Aurora Health Access met at 2PM on Wednesday, December 14th at St. Therese in Aurora.

Over 20 organizations and 40 individuals attended the meeting. Rich McLean, a leader with St. Therese FAMILY, opened the meeting with our mission statement: Aurora Health Access is working to build a community health system in Aurora that meet the needs of all residents.

Welcome from Mayor Steve Hogan

After introductions of those present, Aurora Mayor Steve Hogan introduced himself and offered his support to Aurora Health Access moving forward. Mayor Hogan stated that he would love to attend a future AHA meeting.

Health Care Innovation Challenge

The Colorado Health Institute estimates that Colorado needs an additional 200 primary care providers (doctors, Nurse Practitioners, and Physician Assistants) presently to bring the state up to par. We will need an additional 141 primary care providers as 510,000 new people get health insurance through the Affordable Care Act (ACA).  AHA asked, how does Aurora help meet this need? Communities must take the initiative, using the tools the ACA gives them, if the challenge of affordable, accessible health care is going to be met.

On November 14, 2011, the Department of Health and Human Services released a funding opportunity announcement for the Health Care Innovation Challenge.  Under this Challenge, up to $1 billion dollars will be awarded to innovative projects across the country that test creative ways to deliver high-quality health care services at lower costs.

• Priority will be give to projects that demonstrate cost savings, workforce development and deployment, rapid implementation, and model sustainability post funding.

Within the AHA Care Coordination Workgroup meeting several important discussion topics arose:

1. It seems advantageous to pursue the grant application under Colorado Access.
   1. Although the final decision was not made, the group made efforts to specifically define the relationship between CO Access and AHA and establish a governance structure.
   2. CO Access would pair with a community-based organization in each of its Regional Care Collaborative Organization (RCCO) Regions. Aurora is in Region 3 composed of Adams, Arapahoe, Douglas counties.
   3. As a payer, CO Access has the means to track cost-savings.
2. The group asked if focusing on reducing per member per month was the best metric for cost savings.
3. The group discussed who the most expensive patients were in the area and how to define our target population.
   1. For the first year of the grant, it seems logical to start with a broad population within the three Aurora zip codes (80010, 80011, 80012).  These zip codes have the highest levels of poverty in the community and have the highest ER utilization at University and Children’s Hospitals.
   2. In following years it could be possible to target more specific populations (mental health patients, frail/elderly, young women likely to have unplanned pregnancy… etc)
4. Based on the review of other successful community health initiatives, AHA hopes to develop a three pronged approach in the community to improve care and lower cost for high risk/high opportunity patients.
   1. Build a network of trained community health workers that live in the community and can provide valuable health information and support to residents
   2. Develop and deploy a new kind of trained and paid “Case Manager/Patient Navigator/Community Health Liaison” health care worker that can operate in multiple settings across the community and serve as a bridge between the larger health care system and the individual patient.
      • Currently, Medicaid does not pay for health care navigation services.
      • The larger AHA group emphasized the importance of defining the “patient navigator” goals and metrics.
      • The group also recommended pairing with the Community College of Denver and Community College of Aurora to develop sustainable curriculum  for this “patient navigator.”  Currently, the Colorado School of Public Health has a pilot program, but their patient navigator model focuses mostly around cancer.  There is the possibility to expand this role as well.
   3. Expand and strengthen relationships and care compacts between health care providers in the community.
5. It was important to note that Colorado has many excellent existing resources and we shouldn’t abandon these simply to “chase the money.”  AHA wants to remain true to its roots and values within this grant application process.

During the larger discussion, the question was asked, “Can we re train and re deploy our current workforce?”

• The group emphasized the importance of preventative care within the grant proposal.

Important Deadlines

1. Non-binding Letter of Intent: December 19, 2011
2. Application Due: January 27, 2012
3. Anticipated Award Date: March 30, 2012

Next meeting: Early January.  Please contact Joe Campe at Joe.Campe@ccmu.org with questions and comments or if you are interested in joining the working committee for this opportunity.

Thanks to the following organizations who attended:

Alternative Pregnancy Center, Arapahoe County Commissioner, Arapahoe Early Childhood Council, Arapahoe House, Aurora Adams County Medical Society, Aurora Chamber of Commerce, Aurora Mental Health Center, Aurora Public School, Aurora Residents for Recreation, Bacchus/Tobacco Free Aurora, Children’s Hospital Colorado, City of Aurora, Colorado Access, Colorado Childrens Healthcare Access Program, Colorado Coalition for the Medically Underserved, Department of Health Care Policy and Finance, Colorado Regional Health Information Organization, Colorado School of Public Health, Colorado Tobacco Education and Prevention Alliance, Denver Health, Governor’s Office, HCAC, Kaiser Permanente, Mayor of Aurora, Metro Organizations for People, residents of Aurora, Senator Morgan Carroll’s office, St. Therese Catholic Church, The Medical Center of Aurora, and Tri-County Health Department

Aurora Health Access met at 2PM on Wednesday, September 14 at St. Therese in Aurora.

Over 20 organizations and 40 individuals attended the meeting. Rich McLean, a leader with St. Therese FAMILY, opened the meeting with our mission statement: Aurora Health Access is working to build a community health system in Aurora that meet the needs of all residents.

Reflection on Town Hall with Governor Hickenlooper

After introductions of those present, Rich led a reflection on the Aurora Health Access sponsored Town Hall at the North Middle School of Health Sciences and Technology on August 17 featuring Governor Hickenlooper as well as Lorez Meinhold and Joan Henneberry.

The Governor emphasized that no one is exempt from sickness or injuries so viable health systems are critical to every community. Viable means quality health care is provided and costs are contained. Because costs are so high and consistently climbing we need to find ways to transform our health care system from one that pays for volume to one that pays for value. Communities know best what that value means to them so they are important leaders in defining their own health systems. The governor praised Aurora Health Access for being such a leader.

Importantly, the Governor also emphasized that Colorado should be a leader in transforming health care, and that it is economically imperative that we do so, starting with cities like Aurora where residents and health care providers and advocates are willing to work together and be innovative.

Progress in the Community

Joe Campe, Community Partnerships Coordinator with the Colorado Coalition for the Medically Underserved, led a review of progress in the Aurora health care community.

1. Culture of Coverage
   1. Tonya Bruno, Senior Marketing and Outreach Specialist for Kaiser Permanente, discussed the details of its new KP Step Health Insurance program for low income individuals and families. Uninsured individuals must be age 34 or under with family incomes 300% or less of poverty (small list of preconditions apply). Premium costs are sliding scale based on family income and family size. While the benefits don’t appear as robust as the old Kaiser Connections, nevertheless, KP Step is truly a step in the right direction in providing affordable health insurance for young families and residents of Aurora. Tonya provided the KP Step Plan brochure and premium guidelines to everyone at the meeting.
   2. Rich then described our MORE grant project which provided specific Aurora health care information to low wage employers, like ethnic restaurants. This project will continue thanks to a small grant from HCPF. We encouraged each AHA member to patronize those restaurants and thank the managers for participating in Aurora Health Access.
   3. The Coverage workgroup also encouraged AHA members to promote PEAK with businesses that interact with families, like churches, schools, daycares, pharmacies. PEAK is Colorado’s new online public program enrollment system, and greatly simplifies availability of Medicaid and CHP+ to low income families. Aurora Public School (APS) families should be encouraged to contact the APS Medicaid office through the school family liaison or nurse.  APS and Tri-County Health have enhanced their work and coordination in enrolling families.
2. Access and Care Coordination
   1. Molly Markert, Community Liaison for Regional Care Coordination Organization at Colorado Access, described the statewide project to find practical ways to lower the costs and improve the quality of Medicaid care. The project encompasses seven Regional Care Collaborative Organizations (RCCOs) made up of registered Medicaid providers affiliated with Colorado Access and selected Medicaid clients. Aurora is in the East Metro region or Region 3. The RCCO project tests different regional implementations of Medicaid reform that attempt to change the incentives and health care delivery processes for providers from one that rewards a high volume of services to one that holds them accountable for health outcomes. It’s a complex program with initial glitches, especially in assigning Medicaid clients to specific RCCOs, but those problems are being worked out. Ultimately we need a more efficient way to manage Medicaid for any health care reform and community health system to be effective.
   2. Aurora Health Access is also analyzing Aurora community ER use data that has been supplied to us from Childrens, University, Saint Joseph’s and Parker Adventist hospitals. We expect similar data from Medical Center of Aurora shortly. This data will provide a quantifiable picture of the issues in Aurora health access. Once the data is obtained and analyzed, all Aurora Health Access partners can brainstorm solutions for the specific problem areas identified. Other urban communities throughout the country have done the same thing. Part of Aurora Health Access’ job will be to evaluate those models in light of the needs of Aurora identified by the ER data and other analysis of health care in Aurora. We expect to have preliminary results of the ER data analysis available to discuss at the December 14 Aurora Health Access meeting.
3. Health and Wellness
   1. Heather Jackson of Aurora Mental Health reviewed projects and programs supported by the Health and Wellness team:
      • Recreation Centers. Most members agree Aurora should have more readily available centers for family and children’s healthy activities and are supporting Aurora Ballot Number 301.
      • Steps to Fresh Produce Program. Aurora Health Access supports Aurora’s/Tri-Counties’ grant to businesses to supply fresh produce to areas of the city where such produce is limited. This is a great step to provide healthy eating options to families in neighborhoods where those options don’t exist within walking distance. It’s just a step but can build a model for expanding fresh produce to food deserts in the city.
      • Tobacco Free Aurora. Most members support this Bacchus Networks project to license tobacco sellers in Aurora. Tad Spencer passed around the cute containers of Camel Orbs, Sticks and Strips of dissolvable tobacco products that can be sold without any license. While such products should not be sold to minors, we need meaningful disincentives for stores that do, such as revoking their license to sell tobacco if caught selling to children. Minors will find these products very cool because they don’t have tobacco taste, you don’t need to spit, and you can conceal them easily as you would a breath mint. But they are highly addictive as a nicotine product. It makes sense to most of us that sales of such dangerous products should be licensed.
      • Small business incentive. Building on the work of the Culture of Coverage, Health and Wellness members will meet with Art Heredia to expand the message of coverage to also one of health and wellness to small business, such as ethnic restaurants. We’ll encourage them to display fliers and posters emphasizing healthy options in employees and customers’ lives.
      • Support for Active in the Park. Aurora’s new 2040 Partners in Health office has a grant to promote children’s activities in Civic Park. Aurora Health Access supports this project to keep children active.
4. Health Information Exchange (HIE)
   1. Dave Myers of MCPN, Chris Beasley of Aurora Mental Health and Mark Carlson of the Colorado Regional Health Information Organization (CORHIO) reviewed the status:
      • We need to link providers and hospitals with real time electronic health information about their patients. Providers and hospitals should have quick and secure access to lab test and pathology results, X-ray, MRI and other imaging reports, physician transcription reports,  patient medication, allergies and immunizations lists, as well as lab and imaging orders for each patient. Relying on manual records, faxes and telephone calls is costly, time consuming and reduces quality of care. CORHIO is Colorado’s path to linking providers up electronically this way. Patients would also have access to their records through the patient portal, once provides are on board. Currently Centura Health (ie Parker Adventist) is partnered with CORHIO, as well as other providers in the San Luis Valley and Pueblo. Childrens should link up in early 2012. We need to work with University and Medical Center of Aurora and other providers to link up.
      • Aurora Health Access’ strategy is meeting one on one with interested parties to explain the benefits of a true health information exchange system and begin to develop a critical mass of adopters so that within 2 years all significant providers are communicating their patients’ status and needs electronically. Aurora Health Access agrees that this HIE project should be aligned with the innovations coming out of the RCCO project to improve quality and reduce costs in Medicaid. Med student, Joseph Johnson, underscored how important an effective HIE would be to him in his practice. Presently he spends 1/3 of his time in patient care trying to look up patient medical records through existing manual means. That is costly and inefficient for everyone in our community because his time and talent is best accomplished in hands on patient care not tied up in historical research on patients.
5. Policy
   1. Our last Aurora Health Access meeting generated the need for a workgroup to monitor, analyze and advocate on policy that could impact the Aurora community from local, state and federal sources. We need our health care community to be prepared to implement and adjust practices that are most efficient and effective the changing health care environments around us. We also need to be aware of new health care models that other communities have adopted that might improve quality, reduce costs and improve access to care in Aurora.
      • We are looking for Aurora Health Access members to participate in this work group! Presently Joe Campe, Zach Zaslow, Nancy Jackson, and Erica Chavez have signed up.

After this review of Aurora Health Access progress, we broke into small groups to discuss who needs to know about the work of Aurora Health Access. The Aurora Health Access leadership team will distill the notes from these discussions and share the findings soon!

Thanks to the following organizations who attended:

MCPN, Aurora Public Schools, University of Colorado Hospital, Metro Organizations for People, Aurora Mental Health Center, CORHIO, The City of Aurora, CCHAP, People House, Adams County Human Services, HCPF, Tri-County Health Department, Arapahoe County Commissioners, The Bacchus Network, Kaiser Permanente, The Children’s Hospital, Family Voices Colorado, The Center for Public Health Practice, Colorado Access, Next Care / Urgent Care, Aurora Chamber of Commerce, Colorado Association for School Based Health Care, 2040 Partners in Health, CTEPA, Rural / Metro Ambulance, Arapahoe Early Childhood Council, Colorado Coalition for the Medically Underserved