Utilization of Care
A healthcare system is made up of tiered levels of care. At the primary care tier, providers address the majority of a patient’s health needs throughout their life including preventive care and diagnosis and treatment of routine medical concerns. Primary care happens in the patient’s local community.
Second tier care includes specialized treatment from doctors the patient is referred to for a specific issue. It is usually still delivered in the patient’s community.
Third tier care is even more specialized and may happen at a regional or national hospital or medical center. Emergency room care can be considered second or third tier, depending on the type of intervention required.
Since Mesa County is a regional health care hub, the medical system delivers all three types of care. Ideally, patients would usually access care at the primary level and only extend to higher levels of care during emergencies or when referred by their primary care provider.
Several systemic and individual barriers can disrupt that model of care. The system can have barriers such as lack of providers, limited insurance acceptance, and insufficient training pathways for new providers.
Individuals can face cost barriers and language or cultural barriers. They can also experience socio-economic barriers like unstable housing, lack of transportation, untreated mental health conditions, or substance use. These barriers can make the typical process of accessing primary care more challenging.
When systemic and individual barriers prevent patients from accessing primary care, more emergency and specialized care is necessary. This is due to missed preventive care, unmanaged chronic illness, and a lack of relationships with a primary care provider.
HEALTHCARE SYSTEM PYRAMID.
Primary Care
“Having a usual primary care provider is associated with a higher likelihood of appropriate care, and… better health outcomes.”
County Health Rankings & Roadmaps
Rankings & Roadmaps. 2024.
People without a usual source of care are more likely to utilize Urgent Care and the Emergency Department for cases that could be treated by a primary care provider at lower cost, or could have been entirely prevented by treatment by a primary care provider. This puts a strain on these second or third tier care providers, and drives up the cost of care.
One in six Mesa County residents has no usual source of health care.
Two in three uninsured Mesa County residents have no usual source of health care.
Source: Colorado Health Access Survey, 2023
Source of Care - Mesa County (2023)
Source: Colorado Health Access Survey, 2023
84.6% of Mesa County residents visited a health care professional or facility in the past 12 months. Among the uninsured population, however, only 32.0% reported they had a visit. Of all respondents who reported a visit, 78.5% saw a general doctor, and 54.8% saw a specialist.
Monument Health represents nearly half of Mesa County patients across a variety of providers and insurance types, making them a meaningful sample of the overall population excluding uninsured patients.
2023 patient data indicates that 70% have a medical home, which means they are both registered with a primary care provider and have seen that provider in the past 12 months. People who qualify for both Medicare and Medicaid had the highest rate of having a medical home at 88%. 78% of people with commercial insurance through private or employer sponsored plans had a medical home. 65% of Medicaid patients had a medical home.
These numbers compare favorably to the rest of the state, which is likely a result of a concerted effort by Mesa County primary care providers to build relationships with patients. In addition, the past two years have brought increased care coordination and navigation services that can help make connections between clients with various needs that include a primary care provider, such as Grand Valley Connects or the Mesa County MAC team. See the Resource Navigation section for more information about these programs.
Mesa County is identified by the U.S. Department of Health and Human Services as a low-income primary care provider shortage area. This means that by their measures, the county has enough primary care providers for the population earning 200% or more of the federal poverty level, but not enough who provide services to the population earning less than that. Typically these patients qualify for Medicaid or Medicare.
Geographically, the Colorado Department of Public Health and Environment designates the metro areas of Mesa County as adequately covered by primary care providers, but designates the rural sections as primary care shortage areas.
In an effort to address the shortage of primary care services for low-income Mesa County residents, Mesa County Public Health offers immunization and reproductive health care on a sliding-scale fee basis. The Mesa County Public Health Clinic offers a variety of routine and travel vaccines, and in 2023, their providers gave over 2,000 flu vaccines and 5,000 COVID-19 vaccines. In addition, they provide a range of reproductive health care services. In 2023, 412 patients selected longacting reversible contraception (LARC). For more information on the impact of LARC on birth trends, see the section Components of Population Change.
Specialty Care
As a regional healthcare hub, Grand Junction offers many types of specialty care. Nearly half of Mesa County residents, 46.3%, saw a specialist in the past year.
Nonetheless, nearly a quarter indicated that they were unable to get an appointment with a specialist as soon as they thought one was needed, and one in eight Mesa County residents skipped specialist care because of cost.
A broad range of care can be delivered by a primary care provider. We would expect specialty care, a second or third tier service, to make up a smaller percentage of visits than primary care across a community. However, Monument Health data suggests that there is roughly one specialist visit for every primary care visit in Mesa County. This could be an indication that patients are relying on specialists to manage types of care that could be provided at the primary care level. It could also indicate that people are waiting to see their primary care doctor until they have a health issue that requires a specialist.
Urgent care/after hours utilization
Urgent care is intended to fill a critical need for health care services that do not require emergency intervention, but cannot wait for a scheduled appointment. In communities with barriers to care, urgent care sometimes takes the place of a primary care provider. This isn’t ideal since urgent care isn’t the correct setting for many types of preventive care or building a strong relationship with a provider through regular visits.
The 10 primary health concerns, also called chief complaints, for people visiting one of several urgent cares in Mesa County are shown below.
Most of these conditions could be treated at a primary care appointment, but it’s difficult to determine the urgency of the situation from the chief complaint alone - it may not have been possible for the patient to wait for an appointment, in which case the urgent care is the correct context for the visit. Focusing this type of care on the primary care provider means care is delivered in a context where the provider has a robust understanding of the patient’s overall health. Many primary care providers in the county are increasing their flexibility for urgent appointments, and providing additional information about managing chronic conditions to reduce the need for urgent appointments. This also decreases the burden on urgent care centers, reducing wait times for appointments that are, in fact, urgent.
Top 10 primary health concerns, urgent care, Mesa County (2023)
Top 10 primary health concerns, urgent care, Mesa County (2023)
| Sore Throat |
328 |
| Cough |
122 |
| Sinus Complaints |
102 |
| Urinary Tract Infection |
92 |
| Ear Complaints |
79 |
| Leg/Foot Pain/Injury |
67 |
| Arm/Hand/Wrist/ Finger Pain/Injury |
43 |
| Abdominal Complaint |
35 |
| Eye Complaint |
32 |
| Back Pain |
29 |
Emergency Department Utilization
The emergency department spans second and third tier health care, depending on the severity and specialty required. In Mesa County, St. Mary’s Hospital serves a regional population for third tier emergency services.
Top 10 Primary Health Concerns, Emergency Department, Mesa County (2023)
Top 10 Primary Health Concerns, Emergency Department, Mesa County (2023)
| Abdominal Pain |
1977 |
| Chest Pain |
1446 |
| Fall |
1027 |
| Shortness Of Breath |
994 |
| Multiple Complaints |
530 |
| Back Pain |
526 |
| Altered Mental Status |
467 |
| Alcohol Intoxication |
449 |
| Seizures |
382 |
| Motor Vehicle Crash |
351 |
Source: Essence Syndromic Surveillance
In an analysis of emergency department visits by Monument Health patients from February 2023 to January 2024, approximately 40% of visits were for non-emergency diagnoses such as headache and abdominal pain. An additional 5% each month were for emergency visits that could have been prevented by accessing a lower tier of care, sooner, such as lower back pain. Approximately 35% of visits were for health emergencies that were not preventable, including chest pain, and the remaining 20% fell into categories that are difficult to classify as emergency or non-emergency, such as substance use and mental health.
This means that more than 45% of these visits could have been routed to a less expensive urgent care or primary care provider. In the primary care context, the treatment for the specific diagnosis would have accounted for the patient’s full health status, and been delivered with appropriate preventive care recommendations and follow up.
Understanding why the patients accessed the emergency department instead of a lower tier of care is an important step in addressing the problem. Some barriers are systemic, such as provider shortages. Other barriers are individual, which are discussed in the section Accessing care.
Behavioral Health Care
According to the 2022 Tell Us Community Survey, Mesa County residents, regardless of age or income, were overwhelmingly in favor of increasing support for mental health and substance abuse services. Only 13% of residents agreed that Mesa County provides adequate support for these services and 50% completely disagreed.
“Mental health resources have been extremely challenging to find for my family.”
Female, 40-49, Tell Us Community Survey 2022.
Grand Valley Connects, a resource navigation hub based at Mesa County Public Health, offers mental health care referrals as one of its diverse services. Among all needs expressed by incoming clients, 25% were for some type of mental health service.
In a 2023 survey, 19.1% of Mesa County residents had spoken to a mental health or substance use disorder professional in the past year. 12.9% indicated they needed a visit but did not get it. The survey did not ask why they did not get the visit, but there are likely two main reasons:
- stigma or confusion about how to pursue care may have prevented the patient from seeking care, or
- shortages in care providers across Mesa County may have made it difficult to get connected with an appropriate provider.
Mesa County is a behavioral health care shortage zone.
According to the Health Access Branch of CDPHE, Mesa County has some of the most intense shortages of Mental Health care providers in the state - every Mesa County census tract ranks in the top 30% of shortage across the state. This means that the number of licensed or certified professional providers across mental health and substance use treatment is deeply insufficient to meet the needs of the number of patients suffering from mental health or substance use disorder. (HC22) A similar federal database indicates that Mesa County would need to add 8 additional full time psychiatrists to meet demand, along with other types of providers.
For information about rates of mental illness in Mesa County, see section Behavioral Health in Health Outcomes
West Springs Closure Impact
West Springs Hospital is a psychiatric hospital offering inpatient care and a psychiatric emergency department. It is the only psychiatric hospital with a 24/7 psychiatric emergency department between Denver and Salt Lake City, and the only inpatient psychiatric hospital in Western Colorado.
Western Slope residents, and especially those in Mesa County, experience rates of suicide ideation, attempt, and death higher than the state and country.
Source: Colorado Health Information Dataset
In 2024, Mind Springs (the parent organization of West Springs Hospital) announced that without significant financial intervention, the hospital would have to close. While imminent closure was averted by an agreement with Rocky Mountain Health Plans and a significant downsizing of staff, the threat of a possible future closure remains.
A West Springs Hospital closure would impact the Western Slope economy and the health and access to care of Western Slope residents.
Economic Impact
- A West Springs Hospital closure would result in 200 lost jobs for Western Slope employees.
- The loss of $11.8m in annual payroll costs could result in $40m or more in lost spending within the Western Slope.
- $8m budgeted for non-payroll expenditures would be lost, including dollars spent on local and regional vendors.
- Indirect impacts would include job losses at regional businesses that serve West Springs Hospital, and reduced local economic vigor due to the multiplier effect of local employees having less money to spend.
Impact on Resident Health and Mental Health Care System
- An effective mental health care system relies on robust care at all levels. If West Springs Hospital were to close, it would adversely affect care at other levels of the system such as law enforcement co-response and medical emergency departments.
- From January to December 2023, after West Springs Hospital’s Psychiatric Emergency Department opened, Mesa County hospital Emergency Department visits including mental health concerns decreased by 15%.
- Existing significant mental health care provider shortages would intensify if West Springs Hospital were to close.
- In a recent community survey, Mesa County residents were overwhelmingly in favor of county leadership supporting mental health programs and services.
- Without a regional psychiatric inpatient and Emergency Department facility, Western Slope residents would go without appropriate care, or be forced to incur the additional burden of traveling out of the region for care.
Pharmacy Care
Approximately half of Mesa County residents take a prescription drug. Nearly 90% reported it was easy or somewhat easy to pay for their prescriptions, but 8% reported not filling a prescription because of cost. Within that small group, 40% indicated that their condition got worse without the needed prescription.
Mesa County has good coverage of pharmacies during weekday business hours, but options are more limited in the evening and on weekends. Patients who select their pharmacy based on location or shopping convenience may find that they can’t fill a prescription outside of business hours. Additionally, all pharmacies are located in the metropolitan center of Mesa County.
PHARMACY LOCATIONS IN MESA COUNTY (2024)
Pharmacy Locations, Mesa County Urban Area
Pharmacies Open by start of hour
Pharmacies Open by start of hour
| Weekday |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
22 |
23 |
23 |
23 |
18 |
23 |
23 |
23 |
21 |
18 |
9 |
0 |
0 |
0 |
0 |
0 |
| Saturday |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
14 |
15 |
15 |
15 |
10 |
15 |
13 |
13 |
9 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| Sunday |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
13 |
13 |
13 |
8 |
12 |
12 |
12 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Source: Mesa County Public Health Research
Health Insurance Coverage
Insurance is a key component of health care affordability. In Mesa County, coverage comes from a variety of sources.
91.6% of Mesa County residents have health insurance.
HEALTH INSURANCE TYPE, MESA COUNTY (2023)
HEALTH INSURANCE TYPE, MESA COUNTY (2023)
| Medicaid/CHP+ |
39.0% |
| Employer-Sponsored Insurance |
32.1% |
| Medicare |
15.4% |
| Uninsured |
8.4% |
| Individual Private Insurance |
5.1% |
Source: Colorado Health Access Survey, 2023
Did not get needed care because of cost, Mesa County
- 28.8% of private insurance (private plans and employer coverage)
- 22.4% of public (Medicaid/CHP+/Medicare)
- 52.7% of uninsured individuals
Source: COLORADO HEALTH ACCESS SURVEY, 2023
In a 2023 survey, some Mesa County residents were told by a potential new provider that the provider was not taking their type of insurance:
- 4.7% of residents with private or employer insurance coverage.
- 7.0% of residents with Medicaid, CHP+, or Medicare coverage.
While cost is a major barrier to care for the uninsured in Mesa County, approximately one in four insured patients also reported skipping needed care because of cost.
Medicaid Enrollment
During the COVID-19 Public Health Emergency, Medicaid (Health First Colorado) patients were able to continue their coverage without the typical review process. This resulted in a reversal of the previous years’ steady decline in enrollment.
After the Health Emergency concluded, reviews resumed, resulting in a 15% decrease in enrollment in November 2023 compared to November 2022, both in Mesa County and across Colorado. This trend is anticipated to persist into 2024.
When the Health Emergency ended, reviews resumed, and November 2023 saw a 15% decrease in enrollment compared to November 2022 in both Mesa County and across Colorado - a trend expected to continue in 2024.
Some Health First Colorado patients are able to move to an employer sponsored plan or a subsidized marketplace plan at a cost, and others may become uninsured.
MEDICAID ENROLLMENT OF ADULTS AND CHILDREN - November 2017-2023
MEDICAID ENROLLMENT OF ADULTS AND CHILDREN - November 2017-2023
| Mesa |
Children (under 20) |
50.2% |
47.1% |
45.3% |
50.5% |
54.5% |
56.4% |
48.9% |
| Mesa |
Adults (21+) |
22.9% |
21.6% |
20.6% |
23.4% |
25.8% |
27.7% |
23.3% |
| Colorado |
Children (under 20) |
40.5% |
38.4% |
36.6% |
41.2% |
44.5% |
46.8% |
39.7% |
| Colorado |
Adults (21+) |
17.6% |
17.0% |
15.9% |
18.3% |
20.8% |
22.8% |
19.0% |
Source: Colorado Department of Health Care Policy and Financing
Monument Health, a Western Slope integrated healthcare system, has created an Insurance 101 video series intended to help patients better navigate their insurance plans.
While technical support for insurance questions is limited to patients with a Monument Health plan, the videos are available and relevant for any patient in Mesa County.
Accessing care
Telehealth
Telehealth became a lifeline for health care delivery during the COVID-19 pandemic. Today, telehealth is still a popular choice for receiving care, though less popular than in 2020.
From 2019 to 2021 half of telehealth visits in Colorado were for mental health conditions.
The Colorado Center for Improving Value in Health Care (CIVHC) collected data on many providers offering telehealth services between 2019 and 2021. In that time, 39% of telehealth visits were provided by a behavioral health provider and 23% by a primary care provider. Across all age groups, mental health was the most common service. Musculoskeletal conditions were the second most common. For older adults over age 65, visits for endocrine and nutritional conditions were also common.
Adults age 18 to 44 years continued to regularly access telehealth services through 2021, but other age groups steadily reduced use, especially adults over 65.
Women were 40% more likely to utilize telehealth services than men. No significant differences were identified in telehealth use by race and ethnicity, but the analysis is limited by inconsistent and incompatible data collection by some insurance providers.
Language and Culture based barriers
Language and cultural differences are increasingly recognized as a barrier to effective physical and mental health care. These differences lead to a variety of challenges to delivering good care:
- difficulty navigating application and enrollment systems,
- difficulty establishing rapport with a provider,
- difficulty receiving accurate information when professional interpretation services are not available.
Family members, often young children, are routinely asked to step in and provide interpretation.
However, these providers can be difficult to find in the local candidate pool. Additionally, some Mesa County residents have language and cultural barriers that are not solved by receiving care from a Spanish-speaking provider.
Many healthcare providers in Mesa County are making efforts to expand their Spanish-speaking staff. This effort will improve the experience of many Mesa County residents seeking health care.
During the COVID-19 public health emergency, Mesa County Public Health worked to ensure that Spanish-speaking residents of Mesa County had equitable access to accurate information, testing, health care, and vaccine resources. MCPH established the Spanish Advisory Group, made up of local Hispanic or Latino and Spanish-speaking community leaders and professionals. This group advised MCPH on effective communication and served as trusted messengers and points of contact for the Spanish-speaking community in Mesa County.
As the need for pandemic-specific advising declined, MCPH recognized the value of the Spanish Advisory Group for continuing to improve health equity. The MCPH facilitator of the group was shifted from a COVID-19 specific role into a new position as Hispanic Outreach Coordinator. In 2022, the Spanish Advisory Group worked with partners to illuminate the experience of seeking and providing care for Spanish-speaking residents.
One of the key findings was that residents did not feel a fluent Spanish-speaking provider was necessary to effectively deliver care. Professional interpretation could offer a similar level of accuracy and facilitate relationship building between providers and patients. As a result, MCPH and the Spanish Advisory Group sought funding from CDPHE and the Colorado Health Foundation to train local Spanish speakers in simultaneous and consecutive interpretation with the Community Language Cooperative.
100% of interpretation trainees had been asked to interpret in professional settings without training in the past.
Source: CLC INTERPRETATION TRAINING SURVEY, 2023 AND 2024
Since 2023, the Spanish Advisory Group has supported training of 43 local interpreters, many of whom provide interpretation services in healthcare and other settings. The County’s purchase of simultaneous translation technology facilitates interpretation in any language for which an interpreter is available.
Medical debt and cost as barrier
The cost of medical care can impact people’s choices about how, when, and whether to seek care. Health insurance helps, but some patients still find themselves with higher costs than they expected. Recognizing this issue, the Colorado Legislature enacted several pieces of legislation meant to address cost and transparency in healthcare billing.
- More than 1 in 3 private insurance patients were surprised by a bill for medical services they thought were covered.
- More than 1 in 4 Mesa County residents skipped needed medical care because of cost (26.7%)
- 14.5% of Mesa County residents skipped needed dental care because of cost (down from 26.1% in 2019)
Source: Colorado Health Access Survey, 2023
Medical Debt
In a 2022 nationwide survey, the Kaiser Family Foundation found that 41% of respondents had medical debt, and 24% had a medical or dental bill that was past due or that they could not pay. Locally, in a 2022 study, the Urban Institute found that 10% of Mesa County Residents had medical debt in collections, with a median amount of $923.
The Colorado legislature passed three bills between 2021 and 2023 that changed how hospitals and providers must provide pricing and insurance information, and limits their ability to pursue certain types of debt for low- income patients. Medical debt interest rates were capped at 3% per year and patients were given additional power to negotiate payment plans.
In addition, three national credit reporting bureaus agreed to limit the impact of medical debt on credit scores.
Equity in Healthcare
In Colorado, areas with the highest rates of poverty have the lowest access to care for adults.
In the 2022 Tell Us Community Survey, both low income and Hispanic or Latino Mesa County residents had lower satisfaction with the health care system than the rest of the population. Some of the unsatisfied residents gave write-in feedback such as the need for more Spanish-speaking care providers, and the difficulty connecting with a behavioral health provider with openings.
In 2023, CIVHC released a health equity report which compared the health care access of people in different Colorado census tracts to the demographics of people in that tract. They considered the impact of income, education, employment, housing and transportation, and race, ethnicity, and language. They analyzed these factors against health care utilization:
- access to care for children and adults,
- follow up after a mental health
- emergency department visit,
- cost of care, and
- potentially preventable emergency department visits.
Access to care for children, cost of care, and emergency department follow ups were not strongly linked to any of the social factors CIVHC reviewed. Access to care for children may have been positively impacted by Colorado’s policy of offering Medicaid or CHP+ coverage to children in households up to 247% of the federal poverty level, $78,000 for a family of four.
Access to care for adults and potentially preventable emergency department visits were moderately or strongly linked to every social factor. These linkages were stronger in urban areas than rural areas. Mesa County is made up of a combination of urban and rural areas, so there is likely a range of impacts from these factors.
Resource Navigation
From 2018 to 2022, various efforts to understand the barriers to access to medical and mental health care identified two recurrent themes:
Economic instability intensifies the challenges of accessing effective health care, and in return, unmet health needs can intensify economic instability.
Medical and mental health care providers often identify the need for other services in their clients or patients, but don’t have the network or expertise to consistently refer to the right program, service, or provider.
As a result, Mesa County Public Health launched Grand Valley Connects, a resource navigation program that assists clients with
- identifying needs,
- connecting to resources,
- help filling out application forms,
- making appointments, and
- submitting documentation.
In 2023, 757 Mesa County residents reached out to Grand Valley Connects for help with resource navigation. 270 clients had a mental health care need, and 186 clients had a medical care or access to medical care issue (e.g. enrolling in health insurance). These clients were also assessed for economic stability needs, and often received resource navigation in several categories.
In addition to Grand Valley Connects, programs like the Mesa County Behavioral Health team’s Multi-Agency Collaboration (MAC) team are equipped to work with individuals who require a higher level of case navigation.
MAC clients are often justice-involved or completing a residential substance use treatment program, and full wrap-around support is key to their successful reintegration into the Mesa County community. Among many types of resources, the MAC team coordinates medical care, behavioral health care including substance use treatment when necessary, and health care coverage as a foundational part of the overall support clients receive.
GVC and MAC bring clients toward many types of stability at once because medical and mental health care needs are intertwined with economic stability needs. Through these programs, Mesa County has established a cutting edge system for interrupting cycles of poverty and establishing a steady foundation from which clients can make healthy choices.
Colorado Health Institute, [Colorado Health Access Survey]https://www.mesacounty.us/departments-and-services/public-health/community-health-data/tell-us-survey) - Region 19, Data Request, 2023
Source: Monument Health, 2023 Patient Data, Data Request, March 2024
Source: U.S. Centers for Disease Control and Prevention, National Syndromic Surveillance Program, Electronic Surveillance System for the Early Notification of Community-based Epidemics, 2023
Source: Mesa County Public Health - Grand Valley Connects and Multi Agency Collaboration, Data Request, May 2024
Source: Mind Springs Health, Data Request, May 2024
Source: Google Maps, Pharmacy Location Data, 2024
Source: Community Language Collective, Mesa County Interpretation Training Survey Results, 2023- 2024
Barriers
Quick Stats
Monument Health