Health care in crisis
Coalition looks for solutions to county's woes

SideStory: Remedies to go public

A sign directs visitors to Mercy Medical Center’s Emergency Room. The state of health care in La PLata County also is in crisis mode, thansk partly to bthe closing of Valley-Wide Health Services last spring and a dearth of primary care physicians in the area. A recently formed community coalition is attempting to find solutions to the problem and will be discussing options with residents on Mon., Sept. 24./Photo by David Halterman

by Will Sands

Between 6,000 and 10,000 La Plata County residents currently lack access to health care. However, there may be a grassroots solution to this “crisis” situation. A community coalition recently took the first step toward healing La Plata County’s health-care woes.

In March of this year, Valley-Wide Health Systems pulled the plug on its Durango clinic, which served more than 12,000 local adults. Many of these patients were covered by Medicare and Medicaid, lacking health insurance or recipients of the Colorado Indigent Care Program. With the clinic’s closure, the vast majority of the 12,000 residents using its services were effectively left without medical care.

“Valley-Wide’s population was largely self-pay, Medicare- and Medicaid-dependent, or indigent,” explained local businessman Pat Murphy. “That closure created a crisis for people who counted on that service and suddenly can’t find providers who would accept that form of payment. That problem was further accentuated by the fact that we don’t have enough primary care physicians in our community to serve our population to begin with.”

Valley-Wide first announced its impending closure in the summer of 2006, shortly after voters rejected the Health Services District, a grassroots ballot initiative to open health care to La Plata County’s underserved populations. In response to these two turns, Murphy and others flew into action. In a short time, a broad coalition of community members, physicians and service providers took shape and named itself the Primary Health Care Community Coalition.

“With the Health Services District failing and Valley-Wide leaving the community, it became obvious that a new approach was needed,” said Marsha Porter-Norton, coalition member. “There is a critical need for primary care in our community, and it’s mostly for populations who do not have easy access to health care.”

Shortly after forming in late 2006, the coalition set to action. First, the group partnered with Mercy Medical Center, the City of Durango and La Plata County to put a safety net in place for the time when Valley-Wide closed. As a result, a short-term, stopgap solution to the primary care shortage, the Health Service Clinic, opened in late April at the former hospital site. Since that time, the clinic has offered medication management; acute medical care for minor illnesses; preventative care checkups; and medical monitoring of chronic medical conditions.

The coalition and Mercy then kicked off a search for a more permanent solution to the local health-care crisis. With the help of funding from the City of Durango and La Plata County, they engaged a consultant to study the existing primary care picture and design a primary care improvement plan. John Snow, Inc., a national firm that has conducted similar studies elsewhere, has worked to create a plan to provide sustainable primary care access to La Plata County’s most vulnerable residents.

Reesa Webb, JSI’s project director, explained, “There were a number of events that led up to coalition approaching us. Basically, there was a concern that many patients no longer had access to care. The underserved populations in particular were in crisis, since not a lot of physicians take Medicare or Medicaid or accept the uninsured.”

With this in mind, JSI began to compile an overall assessment of La Plata County’s primary health care environment and determine appropriate solutions. First, the firm reviewed and updated past studies on the capacity of primary health care providers in La Plata County.

“We reviewed a lot of the data that was readily available, and then we went to focus groups and interviews,” Webb said. “Then we took the historic data and our new findings and integrated them.”

Using the assessment, JSI developed recommendations for addressing the primary health care needs of La Plata County residents. Those solutions will eventually go into a primary care improvement plan specific to La Plata County. JSI will present its current findings and gauge community input during a series of community meetings on Sept. 24 (see sidebar). While JSI will not reveal the specifics of its findings until the meetings, Webb did offer some generalities.

“We looked at potential models for La Plata County’s existing clinics to enhance their reimbursement strategies so that they would be more willing to take people with Medicare or those without insurance,” she explained.

The big problem for La Plata County, however, is an absence of primary care physicians, she said.

“We did determine that there was a need for additional primary care providers in the community,” she said. “For rural health care, it’s always a big issue, although Durango is becoming more of a resort than a rural area. It’s just difficult to recruit physicians to those kinds of areas, and more providers are needed.”

Webb and JSI will go into much greater detail Sept. 24. However, the most important step in the process in now bringing La Plata County to the table.

“The goal is to bring the community on board,” she said. “We want your buy-in on these recommendations, then the coalition can go ahead and begin to implement them.”

Murphy echoed this sentiment, commenting that now is the time for La Plata County to begin addressing its own problems.

“There’s not going to be any easy answer, and it’s not something that someone else is going to solve for us,” he said. “This problem is something we as a community have to work on, and the first step in that direction is finding out how acute that problem is.”