Impact of Reform

Montrose

The story of health reform in Montrose County

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

Montrose has a really varied base of educated people here, that are educated on health care, that are interested in it, that do have good opinions about it. Most of these people are willing to share those opinions, but also not force opinions. I think that there are probably also people out there that are hoping that this is going to fail miserably and won’t affect them.

–Tina Baize, Senior Billing Coordinator at Miller-Peterson MD

Overall, Montrose County’s health care leaders have mixed feelings about the potential of coming health reforms. When it comes to assisting residents in taking advantage of new coverage options, the commitment to the goal is clear: get them signed up. However, there is a general concern about the system’s preparation and capacity for change. There is a sense that health reform is something that is happening to them, rather than with them. Despite any anxiety though, the communities of Montrose County have always persevered through hardship and there is a determination to continue the hard work of improving their health care system.


Blue Sky

COVERAGE

Much work has been done by Montrose leading up to the 2014 expansions of coverage. New enrollment sites and guides are prepared to help residents access insurance—many of them for the first time in many years.

 

What I think is really astonishing is how many people really have no idea that they would be eligible for Medicaid. They really have no idea.

–Susan Rice, Library Coordinator, Naturita Community Library


Pharmacy

ACCESS

With below average incomes and high rates of poverty in Montrose County’s west end, many residents are expected to qualify for Medicaid. A current lack of Medicaid-accepting providers has health care leaders worried about the ability of the newly insured to access care. Additionally, there are concerns about misuse of the Emergency Department and capacity of the health care system.

Lynn BorupJust how big a deal is the shortage of Medicaid-accepting providers in Montrose? Lynn Borup, Executive Director of the Tri-County Health Network, expects major issues.


Train

LEADERSHIP & COLLABORATION

Resources are extremely limited in Montrose County, and its local communities have come together out of necessity to utilize what’s available as creatively as possible. However, it’s been a delicate balance focused on day-to-day subsistence, without much remaining time to focus on what’s ahead. The major changes that will be ushered in through health reform have the potential to destabilize the local health care system.

Spring 2014

I’m still hearing that people don’t think that this is going to work. That’s the bottom line. I hear that more than anything: I don’t think it is going to work.

–Kathryn Steele, Quality Improvement Specialist, Colorado Rural Health Center

Montrose County is wary of major changes to their health care system. Often major change to any local infrastructure means losing local control or facing the unintended consequences of such upheaval, and many residents of Montrose County would rather opt out. Due in part to this outlook, the impact of health reform so far has been a story of extremes. On one hand, health care leaders determined to maximize coverage expansions for their communities have done extraordinary work to enroll Montrose residents in health insurance. On the other hand, there is real concern that the capacity of the system to care for the newly enrolled has been stretched beyond its limits and providers and clinics are becoming more vocal in their frustration.

There are additional concerns that major gaps in coverage and access still exist for migrant workers, native Spanish speakers, and those in need of mental or dental care. However challenging the last few months for health care in Montrose County have been though, they continue to persevere and undertake change on their own terms. New programs—like one that will improve transportation options for seniors—are in development, and the commitment to a healthier community remains strong.


Residents

COVERAGE

Impressive gains in coverage—due to the hard work and dedication of the community to enrolling the uninsured—are a source of community pride and a relief for individuals that are newly insured. Since open enrollment began, Montrose County has enrolled nearly 7% of all its residents in either Medicaid or into private coverage through Connect for Health Colorado.

Enrollment Data
Montrose County Residents
Medicaid (as of 4/16/14) 1,756
Connect for Health Colorado (as of 4/26/14) 1,054
Total New Enrollments 2,810
Estimate of Total Uninsured (2012 ACS) 8,752

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


Hospital

ACCESS

The influx of new enrollees has, as predicted, been a challenge for providers to keep up with. Concerns about low Medicaid reimbursement rates and patients potentially not paying the premium for their new insurance have heightened fears about long-term sustainability. Some providers are now considering a switch to cash only services or early retirement.

Tina Baize

Is having health insurance the same as having access to health care? Tina Baize, Senior Billing Coordinator at Miller-Peterson MD, explains the difference.


Sign

LEADERSHIP & COLLABORATION

Leaders have noticed a change in the relationships between health care organizations: previously there was informal collaboration to “make it work” despite limited resources, but recently there have been fewer such efforts. Health reform has left the community’s health care system overwhelmed and struggling to maintain those relationships.

Summer 2014

There appears to be a lot of focus on healthy living across the community, with an increased focus on local foods and nutrition, including the LiveWell Montrose-Olathe project, which is just starting to take off. The work done to pass the new Montrose Recreation Center attests to the importance of fitness to the community. Additionally, the Montrose Daily Press, our local paper, has done much to promote health and exercise over the last several months.

–Karen Sherman-Perez, Development Director of the  Colorado Immigrant Rights Coalition

The residents of Montrose County feel distanced from the federal decision-making process, and believe that they have little control over the way the Affordable Care Act is implemented. However, that has never kept local leaders from their tireless efforts to improve the community, and they’re happy to drive change in concert with or in spite of state and national reforms.

With their significant success in enrolling residents in new health coverage options during the first open enrollment period, the community conversation is now focused on ensuring access to care. In line with their independent spirit, the community recognized a need for more Medicaid providers, so they expanded the existing clinic in Olathe into a new building that allowed for increased patient capacity. They also saw that the VA was not meeting all of the needs of local veterans, so they took on that responsibility through new programs. The community, with help from LiveWell Montrose Olathe and the approval of a new Montrose recreation center, has also increased their focus on healthy living, with an emphasis on local sources of nutrition and fitness.

There is still widespread concern about provider shortages and the unpredictability of the future of health reform, but as it always does, Montrose County will continue to develop its own responses to its own priorities.


Residents

COVERAGE

With a very successful first open enrollment under their belts, the coverage conversation in Montrose County is now more focused on gaps in coverage and concerns with the new insurance options. Some providers remain skeptical that patients insured through Connect for Health Colorado will have their premiums paid, and the movement of patients between insurance products affects patients’ ability to access care. Montrose County also has an above average population of migrant workers, and coverage for their health needs has been identified as an issue that needs attention.

One of the big challenges is how a patient moves between payers in the Medicaid arena. There are different programs and eligibility changes, sometimes frequently. This generates big issues for billing if the provider does not have correct and up-to-the minute verification of eligibility.

–Kathryn Steele, Quality Improvement Specialist at the Colorado Rural Health Center


Pharmacy

ACCESS

Access remains the primary focus for health reform in Montrose County. Leaders report a shortage of providers accepting Medicaid, and more particularly, some providers are now limiting their acceptance of Medicaid patients to only residents of Montrose County. Additionally, there are reports that some physicians are considering closing their practices because they are no longer financially viable. Another challenge facing providers is how to maintain patients’ continuity of care as life circumstances change, especially income. These challenges aside, the expanded clinic in Olathe has greatly increased the community’s capacity to care for Medicaid patients. Since its opening, all waiting list appointments have been scheduled, and primary care is now co-located with behavioral, mental, and (soon) oral health care.


Hay Bales

LEADERSHIP & COLLABORATION

Although leaders previously reported that the loose collaborations among leaders had begun to fray, there are signs now that local collaboration is as strong as ever. The expanded clinic in Olathe has led to greater engagement with providers and Montrose Memorial Hospital. Leaders have come together to launch new programs to care for veterans and other populations. However, although there has always been a limited relationship between the city of Montrose and the county’s west end, that divide is growing larger. Beyond a general awareness of each other’s presence and limited networking efforts, partnership between the two is rare.

Fall 2014

Health reform, yes, has impacted the community…positively for those individuals that had not had coverage previously, but again, it’s created unintended consequences: increased demand for care without increasing the workforce.

–Lynn Borup, Executive Director of the Tri-County Health Network

It’s been a challenging year for Montrose County, but perhaps no more challenging than most years. While the changes ushered in by health reform have solved or improved some community issues, they have created or exacerbated others. Still other issues—such as a dearth of specialty care and limited options for financing the health system—remain challenges due to the rural nature of the community.

There is optimism about the coverage situation in Montrose, as many residents qualify for Medicaid or have been able to access low-cost health insurance through Colorado’s health insurance marketplace. As the second open enrollment begins, leaders are confident that the rate of insured residents will continue to rise. However, there is a fair amount of pessimism around the system’s ability to care for the newly-insured, and patients’ ability to afford their co-pays and premiums. An expanded clinic and a potential new clinic offer some hope to increase the county’s capacity to care for low-income patients, but leaders disagree about how much additional capacity is needed.

One change that has been widely welcomed as positive, though, is the community’s new interest in healthy living. Leaders note that residents have begun reading food labels and attending health courses at the library, which they recognize as an important shift. They note that the local newspaper and healthy living organizations have been instrumental in helping individuals see their personal role in getting and staying healthy.

With so much still to be done, the community is focused on controlling what they can locally, and enduring through challenging times.


Residents

COVERAGE

Montrose was successful in enrolling a large number of residents in the first open enrollment, and leaders hope to continue that success through the second open enrollment as residents adjust to the new health insurance rules. For some individuals, plans through Connect for Health Colorado remain unaffordable or unpalatable, but for many more, the issue is a lack of understanding about the options. Leaders expressed a need for more education around Medicaid eligibility and Spanish-language outreach.

There are a lot of people out there who don’t have coverage but could qualify for Medicaid or some other insurance. We have a strong community of outreach and enrollment workers in our area…and they’ve been working very hard to reach out to our community to let people know that they can get insurance… But, it would be a job that will need to continue for quite some time.

–Debby Harrison-Zarkis, CEO at Olathe Community Clinic


Pharmacy

ACCESS

Access to care has been and remains a significant concern in Montrose. Leaders report that providers are limiting their patient load or considering retirement as a way of escaping burnout, and neighboring counties are uninterested in or unable to serve Montrose patients. The sudden increase in insured patients has exposed gaps in the access system, and leaders are scrambling to fill them.

By expanding coverage, we have created a greater shortage of health care providers. They are so overburdened to the point where they are not accepting new patients even though they are in-network. Montrose does not accept patients from Delta, and so forth; this greatly limits choices… There is ongoing discussion in Montrose County with the local hospital here and others, to try to figure out how to serve the needs of the community. Hopefully we can get better access.

–Kathryn Steele, Quality Improvement Specialist at the Colorado Rural Health Center


Hay Bales

LEADERSHIP & COLLABORATION

The magnitude of the challenges facing Montrose leaders as they work to reform their health system is forcing enhanced collaboration. Although the circumstances are difficult, the upside is that leaders see an opportunity for stronger relationships with one another and want to come together to look out for their community. As they always have, leaders will find a way to continue on, making incremental but important progress.

There is a lot of opportunity to grow. As you move away from Denver, the rural areas are so different. However, there is a lot more collaboration than before, around health equity and health in general. But not much around the ACA.

–Karen Sherman-Perez, Development Director at Colorado Immigrants Right Coalition

Hot Topics in Community Conversations

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