Grand Junction, Colo., where President Obama will host a town hall Saturday, is a model of efficient health care. The community of 120,000 on the scenic western edge of the state delivers gold-standard health care at cheaper prices than almost any other place in the country -- $5,873 per Medicare patient in 2006, about 30 percent below the national average, according to Dartmouth University researchers
The keys to success seem to include community collaboration and what one health care expert called "a culture of trust."
"It's a great example for the nation," Len Nichols, a health care economist at the centrist new America Foundation in Washington, D.C., told the Los Angeles Times.
"They have managed to contain the natural impulses of excessive competition and the medical arms race . . . Everybody's looking into this."
Grand Junction, known for its great peach crops, moderate climate and friendly retirees, was featured in a ground-breaking New Yorker magazine article
in June on the U.S. health care system. Written by Dr. Atul Gawande, the article contrasted McAllen, Texas, which spent an average $14,946 per Medicare patient in 2006, to Grand Junction, which spent less than half that and maintained a healthier population. Paradoxically, nationwide, the highest-priced health care is often the least effective, Gawande discovered.
President Obama was so impressed with the article that he reportedly ordered his staff to read it.
As for Grand Junction, it's an appropriate venue for the president since the community reflects so many of the principles of his health care overhaul.
What is Grand Junction doing right? Below, 10 initiatives that set the city apart:
1. Universal prenatal care. "We set up a program in the '90s called B4 Babies where every woman in the community who is pregnant gets prenatal care -- period," said Steve ErkenBrack, president of Rocky Mountain Health Plans, Grand Junction's H.M.O. "Not only (does it provide) better care for the moms and better care for babies, it's less expensive for the community because the more women who are in prenatal care, the fewer babies will be in the intensive care nursery for weeks, costing hundreds of thousands and dollars."
2. Online medical records databank. "Five years ago we . . . created interactive electronic medical records -- a health information system," said ErkenBrack. When someone shows up the emergency room, the staff can access a wealth of information, including the patient's medical records, what pharmaceuticals the person is using, and whether he or she is allergic to anything. "You have access to all that information instantly," he said.
3. Peer-review. "We have a fairly good peer-review system," Dr. Greg Reicks, a family physician in Grand Junction, told the Denver Business Journal
in June. "We are aware of how other doctors are practicing, which keeps doctors from overutilizing tests and procedures."
4. Collaboration between Grand Junction's main doctors' group, hospitals and health insurance carriers. "Doctors, hospitals and health plans - which typically work at cross purposes - have worked together to define the best practices for patients with diabetes, heart disease, asthma, transplants and cancer," the Business Journal reported.
5. A doctor-run financial reimbursement system that rewards doctors equally for seeing patients, rich or poor. In the 1970s, doctors and other health-care providers in Grand Junction formed the non-profit Rocky Mountain Health Plans. Doctors work under a cooperative agreement with RMHP. Here is how Gawande describes it in The New Yorker: "Years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up."
6. Coverage for all. "One of the things we focused on from the outset was trying to find a way to offer (health care) to everyone in the community, whether they were Medicaid or Medicare, large group or small group, or individual," said ErkenBrack. "We find a way to get them into the system. We provide access to the Medicaid community and to every private care physician in the community, and to more than 90 percent of specialists in the community, and when you create that kind of access, you're able to get on top of care and deliver it in the most cost-effective way over time. So, you wind up with having created a system that because of the care that we give, you end up with healthier people. The healthier people are, the less expensive they are."
7. Home health care. Grand Junction has a vast network of nurses and therapists who visit patients at their homes after they are released from the hospital. Only 12 percent of Medicare patients required admission 30 days after a hospital visit, as opposed to a nationwide rate of 20 percent, according to the Los Angeles Times
. "When someone gets to a point in their hospitalization where they can leave the hospital if they have a nurse come to their home a time or two a day, then we have that option available and that's a lot less expensive way to deliver care," said ErkenBrack. Sen. Michael Bennet (D-Colo.) is sponsoring legislation that would provide incentives for communities to create hospital-home transition teams like those in Grand Junction.
8. Low-cost community clinic. "In partnership with the two hospitals in town, RMHP also opened a clinic where unisured patients can seek low-cost treatment. This keeps them from clogging emergency rooms for routine problems," writes Nicholas Riccardi in the LA Times.
9. Coordinated end-of-life care. The Dartmouth researchers found patients with terminal illnesses in Grand Junction spend fewer days in the hospital, don't see as many specialists and undergo far fewer medical tests than most places, the Denver Post reports.
Workers at Hospice & Palliative Care of Western Colorado help residents sort out their options, including dying at home if they want.
10. Ongoing doctor education. RMHP teaches doctors about prescribing practices and urges them to use cheaper drugs and to avoid heavily advertised drugs that may not provide extra benefits, according to the Denver Post.