Initiative Examines Impacts of Healthcare Reform in Telluride Region

05 Jul Initiative Examines Impacts of Healthcare Reform in Telluride Region

The Patient Protection and Affordable Care Act (ACA), also known as “Obama Care,” goes into effect in less than 100 days, and the Telluride Health & Wellness Center Initiative has been busy analyzing how healthcare reform will impact health care and health care providers in the greater Telluride region.

“Because more people will be insured in 2014, there will be a significant increase in the number of people accessing care,” said Lynn Borup, Executive Director, Tri-County Health Network. “This will create increased wait times to get in to see a doctor, and especially to see specialists. Some experts are saying that a three-month wait for a specialist could increase to a six months.

Similar to the 17 other states setting up their own state-based Health Insurance Exchange, Colorado has chosen to create its own exchange rather than rely on the federal government. Named “Connect for Health Colorado,” the exchange is designed to help people understand what their health benefits options are and find coverage.

The ACA requires that all Americans be enrolled in some type of program by January 31, 2014. Individuals can either decide to keep their current insurance plan or purchase an insurance plan through an online marketplace otherwise known as a “health insurance exchange pool”. The exchange will be similar to travel websites and make it possible to easily compare and buy private insurance and determine if you qualify for financial help. Individuals will be able to choose the provider they want for their family based on which carrier offers the most attractive package in regards to affordability, coverage, and quality. Exchange pools are meant to be competitive and help increase the quality of healthcare while driving costs down.

Connect for Health Colorado will be open for business October 1, 2013, selling coverage that becomes effective January 1, 2014. Individuals may qualify for discounts to help pay for premiums if their individual income is from $15,302 to $46,021 or $31,155 to $93,700 for a family of four. Individuals can also find out if they qualify for extra subsidies to help with out-of-pocket costs or for government programs such as Medicaid and the Children’s Health Insurance Plan (CHP+).

There are currently 6,480 people residing in San Miguel County, and it is estimated that 24 percent are uninsured, while 13 percent are underinsured. Underinsured people have health insurance, but it is so limited that it does not cover basic health and healthcare needs or the deductible is too high, preventing people from seeking much needed care. By 2014, it is estimated that the number of uninsured people will drop to just over 11 percent and the underinsured population should reach near zero.

“Telluride currently has excellent primary and emergency care and limited specialty care.” said Davis Fansler, member of the Telluride Health & Wellness Community Council. “However, the implementation of Obama Care will fundamentally expand services and usage at the medical center from not just diagnostic and treatment but to also include prevention and wellness. This dynamic along with the surge in the number of insured will invariably create pressure on access both locally and regionally.”

Locally, it is estimated there will be an increase of at least 287 visits to doctors – with the highest projection at 485 more visits per year – creating a need for staff and space to address this increase of people accessing care visits. The Telluride Medical Center building has a lease on land it does not own. Built in the 1960s, the current 9,000 square foot building has been expanded and remodeled over the past 15 years but does not meet medical building licensing requirements.

Many experts predict a fundamental consolidation of providers within the healthcare system. Preliminary research has shown that as demand increases and payment reimbursements flatten due to competition and efficiency, clinics and medical centers will need to consolidate or develop joint ventures with larger healthcare systems to stay financially viable.

“With the shift from paying for procedures to paying to keep people healthy, we are seeing a rapid movement away from the independent practitioner to systems and group practices, said Fansler, “We are telling physician groups that they need to live on Medicaid level reimbursements. Efficiency and collaboration will be key to thriving in the new health reform marketplace.”

To address this issue, the Telluride Health & Wellness Center Initiative has been created to examine how this shift in policies and the healthcare delivery system could change practices for the Telluride Medical Center and if a new medical facility could open new opportunities for expanded services and relationships for Telluride.

The Telluride Health & Wellness Center Initiative is charged with investigating the feasibility of a new facility or campus that is financially self-sustaining, expands the range of health, wellness and healthcare services offered in Telluride and that can be done without taxpayer money. The guiding principles of the initiative include:

·         Genuine and active public participation is vital to determining the community’s health and wellness needs now and into the future.
·         The Medical Center needs a new facility given the age of its current building, location and space, and licensing constraints and to meet the burgeoning demand, changing patient needs, and variety of future health care models.
·         An opportunity may exist to expand the scope of healthcare services offered in the Telluride region based on a suitable site and a sustainable business plan. Additional services not presently available could be included in a facility and/or campus, providing cost savings and regional economic development.
·         Limited sites in Telluride, Mountain Village, and Society Turn are available that are being evaluated, as they may be suitable for the current and expanded facility needs.
·         Plans should be developed that will avoid additional district tax levies, and the facility should be financially self-sustaining.

For more information on the Community Council and the Telluride Health & Wellness Center Initiative, or to join the conversation, please go to www.telluridehealthideas.org, or to join the list serve at www.bigtent.com/groups/tellwell, “like” our Facebook page “Telluride Health & Wellness,”  follow us on twitter @TRIDEWELL, or contact the Telluride Foundation at 970-728-8717 or vista.develop@tchnetwork.org to be added to the e-mail distribution list.