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

Focus on the facts

A conversation with...
...John R. Moran, Jr., President and CEO of The Colorado Trust

John R. Moran is retiring this year after 20 years with The Colorado Trust, including 15 years as president and CEO. Under his leadership, The Trust’s endowment grew from $191 million to more than $460 million, with grants totaling $247 million made to nonprofit organizations in each of Colorado’s 64 counties. Moran also oversaw a move from responsive grantmaking to initiative-based grantmaking, which allowed the foundation to be more strategic by providing for a length and depth of commitment appropriate to address major social issues.

Q: As you reflect on your 20-year relationship with the Trust, what do you view as your greatest success? Is there anything you would have done differently?
Moran: There are so many facets, it’s hard to pick just one. One area where I’ve worked the hardest is in developing a strong, cohesive staff and an engaged, focused board of directors. There’s a common vision based on a mission that the staff and board understand and support. The staff is extraordinary and they’ve made my job easier. I think we’re on task and working together in a way that maximizes our capabilities and stays true to our mission of advancing the health of the people of Colorado.

In retrospect, maybe I could have been a little more relaxed, but my tenacious nature helps keep me pushing forward. At The Trust, we are always trying to make a difference. For me, that means putting my heart and soul into my work, and that’s what I’ve done.

Q: During your tenure, you developed and implemented a proactive, more targeted grantmaking process. How has that worked?
Moran: We developed the grantmaking process together and, yes, it is a more proactive and targeted approach that has served us well. We don’t just shoot from the hip in some random way. We’re diligent and careful in our approach, and our process has kept us focused on the initiatives that we think can make a difference. Our most unique factor is that we couple the grantmaking with an evaluation. The evaluation component is critical and helps us measure the outcomes and track the successes or failures within each initiative.

The evaluation component works like a compass for all of us. Sometimes we’re not headed in the exact direction we intended, but we can make adjustments and stay on course. As we move through our initiatives, the evaluation helps strengthen our commitment to our work. Everything we do should reflect back on our mission.

Q: What’s the next big challenge on the horizon that health care foundations will need to address?
Moran: It’s already here. We need to figure out how we can bring health care to the medically underserved in a cohesive way that addresses mental health as well as physical health. We need to address the complete and overall health of a person, not fragment the care into parts. If we’re ever going to make a difference, we need to deconstruct and reconceive the current health care system. We suffer paralysis because we’re stuck in an old model that doesn’t address the needs of the world around us.

Q: What does the future hold for John Moran?
Moran: If I had known 40 years ago that The Colorado Trust was in my future, I would’ve been so excited. The future will reveal itself as it always has. I imagine I will stay involved in health care and policy, but I also need to catch up on a lot of things, including leisure. That will include traveling, a little fishing and a variety of other interests I have. I feel so good that I think I’ll be around a while.

CHI spotlight
Health Care Vision 2006 and Beyond
Health Vision 2006 and Beyond, a planning group meeting under the auspices of the Colorado Health Institute, brought former Oregon Governor John Kitzhaber to Denver on June 12 and 13 to talk with business leaders, health care providers, foundation representatives and others about how to make the current health care system in the United States more equitable.

Employer-sponsored health insurance coverage, Medicaid and Medicare have resulted in people having to fit into a category to be eligible for subsidized health insurance coverage, he told participants at two events. While these were great programs in their time, Kitzhaber said he believes public resources need to be allocated in a way that benefits everyone, much like public education funds.

Kitzhaber called for a new vision of universal access to a set of publicly funded health care services. The Archimedes Movement, which he is leading, calls for reorganizing existing public dollars going to health care to provide this base.

CHI, the Kaiser Foundation Health Plan and the Colorado Medical Society brought Kitzhaber to Denver as the first in a series of events to spark the thinking of business and political leaders about what is possible in the health care system.

For more: http://www.coloradohealthinstitute.org/documents/kitzhaber06.ppt and http://www.archimedesmovement.org/.

HIT: New Efforts; New Web Site
Colorado is participating in two new efforts to speed up the sharing of electronic health information to improve health and health care. The Colorado Health Information Security and Privacy Collaboration (HISPC) project is part of a nationwide effort led by the U.S. Department of Health and Human Services and involving the National Governors Association. The project calls for all participating states to analyze and address the privacy and security concerns that are barriers to sharing electronic health information.

Governor Bill Owens designated CHI to oversee the year-long project. Coloradans in all regions of the state will be asked to provide information about the policies and procedures their agencies and institutions use to address security and privacy issues. In addition, health care providers, consumers and others will contribute to an analysis of practices used to share health information and help develop solutions and implementation strategies to ensure health information is used properly and securely.

Colorado also is one of nine states selected to participate in a study to recommend “best practices” in developing a statewide electronic network that allows patients’ medical records and other electronic health information to be exchanged among health care providers and entities. The project will look at governance, structure, financing, operations and health information exchange policies in statewide regional health information organizations (RHIOS). It is administered by the Foundation of Research and Education of the American Health Information Management Association under a contract to the Office of the National Coordinator for Health Information Technology. Recommendations about state RHIOs will be released in late August. For more information, visit www.staterhio.org.

For more on Colorado’s efforts to create a RHIO, see the newly launched Web site http://www.corhio.org. The site will feature the latest news on what’s happening in the world of health information technology and health information exchange in Colorado and across the nation.

Upcoming events

6th Annual Colorado Cancer Conference
The Colorado Cancer Coalition presents its annual training, skill building and information effort, August 9-10, Colorado State University, Lory Student Center, Fort Collins.

For more: http://www.coloradocancercoalition.org/conference/conference_index.aspx

National Association of County and City Health Officials (NACCHO)
The year’s largest gathering of local health officials is coming up July 26-28 in San Antonio at the NACCHO annual conference. The meeting will focus on communicating the importance of local health departments to policymakers, decisionmakers, the media and the public. Also meeting in San Antonio from July 26-29 is the National Association of Local Boards of Health.

For more: http://www.naccho.org/conferences/NACCHOannual06/ and http://www.nalboh.org/confer/confmain.htm

Hot issues
Transparency
The average consumer today obtains more information about choosing a refrigerator than choosing a doctor or hospital. As a result, a new trend has emerged across the nation, and in Colorado, to encourage or mandate the public reporting of certain health care quality and outcome data. The notion of public reporting and increased transparency is generally accepted as a positive step to help consumers better understand health care costs and become more savvy purchasers of health care.

The policy debate typically centers on how the data are collected and reported, what level of data is appropriate for which audience, and how health care providers, hospitals and consumers can use the information to improve the quality, safety and affordability of health care. During the 2006 legislative session, Colorado policymakers from both sides of the aisle supported several pieces of legislation that focused on transparency issues. In the end, HB1045 and HB1278 were signed into law. HB1045 requires facilities to collect data on infection rates for certain procedures, while HB1278 requires each hospital to release a report card that discloses certain quality and patient safety standards.

In March, CHI hosted Barbara Rudolph, director of Leaps and Measures at TheLeapFrog Group in Washington, D.C., to speak at the Hot Issues in Health Care Luncheon. Her presentation offered a national overview of the state of the art in quality reporting as well as state-specific best practices.

How we define “transparency” and how consumers and employers actually use the information will continue to play out in the capitol and households around the state. In the end, an empowered, fully informed consumer could be a new force within the health care market.

See Web Watch below for more information on transparency.

Who's who?
Each issue, CHI HealthTalk introduces you to individuals who are making a difference in health care in Colorado.

Kraig Burleson is the CEO of the Inner City Health Center, a private faith-based nonprofit health care facility that provides comprehensive primary health care to low-income and uninsured families. After joining the center’s staff in 1994, Burleson held various positions such as business manager and chief financial officer prior to becoming CEO in 2001.

As CEO, he handles the overall governance of the center’s programs and operations and its outreach clinic, New Hope Dental Services. As an active community leader, Burleson also serves on numerous boards and committees devoted to increasing access to quality health care for people who are uninsured, underserved or underinsured. These organizations include Health Ministries, ClinicNet, Denver Healthy People 2010, the Colorado Coalition for the Medically Underserved and Healthy Impact. Burleson’s most recent commitments are to serve as a member of the Health Advisory Committee of the Denver Foundation and the Denver Public Schools/City of Denver Early Childhood Council.

“As I walk through the Center, I see patients of all ages in the waiting rooms. I think to myself that here, inside these walls, we are doing our part to be of service to those in need. What a blessing to behold!” Burleson said.

For more: http://www.innercityhealth.com

As program coordinator for Aging Well, Dace Carver Kramer continues to demonstrate loyalty to her rural community. Aging Well, a program of the Northwest Colorado Visiting Nurse Association, strives to provide Northwest Colorado with comprehensive healthy aging practices that include social and health services.

Kramer’s passion for improving rural communities is evident in her past experiences. As a committed public servant, Kramer’s background includes serving as a legislative staff member for U.S. congressmen and state senators, working with the western regional office of the Advisory Council on Historic Preservation and being a resource development manager for the Orton Family Foundation, where she worked on project designs and program implementations for rural life and landscape.

“We have a collective responsibility to create a culture of community investment that fosters greater opportunity for our elders to remain independent and socially engaged, mentally fit and physically active. Eventually, it is my hope that such a culture will take hold nationally through social and health care policy promulgation,” says Kramer.

For more: http://www.nwcovna.org

Inside Colorado

Long-term Care Committee Finishes Its Work
After 10 months of work, Colorado’s SB 173 Long-term Care Advisory Committee has completed its recommendations for improving the state’s long-term care system. In examining elements that need a fresh look, the legislatively appointed committee focused on features that would provide better access to the full continuum of long-term care services while promoting consumer choice and value-based purchasing, and improving consumers’ quality of life in the least restrictive setting.

The target population of these reform efforts is elders and adults with disabilities who are, or are at risk of becoming, eligible for long-term care services under Medicaid.

The committee submitted its report to the Department of Health Care Policy and Financing on July 1. The department will review and forward the committee’s recommendations to the Governor’s Office, Joint Budget Committee, and Senate and House Health and Human Services Committees by August 1. The recommendations must include any legislation or rule changes necessary to implement programs and program modifications.

The Colorado Health Institute facilitated the committee deliberations and provided analysis and research as requested.

Read the report: http://www.coloradohealthinstitute.org/Documents/LTC/LTC_final.pdf

New Report Card Gives Colorado a C+ in Health
In spite of Colorado’s reputation as a healthy state, the first report card on Coloradans’ health status ranked the state as slightly above average with a C+ grade. The report card was released recently by the Colorado Health Foundation (CHF), which worked with CHI to grade the state on 20 indicators.

Findings include:

• Colorado’s adults are healthier than its children – Adults received As and Bs on risk factors and outcomes ranging from obesity rates to heart disease deaths. Children, on the other hand, received Cs on almost all their indicators, from vaccination rates and cases of whooping cough, to mothers who receive adequate prenatal care and have low birthweight babies.
• The high percentage of uninsured people compromises health – The number of adults and children without health insurance in Colorado were graded a C and D, respectively, ranking 38th and 44th in the country.
• Good grades shouldn’t be taken for granted – While Colorado is a leader in the battle against obesity, the report card showed a C- for the number of children who exercise at least five hours per week, a number the report says has “ominous implications” for the future.

For more: http://www.coloradohealth.org/issues/report.cfm

Beyond our borders

Ohio Dental Roundtable Makes Recommendations
The Ohio Dental Workforce Roundtable recently issued its recommendations regarding workforce-related approaches to improve access to oral health for vulnerable Ohioans. The roundtable, appointed by the Department of Health and the Health Policy Institute of Ohio, included representatives from the oral health professions; public and private associations, foundations and coalitions; dental schools; and government. Throughout 2005, members met to debate and develop strategies on using Ohio’s oral health care workforce more effectively. The result is a set of core values to guide dental workforce policy implementation in Ohio, as well as recommendations to the director of the Ohio Department of Health.

For more: http://www.healthpolicyohio.org/pdf/Dentalroundtable.pdf

Environmental-Caused Diseases
The World Health Organization (WHO) issued a recent report saying that nearly one-fourth of diseases caused by environmental factors are preventable. WHO estimates that each year 13 million deaths worldwide are due to preventable environmental risks, such as exposure to air pollution, industrial workplace fumes and accidents, and traffic injuries due to poor design of transportation systems. The report shows how more than eight major diseases are influenced by the environment, including cardiovascular diseases, lower respiratory infections and cancer. Through modifying environmental factors, exposure to risks can be reduced, creating a healthy environment for everyone, the report says.

For more: http://www.who.int/mediacentre/news/releases/2006/pr32/en/index.html

Web Watch

Here are some Web sites that provide information on making information on health care quality more transparent.

• The LeapFrog Group – A voluntary effort involving 170 companies and organizations that buy health care to reduce preventable medical mistakes and improve the quality and affordability of health care by encouraging and supporting public reporting of health care quality and outcomes – http://www.leapfroggroup.org/
• Hospital Quality Initiative – A federal effort from the Centers for Medicare and Medicaid Services to provide hospital quality information to consumers and others and improve the care provided by the nation’s hospitals – http://www.cms.hhs.gov/HospitalQualityInits/
• Colorado Hospital Quality – In association with the Colorado Health and Hospital Association, this Web site provides comparable data on the quality of care provided in hospitals throughout Colorado. http://www.hospitalquality.org/

CHI HealthTalk Contributors
Writers: Jo Donlin, Martha Saenz and Sherry Freeland Walker
Design: Kindle Fahlenkamp-Morell