In Colorado, we don't have to guess at what the future of healthcare is supposed to look like: We've got a pretty good model justover the mountains in Grand Junction.
Grand Junction provides some of the lowest costs - nearly a thirdlower than the national average for Medicare patients - and some ofthe best health outcomes anywhere.
The Federal Trade Commission once sued the Mesa Countyphysicians' association on anti-trust grounds. Now, thecollaboration going on in Grand Junction is a national model.President Barack Obama even visited Grand Junction in 2009, when hewas promoting what became the Patient Protection and Affordable CareAct (PPACA).
In Mesa County, doctors work with the region's dominant insurer,the nonprofit Rocky Mountain Health Plans. They receive lowerpayments at the front end, but can earn bonus payments based on theoverall performance of the system.
Doctors are paid the same for every patient, including Medicareand Medicaid patients. The emphasis is on primary care, nothospitals or specialty care, and on preventative care. Costs,outcomes and effectiveness of treatments are tracked at every stepand physicians promote best practices and protocols.
It's exactly what the state's Medicaid Regional CareCollaborative pilot program is shooting for and what the accountablecare organizations called for in the PPACA hope to achieve.
The system in Grand Junction was built up over decades, saidPatrick Gordon, director of government programs for Rocky MountainHealth Plans. You can't wave a magic wand and make the rest of thestate and country look or work like Grand Junction.
'Creating something like that in other communities is possible,but it's not something you do from the top down,' Gordon said.
Nevertheless, Rocky Mountain Health Plans is trying to duplicateits success. It's signed on to run one of the seven MedicaidRegional Care Collaboratives in the state. However, Rocky Mountainisn't simply signing up people it already sees and calling it good.Most of the patients in Rocky Mountain's territory for the pilotproject will come from Larimer County in northern Colorado - a longway from Grand Junction.
In Mesa County, the Rocky Mountain way of business may be oldhat, but it's a new challenge for groups in Larimer. But thehospitals, specialists and primary care Medicaid providers thereunderstand the problems and want to find solutions, Gordon said. Andthe success or failure of the state pilot will hinge on thoseproviders, he said, not an insurance company. Rocky Mountain's rolewill be to provide experience, coordination, data analysis andaccountability.
'The way that people are approaching these problems, comingtogether around the table, is very similar to what's happened inwestern Colorado over the years,' he said.
Will it work? It has already, both in Grand Junction and in otherplaces around the country, Gordon said. It's too important not totry in all of Colorado, he said.
'You have to start somewhere. You can't boil the ocean,' Gordonsaid. 'Why not start with the most critically challenged aspect ofthe system?'?
