Local health care in national spotlight
New Yorker magazine features efforts of Grand Junction doctors
Three decades ago, local doctors Edward L. Ellinwood, Gilbert Madison, Ward Studt and Charlie Wilson couldn’t have fathomed that the health care model they designed for Mesa County would today be in the national spotlight, sought by policy makers as a shining example of potential health care reform.
Local doctors merely wanted the working poor, an under-served segment of the population, to have the same access to health care available to the rich and to the indigent. By cultivating collaboration among hospitals and physicians, and forming a nonprofit HMO, they created a low-cost, high-quality system that long has earned high marks and is now turning heads as the nation grapples with rising health care costs.
“I kind of appreciate being recognized for what we did,” Wilson said Tuesday at his home. “A lot of us who were doing this took a lot of flak in the beginning.”
In 2006, St. Mary’s Hospital and Community Hospital reported some of the lowest Medicare reimbursement rates in the country, at $2,664 a year, compared to a national average of $3,193. While keeping costs low, the hospitals consistently receive some of the nation’s highest quality of care scores from Medicare.
A June 1 article in The New Yorker magazine, written by Atul Gawande, illustrates the difference between Grand Junction and McAllen, Texas, an area with Medicare reimbursement rates that were five times higher, or $15,000 per person, in 2006.
Despite the additional spending, quality of care there in McAllen is considered low.
Grand Junction also previously has been featured in The Dartmouth Atlas of Healthcare, a publication that compares how Medicare dollars are spent. Policy makers and groups around the country are seeking out Grand Junction health leaders for advice on how to apply the local model on their turf.
In the early 1970s, doctors in the local Independent Physicians Association created Rocky Mountain Health Plans and secured government contracts for Medicare and Medicaid patients. Doctors agreed to fairly divvy up payments on those plans, which means that some doctors make less so others can make more. That has resulted in all physicians accepting the government-issued insurance plans.
Also, doctors created a peer-review policy. Doctors began querying each other about whether patients really needed some treatments, such as hospital stays or referrals to specialists. Over the years, this has resulted in Grand Junction boasting the state’s lowest readmission hospital rates, doctors say.
In 2005, as part of a collaborative effort among health care providers, an Internet data sharing system was developed. The system, dubbed Quality Health Network, can be viewed by any physician in Mesa County, and works to ensure that patients are neither over- or under-treated, doctors say.
In the first couple years of Rocky Mountain Health Plans, investing doctors lost money by overtreating patients. But because physicians took on that risk, it provided an incentive for them to make local health care viable.
“I don’t think this would have worked if we weren’t such a close community,” Wilson said.