DREAM CITY: Vision to Action - Taking the pulse of health care options

The Dream City committees looking into the future of health care in the Pikes Peak region wasted their time.

We’re already among the healthiest communities in the country, right?

Didn’t Outdoor Magazine recently rate us No. 1? Doesn’t Men’s Fitness magazine always rank Colorado Springs among the fittest cities in America?

Don’t we live in a state rated 50th in obesity?

We sure look good through a soft-focus lens. But look with a bit sharper focus and that picture of health reveals blemishes. Just skim through the recent in-depth, county-by-county health rankings report or as the ongoing local Quality of Life Indicators reports. It’s not pretty.

According to the report released in February by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, El Paso County ranked 29th among Colorado’s 64 counties when it comes to health outcomes, and slightly worse when it comes to factors that influence health.

That report, and the QLI (a community initiative spearheaded by the United Way and several other local groups), said the Pikes Peak region has high infant mortality rates, suicide rates (particularly among young men and veterans), poor access to health care and expanding waistlines. (Yes, obesity levels are low, but when you factor in the number of people simply overweight, we end up toward the middle of a very chunky pack.)

Among the goals boiled down from Dream City brainstorming sessions with more than 3,000 local citizens:

“A broad range of quality health care options that are accessible to all.”

With two major hospital systems and dozens of health clinics, physician offices and health care organizations, we’re doing OK on broad range of options part.

Is it all accessible? Not so much.

In El Paso County, 98,430 — about 19 percent of the under 65-year-old population — are uninsured, according to 2006 Census figures. That’s a bit higher than both state and national averages.

The QLI report said, “This high rate of uninsured is troubling since uninsured individuals are more likely to report poor health status, delay seeking medical care and forego necessary care for potentially serious symptoms. Adults with health insurance are twice as likely to receive a routine checkup as are adults without health insurance. Indeed, many uninsured in the Pikes Peak region rely on hospital emergency rooms for primary and preventive care.”

Add to those uninsured an even larger number of under-insured, and the problem magnifies.

Obviously, local health care workers are keeping a close eye on what’s happening with the national health-reform bill in Congress. But some haven’t been waiting for Washington to fix the problem.

Peak Vista Community Health Centers, for instance, has been providing primary care services to low-income, uninsured and underinsured people in the Pikes Peak region since 1971. With 16 outpatient centers and counting, Peak Vista has been racing to keep up with the need. But it’s a race they’re losing.

They served about 57,000 patients in 2009, and they expect that number to be much more this year.

“The need has been growing exponentially,” said Peak Vista President and CEO BJ Scott.

From December ’08 to December ’09,  17 percent more patients walked through the doors of their clinics than the previous year, which represents “the biggest increase ever,” Scott said.

Complicating the problem of increasing need is a shortage of local primary care physicians.

“They’re specializing more,” Scott said, which means those seeking what Scott calls “the front door to care” may have to wait longer for treatments.

So, if we can’t grow clinics fast enough to meet the need, and we can’t pay primary care physicians enough to stay generalists, what can we do on the local level to improve?

Local health care workers have come up with several ideas, including more partnerships.

Twenty local health-care related organizations and individuals recently formed Community Health Partnership to foster those collaborations.

“It’s about coordinating the right care at the right place and the right time so we can maximize our local resources,” said Pam McManus, the group’s board chairwoman. “We’re working on getting more information sharing, so, for instance, if a person gets a lab test at an ER, the results can be shared with a primary care physician, so we don’t have to do tests again.”

A changing model of health

As city officials consider selling our city-owned Memorial Hospital, Dr. Larry McEvoy doesn’t just want to add to the discussion. The hospital’s president and CEO wants to broaden it.

And he doesn’t want the fate of the hospital decided based on what it is, but what it could be. That potential plays into these Dream City ideas about access to health care options and a lot more, he said.

“We need to talk about how we create health care that drives our dream city,” McEvoy said. “When we do that, we begin to realize we have a rare opportunity here to drive the vision statement about what we want the community to be.”

He says he’s open to where that will go, but he believes the hospital’s entire business model should be turned upside down.

When he was an emergency room doctor, McEvoy saw the problem.

“When you work at the back end of the practice long enough, you learn it’s time to get on the front-end of the process,” he said.

He’s talking about keeping people well. Prevention.

“When you’re taking care of somebody with a heart attack, for example, you’re almost always taking care of a very preventable accident,” McEvoy said.

Margaret Sabin agrees. The president of CEO of Penrose-St. Francis Health Services has become a crusader for prevention.

“Sick people are expensive,” she said.

Keeping people well can be enormously cheaper.

She likens the problem to forest fires. About 75 percent of efforts of national fire services focus on prevention and mitigation. If they just focused on putting out fires it would be a disaster.

“We need to take a page from their book,” she said.

Sabin puts her muscle where her mouth is about the issue and leads regular fitness boot camp sessions for her employees. It’s part of one of the longest-running employee fitness programs in the country.

What prevention looks like

Keeping people healthy, the exact kind of front-end attack hospital officials tout, represents the core mission of the El Paso County Health Department. Among other things, the department has monitored meth lab cleanups, worked with schools on suicide prevention efforts, inspected pools and worked on several fronts to stop the spread of sexual diseases, H1N1, West Nile and more.

But, as the county has grown, the department’s budget has been cut in half and the missions have been scaled back.

To department director Kandi Buckland, the toughest part of budget cuts is not being able to get at the “whys.” “What precisely is behind our poor infant mortality rate?” “Why has El Paso County received some of the rankings it has?”

The more modest mission has forced the department to focus on more broad questions:

“How can we get people the support and education they need to keep them healthy?” she asked.

The Dream City groups asked similar questions. And they saw several routes to wellness. One route leads to our mountains and other open spaces.

They envisioned an active populace that helps turn the region into the “outdoor capital of the West.”

“Why can’t we be a Moab?” asked Trails and Open Space Coalition spokeswoman Susan Davies.  “We certainly have the natural resources. ... I guess we get there one trail and open space parcel at a time.”

The Dream City groups also stressed the importance of a clean natural environment and expanded local food options.

To Michele Mukatis, the local food part needs to be the foundation our community’s health is built upon. As administrator of the Peak to Plains Alliance, a group dedicated to developing southeastern Colorado’s food resources, she looks at Colorado Springs’ all-local Colorado Farm and Art Market, Venetucci Farm, a few small restaurants that get herbs and vegetables from local gardens, and she sees an urgent need for growth.

She says we need more farmland, more young farmers, more urban gardens, and more people buying from the Farm and Art Market, which sets up shop during the summer months in America the Beautiful Park and the Margarita at PineCreek.

“They’ve been in existence for five years and are still small because there are not enough members of our community who will go out and buy from them,” Mukatis said. “Conversely, they can’t attract more vendors because there isn’t a critical mass of shoppers. It’s changing, but slowly.”

To figure out how to get more farmers, city growers, local produce buyers and infrastructures to support them, her organization and others in the region plan to come together to create the Pikes Peak Food Forum, a community gathering, this fall.

“We hope to find out what’s working and identify the key changes necessary to a healthy local food system,” she said.

She’s not sure how quickly change will happen, but she knows it’s a healthy discussion.

Vision
to Action

This is the 10th in an 11-part weekly series about Dream City: Vision 2020, a project spearheaded by The Gazette and other organizations, designed to engage people in dialogue about what we want for our community in the coming decade. Are you working on ways to move us toward the visions outlined by Dream City? Tell the community about it at dreamcity2020.org.