Welcome to CHI HealthTalk, the bimonthly e-newsletter of the Colorado Health Institute (CHI). This newsletter keeps you up to date on the latest data, reports and activities from CHI, upcoming health-related events in Colorado, and other helpful resources about health and health care. Please subscribe, unsubscribe or give us feedback at info@coloradohealthinstitute.org.
Focus on the facts
Comparison of salaries of RN respondents practicing in urban and rural areas based on number of hours worked every two weeks and educational level attained
Also see Hot Issues below.
A conversation with...
 ...Marguerite Salazar, CEO/President CEO of Valley-Wide Health Systems, Inc.
Marguerite Salazar’s career has centered on providing primary health care to indigent and underserved populations. Since 1989, she has directed Valley-Wide, a community/migrant health center with 14 primary health care delivery sites, six dental clinics and a variety of ancillary health services located throughout southern Colorado.
Q: Valley-Wide promotes a holistic approach to health care by focusing on patients’ physical, mental, social and economic health. How do you keep your focus on this broader definition of health?
Salazar: We’re no different than any other community health clinic because our mission drives our approach. With our funding, we try to look at new, innovative strategies that will affect a large group of people. It’s about the community as a whole. Moving beyond the single doctor visit to programs involving prevention and education helps move our communities forward. If I can bring a dietician in to talk about lifestyle, nutrition and smart choices, that helps patients with diabetes sustain their lives far beyond a simple discussion with a doctor.
Q: Over the years, Valley-Wide has expanded and shown an entrepreneurial spirit while serving a broad geographic area. What brought about the expansion to 12 different counties in southern Colorado?
Salazar: We spread out our services because of two waves of change. First, in the late 1990s, some large hospital systems came to Colorado and took over many of the primary care practices in southern Colorado. These acquisitions proved less lucrative than expected and the hospitals pulled out, leaving little access to primary care services in our area. Our board of directors took a stand to grow, expand and keep serving the growing numbers of medically underserved individuals. We had two requirements. We had to be invited into the community and the community had to be underserved. In truth, our success is due to other failures in the system that created a situation where many communities had little or no access to primary care.
The second wave came during the Clinton Administration’s attempt at health care reform that brought community health centers into the forefront. President Bush continues to strongly support our centers and we’ve had continued bipartisan support from Congress. As a result, federal funding has helped us expand and strengthen our infrastructure. Now, our challenge is to find enough providers to fill the positions we have in our clinics so people can be seen and have a medical home.
Q: How have needs changed over the past five to 10 years? What does it mean for your clinics?
Salazar: The uninsured numbers continue to rise, but there’s not a lot of competing entities trying to serve this population. In fact, Valley-Wide has very little competition and patients need access to health care. In a lot of communities, we’re the only game in town for anyone. Over 50 percent of our patients are commercially insured and we probably work with 50 different insurance companies. The uninsured are still our priority, but we serve everybody.
In addition, we’re an attractive employment option for the few rural providers who recognize the expertise we have in working with a multitude of insurance companies. The business side of the health care system has become increasingly complex and these physicians don’t want to deal with it.
Just recently, we are seeing that our capacity is maxed out and we have a waiting list. It’s most difficult with the uninsured who have no other options. We’re trying to recruit providers, but it’s tough to recruit them to rural locations.
Q: Does residing in a rural area make someone vulnerable by definition?
Salazar: Not necessarily. People who don’t have insurance are more vulnerable, but I think we have primary care covered pretty well. Specialty services are a bigger problem. We are continually bartering with specialists to serve our population.
Q: What does the future hold?
Salazar: We need to do some serious thinking about our health care system. We need the political will to keep our communities healthy beyond a single doctor visit.
CHI spotlight
Safety net project seeking data
CHI has been working with a number of safety net providers to obtain data on users, staffing and revenues. These data will help CHI understand capacity and utilization patterns in communities across Colorado.
In September, the board of the Colorado Community Health Network endorsed participation in this project, and several Federally Qualified Health Centers have agreed to share with CHI standardized data they report to the federal government. More recently, the board of directors of the Colorado Behavioral Healthcare Council expressed interest in sharing data on community mental health centers. CHI also has worked extensively with nonprofit clinics affiliated with ClinicNet and with rural health clinics to assess their data reporting capacity.
The biggest missing piece in the safety net puzzle is the utilization of hospital emergency departments for non-urgent conditions. CHI is talking with several community hospitals about gaining access to this information. CHI anticipates this information will provide a more detailed look than is currently available at how and to what extent local safety nets are meeting the basic health care needs of the state’s medically underserved populations.
New on the CHI Web site
- Hot Issues: Workforce
A technical paper, Public Use Data file, Codebook and other information from the 2005 Colorado Registered Nurse (RN) Workforce Survey are now available.
- Hot Issues: Safety Net Indicators and Monitoring Project
A safety net framing document with definitions, a policy framework and set of questions that will guide the initial activities of the safety net indicator and monitoring project has been posted.
- Hot Issues: Health Insurance
A fact sheet on the status of children’s health insurance coverage in Colorado was recently completed.
- Data: Geographic Inventory
Maps added to CHI’s geographic inventory include Colorado Community Centered Board regions, Colorado Tourism Regions and the Colorado State Comprehensive Outdoor Recreation Plan.
- Data: State Health Rankings
This section, which lists organizations that track, profile or rank the health of Coloradans, has been revised and updated to include new items and add descriptions and links to Colorado profiles.
New CHI staff
Jennifer Kincheloe joined the safety net monitoring team in October as a senior research analyst. She previously was a research scientist at the UCLA Center for Health Policy Research where she served as principal or co-principal investigator on a variety of research projects, including health insurance access and the health status and quality of care provided to low- and moderate-income Californians. As part of CHI’s safety net team, Kincheloe will assist in developing community case studies and safety net indicators to assess providers’ ability to meet the primary medical, mental and dental health care needs of Colorado’s medically underserved populations.
Susan Stantejsky joined CHI in April as a senior statistician. In this role, she provides statistical analysis and programming support to CHI’s research and analysis activities. Prior to coming to CHI, Stantejsky was a biostatistician at the University of Colorado Health Sciences Center. Among other activities at CHI, she will be developing advance statistical analysis techniques to identify trends in uninsured rates over time using the Current Population Survey published annually by the U.S. Census Bureau.
Upcoming events
Environmental health
The seventh National Environmental Public Health Conference, sponsored by the Centers for Disease Control and Prevention, will take place December 4-6 in Atlanta. The conference will address the need to revitalize environmental public health, and it will chart the nation's vision for the future. Register by November 14.
For more: http://www.cdc.gov/nceh/conference/index.htm
Disease Management Leadership Forum
"Raising the Bar: Delivering Health Care Value" is the theme of this year’s leadership forum of the Disease Management Association of America. Dates are December 3-5 at the Hyatt Regency Denver at Colorado Convention Center.
For more: http://www.dmaa.org/DMLF06/index.asp
Hot issues
CHI releases data from 2005 RN workforce survey
The Colorado Health Institute (CHI) released a Public Use Data file and a technical paper summarizing key findings from its 2005 survey of registered nurses (RN) in Colorado. Both documents result from CHI's Health Workforce Database Project funded by The Colorado Trust as part of its Health Professions Initiative.
The Public Use file contains data on nearly 11,000 registered nurses who responded to CHI’s 2005 survey. The technical paper reports on key findings from the survey and summarizes survey methods and issues related to generalizing the data to the entire RN population. Key findings include:
- A discussion of retention factors related to the active professional nursing workforce;
- Differences in demographic and practice patterns of RNs practicing in urban versus rural areas; and
- Respondents’ perceptions of their workplace environment.
Almost 52,000 individuals hold an RN license in Colorado. In August 2005, CHI surveyed those RNs whose licenses were due for biennial renewal, about half of the total. About 24,000 individuals renewed their license, and CHI received responses from 45 percent of those, or nearly 11,000 RNs.
The workforce project will consist of survey data collected by CHI from a cross-section of health professions, including medicine, nursing, dentistry, pharmacy, mental health and allied health. Survey findings from each profession will be compiled into a profession-specific database that will be transformed into public use data files available to inform workforce policy and funding decisions. The databases will make up a set of primary health professions workforce indicators displayed on CHI's Workforce Web site.
For more: http://www.coloradohealthinstitute.org/hot_issues/healthprofessionsdatabase.htm.
Also see Web watch below.
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. This month, meet a newcomer to the scene.
 Denise (Dede) de Percin joined the Colorado Consumer Health Initiative (CCHI) as executive director in September 2006. Her commitment to social justice and activism includes 25 years of experience with nonprofit organizations focused on issues such as HIV/AIDS prevention; women’s reproductive/health issues; gay, lesbian, bisexual and transgender equality (GLBT); transportation efficiency; energy sustainability; and anti-violence advocacy.
Originally from the Washington, D.C., area, de Percin came to Denver in 1998 to run the Anti-Violence Project with Equality Colorado, a statewide advocacy, education and services program working with the GLBT community. In 2001, she guided the Anti-Violence Project through its transition to an independent agency, becoming the founding executive director of the Colorado Anti-Violence Program.
"CCHI has created great energy and momentum during the past five years," notes de Percin. "The nexus of increased consumer empowerment, the suspension of TABOR and the blue-ribbon commission created by the legislature creates enormous potential for health care access to expand significantly during the next few years."
Inside Colorado
CPR examines Colorado’s uninsured population
If you missed some of Colorado Public Radio’s continuing series on Colorado’s uninsured population, you can hear the shows online. The series began September 15 and examines the problems associated with being uninsured, including the impact on children’s health and perspectives of physicians, employers and the insurance industry and hospital sectors.
To hear the archives: http://www.kcfr.org/index.php?option=com_content&task=view&id=94
Colorado’s increases maternal and child health coverage
Colorado is among several states that achieved modest expansions in 2005 in enrolling low-income women and children in the Medicaid and Children’s Health Insurance (CHP+) Programs, according to a new report from the National Governors Association. Colorado implemented presumptive eligibility policies, expanded the duration of continuous eligibility and enhanced its existing continuous eligibility policy for pregnant women under Medicaid, which covers nearly 32 percent of all births in the state.
For more: http://www.nga.org/Files/pdf/0609MCHUPDATE.PDF
Beyond our borders
Making cultural competency real
While much research has focused on assessing cultural competency in the provision of health care services, a new paper from the Commonwealth Fund recommends ways to put culturally competent care into practice. The following six principles, gleaned from case studies, are key to achieving culturally competent care, say the authors of Taking Cultural Competency from Theory to Action:
- Community representation and feedback are essential at all stages of implementation.
- Cultural competency must be integrated into all existing systems of a health care organization, particularly quality improvement efforts.
- Changes made should be manageable, measurable and sustainable.
- Making the business case for undertaking cultural competency initiatives is critical for long-term sustainability.
- Commitment from leadership is a key factor to success.
- Ongoing staff training is crucial.
For more: http://www.cmwf.org/publications/publications_show.htm?doc_id=414097&#doc414097
Health insurance costs moderating
Increases in the cost of health insurance premiums have slowed for the third year in a row, but still outpace the rate of inflation and growth in workers’ salaries, according to an annual national survey of private and public employer health benefits. The Kaiser Family Foundation and Health Research and Educational Trust report that employer-sponsored health insurance premiums rose by 7.7 percent from spring 2005 to spring 2006, more than twice as much as general inflation or salaries, but less than they did in the two previous years. Other findings include:
- Premiums for family coverage have increased by 87 percent since 2000, compared to an 18 percent rise in general inflation and a 20 percent increase in wages.
- Health benefits vary considerably by firm size, with less than half (48%) of companies with fewer than 10 workers offering health insurance, compared to 73 percent of firms with 10-24 workers, 87 percent of firms with 25-49 employees and more than 90 percent of companies with 50 or more workers.
- Employers are offering consumer-directed health plans (health savings accounts), but the market share of these plans remains small.
For more: http://www.kff.org/insurance/7527/index.cfm
Web watch
These Web sites provide information on the nursing profession.
  
CHI HealthTalk Contributors
Writers: Jo Donlin, Reid Reynolds and Sherry Freeland Walker
Design: Kindle Fahlenkamp-Morell |
