It’s taken a few years to get there, but the Grand Junction-based Monument Health provider network has reached a significant goal recently, offering rates that are comparable to those on the Front Range.
That’s not always been the case.
While state officials say much of that was because of a relatively new reinsurance program approved by the Colorado Legislature in 2019, Monument Health officials say that isn’t the whole story, at least not here in the Grand Valley and other parts of the Western Slope.
“This is what happens when the partners cooperate,” said Patrick Gordon, president and CEO of the Grand Junction-based Rocky Mountain Health Plans, a subsidiary of United Healthcare that is part of the network.
“This is what happens when the partners compromise. This is what happens when you actually get passed talking and actually build systems,” Gordon added. “These concepts are nothing new to Mesa County, they existed in one form or another for decades. The point is that, in this very competitive and different era that places like Grand Junction find themselves, is we’ve got a model to produce meaningful results.”
In 2015, Rocky Mountain Health Plans, St. Mary’s Hospital and Primary Care Partners created what is known in medical-provider circles as a clinically integrated network, a partnership of physicians and health care providers collaborating with hospitals and an insurer to deliver evidence-based care.
Since then, the network has grown to be the largest on the Western Slope and has served as a model for other areas of the state, said Ashley Thurow, executive director of Monument Health.
As of now, the network has three hospitals, 229 primary care providers and more than 1,000 specialists located in Grand Junction, Fruita, Cedaredge, Hotchkiss, Delta and Montrose, and is serving more than 20,000 members.
It works because of an emphasis on preventative medicine, catching health problems with patients before they grow into something life-threatening.
That’s not only what patients prefer, but is also helps reduce overall medical costs to insurers.
“We feel that our role is more to support providers in the community,” Thurow said. “We design mechanisms keeping patients in primary care instead of paying more for them to go to a hospital.”
As a result, the network’s 2022 rates that were recently approved by the Colorado Division of Insurance for the state’s health care exchange, known as Connect for Health Colorado, are anywhere from 4% to 13% lower than similar silver and bronze plans offered by two …….