In McAllen, Medicare patients spend more time in the hospital. Their doctors see them there more often, and diagnose them with more problems, according to Dr. Elliott Fisher of the Dartmouth Atlas study group. As a result, inpatient costs are double in the last two years of life: $45,000 in McAllen and $21,000 in Grand Junction.
That's in large part because many patients move to hospice care in Grand Junction, both at home and in an elegant, Mission-style building with fireplaces, with the atmosphere of a luxury club and 13 beds in rooms the size of small apartments.
Typically when a cure is no longer possible, the hospice provides care to ease symptoms and pain. By emphasizing this palliative care over costly but futile care, the hospice found that patients actually live longer and in less pain. And that also cost far less money.
Of course, Medicare pays $3,000 more per patient for hospice in Grand Junction than in McAllen — but it saves $24,000 per patient on hospital care.
The community created Grand Junction's nonprofit Hospice and Palliative Care Center of Western Colorado with $15 million it raised from grants, state money, corporations, businesses and individuals. An annual fundraiser nets about $1 million a year for operating costs. Each of the spacious, hardwood-floored hospice rooms is named for a sponsoring local business or health agency.
There, patients live an average of 22 days, versus the 12 days of the national average of people in hospice.
The starkest contrast is in home-health care for Medicare patients in the last two years of life. In Grand Junction, the costs average $390. In McAllen, it's $4,565. Many of the home-health-care facilities are owned by doctors.
Prenatal care for all
Another key factor is a community commitment to guaranteeing full prenatal care to all pregnant women, whether they have insurance or not. Low-income women who qualify for Medicaid can find a regular doctor to take them.
As a result, Dr. Amy Bratteli sees pregnant women on Medicaid in her regular clinic. She can check them for problems like infections and pregnancy-related diabetes, which can cause damaging and expensive problems for newborns.
One chilly morning, Bratelli pushed on the belly of Ashley Unverferth to check the position of her soon-to-be born baby. As the physician placed a microphone on her belly, the sound of a pumping heart filled the room. "That's the baby, a very healthy baby!" she told the 27-year-old mother of two.
Unverferth, who gets her health insurance from RMHP, had no idea that her doctor and her insurance premiums were combining to help ensure every pregnant woman in Grand Junction could get the same pre-natal care she was receiving. But she was pleased to hear it.
As result of this system, at Rocky Mountain Health Plans, 96 percent of the pregnant women eligible Medicaid received pre-natal care, compared to just 55 percent who were in other plans, according to a report last year on health outcomes in western Colorado.
County-wide, 98 percent of pregnant women receive some prenatal care. The result: Mesa County cuts Colorado's 8.9 percent of babies born with low weight to 7.3 percent, saving a fortune on expensive intensive-care for newborn, according to a report from Colorado Department of Health.
Care for uninsured
Pregnant women and other patients who do not have incomes low enough to qualify for Medicaid often still don't have money to pay for healthcare. Grand Junction takes care of these people in the Marillac Clinic.
Marillac receives more than $1 million of its $7.5 million annual budget from St. Mary's Regional Hospital. It's a great investment for the hospital, which is right next door to the clinic and which doesn't have to pay for these patients to receive expensive non-emergency care in its Emergency Room. Instead, these patients are transferred to the clinic.
"Many of these patients wouldn't be able to pay us in the emergency department," says St. Mary's CEO Bob Ladenburger. "So we don't have that bad debt or charity care to write off."
That literal proximity aids the collaboration that is key to the Grand Junction system, say doctors, nurses, and health officials. Not only are the hospital and Marillac adjacent, but a few blocks away, the hospice is across a parking lot from two of the city's largest family physician practices.
It is the simple act of talking to one another that makes the Mesa County model work so well. "It's kind of how we do things here," says Terri Walter, a nurse who is senior vice president for quality at the Hospice and Palliative Care Center of Western Colorado. "Collaboration is comfortable here, nice and warm and cozy."
Specialists vs. primary care