//Annie Lee, the first woman and first woman of color to lead Colorado Access, the state’s largest Medicaid contractor. She was hired as CEO in January 2022. Photo courtesy of Walnut Street Photography.
As a first-generation Korean American, Annie Lee remembers difficult years after the business her parents ran went under and more than one safety net fell out from under them.
“My parents had put everything into the business,” Lee said. “They found themselves struggling to have jobs, pay bills, and when that happens, healthcare coverage is not something that you can prioritize.”
Lee’s experience as a 12-year-old trying to help out her parents as they also developed chronic illnesses is something she’s bringing to her new role as the CEO of Colorado Access. The group is a nonprofit contractor with Health First Colorado, the state’s Medicaid program.
That personal connection to Medicaid is one of the things that made her attractive to the hiring committee that evaluated potential candidates.
“It means a sensitivity and awareness to the unique challenges of the Medicaid community,” said Simon Smith, who was chair of the hiring committee for Lee’s position. “We felt that Annie with her various experiences, specifically here in Colorado, both working directly for Medicaid, as well as several different nonprofit healthcare providers, had a really strong viewpoint into the unique needs of those patients and really brought her own personal story growing up and experiencing what it was like to be a family of immigrants and needing to navigate their way through the social and healthcare systems.”
Colorado Access helps provide access to healthcare for lower-income and underserved communities, as well as services for all Coloradans to navigate the byzantine system. Although the group is not itself an insurance provider, it assists individuals with Medicaid by coordinating between patients and providers. Say a patient sees their primary care doctor: The doctor would be paid by Health First Colorado, the state’s Medicaid program. However, if a specialist was needed afterward, Colorado Access can find that doctor and coordinate care. The nonprofit covers around 625,000 members, while over one million Coloradans are on Health First Colorado or related programs.
Making sense of the healthcare system is already a nightmare for people who have insurance. For underserved groups that have to rely on Medicaid, there can be extra layers of complications. For that reason, Lee said solving the challenges that come with providing healthcare to Medicaid recipients requires a holistic approach.
“If you think about those populations, and people who would qualify under those kinds of criteria, then you can kind of imagine the other challenges that they’ve had going on in life that aren’t going to be all about healthcare coverage,” she said. By criteria, Lee means the health or income challenges that determine Medicaid eligibility. It’s important to consider what role those challenges play in someone’s ability to receive healthcare.
Relating back to her experience with her family when she was younger, Lee said encountering a system that didn’t allow people to get healthier made her question how individuals would be able to work toward any other dream. In fact, research on the relationship between debt and health shows that low-income people are more likely to have health issues. According to healthaffairs.org, poor Americans have higher rates of heart disease, diabetes, stroke and other chronic conditions. Poverty also creates a feedback loop, where high medical costs can keep people trapped in debt and poor health because people can’t afford to go to the doctor.
“What has happened is, we have not been great in setting up a safety net system so that people don’t get themselves into crisis,” Lee said. “What supports are there in the community so they don’t find themselves in the emergency room after not getting the care that they needed because they were afraid they couldn’t afford it or put their job at risk?”
It’s a systemic approach to healthcare, where according to Lee, success comes from evaluating not only internal factors such as health and pre-existing medical conditions but external ones as well, like income or housing and childcare.
That said, there are specific areas that Lee wants to target. She said Colorado is one of the states that spend the least on its behavioral health system, which has not served people well. There’s more to the problem than money, and she said there are a lot of complicated ways that the system has not worked. However, it’s an issue that the Polis administration has taken on, and Lee is excited to partner Colorado Access with the governor’s initiatives. The governor already committed $500 million of federal money to overhaul the state’s mental healthcare system. He’s also established the Behavioral Health Administration, which will manage the state’s behavioral health programs under one entity, with an eye toward streamlining the system.
In some ways, the organization is taking a bottom-up approach to figuring out the needs of the people they serve. Lee called that approach, “Human-Centered Design.” The idea behind that term is to try to understand what community leaders and members need when it comes to taking care of their own health. That approach also takes into consideration the external factors that make it difficult to seek out healthcare. Among the things Colorado Access found is that much of the community wants a focus on Black birthers who along with their babies suffer the worst health outcomes, as compared with peers from other races.
“I think that’s the kind of work that’s going to get us to a different place. It’s not about policy wonks looking at all the evidence, although that does have its value,” she said. “It really needs to be led by the voices of the people who are struggling to access care, the people who are experiencing the challenges that we’re looking to address in some way.”
Lee’s own lived experience in Medicaid is what drives her desire to connect with Colorado Access members on a deeper level. She is the first woman of color who comes from an underrepresented, underserved background to lead the organization. Under her leadership, she hopes to steer Colorado Access down a path that prioritizes member voices more. It’s an approach that Shanice Sims appreciates. As a Black woman who is also a mother, the issue of diversity is an important one for her.
“Because [Lee] is a person of color, she has a greater understanding of the biases that people experience in the healthcare system,” Sims said. “I’ve had issues where I’ve gone into the doctor and they just don’t believe what I say.”
Sims mentioned a trip to the hospital for pain where the doctors told her she had a urinary tract infection and suggested she take Tylenol. A trip to a second hospital for a second opinion revealed that she in fact had a large kidney stone that was not passing. She said that if they had believed her pain at the first hospital, they would have caught the source of the problem too.
However, Lee is aware of the challenges that come with this kind of approach. People who have a lot going on in their lives will not always give feedback in ways that are bureaucracy friendly, such as surveys and forms. Lee wants to expand on the work that the organization has already done to engage with members on a deeper, more meaningful level. What would that mean exactly? It’s a question that the organization is still grappling with. Lee wants to see members who have trouble accessing healthcare lead the way on this so Colorado Access can tackle those challenges along the way.
One way that Sims thinks the organization can do this is by expanding the communication Colorado Access has with its members. She said that although a lot of excellent programs exist at Colorado Access, many people don’t know about them. She herself didn’t know about them until she started serving on the Member Advisory Board. Accountability is another area Sims wants to see progress in. She wants to see a database where people can file complaints against doctors and hospitals through Colorado Access and allow patients to get responses to their complaints. She wants this because she doesn’t trust providers to police themselves.
The pandemic has especially laid bare the inadequacies in the healthcare system, exacerbating the daily struggles that many underserved people already face. Lack of access to housing, food insecurity and other basic needs all contribute to the larger healthcare picture.
“There’s so much going on, and appreciating that fuller picture is the only way I think that we can really connect and have people engaging in their care and kind of working with you on what’s important to them,” Lee said. “So I don’t think of [the pandemic] as an obstacle. But, I do think of it as a challenge that we have to appreciate at a different level than ever before.”
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