La Plata County Community Summit Launches Effort: The Citizens Health Advisory Council (CHAC) was started in 2001 as a result of the La Plata County Community Summit – “Access to Healthcare” breakout session. Over 50 people attended this session including community leaders, elected officials, health care providers, non-profit representatives and many interested citizens. Together, these participants envisioned that a broad coalition dedicated to improving access to health care was needed. CHAC was formed in that summer and celebrated its 10th anniversary in 2011.

An Inclusive, Open Model: CHAC was established early on as an open group. Anyone with an interest and stake has a seat at the table. A variety of viewpoints and the concept of inclusiveness are valued since La Plata County is both culturally and geographically diverse and is a very active community, with many people and groups making a difference. Since that time, representatives from key health care organizations have attended CHAC meetings as well as representatives of local government, business groups, elected officials, non profits, community groups, and interested citizens with diverse backgrounds.

Early Projects and Results:  After several organizing meetings, CHAC quickly got to work and published a report, “A Picture of Healthcare in La Plata County” which documents trends, needs and priorities. Also during its early days, CHAC planned and facilitated, with partners, a number of health care forums, trainings and/or community meetings to educate citizens and elected officials about health care issues and reforms; to mobilize advocacy efforts; and to link with state and federal organizations. This is a vital role CHAC continues to play today as bringing our communities together around pressing topics is as important as ever.

Also, in the early 2000s, CHAC assisted in launching and giving political credibility to a separate coalition that later established a regional acute treatment mental health facility called Crossroads (operated today by Southwest Colorado Mental Health Center doing business as Axis Health System).

Lessons Learned from a Failed Election: In the mid 2000s, CHAC members and participants came to realize that with State budget cuts occurring, population growth soaring and health care reforms stalled at the federal level, a local Health Service District was needed to ensure needed funding for addressing priority issues around primary care, mental health and preventive health care. So, from 2003 to 2005, the group studied other Health Service and Hospital Districts in Colorado; led the effort to conduct a valid Primary Care Access Study; hosted many community forums to gather input; conducted community surveys; and learned all of the necessary steps to run a Health Service District campaign. This work led to a Health Service District campaign that was launched from September 2005 to May of 2006. CHAC melded with several other entities to form the all-volunteer campaign team.

While the election of May 2006 was not successful, many important issues were raised. Most importantly, our county-wide community became much more aware of health care issues, ideas for change, funding gaps and consumer and patient desires and needs. A small group of business and health care professionals joined together as the Primary Health Care Community Coalition (PHCCC). This group undertook two important tasks. First, they approached both La Plata County and City of Durango officials and requested funding to help establish a Health Services Clinic, to be operated by Mercy Regional Medical Center, which would address the crisis of care that resulted when Valley Wide Health Systems left La Plata County following the defeat of the HSD campaign. Secondly, the group requested funding from La Plata County and the City of Durango, to hire consultants JSI Research and Training Institute. JSI was charged with evaluating La Plata County’s access to primary care issues and developing a long-term, sustainable solution.  JSI presented their findings in September 2007. The findings included four recommendations:

• Take advantage of the Certified Rural Health Clinic program.
• Recruit and retain primary health care providers.
• Build upon the existing Health Services Clinic
• Utilize a variety of funding sources.

With the report completed, the PHCCC dissolved, having achieved its two primary objectives. The responsibility of taking the JSI recommendations forward was given to a newly organized group of health care decision makers given the name Health Services Steering Committee.

The Election Aftermath and a Strategic Plan for the County: From 2006 to 2010, CHAC worked with two smaller community groups (the Primary Health Care Community Coalition and the Health Services Steering Committee) that formed after the election’s failure. This collaborative effort resulted in a grant from The Colorado Health Foundation for the ‘La Plata County Community Health Care Capacity Project’. Through this effort, Julie Thompson, was hired as a consultant in 2009 to conduct a very through community assessment including studying other models in Colorado and across the nation. The mandate was to produce a strategic plan for the county that could enjoy wide-spread support. 18 months of comprehensive work led to the creation of a report including eight recommendations to increase access to health care. 

Implementation of Health Care Capacity Report 2010-2013: The Colorado Health Foundation funded a three-year grant to move the eight recommendations forward. Jaynee Fontecchio-Spradling was hired as the first Executive Director. Progress as of Nov. 2011 is summarized here. Among many highlights, CHAC brought “big thinkers” to the community through annual Summits and Mini Summits. These stimulated our local efforts including action about emerging health issues such as behavioral and oral health as well as supporting community efforts such as Health Information Technology, Care Coordination and Health Insurance Exchange. Other successes included catalyzing the La Plata Community Clinic (donated care), supporting the FQHC application by Axis Health System which created La Plata Integrated Health Care Clinic, administering the CARES program (single source eligibility determination), initiating the Oral Health Team, and securing a grant from The Colorado Trust to develop a community plan for behavioral health.

Implementation Phase II 2013-2015
In Fall 2013, another two year grant from The Colorado Health Foundation began which continued implementation of the recommendations. As noted in the previous section, several recommendations were spectacularly achieved; however, a couple did not begin which reflected factors beyond CHAC’s control such as a low degree, or lack of, readiness, resources or interest among community organizations and businesses. pattie adler was hired as Executive Director in late 2013 while Jaynee became the Special Projects Manager to lead the behavioral and oral health efforts. The Board updated the Logic Model to become the Blueprint for the Future  to provide big picture guidance. A revised Marketing and Sustainability Plan was drafted and Summary finalized. The beginning of 2015 saw CHAC supporters and Board adopt a new name of Community Health Action Coalition (still CHAC) to better reflect the organization’s evolving direction. New vision, mission and values statements were approved. The 6th Annual Summit had prevention as its theme with attention paid to worksite wellness. Three other educational events were held about oral and behavioral health, and infectious diseases.

2016 – 2018
The La Plata Healthcare Capacity Project was completed in March 2016; funding from the Colorado Health Foundation ended at that time. Related outcomes such as La Plata Integrated Health Clinic, the CARES program, behavioral health, oral health, and other efforts will live on led by partners.

A needs assessment process in early 2016 identified Advance Care Planning (ACP) as an unmet community health need. ACP can be defined, most simply, as the development and expression of wishes for health care should an individual become unable to make a decision or speak for themselves in the future. It includes: 1) considering personal preferences, 2) communicating them to loved ones, designating a spokesperson (agent) and healthcare provider, 3) documenting them through Advance Directives (ADs) and 4) delivering these forms to the healthcare system so they are accessible if needed.

CHAC led a team of diverse partners in developing strategies to increase ACP among adults 18+ in La Plata County; it was called, “My Life: Deciding in Advance”. The Colorado Health Foundation awarded a two-year grant to implement this work during October 2016 – October 2018. Strategies include: 1) community education, 2) professional training, 3) provision of Advance Directives (ADs) and 4) community-care linkages to electronically store and retrieve ADs involving two pilot projects with Mercy Regional Medical Center (MRMC) and the Colorado Regional Health Information Organization (CORHIO).

The initiative was wildly successful including these accomplishments: 1) facilitated 5,160 ADs being accessible in the MRMC/Centura electronic medical record system, 2) educated over 1,600 community members through four open education events and 65 presentations at groups, 3) trained 287 professionals at 20 trainings, 4) provided trained Personal Resource Specialists who met with more than 20 residents individually in homes to offer personalized assistance with any aspect of ACP, 5) improved ACP communication protocols during transitions of care between MRMC and 12 skilled nursing facilities, first responder organizations, long-term care/rehabilitation entities and senior residences, and 6) increased focus on ADs within the electronic medical record system within both MRMC and CORHIO. In fact, there is a potential for a pilot project between CORHIO and MRMC in 2019 to continue this effort catalyzed by “My Life.”

In addition to the ACP initiative, CHAC maintained monthly coalition meetings providing education about a variety of health topics, member updates and networking, and provided biweekly electronic newsletter communication about announcements, events and news.