Insurance Coverage Gaps Create Health Care Challenges

Dec. 28--A new effort to provide holistic health care is facing an old challenge: Insurance coverage gaps.

Ten months after the opening of the Lane Center for Academic Health Sciences at the University of Colorado at Colorado Springs, officials say they have made encouraging progress in melding physical care, behavioral therapy, nutrition services and exercise under one roof -- all to treat patients' underlying health needs while preventing new ailments.

Nearly 1,000 patient visits a month have been logged at the roughly $18 million health care center, which doubles as an academic hall with classrooms and, in the future, openings for clinical rotations for UCCS students. The figure doesn't include the thousands of people who primarily use Peak Vista Community Health Services' clinic housed inside the center.

But while some clinics in the facility accept myriad types of insurance -- including Medicare, Medicaid and many private carriers -- others do not. Companies typically cover primary care visits, for example, but often decline to pay for nutrition and exercise-based programs.

The patchwork payment systems highlight one of the challenges facing some innovative health care efforts: Integrated care may only go as far the insurance covering it.

"Some of the insurance companies are slowly, gradually coming around," said Jeff Spicher, the center's Primary Care Clinic director. "Part of the issue, my opinion, is that in this country we typically have set up a system that is a disease-based system, not a health-promotion system."

UCCS worked for months after opening the center to negotiate insurance contracts with several carriers, including Anthem, United Healthcare and Cigna. But those contracts largely focus on primary care, and some services at the center were not included due to insurers' long-held reluctance to cover such things as exercise classes.

For the time being, some university and nonprofit officials say grants appear to be the best solution to help patients pay for services not covered by insurance. One goal is that the grants prove to insurance companies that the center's model can work, said Michael Bigelow, the center's senior executive of clinical activities.

"That's part of why you do innovative things -- because this will be the future model," Bigelow said.

UCCS Chancellor Pam Shockley-Zalabak echoed that sentiment, noting that university officials knew they'd face coverage barriers when opening the center.

"There are obviously some barriers that remain, but if we just stop because there are some challenges, we will never get where we need to be," she said.

The payment issues come as the university focuses on increasing the number of patients.

The goal is to offer all-encompassing care -- often preventative, and often for the aging Baby Boomer generation -- by centralizing services and removing transportation barriers.

In all, five UCCS clinics occupy the building's first three floors, along with the Peak Vista clinic.

Under the model, if a person complained to a Peak Vista physician or to the UCCS Primary Care Clinic's nurse practitioner of back pain, he or she could receive a prescription to immediately reduce inflammation. But if that patient was overweight, the nurse could issue a referral downstairs to the Center for Active Living, which focuses on highly-specialized exercise regiments that often double as rehabilitation. And the nurse could recommend a visit to the Peak Nutrition Clinic on the first floor for help with formulating a diet -- all to treat the ailment's underlying cause.

The UCCS Aging Center also offers mental health care, along with programs addressing memory loss. And the Veterans Health and Trauma Clinic specializes in treatment for physical and psychological trauma.

One of the clinics most affected by the coverage gap is the high-tech Center for Active Living.

Resting after an arm workout in the center, Barbara Coffee said she initially came to the Lane Center for group therapy classes. She has since started workout sessions to regain strength lost amid several joint replacement surgeries.

"I had been in a big gym -- it wasn't a good fit, let's just put it that way," said Coffee, recalling treadmills too high to step onto, and high personal trainer turnover rates.

The UCCS exercise center operates as a small, data-driven gym. People undergo physical assessments on their first visit, then receive their own USB computer drives to plug into machines -- such as a treadmill -- during each visit. The USB devices describe the day's exercise regimen, then collect information during the workout.

"We really go in-depth depending on how you come to us, and what your needs are," said Michelle LeCompte, the clinic's wellness coordinator.

Few patients who enter the Lane Center for medical problems, however, also visit the workout room.

Despite treating six to eight people a day, the UCCS Primary Care Clinic</org> has only a couple patients a month who also get care at the Center for Active Living or the Peak Nutrition Clinic, Spicher said.

A similar trend has developed at the Peak Vista clinic, which expanded in recent months beyond just senior care.

A very small number of the thousands of Peak Vista patients who primarily use the Lane Center have been sent to the clinic, and even then, funding help has been needed, said Pam McManus, Peak Vista's chief executive. For example, two people were recently directed to the nutrition clinic thanks to a recently awarded grant, said Pam McManus, Peak Vista's president and chief executive.

She framed the low numbers as a byproduct of a new type of integrated care -- one going beyond physical and mental care to include nutritional and exercise programs to form a more holistic health care experience.

She viewed grants as the best way to remedy coverage gaps until insurance companies expand their payments.

The Aging Center recently received a $27,000 grant to allow some people to attend clinics who otherwise wouldn't be covered.

Perhaps in time, the Lane Center will show insurance companies that those programs work, and should be covered, McManus said.

"We are exploring new territory by having this collaboration," McManus said.

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