1. A Presentation of the Colorado Health Institute 1576 Sherman Street, Suite 300 Denver, Colorado 80203-1728 www.coloradohealthinstitute.org Hot Issues in Health Care Legislative Conference November 17-18, 2006 Health Care Access Legislators as active partners in promoting local health care innovation

2. 2 The diversity of Colorado’s communities

3. 3 Overview The role of community innovation What is the community safety net? Legislators’ role in community innovation –Regulate –Appropriate –Facilitate Lessons learned

4. 4 The content of this presentation… Is based on interviews with community innovators around Colorado Focuses on the health care safety net Highlights case studies in which communities have successfully collaborated with state lawmakers to create access to care solutions

5. 5 Promoting access to care: The role of community innovation Three entry points into health care system: Employer- sponsored health insurance, public health care coverage and community safety net systems Coverage vs. direct access to care: Complementary or alternative strategies? Access to health care is more than a health insurance card – it is health care that is available, accessible, accommodating, affordable, acceptable and culturally appropriate

6. 6 What is a community safety net? Private and public entities collaborating to provide medical, dental and mental health care to medically underserved individuals, including (but not limited to): –Private doctors –Faith-based, nonprofit clinics –Local health departments –Rural health clinics –Community health centers –Community mental health centers –Hospital emergency departments

7. 7 What makes communities ideal innovators? Natural laboratories for testing new ideas Immediacy of the problem: Friends and neighbors facing barriers to medical, dental and mental health care access Closer to the problem, clearer vision for practical solutions Willing to try new ideas Sustainable partnerships more likely when community members collaborate to solve shared problems

8. 8 The role of legislators as catalysts of community innovation Legislators… – Promulgate rules and regulations – Appropriate state and special funds – Facilitate local innovation through partnerships with local policymakers and community leaders – Are the ultimate policy connectors to the community

9. 9 Mediating the regulatory environment… Legislators are positioned to be arbiters of federal, state and local regulations Regulations can serve as barriers to community innovation Knowledge of community variation is key to avoiding unintended consequences

10. 10 Mediating the regulatory environment… State-local partnership providing regulatory relief for community innovation: Health District of Northern Larimer County

11. 11 An example of mediating the regulatory environment Health District of Northern Larimer County: –More expensive to provide substance abuse treatment in hospitals –Antiquated regulation –Worked with state agencies and key legislators –Regulation was fixed to allow co-location of mental illness treatment and substance abuse treatment within acute treatment centers

12. 12 Rules and regulations that work Effective regulations are those that… –Remove barriers to local implementation while guaranteeing health and safety –Create incentives for innovation –Enable creative problem-solving –Respect variations that exist among communities (e.g., rural and urban) –Provide flexibility to accommodate local customs and norms –Allow collaboration across jurisdictional boundaries

13. 13 Appropriations to increase access Amendment 35: From voter initiative to release of first round of primary care funds Voter-approved initiative Enabling legislation to set parameters for release of Primary Care Fund Rule-making to establish criteria for eligibility for funding

15. 15 Matching appropriations to local needs Legislators can often leverage federal funding to match with state and local funds (federal/state/local funding partnership) Monitoring return on investment outcomes Although 80% of Colorado’s population lives in a metro area, some of the greatest access challenges occur in rural communities

16. 16 Facilitating policy innovation A prospective example of legislators facilitating state-local policy innovation –Diffusion of health information technology through state-local partnerships: The case of the Colorado Regional Health Information Organization (CORHIO)

17. 17 Bridging the state-local partnership gap Federal State Local Level of Government Community Innovation Facilitated by: O pen communication Collaborative strategies Engagement of key partners

18. 18 Maximizing innovation… Ensuring that political ideology does not trump community interests Building creative partnerships of individuals and organizations that collaborate to fill the access gap Being data-driven and evidence-based Ensuring maximum community participation across community sectors Maintaining ongoing and strong relationships with state policymakers Being active listeners

19. 19 Lessons learned from successful state-local partnerships Policymakers blend the interests of their communities with the interests of the state as a whole Creative thinking, flexibility and mutual commitment are necessary ingredients for innovation and policy development at the community level

20. 20 Now for the experts… Sue Birch, Northwest CO Visiting Nurse Association Dace Carver Kramer, Northwest CO Visiting Nurse Association Mark Wallace, MD, North CO Health Alliance