Impact of Reform

Summit

The story of health reform in Summit 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

A great part about living in Summit County [is that] we’re all invested in improving our county and making access better. Our most recent health assessment still shows access is a huge issue, especially with our seasonal workers… Cost and language are also other barriers. And specialty care is an issue here. I think that [health reform] has really brought people together, though.

–Amy Wineland, RN, Summit County Department of Public Health

Well-established relationships and partnerships within the health care sector enabled leaders in Summit County to have robust conversations and develop comprehensive plans in preparation for the implementation of health reform. These conversations included planning for the expansion of both public and private health insurance coverage for residents. However, Summit County has been identified as having among the highest insurance premiums in the nation. Concerns about the affordability of private insurance for residents have created new worries for health care leaders about the impact of reform and have led some to wonder about its potentially harmful long-term effects.


Trailers

COVERAGE

Leading up to open enrollment, Summit County was feeling excited and prepared for the expansions of coverage. However, the announcement of higher-than-expected insurance premiums has deflated enthusiasm and raised serious concerns about affordability and access to subsidies.

I think before the marketplace went live we were incredibly optimistic. For a long time we have known that the number thing that causes a financial crisis with the families we work with is an unexpected medical bill. I think now we are still potentially excited about the marketplace, but the rates we have found are still unaffordable for the majority of Summit County residents.

Tamara Dragstveit, Executive Director of the Family and Intercultural Resource Center


Hospital

ACCESS

Despite its seasonally fluctuating population, Summit County has managed to build a solid health care infrastructure that includes both high-level trauma care and a robust safety net. As with other rural areas, there is a shortage of providers, and in particular, specialists, but the ability of most residents to access necessary care is a point of community pride.

Sarah VaineHow do health care leaders characterize access to care in Summit County? Sarah Vaine, CEO of the Summit Community Care Clinic, says it’s pretty exceptional.


Mountains

LEADERSHIP & COLLABORATION

Summit County came together several years ago to begin changing the local health care system, so the latest health reforms are merely providing new momentum to an existing conversation. The community has developed a shared vision for the future and forged partnerships that are facilitating forward progress. Local leaders believe these relationships will be the key to successful health reform implementation in the coming months.

Spring 2014

There is so much anger for those at about 400% [of the federal poverty level], but we still want to encourage those under 400% to try [to apply for coverage]. For lower income residents, it is a relief. They can get a subsidy and cost sharing reductions. It is good news for them.

Tamara Drangstveit, Executive Director of the Family and Intercultural Resource Center

It has been a busy few months in Summit County. In addition to the expansions of coverage and implementation of local reforms, the county has faced much national attention for its dubious distinction of having some of the most expensive health insurance premiums in the country. Summit County leaders applaud the Colorado Division of Insurance’s proposed new geographic rating areas, which will potentially lower local health insurance costs.

Health care leaders feel that there is an inaccurate perception of community-wide affluence, when in reality there are large socioeconomic disparities among residents. This can create challenges to achieving their healthy community goals. These disparities are reflected in the immediate impacts the community has seen from health reform, as low-income and high-income residents are experiencing the changes differently. For some, gaining coverage has meant life-altering access to care; for others, coverage remains financially out of reach and frustrations are running high.

There is concern that some of the complex issues around health care costs cannot be solved locally, but the commitment to getting all residents covered by health insurance remains absolute. Health care leaders are working to temper community expectations in the face of unexpected challenges, but there is community pride that despite the looming issues, their community, and Colorado as a whole, is still ahead of other parts of the country and a leader in this work.


Young Woman

COVERAGE

For some newly insured residents in Summit County the impact of reform has been dramatic. For middle-and upper-income residents, it has been more mixed—some are happy to no longer be worried about a pre-existing condition, but many have found coverage to be too expensive. Leaders also noted a stigma surrounding Medicaid that is keeping some eligible residents from enrolling.

Enrollment Data
Summit County Residents
Medicaid (as of 4/16/14) 707
Connect for Health Colorado (as of 4/26/14) 1,106
Total New Enrollments 1,813
Estimate of Total Uninsured (2012 ACS) 5,976

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


Hospital

ACCESS

The unique population mix of full time residents, part time residents, and tourists in Summit County places unusual demands on the local health care infrastructure, requiring it to be more robust than other similarly sized rural areas. Thus, Summit County’s health care system has many resources to meet the needs of newly insured residents. The hospital and most non-safety net care providers have felt limited impact so far, with the exception of a changing payer mix and continued questions of cost. There are concerns about the capacity of the system to care for Medicaid patients though, and many providers have or are preparing to adapt their business model to the changing environment.

Jennifer Gonzales

How is the community going to serve new Medicaid patients? Jenniffer Gonzalez, Director of Patient Support Services at Summit Community Care Clinic, shares her concerns.


Sign

LEADERSHIP & COLLABORATION

Summit County has built an impressive collaborative of individuals and organizations committed to the health of their community. As health reform continues to change the way the health care system looks and functions, this group remains firmly focused on pursuing their local priorities of patient-centered medical homes, accountable care organizations, and more.

Summer 2014

There is a shift in focus with our top four community health improvement goals being: Access and Insurance enrollment, Community activation and engagement, Wellness and obesity, and Behavioral Health.

Father Tema Nnamezie, Director of Mission Integration and Spiritual Care at St. Anthony Summit Medical Center

For the first enrollment period in October 2013, Summit County residents faced some of the highest private insurance rates in the nation. However, in the months following, Summit County leaders and state officials worked together to achieve a decrease in rates. Having succeeded, there is a sense of optimism and pride for the ability of different voices to come together around community-specific issues to drive change. The areas of focus for Summit’s health care system have remained consistent since earlier this year. Despite the enduring misperception of countywide affluence, the community has dedicated resources to addressing the socioeconomic factors that limit access to optimal health care for some.

While Summit County is generally optimistic about the potential success of health reform, there is lingering uncertainty around the next open enrollment period. With the rate issue mostly addressed through a state-level remapping of the insurance regions, the community is approaching the upcoming enrollment for Connect for Health Colorado as a chance to start over. Expectations are moderately high that this year’s experience will be more positive.

With the announcement that Kaiser Permanente plans to expand into the county, there are many new questions being voiced about the impact that will have on both coverage and access to care.


Farmer's Market

COVERAGE

Higher than average incomes in Summit County, due to the cost of living, mean that proportionally fewer residents are eligible for Medicaid than some other Colorado communities. However, county agencies report that there has been a 40-50% increase in the caseload for Medicaid and other social welfare benefits, and the local hospital echoes that. Fortunately, the health resources available to these individuals are more robust than in similarly-sized communities, thanks to the well-developed network of safety net organizations in the area. All this aside, the coverage conversation in this community is primarily focused on the next open enrollment period, especially with new, lower private insurance rates.

We need to reeducate the community to try again. Some next steps that our community is working on is to help residents understand what the ACA means to them: what should now be covered and how to ask for it.

–Amy Wineland, RN, Summit County Department of Public Health


Clinic

ACCESS

Other than the changes to payer mix, access to care has not been a prominent topic of conversation in Summit County so far, as the residents and leaders feel their preparation for changes in demand were successful. This is due in part to the growth of the community’s primary safety net provider in the past year to accommodate new patients, and in part to the hospital’s ability to absorb additional demand.


Flowers

LEADERSHIP & COLLABORATION

Local leaders and state officials strengthened their relationships through their work to lower private insurance rates, and because of that, they see more opportunities for collaboration for the next open enrollment period. Leaders also report that new collaborative efforts have begun to track data and that some local leaders have been invited to leadership positions on state boards.

Fall 2014

Health reform has been very beneficial to our community in a lot of ways. I think more people are getting care, I think all the leaders are talking to each other, [and] we are working on solutions together. And I think the community is settling in with the change…people are understanding what resources are available to them and how to get help navigating.

Sarah Vaine, CEO of Summit Community Care Clinic

With a growing economy and a reduction in insurance premiums in place for the second open enrollment period, Summit County is optimistic for a great start to 2015. There is a widespread sentiment that the community is starting over with health reform after last year’s insurance rate issues. Although there isn’t total satisfaction with the resolution of those rate issues, there is appreciation for the process and the quick response by the state. Leaders are cautiously optimistic that this go-around will be better, although they are unsure if the residents are ready to give it a second chance.

Over the past few months, the number of newly-insured residents has begun to exceed the capacity of local providers and affect access to care. ER visits have increased by nearly 20% over last year and there is need for both providers that accept Medicaid and providers that speak Spanish. While leaders work to address these issues, they are also—wisely—thinking long-term about sustainability.

Fortunately, Summit County is a small enough community that leaders all “fit around one table,” making collaboration and conversation across organizations possible. With their recent successes working together to advocate for lower rates, they’re energized to continue to tackle the challenges that remain.


Farmer's Market

COVERAGE

Community leaders are anxious to see if their efforts to lower rates paid off, and that many more residents gain insurance for 2015. To help achieve that, there have many intense efforts to soothe the hard feelings from last year’s open enrollment and educate consumers on why coverage is important and how to use their benefits. Leaders in Summit County also expressed concern about Medicaid’s reimbursement rate, and how although it has been temporarily increased, once it returns to previous levels there may be sustainability issues. The hospital especially is working to drastically cut operating costs so the reimbursement cut won’t affect their bottom line.

It’s not the first year, but it’s not a totally new horizon. I’m optimistic [about enrollment]. Hopefully we can spend more time getting people into the system instead of learning how to navigate it.

–Tamara Drangstveit, Executive Director of the Family and Intercultural Resource Center


Clinic

ACCESS

Other than the changes to payer mix, access to care has not been a prominent topic of conversation in Summit County so far, as the residents and leaders feel their preparation for changes in demand were successful. This is due in part to the growth of the community’s primary safety net provider in the past year to accommodate new patients, and in part to the hospital’s ability to absorb additional demand.

I would say that the doctors are happier. Because we can take care of patients, accept Medicaid, and be reimbursed enough that we can keep our doors open.

–Dr. Chris Ebert-Santos, Ebert Children’s Clinic


Flowers

LEADERSHIP & COLLABORATION

Local leaders and state officials strengthened their relationships through their work to lower private insurance rates, and because of that, they see more opportunities for collaboration for the next open enrollment period. Leaders also report that new collaborative efforts have begun to track data and that some local leaders have been invited to leadership positions on state boards.

I think we’re a small enough community to get around a table and discuss critical issues face to face. We use our community needs assessment as our guiding tool and where people can collaborate, it’s successful. We know each other on a first name basis and have a good understanding of the capabilities of our organizations. There is alignment on the priorities for our community.

–Dr. Paul Chodowski, CEO of St. Anthony Summit Medical Center

Hot Topics in Community Conversations

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