It’s been a lot [of change] in a short period of time, so I am hoping best practices reveal themselves, and there won’t be so many different things going on that people feel pulled in so many directions. That it all levels off and they say, ‘Okay, this is working.’
–Sarah Vaine, CEO at Summit Community Care Clinic
At the end of 2013, which marked the beginning of the Health is Local project, each of the four highlighted communities were in different places as far as their preparation for and perspective on health reform. One year later, it’s not surprising that this is still the case. Federal and state policies are implemented into local systems that each have their own resources, priorities, and capacities. For those communities that were committed to working collaboratively and taking advantage of the new tools that health reform introduced—like Colorado Springs—the experience has been generally positive and the future holds even more promise. For other communities—specifically those in rural areas who may have struggled to form close partnerships and were already facing significant challenges with their health system—the experience has been mixed, and the future is uncertain.
Of all the changes brought about by health reform, the increase in the Medicaid population has had the largest effect on our four Health is Local communities. However, while the communities that were able to expand capacity or already had enough capacity to increase their patient load have found the expansion of Medicaid to be good news for residents and providers, the story has not been the same in low-access communities. Montrose County faced a shortage of Medicaid-accepting providers prior to the expansion, and one year later the system is straining even harder to keep up with demand.
As these communities look to the future, they will all need to continue to increase coverage, improve access, and continue to collaborate with other leaders. However, while Summit County will largely be focused on coverage in the short term, Yuma County is placing a higher priority on identifying opportunities for collaboration. Furthermore, while Montrose County is determined to make progress on access, Colorado Springs is now looking to lead the state on major systems reforms.
We have appreciated the opportunity to watch the story of health reform play out in Colorado over the last year. The state’s health system has made important steps forward through the collective efforts of local communities and state leaders, but progress has been measured. It is critical as we continue to implement health reform that state leaders not only recognize that each community has different capacity and resources to carry out the laws that are passed, but also that each law or policy will affect each community in differently. The coming year is shaping up to be just as exciting as the last, as the story of health reform in Colorado continues to unfold.
With the second open enrollment period underway, Colorado hopes to identify and enroll many more of those who were still uninsured after the expansions of coverage in January 2014. It is estimated that over the past year, the state’s rate of uninsured residents dropped from 17% to 11%, which is the fifth largest drop across the country. For many communities, a new challenge is health insurance literacy, or helping residents understand what their benefits are and how to use them. The affordability of coverage also remains an issue, and one that will likely be a long-term issue until consumers adjust to including health insurance premiums in their monthly budget.
I think coming up this next year, it will be important for us to focus on enrollment. It’s a new group that is going to be looking at the different options, and they need to understand… I love how so many were able to get information last year, but I don’t think that lets us off the hook for this year as we start open enrollment.
–Pam McManus, President & CEO at Peak Vista Community Health Centers
Balancing the supply of primary care providers and specialists with the demand for health care services is challenging, long-term work. Some communities have an easier time recruiting and retaining providers than others, but shortages are widespread. As local leaders catch their breath from the heavy focus on coverage issues over the past year, many are preparing for more intensive access conversations. Larger, more stable health systems are able to look beyond workforce issues to begin tackling cost, quality, and other access to care issues, while smaller, more rural systems are just trying to keep clinic doors open.
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, Tri-County Health Network
Perhaps the most accurate predictor of a community’s experience with health reform over the past year was their local commitment to collaboration. The two communities with the most established collaborative relationships—Colorado Springs and Summit County—were better prepared for both expected and unexpected changes, and were able to effectively leverage those partnerships to make health reform work locally. With many more years of health reform changes still to come, local leaders should place a high value on collaborative efforts focused on a shared vision for the health of their community.
I think things will continue to improve. …We all work together for the best of residents. So whatever happens in the future, we are going to figure it out together.
–Jenniffer Gonzalez, Patient Support Services Manager at the Summit Community Care Clinic