The State of Colorado has been working hard to increase access to healthcare for every person regardless of race, socioeconomic status, age, and citizenship. One demographic that still needs focus is the residents of rural Colorado. There is work to be done so that healthcare equality is achieved with this group.
There are places in Colorado where people are routinely driving over an hour to see a provider for very routine visits. In the Colorado State 2017 Health Access Survey 5.5% of people surveyed stated that transportation and distance to a provider was the biggest barrier to getting health care. In a state of approximately 5.6 million people that works out to about 304,000 people where distance and transportation is inhibiting access to quality care. This represents a group of people larger than the 4th largest city (Fort Collins) in Colorado. These numbers do not include those that have larger barriers to care such as being able to get time off work or finding child care for the duration of the visit, who also still have distance and transportation as a limiting factor.
Let’s dig deeper into why this barrier exists. Colorado has 64 counties of which 73% are considered rural. This means that people who live in these areas are spread farther apart from each other and from population centers. Traditionally, in many small towns, there was a doctor who provided a broad range of services, but with primary care doctors decreasing, increased urbanization, and retiring of existing physicians, the towns with a doctor present are decreasing. Examples in Colorado include Park County which presently has no medical provider in the county after the last physician from Fairplay retired four years ago. San Juan County has one advanced practice nurse that is available one day per week. Crowley county also has no doctor and has a single clinic with one advanced practice nurse. Not only is the primary care physician less present in small towns, but as a whole, medicine has become more specialized. Illnesses that in the past may have been treated by primary care, are now increasingly being sent to specialists.
Lack of rural health clinics, and especially hospitals and emergency rooms is another barrier to care. There are many federally qualified health centers and critical access hospitals with small emergency departments in rural Colorado, but there are still counties who do not have these resources. According to a 2017 Colorado Rural Health Center Snapshot of Rural Health Report, 11 counties in Colorado have no hospital, and two counties have neither a hospital or clinic.
There are several solutions that people have tried in the past to help address the access to care issue. On a system level, the critical access hospitals and federally qualified health centers receiving government funding have helped to increase the access of care in some areas. Some individuals will also drive the distance knowing that the choice to live in a rural area has this drawback. Other people have decided to move to more urban locations due to medical needs being more easily met. Many people will delay care as long as possible so that they can reduce the need for travel and cost. These solutions have inherent problems of their own. Opening more clinics and hospitals is difficult because of the costs and numbers of patients needed to be successful. With more people moving from rural to urban areas, this is going to be an increasingly difficult solution. Delaying care, or traveling long distances can also increase cost, increases morbidity, and decreases overall health of the patient.
Like any complex problem, there are multiple solutions to the problem of rural health care access in Colorado. Technology can be used in many ways to try and help overcome these problems, and at Care on Location, our goal is to use technology to provide convenient access to care when it is indicated. Sometimes it’s easy to look at the numbers and start thinking about demographics on a large scale and have a desire to implement system wide policy changes hoping for improvement, but let’s think about individuals for a minute, and give some real examples of what Coloradans face.
A family lives in central Park County with three children. The father works in construction while the mother stays home and raises her children. During the day the mom notices her youngest child start to have a red eye with mild discharge. She is concerned about the eye but lives 30 minutes from the nearest doctor in Summit County. She would travel over to Summit County with her three kids, but has had an unpleasant medical visit from that clinic before, so she doesn’t feel comfortable. The next closest provider she could take her child to is an urgent care or emergency room in Denver one hour away. As you can see, a system wide change of increasing clinics may be beneficial in Park county, but there also needs to be quality and trust. As individuals we want what’s best for ourselves and our kids, and sometimes even the convenient solution (in this case going to Summit County) won’t be chosen. The point of all this is to say that individuals and individual locations need special attention that is not a broad brushed solution, but rather tailored toward the specific needs.
Care on Location is primarily focused on illnesses and injuries that are acute and need attention now but are not true life-threatening emergencies. We use secure video doctor visits to diagnose patients and treat as necessary. As a local Colorado company, we want to provide solutions that are dedicated toward improving each area in Colorado. There are several key overarching building block components that are necessary to create these solutions.
The most important aspect of what we do needs to be the quality of medicine that we provide. As a telemedicine urgent care company, we could be similar to some national companies that hire contract doctors to provide their care, but we want to provide more. Our providers are trained specifically in telemedicine emphasizing the key components that are different between in-person and video visits. Our providers are also all local to Colorado, ensuring that Colorado unique diseases and illnesses such West Nile Virus, or altitude sickness are not forgotten about. We strive to maintain a high level of medicine so that trust can be created.
Another key building block of our company is to align our services with the interests of the patient and not with the interests of for-profit entities when it is clear their goal is to extract maximum revenue from those patients. This also enables us to have the freedom to work with different groups, municipalities, and companies.
We also feel that as a company whose mission it is to improve access to care, our goal should be to work with all of Coloradans. This means that we have an increased focus on seeing patients with Medicaid and CHP+ insurances. Healthcare advancements often come to public insurance utilization last, but this group of people in Colorado is in the most need of local solutions.
Here are some examples of the unique ways that Care on Location is working to improve access to care in rural Colorado.
We are working with county public health offices to understand the unique problems each county faces in Colorado. The solutions that come out of these discussions vary by county.
- In one location it may be best for Care on Location to work with a local clinic that does not have a provider on staff regularly. This allows Care on Location to see patients over video, thereby creating a locally functioning clinic staffed by local residents with distant but connect Colorado medical providers.
- Another solutions is the collaboration with mobile care providers such as local nurses, paramedics, and more to connect patients to physicians, physician-assistants, and advanced practice nurses.
- In some areas the schools are in need of video-based medicine. Having a provider available in clinic over video helps to provide the student with prompt care, allowing them to get back in the classroom sooner and avoid unnecessary absences and emergency room visits.
- In other counties, providers that are already present need after-hours coverage that Care on Location can provide. This coordination increases provider availability to the patient while creating a closed loop of communication with the patient’s primary doctor.
To improve Colorado’s urgent care and overall health needs, Care on Location is overcoming several hurdles in the widespread acceptance of a new healthcare provision model. Many people don’t understand the power of technology, and the ways that Care on Location is able to take care of their medical needs. Telemedicine education is a work and progress, and requires time to build up, just like the trust of any medical provider. Some areas of Colorado also don’t have internet access that is necessary to facilitate the connection for a video visit. Thankfully, in Colorado recent legislation has put an increased emphasis on broadband access to every Coloradan. One hurdle that is harder to overcome then imagined is the coordination of local and telemedicine providers. Many local providers that I have talked to express a distrust for telemedicine because they feel that their patients who have used these services have not had information relayed back to them as the primary care providers. We are working to clear all of these hurdles so that we as Coloradans have better, more convenient healthcare that improves not only the “system” as a whole, but individuals lives.
Consider the mother from Park county who we discussed earlier with the difficult decision of where to take her child. With Care on Location she can see a provider from her home over her smartphone. The provider is able to reassure her, provide areas for her to monitor her child, give a prescription if necessary, and then give options for follow up based on her local area. As symptoms change she can recontact the provider, and change treatment plans as necessary. The provider is also able to communicate with the patient’s primary care provider, closing the circle of communication. This is a system where patients can trust that their local needs are provided for, no matter how far away they are.
Consider leaving your comments about solutions you would like implemented in your area, or, we are also happy to hear from you if you would like to contact us directly about working together to improve your local Colorado.