By Katie Kerwin McCrimmon
Kaiser Permanente is grappling with double the number of new customers that the nonprofit health provider projected it would attract through Colorado’s exchange this year.
To handle the surge in patients, Kaiser managers have opened new clinics, are offering some evening hours and are hiring the equivalent of about 70 new providers and support staff.
Kaiser enrolled about 58,000 people — or nearly half of the customers who bought private insurance through the exchange, Connect for Health Colorado. Kaiser spokeswoman Amy Whited said the nonprofit was expecting about 25,000 sign-ups through the exchange and has seen an overall jump in customers this year of 15 percent to about 615,000 members.
As a result of the unexpectedly fast growth, phone banks were jammed at the beginning of the year, pharmacy lines at some clinics now stretch out the door during peak hours and Kaiser is using an all-hands-on-deck approach to ensure that patients get quality care quickly.
Managers are shuffling staffers to return calls fast, nurses are trying to solve problems for patients who can skip a visit and get help via email or over the phone, and some doctors who normally do research are covering clinic visits while managers work to recruit new providers.
“There’s not a mandate, but our physicians who want to pick up some extra shifts and decrease their administrative time in the short period of time while we’re recruiting (can do so). We are cognizant of our access issues,” said Debbie Zuege, senior director of primary care and Medicaid for Kaiser Permanente of Colorado.
Kaiser is not alone in grappling with an influx of new patients. Colorado’s Community Health Centers, which offer care to uninsured and low-income patients, have seen a dramatic increase in demand and are struggling to find enough providers to care for thousands of new Medicaid patients. (Click here to read Doctor shortages accelerate as patients pour in for care.)
While the surge at Kaiser was bigger than expected this year, Zuege and Whited said Kaiser has been planning for growth and adding new facilities. Kaiser is also considering expanding west by 2016 into ski resort communities along Interstate 70 in Colorado’s mountains. Whited said those plans are on track.
In December, Kaiser opened a large new specialty center in Lone Tree to serve patients in the southern part of the Denver metro area. The new facility is like specialty centers in downtown Denver and in Lafayette.
“We’ve been planning for this for several years and have increased our services. We’ve added medical offices in Parker, Loveland, Greeley, Fort Collins, Castle Rock and Brighton,” Zuege said.
In all, Kaiser now has 28 primary care offices. Two weeks ago, the Lakewood primary care center began staying open until 9 p.m. to give patients evening options for routine appointments.
So far, Zuege said those later appointments have been very popular, with usage hovering at about 78 percent. In Fort Collins and Greeley, patients have always been able to see providers for routine care until 7:30 p.m.. Use there hasn’t been as high in the evening, Zuege said, but she and others are keeping close tabs to make sure patients are getting what they need.
Years ago, Zuege said Kaiser offered extended hours until 8 p.m. at many primary care clinics, but patients didn’t fill the appointments, so the facilities stopped staying open late.
“In health care, things are cyclical,” Zuege said. “We need to try some different things.”
Kaiser is also working to use nurses to their fullest abilities. Across the country, it can take well over a year to recruit new doctors and that’s true in Colorado as well. As more patients stream into Kaiser and other health systems, Zuege said nurse practitioners and physicians’ assistants — who are nurses with advanced training — can handle about 90 percent of routine visits.
“Even though it is a challenge with the (the degree to which) we’ve grown, we feel like we have a good handle on what’s going on,” said Zuege, a registered nurse who has been with Kaiser for 30 years.
She said it’s helpful that Kaiser has an integrated system with digital health records accessible throughout the system. If one clinic is getting overwhelmed with calls, workers elsewhere can jump in and help.
For example, Zuege tracks in real time how many patient calls are stacking up. If wait times are getting long, she and other managers can have workers from one facility drop what they’re doing, access patient records and help out other facilities.
Zuege also closely tracks exactly how long patients are waiting for primary care appointments. Anyone with urgent needs can get help the same day, Zuege said. The average wait time for a routine appointment is about 6 days, but there is wiggle room if patients want to go to other facilities. In Fort Collins, for instance, patients are currently waiting about 10 days for basic appointments, but in nearby Loveland, they can get in within a day or two.
“We are able to watch the access. I can watch it on a daily basis…and can move staff around,” Zuege said. “That’s the beauty of our organization.”
Overall, Zuege said she’s pleased that more people have coverage and should now get the preventive care they need. She doesn’t consider the influx a flood.
“I wouldn’t use the word inundated. We have been uniquely positioned to expect all of these members. Certainly we’ve had challenges,” Zuege said. “(But) we’re very excited about the growth.”