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THE WALL STREET JOURNAL
SEPTEMBER 30, 2010, 2:27 PM ET
Remember the New Yorker article about how health-care costs can vary widely
between different areas of the country? The story favorably singled out Grand
Junction, Colo., saying that the community is “one of the lowest-cost markets in
the country” but “nonetheless has achieved some of Medicare’s highest qualityof-
care scores.”
Since then, as two researchers write in a perspective piece just published online in the New England Journal of Medicine, “numerous reporters have made the pilgrimage to this low-cost mecca, attempting to explain why health care there is cheaper than elsewhere in the United States.”
Obviously, some things about the community, such as its “small-town nature” and “relatively homogeneous racial
makeup,” can’t just be adopted by other areas looking to hold down their own health-care costs, write Thomas
Bodenheimer, of the University of California, San Francisco School of Medicine’s Center for Excellence in
Primary Care, and David West, a hospitalist at Grand Junction’s own St. Mary’s Hospital.
But, they write, “seven interrelated features” that may help explain Grand Junction’s lower costs might be more
easily transferred. Here’s what they identified:
Leadership by the primary care community
elsewhere, control the county physicians’ practice association and physician-run Rocky Mountain Health Plans,
a benefits provider. They “fostered a culture of incentives for cost control and cost transparency,” the authors
write.
A payment system built on risk-sharing:
withhold 15% of doctors’ fees, then give them back if costs stay low during the year. And physicians who rack up
unusually high costs are singled out.
Equal reimbursement for private and public insurance
Medicaid patients as for other patients, those publicly insured patients have access to private primary and
specialty care and were less likely to rely on the ER.
Well-organized and tiered services
smaller hospitals “that don’t offer expensive interventional services” such as cardiac procedures.
Limits on supply of expensive resources:
at reasonable levels.”
Payment of primary-care docs for hospital visits:
helps to cut the chance of unnecessary hospital readmissions.
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Robust end-of-life care:
advance directives with patients and the public learns about end-of-life choices.
“These features could be replicated in other markets — though generally not without political battles,” they write.
Do you agree?
Image: iStockphoto
The area’s nonprofit hospice also offers palliative care, physicians learn to discussThis improves continuity of care and, the authors say,St. Mary’s “has kept its number of beds and expensive equipment: St. Mary’s is the only tertiary care hospital in the region and is fed by: Because physicians are paid the same for treatingRocky Mountain Health Plans and the physicians’ association: Family physicians, more plentiful in Grand Junction than
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