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Focus on the facts
Eligibility for publicly financed health care services in Colorado
A conversation with... ...Bill Lindsay, president, Benefits Group, Lockton Companies, and chair of the Colorado Blue Ribbon Commission for Health Care Reform
In 2006 the Colorado General Assembly created the Blue Ribbon Commission for Health Care Reform to recommend three to five health care reform proposals for legislative consideration in the 2008 session. The proposals are expected to expand health care coverage to more Colorado residents while reducing the overall costs of health care in the state. The commission recently selected four health care reform proposals from a field of 31 and retained The Lewin Group to develop cost estimates for each proposal and discuss their impact on Colorado’s current health care system. The four proposals will be the basis from which the commissioners will formulate a final set of recommendations for health policy reform to the Colorado General Assembly by January 31, 2008.To learn more about the commission: http://www.colorado.gov/208commission
Q: Now that you’ve selected the four plans to be modeled and sent them off to Lewin, where will the commission focus its energy over the summer? Lindsay: We have several activities planned to help move our process forward. First, we’re developing four task forces to help us evaluate the four plans. The task forces will represent specific areas of interest including employers, providers, rural Colorado and vulnerable populations who may need special consideration when broad health care policy reforms are selected and debated. It’s another effort to get feedback from “real people,” not just commissioners who have been immersed in this process. We’ve received over 250 nominations for about 60 spots. The task forces will begin their work in July, so we’ve got to evaluate the nominees, make choices and get them going.
Second, we’ll be working with Lewin [a national health care and human services consulting firm] and the four proposers to fine-tune the proposals we selected. Not all the proposals provide the level of detail Lewin needs to estimate the plans’ costs and impacts on Colorado’s health care system. The work will be an iterative process where proposers will continue to fine-tune their proposals with Lewin until the final report to the commission is issued in August.
Third, we need to see how the commission wants to proceed with a fifth consolidated proposal. We could cobble together a plan that is based on one of the four but includes other elements, or we may start from scratch. Our time is limited, so we need to move on this soon.
As we head into fall, we’ll begin to plan our meetings around the state as determined in the original bill. We’ll go to all congressional districts and probably a few other communities.
Q: When you accepted your appointment, you weren’t planning to be chair of the commission; the commission elected you. As chair, what has been your biggest surprise? Lindsay: I’ve been amazed at the complexity of the human interaction among commissioners; we’ve got 27 very diverse individuals. It goes beyond political ideology and crosses into general values about the role of government, the need for health care reform and how commissioners determine their point of compromise. There’s a wide disparity of opinions, and I guess I was a little naïve about how complex the interaction would become.
Q: There’s been a lot of talk about the fifth proposal that the commission will construct from a variety of policy ideas and options. How will development of this proposal fit into the commission’s other activities? What elements do you think it will contain? Lindsay: The real issue is what process we’ll use to create a fifth proposal, and we’re working on that right now. We’ve all staked out parts of reform that we’d like to include, but how do you choose? Commissioners understand the challenges ahead of us. The proposers wrote their proposals through their own lens, but none of them examined the health care system in a truly comprehensive way. Our collective perspective may increase the comprehensive nature of a proposal. This process could continue into September, but the time is short.
The commission also needs to remember that one of our charges was to reduce costs. The proposals didn’t address this issue very thoroughly, so it may be the focus of the commissioners to add a cost-reduction element to one of the four or use it as the basis for developing our consolidated fifth proposal.
Q: As you look toward the next six months, what are your greatest challenges as the chair? As a full commission? Lindsay: For me, I need to carefully outline priorities. We have limited money and time and much work to complete. We’ll need to set priorities and keep the momentum moving forward. I will also challenge the commissioners to continue the collaborative approach they’ve brought to their deliberations so far. The discussions will get more difficult and individuals will be basing decisions on what they value most. People can become reluctant to be open when the decisions get tough, but I am optimistic.
As a commission, it will be tough to keep the pace we’ve set. Since November, I figure each commissioner has spent at least 200 hours on this work, and we’re probably 40 percent finished. The commitment has been intense. I also hope commissioners can continue to be open, thoughtful and objective. We’ve got some long hours ahead and the tendency sometimes can be to ask for a quick decision or vote because people are tired and want to move on. We’ll work hard to stay focused.
The commissioners deserve our gratitude for their unending commitment to this project. It’s remarkable.
CHI spotlight CHI unveils new Web sites
The Colorado Health Institute (CHI) has launched three new Web sites – its main site with a new look and added features, and two new companion sites devoted to the health care workforceand the safety net.
New features include a data center where users can view and compare information about Colorado or other geographic areas. Indicators can be downloaded or printed in table, graph or map format. Currently, the data center features the following safety net indicators which users can view and download at the state or county level or select up to six counties to compare.
Also, let us know what you think about the new sites and how we can improve them.
New CHI publications and presentations
Safety net symposium – If you missed the Safety Net Symposium in early May, you can still take a look at the presentations from that event. The symposium attracted nearly 200 health care providers; policymakers; safety net, hospital, foundation, local and state government representatives; plus numerous others interested in the system that serves Colorado’s vulnerable populations.
Safety net primer – This primer provides a working definition of safety net providers and a snapshot of current and potential users of safety net services. In addition, it discusses the important role played by the safety net, how it is financed and the range of services safety net providers offer.
Emergency Department Database – This CHI Issue Brief describes the benefits that could result from a statewide database on hospital emergency department visits.
Deficit Reduction Act and Medicaid – New summaries of findings present the results of CHI surveys that queried two groups of workers on the impact of new federal documentation requirements on enrollment: eligibility technicians (county workers who enroll families in the Medicaid and CHP+ programs) and community-based outreach and enrollment workers who assist families in applying for Medicaid and CHP+ coverage.
2007 Culture of Data Conference
Friday, October 12, Tivoli Center at Auraria Campus
The 2007 Culture of Data Conference will focus on "Culture of Data: What Does it All Mean?" The conference is seeking abstract submissions for posters and presentations. Stay posted for additional registration and agenda information.
2007 Annual Colorado Rural Health Conference
June-August
This annual event is being held in four rural communities this year. The first meeting took place in Trinidad on June 7-8 and will be followed by additional meetings in the towns listed below. Each conference will be different, depending on needs of the individual communities.
27th Annual Dorsey-Hughes Symposium
July 26-28, 2007, Park Hyatt Beaver Creek, Beaver Creek, Colorado
For more than 25 years, the Dorsey-Hughes Symposium sponsored by The Colorado Health Foundation has offered a lively and open exchange of information and ideas focusing on health care reform and the social, political and financial issues that affect the delivery of health care in this country. This year’s event will look at the major forces influencing American health care.
For more: http://www.coloradohealth.org/news/dorsey.cfm
State Coverage Initiatives
August 2-3, 2007, Marriott Denver City Center, Denver, Colorado
This summer workshop for state officials will feature sessions on cost containment, systems improvement, insurance coverage for young adults, Medicaid and other issues of high policy importance to the states.
For more: http://statecoverage.net/0807agenda.htm
Hot issues Colorado’s health care safety net
Colorado’s health care system has been getting almost daily attention lately. Reports of rising health insurance costs, 770,000 uninsured Coloradans, hospitals leaving Denver for the suburbs, legislative action on health issues and the work of the state’s Blue Ribbon Commission on Health Care Reform all point to the need for – and interest in – improving Colorado’s health care system.
CHI has taken a special interest in the part of the health care system that serves the state’s most vulnerable populations – safety net providers. An integral component of Colorado’s health care system, the safety net consists primarily of public and private health care clinics and community hospitals whose mission is to provide care to low-income uninsured and publicly financed Coloradans – roughly 25 percent of the state’s population.
With support from The Colorado Health Foundation, CHI is engaged in a multi-year effort to create a Safety Net Indicators and Monitoring System that will identify, describe and monitor Colorado’s health care safety net (including physical, dental and mental health care providers) and the populations it serves. The ultimate goal is to document and monitor the ongoing viability of Colorado’s safety net and ensure through this documentation that sound policy and program decisions can be made.
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.
Theresa Donahue, Executive Director, Metro Denver Health and Wellness Commission
Under the leadership of its executive director, Theresa Donahue, the Metro Denver Health and Wellness Commission is working to make the Metro Denver area America’s healthiest community. With more than 25 years of leadership, senior management and strategic public policy experience in the public, private and nonprofit sectors, Donahue is working to stem or reverse Colorado’s growing obesity rate through her work with metro area leaders.
“Obesity is a major driver in the escalation of chronic disease and our health care costs,” Donohue said. “By engaging our CEOs, parents, elected officials, principals and other leaders in taking small steps – healthier foods at home, getting physical education back into our schools, replacing employee smoking breaks with walking breaks, building streets so they’re safe for pedestrians and bicyclists – we can realize big changes in our health, work site productivity, academic performance and our economic vitality.”
The commission’s mission is to promote policies and programs that support a culture of healthy eating and active living in schools, work sites and communities. It is also compiling metrics to establish a baseline with benchmarks to monitor the metro region’s progress toward achieving better health.
Alexandra Hall, Labor Market Information Director, Colorado Department of Labor and Employment
Alexandra Hall is the director of Labor Market Information (LMI) and chief economist for the Colorado Department of Labor and Employment. She joined the department in 1994 as an economist intern and has held a series of increasingly responsible positions, becoming director of LMI in 2002. Hall is responsible for Colorado’s contribution to a number of U.S. Department of Labor data collection and analysis programs.
In recent years, she has expanded the focus of LMI to include customized product development and user training. Hall and her staff provide labor market analysis to both internal and external customers, making workforce information available to a variety of policymakers in the public and private sectors.
Applying her expertise at the national level, Hall chairs the Projections Management Partnership, a national coalition of state and federal agencies that provide technical resources and support to states in producing state-level workforce projections. Hall is also a member of the Workforce Information Council and the National Association of State Workforce Agencies, both of which are committed to developing professional training programs for labor market economists. Locally, Hall co-chairs the Workforce and Economic Information Coalition and is a member of the Skills Development Partnership Committee.
“The development of sound, state-level policies to support health care industries has been a high priority in Colorado for many years. It’s rewarding to provide workforce analysis for industry leaders and policymakers to enhance their understanding of the issues faced by this sector,” Hall said.
Pueblo area gets Ritter’s attention
A pilot program designed to enable Pueblo County to expand health care coverage to small businesses was signed into action on June 5 by Governor Bill Ritter. At the same time, the governor signed HB 1101, which will be used to study the factors that contribute to high health care costs in the city and county of Pueblo.
Nursing task force under way
The first Nurse Workforce and Patient Care Task Force meeting was held May, 31, 2007, at The Colorado Trust offices in Denver. Governor Ritter and a task force team outlined the guiding principles that would inform the task of finding “common ground” among hospitals, nurses and consumers with regard to nurse staff ratios in health care facilities. The conversation at the first meeting focused on best ways to collect and publicly report quality data in the most effective and understandable ways for public consumption.
Profile of a Colorado rural doc
A doctor who left his busy Boulder clinic to become a “country doc” in Cheyenne Wells, one of two doctors in the county, made the TV news headlines lately in a Channel 9 profile. Trading traffic for farm fields, Dr. Gary Grasmick made the move to inspire new challenges and to fill a gap in rural health care.
Colorado’s health rankings vary
Colorado ranks anywhere from second to 45th among states in two health and health care rankings recently released by the Agency for Healthcare Research and Quality (AHRQ) and the Commonwealth Fund. In the AHRQ State Snapshots, based on the 2006 National Healthcare Quality Report, Colorado ranked as high as third in the percent of adults over age 65 who get pneumonia vaccinations and as low as 45th in the percent of young children receiving all recommended immunizations. In the Commonwealth Fund scorecard on health care performance, Colorado ranked second among states on “healthy lives” but 43rd on equity with an overall rank of 22.
Physician supply/demand model
In 2006, the Utah Medical Education Council (UMEC) conducted a study on Utah’s physician workforce in an attempt to understand workforce shortages that not only had been affecting Utah but also the nation. The study found that less than one-third of Utah physicians practice in generalist fields and that the workforce in rural areas is far below optimum levels. UMEC has recently teamed up with the Association of American Medical Colleges (AAMC) to develop a national model to measure the mismatch between the number of physicians in a state and the number of patients seeking care. At a conference this past May, AAMC and UMEC presented the methods they used to create a new model for projecting physician supply and demand.
More information on this study and its findings will be available soon.
SCHIP resources
Extending health care coverage to the uninsured is fodder for many policy discussions these days, especially coverage for uninsured children. Re-authorization of the State Children’s Health Insurance Program (SCHIP) is before Congress after a decade of serving millions of children. In May, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured held a policy briefing to highlight state action and release several new resources. SCHIP must be reauthorized by October 1 to continue to receive federal funding.
...Bill Lindsay, president, Benefits Group, Lockton Companies, and chair of the Colorado Blue Ribbon Commission for Health Care Reform 
Theresa Donahue
