LINDA WERTHEIMER, host:
It's MORNING EDITION from NPR News. I'm Linda Wertheimer.
STEVE INSKEEP, host:
And I'm Steve Inskeep. Good morning.
President Obama continues his effort to sell an idea: getting better health care for less. The concept is easy to endorse. The problem is getting there.
WERTHEIMER: In a moment, we'll meet a Democrat trying to defend the health care overhaul against attack. We begin with the place where the president travels this weekend.
INSKEEP: He's visiting a Colorado city that has one of the nation's most cost-effective health care systems. NPR's Scott Horsley reports on what the country might learn from Grand Junction.
SCOTT HORSLEY: Grand Junction, Colorado has long been known for its spectacular scenery and lush fruit orchards. More recently, it's been getting attention as one of the country's great bargains in health care. According to the Dartmouth Atlas of Health Care, which ranks Medicare spending around the country, Grand Junction's cost are among the lowest - about 30 percent below the national average. What's more, Dartmouth's Jim Weinstein says even while saving money, Grand Junction manages to produce healthier patients than most other parts of the United States.
Dr. JAMES WEINSTEIN (Dartmouth Atlas of Health Care): The fact of the matter is that their quality is quite good. And when you see places like this that are performing really well, we can learn from them.
HORSLEY: The Grand Junction success story begins back in the 1970s, when area doctors agreed with a local nonprofit insurance company to treat all patients for a similar fee, regardless of whether they had private insurance, Medicare or Medicaid. Steve ErkenBrack, who heads the insurance company Rocky Mountain Health Plans, says thanks to that agreement, even the poorest resident has access to just about every doctor in the county. And because most patients have a personal doctor, they're more likely to get vaccinations and prenatal care and better able to manage chronic conditions like high blood pressure and diabetes.
Mr. STEVE ERKENBRACK (Chief Executive, Rocky Mountain Health Plans): And, of course, the interesting component of health care is once you get ahead of this curve, a healthier population doesn't access the health care system as much. And so it winds up saving money over the passage of time.
HORSLEY: The doctors in Grand Junction still practice independently and charge fees for their services, unlike the salaried physicians at the Mayo Clinic, which President Obama has also held up as a model. But with encouragement from the insurance company, the Grand Junction doctors do get together regularly. They compare notes and look for ways to improve care, while keeping costs in check.
Mr. ERKENBRACK: A core concept since the 1970s, when we started, is that medical decisions should be made by a physician and a patient. But those decisions should be not made in a vacuum. They should be made with an idea of the whole community.
HORSLEY: No one talks about pulling the plug on grandma. The doctors do ask, collectively: are we ordering too many diagnostic scans, for example, or prescribing too many brand-name drugs? Data is shared freely, so all the doctors know how their peers are performing. Family physician Greg Reicks has been practicing in Grand Junction for 20 years and says by now, the collaboration has come to be second nature.
Dr. GREG REICKS (Family Physician, Grand Junction): I think there's a true sense of accountability amongst the physicians in this community. The data's fairly transparent amongst the physicians, so that if a physician is - appears to be an outlier in terms of their cost, that physician faces some scrutiny. That tends to keep physicians from over-utilizing or utilizing services that are, you know, maybe marginally necessary.
HORSLEY: The doctors have some financial incentives not to run up the bill. Part of their payment from the insurance company depends on keeping costs in check. But Reicks says it's also just part of the medical culture in Grand Junction to discourage excessive fees.
Dr. REICKS: When new physicians come into town, they're brought into this culture and they sort of understand that physicians in the community are concerned about costs, are concerned about medical appropriateness, are concerned about quality.
HORSLEY: For all the focus on competition as a way to lower the cost of health care, in Grand Junction, it's cooperation that's made the difference. A few years ago, the doctors, hospitals and insurance company teamed up to invest in electronic health records. That's made it easier to share information, cutting costs even further while improving quality. Researchers at Dartmouth have identified similar pockets of cost effective care in other places around the country. Together, they offer hope for an improved health care system nationwide.
Scott Horsley, NPR News, The White House.
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