Can other communities copy the Grand Junction model of low-cost, high-quality, near-universal healthcare?
Some doctors in this Colorado city of just over 53,000 say yes, others no. But clearly, some parts could be replicated elsewhere.
The House of Representatives has included in its version of healthcare reform a provision allowing the creation of nonprofit, consumer-operated insurance cooperatives as an alternative to the ballyhooed and cursed public option.
"This says they want to create a potential place in the world for systems like (this)," says Dr. Michael Pramenko, a leading advocate who practices with Primary Care Partners in Grand Junction. "It says that if you don't like the public option, and want another way, here is your opportunity."
Key to the Grand Junction plan is coordination among providers, says Len Nichols, an economist who is director of health policy for the New America Foundation in Washington, D.C. and a supporter of the reform bill.
By working together, providers in Grand Junction and the surrounding area emphasize primary care and prevention. They cover nearly everyone. They conduct peer reviews to see if doctors generally choose proven treatments. They also have made less expensive hospice care an attractive and popular option for the end of life.
Nichols says the Mesa County model "absolutely" can be replicated if a community can agree on a common vision of accountable, low-cost care for all.
Dr. Elliott Fisher, co-director of the influential Dartmouth Atlas of Health Care, agrees. "The question, I think, is whether there is physician leadership in other areas that would and could take it on."
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."
Is it just healthier people?
Some critics see little to replicate. Blogger Daniel Gilden says Grand Junction's costs are low only because it has an unusually healthy population, with low rates of obesity, diabetes and other major illnesses.
Grand Junction residents may be a bit healthier than the national average, but "its health system also keeps them healthier than other systems would," Nichols counters.
Is it luck? Or is Grand Junction's emphasis on prevention keeping its citizens from contracting major chronic illnesses, which are the biggest drivers of healthcare costs?
Grand Junction has few poor people, who typically have worse health, Gilden argues.
But in most of the United States, poor people have trouble finding doctors to take Medicaid's low rates. So one factor in their poor health is poor healthcare. In contrast, Grand Junction provides health care and preventive services to nearly all its low-income residents. So is that driving down the rate of expensive chronic disease?
There are arguments on both sides, and no clear answer.
Darene Schroeder, a Grand Junction nurse who has worked in far less healthy areas of the country, thinks that who lives there plays a huge role in the area's low cost of healthcare.
"While health care can be improved in terms of lifestyle, at least 50 percent is genetic," she said.
Pramenko counters that Mesa County's care system should receive partial credit for the low rates of diabetes and complications. Providers worked together to cover everyone, to emphasize prevention, to provide good transition care, thus keeping down hospital readmissions down.
In any case, the data in Grand Junction shows that reducing major chronic illness and their complications are a major factor in cutting cost.
Cindy Sovine, a political consultant for the Colorado State Association of Health Underwriters, says the debate in Congress over health care reform should be considering that. They're "doing nothing to increase the health of the population."
Sovine called for discounts for patients who take care of themselves. Employers should get discounts on premiums for putting gyms in offices. "We need to realize that we have an aging population. With our current lifestyle trends, we're seeing increases in diabetes and heart disease. Insurance costs are going to go nowhere but up."
Her association has written proposed legislation to allow insurers in Colorado to reduce premiums if a customer loses weight, she said.
"We need a societal change in thinking," Sovine said. "Away from how come insurance companies can't lower prices to what we are doing as a society to change the focus on sick care to a focus on improving the health of our population."
Another way Grand Junction keeps patients healthier and also saves money is "to have guidelines in terms of treating common problems, such as lower back pain," said Dr. Susan Hemley.