. That’s why we’re advocating steps Colorado can take to bridge the health care coverage gap,” Spence said.
For more: http://www.nancyspence.org/
Inside Colorado
Blue Ribbon Commission to seek reform proposals
Colorado’s Blue Ribbon Commission for Healthcare Reform is scheduled to issue a request for proposals for comprehensive health care reform on February 22. Proposals will be due by April 6. As required by Senate Bill 06-208, proposals considered by the commission must ensure access to affordable coverage for Colorado residents.
For more: http://www.colorado.gov/208commission
Long-term care proposals sought
The Department of Health Care Policy and Financing is seeking proposals for a coordinated care pilot program for community long-term care services for the state’s Medicaid program. The deadline to apply is February 15.
For more: http://www.chcpf.state.co.us/ See “Current Issues and Projects,” then click on “Long-term Care Pilot Proposals.”
If you can’t visit the legislature, you can still hear it
Coloradans interested in following the workings of the 2007 legislative session can tune in via the Internet. Check the House calendar or Senate calendar to see where bills are in the process and where and when hearings are scheduled (schedules change frequently, so check daily). If you want to listen to a hearing, listen to the audio over your computer. The General Assembly home page also has other information, such as district maps, a legislative directory and other helpful resources.
Beyond our borders
Universal health coverage
Before Governor Arnold Schwarzenegger released his universal health coverage plan early this year, the California HealthCare Foundation released an analysis of three alternative approaches to coverage:
- Basic Individual Mandate, requiring individuals to obtain coverage and making government subsidies available for low-income Californians;
- Pay or Play Plus, combining an individual mandate and subsidies with required employer contributions; and
- All-Consumer Choice Exchange, replacing today's employer-by-employer coverage system with a "choice pool" funded primarily by payroll fees on all employers and workers.
All the plans assign individual, employer and government responsibility.
For more: http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=125690
State of the States 2007
State Coverage Initiatives at AcademyHealth recently released its 2007 State of the States: Building Hope, Raising Expectations. The report details a variety of factors that are motivating states to address issues related to the uninsured, and also highlights a mix of comprehensive and incremental health care reforms. It also provides a nationwide review of state-based, health care trends.
For more: http://statecoverage.net/pdf/StateofStates2007.pdf
Web watch
Other Web sites that provide information on physicians.
  
CHI HealthTalk Contributors
Writers: Jo Donlin, Jessica Dunbar and Sherry Freeland Walker
Design: Kindle Fahlenkamp-Morell |
