Doctor: Western Slope a model for health care reforms

Phil Castle, The Business Times: 

Western Colorado serves as a model for instituting the reforms necessary to change an otherwise unsustainable health care system in the United States, according to a doctor who advocates a more coordinated approach directed by primary care physicians.

The end result is not only better health care at a lower cost, but also a more attractive environment for businesses that pay for that care for their employees.

Paul Grundy

“You have really organized yourselves to try and do the right thing,” said Dr. Paul Grundy, global director of health care transformation for IBM and president of the Patient Centered Primary Care Collaborative.

Grundy delivered the keynote address at a Grand Junction meeting of the Colorado Beacon Consortium.

The consortium is comprised of Rocky Mountain Health Plans, the Mesa County Independent Physicians’ Practice Association, Quality Health Network and St. Mary’s Regional Medical Center. The group will use nearly $12 million in federal funding on a three-year pilot project to expand on a collaborative approach to health care. The group collects clinical information from doctors, hospitals and other medical providers to integrate and improve health care. The project involves Delta, Garfield, Gunnison, Mesa, Montrose, Pitkin and Rio Blanco counties.

In his role with IBM, Grundy develops and executes strategies that promote the shift of health care delivery towards primary care-based systems and the use of information technology to bring about those changes.

The Patient Centered Primary Care Collaborative is a coalition of employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and others that have joined to develop and advance the patient-centered medical home concept.

Speaking to primary care doctors, nurses and staff at the Grand Junction meeting, Grundy discussed what’s wrong with health care in the U.S. as well as what should be right.

Anywhere from 35 percent to fully 50 percent of what’s spent on health care is wasted, he said. “We can’t afford that anymore.”

Grundy also blamed health care problems on an unregulated system of paying fees for services as well as too much reliance on costly “rescue” and specialty care for patients.

In contrast, the results of pilot projects involving a more coordinated approach to health care directed by primary care physicians have shown promise for reducing emergency room visits, hospital stays and other costs, he said.

Grand Junction and, through the efforts of the Colorado Beacon Consortium, Western Colorado have earned national attention for just such an approach.

A study conducted by Dartmouth College researchers found the average cost of care per Medicare patient in Grand Junction in 2006 was about $5,900 — 30 percent below the national average.

A policy paper subsequently published by the New America Foundation public policy institute in Washington, D.C., offered what the foundation termed as “lessons” from the Grand Junction model for national health care reform.

Rocky Mountain Heath Plans pays doctors similar rates for Medicare, Medicaid and privately insured patients, eliminating incentives to treat only privately insured patients. Cost and quality reporting by RMHP and the Mesa County Independent Physicians Practice Association exerts peer pressure to deliver quality care at lower costs. And Quality Health Network, a regional electronic records system, serves as a single source of medical records, helping to better coordinate care and reduce redundant testing and costs.

Grundy praised the effort for coordinating public and private health care and using electronic records in a timely manner as well as for the leadership of primary care physicians.

The approach reflects many of the principles of a patient centered medical home, including integrated services directed by primary care physicians, improved access to health care services and payments that recognize added value to health care rather than simply services.

The next step, he said, is to string up proverbial barbed wire around the unnecessary and sometimes harmful medical tests and procedures ordered for patients. In that regard, primary care practices must remain vigilant in advocating the best interests of their patients.

“I’m very optimistic that you already have some of this right,” he added.

The ultimate goal, he said, is to better manage the health care of the population of patients for which a practice is responsible. “We’re really on a journey toward managing a population.”

When that occurs, health care quality will increase and costs will decrease, in turn offering better value for the companies that pay for health care for their employees, Grundy said.

Cities and regions that are successful in improving health care and control costs will become “destinations” for businesses looking for those attributes, he added.