Since 1993, Family Practice Management has chronicled the progress of the Grand Junction, Colo., medical community, where physicians organized as an independent practice association in 1971 and spearheaded the creation of a local, non-profit health maintenance organization in 1972. This combination of an inclusive independent practice association (85 percent of local physicians belong) and a health plan that shares data with these physicians and listens to them has produced remarkable results in hospital and emergency room utilization, measurable quality and access to care.

The Dartmouth Atlas of Health Care study first revealed that Grand Junction's overall medical cost data was nearly the lowest in the nation,¹ and more recently the local health community was prominently discussed in a New Yorker article² that compared it with one of the more costly medical service areas in the nation. Subsequently, an accurate summary of Grand Junction's health care system was published by The New America Foundation,³ and the attention prompted President Obama to deliver a health care speech in Grand Junction in August.

Lessons learned

Here are some lessons from Grand Junction that might prove useful for other medical communities and health care policymakers:

1. A non-profit health plan can clearly out-perform for-profit health plans in terms of cost of care.

2. Providers who collaborate with one another can clearly out-perform those who compete with one another.

3. High cost is not necessary to achieve high quality.

4. Physician attitude is a more effective driver of behavior than financial incentives.

5. Access to care is not a problem when Medicaid and Medicare payment is adequate.

6. Physicians provided with financial data can make very good decisions about cost and value of services.

7. Cost awareness carries over to all physician behavior, not just the lines of business or health plans where there is major financial risk or opportunity for financial gain.

8. Ambulatory care peer review by physicians, coupled with the sharing of cost data of individual physicians, is an effective tool for cost containment.

These are not theoretical conclusions. The health care system in Grand Junction has served the community well for 37 years and continues to thrive.

We are frequently approached by physicians who want to know whether our system might work in their area. In discussing their options, we have found that certain issues impede efforts to develop a collaborative medical community.

1. Few non-profit health plans are available with which a physician group can collaborate. Most for-profit plans are unable or unwilling to work with physicians and share meaningful and believable financial data.

2. The Office of the Inspector General (OIG) and the Federal Trade Commission (FTC) are huge obstacles to any physician group attempting to be inclusive and collaborative. The current aggressive approach of the OIG needs to be modified. The FTC serves as the bulldog of for-profit health plans.

3. The demoralizing effect on physicians of years in the for-profit, competitive health care environment has made collaboration exceedingly difficult. However, physicians are resilient, and most are altruistic.

4. Most segments of the health care industry, including some physicians, are not solidly behind reduced spending (read: profit), given our current payment systems.

Grand Junction physicians are eager to see whether their adventures and misadventures can somehow be used to help the nation evolve toward a better health care system.