Q.  What role should the Health District play in health policy development and advocacy?

A.  The Health District is well-positioned to develop health policy and do advocacy. Over the years, it has established a strong research team. Not only does it conduct a triennial community health assessment, but it conducts other research as well. A legislative analyst keeps the Board up-to-date on bills at the Colorado General Assembly. When you hear any of the staff speak at meetings, you can tell that they are thoroughly knowledgeable. With these strengths, the Health District should continue to weigh in on community health issues. It should be assisting not only our state lawmakers, but also Larimer County, Fort Collins, Windsor, Timnath, Wellington, and people in outlying communities such as Laporte, Bellvue, and Red Feather Lakes. I would also like to see Board members take on a greater role in reaching out to elected officials of other jurisdictions. It seems like this may not be happening, and yet it could be very beneficial for all to nurture these connections.

Q.  How should the District partner with other key community health organizations?

A.  In my work in the community, I find that partnerships among organizations make many things possible that would not be possible on one’s own. Partnerships are key for creating substantive change. Finding common values and goals leads to good collaboration and to finding solutions that work for everyone. It seems that the Health District has good partnerships with many organizations in Northern Colorado – for example, the Mental Health and Substance Use Alliance (see more below). At the same time, sometimes key contacts retire or new organizations come into being. The Health District staff and its Board should be continually seeking new connections with people and organizations in the community.

Q. What is the role of the Health District with the current statewide public health crisis caused by COVID 19? What new or expanded approaches, such as telemedicine, would you support to increase prevention and access to care, especially in the midst of a crisis like COVID-19?

A. The role of the Health District in the response to COVID-19 is a support role. The Larimer County Health and Environment Department and the Colorado Department of Public Health and Environment are the lead players. The Health District should and has altered its services to serve the public in a safe manner. It stopped most in-person services. It ordered 61 new cell phones and, in a short period of time, set up new infrastructure so that its staff could telework. I was impressed at how nimble the organization was in shifting to a very different style of work, so that it could continue to provide mental health services and insurance navigation when so many people are going to need them. Not only that, but the Health District jumped in to assist with several homeless services organizations that are setting up a shelter at the Northside Aztlan Center.

Given the Health District’s strong research capabilities and the Board’s role in advising other entities, I wondered if the Board would take a position on sheltering in place at its March 24 meeting. The question was not raised. I’ve also been wondering about greater collaboration with Larimer County, about a possible role of the Health District at the Emergency Operations Center, and about the possibility of a policy around reassigning staff to assist other agencies during emergencies. However, this is an unprecedented time and things are moving rapidly, so some questions will have to wait.

On the question of new or expanded approaches, I think we’re all going to be trying new things! Certainly, telemedicine is a godsend in times such as these, where meeting in person carries risk. There are apps that clinics could explore for tracking and keeping in touch with patients or clients. Holding classes using online platforms is a possibility, as is online learning with video or game modules. So many people are using social media during this crisis, that now would be a great time to enhance the Health District’s social media presence.

Q. What do you see as the role of the Health District in planning and implementation of the Larimer County Behavioral Health Project? Do you think the Health District should expand its public education to reduce the mental health stigma? If so, how?

A. I supported and was happy to see the Behavioral Health Services tax pass in 2018. As we learned at the time, there were 26,000 Larimer County adults with a substance use disorder. About 2,300 people were receiving care, but another 1,200 were seeking treatment and couldn’t get it. That was not the only type of behavioral health the tax sought to address, but it was a big one.

Larimer County has the lead in administering both the new services and in designing the new facility. In 2019, it awarded $1 million in grants to 28 organizations all across the county to serve students, veterans, seniors and others struggling with behavioral health issues. Grant money is expected to grow to $2.5 million in 2020. The Health District has been serving in an advisory role – mostly through Executive Director Carol Plock’s participation on the Technical Advisory Committee. She has made several positive comments at Board meetings about the design of the new facility. I’m glad that the Health District is using staff expertise in helping to shape the future of Behavioral Health Services.

As for reducing the stigma around mental health, yes, the Health District should continue its public education programs. A 2018 report found that one in five adults – or about 54,000 people – in Larimer County have mental illness, along with a similar percentage of kids. We can see from the numbers that the need for care is strong and we should be striving to make sure people can access it. Shoring up gaps in mental health in Northern Larimer County is one of the Health District’s biggest efforts. The Connections Program has both an Adult Team and a Child, Adolescent and Young Adult Connections (CAYAC) Team. The Health District provides navigation and care coordination, along with many kinds of community classes, such as Mental Health First Aid.

Additionally, the Health District has a key role as a convenor and fiscal agent of the nonprofit Mental Health and Substance Use Alliance of Larimer County – a group that represents 35 different agencies. The purpose of the Alliance is to raise awareness about mental health and addiction, ensure effectiveness of treatment and services in our community, and create access to needed care for individuals. It will be interesting to see the interplay of Larimer County Behavioral Health Services, its various grantees, and the work of the Health District and the Alliance in the coming years. The Health District’s Board may need to be ready to shift and change some priorities.

Q. What role should the Health District play in addressing the opioid crisis?

A. Larimer County residents – like those elsewhere in the United States – are suffering from the opioid crisis. In 2014, the Larimer County Coroner reported 51 overdose deaths with 31 of those attributed to prescription opiates and another 8 from fentanyl and heroin.

The Health District has been responding to the opioid crisis in several important ways over the last few years. It joined the Northern Colorado Opioid Prevention Workgroup, which was formed in 2017. One of the workgroup’s key priorities is naloxone education and kit distribution. The Health District has been training “Naloxone Champions,” such as law enforcement, emergency responders, pharmacists, and concerned citizens on how to administer the life-saving treatment.

The Health District has also been partnering with several organizations to bring medication-assisted treatment (MAT) to Northern Colorado. This is an effective, evidence-based approach. Through a grant and with partners, the Health District helped to bring MAT to the county jail, as well as to area clinics. The Health District is also working to destigmatize substance use disorders and promote recovery through its classes and through its ChangingMindsLarimer.org website.

The Board of Directors studies bills in front of the legislature and makes recommendations. For example, the Board recently voted to support SB20-007: Treatment Opioid and Other Substance Use Disorders. This bill “helps to solidify MAT across the state as a standard of care” and requires that “all health benefit plans provide coverage for [substance use disorder] treatment.”

In 2018, the Larimer County Coroner reported 50 overdose deaths. The number of deaths due to prescription opiates had dropped to 8, but the number due to fentanyl, heroin, or meth and heroin was 13. Even with progress in one metric, we should keep seeking solutions.

The Health District should continue to play roles in coordinating with partners, educating and training community members, raising awareness about substance use disorders, promoting recovery, and advising the legislature on bills. I would suggest that the Health District and its Board could do more to let the public know about its many efforts in combating the opioid epidemic.

Q. Will the proposed Colorado Affordable Health Care Option have any impact on your services? What do you see as the pros and cons of that proposal?

A. The proposed Colorado Affordable Health Care Option (HB20-1349) would have an impact on Health District services, such as prescription assistance and Larimer Health Connect (the insurance navigators program). The purpose of the plan is to save people money on health insurance by bringing down the costs of health care. At first, the plan would be available to any Coloradan on the individual market, but later it could be made available to those in the small group market, too. Even if this public option were possible, some folks might still find their best option is an employer-based plan, Medicare, or Medicaid. That’s where the Health District’s navigators come in. There would likely be more demand for their assistance in choosing the right health insurance plan. On the other hand, if more people are covered by insurance, then the need for prescription assistance would likely decrease.

The Colorado Department of Health Care Policy and Financing (HCPF) has been looking for ways to reduce costs and get more people covered. Its Executive Director, Kim Bimestefer, spoke at the Northern Colorado Legislative Alliance Regional Issues Summit last November. Colorado has the eighth highest healthcare costs in the nation and the fourth highest administrative costs, she said. Another speaker, Bob Smith, Executive Director of the Colorado Business Group on Health, shared data showing the prices at Northern Colorado hospitals are higher than most other parts of the state – even twice as high in some cases. With this information in mind, it is not surprising that the bill would propose paying hospitals 175-225% of what Medicare pays (instead of the current average of 289%).

The biggest pros of the public option bill would be helping Coloradans to save 9-18% on individual premiums and to get more people covered. The plans would be sold using the current infrastructure of Connect for Health Colorado and people who receive federal subsidies could still get them. The HCPF said there would be low administration costs and no financial risk to the state or taxpayers. The HCPF also said hospital reimbursements would be set in a way that protects rural hospitals and allows for profits. On the con side, hospitals are worried. Another Regional Issues Summit speaker was Margo Karsten, CEO of NoCo Banner Health. She said hospitals need time to adjust to the financial changes brought about by the 2019 legislative session. She said that 22 counties have only one insurance carrier now and she was concerned that insurers might choose to leave the state altogether if they couldn’t operate profitably.