PCMH and primary care is but one part of an integrated, optimized and cost-efficient health system
By Chris Valerian, DO, MMM – Executive Medical Director, Health Integrated

I had the distinct pleasure of speaking with Julie Barnes, the Deputy Director of the Health Policy Program at the New America Foundation[1] .  We spoke about many different things including healthcare reform, her perceptions on how the debate is going, what, if anything, might be resolved once the discussions are over and the like.  Ms. Barnes shared her thoughts on how the stimulus money would be used to assist in building the healthcare infrastructure in the form of EMR, which in turn, will and can be used to fuel healthcare efficiencies in both the near term and longer term.  All of this was very intellectually stimulating regardless of your political persuasion.  Since the healthcare reform challenge is still in debate, it is therefore in flux and the likely outcome is anyone’s guess at this point.  More on this as it develops.

That said, I was particularly intrigued with a study that Ms. Barnes co-authored entitled, Grand Junction, Colorado: A Health Community That Works.  Grand Junction is a small but robust community on the western slope of Colorado, near the Utah border.  The population of the town is around 47,000 (120,000 in the ‘metro’ area) and aside from the beauty of the Rockies, it is a pretty typical small western town.  They do maintain a higher than average demographic over 65 (17.9% vs. 9.7% for CO).  The bottom line regarding their healthcare system though is that Grand Junction has a mean Medicare spend of $5,873 per capita vs. $7,496 for CO and $8,304 for the nation.  This is the lowest per capita Medicare expenditure in the nation.  This contrasts with $14,946 for McAllen, TX which has the highest.  It seems that there are two obvious questions then. 

1. Are the patients of Grand Junction any healthier as a result, and
2. If so, what are they doing to gain these health and financial results

In answer to the first, Grand Junction’s major Regional Medical Center – St. Mary’s,  generally exceeds both national and state averages on quality of care metrics as seen on their Hospital Compare scores (the database compiled by Medicare)[2].   Some could argue that the underlying health of the community is above average, but on the whole, physicians perform few procedures as well.  The second answer yields some very interesting findings.  They can be categorized as follows:

Sense of community:  Grand Junction represents a cooperative between the insurer (Rocky Mountain Health Plans), the providers (St. Mary’s Regional, Community Hospital and Marillac Clinic) and the physicians (over 218 unaffiliated physicians).  There are no boundaries between these groups.  Grand Junction has the Marillac Clinic which offers care exclusively to the uninsured.  There is a balance here where everyone is covered in this community.

Integration and Innovation:  There is an emphasis on all forms of innovation including information management systems (EMR) to make health records readily accessible.  As well, they tout the utilization of the latest innovations in primary, preventive and palliative care, and yet maintain the most effective financial outcomes.

Incentives vs. disincentives:  Community and self interests are aligned and the incentives are focused to support this.  The target is better healthcare and hence the quality and efficiency targets support cooperation without competitive disincentives that a less-reimbursed Medicare patient might offer focuses on in other systems.

Physician-to-Patient Ratios and Specialties:  Possibly the biggest contributing factor to their success lies in the higher-than-average physician-to-patient ratio.  Although the hospitals collectively have fewer beds than the national average, they have more physicians.  Specifically, they have 111% of the national average.  As you have seen in the entire focus on PCMH, Grand Junction exemplifies the fact that the primary care physician is at the core of better healthcare when allowed to proactively address the patients needs.

Recapping what makes it work in Grand Junction – Community (communication, cooperation and sharing), Incentives (no disincentives), Innovation (IT and medical technology), and MORE (PCP) Physicians.  I highly encourage you to read more about this success story.  The papers can be downloaded for your viewing.  If you need further details or would like to provide input, please drop me an email so we can link up one on one at pcmhdialog@healthintegrated.com. 

Finally, I have listed some future topics in which I would welcome your review and comments.  Thanks in advance for your comments. 

Best Regards,

Dr. Chris Valerian

 

Upcoming topics for the Health Integrated PCMH Collaborative Community

• Healthcare reform and the PCMH – the continuing review and update
• Expert opinions on the healthcare reform and PCMH
• IT and the PCMH – how to use stimulus funding
• Examples of ongoing PCMHs

Notes:

1.  Download:  In Brief:  Grand Junction, Colorado:  A Health Community that Works
2.  Download:  Grand Junction, Colorado:  A Health Community that Works

                                                                                                                                                                                                    

[1]  http://www.newamerica.net/
[2]  24. U.S. Department of Health and Human Services, “Hospital Compare: A Quality Tool Provided by Medicare,” http://www.hospitalcompare.hhs.gov/, accessed July 2009. We only provide data from Hospital Compare for St. Mary’s Hospital & Regional Medical Center and not for Community Hospital because the sample size for Community Hospital was too small to draw statistically significant findings.

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