The ideal healthcare system is in... Grand Junction?
In a report about efforts to control healthcare costs broadcast on National Public Radio this morning, Len Nichols, of the New America Foundation, an organization lobbying for reform in a wide array of areas, declared that "the ideal healthcare system" already exists in a number of places -- and the first one he mentioned was Grand Junction.
The effusive press the Western Slope community has been receiving of late about its healthcare approach can be traced to "The Cost Conundrum," a June 1 New Yorker piece by Atul Gawande. Here's how he explains the GJ system:
One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare's highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But 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. Then, in 2004, the doctors' group and the local H.M.O. jointly created a regional information network--a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.
Grand Junction's medical community was not following anyone else's recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.
With the healthcare debate devolving into precisely the sort of political quagmire that doomed an overhaul during the early years of the Clinton administration, expect representatives of both the left and the right to cite Grand Junction -- with progressives using it to prove that change is good and conservatives mentioning it to show that upgrades can be made without onerous new regulations. Sounds like a healthy discussion.
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