I_StatewideHealth_2021A 10/19/2021 09:40:52 AM Committee Summary

PUBLIC
STAFF SUMMARY OF MEETING
INTERIM COMMITTEE STATEWIDE HEALTH CARE REVIEW COMMITTEE

Date

10/19/2021

Attendance
Ginal	E
McCormick	X
Michaelson Jenet	X
Pelton	X
Ricks	E
Smallwood	E
Van Beber	E
Young	X
Fields	E
Lontine	X

Time

09:40:52 AM to 03:41:39 PM

Place

HCR 0112

This Meeting was called to order by

Lontine

This Report was prepared by

Elizabeth Haskell

Hearing Items	Action Taken
hCall to Order and Introductions	Committee Discussion Only
hCOVID Situational Awareness and Future Implications for Public Health in Colorado	Committee Discussion Only
hThe Long-Term Impact of COVID-19 on Colorado’s Health Care Workforce and the Broader System	Committee Discussion Only
hMoving Forward in a World with COVID	Committee Discussion Only
hCOVID-19 and Health Disparities	Committee Discussion Only
hHealth Disparities and Equity – State Perspective	Committee Discussion Only
hAsian Pacific Development Center Presentation on Health Equity	Committee Discussion Only
hResilient & Resourceful: LGBTQIA+ Community Member Perceptions of Living in Southwest and West Colorado	Committee Discussion Only
hAdvancing Health Equity from the Consumer Perspective	Committee Discussion Only
hHealth Equity and Children	Committee Discussion Only

Call to Order and Introductions - Committee Discussion Only


	09:41:23 AM	Representative Lontine, Chair, called the meeting to order. The meeting agenda can be found on the committee's webpage: https://leg.colorado.gov/sites/default/files/images/october_19_draft_agenda_formatted_with_presenters.pdf.

COVID Situational Awareness and Future Implications for Public Health in Colorado - Committee Discussion Only


	09:44:45 AM	Dr. Rachel Herlihy, Communicable Disease Branch Chief and State Epidemiologist, Colorado Department of Public Health and Environment (CDPHE), presented about the current number of COVID-19 cases in Colorado. She referred to a slide deck during her presentation. The slides may be found on the committee's webpage at: https://leg.colorado.gov/sites/default/files/images/1_cdphe_covid-19_statewide_health_care_review_committee_-_briefing_0.pdf. She discussed the number of COVID-19 cases in the past seven days for the entire state and by age and county.
	09:53:25 AM	Dr. Herlihy continued her presentation. She discussed COVID-19 vaccination rates, hospitalizations, and mortality rates for those who have not received the COVID-19 vaccine. She stated that the Delta variant is currently the dominate variant in Colorado and discussed the case rate and death rate in various counties.
	09:55:50 AM	Scott Bookman, Director, Division of Disease Control and Public Health Response, CDPHE, continued with the CDPHE presentation (http://leg.colorado.gov/sites/default/files/images/1_cdphe_covid-19_statewide_health_care_review_committee_-_briefing_0.pdf). He discussed the current number of hospitalizations due to COVID-19 infections and stated that hospitalizations are at the highest rate since December 2020. He discussed the availability of intensive care unit (ICU) beds and the impact COVID-19 infections have on the overall health care system.
	09:59:16 AM	Mr. Bookman discussed vaccination rates and the efforts of the department to distribute vaccine across the state. He spoke about the deployment of the vaccine through partnerships with CDPHE, health providers, and community organizations in communities with high rates of COVID-19.
	10:02:01 AM	Mr. Bookman discussed the department's plan for distributing COVID-19 vaccination boosters and inoculating children between ages 5 to 11 year olds.
	10:04:12 AM	Tom Gonzales, Larimer County Public Health Director, Colorado Association of Local Public Health Officials (CALPHO), presented on COVID-19 related issues facing local health agencies. His presentation can be found on the committee's webpage: https://leg.colorado.gov/sites/default/files/images/1.2_calpho_covid-19_pandemic_situational_awareness_and_implications_for_public_health_in_colorado.pptx_.pdf. He stated that the average length of time that COVID-19 patients stay in the hospital is 15 days. He discussed the local cooperation to manage the spread of COVID-19 and strategies related to providing access to the COVID-19 vaccine.
	10:10:33 AM	Mr. Gonzales discussed the work public health agencies do to prevent disease and categorical funding for public health activities. He spoke about the stress the pandemic has place on the public health workforce and the struggles public health agencies face retaining staff. He stated that public health professionals are leaving the workforce due to stress, harassment, and burnout.
	10:19:30 AM	Mr. Gonzales discussed the difficulty that public health agencies and health care systems have sharing health data, which significantly hampers the ability to identify and address public health threats in a timely and effective manner. He spoke about disparities in health outcomes among different populations.
	10:22:06 AM	Mr. Bookman and Mr. Gonzales responded to questions related to: sharing information between public health systems and health care systems; health disparities identified by zip code; public health agencies' responsibility to look at social determinants of health when making public health recommendations; and ways to invest in community infrastructure to improve health outcomes. Mr. Bookman told the committee that CDPHE can provide specific data about the areas of the state that have the highest health disparities. The committee discussed the COVID -19 vaccine booster and data from Israel associated with the booster vaccine dose.
	10:34:35 AM	Committee discussion continued. Dr. Herlihy responded to questions about the high rate of hospitalizations due to COVID-19. She stated that unvaccinated individuals over 65 years old are nine times more likely to be hospitalized than those who are vaccinated. The committee continued to discuss hospitalization rates, the number of Medicaid clients who have been vaccinated, and the efforts of CDPHE and the Department of Health Care Policy and Financing to bring the COVID-19 vaccine to Medicaid clients.

The Long-Term Impact of COVID-19 on Colorado’s Health Care Workforce and the Broader System - Committee Discussion Only


	10:47:06 AM	Dr. Mark Johnson, President, Colorado Medical Society (CMS), presented on the impact the COVID-19 pandemic has had on physicians and the impact patients who delayed or postponed health care during the pandemic have had on the health care system. He stated that the Delta variant has caused additional delays in care. He expressed concern that relationships with patients and patient trust in physicians have eroded. He provided examples of cases where physicians were threatened and aggressively questioned about the care they provided. He also discussed vaccine mandates for health care workers, burnout of the health care workforce, and a recent survey of physician designed to identify the burnout rate. He suggested that the state look for ways to support physicians to lower burnout rates, such as reducing administrative burdens.
	10:54:55 AM	Colleen Casper, Director of Practice and Government Affairs, Colorado Nurses Association (CNA), discussed healthy work environments for nurses and nursing assistants. Ms. Casper's presentation slides can be found on the committee's webpage at: https://leg.colorado.gov/sites/default/files/images/2.1_cna_long-term_impact_of_covid-19_on_colorados_health_care_workforce_adn_the_broader_system.pdf. She discussed the practice standards for the nursing profession. She stated that a nurse's greatest fear is to speak out about adverse working conditions due to expected retaliation. She said nurses are being told not to speak about working conditions outside of the organization where they work. She referenced the increased incidents of violence towards nurses from patients. She told the committee that medication and medical equipment supplies that were low at the beginning of the pandemic have stabilized but workforce shortages have increased.
	11:04:01 AM	Joshua Ewing, Colorado Hospital Association (CHA), presented on the collaboration of the health care community during the pandemic and the current status of hospital admissions. Mr. Ewing's slide deck may be viewed at:https://leg.colorado.gov/sites/default/files/images/2_cha_the_long-term_impacts_of_covid-19_on_colorados_health_care_workforce_and_the_broader_system.pdf Mr. Ewing pointed out that one third of hospitals are anticipating staffing shortages and many metro hospitals are forced to go on emergency department divert. He explained that one quarter of hospitals are anticipating ICU bed shortages in the near future and that nearly half of all critical care ventilators are currently in use. Mr. Ewing discussed the shift in accessing care in hospitals due to delayed care and the acuity of patients is higher since care was delayed during 2020 and 2021 due to the COVID-19 pandemic. He discussed aggressive acts by patients toward health care workers and how the pandemic exasperated this trend. He discussed doxing of health care workers personal information and that anger around government policy is being directed at hospitals and health care workers. Mr. Ewing discussed medical supply chain issues and burn out out among health care professionals.
	11:16:09 AM	Mr. Ewing presentation continued. He discussed increased regulatory activities that stress health care workers and the impact vaccine mandates have on the health care workforce. He discussed strategies focused on supporting those who take care of patients today; preparing those who will taking care of patients tomorrow; and recruit those who will take care of patients in the future. He discussed leveraging federal dollars to support health care workforce training and the training challenges for new health care providers. He suggested training health care workers to practice at the top of their scope of practice and to move into leadership roles.
	11:23:16 AM	Mr. Ewing referenced House Bill 21-1005, which established the Health Care Services Reserve Corps Task Force. He discussed updating and implementing the Colorado Health Workforce Development Strategy that was published in 2014 and can be found through the following link: https://drive.google.com/file/d/1_9bw7XSNmJ0jEqLO5PU9As3TK7zp2rPx/view. Mr. Ewing discussed the long-term goal of working to grow the workforce pipeline and diversifying the workforce.

Moving Forward in a World with COVID - Committee Discussion Only


	11:26:49 AM	Cara Bradbury, Executive Director, CALPHO, discussed how the pandemic has impacted the public health workforce. Her presentation can be found on the committee's webpage: https://leg.colorado.gov/sites/default/files/images/3_calpho_future_outlook_for_local_public_health_in_colorado.pdf. Ms. Bradbury discussed the importance of a highly skilled and trained public health workforce that provides evidence-informed programs and services that address community health needs and encourages healthy behaviors. She stated that public health entities need to establish programs to prevent and treat burnout of the public health providers; establish state and local programs to build employment pathways to recruit, hire, and retain the next generation of public health practitioners with cross-cutting skill sets (e.g., outreach workers, communications professionals, public health lawyers, grant writers, and public health nurses); and strengthen plans for transitioning people hired during the pandemic into long-term jobs, including by supporting appropriate pay and benefits.
	11:33:31 AM	Ms. Bradbury discussed the local public health future outlook and regional resource sharing among local health agencies. She discussed modernizing public health information systems to gain better health data to inform public health initiatives. She discussed the potential to use federal funding to improve technical systems and pointed out that there are issues related to the governance of the health data.
	11:40:13 AM	Dr. Mark Johnson, CMS, discussed his experience with confrontational public responses to public health workers and health care providers. He explained that COVID-19 is not going away and that there are sure to be other pandemics. He stated that there is a need for health care systems to cooperate to address pandemic related stressors. He spoke about the cooperation that has been happening as a result of the COVID-19 pandemic.
	11:47:17 AM	Colleen Casper, CNA, emphasized three points that focus on helping Colorado move forward in a world with COVID: vaccines; supporting reliable workforce data; and supporting workforce pipeline development and retention.
	11:51:03 AM	Joshua Ewing, CHA, discussed the need to reinvest in the public health system to support the health care needs of the state and to work on moving from pandemic to endemic because delayed care will negatively impact overall health of the population. He stated that Colorado did well during the pandemic because of previous investments, support from the continuum of care, and collaboration between providers. He spoke about the concept of hospital-at-home which enables some patients who need acute-level care to receive care in their homes, rather than in a hospital. This care delivery model has been shown to reduce costs, improve outcomes, and enhance the patient experience.
	11:56:28 AM	Committee questions followed about bringing people back to health care, how to increase the health care workforce, specific concerns related to health care in rural communities, and ways to share health information between the public health and health care systems.
	12:10:24 PM	Panelist continued to respond to committee questions and discussed the types of data that would be useful to share between the health care system and the public health system, such as identifying patients who could benefit from being enrolled in the Women, Infant, and Children program. The committee and panelists discussed scholarships for rural health care providers and the need to provide support to these providers. The committee asked questions about adding to degree programs at community colleges to help work force issues. The panelists discussed thinking more creatively about the workforce pipeline and revisiting workforce development strategies, especially for placements for providers to finish training. The panelists discussed conducting a capacity assessment to identify gaps and opportunities.
	12:18:40 PM	The committee asked questions about the number of retired registered nurses who came back to help provide care during the pandemic, and discussed vaccine mandates for health care workers and the challenges for hospitals associated with this mandate. The panelists spoke about the supports that are in place for hospital workers who receive threats or are victims of violence and the possiblility that care may be limited if hospitals become overwhelmed with patients.
	12:39:15 PM	The committee recessed.

COVID-19 and Health Disparities - Committee Discussion Only


	01:21:15 PM	The committee came back to order. Joe Hanel, Communications Director, Colorado Health Institute (CHI), discussed COVID-19 and health disparities. Mr. Hanel's presentation slides may be found on the committee's website at: http://leg.colorado.gov/sites/default/files/images/4_chi_covid-19_and_health_disparities.pdf. He spoke about CHI's report on missed care during COVID-19. Members of the committee asked questions to Mr. Hanel about the report. He stated that according the CHI research, the volume of visits to Front Range health care providers dropped 25 percent during the COVID-19 pandemic in 2020. These missed visits led to missed diagnoses, untreated health conditions, and the exacerbation of inequities. He suggested that a concerted effort is needed to reconnect patients with services and address undiagnosed or worsened illnesses. Mr. Hanel suggested ways to address the health care challenges resulting from the COVID-19 pandemic, including having providers proactively reach out to patients with chronic illnesses, particularly those with comorbidities, increasing resources for behavioral health services, and encouraging patients with new or worsening physical symptoms to seek medical advice.
	01:39:35 PM	Mr. Hanel, Communications Director, Colorado Health Institute, continued his presentation. He discussed a case study about health disparities surrounding the COVID-19 pandemic. Members of the committee asked questions to Mr. Hanel.

Health Disparities and Equity – State Perspective - Committee Discussion Only


	02:05:38 PM	Dr. Sheila Davis, Director of Health Equity, CDPHE, presented to the committee on the health disparities landscape in Colorado and CDPHE's approach to address those disparities. Dr. Davis' presentation slides may be found at: http://leg.colorado.gov/sites/default/files/images/5_cdphe_health_disparities_and_equity_0.pdf. Dr. Davis spoke about the changes in life expectancy in Colorado, mortality rates for people of color, the underlying conditions found in populations with the greatest disparities, access to care for various populations, and discrimination in health care. She pointed out that racial and ethnic health disparities in Colorado are widening, racial and ethnic health disparities exist across many disease classifications and throughout the health delivery continuum, and structural inequities (e.g., racism, heterosexism, ableism, etc.) are at the root of these issues. She discussed the effects of racism and discrimination on the health of minority populations. She spoke about CDPHE's approach to addressing health inequities and solutions to barriers that prevent health equity. Committee questions followed.

Asian Pacific Development Center Presentation on Health Equity - Committee Discussion Only


	02:30:21 PM	Harry Budisidharta, Executive Director, Asian Pacific Development Center, presented on health equities and health challenges within the Asian American Pacific Islander community, which includes people from over 40 different ethnicities. Mr. Budisidharta's slide deck may be viewed on the committee website at http://leg.colorado.gov/sites/default/files/images/6_asian_pacific_development_center_presentation_on_health_equity.pdf. He discussed the diversity of the Asian American Pacific Islander community, including the number of Asian Americans who live in poverty, and discussed the difficulty of collecting informative data from this community. Members of the committee asked questions to Mr. Budisidharta.

Resilient & Resourceful: LGBTQIA+ Community Member Perceptions of Living in Southwest and West Colorado - Committee Discussion Only


	02:45:08 PM	Rachel Esters, Project Administrator, The Colorado Trust, presented to the committee on a report about the LGBTQIA+ community member perceptions of living in Southwestern and Western Colorado. Ms. Esters distributed the report to the committee, which can be found on the committee's webpage: http://leg.colorado.gov/sites/default/files/images/7_colorado_trust_report_2021_-_resilient_and_resourceful_.pdf Ms. Esters discussed the diversity of backgrounds of people in the LGBTQIA+ community. She discussed the lack of health insurance and difficulty in finding employment for members of the LGBTQIA+ community. Ms. Esters discussed members of the LGBTQIA+ community delaying preventative health care, the rates of depression and sucidiality in the community, and her work with LGBTQIA+ populations within prisons. She discussed the findings of the report related to training of health care providers and the trends of accessing health care in other regions of the state. Ms. Esters highlighted the challenges youth face with bullying and the indigenous community faces with racism. She reviewed the recommendations from the report related to training for government agencies, modeling inclusion, providing tools to law enforcement, and increasing access to shelter services. Ms. Esters responded to comments from the committee.

Advancing Health Equity from the Consumer Perspective - Committee Discussion Only


	03:02:48 PM	Isabel Cruz, Policy Manager, Colorado Consumer Health Initiative(CCHI), presented on advancing health equity from the consumer perspective. Ms. Cruz's slides may be found on the committee's webpage at:http://leg.colorado.gov/sites/default/files/images/8_cchi_advancing_health_equity_through_the_consumer_perspective_0.pdf. She discussed the uninsured rates of different populations, the root causes of health inequity, and CCHI's efforts to create a consumer centered approach to health equity. She spoke about the barriers to advancing consumer-centered health equity, including the complexity of the health care system; the lack of resource for culturally and linguistically responsive outreach, implementation, and services; and the lack of consistent data to understand systems and problems.

Health Equity and Children - Committee Discussion Only


	03:22:33 PM	Samantha Espinoza, Senior Policy Analyst for Health Equity, Colorado Children's Campaign, and Rayna Hetlage, Senior Policy Manager, Center for Health Progress, presented on health equity and children. Ms. Hetlage and Ms. Espinoza discussed the difference between health equity and health equality and the impact of health inequity on families and children. Ms. Espinoza highlighted statistics for maternal mortality for black and indigenous women. She discussed House Bill 19-1122, concerning the Maternal Mortality Review Committee in the Department of Public Health and Environment. Ms. Hetlage discussed the disparity in children's health insurance coverage for children of color and immigrant children. She discussed the Coalition of Immigrant Health and community engagement on policy matters. She highlighted the importance of language access and barriers to engaging in the legislative process. Ms. Espinoza referenced the Diverse Colorado Voices report that can be found here: https://www.claytonearlylearning.org/file_download/inline/76f77680-9b25-4a49-b44f-bbcd6f52ad77.

03:41:39 PM

The committee adjourned.