Rural Colorado Portfolio
Jan 19, 2016
Rural Colorado Portfolio
AD AM S
ALAM O SA
AR APAH O E
AR C HU LETA
BAC A
BEN T
BO U LDER
C HAFFEEC H EY ENN E
C O N EJO S
C O STILLA
C RO W LEY
C U STER
D ELTA
D O LO RE S
D O U G LAS
EAG LE
ELBER T
EL PASO
FR EM O NT
G A RFIELD
G ILP IN
G RAN D
G U N NISO N
H INS DALE
H U ER FA NO
JAC KS O N
KIO W A
KIT C AR SO NLAK E
LA PLATA
LAR IM E R
LAS AN IM A S
LIN CO LN
LO G A N
M ESA
M IN ER AL
M O FFAT
M O N TEZUM A
M O N TR O SE
M O R G AN
O TER O
O U RA Y
PA RK
PH ILLIPS
PITK IN
PR O W ER S
PU EBLO
R IO BLANC O
R IO G R AN DE
R O U TT
SAG U AC H E
SAN JU AN
SAN M IG UEL
SED G W IC K
SU M M IT
TELLER
W ASH ING TO N
W ELD
YU M A
JEFFER SO N
D ENV ERC LE AR C R E EK
Colorado Rural, Frontier, and Urban CountiesU pdated Ju ly 2003
R ural - 24 C ounties (N ot M etropolitan; not frontier)
Frontier - 23 C ounties (6 persons or less per square m ile)
U rban - 17 Counties (M etropolitan A reas)
Rural, Frontier and Urban Counties
BR O O M FIELD
Provided by:C olorado R ura l H ea lth C enter225 E . 16 th Ave., Su ite 1050D enver, C o lorado 80203(303) 832-7493 / (800) 851-6782w w w .corura lhea lth .org S :/W eb/C R H C M aps/M aps/C O _RU R AL_FR O N TIER _U RB AN _2003
Rural Community
Legislature
Determinants of Health
• Individual biology• Access to health care• Health behaviors• Socioeconomic factors• Physical environment
• What can public policy impact?• What should public money buy?
Rural is NOT Urban
• Think about the impact of your policy on a rural community. Think small town.
• The social, political, and behavioral factors/determinants are different.– Some policy may target rural life– Some policy may explicitly avoid rural life
• ASK someone from a rural community
For Instance - access• Currently “limited-scope” radiology technicians must
show proficiency through successful completion of a rigorous test.
• Proposed change in the requirements would require all folks to take a semester-long course to be able to take x-rays.
• This added requirement would drastically decrease the access to radiology services in rural ambulatory sites.– Course costs– Time away from the office– Travel distance
Rural Is…
• You call a patient; get the wrong number, but it was someone you needed to talk to anyway.–Bob Yanni
Pay for performance
• Pay for performance?• Pay for outcome. Pay for better living.• Pay for performance is not a
physician/provider/practice level issue
• System level performance• Consider broader initiatives
–Public-private collaborations
For Instance
• Because many patients are transferred out of rural hospitals and into urban hospitals (In the case of acute heart attack, transferred patients are often younger and healthier), this may disproportionately move money away from rural care towards urban hospitals
THE NEW YORK TIMES NATIONALFRIDAY, JULY 11, 2003
Medicare to Pay Bonuses For Best of
Hospital Care
Rural Is…
• They hold a ribbon cutting for a traffic light
Balancing the Rural Portfolio
• Look outside the “medical” sector for improved health care.– Baby Bear Hugs (home visitation) in Northeast Colorado
drastically reducing infant mortality – Hispanic Access in West Yuma County improving CSAP
scores• Reward local solutions
– Support the translation and export of those solutions to other rural communities
• Resource ≠ Dollars invested– Volunteerism, time, energy, commitment, that extra mile
The good panel discussant
Sell an idea
Ask for the money
Never Ask for Money
• The State Legislature makes lots of healthcare policy
• You are part of a Balanced Rural Portfolio