Region battles issues of access, education

Health care deserts — places where people face significant barriers to care, clinics and doctors — are normally associated with major cities like Detroit, St. Louis or Atlanta. But depending on where you live, finding medical treatment can be a problem in Colorado Springs as well.

Data compiled through the Regional Care Collaborative Organization, which connects Medicaid clients to providers and other social services, points to significant health-care barriers on the southeast side of the city, said Mina Liebert, public health planner with El Paso County Public Health.

“Specifically in the area of 80916, there are extremely limited health services and no primary-care medical providers,” Liebert said in an email. “Coupled with neighboring 80910, these two ZIP codes have the highest enrollment in Medicaid and greatest emergency department utilization rates [in the county].”

Health care groups in Colorado Springs are gathering information to address the problem in 80910, which covers the area southeast of downtown, and 80916, east of Academy Boulevard and south of Platte Avenue.

Known as the BUILD Health Challenge, the local partnership includes the YMCA of the Pikes Peak Region, El Paso County Public Health and Penrose-St. Francis Health Services “to identify upstream causes of negative health outcomes,” Liebert said.

“In order to get a true picture of the root causes that disparately impact residents in this area, we are gathering and layering data specific to these neighborhoods, and are meaningfully engaging the community in a process to understand their perspective of health.”

Up to 50 percent of the families in the 80916 ZIP code live below the federal poverty line, with unemployment between 11 and 15 percent, she said, adding “there is a disproportionately high incidence of youth violence.” El Paso County’s Department of Human Services identifies 80916 as a hot spot for violent crime and allegations of child abuse and neglect.

“The impact of funding like BUILD will ultimately engage community residents and create a network of individuals that are working towards improving the health of their neighborhood,” she said.

The CARES Team

Jeff Martin is community and public health administrator for the Colorado Springs Fire Department. He oversees CSFD’s Community Assistance Referral and Education Services, or CARES Team, which engages communities in the proper usage of the 9-1-1 emergency call system. His team also assists those facing economic or physical barriers to care.

Martin said 6 to 7 percent of callers in most Colorado Springs neighborhoods experience delayed service due to blocks caused by non-emergent calls. In the southeast quadrant of town, specifically the 80916 and 80910 ZIP codes, about 20 percent of calls are blocked.

“You don’t need an eight-minute response time when you have gout,” Martin said. “[Some in these areas] use 9-1-1 for transit because they don’t have access to detox facilities or they have difficulty accessing medication or they can’t access primary care. They know if they can get to the emergency department, they’ll at least get a limited supply of medication.”

Martin said he knows firsthand of one chronic 9-1-1 user who generated more than $1 million in uncompensated bills.

“We manage a case load of about 600 patients at a time, and the requirement for everyone in that caseload is that they have to have called 9-1-1 at least 10 times in the past year,” Martin said. “We’ll manage those cases for 90 to 120 days at a time and we’ve seen a 69 percent decrease in 9-1-1 activity. They’re moving to more appropriate care.”

Incredible barriers

“I think there are incredible access barriers around the Pikes Peak region,” said Pam McManus, CEO and president of Peak Vista Community Health Centers. The organization provides affordable and uncompensated care for the uninsured, the working poor and the newly jobless in the region. More than 80,000 people within the Pikes Peak and East Central Plains regions utilize its services.

And while McManus sees barriers to care across the community, the majority of Peak Vista’s users live within City Council’s southeastern District 4, with downtown’s District 5 coming in second.

According to Peak Vista’s 2014 data, its most recent numbers, 18,462 patients came from District 4, which is comprised in part of ZIPs 80916 and 80910. More than 10,000 of Peak Vista’s users come from downtown. District 2, which borders the Air Force Academy, has the fewest Peak Vista users, at just over 1,000.

McManus said something as simple as lack of transportation can drive up the costs of care, and that many of Peak Vista’s users, especially those with chronic conditions, will put off care until it becomes emergent because they can’t easily get to preventative appointments.

McManus said Peak Vista offers flexible appointment scheduling and transportation services, and it collaborates with third-party partners to get patients to and from the doctor.

“We’re part of the solution,” McManus said of Peak Vista’s role in shrinking health care deserts. “If we weren’t here, this desert would be even [larger].”

Mobile and accessible?

Navigating the health care system has become such a priority for Pikes Peak United Way, the organization has added a health care navigator to its 2-1-1 referral system. The top three call categories are from people seeking assistance with utilities, rent and food, according to Cami Anderson, PPUW’s 2-1-1 center director. But the complexities of health care and insurance led to the creation of a navigator position, filled in February by Melissa Ugianskis. Ugianskis connects the community with resources and answers care-related questions. She said 2-1-1 fielded about 30,000 calls in 2015 and about 10 percent of those had a health care component.

Jason Wood, president and CEO of Pikes Peak United Way, created the navigator position. He said gaps in care, especially in socioeconomically disadvantaged neighborhoods, are often exacerbated by other issues.

“We’d gotten a call from a woman who had her power shut off and her mom was on an oxygen machine that needed electricity,” Wood said. “Sometimes these [barriers] are the result of bigger issues, but we realized a lot of callers were having trouble navigating the system. … We’ve been addressing gaps in services, and hospitals and providers don’t always focus on that stuff.”

Wood said United Way data indicates an increase in suburban poverty nationwide, adding the impact has been felt locally around Fountain and in the 80916 and 80910 ZIP codes in Colorado Springs.

“If you look at Census data, these are school district’s with high levels of free and reduced cost lunches,” Wood said. “It’s also where the affordable housing is.”

But it’s where health care isn’t, he said.

“The question is, are we putting facilities where the needs are? And if we’re not, are we making more resources mobile and accessible?”

Behavioral health

“We do pay attention to low access areas,” said Michael Allen, vice president of operations and managed care for AspenPointe, a local behavioral health care provider. Allen said within the 80916, 80910 and 80915 ZIP codes, AspenPointe saw 4,400 unique clients from July 1 through January. The provider has five locations to serve those communities, Allen said, adding patient loads have increased 50 percent thanks to the state’s Medicaid expansion.

“Before Medicaid expansion, we covered about 60,000 people in [those ZIP codes],” he said. “Now we’re at about 155,000.”

Allen said AspenPointe partners with primary care and other providers in the area to catch those who may otherwise fall through the gaps.

Allen said a move to electronic health records has facilitated a continuum of care with primary care providers and other specialists and telephonic care has broken down some access barriers.

“Care is becoming less dependent on place because of technology,” he said.

Economics

According to Tatiana Bailey, a health care economist and executive director of the Southern Colorado Economic Forum, about 75 percent of health care expenditures in the U.S. are preventable.

“[Those costs] are often the result of chronic diseases we inflict upon ourselves through poor lifestyle choices,” she said. “And for every $100 spent on health care, about $40 is going to uncompensated care.”

Bailey said there are two confounding factors that lead to runaway uncompensated care costs.

“Socioeconomic status is directly correlated with health status,” Bailey said. “Put that next to the fact that a lot of areas that are underserved don’t have enough health providers, and that exacerbates the issue. Especially when people don’t have transportation. … What do they do? They wait. Add that to not enough service providers for an area and it’s the perfect storm for spending.”

Bailey said another confounding factor is accessing, growing and retaining physicians willing to accept Medicaid and to locate in high-need areas.

“Because Medicaid compensation is lower, you have doctors saying they don’t want to deal with it,” Bailey said. “Administratively it’s a pain and [doctors] don’t make much money from it. It’s a huge issue for the Affordable Care Act. It’s well and good to say … millions of people are signing up on health exchanges, but that doesn’t address the shortage of providers — even for those with insurance.”

So what can be done to mitigate the effects of health care deserts?

Bailey said there are some common sense approaches.

“It’s really logical,” she said. “You want ambulatory neighborhood health centers that provide mostly preventive care. You want several of them because bus routes are a huge problem for us here. We don’t have a good bus system and that exacerbates everything. … You want the diabetics to [seek care] every month. It sounds expensive, but it’s cheaper than an in-patient stay.”

Bailey said low cost clinics offering a continuum of care are vital to improve access and cut costs.

“You also want to make immunizations free and, ideally, you’d have a nutritionist who, once a week, would go to the different clinics,” she said.

Bailey said several urgent care clinics with extended hours would also address the problem.

“They could be open all night, or at least until midnight so these individuals are not going to hospitals in ambulances when have an acute care episode,” she said.

Bailey said issues surrounding care have only compounded because households in poverty have trended upward.

“The percentage of people at or below the poverty line in this country has actually increased,” she said. “The problem hasn’t gotten better — it’s actually gotten a little worse, and the last recession helped that along.

“When you compare us to other developed countries, we have a very low minimum wage, which doesn’t help matters,” she said. “Some [disadvantaged populations] would rather forget it because it’s not worth it to work. They’re better off on welfare and Medicaid. Or they take jobs and don’t get any benefits, so they’re living at a subsistence level and they can’t take care of themselves.”