rural colorado portfolio. rural community legislature

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Rural Colorado Portfolio

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Page 1: Rural Colorado Portfolio. Rural Community Legislature

Rural Colorado Portfolio

Page 2: Rural Colorado Portfolio. Rural Community Legislature

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

Page 3: Rural Colorado Portfolio. Rural Community Legislature

Rural Community

Legislature

Page 4: Rural Colorado Portfolio. 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?

Page 5: Rural Colorado Portfolio. Rural Community Legislature

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

Page 6: Rural Colorado Portfolio. Rural Community Legislature

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

Page 7: Rural Colorado Portfolio. Rural Community Legislature

Rural Is…

• You call a patient; get the wrong number, but it was someone you needed to talk to anyway.–Bob Yanni

Page 8: Rural Colorado Portfolio. Rural Community Legislature

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

Page 9: Rural Colorado Portfolio. Rural Community Legislature

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

Page 10: Rural Colorado Portfolio. Rural Community Legislature

Rural Is…

• They hold a ribbon cutting for a traffic light

Page 11: Rural Colorado Portfolio. Rural Community Legislature

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

Page 12: Rural Colorado Portfolio. Rural Community Legislature

The good panel discussant

Sell an idea

Ask for the money

Never Ask for Money

Page 13: Rural Colorado Portfolio. Rural Community Legislature

• The State Legislature makes lots of healthcare policy

• You are part of a Balanced Rural Portfolio