By Katie Kerwin McCrimmon

Summer is officially over, but with temperatures approaching 90 degrees and bright sunny September days, you still might be able to dose up on some vitamin D.

That raises a health conundrum, however.

Sharon McKenna spent her childhood getting blistering burns before she’d get tan. She survived melanoma and now advises people to protect themselves from potentially dangerous sun exposure. Source: U.S. Centers for Disease Control and Prevention.

On the one hand, skin cancer is the most common cancer in the U.S. and dermatologists would much prefer if we stayed out of the sun altogether or remain well covered with sunscreen, hats and long sleeves during peak sun hours. New research has found that melanoma, the deadly form of skin cancer, is striking younger people — especially teen girls — in much higher numbers.

At the same time, researchers say Americans are chronically deficient in vitamin D. The name is misleading. Vitamin D is a hormone, not a vitamin, and we get it by converting UV rays into the hormone. Vitamin D is crucial to bone health and may have all sorts of other benefits from preventing some types of cancer to thwarting infections.

With seemingly incongruent advice to stay out of the sun because it causes skin cancer while finding ways to get adequate vitamin D, what do doctors advise?

Skin cancer experts are adamant. They say UV radiation is a known carcinogen, and potential harm from sun exposure is too great to risk spending time outdoors without sunscreen. People who need vitamin D should get it through fortified foods or supplements.

But vitamin D experts say that some individuals may decide to load up on vitamin D by spending very short periods of time outside on sunny days without sunscreen since sunlight gives much bigger boosts of vitamin D than people can get through food or supplements.

“I’m not personally making this recommendation, but the amount of vitamin D that a light-skinned individual in the summer in Colorado would get wearing short sleeves for about 10 to 15 minutes would be as much vitamin D as you’d get in 30 glasses of (fortified) milk,” said Dr. Adit Ginde, an emergency room physician at University of Colorado Hospital and an associate professor of emergency medicine at the University of Colorado School of Medicine.

“The darker your skin tone, the more likely you are to need vitamin D,” Ginde said.

“It’s a personal decision. If you want to raise your vitamin D levels and you want 0 risk, taking a supplement is probably the safest way to do that,” he said.

For those who want some vitamin D through minimal sun exposure, Ginde said you’d never want to stay out to the point of getting a sunburn. Rather, you’d absorb some rays for less than half the time it would take to get any kind of burn.

The complication is that individuals are so different. Some people have a greater risk of getting skin cancer, so they should be very cautious. Skin tones vary, as do exposure levels depending on the latitude. In Colorado, it’s very difficult to get any exposure to vitamin D in the winter and you don’t absorb much during off-peak hours.

Ginde was the lead researcher of a 2009 study that found that three out of four people are deficient in vitamin D and that deficiency levels are growing.

Deficiencies among African-Americans and Hispanics are particularly high, according to the study, which was published in the Archives of Internal Medicine.

Ginde is completing a study now on the role that vitamin D might play in preventing infection. He can’t share those results yet, but said researchers may find that lower vitamin D levels in the winter may make people more vulnerable to colds, the flu and respiratory infections.

The optimal level of vitamin D in the blood ranges from about 30 to 40 nanograms per milliliter, he said.

Ginde and his fellow researchers found a marked increase in people who were deficient. The population of people who were severely deficient with levels of less than 10 nanograms per milliliter had gone up from 2 to 6 percent when the researchers compared vitamin D levels in people in the late ’80s and early ’90s compared to those tested between 2001 and 2004.

Since Ginde’s study, the Institute of Medicine issued new guidelines ecommending 600 IUs per day for adults ages 70 and younger and 800 IUs per day for those 71 and older. Those recommendations were controversial as soon as they came out in 2010 and some researchers have said people should be getting much more vitamin D.

“It’s clear that the rates of deficiency are high and increasing,” Ginde said. “Increased sunscreen (use) has some part of it, but also becoming a more indoor population has played a big role.”

Ginde said that 80 to 90 percent of vitamin D intake is related to UV exposure and that outdoor exposure is the “primary determinant of vitamin D levels in people.”

If most of the exposure to vitamin D happens outdoors, that brings back the concerns about skin cancer.

Melanoma surged into the news recently when former President Jimmy Carter revealed that he had been diagnosed with melanoma that had spread to his brain.

While Carter is 90, researchers at a New York cancer center have found staggering increases in melanoma rates among young patients.

Researchers at the Roswell Park Cancer Institute in Buffalo, N.Y., earlier this summer unveiled a study that found that the number of cases of melanoma in children, adolescents and young adults increased by 253 percent from 1973 to 2011. Survival rates linked to much better treatments for melanoma have also increased.

But the disease still can be deadly or require extensive, costly treatments. Young people who get it are shocked to have cancer at such an early age. In particular, melanoma cases have shot up among young women. Risky behavior including the use of tanning beds is a likely culprit for the increase in cases among younger women.

Dr. Demytra Mitsis, a fellow at Roswell Park and lead author of the study, said she often meets young patients who wish they could turn the clock back.

“They say, ‘I thought I was invincible. If I could go back and talk to my 16-year-old self, I would do things differently.’ It’s hard for them to understand that something like this can happen,” said Mitsis.

For her study, she analyzed data from 35,726 people who had gotten melanoma between 1973 and 2011. Before 1980, females represented 57 percent of cases. That percentage rose to 65 percent from 2001 to 2011.

While survival rates have improved, about 7 to 10 percent of people diagnosed with melanoma will die, Mitsis said.

Dr. Ilene Rothman, chair of the dermatology department and Mitsis’ colleague at Roswell Park, said she used to see one or two patients a month with melanoma.

“Now we’re seeing them all the time. One American dies from melanoma every hour. It’s still quite common and quite serious,” Rothman said.

“Skin cancer is the most common (cancer) in the U.S. One in five Americans gets some kind of skin cancer. One in 58 gets melanoma,” Rothman said.

Rothman said vitamin D is very important to bone health. Other potential benefits haven’t been proven yet, so she sees no conflict between the need to get vitamin D and the importance of preventing skin cancer.

“There are excellent sources of vitamin D that don’t cause skin cancer. Any UV exposure — whether it’s from the sun or tanning beds — can cause cancer. We already know that. We can get vitamin D from our diet, from fatty fishes like salmon and tuna. And supplements are readily available.

“I do not recommend that people get their vitamin D from the sun,” Rothman said.

She said the jury is out on exactly how much extra vitamin D people should take. Rothman recommends getting your levels checked, then mapping out a plan with your doctor.

And she says skin cancer can be prevented.

About 24 states have some kind of ban for tanning beds for teens. (Colorado does not.)

Adults and young people need to use sunscreen properly and more often. The U.S. Centers for Disease Control and Prevention found that only about 30 percent of women and 15 percent of men regularly use sunscreen.

“It’s abysmally low,” Rothman said.

Even when people use sunscreen, they often don’t put it on properly or forget to reapply it.

“You need water-resistant sunscreen if you’re active, and try to avoid the middle of the day. Seek shade. Wear hats. Think of enjoying yourself outside, but not trying to get a tan,” Rothman said.

The non-melanoma skin cancers are directly linked to sun exposure. Causes for melanoma are more complex.

“We can’t say for sure, but many patients recall those blistering burns as children,” Mitsis said. “They could have actually prevented this. It can be very frustrating for patients.”(Click here to see the video Dear 16-year-old me.)

“There are a lot of factors we can’t do anything about. We can’t change our genetics. One thing we can change is our behavior,” Rothman said.

Telling young people that they might someday have cancer doesn’t always resonate. But teens who want to be beautiful sometimes heed warnings if they hear that sun exposure could make their skin look bad.

Colorado has a higher rate of melanoma than the U.S. average, but surprisingly some northern states have higher rates. Colorado’s rate is 21.6 per 100,000 people compared to the U.S. average of 19.7. By comparison, Vermont has a rate of 28.1 while in Minnesota the rate is 27.5 per 100,000 people.

For Ginde, the vitamin D expert, health choices are always about tradeoffs.

“Certainly by using sunscreen all the time, you increase your risk of vitamin D deficiency and you have some protection from skin cancer,” he said. “Perhaps for an individual, there’s some middle ground.”

By Katie Kerwin McCrimmon

Child poverty rates and the percentage of children without health insurance continue to decline in Colorado, giving advocates hope that the economic recovery is finally beginning to reach the state’s lowest income families.

Emmanuel Arroniz, 4, gets a checkup at the Rocky Mountain Youth Clinics’ Kids Clinic at Crawford Elementary School in Aurora. The clinic provides care for children in one of the highest poverty areas in Colorado.

The percentage of children living in poverty has declined for the second year in a row and poverty rates for families with children finally reached pre-recession levels, according to new data from the U.S. Census Bureau’s 2014 American Community Survey.

The 2014 rate was 15.4 percent, down from 16.9 percent in 2013.

The decreases two years in a row mark the first time Colorado has seen continuously declining child poverty rates since the survey started in 2000.

“We’re pleased that things are heading in the right direction,” said Sarah Hughes, research director for the Colorado Children’s Campaign. “We are hoping this marks a turnaround.”

The recovery has not been even across the country or in Colorado. Colorado had the sixth-largest percentage decline in 2014 and was one of just 10 states to see a statistically significant drop in child poverty rates for 2014. Hughes said many rural areas of the state are still struggling with a less-than-stellar recovery. County level poverty data will come out later this year, but some parts of the state, like the San Luis Valley, have seen persistent, multi-generational poverty rates that can leave up to one-third of children living in impoverished families.

Even with the recent declines, about 190,000 children live in impoverished families, up from 104,000 in 2000. Poverty is defined as annual income below $23,850 for a family of four.

On the health insurance front, the new census data confirm newer information from the Colorado Health Access Survey, which came out earlier this month and is based on a 2015 Colorado survey conducted by the Colorado Health Institute.

The census numbers from 2014 show that just 5.6 percent of Colorado children lacked health insurance, down from 8.2 percent in 2013. The newer data from the 2015 Colorado Health Access Survey showed an even more dramatic decline in uninsured children, down to 2.5 percent.

Hughes said timing explains the difference in the survey results. Census officials gather data throughout 2014. Some of the early numbers would not have reflected full implementation of the Affordable Care Act. Colorado has seen some of the largest jumps in the country in its Medicaid enrollment and health experts have said that as adults got health coverage, so did their children.

“Kids in Colorado are among the biggest winners in health reform,” said Chris Watney, president and CEO of the Colorado Children’s Campaign. “Expanding Medicaid access for whole families and establishing our own, state-based Colorado (exchange)… are among the reasons that Colorado experienced the nation’s second-largest percentage point decline in the rate of kids without insurance.”

Hughes said health insurance for families allows children to get preventive care and immunizations. They also have a place to go if a child gets sick.

“We’re on the right track. We have more kids covered by health insurance in Colorado than ever before,” Hughes said.

Coverage does not guarantee a child will have a provider, but school based clinics and community health centers are helping provide access for newly covered children in some parts of the state.

Children from Latino families continue to struggle the most. While many more African American and Native American kids got health coverage, Hispanic kids still are most likely to be uninsured. The census data showed that 9.6 percent remained uninsured in 2014, down from 13.1 percent in 2013.

The 2015 Health Access Survey showed similar trends for Hispanics of all ages. Hispanics had the highest uninsured rates overall. About 11.8 percent of Hispanics remained uninsured in 2015, compared to 21.8 percent in 2013, according to the Colorado Health Access Survey.

Geographic and ethnic disparities remain a challenge for the state.

Said Hughes: “We still have work to do to make sure all kids can access high quality coverage.”

By Katie Kerwin McCrimmon

Colorado’s health exchange board unanimously voted on Monday to give its chief strategy and sales officer a contract that could pay up to $150,000 for six months of work.

On an annual basis, that’s a higher rate of pay than the interim CEO for the exchange who receives $199,200 a year and more than triple what the governor of Colorado receives: $90,000 a year.

Marcia Benshoof will get paid $120 an hour and up to $150,000 over six months at Colorado’s health exchange. Lawmakers are questioning her lucrative contract.

The lucrative contract comes after exchange managers earlier this year hiked costs for customers to fund a ballooning budget and vowed to operate more efficiently with fewer highly paid contractors and more salaried employees. The previous head of Colorado’s exchange, Patty Fontneau, incurred the wrath of some critics when she sought a raise and bonuses when the exchange was performing poorly.

The exchange board met in secret during an executive session on Monday, then voted in public on the contract for Marcia Benshoof. She will receive $120 per hour and up to $150,000 during the next six months. A spokesman called Benshoof’s work “invaluable.”

Altogether over the past three years, Benshoof has received $542,880 for consulting work and expenses. On top of that, she worked for seven months in 2014 and early this year as an exchange employee. During those seven months, she earned $165,000 a year or about $96,200 in additional pay.

She’s not alone in receiving a high-paying contract. Another high-level exchange manager, Adele Work, worked as a contractor from spring of 2012 to spring of this year and the exchange paid North Highland Consulting just over $1 million for Work’s services. Earlier this year, Work became an exchange employee — chief information officer — and now earns $165,000 a year.

Among other work, Benshoof has overseen the small business exchange. As of April of this year, the small business exchange had only attracted 329 employer and 2,589 individual customers. In a report to board members at that time, Benshoof conceded that the small business exchange was “underperforming” and was at a critical juncture. Managers promised to make the system easier to use, but have shelved any fixes until spring.

Benshoof also oversees brokers working with the exchange, does outreach and eligibility work, partners with insurance carriers and federal officials, and is the official “insurance license” holder for the exchange, according to interim CEO Kevin Patterson.

In presentations to the board about enrollment projections this year, Benshoof has said that the exchange will have to perform much better in 2016 than it has in previous years. She predicted individual sign-ups closer to 217,000 for 2016, compared to about 143,000 for 2015. And she is gambling that the small business exchange will cover nearly 7,000 people by the middle of next year, compared to over 2,500 this year.

So far, the health exchange has not managed to attract the majority of customers in the individual market. The Colorado Health Access Survey released earlier this month found that Colorado’s exchange so far has captured 42 percent of the individual market.

After the Monday vote, the exchange’s lawyer, Alan Schmitz, and spokesman Luke Clarke both tried to stop Benshoof and board members from commenting on the contract.

Benshoof declined to comment.

Board Chair Sharon O’Hara said that the contract amounted to “appropriate spending” and “is necessary.”

Adela Flores-Brennan, a board member and former Connect for Health employee who now represents consumers as head of the Colorado Consumer Health Initiative, declined to explain why she voted yes.

Patterson said he recommended that the board approve Benshoof’s contract.

“When you look at the amount of responsibility and work that Marcia has to do, I think it’s very justifiable,” Patterson said after the board meeting. “She has a unique set of skills and a history of knowing this insurance world extremely well.”

Why not then make Benshoof a salaried employee?

Patterson said it’s unlikely he could replace Benshoof with a single person. He said she has the expertise, knowledge and relationships that add value for the exchange.

“For what she is able to deliver to our organization, I think it’ is the right amount (of pay),” Patterson said.

Exchange critics, however, said that the contract for Benshoof is typical of out-of-control spending at the exchange.

“Unfortunately, I’m not surprised, but I’m deeply disappointed,” said Sen. Kevin Lundberg, R-Berthoud, who sits on the legislature’s exchange review committee. “I’m not surprised because I’ve found that they spend money like water. They’ve already burned through (as much as) $200 million setting this whole system up and it’s still not functioning as expected.”

Lawmakers have tried to more carefully scrutinize exchange managers and board decisions. But Lundberg said the committee has little power over decisions like contracts.

Lundberg is planning to introduce a bill next year that would require voter approval for consumer cost hikes at the exchange that he believes amount to illegal taxes. Unlike a typical fee, Lundberg said all Colorado customers who buy health insurance have to pay to fund the health exchange and he calls that an illegal tax.

He said high pay has been the rule, not the exception at the exchange.

“Everybody who had done anything (for the exchange) has been paid well beyond the scale for state workers,” Lundberg said. “This is part of the state of Colorado. The state seal is on all their letters. They are created by the state. Yet they operate with impunity.”

Connect for Health Colorado is a public entity, but operates independently of state government.

“I believe their entire system is a fantasy. It does not provide affordable insurance for the people of Colorado. It just adds a layer of bureaucracy. They have driven a lot of people into Medicaid, but fewer people can afford to pay their medical bills,” Lundberg said.

Sen. Beth McCann, D-Denver, who is vice-chair of the legislative oversight committee, said that exchange workers have “confronted an extremely heavy work load with many challenges. Overall, they have been successful in signing up large numbers of people both for Medicaid and private insurance.”

McCann said “much work remains to be done” particularly with respect to glitches in the enrollment system.

“Marcia appears to be highly qualified and committed to the success of Connect for Health. The potential of $300,000 a year, if that is in fact the case, is too high. I would hope the Board will monitor her hours so that her compensation remains within reasonable limits, certainly not more than the CFO or CEO are making.”

Benshoof joined Connect for Health Colorado in 2012. She initially worked as a contractor at a rate of $74 an hour, a rate that jumped to $85 an hour, then to $120 per hour this year. Altogether, Benshoof has received $542,880 for consulting fees and expenses over the last three years, according to exchange spokesman Luke Clarke.

For six months last year and one month this year, Benshoof, worked as an employee for the exchange at a compensation rate of $165,000 per year. At the end of January this year, Clarke said she asked to go back to being a contractor.

By Katie Kerwin McCrimmon

Colorado lost the largest number of people to suicide in state history last year —1,058 — and the state once again ranks among the worst in the U.S. for high suicide rates.

Photo by Casey A. Cass.

Suicide kills more Coloradans each year than homicide, car crashes, diabetes, breast cancer, flu or pneumonia, according to state health officials.

Middle-aged men are at the greatest risk for suicide and half of those who killed themselves used a gun. Colorado is planning to update and continue promoting a unique website called Man Therapy that uses humor to reach depressed men and try to stop them before they consider suicide. (Click here to read ‘Man Therapy’ goes global.)

Health experts say guns are too easily accessible for people who are depressed. They also blame Colorado’s extremely high suicide rate on inadequate mental health systems and a lack of funding for prevention programs.

Like other states in the Rocky Mountain West, Colorado consistently tops the list of states struggling with suicide. Colorado ranked seventh in the nation for suicides in 2013, the most recent year for which national data are available. That year, Colorado tied with Idaho. Topping the list were Montana, Alaska, Wyoming, New Mexico, Utah and Nevada.

Jarrod Hindman, manager of suicide prevention programs for the Colorado Department of Public Health and Environment, said the primary theories for why mountainous Alaska and states in the Rocky Mountain region year after year rank high for suicides center on attitude and altitude.

“In the western U.S., particularly the Rocky Mountain region, we have a great deal of rural geography. One of the issues is the lack of access to available mental health resources. There’s also that notion of rugged individualism. When you’re struggling or need support, you don’t ask for help. You want to pick yourself up by your bootstraps, but your brain won’t allow you to do that,” Hindman said.

Research also shows that suicide rates are higher in areas where more people keep guns in their homes. And brain experts have found links between high rates of depression and suicide and areas around the world that sit at higher altitudes. (Click here to read Record suicide rate rocks Colorado. Could altitude be to blame?)

Colorado established a new suicide prevention commission in 2014 and public health officials are partnering with hospitals and gun shop owners to try to foster better awareness about suicide risk. But, prevention programs are expensive and a dramatic reduction in suicide rates will require a comprehensive approach like the concerted efforts to drive down automobile death rates.

“With cars, everybody knows about the danger of motor vehicles. You know if you drive drunk, there are serious consequences. They know about seatbelt laws. Cars have airbags and are much safer. With a good amount of money and marketing, we’ve seen reductions in the motor vehicle death rate,” Hindman said.

With respect to cutting suicide rates, “It will most certainly take will and both human capital and financial capital,” Hindman said.

Added Dr. Larry Wolk, executive director and chief medical officer for the state health department: “For too long, suicide has devastated Colorado families. We need to put our best minds and resources toward battling depression and preventing suicide.”

Unfortunately, Hindman points out that there is not one key factor or device like an airbag that can help prevent suicides.

Depression is complex and in many parts of rural Colorado, guns are commonplace.

Excerpt from a brochure that gun and pawn shops and shooting ranges are sharing with customers in western Colorado. Courtesy of the Office of Suicide Prevention at the Colorado Department of Public Health and Environment.

To try to keep guns away from people who may be suicidal, health experts are partnering with gun and pawn shop owners, firing ranges and advocates for firearm safety.

Colorado last year piloted a program modeled after a New Hampshire education effort that works with hospitals and gun retailers to try to keep guns away from people who are depressed.

Through the program, gun advocates distributed information about the “11^th Commandment” of gun ownership: temporary off-site storage of guns if a family member is suicidal.

Brochures being distributed at gun shops and shooting ranges highlight Colorado’s dangerously high suicide rates and say: “When an emotional crisis (like a break-up, job loss, legal trouble) or a major change in someone’s behavior (like depression, violence, heavy drinking) causes concern, storing guns outside the home for a while may save lives. Friends, as well as some shooting clubs, police departments or gun shops, may be able to store them for you until the situation improves.”

Suicide prevention experts are also piloting a program with hospitals to be sure people who have come to an ER for suicidal thoughts have a place to call for help when they’ve been released.

So far, Denver Health, Presbyterian/St. Luke’s Medical Center, St. Mary’s in Grand Junction and a group of hospitals in southeastern Colorado have signed on to pilot a new effort to make sure all at-risk patients or their family members go home with an appointment for follow-up talks with suicide experts through the state’s phone crisis line called Rocky Mountain Crisis Partners.

“They follow up later that same day and two or three more times over the next two weeks,” Hindman said. “Just making a connection with an individual can be a protective factor.”

“We’ve got all these really great ideas and programs started. If they are effective, we’re hoping to expand them as quickly and efficiently as we can,” Hindman said.

But that takes money. The new hospital effort, alone, is costing $42,000 a year. And with that amount of money, the state is reaching just a handful of the state’s 88 hospitals with emergency departments.

“The optimistic side of me suggests that we are moving in the right direction,” Hindman said. “But it’s such a multi-faceted problem. Everybody has to be involved from prevention workers to primary care to insurance companies and private industry.”

Suicide prevention help is available 24/7 at the Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Colorado Crisis and Support Line at 1-844-493-TALK (8255).

By Katie Kerwin McCrimmon

Dogged by technology failures last year that snagged at least 10 percent of customers, Colorado health exchange managers promised Monday that they’ll have a new streamlined IT system ready by Oct. 18, just two weeks before the Nov. 1 launch of the next open enrollment season.

In order to get the sign-up system for individuals finished by mid-October, exchange managers revealed Monday that they are delaying any fixes for a poorly performing small business portal until at least February.

The news that the system for individuals won’t be ready until October prompted concerns from consumer advocates at a hearing of the health exchange board on Monday.

“We continue to be very concerned about that timing,” said Deb Judy, policy director for the Colorado Consumer Health Initiative.

For the past two years, exchange and Colorado Medicaid and IT managers have made similar claims that they would be ready for sign-up season and that the IT systems would function well for customers. Each time, the systems have had major failings. The exchange, Connect for Health Colorado, has a new interim CEO and several new board members. Former Chief Technology Officer Proteus Duxbury stayed at the exchange just over a year and left this spring to take another job. But many of the same IT vendors and IT managers who have failed to produce simple systems in the past are trying to make fixes now.

Adele Work, formerly a consultant who was the project manager for the exchange and now the exchange’s chief information officer, said she’s aiming for a better experience for customers this year. But she warned that some customers still will have trouble.

“Flawless is a goal that we will never attain,” Work told board members.

Easy sign-ups are critical for the long-term success of Colorado’s health exchange. The exchange is banking on a big bump in sign-ups for 2016 — about 215,000 compared to about 140,000 during open enrollment this year.

Without attracting more customers, the exchange can’t bring in enough cash to survive. A legislative oversight panel has been meeting to decide whether to keep a state-based exchange in Colorado and the state auditor is conducting a broad audit after a narrow review last year found extensive problems and questionable spending.

Work said there’s never enough time to do adequate testing with a system as large and complex as the “Shared Eligibility System,” a combined IT portal for the exchange and Colorado’s Medicaid system. Colorado’s exchange is an independent public entity outside of state government. But customers who want tax subsidies to help pay for health insurance premiums must first show they don’t qualify for Colorado’s Medicaid program. So the exchange and Medicaid systems must work together.

In many states, the state government runs the health exchange. In Colorado, managers for the entities bickered for years. On Monday, managers for the state exchange, Office of Information Technology and the state Medicaid programs attended the exchange board meeting to try to show a unified front. The new interim CEO for the exchange, Kevin Patterson, is Gov. John Hickenlooper’s former chief administrative officer. Board members hope that Patterson can foster better cooperation among the separate entities and score millions in support for the exchange from Medicaid.

Work told board members that “there are a number of risks” to the timeline, so she’s trying to focus on the most critical fixes.

They include:

• Automatically renewing people for the same plan they had the previous year if they don’t take any action. Last year, hundreds of people who browsed for new plans, but didn’t select one automatically lost coverage instead of keeping their old plans.
• Preventing the system from randomly increasing a person’s income. Some customers found that each time they logged in, their income had inexplicably doubled or tripled.
• Improving the call center operations and allowing customers with problems to check their status through an online system, rather than requiring them to wait on hold to see if their problem has been solved.
• Making it easier for people to learn if they’ll qualify for Medicaid or can shop for private plans with subsidies.

Patterson said it was important to delay fixes for the small business system, which has attracted very few customers, in order to make sure the main system is working well.

“We are trying to control how much technology we are changing,” Patterson said. He and other top managers nonetheless promised to increase the number of people using the small business system since that will also help bring in more cash.

Work said testing on the new individual sign-up system will begin in late September.

“We can’t really say how well open enrollment is going to go until we (do key testing) about one month from now,” Work said.

She also warned board members that capacity problems are likely to surface and could require contingency spending since most customers are likely to wait until the last minute to sign up.

The open enrollment season begins on Nov. 1 and ends on Jan. 31.

Work said she expects customers won’t begin signing up in earnest until after Thanksgiving and the exchange will have to brace for as many as 10,000 sign-ups a day during the crunch period just before the enrollment deadline.

When they do shop and buy, she hopes exchange users will be happier.

“It’s all about the customer experience,” Work said. “I believe we weren’t ready to handle the kind of issues that came out of the woodwork (last year).”

Since the exchange has new board members, the board elected new officers and reorganized committees, vowing that the committees would meet more often to try to do a better job of strategic planning.

Sharon O’Hara, vice president of the Colorado-Wyoming chapter of the National Multiple Sclerosis Society, will remain board chair.

Steve ErkenBrack, a veteran of the board since its inception and president of Rocky Mountain Health Plans, will become vice chair.

Eric Grossman, president of NextHealth Technologies and another board veteran, will take over the key board committee that oversees finance and operations.

Newer board members, Adela Flores-Brennan, a consumer advocate; Marc Reece of Aetna; and Jay Norris, an insurance broker, will work on a policy committee with Colorado’s Insurance Commissioner, Marguerite Salazar.

Correction: An earlier version of this story said that open enrollment for 2016 would end on Dec. 15. That’s incorrect. Open enrollment begins on Nov. 1 and ends on Jan. 31.