|Rocky Mountain High in Colorado
Mountain Family Health Centers is proud to be the primary care, dental, and behavioral health provider to over 13,000 rural residents living in or near the Colorado Rockies. With four (soon to be five) sites spread over 150 miles, MFHC providers, care teams and support staff are dedicated to delivering high quality care, as evidenced by National Committee for Quality Assurance Level 3 Patient-Centered-Medical-Home recognition and state-of-the-art health information technology. After the Gold RushMountain Family Health Centers (MFHC) was born in 1978 in Black Hawk, a town founded during the Gold Rush and located at over 8,000 feet in elevation in the Colorado Rockies, 40 miles west of Denver. For years, the residents of the quiet, semi-deserted town and surrounding region had been served by a family doctor whose office was in his home. He would treat anyone knocking on his door, any time of the day or night. He even delivered babies in his own bedroom, and used his dresser drawer as a crib for the newborn. His fees were whatever the patient felt like paying.
When he retired in 1977, leaving the community with no healthcare provider, a group of citizens banded together under the umbrella of the Red Cross, formed a non-profit organization, and set out to find a new one. This group of motivated citizens, joining together to meet a community need, would turn out to be a common theme in our history.
After obtaining seed money from a federal rural health program, they renovated and equipped a small clinic of the second floor of a stone building built in the 1800’s, donated by the local Veterans of Foreign War (VFW). They hired a family nurse practitioner and opened the doors as the Gilpin County Health Clinic. The clinic was immediately busy providing care to many elderly locals, miners injured in the few still active mines, and young families, many of whom commuted to the Denver metro area for work. As the practice grew, a succession of National Health Service Corps physicians also served there.
In 1982, our still young Gilpin organization was approached by a group of residents and public officials from Boulder County about opening a clinic in Nederland in western Boulder County, which was 18 miles north of Black Hawk on a winding mountain road and 25 miles west of the city of Boulder. The population had been growing steadily in the mountains outside of Denver, and the Black Hawk clinic had noticed a steadily increasing number of patients coming to Black Hawk for their healthcare. The Board of Directors studied the situation and, given strong local support, approved an expansion to Nederland. This would mark another common theme in Mountain Family’s history: Our Boards of Directors have always committed to expanding access to the underserved, whether in their communities or many miles away. To reflect the wider geographical reach, the organization changed its name to Columbine Family Health Centers.
Gold Rush 2.0
When Colorado citizens passed a limited stakes gambling law in 1990, Black Hawk went through another construction boom reminiscent of the first Gold Rush. Columbine Family Health Centers was still in the original cramped facility when St. Anthony’s Hospital (now Centura) proposed that Columbine and the hospital share a new modular building in which hospital staff would offer work comp and urgent care and Columbine would provide primary care. This would be the first of what would become another common trend in our history: Working collaboratively with local hospitals to provide care to the underserved.
Finding a suitably flat, much less affordable, building site in the rocky terrain in the midst of a high stakes construction frenzy was a challenge. Fortunately, Norman and Mildred Blake, long time local residents, miners, and health center users, generously rented the site upon which the clinic still stands today for $1 per year.
The new facility quickly filled with patients. Companies were in a hurry to have buildings ready and open for gamblers when gaming officially opened in October of 1991; in fact, one casino was built in 30 days, an amazing feat. Accidents were inevitable as workers swarmed construction sites, blasting rock, pouring foundations, and erecting girders skyward. Some days the Blackhawk clinic resembled a scene reminiscent of a cross between the TV hits MASH and Northern Exposure as construction workers, with lacerations, sprains, and fractures from falls off ladders or scaffolding and other mishaps, came through the ambulance entrance on the side of the building as soon-to-be moms came through the front entrance for prenatal care to join a hung-over old miner with a scraggly beard seated in the waiting room.
By the mid-1990’s, the construction tapered off and the gambling boom commenced. The hospital no longer saw sufficient demand for work comp and turned the entire facility over to Columbine Family Health Centers. The county went through a dramatic change as more than 15,000 casino workers and gaming customers came in and out of Black Hawk every day. The Black Hawk health center experienced firsthand the changing demographics of the area. Locals then shared the waiting room with casino workers, such as the food prep worker with a finger laceration, to elderly gamblers fainting from too much alcohol and excitement at high altitude.
Both Black Hawk, aided by Gaming Impact Funds from the Colorado Department of Local Affairs, and Nederland flourished between 1984 and 1990.
Over the Great Divide
Unbeknownst to Columbine, another group of citizens, public officials and members of the medical community in Glenwood Springs, located in Garfield County in what is known as Colorado’s Western Slope (west of the Continental Divide), was trying to figure out what to do about their healthcare crisis because the only pediatric practice willing to accept Medicaid patients suddenly closed its doors in 1998. The ad hoc group sought advice from the state Medicaid office, and was referred to the Colorado Community Health Network (CCHN), the state primary care organization representing all community health centers.
CCHN sent inquiries to all the large health centers to see if any was interested in establishing a new site, although this was not going to be just another site a few miles down the road in a metro suburb. Glenwood was 140 miles from Denver along Interstate 70, which climbs over the Continental Divide and two 10,500 foot passes that are notorious for dangerous winter driving conditions and road closures.
However, Columbine’s executive director was born and raised in the mountains, and not daunted by the long distance or snowy roads. She also had plenty of business savvy and knew Columbine’s expansion opportunities were few and far between along the Front Range because many foothill residents commuted to the urban areas where there were stores, employment, and well-established health centers. She recommended to the Board of Directors that Columbine should learn more about the situation in Garfield County.
Over the next few months, she made numerous trips to the Western Slope to meet with the group. The county was in the midst of a construction boom, driven by second home building, whose owners were attracted by Garfield County’s close proximity to the resort towns of Aspen and Vail, and housing for a large influx of construction and resort workers. Many of these workers were Latinos.
With each contact, she was more and more impressed with their enthusiasm for establishing a CHC and their collaborative spirit. Some key elements necessary for a health center to succeed were in place. Valley View Hospital in Glenwood Springs offered to contribute clinic space. A physician, who had been born and raised in the area and presently working for a health center on a Front Range, was interested in returning to Glenwood Springs to practice. Not only was he was ready for the hard work of establishing a new health center, he was also fully bilingual, a critical skill when half the patients were forecast to be Spanish speaking.
After more trips and discussions with committed funders, such as the Caring for Colorado Foundation, Boettcher Foundation, and the Aspen Community Foundation, she recommended to the Board of Directors that Columbine should expand to Glenwood Springs, despite the obvious challenges of long distances and unknowns. The Board deliberated and approved the expansion, as well as added two new Board members from the ad hoc group who got things started in Garfield County.
The new clinic in Glenwood Springs was named Mountain Family Health Center and opened in a cramped 1,200 square feet facility with four exam rooms for two providers.
By 2000, the Board of Directors and executive director recognized that as the significant need for services on the Western Slope continued to increase and present constant challenges for our organization, they needed to prepare a plan. At the time, Columbine provided care to around 5,000 individual patients.
The Board of Directors, executive director and management team gathered at the executive director’s home in Gilpin County to develop the first actual strategic plan. The plan set forth the goals and milestones that would guide the organization for the next decade, including the development of a quality program, improved information technology infrastructure, addition of direct dental and mental health services, and new management positions and financial strategies to support the growth. The new plan also called for expansions into other locations along the I-70 corridor through the Rockies.
In 2002, Columbine Family Health Centers commenced their first foray into a formal quality management program by joining the BPHC Diabetes Collaborative in Black Hawk and Nederland. Through this health disparity program that was underway in CHCs nationwide, Columbine learned how to create and manage patient registries and take first steps towards integrating quality data into chronic disease programs for diabetes and depression.
That same year the organization received an Expanded Medical Capacity grant from the Bureau of Primary Health Care that further accelerated patient visits to the Glenwood Springs site, and started MFHC on a path where within two years, MFHC would become the fastest growing rural health center in the state, a distinction it still enjoys today. In short order, again with the support of Valley View Hospital, Mountain Family in Glenwood grew from 1,500 sq. ft. with two providers to 4,500 ft. and four providers.
By 2003, it was obvious to the Board of Directors and management team that that growth on the Western Slope would be so swift and impactful that our organizational focus needed to shift there. Formalizing this, the Board formally changed the name of the organization from Columbine to Mountain Family Health Centers. When the executive director, who had served our organization in various management capacities for twenty-three years, announced her retirement in 2004, she could look back with great satisfaction that she had successfully guided this transition, thereby expanding primary care services to thousands more uninsured patients in an underserved area of Colorado, and assembled a strong management team to propel Mountain Family’s success in the future.
The Board of Directors decided it was the opportune time to complete the management shift to the Western Slope. The Board selected an existing management staff member already located there and who had been establishing strong relationships with medical and human service agencies in the region. He also happened have once been an executive in technology years before who strongly embraced one of the goals in the organization’s strategic plan: “To be the state’s leading health center in the utilization of technology to reduce cost and improve quality of care.”
Before fully embarking on a pioneering technology journey, however, the Glenwood Springs site first needed additional space. In 2006, again with well-timed support from Valley View Hospital and the Boettcher Foundation, Mountain Family moved to a newly remodeled clinic site with 9,000 square feet and fifteen exam rooms that would accommodate five providers every day. As always, the Caring for Colorado Foundation provided financial support for the recruitment and ramp-up for new providers.
High Altitude High Tech
In order for Mountain Family to advance its ambitious technology agenda, it would be necessary to figure out how to fund a high-performing information technology infrastructure because with large numbers of uninsured patients, our financial resources were stretched thin. CHCs always have revenue challenges because they care for so many persons who are uninsured. Mountain Family had, and continues to serve today, one of the highest percentages of uninsured of all CHCs in the state.
Colorado had a small budget surplus in 2005, and the Governor had allocated some funds to a program for rural health entities, mainly hospitals, to purchase major technology upgrades, such as imaging and lab equipment. The state agency designated by the Governor to allocate the funds, known as the Department of Local Affairs, normally specialized in roads and bridges, and was uneasy handling decisions related to expensive technology with which they had little experience. They were a little uncomfortable when Mountain Family approached them with a long list of meaningless part numbers that included servers, routers, and software we needed build a robust IT system. Ultimately, the agency made a courageous decision that enabled Mountain Family to fulfill our vision. With high performance network hardware in place, Mountain Family commenced the implementation of a leading electronic practice management system linked to the various sites, and quickly followed by a comprehensive electronic medical record that was fully operational in 2007.
Mountain Family also embarked on a total practice redesign to improve patient flow and access. The Glenwood facility would not be able to fit any more providers due to space limitations. The only way to accommodate more patients was to become more efficient. A new operations director joined Mountain Family who had participated in several practice redesigns in California. Over the next year, we went to an open access system where patients could be seen when they wanted to be and redundant administrative steps were streamlined to reduce patient time in the waiting room.
Being able to serve more and more patients was exciting and fulfilling, but it was also a challenge for staff at every level. With new employees to train, the urgency to see more patients, the constant learning curve for new technology and practice redesign, and an increasingly bicultural environment, sometimes communications between departments could break down, leading to frustration and poor morale. In 2006, representatives from management and staff at all sites and departments, working mainly through conference calls and lunchtime meetings, initiated the Mariposa Project. Mariposa is the Spanish word for butterfly. It was chosen because butterflies are ugly in their early growth stages, but metamorphose into beautiful beings. Likewise, our growth and reorganizing could be at times stressful and disruptive, but in those moments everyone needed to remind themselves of our core values, which were distilled into the following “Six Principles” that still guide the organization today:
• We are a team on an important mission • We are committed to providing high quality health care • We provide excellent customer service • We celebrate cultural diversity and pluralistic values • We each make Mountain Family a good place to work • We constantly improve
These values also extended to our outreach activities in our respective communities. We provided health fairs, breast cancer screenings, and health education classes. In a multi-year project with Denver Health, Mountain Family screened over 4,000 people for cardiovascular disease.
Mountain Family’s development was not always without setbacks and hard decisions. In the same year the Mariposa Project was launched, the Board of Directors voted reluctantly, but unanimously, to close the Nederland as the demographics of the area had become more upscale and two private practice providers set up in town, making a community health center no longer financially sustainable. A brief attempt to run a satellite clinic in Idaho Springs, a short distance from Blackhawk, also proved financially untenable due to a lack of local support.
In stark contrast, patient demand, and the financial resources to address it, continued to increase on the Western Slope. With the Glenwood Springs facility operating at capacity and patients travelling from a hundred mile radius to receive care, either new sites would need to open or for the first time in our history, patients would have to be placed on a waiting lists to receive care.
Rifle or Bust
For several years, Mountain Family had been pursuing a Medically-Underserved Population designation for the Rifle area, 30 miles west of Glenwood Springs. The designation was granted in 2007 by the Bureau of Primary Health Care, and planning immediately commenced to explore the feasibility for a new 12,000 square foot facility there. Finding an affordable site to build proved difficult because the area was in the midst of a methane gas drilling boom, sending land prices sky high. Understanding our predicament, Garfield County stepped forward and offered a 60 year term lease on a piece of ground at a charity price. With that assured, the Board of Directors gave a green light to pursuing funding to build a new site.
Fund raising was just getting underway for the new Rifle building when the October 2008 stock market crash occurred, marking the start of the Great Recession. House prices plummeted, construction stopped, tourist-based businesses folded, and foundation portfolios were decimated. As the downturn spread worldwide, drilling companies in Garfield County were shutting down rigs and laying-off workers. It was one of those tipping point moments when our organization’s board and management had to make a risky decision whether to stop the project or proceed with hope the resources could be found. In either case, the wrong choice could lead to long term repercussions.
The Board of Directors elected to proceed because, if anything, the need for access to care would continue to rise as the economic crisis deepened. Within a few months, Mountain Family got totally unanticipated help from the American Recovery and Reinvestment Act (ARRA). A team of board and staff members had already modified the building plan to reduce the size of the footprint from 12,000 to 9,000 sq. ft. to trim costs, while still including design features to easily accommodate expansion at a future date.
Although the ARRA funds would cover about a third of the cost, there was still a large sum to raise in a depressed economic environment. However, one by one committed financial supporters stepped up to bring the project to fruition, including The Colorado Health Foundation, the Caring for Colorado Foundation, the Gates Foundation, the Aspen Community Foundation, and EnCana Energy Corporation. Mountain Family broke ground on the new facility in 2010.
A CHC Coming of Age
As the building was being constructed, Mountain Family continued to serve more patients with more services, including internal medicine and behavioral health. Mountain Family had a large number of persons in our Diabetes Registry, along with more elderly, with numerous medical complications best managed by and internist. In a joint venture with the regional behavioral health organization and financial support from The Colorado Health Foundation, we also introduced the integrated behavioral health model in which a mental health professional works in the primary care setting to assist patients.
We were also pleased to be invited to join the first cohort of medical practices, and only community health center, into the Colorado Beacon Consortium, one of seventeen projects initiated by HRSA’s Office of the National Coordinator for Health Information Technology to improve quality and reduce cost of care.
On a sizzling hot evening in August 2011, Mountain Family had the Grand Opening ceremony for the new Rifle primary care and dental facility. An outstanding dentist had come from California earlier in the spring to train staff and get everyone familiar with the new state-of-the-art equipment and electronic dental record. A seasoned provider and support staff from Glenwood also transferred there to ensure immediate patient access guided by standard Mountain Family policies and procedures.
The same summer, a smaller, quieter, but equally needed, expansion site had already opened. A group of public health and social service agencies from Pitkin and Eagle Counties, along with Aspen Valley Hospital (AVH), all of whom Mountain Family had worked with for years on various projects, had asked us to consider opening a satellite clinic for the under-served in Basalt. AVH donated space in a clinic facility that in a unique arrangement where MFHC provides primary care in daytime hours and AVH provides urgent care in the evening.
In September 2011, the executive director announced to our Board of Directors that he would be retiring from Mountain Family in 2012. With our administrative team, he had accomplished most of the goals in the strategic plan he helped develop a decade earlier – Mountain Family had expanded on the Western Slope, added dental and behavioral health services, been a pioneer in exploring quality informed by advanced HIT, and, most important, more than doubled the number of patients served.
The Winds of Change
Our Board of Directors recognized enormous changes would unfold over the coming years under the Affordable Care Act – accountable care organizations, pay-for-performance, patient-centered medical homes, insurance exchanges, more reliance on costly technology. With Mountain Family destined for an unprecedented period of rapid change as healthcare reform unfolds in Colorado, the Board elected to conduct a national search to recruit a leader with the energy, skills, and vision to ensure we hold true our mission to provide high quality care to the underserved. The Board found the person they were looking for serving as the Chief Operating Officer at CCHN. He had the all the right stuff, including a Geiger Gibson Emerging Leader Award from NACHC. Through his years working at CCHN with Mountain Family, he was also very knowledgeable about our opportunities and challenges.
In July 2012, the new executive director joined an enthusiastic Board, administrative team, provider group, and staff. He immediately got to work developing a new strategic plan to enable Mountain Family to flourish in the changing environment of American healthcare. Some of the themes were familiar, such as quality, HIT, and further expansion. Others were new, such as ensuring high staff satisfaction and financial viability and abundance.
In June 2013, the National Committee for Quality Assurance recognized MFHC-Glenwood as a Level 3 Patient-Centered Medical Home, the highest national recognition that is bestowed on primary care providers. The Blackhawk, Rifle, and Basalt sites will follow in the coming year. In the coming 12 months, Mountain Family will open a new facility in Eagle County.
Again in 2013, we’ll provide high quality primary, dental, and behavioral healthcare to more people living in the Colorado mountains than at any time in our history.
MFHC was flying higher and higher, and in new, exciting directions.
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