After years of debate, analysis and Monday morning quarterbacking about our broken health care system, Coloradans find ourselves presented with a unique opportunity to think outside the box and create a solution to cut costs while extending quality coverage to all our residents.
With the federal Patient Protection and Affordable Care Act in the process of being implemented, and with the Colorado Health Benefits Exchange board set in motion by the state legislature earlier this year, the time is ripe to make real reform to a system demanding change.
We already have two outstanding homegrown examples of how to improve quality and access while containing costs and helping ease the burden on businesses. What if we designed a uniquely Colorado solution building on the lessons learned from our own health reform leaders in Grand Junction and at Denver Health?
There are well-documented solutions to cutting costs and eliminating underpayments, but a full solution calls for a new vision. The American health system is not facing a challenge from scarce resources.
We could spend essentially what we spend now and do a far better job. How? Let’s look to Grand Junction, which has become a national model for quality and cost containment. The insurer, Rocky Mountain Health Plan, and the physicians, Mesa County Independent Physicians Association, recognized that having patients show up repeatedly in the hospital and emergency room was not only costly, but detrimental to their community’s health. They decided to work together for the common good.
Providers agreed to accept less payment up front and create a reserve that would be distributed based on cost and quality outcomes. They agreed to openly share their cost and quality data amongst themselves. The insurer agreed to pay the same for every patient visit, no matter the payment source (Medicaid, Medicare, private). Both compromised, and the good news is both won. The best news is the patients won. Grand Junction is widely recognized for having among the lowest per-enrollee costs for Medicare and the best quality outcomes.
Denver Health, an integrated health care system, takes this model one step further and includes emergency and hospital care in the equation, using cost savings to provide access to care for the uninsured. Denver Health’s focus on spending wisely has won national recognition for its quality care, and they recently received the Shingo Prize for Operational Excellence.
Grand Junction and Denver Health offer an out-of-the-box blueprint for designing a Colorado health care system as a non-governmental, member-owned and operated cooperative, allowing us to provide quality universal health care for all while saving money.
A creative cooperative system could be transparent and accountable to the people of Colorado for spending and outcomes. Our innovative insurers could work with our medical providers to design a system which is patient-centered, primary-care oriented, and focused on wellness and prevention while ensuring access to top-notch catastrophic care when needed.
This solution not only employs Colorado common sense, but it makes good business sense as well. Costs would be contained by rewarding providers for quality care, not quantity of tests or procedures; by negotiating bulk medicine and medical equipment rates; and by a simplified billing system providing timely reimbursements.
As a bonus, a state cooperative would free businesses from administering health care benefits, permitting them to fully focus their assets and time on production and output.
Designing a state health care cooperative is an opportunity for our state to build on its own successes and develop a unique solution ideally suited for Colorado, offering our residents a bright alternative to a system needing a fundamentally new vision.
State Sen. Irene Aguilar, M.D., of Denver has worked for 22 years as primary care physician at Denver Health’s Westside Family Center.
