Impact of Reform

Colorado Springs

The story of health reform in Colorado Springs

Over the course of the next year or so, we are following each Health is Local community as major health reforms are implemented. The impacts of health reform will be documented over time with both reflections from community members and analysis of statewide themes. Each dated entry below represents a snapshot in time of the community’s perspective on the progress and challenges they are facing. Taken collectively, these narratives reflect the changes over time to both the health care system and the community conversation about health reform. Please check back regularly for updates.

Winter 2013

Local, collaborative health care was occurring in Colorado Springs even prior to the arrival of the Affordable Care Act. Local collaboration benefits our hospitals, it benefits our health care nonprofits, and it obviously benefits the individuals when we can all work together to create a more vibrant health care community. I think that’s what we’ve done in Colorado Springs. And as we go forward, we all hope that we will work in parallel with the Affordable Care Act rather than separately.

Jan Martin, Colorado Springs City Council Member

Community and health leaders in Colorado Springs speak proudly about their long-standing, collaborative approach to creating a robust and inclusive local health care system. Their hard work has ensured that a majority of Colorado Springs residents have a usual source of care and are covered by some type of health insurance. In this context, state and national health reforms are welcomed as new tools for driving positive change in the local health system. However, these reforms are no replacement for the community-driven innovations and locally focused solutions already in motion. In other words, local health reform has been happening in Colorado Springs for decades, and recent state and national reforms are simply stepping stones on a much longer path.


Biker

COVERAGE

A unique insurance payer mix, including a large TRICARE population, provides an interesting health landscape in the city. For residents without health insurance coverage, local innovations and a strong safety net provide access to quality care. The expansion of Medicaid is expected to be an important gain for many Colorado Springs residents, but the system’s capacity to care for new enrollees remains untested.


Signs

ACCESS

Measurements of coverage and access are ahead of the state average in Colorado Springs, but provider shortages and capacity issues loom large. Fortunately, leaders have been preparing for these changes for years by crafting local solutions to improve coordination, quality of care, and communication between health systems. Safety net clinics are currently evaluating how they’ll respond to expected changes in their patient population from reform.

Our community has a lot of amazing, caring people to include some incredible professionals–experts in the health care industry. Together we strive to work to find solutions to access barriers throughout our region. While a majority of people use local healthcare services, sometimes it’s not at the right place, or at the right time, and that can cause problems – both financially and medically. Overall, this community is making progress in educating and advocating for better, use of preventive care for all.

–Pam McManus, CEO of Peak Vista Community Health Centers


City

LEADERSHIP & COLLABORATION

Strong leadership and deliberate collaboration are hallmarks of the Colorado Springs health care system. The Pikes Peak region is a self-contained medical island, in the sense that all of a patient’s needs can be met by their internal system, and that’s due in large part to the robust partnerships they’ve established.

Spring 2014

I never would have thought [the Affordable Care Act] would have hit us the way it did. And it’s a positive, because our patients complied, they have insurance, and they’re getting the care they need.

Barb Cronin, Executive Director of Mission Medical Center

The headline story in Colorado Springs—at least amongst health care leaders, and at least in the first few months of major changes—is that health reform is working. Although it is early and there remains much work to be done, Colorado Springs leaders generally believed that state and federal health care reforms were in line with their commercial and economic needs, so they invested time and effort to adequately prepare—and it has all paid off.

New coverage through Medicaid has had a big impact for patients and providers. In fact, so many residents have gained coverage that some safety net clinics that previously only served the uninsured are amending their by-laws and altering their business models because their patient population has decreased by half or more. However, the impact of changes in private insurance haven’t been felt yet, cost and affordability remain unanswered questions, and the impacts on health care access are unknown. Leaders are shifting their attention to next steps, including integrated care, payment reform, the remaining uninsured, and patient education.


Young Man

COVERAGE

Although many residents have gained coverage through Medicaid, there is significant stigma surrounding public coverage that is keeping additional residents from enrolling. It is also unclear whether newly insured residents will be able to afford their co-pays and deductibles. Overall though, there have been significant shifts in payer mixes for health care facilities of all sizes, and it’s expected to continue as such.

Enrollment Data
El Paso County Residents
Medicaid (as of 4/16/14) 21,011
Connect for Health Colorado (as of 4/26/14) 8,402
Total New Enrollments 29,413
Estimate of Total Uninsured (2012 ACS) 81,031

Note: Not all residents who are newly-enrolled were previously uninsured.


Hospital

ACCESS

Health care facilities, and especially safety net clinics, prepared for health reform implementation by increasing their workforce and capacity. For one network of clinics, increasing capacity has meant being able to completely eliminate their waiting list—a list that had grown to 9,000 people during the economic recession—despite the influx of new patients due to coverage expansions.

Jamie Smith
How is the Medicaid expansion increasing access to care for patients? Jamie Smith, Senior Vice President and Chief Administrative Officer of Penrose St. Francis Health Services, explains.


Mountains

LEADERSHIP & COLLABORATION

Leadership and collaboration are difficult when a community is so large and interests are so diverse, but Colorado Springs makes it work. Going forward there is an ongoing conversation about how to encourage closer partnerships between providers and administrators and improving communications and data sharing between the military health care and civilian health care systems.

Summer 2014

We continue to offer health services to people who need it from all income levels. That hasn’t changed. What has changed is more people are now covered and able to afford the health services they need.

Jan Martin, Colorado Springs City Council Member

Since the noticeable changes in the spring of 2014 to Colorado Springs’ health care system, specifically the gains in coverage and the changes in payer mix for clinics, the system has stabilized and no more major changes have been identified. Another reason there were no new changes was that a number of local reforms were already in motion before the law was signed.

Community leaders are increasingly shifting their attention toward integrated behavioral health care and physical health care to take care of those who are dealing with physical and behavioral issues in a more holistic way. They are also aiming to ensure adequate numbers of providers who accept Medicaid. Another area of focus is providing sufficient care for those in the military community as leaders report a decreasing number of providers willing to accept TRICARE patients.


Walking

COVERAGE

Local leaders have felt a noticeable increase in Medicaid enrollment in Colorado Springs. With a change in the federal law to allow veterans to access Medicaid services as well, some providers are beginning to feel at capacity for caring for these patients. Some leaders also report new concerns with the Connect for Health Colorado marketplace, and the potential inadequacy of its insurance products—both in terms of networks and reimbursements.


Hospital

ACCESS

Hospitals and clinics report an ongoing shift toward more Medicaid patients and fewer uninsured charity care patients, which will ultimately increase revenue, although lower reimbursement rates and the shift in payer mix continues to provide challenges. Those who previously only served uninsured patients continue to make organizational adjustments to adapt to the change in patient population. Leaders report that newly-insured patients are seeking care, which has led to more preventive care and earlier diagnosis of illness—an important shift for the health care system in the long run. Ensuring adequate access to behavioral health and substance abuse treatment also remains a local priority.

While we have not been seen hard data yet, our partner agencies do indicate that more veterans are signing up for Medicaid. One of our behavioral health partners has seen a marked increase in Medicaid patients, which is affecting their capacity, so they are not currently accepting new TRICARE patients. We are looking at what the long-term implications may be regarding the number of providers who will continue to serve TRICARE patients, based on Medicaid, TRICARE, and other healthcare changes.

–Kate Hatten, Executive Director of Peak Military Care Network


Mountains

LEADERSHIP & COLLABORATION

Health care leaders in Colorado Springs have been proactive when it comes to effective collaboration, with decades of experience working together to improve the local health system. They are currently using that same strategy to shift toward long-term planning for services focused on integrated behavioral, physical, and oral health care, for both the military and civilian populations.

Fall 2014

It’s interesting to see federal legislation…get signed into law, and then fast forward a couple years and see some of the tangible impact it’s had in our community. …the ACA has made positive a difference, but the story is far from over.

Jamie Smith, Senior Vice President and Chief Administrative Officer of Penrose St. Francis Health Services

For decades, Colorado Springs has had a clear vision of its health care system goals, and has been working collaboratively and persistently toward them. While many other communities felt major disruption—both positive and negative—because of 2014’s health reforms, leaders reported that it was mostly smooth sailing in Colorado Springs. There are two major reasons for this: first, the major changes to the health system ushered in by health reform were already in line with the city’s long-term goals, so the changes were welcomed, and second, the city’s health care infrastructure is stable and resilient, so leaders felt confident in its ability to overcome any challenges that might arise.

Over the past few months, leaders continued to focus on ensuring access to care for the large number of local residents that gained coverage. Other issues that are receiving more attention include health insurance literacy, underinsurance, and reaching out to gap populations—such as formerly incarcerated and undocumented individuals.

With an important year of changes coming to an end, Colorado Springs is well-positioned to continue its encouraging trajectory. Leaders recognize that there is still much work ahead, but they have a big picture perspective and a shared vision that will guide their way.


Walking

COVERAGE

The expansion of Medicaid has had a significant effect on Colorado Springs over the past year. Although it’s widely regarded as a positive change, there are residual effects that leaders are now grappling with. Churn, or the movement of individuals between health insurance providers due to income changes, has made it challenging for patients and providers alike. Other issues, such as helping consumers understand their health insurance and how to use it, and assisting underinsured consumers with issues of affordability, have become important as well.

This has been the year of significant coverage for so many people, many times adults who have either not had health coverage for years, or never. And so, really, the impact of… the Colorado Health Exchange opening and the Medicaid screening…has not only identified a new population that we can serve, much more holistically, but it has also identified folks who have always had a benefit but never knew it or didn’t access it.

–Kelly Phillips-Henry, Chief Operating Officer of AspenPointe


Hospital

ACCESS

Colorado Springs’ hospitals and clinics continue to adjust to their expanding patient base and ensure they can continue to provide the high quality care they are known for. However, the success of the city’s health care system has attracted entrepreneurs interested in piloting new models of care, such as freestanding emergency departments and concierge medicine. Large hospitals and provider groups are also purchasing private practices. It’s unclear how these changes will ultimately affect local access to care, but leaders are monitoring the situation closely.

I would hope that we continue to have easy access to healthcare for everyone. That’s really the key. That we bring as many people into the system as we possibly can.

–Jan Martin, Colorado Springs City Council Member


Mountains

LEADERSHIP & COLLABORATION

As it has for many years, the collaborative nature of Colorado Springs remains strong and consistent. The past few months have seen some leadership changes, and bringing those new leaders into the coalition has been critical to maintaining the community’s ability to coordinate efforts. Also, the need for more veterans care options has sparked new partnerships between civilian and military organizations. As they look toward the future, local leaders are firmly focused on big picture changes and long-term outcomes for their community health system.

I would think that, if anything, our area has seen enhanced collaboration. I would have said we had a strong community of collaboration already, but I think that it’s more apparent in this time frame. And I think it’s really focused about the patient which is kind of cool.

–Pam McManus, CEO of Peak Vista Community Health Centers

Hot Topics in Community Conversations

As the impacts of health reform are felt in each community, the conversation changes to reflect the current issues.