In the following Q&A, Matt Guy, executive director of the Pueblo Triple Aim Corporation in Pueblo County, Colorado, explains how his community coalition helped decrease the teen birthrate by 40 percent in six years. 

Image by David Shankbone

Q: Why did Pueblo County decide to pursue the Triple Aim?

The Pueblo Triple Aim Corporation was founded three years ago, but we really started five years ago.

At that time, our public health department had to do a community health improvement plan because of the reauthorization of a state law. At the same time, the Affordable Care Act was requiring our two nonprofit community hospitals to do a community health needs assessment, which was new for them. Then, Kaiser Permanente came to the community. They saw our health statistics and had some concerns because we’re not the healthiest community Kaiser’s ever moved into. Meanwhile, the business community was struggling to afford health insurance for their employees.

In October of 2010, Kaiser convened these groups and brought in IHI to talk about the Triple Aim. IHI asked us if we would be interested in doing this on a community level. We ultimately became one of the Triple Aim prototype communities.

About 20 organizations got together, both inside and outside of health care. We had representatives from education, social services, and economic development, and we formed a volunteer coalition. In 2012, we decided to set up a neutral, nonprofit entity, and created the Pueblo Triple Aim Corporation. Our mission is to make Pueblo County the healthiest county in Colorado using the Triple Aim.

Q:  Drawing from your experience in the community, what do you think are the keys to successfully pursuing the Triple Aim?

Patience is number one. We are not going to solve long-standing health issues in six months. We’re not going to solve them in a grant cycle. It takes longer than that.

You have to have some precision, too. You need to have data. You need to be willing to share data across the board and develop a common measurement strategy.

It’s also essential to have a good group of committed people — from health systems to the business community to education to social services to average citizens. You need a broad spectrum of people to represent what health truly means in a community. Recruiting those non-health care entities has been a huge part of our success — they are our major players. Sometimes they are the loudest voices, talking about the needs of the community.

Finally, you must have some sort of infrastructure. You can’t just do this on a volunteer basis and hope this is going to remain stable over years. The Pueblo Triple Aim Corporation provides some long-term guidance.

Q:  Your community has reduced your teen birthrate by 40 percent in six years. How did you bring people and organizations together to so effectively address this controversial issue?

We had been working on teen pregnancy for 30 years in Pueblo, a community that’s 50 percent Catholic, has an active evangelical base, and several health systems providing women’s health services.

For the first 25 years, nothing changed. I don’t think people were willing to acknowledge that it needed to be a broad effort. The Triple Aim brings the global effort together. There’s a clinical side to this, but there’s also a social side. We can [dispense] all the long-acting, reversible contraceptives we want, but if these youth don’t have a positive place to go to develop as strong and mentally healthy people, they’re going to be more likely to engage in risky behavior. What finally made it work is [putting the clinical and social supports] together.

The most important thing is respecting each other’s points of view and finding common ground. We have a group that comes together on a monthly basis. One group is very much clinically oriented [and focused on] long-acting contraceptives. You have part of the community that doesn’t believe in those. The common ground is caring about kids.

For the folks in the clinical world, youth mentoring is not something they do, but other organizations can do this really well. The clinical people handle the long-term contraception well. At Pueblo Triple Aim, we take the data from both and say, “These work together.” It’s not one or the other. The efforts of both have reduced the teen pregnancy rate in this community.

Q:  How do you manage the relationships with all these different community stakeholders?

One of the key principles is the one-on-one relationships you build with individuals and organizations. It’s worth spending the time to go one-by-one to individuals and organizations that have influence, and identifying their goals. We then think about how their goals fit into our goal in Pueblo of becoming the healthiest county in Colorado.

Even though the Triple Aim is an amazing concept, you can’t force it on anyone. The individual or the organization has to see how they can fit into it, and not every organization has wanted to do this. We leave the door open for anyone to come on board, understanding that not everyone is ready right away.

We use collective impact as our method to get everybody on board. We truly believe that we have to have a shared agenda, but everybody’s activities are their own. We’re not going to force the hospital to become a public health department, and we’re not going to force businesses to become health care providers.

Q:  Coalition building, as you know, is very challenging. What advice do you have for health organizations trying to build community partnerships?

The scariest thing for a health care entity is to go out into the community they serve. Health care entities have the clinical knowledge, but what other things are affecting people in the community?

For health care entities, I suggest you find your most comfortable spot and start there. Build on the good relationships you have in the outside in the world, with social service agencies or a health plan or with businesses. You have people who come into your doors every day; those are individuals with neighborhoods and families and friends.

You don’t have to do this all at once. Take small steps. Don’t try to eat the whole elephant; eat the elephant one piece at a time. Don’t worry about getting everyone involved right now. Find out who wants to connect with you and get them on board first. Then build from there.

Q:  What’s next for the Pueblo community?

We’ve worked pretty hard on a number of areas beyond teen pregnancy. We’re working on obesity, for example. Our obesity rate is flat, which is a good thing.

Parts of our community have not had a grocery store in 50 years. We’re now seeing our business community asking, “How do we offer full-service grocery stores within food deserts?” We now have a grocery store moving in. Being able to cook and eat healthier will be a massive shift in this neighborhood. It’s been a big culture change for our community, and we’re very excited to see that.

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