Welcome to CHI HealthTalk, the new 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

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A conversation with...
…Steve Tool, executive director of the Colorado Department of Health Care Policy and Financing (HCPF)

In August 2005, Governor Bill Owens appointed Steve Tool to head HCPF, the state agency responsible for the administration of the Medicaid program, Child Health Plan Plus (CHP+) and the Colorado Indigent Care Program, all of which provide health care for low-income Coloradans.

Prior to his appointment, Tool was senior director of the Division of Motor Vehicles in the Department of Revenue and chairman of the state Medical Services Board, which provides direction to HCPF in policies, rules and regulations.

Tool also is a former state legislator, first elected in 1994 to the House of Representatives, where he served for three terms. During his last term, he chaired the Joint Budget Committee. 

Q: What is the biggest challenge facing Colorado’s Medicaid program?
Tool: Not unlike other states, our biggest challenge is sustainability. At the federal level, U.S. Secretary of Health and Human Services Mike Leavitt has set out four areas for close examination as states move forward with their Medicaid programs – pharmaceuticals, long-term care, information technology and the diversification of benefits. Traditionally, Medicaid has been a “one-size-fits-all” type of program. We need to diversify our benefits to better meet the needs of our clients and find efficiencies and improvements where we can. Colorado’s done a pretty good job, but there’s more work to be done.

Q: If you can accomplish one thing as executive director of HCPF, what will it be?
A few months ago, I would’ve said the passage of the Colorado Family Care* legislation. I’m disappointed it can’t be done this year, but I hope it comes back because the ideas are worthy of further consideration. Now, I’m focusing on Senate Bill 06-219. With this legislation, we can reorganize and clean up the statutes that govern the department’s actions and activities. This will give us better access to the counties in regard to how they administer Medicaid programs. We have established a Medicaid User Group that meets four times a year that can be another step toward building stronger relationships with the counties. We’ve needed to do this for a long time and I’m hoping we can get the job done.

Q: What do you think makes the Colorado Medicaid program unique?
Our efforts in the area of long-term care really stand out. We’ve done a very good job in developing our home and community-based services so people can be as independent as possible for as long as possible. Our nursing home population is fairly stable, and we continue to divert individuals into community rather than institutional settings. We want to use the long-term care dollars as efficiently as possible. Maximizing home and community-based services and making sure people are in the appropriate setting for their needs is a good use of public funds and leads to better outcomes.

Q: As a former legislator, how has your perspective changed since working in two state agencies?
I love digging into an organization and figuring out what makes it tick. As a legislator, I always had a respect for the work the agencies accomplished and for the staff. My awareness has certainly been heightened and I think state employees are exceptional. They work hard and deserve respect. That’s really been brought home to me.

* Colorado Family Care was a proposal to streamline Medicaid and CHP+ by consolidating certain children and adults into one program.

CHI spotlight
Health professions database
With funding from The Colorado Trust, CHI is building a comprehensive statewide database that will inform policymakers and the philanthropic community about workforce issues as they relate to the supply and demand for health professionals in Colorado. To date, physicians, registered nurses, pharmacists, certified nurse aides and dentists have been surveyed.

CHI’s preliminary analysis of the 2005 physician survey show that of 16,183 physicians who renewed their license, 7,694 completed the questionnaire. Of the responding physicians who practice in Colorado, 34 percent were over the age of 55. This figure is consistent with the American College of Physicians which reported in January 2006 that 35 percent of physicians nationwide are in this age group, with many likely to retire within the next five to 10 years.

Of Colorado-based respondents who indicated they were primary care physicians, CHI found 80 percent provided care to Medicare and Medicaid patients. Of these, only 54 percent indicated they accepted new Medicare patients and fewer (47%) accepted new Medicaid patients.

For more: http://www.coloradohealthinstitute.org/hot_issues/healthprofessionsdatabase.htm

Safety net clinics and Amendment 35
For the 770,000 uninsured individuals living in Colorado, the health care safety net is a critical health care resource, yet the status of some of Colorado’s health care safety net providers is largely unknown. One group of safety net providers, ClinicNet, asked CHI to evaluate its members’ ability to meet Amendment 35 Primary Care Fund requirements and suggest ways that member clinics can increase their visibility with state policymakers.

ClinicNet is a loosely affiliated coalition of safety net clinics and programs that are not designated as federally qualified health centers. Some member clinics exist only to serve the uninsured and the medically indigent. All either directly or indirectly provide primary care.
Approved by voters in 2004, Amendment 35 to the Colorado Constitution increased the sales tax on cigarettes and other tobacco products. Approximately 19 percent of the revenues will be distributed via a Primary Care Fund to health care providers that meet certain requirements and conform to specified rules.

CHI staff interviewed clinic representatives with regard to the patients they serve, the resources available to provide services and their ability to meet Amendment 35 requirements. The interviews showed that each clinic is different from the next and each faces unique challenges and opportunities.

Read the findings: http://www.coloradohealthinstitute.org/documents/clinic_net.pdf

This summer, CHI staff will undertake a similar study of the state’s 45 rural health clinics.

For more: Contact Erik Nesse at 303.831.4200 x 223 or info@coloradohealthinstitute.org

• Total Births with  ethnic break-outs by percent, 2004  
• Percent prenatal care begun after first trimester, 2004
• Percent preterm births (<37 weeks), 2004
• Percent births to unmarried mothers, 2004
• Percent mother's education < 12 years, 2004
• Total admissions and visits to Colorado Indigent Care Program  (CICP) facilities, 2004 - 2005 FY
  • Admissions and visits to CICP Clinics
  • Admissions and visits to CICP Hospitals
  • Admissions and visits to Denver Health
  • Admission and Visits to University Hospital

 Other improvement include adding access indicators for rural health and ClinicNet clinics,  and organizing the health Indicators by grouping data by birth and death statistics, and oral health. 

For more: http://www.coloradohealthinstitute.org/county/indicators.html

Upcoming events

Colorado’s uninsured
May 1-7 is Covered the Uninsured Week, sponsored nationally by the Robert Wood Johnson Foundation. Colorado already has held a number of events and has others coming up, including a May 4 discussion among CEOs and leaders of various Colorado industries about the effect of rising health care costs on their businesses.

For more: http://covertheuninsured.org/events/?StateID=CO

Obesity and diabetes
From May 16-19, the Centers for Disease Control and Prevention (CDC) will host a national conference in Denver on how to combat diabetes and obesity through improving the environment, changing policies, building better health care systems and helping individuals make lifestyle changes.
For more: http://www.cdc.gov/diabetes/conferences/conf2006/index.htm or 303.893.3333 or 800.444.ADAM

Long-term Care Advisory Committee
The legislatively appointed S.B. 173 Advisory Committee on Long-term Care has only two meetings left before it issues recommendations on how to improve long-term care in Colorado. The final meetings are scheduled from 9 a.m.-3 p.m. on the following dates:

• Friday, May 19
• Wednesday, June 14

For more: http://www.ColoradoHealthInstitute.org/hot_issues/longtermcare.htm or info@ColoradoHealthInstitute.org.

Rural health
The 2006 Colorado Rural Health Conference will take place June 21-23 in Longmont with the theme, “Innovation in Action.”

For more: http://www.coruralhealth.org/crhc/events/conference.htm

Hot issues
Health information technology (HIT)
Moving Colorado forward in the use of HIT to exchange administrative and clinical health information between health care providers got a boost with the April 21 symposium on “Colorado Health Care and the Promise of HIT.” More than 200 people representing hospitals, health plans, policymakers, state and local health departments, physicians, vendors and other interested parties heard state and national experts discuss the benefits and challenges of creating a Colorado Regional Health Information Organization (CORHIO).

For more: http://www.coloradohealthinstitute.org/hot_issues/corhio.htm or info@ColoradoHealthInstitute.org

Who's who?
John Moran, president and CEO of The Colorado Trust, announced on May 1 that he will retire this year. Moran has been with the Trust since its founding in 1985, first as legal counsel and from 1991 as the leader of one of Colorado's largest grantmaking foundations. A national search for a new CEO is under way by EFL Associates.

Moran and The Colorado Trust were instrumental, along with the Rose Community Foundation and Caring for Colorado Foundation, in establishing the Colorado Health Institute in 2002. Moran has been a member of the CHI board of trustees since its inception, serving as chairman of the board from 2002-04 and currently as its treasurer.

 "John has been a wonderful mentor and friend. Although his role on the CHI board will necessarily change after retirement, I have every confidence that he will continue to provide vision and leadership to the institute as it makes ready for its second funding cycle in 2008 and continues to expand its influence in the health policymaking community," said Pamela P. Hanes, CHI CEO and president.

For more: http://www.coloradotrust.org/repository/newsreleases/pdfs/2006/JRMretirementNR.pdf

In early January 2006, Governor Bill Owens appointed Dennis E. Ellis as the new executive director of the Colorado Department of Public Health and Environment (CDPHE). With an extensive background in public policy development, Ellis takes charge of a department that spans a full array of activities. His responsibilities involve a variety of broad-based health and environmental protection programs – everything from disease prevention and health statistics to water quality and hazardous waste disposal.

Before joining CDPHE, Ellis served as a senior policy advisor to Owens where he had oversight for CDPHE as well as other state agencies. He also served as legislative director for Wyoming U.S. Representative Barbara Cubin from 2000-04, where he focused on environmental and natural resource issues. With a staff of more than 1,100 and a budget topping $280 million, Ellis’s extensive facilitation and mediation skills will serve him well as he navigates the department through a multitude of issues.

"I am truly humbled to serve Governor Owens in this crucial position. There can be no more important function of government than to protect the health and environment of Colorado each and every day," Ellis said.

Inside Colorado

Declining small group market
The number of small employer groups covered by insurance dropped by 5 percent in 2005, the fifth straight yearly decline, reports the Colorado Division of Insurance (DOI). This figure represents a loss of 2,628 employer groups representing more than 15,000 individuals, DOI said. Most of the small employers (up to 50 employees) used some sort of managed care, either preferred provider plans (52%) or health maintenance organizations (38%). Only 1.5 percent purchased traditional indemnity coverage; 8 percent used health savings accounts, which grew significantly last year.

For more: http://www.dora.state.co.us/insurance/pb/sga042006.pdf

Colorado’s kids
The quality of life for the state’s children has gotten better over the past decade, says the 13th edition of KidsCount in Colorado! Healthwise, the Colorado Children’s Campaign reports that fewer children ages 1-14 are dying and fewer teens are having babies. Two particularly troubling statistics, however, are the number of teen deaths due to injuries (up from 52 deaths per 100,000 teens in 2003 to more than 60 in 2004) and children living in poverty (up from 9 percent in 2000 to 14 percent in 2004).

For more: http://www.coloradokids.org/includes/downloads/1_kidscount2006.pdf

Beyond our borders

The effects of being uninsured
Cover the Uninsured Week released a new report confirming there is a significant gap in the amount of health care received by people who have and don’t have health care coverage in every state and the District of Columbia. Across the nation, a far greater percentage of uninsured adults report being in “poor” or “fair” health, compared to adults who have insurance.

For more: http://covertheuninsured.org/media/research/CoverageGap0406.pdf

Our aging population
A new report from the Center for Health Workforce Studies at the University at Albany's School of Public Health says the nation is unprepared to meet the health care challenges its aging population will pose over the next few decades as Baby Boomers retire from the labor force. The report looks at future older adults’ health needs, demographic makeup and expectations, and what this will mean for the health care workforce.

For more: http://chws.albany.edu/download.php?id=1004965,224,2

Web Watch

HIT resources
To learn more about health information technology, check out these sites.

• The latest on Colorado’s efforts to create a Regional Health Information Organization – http://www.coloradohealthinstitute.org/hot_issues/corhio.htm
• eHealth Initiative and Foundation for eHealth Initiative – nonprofit organizations devoted to driving improvement in the quality, safety and efficiency of health care through information and information technology. http://www.ehealthinitiative.org/
• Government Health IT – reports on the emerging role for federal, state and local government in driving the use of technology in the public and private health care arenas. http://www.govhealthit.com/
• Office of the National Coordinator for Health Information – provides leadership for the development and nationwide implementation of an interoperable HIT infrastructure. http://www.os.dhhs.gov/healthit/
• AHRQ National Resource Center for Health Information Technology – provides technical assistance and shares new knowledge and findings about transforming clinical practice. http://healthit.ahrq.gov/home/index.html