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Mesa County offers a model for state, nation's attempts at health care reform

By: ANDREW WINEKE
April 11, 2011
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In Colorado, we don’t have to guess at what the future of health care is supposed to look like: We’ve got a pretty good model just over the mountains in Grand Junction.
Grand Junction provides some of the lowest costs — nearly a third lower than the national average for Medicare patients — and some of the best health outcomes anywhere.

The Federal Trade Commission once sued the Mesa County physicians’ association on anti-trust grounds. Now, the collaboration going on in Grand Junction is a national model. President Barack Obama even visited Grand Junction in 2009, when he was promoting what became the Patient Protection and Affordable Care Act (PPACA).

In Mesa County, doctors work with the region’s dominant insurer, the nonprofit Rocky Mountain Health Plans. They receive lower payments at the front end, but can earn bonus payments based on the overall performance of the system.

Doctors are paid the same for every patient, including Medicare and Medicaid patients. The emphasis is on primary care, not hospitals or specialty care, and on preventative care. Costs, outcomes and effectiveness of treatments are tracked at every step and physicians promote best practices and protocols.

It’s exactly what the state’s Medicaid Regional Care Collaborative pilot program is shooting for and what the accountable care organizations called for in the PPACA hope to achieve.
The system in Grand Junction was built up over decades, said Patrick Gordon, director of government programs for Rocky Mountain Health Plans. You can’t wave a magic wand and make the rest of the state 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 duplicate its success. It’s signed on to run one of the seven Medicaid Regional Care Collaboratives in the state. However, Rocky Mountain isn’t simply signing up people it already sees and calling it good. Most of the patients in Rocky Mountain’s territory for the pilot project will come from Larimer County in northern Colorado — a long way from Grand Junction.

In Mesa County, the Rocky Mountain way of business may be old hat, but it’s a new challenge for groups in Larimer. But the hospitals, specialists and primary care Medicaid providers there understand the problems and want to find solutions, Gordon said. And the success or failure of the state pilot will hinge on those providers, he said, not an insurance company. Rocky Mountain’s role will be to provide experience, coordination, data analysis and accountability.

“The way that people are approaching these problems, coming together around the table, is very similar to what’s happened in western Colorado over the years,” he said.

Will it work? It has already, both in Grand Junction and in other places around the country, Gordon said. It’s too important not to try in all of Colorado, he said.

“You have to start somewhere. You can’t boil the ocean,” Gordon said. “Why not start with the most critically challenged aspect of the system?”?

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