GRAND JUNCTION, Colo. — Writer Atul Gawande investigates the “cost conundrum” of U.S. health care in a New Yorker magazine article published this week.

He cites McAllen, Texas, a community where Medicare spends $15,000 per enrollee — twice the national average — as a community that is doing things wrong.

But on the other end of the spectrum, he cites Grand Junction as a medical community that is doing things right.

Grand Junction, he writes, is doing one of the best jobs in the country of balancing health care costs with quality of care.

“One of the lowest-cost markets in the country is Grand Junction, Colo., a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores,” he writes in the article.

Gawande, a surgeon and New York Times best-selling author, describes the factors that he believes contribute to the Grand Junction medical community’s good standing:

“Years ago the doctors agreed among themselves to a system that paid them similar fees whether they saw Medicare, Medicaid or private-insurance patients, so that there would be little incentive to cherry-pick patients,” he wrote. “They also agreed, at the behest of the main health plan in town, an HMO, to meet regularly on small peer-review committees to go over their patient charts together. They focused on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates.”

He described more examples of collaboration, including an initiative in which the local doctors’ group and the HMO (Rocky Mountain Health Plans) created a regional information network that shared office notes, test results, and hospital data for patients across the area.

The result of all of this: Lower costs than just about anywhere else in the U.S.

Local sources

Dr. Michael J. Pramenko, a family physician at Primary Care Partners in Grand Junction, was interviewed for The New Yorker article, as was Steve ErkenBrack, president of Rocky Mountain Health Plans.

According to Pramenko, writers aren’t the only ones investigating Grand Junction’s practices.

Len Nichols, director of health policy for New American Foundation, a non-partisan Washington D.C.-based think tank, has spoken with local leaders and reviewed what’s working well in the Grand Junction area to keep costs down and quality up.

On Tuesday, a day after The New Yorker article hit, the White House released a report titled “The Economic Case for Health Care Reform.”

Page 3 of that report cites inefficiencies in the current system, and cites problems with Medicare.

“Some of the strongest evidence of such inefficiencies comes from the tremendous variation across states in Medicare spending per enrollee, with no evidence of corresponding variations in either medical needs or outcomes,” the report read. “These large variations in spending suggest that up to 30 percent of health care costs (or about 45 percent of GDP) could be saved without compromising health outcomes.”

Pramenko, who pens a column for the Grand Junction Free Press and serves on Club 20’s health care committee, isn’t surprised that Grand Junction is beginning to get noticed in the national health care reform movement.

The relationship Rocky Mountain Health Plans has developed with Medicare is something he believes can be emulated elsewhere.

“This is the only place in the state where Medicare works with an insurance company to provide better access,” he said.

The plan

Five years ago, the Independent Physicians Association and Rocky Mountain Health Plans in Grand Junction laid down $500,000 apiece as seed money to form a physicians network called Quality Health Network, which was described in The New Yorker article.

It’s created a culture of collaboration, Pramenko said, and an environment that has found a compromise between a “single-payer” system and a “free market” system.

Now is the time, Pramenko said, to share what’s working here while it’s in the forefront of the national discussion.

“You use the article to keep pressing folks who are writing policy as we speak,” he said. “These ideas have merit. They’re proven ideas that have been working for 30 years.”

ErkenBrack said he’s been pushing Grand Junction’s approach on statewide level for years.

“Time and again I’ve said this is how we do things in western Colorado,” he said. “It’s been clear to us that this is a very good model.”

But ErkenBrack said that it takes more than other communities just writing a plan down on paper.

It takes buy-in from insurance providers, medical providers and every other entity involved in the delivery and payment of health care services.

It’s not uncommon, he said, for leaders of different local agencies to serve on boards of other agencies in the health care community.

“It’s not just convenient,” he said. “It makes us invested in each other’s success.”

And judging by the attention Grand Junction it beginning to get on a national level, it appears those paying attention to what’s happening in Grand Junction view it as just that: A success.

“It’s something the community should be very proud of,” ErkenBrack said.

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For the full New Yorker story, go to:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande