(Robert D. Tonsing / Colorado…)
GRAND JUNCTION - This Western Colorado city of just over 53,000 delivers some of the best healthcare in the nation, at the lowest cost. And nearly everyone has health coverage.
Getting results like this across the nation could solve much of the nation's healthcare problems, resulting in a healthier population, and saving $700 billion a year.
Grand Junction's success gained notoriety when an article this summer in the New Yorker magazine focused on the opposite extreme: McAllen, Texas, where healthcare is ranked the worst in the country and the costs are nearly the highest. Grand Junction won a brief mention as an example of the other end of the spectrum.
Scientists seeking healthcare comparisons look to Medicare, the government health insurance program for the elderly, to find easily comparable statistics. Grand Junction ranks near the top in Medicare's Composite Quality of Care index, with a score of 91. That's 21 points higher than McAllen.
But costs in Grand Junction are among the lowest in the nation, sixth from the bottom among 307 cities.
Medicare spends just $5,873 per year on the average recipient here, compared to a national average of $8,304, according to the Atlas of Health Care published by Dartmouth University. Grand Junction's costs are well under half the $14,946 average in McAllen, which is second most expensive. As a result, bevies of health-policy experts have been poking around Grand Junction to determine whether the system can be replicated.
Yes, it can, say doctors, insurance executives and patients.
The will has to be there, though. That means community and insurers must put patient welfare first, well ahead of shareholder profits, they say.
In Mesa County, population 120,000 and where Grand Junction is the major city, doctors and insurers have focused on providing quality care to all. High quality has driven costs down, not up.
Len Nichols, a health policy economist with the New America Foundation who favors healthcare reform, calls Grand Junction "a great example for the nation." He says providers here have found a way to stem "the natural impulses of excessive competition and the medical arms race."
"They have an impressive combination of commitment to the community, plus incentives" to boost quality and keep costs down, Nichols says.
Fostering health and forestalling disease
At its essence, the Grand Junction system emphasizes primary care. Advocates believe it fosters health, and forestalls disease, saving skyrocketing costs when people wait too long to see a doctor.
That philosophy plays out from birth to death. The focus is on prevention of problems like premature births; on management of chronic issues so people don't end up in the hospital; and on patient comfort when death is near and inevitable.
It's the opposite of the system experienced by many Americans today, and advocated by some in the healthcare debate. They argue that if patients must pay significantly, they'll go to the doctor less, and that will keep costs down.
There's also serious peer review when doctors order unusual numbers of expensive tests and procedures. Proposals for such oversight in the congressional healthcare reform bill ran into significant opposition from people certain it would be conducted by government bureaucrats.
Phil Smith had to return home to Grand Junction to find a health care system that could ease his back pain with exercise -- when physicians elsewhere proposed killing a nerve or surgical fusing of bones in his spine.
In Grand Junction, real people like Phil Smith and Kay and Bob Fiegel have found better results choosing the less expensive solution
For Smith, it was physical therapy exercises that eased his back pain, not spine surgery. For the Fiegels, it was being able to make the decision to move their dying son Ryan from expensive hospital care meant to extend life, to the city's elegant yet nonprofit hospice last spring. They say they found better care for both Ryan and themselves — without pressure from anything like the so-called "death panels" that some warned last summer could become commonplace under healthcare reform.
This is also a city where doctors don't push patients into the most lucrative treatment for themselves. Doctors don't get rich here. In fact, finding a $1 million-a-year salaried doctor in the area is as tough as finding an overused MRI machine, say the advocates of the system.
"Grand Junction has high-quality doctors who could make lots more money elsewhere, but they've chosen to live here and be an important part of the community," says Kay Fiegel. "They have an impressive combination of commitment to the community, plus incentives" to boost quality and keep costs down. – Health economist Len Nichols
Right time, right place