This story is part of the 2022 Longevity series. View all stories here.
When Joel Wexler learned he would have to travel to Edwards to receive his radiation therapy treatments, he was just relieved that the drive would be made in the fall and not on icy winter roads.
The commute is just about an hour away from his home in Keystone. For five weeks, he made the journey five days each week.
That wasn’t the only bit of traveling he had to do for care, though. Once his cancer diagnosis was confirmed in February 2021, his doctor at Shaw Cancer Center in Edwards advised him to get a specialized scan done at the University of California, Los Angeles. He followed the doctor’s orders.
According to an article published in 2019 by medical journal JCO Oncology Practice, “patients in rural areas face limited access to medical and oncology providers, long travel times and low recruitment to clinical trials — all of which affect quality of care and health outcomes.”
Anne Ladd, CEO of Peak Health Alliance, emphasized this point.
Peak Health is a health insurance purchasing alliance that was founded in Summit County and negotiates lower insurance rates for Coloradans in rural areas. The nonprofit’s inception was to give rural mountain communities like Summit County more bargaining power with insurance carriers.
“In areas where there are lots of people, just like any market, if you think you can sell more widgets with less effort in a highly populated area, you’re going to go to a highly populated area,” Ladd said. “With the smaller population, just by definition, smaller population areas are not as attractive to health insurers and hospital systems as more densely populated areas.”
Even so, in the last few years, access to cancer care has improved in some respects as major health systems like Centura Health and Vail Health continue to grow.
Evolution of services
When Vail Health first got its start in the 1960s, known then as The Vail Clinic, it zeroed in on orthopedics to align with the area’s growing ski industry. Eventually, the system expanded into the organization it is today, which includes its hospital in Vail as well as locations in 12 towns including both Eagle and Summit counties.
More recently, the system opened its 85,000-square-foot Dillon Health Center last November. Housed within the building is a Shaw Cancer Center location. Vail Health chief strategy officer Nico Brown said about 20% of the patients frequenting the Eagle County Shaw Cancer Center were originally traveling from Summit County.
Ann Wilcox, Vail Health’s director of the oncology service line, noted that this is part of the reason why the organization decided to open up additional services locally.
“Any time you can have cancer care close to your home, it’s a benefit,” Wilcox said.
The center is now a home base for a full-time medical oncologist and hematologist and a second medical oncologist and hematologist who is there every Thursday. The center also has a full-service infusion center that is open five days a week.
“For any adult who has cancer … with the exception of extraordinarily rare procedures, we can take care of them,” Wilcox said.
In recent years, Centura Health has grown its oncology care in Summit County, too. Lee Boyles, CEO of St. Anthony Summit Hospital, said this growth coincides with Summit’s popularity among locals and visitors alike.
“We really recognized that with the growing visitor population, the tourism, the second-home owners as well as just how we can better support the growing community — that’s when it really became apparent that we really needed to grow our oncology service and access, Boyles said.
In 2016, Centura engaged with Rocky Mountain Cancer Center to provide oncology care once a week in Summit County. It was around that same time that Centura opened its infusion center in the Medical Office Building next to its hospital in Frisco.
Eventually, Dr. David Biggs contacted the organization. At the time, he was ready to make the leap from Missouri to Summit County, and he was ready to take his expertise as a medical oncologist and hematologist with him. Since 2020, Biggs has worked part-time providing oncology care through Centura in the Medical Office Building. Centura has added a nurse navigator position and a specialized breast surgeon who visits the county a few times per month, too.
Currently, the system is working on adding a specialized oncology-focused nurse practitioner to the office to join Biggs, and in October, the system will have an advanced breast imaging physician living in Summit County as well.
barriers to care
Despite the advancements, there are still barriers to health care that are inherent to rural living. One of those is health insurance.
Many individuals and their families in the US are covered by their employers’ group plans, but this isn’t always feasible for small businesses, many of which serve Summit County and the surrounding mountain region.
According to the Colorado Department of Labor and Employment’s market dashboard for Summit County, the top five growing occupations include waiters and waitresses; cook; fast food and counter workers; housekeeping cleaners; and retail salespersons.
According to the Summit Chamber of Commerce, Summit County’s 15 largest employers are companies that have around 130 employees or more. This means that the vast majority of businesses in the county have fewer than 100 employees.
This is notable since the Affordable Care Act has a provision that requires larger companies to provide their employees coverage.
Smaller businesses such as retail shops and restaurants are less likely than larger businesses to have the means to offer group health insurance plans to employees. Ladd said not many know about individual coverage health reimbursement arrangements, which might be more within reach for small business owners than they think.
Ladd explained that these arrangements are more feasible for small businesses because instead of owners choosing a plan for a small number of employees, owners contribute a sum of money toward a plan of each employee’s choosing. This means that if an employee needs specialized care, they can choose a plan that works best for them and apply their company’s contribution to their monthly premium.
Not only could this help close the health insurance gap, but it could also ensure that individuals who pay monthly premiums actually have access to the care they need. Speaking anecdotally, Dr. Biggs said that Summit County has “a significant population” of individuals who are underinsured. He explained that this means they have insurance, but it has so many restrictions and exclusions that it ends up not being very useful or even limits their access to care.
Across all of its counties, around 65 businesses are currently set up with an individual coverage health reimbursement arrangement. When asked why more businesses aren’t taking advantage of that program, Ladd said not many know about the option.
Not only are small businesses less likely to offer health insurance benefits, but they are also less likely to offer paid time off for things like appointments and screenings. Sarah Dayton, grants manager for the Summit Community Care Clinic, said some screenings, such as a colonoscopy, take at least half a day, and in most cases, patients aren’t allowed to return to work for the remainder of the day.
Even if an individual’s employer allows time off for preventative care appointments — such as attending an annual visit with a primary care doctor — it still doesn’t guarantee a patient’s access to that care. Dayton pointed to the county’s reliable Summit Stage bus system as providing quality transportation, but even relying on that can take considerably more time than if a person were to have their own form of personal transportation.
Dayton said the bottom line is that if a paycheck is at risk, it less a person’s chance of getting preventative screenings done.
“When funding is tight, you’re going to prioritize your leftover money — when it comes to medical bills — on something that is emergent, on something where you’re actually in pain or that is actually impacting your comfort in some form,” Dayton said. “The way to stop cancer is through early detection — so screening. If you don’t have insurance, then why would you prioritize your little funds to cover a screening?”
Dayton pointed out that for those who are in a low-income tax bracket, “the reality is, logically, you’re not going to budget on screenings, preventative work.”
According to 2021 Colorado Health Access Survey results, about 7% of respondents said they were not covered by health insurance. That number more than doubles when putting Summit County under a magnifying glass. According to 2021 estimates from the US Census Bureau, the county’s uninsured rate for individuals under age 65 is about 15%.
Luckily, some of the local health systems have considered barriers to care and have tried to create equitable access. The Summit Community Care Clinic is open until 6 pm during weekdays and is open until noon on Saturdays. Boyles said Centura will also extend hours on a case-by-case basis and that in the past, the oncology clinic will open up hours on the weekends. Most health systems also work with patients on financial planning, too.
A cancer care wish list
When you ask a local health care expert what they wish Summit County had in terms of oncology care, all of their answers vary.
In a perfect world, Dayton said she would like to see there be more funding resources available to those who have a cancer care diagnosis. She noted that the cost of some screenings, such as breast and cervical exams, are covered by the Colorado Department of Public Health and Environment. But what happens when someone is diagnosed?
“Let’s say you actually have colon cancer, well, you are now seeing an oncologist and there (are) no real great services — that I’m aware of — to cover the cost of it,” Dayton said. “I do think facilities will have payment plans and try to work with people, but they still need to cover their bills someway.”
Ladd would like to see more small businesses take advantage of individual coverage health reimbursement arrangements. She also hopes that the business community is better educated about how offering a health insurance benefit may not be as out of reach as they originally thought.
Boyles said a dream for Centura would be to offer radiation therapy in Summit County. Currently, radiation therapy is available in Edwards through Vail Health’s Shaw Cancer Center location or in Centura’s Lakewood facility. Boyles explained that Summit County’s small population is part of the reason why that service is not offered here.
This is a dream of Wexler’s, too. Though he said the drive to Edwards wasn’t bad, it would have lessened the severity of some of the symptoms that came with his treatments.
However, Wexler is more concerned for the individuals who he said “have it worse” than him.
“This young guy I know, he had some tooth problems and finds out it’s cancer, but he’s not getting treated because he doesn’t have insurance,” Wexler said. “He’s going to his dentist. I talked to the lady at Shaw, and she said ‘Tell him to call me,’ but he hasn’t called her. … How much can you do?”
Stories about barriers to access stick with both Wilcox and Boyles. Both are passionate about providing additional services in Summit County and knocking down barriers to care. Over the years, both have witnessed and heard accounts from patients about how doing so has dramatically impacted their lives.
As Summit County continues to grow, local health systems big and small will continue to work toward equitable access to care. Not only does doing so create convenience and hope for those living in rural mountain regions, but it also means more lives saved.