Talking health care with Senator Rachel Zenzinger

Posted 9/11/18

During the break between legislative sessions each year Senator Rachel Zenzinger, (D-Arvada), conducts a series of tours in the district to hear firsthand from constituents, businesses, schools and …

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Talking health care with Senator Rachel Zenzinger

Posted

During the break between legislative sessions each year Senator Rachel Zenzinger, (D-Arvada), conducts a series of tours in the district to hear firsthand from constituents, businesses, schools and other organizations about any concerns or priorities they may have. This year she and her team decided to mix it up a bit and do a health care tour. The Arvada Press sat down with Zenzinger following the tour to see what she learned and how it what to expect in healthcare legislature in the near future.

Why did you focus on healthcare?

It’s not my area, but I’m trying really hard to dig in and learn about it and figure out how we can draft good policy solutions. It’s tough because healthcare as been politicized, which makes it really hard to tackle problems without everyone running to their camps.

For a long time in Arvada, we were a healthcare desert. I’ve been thinking about healthcare for a long time recognizing we were somewhat deficient. When we got our first stand-alone emergency room there were all of these questions about if it was good or bad; if it was regulated or not; and how we should we interpret their emergence in this area.

Fast forward and now they are everywhere and a good majority are now affiliated with hospitals and they operate off of their hospitals license or within a network. But there is still consumer confusion over what is an emergency room and what is urgent care. Because of this customer confusion and the difference in billing, it started to become an issue.

So we took that up over the last session and tried to design some guidelines and transparency measures for these stand-alone emergency rooms. Given that our district does not have a hospital, but we do have a large number of stand alone emergency rooms and urgent cares, it seemed to be something to investigate.

Where did you tour and what did you learn?

One of the places that we toured was the Centura Health Emergency Center at Church Ranch. This is a brand new facility attached to the existing Church Ranch Neighborhood Health Center and open to the public 24 hours a day, 365 days a year for treatment of emergent and urgent medical conditions. They are under the Centura umbrella but they are also an affiliate of Avista Adventist Hospital and operate under the hospital license.

A couple take aways from that visit was they were already implementing the changes mandated by legislature well in advance of the deadline. It was really impressive to see their transparency measures. The second takeaway was that there was so much more there than the ER They had a whole host of other services: primary care doctors, pediatrics, obstetrics, occupational therapy… They also had Health Images, a stand-alone company that does MRI, x-ray and other scans. That was incredible and I had no idea. So the benefit for that was that it was really integrated care. It was similar to when we visited Kaiser. It was that integrated health approach. That was really incredible and eye-opening.

We also toured the Kaiser facility and integrated care has been their model since the beginning. It was exciting to see our district now has more options.

What is the new legislation?

It really had to do with feedback with consumers over that confusion of if you’re at an urgent care or an ER It’s about increasing transparency or consumer information so it’s not a surprise after the fact. In 2017 there was a bill — SB17-064 — which had to do with that licensing for free-standing emergency rooms. It is important to know there are standards and accountability. This year the bill that we focused on was HB18-1212. That’s where they starts to spell out if someone offers urgent care or emergency room services and if you are owned or operated by a hospital or if it is independent, legislature is adopting some rules around the standard of care patients will be receiving and an increase in transparency.

What was the biggest conversation had?

We still had a lot of conversation around the cost of care. One of our takeaways is that by integrating the service — having a one-stop shop is not only preferred from a patient perspective of convenience, but it also more cost effective. It actually has an impact on the bottom line. One of the cost drives is that you don’t get the scan or do the post surgery care because it’s inconvenient. But often times you need more intervention later, which costs more.

That’s where Kaiser has always been a leader. And that’s why Kaiser is the largest HMO in Colorado and they are able to keep those costs down.

There was also conversation and concern over Medicaid reimbursement and providers not getting the full reimbursement of what it costs to deliver care. That causes some concern on the part of the providers because they still have an obligation to deliver good quality care, but they know it will cost them to take on Medicaid patients.

Another topic that came up was access — really trying to make sure that we increase access in our community.

What concerns you about healthcare in the district?

I’m still really concerned about the cost, coverage and access. That is still such a giant problem. Even though I felt that were part of the team what was trying to help, they are more reacting to the problem and they are waiting for us and legislature to drive the solutions. We don’t know what will happen with the Affordable Care Act or with our system in Colorado. Will the new administration come in and change that?

There’s still some uncertainty. But I am happy to know that there are more options now. Now I think it comes down to striking the right balance and making sure that we have that transparency and consumer protections and if we do, then I think we really benefit from having more options.

What legislation around healthcare do you think will come up in the next session?

We discussed with United Healthcare about the guarantee fund, an insurance for insurance companies. The policy question that might come up is that policy has not been updated — how that fund is administered, who pays into it and what it covers — in about 20 years. That was prior to the ACA and stand-alone ERs. Healthcare has changed so much.

The way that it is right now, life and long term care insurance pays 15 percent into the fund and healthcare pays 85 percent into the fund. There are no HMOs that pay into it at all. United thinks the split is not equitable because the recent companies that have gone out of business is life and long term.

Then an issue I heard from constituents is about prior authorization for prescription medications. Some people will go in for a prescription that they are told to get by their doctor and then are turned away at the pharmacy because they had to get prior authorization from the insurance.

Related to that is the drug pricing. There were some bills that came through this last session that was unsuccessful. But I hear a lot that that’s a problem they want to see addressed.

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