Update from the CEO: Change is in the air and certainly a theme for 2013

As the latest administrative healthcare event occurred recently with sequestration, I’m left wondering how our history has encountered the various changes throughout the last one hundred years. Perhaps identifying how we got here will help us determine how to effectively handle our future. In 1900, the healthcare options were few – but cheap. The average American spent five dollars a year (an equivalent of $100 today) on their healthcare expenditures. A person didn’t need to budget for catastrophic events, insurance was of no use, and government intervention wasn’t a necessity.

With the development of antibiotics and the trend of maternity wards, hospitals replaced poorhouses, and healthcare administrators realized that people would pay for treatment when very ill. Baylor University located in Dallas invented the first insurance model that paid Baylor hospital on a per person per month (PMPM) basis. Baylor University employees received adequate healthcare, and the hospital was paid on a risk-sharing concept. After the Great Depression hit, hospitals around the country found themselves with empty beds and the Baylor model, now Blue Cross, became very appealing. Thus, the birth of our current insurance system was born and capitalism was linked with medicine.

In more recent years the government has initiated multiple reforms – some successful, others not. In 1965, President Johnson introduced Medicare and Medicaid. The Consolidated Budget Reconciliation Act (COBRA) of 1985 gave employees health coverage options after termination from employment. In 1997, the State Children’s Health Insurance Program (SCHIP) was created to cover children in poverty. A large healthcare reform movement was attempted during the Clinton administration, but ultimately failed. In 2010, the PPACA was passed and healthcare administrators and clinicians have been vivaciously working to accommodate the new mandates since. And just this week, the Colorado Medicaid expansion was signed into law by Governor Hickenlooper.

Our country has a long history that is continuously evolving to meet the demands of our citizens, accommodate new technology, and we must evolve ourselves. One group, one community, or one individual can create change. By building a foundation for coping with change transformation can occur. Fear, frustration and avoidance will be replaced with hope, energy and innovation. So, as we look at the impending consequences of sequestration and other changes in our healthcare system, let’s look at the opportunity to innovate. CHRC looks forward to working with you on innovating through programs like iCARE, Healthy Clinic Assessments and Community Health Needs Assessments. To learn more visit our website at www.coruralhealth.org

Update from the CEO: Change and Transition

Two weeks ago during the Forum an attendee asked me “how are we going to do all of this and still have time to see the patient?” We both nervously laughed and said “well that’s a great question.” These are tough times and recent reports suggest rural quality is lacking. Last week the President released his budget for FY 2014 which proposes budget cuts to critical access hospital reimbursement in addition to the cuts that are taking place as part of sequestration. Meanwhile, more is being asked of our providers, clinics, and hospitals. Rural healthcare is all about relationships and person centered care so the thought of incorporating new requirements is daunting. Although the rural population makes up only nine percent of the state’s population, 17 percent of people between 65 and 84 live in rural counties along with 40 percent of Colorado residents older than 84. Nielsen Claritas, a consumer trending organization, projects that the 65 and over population in Colorado will grow by 24.32 percent by 2017 (CHI Data Repository). Collaboration has become a vital need in meeting the current needs of the aging populations while also preparing for the increasing demands of the future.

During the Forum we had the opportunity to hear from the Prowers County collaboration through the Community Health Needs Assessments (CHNAs). The Federally Qualified Health Center, High Plains Community Health Center, Prowers County Public Health, the hospital, Prowers Medical Center, and Southeast Mental Health Center together conducted a CHNA as an alternative to the traditional independent assessment. The desired outcome was to develop a plan that integrated public health and clinical services into a holistic approach that would maximize the access for their residents while also improving the overall health of their community. This is a model that is being encouraged statewide to bridge the gap between public health, clinical and behavioral health services.

Critical Access Hospitals (CAHs) have also been submitting data to the Centers for Medicare and Medicaid Services Hospital Compare voluntarily, but often their contributions are omitted from the website due to suppressed data, meaning the numbers are statistically insignificant when compared to the metropolitan contributions. Statistical analysis is frequently based off incidences per 100,000 people, which eliminates the ability to measure data in communities of less than 50,000. In late 2011 HRSA initiated a program called the Medicare Beneficiary Quality Improvement Program (MBQIP). MBQIP focuses on aggregating 1,121 CAHs’ data that is submitted through Hospital Compare and using this aggregated data to demonstrate the great quality work being conducted by CAHs throughout the country. Of the CAHs’ in Colorado reporting MBQIP data from fourth quarter 2011 through third quarter 2012 data shows:

Heart Failure Measures Set Average Data Score: 72%

Pneumonia Measures Set Average Data Score: 86%

Half of the state’s CAHs are engaged in CRHC’s Improving Communications and Readmissions (iCARE) program and this year we have added twelve rural clinics. The clinics are focused on the diabetic population and working in collaboration with the hospital team to improve care transitions. Some of our clinics will be starting a pilot test with a tool to assist clinics in communicating with specialists.

All of this work is being connected through a team based approach of addressing our rural communities’ needs in workforce, quality, health information technology or basic business operations and education. While you are learning to see and do things differently, so are we. We will continue to provide our valued members the most current information in healthcare reform and offer programs relevant to your needs.

Member of the Month: Sedgwick County Health Center

Julesburg, CO located in the most northeast corner of Colorado is the first town in our state to greet travelers heading west to the Rocky Mountains. With a population of 2,341, it is a small town, but is the hub of the healthcare community for the county. Sedgwick County Health Center is the umbrella organization for five distinct business lines: Sedgwick County Memorial Hospital (25-bed Critical Access Hospital), Sedgwick County Memorial Nursing Home, Valley Medical Clinic (Rural Health Clinic), Jacob J. and Anne B. Walter Memorial Living Center, and Valley Medical Clinic in Big Springs, NE. This health center is the largest employer in the county and works closely with its community to provide quality and compassionate healthcare to its residents.  

Sedgwick County Health Center participated in many innovative and exciting programs with Colorado Rural Health Center this past year! Some highlights of their activities include two Healthy Clinic Assessments where their overall score improved from 87% to 96% - a huge accomplishment! Both the hospital and clinic are participating in iCare, Improving Communication and Readmission and have completed a process mapping as part of this project.

"We are using the iCARE diabetic collaborative as not just a gathering of information but to make a definite change for a diabetic patients to improve their overall care." Deb Nail, Clinic/Business Office Manager

In 2012, Sedgwick hospital and the community of Julesburg participated in a Community Health Needs Assessment (CHNA). A CHNA uses data sets to identify needs within the community.  Community stakeholders identify issues they feel are important and develop solutions in which they want to participate. Key positive findings of Sedgwick County’s CHNA are:

• Up to 20% of the health center’s patient population come from outside of Sedgwick County
• Between 2012 and 2017 it is predicted that there will be a 11.91% increase in population of individuals ranging in age from 65-74
• Sedgwick County ranks in the top 25 counties for overall health in Colorado
• Sedgwick County ranks 1 in Colorado for least amount of tobacco use, 1 in best environmental quality and 7 in lowest unemployment rate.
• Violent crimes were at a rate of 1.8 per 1,000 people between 2007-2009 compared to 3.5 in Colorado overall
• Between 2006 and 2010, Julesburg had a population of 10% of people who smoked. Healthy People 2020’s goal is at 12% and Colorado has a percentage of 17.2.

If you are interested in learning more about Sedgwick County Health Center, click here to visit their website. Sedgwick County Health Center is a close collaborator and has been a Colorado Rural Health Center Member for nearly 10 years.  We thank them for their support and continue to work closely with this amazing health center and community.