Impact of Reform

Yuma

The story of health reform in Yuma 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

I think the biggest strength locally is that people know how to access care. Because we are in an area with a small population, we have better relationships with our providers. We don’t tend to feel like we’re not listened to or lost in the shuffle. We’re names and faces, not numbers. I think that is the biggest argument for staying local for health care.

–Annette Bowin, Town Clerk of Akron

The tightly-knit nature of Yuma County provides benefits that are implausible for urban communities. Community leaders speak fondly of the county’s ability to rally together to meet the need of individuals who may have fallen on hard times due to unexpected illness or injury. Although proposed changes to the health care system are often met with skepticism in this community, gathering all influential parties to plan and make decisions when necessary is a swift and straightforward process. In general, Yuma County is proud of its self-sufficiency and unsure if current national and state health reforms are truly necessary for them. Many feel they have the resources within to accommodate community needs, without external involvement. Should they find any opportunities though, leadership is ready to take action.


Blue Sky

COVERAGE

At 15%, the rate of uninsured Yuma County residents is comparable to the statewide rate. However, the rate of underinsured residents is well above state average, leaving a false impression that the community is well off in terms of coverage. Much of its population will qualify for Medicaid through health reform, but it remains to be seen if residents will enroll and if enough resources exist to assist with enrollment.

 

A lot of that isn’t discussed. If [residents] talk about something it’s the corn and the crops. They don’t really talk about insurance.

–Bobbie Reynolds, Loan Administrator at the Northstar Bank Colorado


Pharmacy

ACCESS

Access to care is a great strength of Yuma’s health care system. There are no waitlists, the emergency department is not overwhelmed, and leaders have committed to expanding the local health care workforce in preparation for upcoming reforms. The data reflects this observation: a mere 7% of residents do not have a usual source of care—less than half the statewide average.

Lynn BorupHow do residents interact with the health care system in Yuma County? Pastor Don Smith, of Yuma Christian Church says rural life is different.


Train

LEADERSHIP & COLLABORATION

The two population centers of Yuma County—Yuma and Wray—each have a hospital and a different approach to providing care and leading health reform in their community. At an individual level, residents are committed to “taking care of their own,” and even go as far as hosting monthly fundraisers for community members with health care needs.

Spring 2014

We’ll discover, now that the first open enrollment period is over and when people have had time to catch their breath, just what the impact of health reform is and what’s happened in Colorado. It is going to be very exciting to see how many people have been able to get covered and now have health care insurance.

–Patricia Brewster-Willeke, Co-Director of the Rural Communities Resource Center

It comes as no surprise that Yuma County has barely felt the impacts of health reform so far, what with emergency departments that only see a few hundred patients per year, 85% of their population with some form of health insurance prior to January 1 of 2014, and several years of investing in system improvements to improve quality and capacity under their belts. The community and its health care leaders were prepared for all the access challenges they had been warned of, but feel as if the greater impacts are still ahead.

In Yuma County, the significant impacts of reform over the past few months have been limited to individuals gaining or losing coverage—but for those experiencing the changes, it’s a very big deal. For some, enrolling in coverage has meant an opportunity to access health care for the first time in many years; for others, coverage has become or remains unaffordable, and there are feelings that the system is unfair. Leaders recognize that much work remains, not only to enroll all residents in coverage, but also to close gaps in specialty care, reduce costs, address the issues of their aging population, and improve overall health.


Residents

COVERAGE

Although they got off to a rocky start, Yuma County takes pride in getting hundreds of residents signed up for health insurance, even in the face of enrollment challenges. With a large segment of the population already enrolled in Medicare, most providers have seen little change to their payer mix with these new enrollments. Concerns remain around overall costs and effects on small businesses.

Enrollment Data
Yuma County Residents
Medicaid (as of 4/16/14) 251
Connect for Health Colorado (as of 4/26/14) 296
Total New Enrollments 547
Estimate of Total Uninsured (2012 ACS) 1,511

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


Hospital

ACCESS

Since 2008, Yuma County has been working to develop patient-centered medical homes for residents and improve management of limited resources. These efforts have placed the community ahead of the curve on access to care, and many of the remaining challenges, such as the availability of specialty, medical, and dental care are long-term issues more related to their rural setting than health reform.

John Gardner

How did Yuma get ahead of health reform? John Gardner, CEO of Yuma District Hospital and Clinics, explains.


Sign

LEADERSHIP & COLLABORATION

When enrollments were coming in too slowly, leaders from health care, business, and the insurance industry came together to collaborate and boost sign ups. Moving forward, there is widespread desire for increased patient engagement and personal responsibility for health, and the hospitals and other health care leaders are exploring ways to lead on the issue.

Summer 2014

I would say the people I see are “unsettled” not knowing what coverage they will have. I know personally our insurance is going up, premiums and deductibles and our benefits and coverage is less.

–Vonie Weaver, Director, Wray Senior Community Center

As Yuma County nears the second period of open enrollment, there remains uncertainty about the impacts of health reform on their community. Many county residents share the sentiment that the long-term impact of health reform is an enigma, however, it does seem as though there is decreased community-wide hostility toward the Affordable Care Act, as compared to the spring. Leaders report that there tend to be two competing perspectives: those who have gained insurance and are happy about it, and those who were already insured and are now concerned about their costs increasing.

Yuma has been identified as a leader in prevention, primarily due to Yuma Hospital’s proactive approach to healthy living and preventive screenings. However, access to mental health, oral health, and specialty care services remain a concern. Furthermore, Yuma County’s small size and rural location have helped to expose some flaws and gaps in the system, such as restrictions on prescription refills that inadvertently force skipped doses. These and other issues will be priorities for the community in the months to come.


Clothesline

COVERAGE

When it comes to community perceptions of health insurance coverage in Yuma County, Medicaid carries a stigma, and reversing that stigma is an ongoing challenge for local leaders. The other major aspect of the coverage conversation in this community is health insurance literacy. As the number of Medicaid patients increases, one challenge is getting new enrollees to access the most appropriate facilities. Many residents don’t understand how to use sign up for insurance, where the public money comes from that helps pay for some residents’ coverage, and how to use their insurance once they purchase it.


Residents

ACCESS

Yuma’s rural location has revealed gaps in Medicaid benefits, resulting in some residents not getting their needs met. Leaders have collected anecdotes from patients that have been denied prescriptions or specialty care visits due to strict regulations that make sense in urban areas but create challenges in rural areas—like limiting reimbursement for specialty care visits to one visit per day, although most rural residents have to travel far to access that care and making multiple trips isn’t time or cost effective. There is also a perception of too few Medicaid providers available, which has made accessing care for oral and behavioral health issues—a great need in the county—a challenge.

A recent Yuma County focus group identified a couple of key barriers to accessing health care services for some residents. First, there are a limited number of health care providers and pharmacies available in the community. Secondly, there are only a few choices for health insurance plans for this area. Some people shared the distance they had to travel to get specialized services was a challenge and usually involved taking at least a day off of work and sometimes more if the number of appointments needed could not be scheduled on the same day. If an individual needs to see two different specialists, Medicaid will not cover both visits if they happen on the same day. Another individual shared concerns over getting prescription medication delivered before the last one ran out since a renewal cannot be ordered until the last one was within a day of expiring and it took two to three days to mail the new one.

–Mary Gross, Former Executive Director, Rural Solutions


Train Station

LEADERSHIP & COLLABORATION

Most of the collaboration on community health initiatives reported by local leaders is currently separated by town limits. The town of Wray and the town of Yuma are each separately pursuing community health priorities, with little overlap or coordination, due to the geographic realities and practicalities of their rural location. However, with many community members traveling to urban areas to access care, leaders see an opportunity to continue to develop resources that allow patients to access care more locally.

Fall 2014

I was expecting much more dramatic change with health reform, in terms of utilization of services. …We had braced ourselves for getting hit with this big barrage of patients… That didn’t happen.

–John Gardner, CEO of Yuma District Hospital & Clinics

Small communities in rural parts of the state have always faced health system challenges simply because of their size and location; Yuma County is no different. What has become clear over the last year, however, is that the changes ushered in by health reform haven’t been able to provide much relief for those issues. There remain shortages of providers, funding, and specialty care, and Yuma leaders are concerned about the long-term sustainability of the rural health care system. However, there have been some positive outcomes of reform that leaders hope to build on in the future.

The expansion of Medicaid, and especially adding dental benefits for Medicaid adults, has been very important for individuals and providers alike. Those residents who have gained affordable coverage are happy with the changes they’ve experienced. However, the expected revenue from privately insured patients hasn’t materialized for the local hospital, as some patients neglect to pay bills. Leaders have begun to seek out partnerships with larger systems to help absorb the costs of operation.

The changes to Yuma County’s health system over the past year have been incremental, and the culture shift even less noticeable. However, residents are generally quite happy with their current system, reporting good access to primary care, good care coordination, a strong focus on health and wellness, and great respect and admiration for their local providers. Leaders hope to increase collaboration across the region and continue to work to build a more sustainable system for their community.


Clothesline

COVERAGE

Leaders report that the increase in insured residents has been noticeable, although not overwhelming. There is some concern that insurance isn’t valued in the Yuma community the way it is in some other communities. As the second open enrollment begins, there are no major campaigns planned beyond the tireless outreach of the few committed community members who have been working to enroll Yuma County residents in the available coverage options for years. The need for more education around how to enroll and use health insurance has become clear and will be a focus of the coming months.

I think a challenge for a lot of Yuma providers is that what came with Connect for Health Colorado and suddenly people having access to commercial insurance, is that we had lots of people who bought high deductible plans. So where we’re struggling is in terms of managing our cash. It’s taking a lot of time to receive the part of the bill that’s the patient’s responsibility. We’re having a tough time getting that revenue, which is having an impact on how we’re managing our expenses. For a lot folks, I think because health insurance is new to them, it’s been a whole educational process. Yeah, you have health insurance now, but you still have a responsibility. In hindsight, there’s an on-boarding process when people get new insurance in terms of really educating them. This has been a huge issue for us.

–John Gardner, CEO of Yuma District Hospital & Clinics


Residents

ACCESS

Access to care has not changed much over the past year in Yuma County, largely due to the preparations done in advance to prepare for a larger patient population, but also due to the challenges of providing health care in a rural area. Recruiting and retaining providers remains an issue, and the long-term sustainability of some health access points is questionable. For example, a local nursing home was purchased by a local hospital in order to save it from insolvency, but there is little hope that it will ever be financially sustainable on its own.

In terms of access to care, my insurance, my employees, the number of people I thought might try to go to the exchange …I think they kind of built it up. But it really has been uneventful.

–Andrea Anderson, Human Resources Manager for the Rocky Mountain Region at Murphy-Brown LLC and Smithfield Food


Train Station

LEADERSHIP & COLLABORATION

Leaders see a benefit to more local collaboration, especially between the towns of Yuma and Wray, but have yet to begin that process. However, they have begun to seek out partnerships across the region that are helping to connect them to the much larger state health care system. As health reform implementation continues, local leaders plan to continue their efforts to expand access and keep patients close to home.

There certainly has been more collaboration in Yuma [as a result of health reform]. We have a new collaborative effort between us and local health insurance agents and more collaboration in the health system in general. There has been more collaboration, but I’d like more moving forward.

–Patricia Brewster-Willeke, Co-Director of the Rural Communities Resource 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.