The New Health Dialogue

Grand Junction, CO, is the high-quality, low-cost flip side of McAllen, Texas in Atul Gawande's recent New Yorker article. New America's health policy team just published a case study on how Grand Junction's health care system evolved (full paper here, summary here), and what the rest of our country can learn from it. We gave you an overview on our blog Thursday. Now we're going to look at how the community uses health IT to create quality and value.

We all know that health IT in and of itself isn't a cure-all. But it's hard to fix health care without smart use of health IT across the community.

One of the unusual features about the Colorado community is that the main health plan (Rocky Mountain Health Plans) pays a "blended rate" to physicians. That means it's a similar rate for private insurance, Medicare, and Medicaid. Doctors thus don't have any incentive to cherry-pick better paying privately insured patients, and shun the poor. Everybody gets care. The community benefits.

Rocky ended up in a lawsuit with the state Medicaid program a few years ago and got a $21 million judgment for underpayment in the 1990s. Rocky divvied up most of the money among physicians it contracted with, but a dispute arose over $2.5 million. The solution? Spend the money on something that would benefit the community as a whole. Rocky was already helping physicians install electronic medical records in their offices. Now they would go a step further and create a community-wide system. The Quality Health Network went live in 2005, and is now nationally recognized.

Today, the network serves western Colorado and eastern Utah. It is a community-wide effort, with a board of directors and several subcommittees of leaders from all areas of the health care community. About three-fourths of its funding comes from the community's two hospitals, Rocky, and the Independent Physicians Association of Mesa County. (Our case study explains more about the unusual degree of cooperation between these key health care players).

The health IT network's roots actually go back about 15 years, when Rocky and the IPA doctors wanted to have one place to access information about patients who see both specialists and primary care providers. But it was early in the information age, and the first attempts failed. About three years ago, they tried again. Now network users include physicians and hospitals, clinics, hospice, long-term care facilities, mental health providers, home care agencies, physical therapy, occupational therapy, schedulers, labs, transcriptionists, case managers, and insurers. As of February 2009, there were 1,569 licensed users from 84 different organizations, including the public health department. In just the first two months of 2009, there were more than three million requests of the server. In June 2009, western Colorado was granted $4 million to install a QHN system that would connect outlying areas with an Internet database for physicians to access patients’ medical histories.

Health IT is a big boon to Grand Junction's providers. They get to see a complete picture of their patient. The cardiologist, for instance, knows what the pulmonologist prescribed, what tests were done. The hospital knows what the outpatient community-based care providers did and vice versa. There's less risk of harmful drug interactions if all the doctors can see the complete records. Less duplication of expensive tests and imaging. Better coordination of care. Fewer unnecessary hospitalizations. Higher quality. Lower cost.

Grand Junction's use of health IT shows us what we should all be striving for.