Sean Pauzauskie, MD, CMS President
Rachelle Klammer, MD, CMS President-elect

Colorado’s health care system is under pressure from every direction. Premiums keep rising. Rural hospitals are fighting to stay open, and practices struggle to hire and retain staff. Physicians see the effects in their exam rooms. What has been harder to find is a shared plan.

That is why more than 30 organizations came together last year to form the Colorado Health Policy Forum. The Colorado Medical Society is a founding member, alongside Copic, hospitals, health plans, community health centers, behavioral health providers, consumer advocates, and rural health leaders. Many find themselves on opposite sides at the State Capitol. They do not always agree, but they share a belief that no single organization can fix these problems alone.

Why we came together

Too often, health policy in Colorado is made one bill at a time. Each group pushes its own priorities, and new laws pile up without anyone asking whether they work together.

The Forum has two goals. The first is to build trust around shared values: putting evidence ahead of ideology, considering the health system as a whole, holding each other accountable, and learning as conditions change. The second is to set up Colorado’s next governor and legislature for a better path.

Starting from the same facts

The Forum’s first step was to build a common data baseline. Working with the Colorado Health Institute, members produced a plain language report called the State of the State. It covers seven connected parts of the health system. Four stories stand out.

First, patients are using primary care less frequently. Among insured Coloradans, routine and preventive visits dropped from 191 per 1,000 people in 2021 to 140 in 2024. Over the same period, preventable hospital admissions rose about 24 percent. For Medicaid patients, the increase was 56 percent.

Second, rural Colorado feels the strain first and worst. Nearly half of the state’s rural hospitals are operating at a loss. Only 17 of 43 rural hospitals still deliver babies, and about 45 percent of rural women live more than 30 minutes from the nearest place to give birth.

Third, the workforce is stretched thin. Statewide, Colorado has about one primary care physician for every 1,200 residents. In some rural counties, that ratio tops 9,000 to 1. Most Colorado physicians now work for hospitals, large health systems, or private equity firms rather than independent practices.

Fourth, coverage appears more stable on paper than it does on the ground. Surveys show the state’s uninsured rate is back near where it was before the pandemic. Yet more than one million Coloradans switched, lost, or went without insurance at some point in 2025. Nearly half of patients at safety-net clinics are uninsured, and hospital charity care costs have nearly doubled since 2019. Federal cuts to Medicaid, which covers about one in five Coloradans, will intensify state budget woes.

Building a platform together

With shared facts in hand, the Forum is developing a policy platform for the incoming governor. Members met for a two-day retreat in October to work through draft issues and positions. The group tackled topics ranging from workforce and innovation, to public health and financing. CMS was particularly focused on care delivery, emphasizing support for a strong foundation of primary care and championing proven, practical prevention strategies like a demonstration program offering structured exercise and nutrition education and coaching for high-risk patients through primary care and community partnerships. Health care affordability is critical – care must be sustainable for patients, families, and the system that finances and delivers it. Meaningful savings require reducing avoidable costs rather than shifting costs, risk, or administrative burden among stakeholders. Adequate primary care payment and less administrative work are part of our agenda to support access and prevention.

The draft of the policy platform is still changing, and that is by design. Leaders need room to wrestle with hard tradeoffs, test ideas, and hear from people who see the system differently. The Forum is helping to create a process to do just that.

There is no single right answer, and no organization can do this work alone. It will take collaboration, commitment, a clear sense of urgency, and a process for moving forward together. As CMS president and president-elect, we want this work to translate into timely access, stronger primary care, and practical prevention. A health system that works better as a whole is one where physicians can spend more of their time doing what matters most: caring for patients.