Colorado known for health care policies, but more work remains | OPINION | Opinion
Alicia Plemmons
Colorado had a busy legislative session, which resulted in many policies geared toward increasing access to crucial health services. As planning is gearing up for next year, it is important to look critically at both the wins and places where improvement may still be made.
The most significant health care policy change, HB-1071, allows psychologists who have gone through substantial psychopharmacological training to prescribe behavioral and mental health medications.
Prior to this policy, patients who needed medicine-based treatment for behavioral or mental health conditions would first meet with a psychologist, which can take six to eight weeks in urban areas and significantly longer in rural communities. After that, the psychologist would need to refer the patient to a psychiatrist, which can take another six to eight weeks. This delays care for patients in immediate need.
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Psychologist prescriptive authority shortens the wait time for people experiencing emotional and behavioral distress to get critical medical treatment. Colorado is the sixth state to implement this policy, following New Mexico, Louisiana, Idaho, Iowa and Illinois. In states that expanded psychologist prescriptive authority, the number of lives lost to suicide significantly fell according to my research. These states also had more psychologists graduate and start practices in the state, while not affecting the number of psychiatrists or counselors.
Two other health care policies that received Gov. Jared Polis’s signature were SB-083 and SB-167, which secured more representation for non-physician practitioners. SB-083 focuses on updating the relationship between physician assistants and physicians by moving from requiring supervision to collaboration agreements. Though this may seem like an inconsequential change, the removal of strict supervision requirements allows physician assistants to start practices in rural or marginalized communities that may not have an on-site physician.
SB-167 increases pathways to becoming a certified midwife by recognizing certifications from the American Midwifery Certification Board when obtaining a license from the state board of nursing. The representation of midwives in state health care policies has also been expanded by adding a member to the state board of nursing who is either a certified midwife or an advanced practice registered nurse who is a certified nurse midwife.
Colorado has more than two dozen maternity care deserts. This move to include a new representative ensures the specialty practice of labor and delivery is represented when considering changes to continuing education or licensing requirements. They can also help address policies and incentive programs to increase obstetric care and bring new providers to dozens of rural communities.
Psychologists, physician assistants and certified midwives are all highly skilled practitioners. Each of these professionals complete extensive graduate training which includes clinical hours, courses on pharmacology and many courses built toward learning how to treat patients in their own specialization.
Colorado has made substantial progress toward improving critical health care access, but there is still work to be done. For example, while collaboration agreements provide more flexibility for physician assistants, they still create barriers by causing physicians to spend time on administrative tasks such as contract and chart review rather than meeting with patients. HB-1095, which failed to advance, would have further removed barriers by allowing physician assistants with more than 3,000 hours of experience collaborating with a physician to stop paying for expensive collaboration contracts.
As the population ages and it becomes more lucrative for physicians to switch to a specialty practice, the demand for primary health care services is beginning to outpace new physicians. To face these changes, policymakers need to be creative and empower all members of the health care team to work to the full extent of their training and education. Colorado took important steps this year, but more work remains to be done to improve access to quality, affordable health care.
Alicia Plemmons is an assistant professor and coordinator of scope of practice research at the Knee Center for the Study of Occupational Regulation at West Virginia University.
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