Henrietta Hay Column June 19, 2009

Grand Junction shows how a responsible health system can operate

Miracles do happen. Grand Junction was mentioned in The New Yorker magazine. And it has created quite a buzz in our part of the country.

It had to do with health care.

Health care is the important issue today. The president and both political parties are trying to find an acceptable answer, without bloodshed. That would definitely require health care.

We have had two events recently that have brought the issue to our special attention locally.

We all read that dreadful story about Nadya Suleman. She is the California woman who produced octuplets via in-vitro fertilization. For anyone who hasn’t had Latin, that means eight babies. She already had six children. I have no idea how much she has cost the health system, but it is probably in the millions.

Local physician, Dr. Michael Pramenko wrote an excellent column for The Daily Sentinel, which was the most rational piece I found on the subject. He used the octuplet event to make a strong point: There have to be three contributors to a health-care system for the system to work.

The patient needs to be responsible in his or her requests. Nadya was completely irresponsible and we are paying for it.

The physician has to be responsible for careful screening and sound medical practices.

Suleman’s doctor should never have been permitted to do her fertilization.

And the government must be responsible, for it is footing the bill. That is to say, we are.

The second “event” which is creating quite a lot of interest here in Happy Valley was an article that appeared in The New Yorker June 1, written by Atul Gawande.

The Dartmouth School of Medicine has been doing research on health-care cost. Early on, the researchers found that McAllen, Texas, had possibly the highest cost rate in the country. In 2006, the average annual cost per Medicare patient there was approximately $15,000, twice the national average of $8,300.

By contrast, their further research found, in Atul Gawande’s words, “One of the lowest cost markets in the country is Grand Junction, Colorado, which has achieved some of Medicare’s highest quality-of-care scores.” And that was achieved for a cost of $5,800 per Medicare patient, making it one of the lowest in the country.

In the early 1970s, a group of local doctors got together with the goal of improving medical service for the entire community. They worked out fee inconsistencies. They agreed to meet regularly and start small peer review. Problems went down. Quality went up.

Then in 1974, they formed Rocky Mountain HMO. They jointly created an information network, a communitywide electronic recording system.

The two main hospitals here have been cooperative, taking special measures to ease
financial problems and emphasize patient care.

Financially, one major item that has made a difference is that both hospitals and the HMO are “not for profit institutions.”

According to Dr. David Herr, former chief medical officer, Rocky Mountain Health Plans (formerly Rocky Mountain HMO) was almost sold some years ago to a private company.

After serious consideration, the decision was made not to sell. As a result we continue to have a not-for-profit health plan in the community. 

Not many communities have systems like ours. Gawande writes, “Like Mayo, it created what Elliot Fisher of Dartmouth calls an accountable care organization. The leading doctors and the hospital system adopted measures to blunt the financial incentive, and they took collective responsibility for improving the sum total of patient care.”

I dream of a country in which every city and town has a health system as efficient as ours.

But dreams are cheap. Meanwhile, Congress and the president continue to battle and we don’t know yet what the result will be.

But quality pays sometimes. Recently Colorado was granted $4 million to install a system that would connect outlying areas to an Internet database for physicians to access patients’ medical histories.

My grandfather, making house calls around central Illinois in his horse and buggy, would be tremendously impressed by Grand Junction’s health community. 

So am I.

Henrietta Hay can be reached by e-mail at .(JavaScript must be enabled to view this email address).


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