Colorado Community Health Centers

Strengthening Colorado’s Health and the Economy

August 2018

Colorado Community Health Centers Contribute to the State’s Overall Health and the EconomyIn 2016, Colorado Community Health Centers (CHCs):

�� Strengthened Colorado’s economy by contributing about $1.2 billion in economic activity, including $583 million in direct operating expenditures in local economies, and additional economic activity totaling $644 million.

�� Directly generated 5,353 full-time jobs and supported an additional 4,426 jobs in other businesses.

�� Contributed approximately $177 million in total tax revenue, including $46 million in state and local taxes, and $131 million in federal taxes.1

�� Brought $114 million in federal grants to Colorado.2

�� Delivered high quality, comprehensive primary health care to more than 1 in 8 people in Colorado, who live in 61 of the state’s 64 counties.

Investing in Colorado Community Health Centers is an investment in the economic development of communities and counties across Colorado.

Colorado’s 20 Community Health Centers have a plan to provide a health care home for more than one million low-income uninsured and medically underserved Coloradans. That plan is called Access for All Colorado.

The Value of CHCs to Colorado Communities: Economic ImpactIn 2016, CHCs generated jobs for a total of 9,779 Colorado residents, directly employing 5,353 and supporting an additional 4,426 jobs in other businesses.3 CHCs:

�� Are among the largest employers in local communities, including in many of the state’s most economically challenged areas.

�� Directly help local economies by purchasing goods and services from local businesses. CHC employees also spend their paychecks with local businesses.

�� Engage in building and remodeling projects, acting as catalysts for economic revitalization by attracting investment and other businesses to local communities.

�� Attract and retain more residents, businesses, and employment by adding to the economic activity in communities.

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1The tax impact values show the amount of revenue generated for governments from employee compensation, proprietor income, indirect business taxes, households, and corporations as tallied in the economic analysis provided by Capital Link.22016 Uniform Data System.3CHCs report in the Uniform Data system the number of people as Full Time Equivalents (FTEs) employed. Full-Time Equivalent (FTE) of 1.0 means that the person is equivalent to a full-time worker. In an organization that has a 40 hour work week, a person who works 20 hours per week (i.e., 50 percent time) is reported as “0.5 FTE.” FTE is also based on the number of months the employee works. An employee who works full time for four months out of the year would be reported as “0.33 FTE” (four months∕12 months).

Colorado Community Health CentersEconomic Impact, 2016

Total Economic Impact$1.2 billion

Annually*

Employment

Total Tax Revenue$177 million

Annually*

$583 million Direct

$644 million Non-Direct

$46 million State & Local

$131 million Federal

9,779Total Jobs

5,353 Direct Jobs

4,426 Non-Direct

Jobs

*numbers rounded

Health Center: The health center makes expenditures for services (including salaries) and goods, such as purchase of chairs from a local furniture store.

Indirect Effects: The furniture store in turn purchases supplies from an office supplies store and a truck from a car dealer to make deliveries.

CHC: The health center, the furniture store, the office supplies store and the car dealership all hire staff and pay them salaries to help run the various businesses. These employees spend their income on everyday purchases.

Purchase

Furniture

Store Purchase

Summary of 2016 Total Economic ActivityStimulated by 20 of Colorado Community Health Centers’ Operations

Economic Impact Employment (Number of FTEs)

Direct $582,912,194 5,353

Indirect $208,498,636 1,351

Induced $435,314,743 3,075

Total $1,226,725,573 9,779

Colorado Community Health CentersCommunity Impact, 2016

Patient Profile

56%Medicaid

22%Uninsured

11%Privately Insured

8%Medicare

93%under 200%

Poverty

Patients Served

2,446,065Patient Visits

Cost Savings$1.5 billion

Annually

$738 million savings to Medicaid

594,959Patients

Colorado CHCs Support Other Businesses

The Value of CHCs to Colorado Communities: Health CareCHCs:

�� Provide a health care home to more than 740,000 Coloradans.6

�� Are locally governed by patients of the clinic and other community members.

�� Specialize in providing care to the whole family.

�� Provide comprehensive primary health care, including medical, dental, behavioral health, and pharmacy.

�� Help people manage chronic health conditions.

�� Are actively engaged in pursuing national Patient Centered Medical Home recognition.

A study found that Colorado Medicaid clients who use CHCs are one-third less likely than Medicaid clients of other providers to have an emergency room visit, an inpatient hospitalization, or a preventable hospital admission.7 Another national study found thatCHCs demonstrate equal or better performance on select quality measures, despite serving patients who have more chronic disease and socioeconomic complexity.8

CHCs save the health care system approximately $1.5 billion in Colorado each year. 9, 10 This statistic, however, does not include all of the cost savings that CHCs bring to the overall health care system. For example, it does not quantify the number of emergency room (ER) visits that don’t happen because CHC medical and dental staff treated patients with acute needs that could be cared for at CHCs rather than in ERs. It also doesn’t quantify the savings that are generated due to the CHC cost-effective model that includes extended hours, same-day appointments, open access, after-hours answering services, and more.

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4 2016 Uniform Data System, including data for all 20 Colorado Health Center Program grantees.5 The Henry J. Kaiser Family Foundation, State Health Facts, https://www.kff.org/statedata/?state=co.6A health care home is a patient’s usual source of primary health care to prevent sickness, manage acute and chronic illness, and reduce the need for avoidable emergency room visits and hospitalizations. Many patients who don’t visit their CHC every year do return to it when they need health care services. For the 18-to-24 month period reported to CCHN as part of 2016 data, CHCs provided a health care home to more than 740,000 Coloradans. In 2017, the 12 month patient total was 625,755; the 18-24 month total was 790,000.7Jennifer Rothkopf et al., “Medicaid Patients Seen At Federally Qualified Health Centers Use Hospital Services Less Than Those Seen By Private Providers,” Health Affairs 30:7 (July 2011).8L. Elizabeth Goldman, MD, MCR, et.al., “Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures,” American Journal of Preventive Medicine Vol. 43, Issue 2, pages 142-149.9Ku et al., Strengthening Primary Care to bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform, Geiger Gibson/RCHN Community Health Foundation Research Collaborative, Policy Research Brief No. 19, June 30, 2010.10NACHC, Community Health Centers: The Local Prescription for Better Quality and Lower Costs, page 3, March 2011, http://www.nachc.com/client/documents/A%20Local%20Prescription%20Final%20brief %203%2022%2011.pdf.

CHC Population State Population5

Under 100% Poverty 70% 9%

Under 200% Poverty 93% 23%

Uninsured 22% 10%

Medicaid 56% 16%

Medicare 8% 13%

Colorado CHCs Provide Careto many of the state’s most vulnerable residents4

In 2016, the Federal Poverty Level (FPL) for a family of four

was $24,250, and 200% of FPL for a family of four was

$48,500.

List of Colorado Community Health Centers Included in this Analysis

�� Axis Health System’s Integrated Healthcare Clinics

�� Clinica Family Health

�� Clínica Tepeyac

�� Colorado Coalition for the Homeless

�� Denver Health’s Community Health Services

�� Dove Creek Community Health Clinic

�� High Plains Community Health Center

�� MarillacHealth

�� Metro Community Provider Network

�� Mountain Family Health Centers

�� Northwest Colorado Health

�� Peak Vista Community Health Centers

�� Pueblo Community Health Center, Inc.

�� River Valley Family Health Center

�� Salud Family Health Centers

�� Sheridan Health Services

�� Summit Community Care Clinic

�� Sunrise Community Health

�� Uncompahgre Medical Center

�� Valley-Wide Health Systems, Inc.

How Economic Impact is MeasuredUsing IMPLAN, integrated economic modeling software, this analysis applies the “multiplier effect” to capture the direct, indirect, and induced economic effects of Community Health Center business operations and capital project plans. IMPLAN generated multipliers by geographic region and by industry combined with a county/state database. It is widely used by economists, state and city planners, universities, and others to estimate the impact of projects and expenditures on the local economy. This analysis was conducted using 2015 IMPLAN Online.

Counties served by aneighboring CHC

COLORADOʼS COMMUNITY, FARMWORKER/MIGRANT, SCHOOL-BASED & HOMELESS HEALTH CENTERS(D) = Dental Services Available (S) = School-Based Health Center, limited services (F) = Farmworker/Migrant Site (M) = Mobile Health Care Unit

RIO GRANDE

SUMMIT

RIO BLANCO

GARFIELD

MESA

DELTA

GUNNISON

MONTROSE

OURAY

SAN JUANDOLORES

MONTEZUMA

LA PLATA

SAGUACHE CUSTER PUEBLO

LAS ANIMAS

OTERO

CROWLEY

BENT

BACA

PROWERS

KIOWA

CHEYENNELINCOLN

ELBERT

EL PASO

DOUGLAS

ADAMS

BROOMFIELD

BOULDER

GILPIN

GRAND

MOFFAT

EAGLE

PARK

LAKEPITKIN

JEFFE

RSON

JACKSONLARIMER WELD

WASHINGTON

KIT CARSON

MORGAN

LOGAN

YUMA

PHILLIPS

SEDGWICK

TELLER

FREMONT

CONEJOS

ALAMOSA

COSTILLA

HUERFANO

CHAFFEE

SAN MIGUEL

•Salud Estes Park

(D)(F)

Valley-WideCañon City (F)

Northwest ColoradoVNA-CHC Craig

•Uncompahgre Medical Center

Norwood (D)

Valley-WideMoffat (F)

•

• Peak Vista CHC Colorado Springs19 Sites 5(D) 2(M) 1(S)

Peak Vista CHC • Limon (D)

• Peak Vista CHC Flagler (D)

Peak Vista CHC Kiowa (D)

Pueblo CHC10 Sites

1(D) 5(S) 4(F)•

• Salud Frederick (D)(F)

• Sunrise Greeley

• Sunrise Evans

• Salud Ft. Lupton(D) (F)

• Salud Sterling(D)(F)

• Salud Ft. Morgan

(D)(F)

• Salud Brighton 3 Sites 1(D) 3(F) 1(M)• Salud Commerce City 2 Sites 1(D) 2(F)

Peak Vista CHC • Strasburg (D)

•

Clinica Lafayette

•

•

Pueblo CHC •Walsenburg

Valley-Wide •Rocky Ford

(D)(F)•

Valley-WideLa Junta (F) Valley-Wide

Las Animas (D)(F)

• Colorado Coalitionfor the Homeless Fort Lyon

High Plains Lamar

High Plains Holly (F)

4 Sites 1(D) 1(S) 4(F)

High Plains Wiley (F)

Valley-Wide Center2 Sites 1(D) 2(F)

Valley-Wide Alamosa5 Sites

2(D) 5(F) 1(M)

• Dove Creek CHC (D)

Valley-WideSan Luis(D)(F)

•

Valley-Wide Monte Vista(D)(F)

•Valley-Wide Antonito (F)

•

•

•

•

•

•

•

•

••

•

•

•

Mountain Family Basalt•

• Marillac Clinic Grand Junction5 sites 3(D)

River Valley Family • Health Center Montrose (F)

• River Valley Family Health Center Olathe (F)

• Axis Health System Durango

• Axis Health SystemCortez

Valley-WideCheyenne Wells

(F)•

Valley-WideBurlington

(F)MCPN

Parker (D)

•Valley-Wide

La Jara(D)(F)

Revised 12/15

Homeless Services available atAxis Health SystemClinicaColorado Coalition

for the HomelessDenver HealthMCPNPeak VistaPuebloSunriseValley-Wide

Salud Ft. Collins (D)(F)

5 Sites 2(D) 5(F)

•

•

ARAPAHOE

Forty counties have Community Health Center sites, and patients from a total of 61 counties are cared for at Community Health Centers.

•

•

•

•

•

•

CLEAR CREEK Mountain Family Glenwood Springs

•

(D)

• Clinica Thornton (D)

Counties with CHC sites

ROUTT

• •••

•

•

MCPN11 Sites

4(D) 4(S) 1(M)

•

•

MCPN2 Sites

MCPN Aurora7 Sites 2(D)

Clinica Federal Heights

• Clinica Thornton (D)

Clinica Pecos (D)

DENVER

ARAPAHOE

JEFFERSON

Clínica Tepeyac2 Sites 17 Sites 2(D) 1(M)

Colorado Coalition for the Homeless

Denver Health’s Community Health Services30 Sites 7(D) 17(S) 1(M)

•Sheridan Health Services 2 Sites (D)(S)

Sunrise Loveland 2 Sites 1(D) 2(F)

Salud

Pueblo CHCAvondale (F)

Peak Vista CHCFountain (D)

DEN

3 Sites 1(D) 1(S) 2(F) 1(M)

Summit Community Care Clinic

5 Sites 5(D) 4(S)Summit Community Care Clinic Leadville(D)(S)

Longmont (D)(F)

MINERAL

Peak VistaCHC Divide(D)

Mountain Family Rifle (D)

•

Peak Vista CHC Falcon (S)•

Northwest ColoradoVNA-CHC Steamboat

•

Mountain Family Edwards •

•

•

•

HINS

DALE

Clinica Boulder2 Sites

ARCHULETA

JACKSON

ADAMS

ADAMS

Counties without easy access to CHC sites

COLORADOʼS COMMUNITY, FARMWORKER/MIGRANT, SCHOOL-BASED & HOMELESS HEALTH CENTERS(D) = Dental Services Available (S) = School-Based Health Center, limited services (F) = Farmworker/Migrant Site (M) = Mobile Health Care Unit

Colorado Community Health Network • 600 Grant Street • Suite 800 • Denver, CO 80203 • 303/861-5165 • 303/861-5315 FAX • www.cchn.org

RIO GRANDE

SUMMIT

RIO BLANCO

GARFIELD

MESA

DELTA

GUNNISON

MONTROSE

OURAY

SAN JUANDOLORES

MONTEZUMA

LA PLATA

SAGUACHE CUSTER PUEBLO

LAS ANIMAS

OTERO

CROWLEY

BENT

BACA

PROWERS

KIOWA

CHEYENNELINCOLN

ELBERT

EL PASO

DOUGLAS

ADAMS

BROOMFIELD

BOULDER

GILPIN

GRAND

MOFFAT

EAGLE

PARK

LAKEPITKIN

JEFFE

RSON

JACKSONLARIMER WELD

WASHINGTON

KIT CARSON

MORGAN

LOGAN

YUMA

PHILLIPS

SEDGWICK

TELLER

FREMONT

CONEJOS

ALAMOSA

COSTILLA

HUERFANO

CHAFFEE

SAN MIGUEL

•Salud Estes Park

(D)(F)

Valley-WideCañon City 2 Sites 1(D) 2(F)

Northwest ColoradoHealth Craig2 Sites 2(D)

•Uncompahgre Medical CenterNorwood (D)

Valley-WideMoffat (F)

•

• Peak Vista CHC Colorado Springs20 Sites 6(D) 1(S) 2(M)

Peak Vista CHC • Limon (D)

• Peak Vista CHC Flagler (D)

Peak Vista CHC Kiowa (D)

Pueblo CHC10 Sites

1(D) 6(S) 4(F)•

• Salud Frederick (D)(F)

• Sunrise Greeley

• Sunrise Evans

• Salud Ft. Lupton(D) (F)

• Salud Sterling(D)(F)

• Salud Ft. Morgan

(D)(F)

• Salud Brighton 3 Sites 1(D) 3(F) 1(M)• Salud Commerce City 3 Sites 2(D) 2(F) 1(S)

Peak Vista CHC • Strasburg (D)

•

Clinica Lafayette (D)

•

•

Pueblo CHC •Walsenburg

Valley-Wide •

Salud Trinidad •

Rocky Ford(D)(F)

•Valley-WideLa Junta (D)(F)

Valley-WideLas Animas (D)(F)

• Colorado Coalitionfor the Homeless Fort Lyon

High Plains Lamar

High Plains Holly (F)

4 Sites 1(D) 1(S) 4(F)

High Plains Wiley (F)

Valley-Wide Center2 Sites 1(D) 2(F)

Valley-Wide Alamosa6 Sites

2(D) 6(F) 1(M)

• Dove Creek CHC (D)

Valley-WideSan Luis(D)(F)

•

Valley-Wide Monte Vista(D)(F)

•Valley-Wide Antonito (F)

•

•

•

•

•

•

•

•

••

•

•

•

Mountain Family Basalt 2 Sites 1(D) 1(M)•

• MarillacHealth Grand Junction5 sites 3(D) 2(F)

• River Valley Family Health Center Delta (D)(F)

River Valley Family • Health Center Montrose (F)

• River Valley Family Health Center Olathe (D)(F)

• Axis Health System Durango 2 Sites 2(D)

• Axis Health SystemCortez (D)

Valley-WideCheyenne Wells

(F)•

Valley-WideBurlington

(F)MCPN

Parker (D)

•Valley-WideLa Jara (D)(F)

Revised 16/18

Homeless Services available at:Axis Health System’s Integrated Healthcare ClinicsClinica Family HealthColorado Coalition for the HomelessDenver Health’s Community Health ServicesMarillacHealthMCPNPeak Vista Community Health CentersPueblo Community Health Center, Inc.Sunrise Community HealthValley-Wide Health Systems, Inc.

Salud Ft. Collins 2 Sites 2(D) 2(F)

5 Sites 2(D) 5(F)

•

•

ARAPAHOE

Forty-two counties have Community Health Center (CHC) sites, and patients from a total of 61 counties receive care at CHCs. Medical services are provided at most locations – call the CHC directly to ask questions about specific locations.

•

•

•

•

•

•

CLEAR CREEK Mountain Family Glenwood Springs

•

(D)

• Clinica Thornton (D)

Counties served by a neighboring CHCCounties with CHC sites Counties without easy access to CHC sites

ROUTT

• •••

•

•

MCPN9 Sites

3(D) 2(S) 1(M)

•

•

MCPNEnglewood

MCPN Aurora8 Sites 3(D)

Clinica Westminster (D)

• Clinica Thornton (D)

Clinica Pecos (D)

DENVER

ARAPAHOE

JEFFERSON

Clínica Tepeyac2 Sites 17 Sites 2(D) 1(M)

Colorado Coalition for the Homeless

Denver Health’s Community Health Services31 Sites 8(D) 17(S) 1(M)

•

Sheridan Health Services 2 Sites 1(D) 1(S)

Sunrise Loveland 2 Sites 1(D) 2(F)

Salud

Pueblo CHCAvondale (F)

Peak Vista CHCFountain (D)

DEN

3 Sites 1(D) 1(S) 2(F) 1(M)

Summit Community Care Clinic

6 Sites 5(D) 4(S)Summit Community Care ClinicLeadville2 Sites 2(D) 1(S)

Longmont (D)(F)

MINERAL

Peak VistaCHC Divide(D)

Mountain Family Rifle and Parachute 3 Sites 3(D)

•

Peak Vista CHC Falcon (S)•

Northwest ColoradoHealth Steamboat(D)

Northwest Colorado Health Oak Creek(D)

•

•

Mountain Family Edwards •

Mountain Family Avon (D)(S)

•

•

•

•

HINS

DALE

Clinica Boulder3 Sites 1(D)

ARCHULETA

JACKSON

ADAMS

ADAMS

About Capital Link

Capital Link is a non-profit organization that has worked with hundreds of Community Health Centers and Primary Care Associations for over 18 years to plan capital projects, finance growth, and identify ways to improve performance. Capital Link provides innovative consulting services and extensive technical assistance with the goal of supporting and expanding community-based health care. For more information, visit www.caplink.org.

Colorado Community Health Network 600 Grant Street, Suite 800 Denver, CO 80203 Phone: 303-861-5165Fax: 303.861.5315 www.cchn.org

About CCHN

The Colorado Community Health Network (CCHN) represents Colorado’s 20 Community Health Centers that together are the backbone of the primary health care safety-net in Colorado. Since its inception in 1982, CCHN has made significant strides in ensuring that Colorado’s low-income residents have access to affordable, high-quality primary health care. CCHN is committed to educating policy makers and stakeholders about the unique needs of Community Health Centers (CHCs) and their patients, providing resources to ensure that CHCs are strong organizations, and supporting CHCs in maintaining the highest quality care.

August 2018