FACTS ABOUT DENVER HEALTH
Denver Health separated from the city of Denver in 1997 and became Denver Health and
Hospital Authority, a political subdivision of the state. Denver Health is Colorado and Region
VIII’s largest safety net system, an essential health care provider and a major corporate
contributor to the state’s well-being. Denver Health’s nine organizational components include:
 Ten community health centers (CHCs);
 13 school-based clinics;
 A 349-bed hospital;
 Five dental health clinics;
 Managed care arrangements;
 Substance abuse and mental health treatment;
 A Public health department;
 Emergency (911) service; and
 A poison center and nurse advice line.
Operating as a highly efficient major Colorado business, Denver Health employs 4,000 people
and has an annual budget of more than $400 million. Payroll is $203 million. Recent
construction projects totaling $109 million have created more than 1,000 construction jobs.
Denver Health has many accomplishments. No health disparities exist based on ethnicity,
despite Colorado being 49th in the nation in Medicaid funding and Denver Health having charges
that are below average in most of the services measured by the Colorado Hospital Association.
In 2003, the trauma center provided care for nearly 2,100 patients from 44 counties and eight
states. The overall survival rate (96%) is one of the highest in the nation. In 2003, Denver
Health served 160,000 patients, managed 400,000 outpatient visits, treated 14,000 inpatients,
and took care of 35 percent of Denver’s children. Denver Health provided $240 million in
services to the uninsured, with the City of Denver allocating $27 million to help cover costs, the
State of Colorado allocating $1 million, and the federal government providing $39 million for the
medically indigent. DSH payments have historically represented 14% of Denver Health’s
budget. While only 19% of hospital patients are privately insured, 63% of Denver Health’s total
services are for the uninsured and Medicaid patients.
Denver Health has two governing boards. First, the hospital and other components are
governed by a nine-member board appointed by the mayor and confirmed by the city council.
Second, a separate mayor-appointed 13-member board governs the Neighborhood Health
Program, which includes Denver Health’s ten CHCs and 13 school-based clinics.1 Fifty-one
percent of this board is composed of Denver Health patients, fulfilling federal grant
requirements. One member of the Denver Health board serves on this board. Denver Health is
co-applicant with the Neighborhood Health Program on their federal CHC grant. While having
two governing boards is complex, this co-applicant status has permitted integration of Denver
Health’s CHCs and the other components of the system.
Denver Health is a fully integrated system. First, functional integration occurs though common
patient identifiers, medical records, and billing and information systems. A common
pharmaceutical formulary is used for the CHCs and the hospital. Capital equipment for the
entire Denver Health organization is prioritized by the senior executives during the budget
process on the basis of need and strategic priorities. All full-time physicians at Denver Health
1
Even though it evolved as a separate primary care system, the Neighborhood Health Program is integrated with
Denver Health.
Facts about Denver Health
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are salaried employees, have hospital admitting privileges, and are faculty of the University of
Colorado School of Medicine. Second, horizontal integration is achieved through one
administrative team and shared processes and care protocols across all CHC sites. Third,
vertical integration is achieved since the system links the nine organizational components.
The implications of integration have significant advantages. First, several patient and
community benefits are achieved. Primary care is available within Denver’s medically
underserved neighborhoods. In 1998, there were 164,800 (59%) primary care visits at the
CHCs and school-based clinics and 113,700 (41%) primary care visits on the hospital campus.
There were 18,100 dental visits in the CHCs and 17,800 dental visits on the hospital campus.
Patients benefit by easy access to specialty care, with all adult and pediatric medical and
surgical subspecialty services available at the hospital campus. In 1998, almost 50,000
specialty visits occurred. About 62% of patients seen in specialty clinics had another primary
care CHC visit. Of the 2,700 newborns discharged in 1998, about 98% were scheduled for a
CHC follow-up visit. A sophisticated information system technology has been deployed by
linking billing, medical records, and patient scheduling across the system. A single-imaged
medical record permits access to the medical record at any time at any location. Uninsured
patients benefit by greater access to CHCs, with more than six of ten individuals served at
Denver Health’s CHC sites were self pay in 1998. Denver Health CHCs receive Medicaid DSH
revenues, which is reflected in the 45% Medicaid revenue compared to 35% nationally.
Second, other benefits include patient access to a greater range of services and the
development of Medicaid and commercial HMOs. The affiliation with the University of Colorado
School of Medicine has provided access to certain subspecialties, research support, faculty
status, and training programs. This affiliation allows residents the opportunity to gain
experience in both safety net systems offered by the community health centers and the
hospitals. In 1995, a Medicaid HMO, Colorado Access, was created by Colorado’s safety net
providers, including Denver Health. As Colorado Access serves more than 50% of Medicaid
HMO enrollees, Denver Health has the largest component, with 52% of enrollees. In 1985,
Denver Health developed it own commercial HMO for Denver Health and Denver City and
County employees, expanding to offer the Child Health Insurance Plan in 1998. Third, hospital
benefits include a decline in the use of the emergency department for nonemergency
conditions, discharge to appropriate follow up care and a corresponding minimizing of the
average length of stay to 4.5 days, and having CHCs to feed patients into the hospital beds.
Fourth, vertical integration benefits CHCs in several ways. The two most significant benefits are
the availability of a diversification of funding streams and access to capital. From 2000 to 2002,
Denver Health’s CHCs received more than $700,000 for capital equipment. In 1998, Denver
Health issued revenue bonds, of which almost 30% went to expanding CHC capacity.
Although Denver Health believes that benefits of integration outweigh the disadvantages,
several challenges exist, such as administrative complexity, balance between autonomy of an
individual CHC and uniformity of system process, and areas of competing focus from the needs
of the tertiary trauma system to the needs of primary care and public health. However, the
greatest challenge springs from the success of the system: the burden of uncompensated care
falls disproportionately on Denver Health, which provides 30% of all uncompensated care in the
state. The enormous growth of care to uninsured, which doubled from $1 million in 1990 to $2
million in 2001, is the greatest challenge for the future. As a percent of operating revenue,
charity care and bad debt runs upward of 50%. Attempts to decrease cost while improving care
hold some promise. However, federal, state, and local funding streams are not keeping pace
with this growth, raising the question of sustainability.
Sources:
Gabow P., Eisert S., and Wright R. Denver Health: A Model for the Integration of a Public Health Hospital and
Community Health Centers. Annals of Internal Medicine. 2003;138:143-149.
Denver Health. Facts About Denver Health: An Efficient, High Quality Health Care System. 2004.