In a recent NEJM article, two physicians explore the secrets to this Rocky Mountain community's success.

Grand Junction, located in Mesa County, Colo., has been held up by President Obama and others as a model of low-cost, high-quality care. The average per capita Medicare spending in Grand Junction ($6,599 in 2007) is 24 percent lower than the national average, according to Dartmouth Atlas of Health Care. In addition, Grand Junction has scored above the national average on various quality metrics.

The results cannot be explained away by pointing to an unusually healthy population. In fact, mortality and morbidity data reveal that Mesa County's population is less healthy than some U.S. counties with higher Medicare costs.

So what is Grand Junction's secret?

"The usual explanation is that this town of 50,000 benefits from a cooperative spirit among health plans, hospitals, and physicians, that work together to serve the population," write Thomas Bodenheimer, MD, MPH, and David West, MD, in a recent article in The New England Journal of Medicine.

But Bodenheimer and West don't stop there. Acknowledging that "cooperation" may not be replicable in other communities, they uncover seven specific features that contribute to Grand Junction's low-cost, high-quality atmosphere. "These features could be replicated in other markets-though generally not without political battles," write Bodenheimer and West.

Leadership by primary care community. The Rocky Mountain Health Plans and the Mesa County Physicians Independent Practice Association (MCPIPA) is controlled primarily by family physicians.

A payment system involving risk sharing by physicians. MCPIPA and the Rocky Mountain Health Plan (which has 60 percent market share) withhold 15 percent of fees from physicians-and put that in a risk pool. If costs are held low, physicians receive withheld payments. Cost profiles of each physician are also made available to all physicians to help spur "self-correction" of high specialist costs.

Equalization of physician payment for the care of Medicare, Medicaid, and privately insured patients. Rocky Mountain Health Plans pays physicians who treat Medicaid patients the same amount they'd receive for treating other patients.

Regionalization of services into an orderly system of primary, secondary, and tertiary care. There is only one tertiary care hospital in Grand Junction and its surrounding areas. Smaller hospitals do not offer expensive interventional services.

Limits on the supply of expensive resources. Cardiologists and other specialists are limited in Grand Junction because there is only one hospital that offers interventional services. And the tertiary care hospital has kept bed and expensive equipment at reasonable levels.

Payment of primary care physicians for hospital visits. Rocky Mountain Health Plans has agreed to this policy-even after hospitalists began assuming care for inpatients.

Robust end-of-life care. Compared to national averages, Grand Junction's population spends 74 percent more days in hospice and 40 percent fewer days in the hospital during the last six months of life.


Source: Bodenheimer, T., and West, D., "Low-Cost Lessons from Grand Junction, Colo.,"NEJM, October 7, 2010, vol. 363, no. 15, pp. 1391-1393.  

Publication Date: Tuesday, October 19, 2010