Writing for Kaiser Health News, reporter Bill Scanlon recounts the remarkable success Grand Junction, Colorado has had in improving health outcomes and saving money. He writes that Grand Junction has adopted five key reforms:
"Health Partnerships. Grand Junction's doctors, hospital and the dominant insurer, Rocky Mountain Health Plan, work together on patient care, with many of the doctors on salary rather than being paid for each procedure they do.
Primary care. The Grand Junction health system highlights disease prevention and management of chronic conditions to reduce expensive hospital visits, an emphasis that is also a key component of the new health law.
Treatment protocols. The local physicians and health plan have agreed to guidelines in terms of treating common problems, such as diabetes and lower back pain, based on best practices.
Electronic medical records. Doctors and medical facilities in the area use a region-wide electronic medical records system. It also means a physician's peers can see what he is doing and evaluate his style of care.
Medical homes. Nearly all patients here have a personal doctor who oversees primary care. Such 'medical homes' are also being advocated in the health overhaul."
This isn't the first time that Grand Junction has been featured as a poster child for a better health care system. The Los Angeles Times published a fascinating five part series on Grand Junction, also authored by Scanlon.
Can Grand Junction's approach be replicated? On this, there is less agreement, although many health policy experts believe that the key elements described above can be successfully adapted elsewhere.
Congress clearly believes so. The new health reform law, the Affordable Care Act, provides for a substantial investment of federal dollars to promote accountable care organizations (similar in concept to Grand Junction's health partnership), pilot-testing of alternatives to fee-for-service, new models to train and compensate primary care physicians, adoption of evidence-based treatment guidelines, and rapid expansion of patient-centered medical homes. The federal government also plans to spend billions of dollars to encourage clinicians to adopt electronic health records.
But as the federal government should heed another lesson from Grand Junction: let the doctors and hospitals decide. Scanlon quotes Dr. Michael Pramenko, a primary care physician and leading advocate for Grand Junction's reforms, on the importance of letting communities do their own thing:
"Pramenko says the beauty of the co-op is that the community can make its own rules. That lowers the tension in the public vs. private health-care debate, he asserts. 'If government makes the law that says doctors have to do this, they will get resistant,' he says. 'But if it's home-grown and if we make the rules together and we're all in this together, there's much more buy-in by the local physicians.'"
So my unsolicited advice to CMS Administrator Berwick is this: yes, the federal government should provide seed money for physicians and hospitals to develop their programs to improve outcomes and reduce costs, modeled on the key elements that have worked in Grand Junction. But don't impose so many strings that it strangles home grown initiatives from taking root.
Today's question: What do you think is the "take home" messages from Grand Junction?