For the health of it: Network promotes better care at lower cost

Phil Castle, The Business Times

Ashley Thurow and Michael Pramenko advocate for collaborative efforts they believe will turn what they consider sick care into health care.

By integrating services, promoting preventive measures and rewarding providers for outcomes, Thurow and Pramenko insist it’s possible to offer better care at lower cost. And that’s a benefit not only for individual patients, but also businesses that depend on healthy work forces even as they shoulder growing insurance premiums.

The alternative is an unsustainable system, says Thurow, the new executive director of Monument Health, a clinically integrated health care network based in Grand Junction. “We can’t afford for it to continue to be this way.”

Pramenko, a primary care doctor who just started his latest position with Monument Health as chief medical officer, says the network has assumed a leading role since its inception four years ago. ”The progress that has been made is in the right direction.”

Monument Health announced in a span of less than a week the hiring of Thurow and Pramenko.

Thurow brings to her duties more than a decade of experience in helping organizations transition to value-based health care models. She worked as director of payer contracting and value-based care for Children’s Hospital Colorado. She supported the organization with value-based and traditional fee-for-service contracting and grew a pediatric clinically integrated network through payer partnerships.

While working at Evolent Health and Deloitte, she consulted with more than 80 organizations across the country on population health care efforts, including accountable care organizations and provider-sponsored health plans. 

A certified public accountant, Thurow holds business degrees from the University of Arizona and George Washington University.

Pramenko, who also serves as chairman of the Monument Health board of directors, says Thurow was hired because of her experience and passion — as well as her belief some disruption could be necessary to improve health care.

Thurow says she was attracted to Monument Health because of the partnerships in place among doctors, hospitals, insurance companies and employer groups that are required to improve health care. “I think it really has all the right elements.”

Pramenko, a doctor with the Primary Care Partners physician group in Grand Junction, has been involved with Monument Health since before its inception.

As chief medical officer, Pramenko says he’ll work with administrators and health care providers to improve efficiency and quality while reducing waste. He says he brings to the newly created position the experience and perspective of a clinician who understands medical practices and relates to other practitioners.

Monument Health integrates efforts among doctors, hospitals, insurance companies and employer groups to provide health care. 

Since its inception in 2016, the network has grown to include more than 200 primary care providers and nearly 1,000 specialists in Western Colorado. The network includes St. Mary’s Regional Medical Center in Grand Junction as well as Family Health West and its Colorado Canyons Medical Center in Fruita and Delta County Memorial Hospital in Delta.

The network serves about 20,000 patients, Thurow says. Of those, more than half are covered under employer-sponsored health insurance. Another 3,900 are covered under the Medicare Advantage program and 3,350 enrolled as individuals under the Connection for Health Colorado exchange.

Pramenko says Monument Health has played a role in lowering health care costs and in turn insurance premiums. One contributing factor has been to obtain lower prices for services under contracts with health care providers in the network. “That’s been a success.”

Primary Care Partners used to face annual increases in insurance premiums of more than 20 percent, Pramenko said. Under Monument Health, the increases have decreased to single digits. “It’s night and day for us.”

Additional efforts are planned, Thurow and Pramenko says.

Thurow says she expects Monument Health to continue to expand the number of patients it covers and geographic service area as well as the types of health plans and clinical programs offered.

In a broader sense, Pramenko says it’s important to improve communication among providers, insurers and patients to align services. That improves outcomes and increases efficiency while also reducing unnecessary services and waste.

In shifting from payments based on quality rather than quantity, providers that achieve measurable results and lower costs share in the money from savings, he says.

Pramenko says another way to improve care while lowering cost is to devote more resources to preventive measures that identify and treat problems before they become more serious.

Thurow says efforts that promote wellness whether at single business or in an entire population pay off in lowering health care costs over the long term.

Pramenko says improving care and lowering costs is not only a health care issue, but also a business issue.

Businesses depend on healthy work forces to operate. Money that’s not spent on health insurance can be allocated to other uses, such as additional staff or equipment to expand operations.

Health care becomes an economic development issue, he says, because it’s an important criteria businesses consider in relocating operations.

Monument Health is leading efforts, Thurow and Pramenko say, in turning sick care into health care.