Health care in Pueblo is markedly improving.

That's what a recent study published by the Commonwealth Fund found, as Pueblo was one of just 14 local regions across the country to improve on a majority of tracked performance measures, as reported in the 2016 edition of the Commonwealth Fund's Scorecard on Local Health Performance.

The study -- published in September by the Commonwealth Fund, a private foundation that conducts research on a wide variety of health care issues -- found that Pueblo significantly improved on 17 out of 32 trackable health measures, largely due to increased access to care and collaborative efforts by local providers, government agencies, businesses, educators and nonprofit organizations.

"The scorecard they use is a very valid scorecard," said Pueblo Triple Aim Executive Director Luann Martinez. "It wasn't built around Pueblo, it was a scorecard they used in different places; and when they applied it to data in Pueblo, they saw tremendous growth in the right places and tremendous decreases in the right places. � Pueblo County is really making great progress."

A large part of Pueblo's improving health outcomes can be attributed to the fact that the city has seen large gains in its number of insured residents since the expansion of Colorado Medicaid through the Affordable Care Act. But perhaps the biggest influence on the city's improving health has been the collaboration of local entities, such as member groups of Pueblo Triple Aim, a cross-sector improvement collaborative that uses Pueblo-specific data to define problems in the community and create shared accountability in order to solve them. Its membership includes virtually all of Pueblo's heavy hitters in health care, with Parkview Medical Center CEO Mike Baxter, St. Mary-Corwin CEO Brian Moore, Pueblo City-County Health Department Director Sylvia Proud and Pueblo Community Health Center CEO Donald Moore all members of its board of directors.

By bringing figureheads of the Pueblo health care industry together with local business leaders, social service agencies, philanthropists and more, Pueblo Triple Aim is able to identify the community's most pressing health care needs, and collaborates to take a collective approach to addressing its issues.

"It is really counter-intuitive to imagine the CEOs of the two hospitals in town coming together with other people at the same table to empty their hospitals instead of fill them up," Martinez said.

"There are no two greater natural competitors in town and in this county than Parkview and St. Mary-Corwin, but you get not just their CEOs on our board, but their management teams working together with the director of social services and the fire chief and all these other people to come together and say, 'How do we really effect change?' And that change should be improving population health."

The group uses Pueblo County-specific data to assess the needs of the community, specifically by implementing initiatives that address the structural determinants and conditions that dictate health outcomes, known as social determinants of health.

The Commonwealth Fund's Scorecard detailed that Pueblo's socioeconomic challenges and relative geographic isolation have fostered a sense of interdependence among the region's health care providers, and Pueblo Triple Aim board president Donald Moore said that in order to overcome those socioeconomic challenges, Pueblo providers have focused intently on those social determinants.

"When you have a community that has a disproportionately high percentage of low-income population, there's a need to focus on social determinants of health," Moore said.

"The more poverty you have in a community, the more you have to address social determinants, because poverty just means you lack resources. And when you lack resources, you have trouble overcoming barriers, which are things in the way of people's ability to be healthy, whether it's accessing medical care, having adequate income, adequate housing or having lower education levels."

In order to overcome those predispositions, health care institutions have banded together to develop mutually enforcing programs that work to prevent detrimental health outcomes by affecting the social determinants that create them. For example, ensuring access to physical recreational activities and healthy foods as opposed to treating patients for complications from obesity or diabetes.

Moore said that in a community like Pueblo, providers working together with the community is a partnership that's pivotal to overcoming some of the city's socioeconomic shortcomings.

Additionally, Moore identified an innate Pueblo pride shared by the city's providers that contributes to the improvements noted by the Commonwealth Fund.

"You see this in all sectors of our community -- that we kind of take pride in Pueblo in being collaborative and working together," Moore said.

"We're showing Denver and Colorado Springs and Boulder that, 'Yeah, we're poorer, less educated and have lower household incomes, but we know how to get around the table and figure out our problems and solutions.'?''

zhillstrom@chieftain.com