Peak Health Alliance advocates with local stakeholders and hopes to come up with plans by 2023
Peak Health Alliance presented its case to stakeholders in the Routt County community last Thursday, trying to convince them to support the group as it tries to bring lower cost health insurance options to Yampa Valley .
Established in 2018 in Summit County, the Healthcare Purchasing Co-op is looking to expand to offer plans in partnership with a Routt County health insurance provider, in hopes of coming up with plans from from 2023.
But Peak needs to build community support first – the first step in its process which they say has shown promising results in seven other Colorado counties all of which saw rate cuts in 2021, with some reaching 38%. . One is near Grand County, which first offered Peak-sponsored plans this year and saw premium savings estimated at $ 200 on some plans offered in the home market.
“We are here because health care is too expensive in Routt County,” said Commissioner Beth Melton. “This is something that many of us have had in mind for many years, and Peak’s model really presents a unique opportunity.”
Thursday’s meeting included local human resource managers, representatives from local healthcare providers and some government officials and aimed to explain how Peak works and what needs to happen in order for it to successfully enter the local market.
Peak’s model gathers claims data, then works to renegotiate fee schedules with vendors and hospitals, then pass those lower costs over to insurance companies to create a Peak-sponsored plan with premiums. lower.
Buying from local suppliers is a crucial part of Peak’s ability to reduce premiums.
Despite promising results elsewhere, Peak has not always been successful in coming up with plans, mainly because some local hospitals have not subscribed to them. An effort in Garfield County ultimately failed earlier this year when local hospitals stopped contacting officials who worked with Peak.
After Peak CEO Claire Brockbank gave an hour-long presentation to the group, the self-proclaimed elephant in the room took the floor to share his concerns.
“As Claire said, part of the process is dancing around the elephant, and I am the elephant,” said Soniya Fidler, president of UCHealth Yampa Valley Medical Center.
Fidler said she likes to say that health care is the only service someone receives without knowing how much it’s going to cost up front. But she says she added to that remark because healthcare is the only service a business provides without knowing how much it will also be paid for it, if at all.
The hospital has taken many steps to cut costs locally, Fidler said. She mentioned a joint venture that opened an outpatient surgery center and the opening of an emergency care center, two less expensive forms of care.
Fidler said the community is fortunate to have the level of services they offer locally and that the services they offer that are cost effective allow them to offer a wider range, including some that are often not found. not in rural areas.
“My concern that I shared with Claire is exactly that. What does this negotiation bring and will I be able to maintain and maintain a profit margin that allows us to do these things? Fidler said, focusing on the costs of paying competitive salaries to staff and keeping up with equipment and capital upgrades.
When Peak started in Summit County, the hospital was billing about 850% of the Medicare rate, Brockbank said – much higher than YVMC. Fidler said the hospital rates are between 190% and 290% of the Medicare rate, a common but flawed measure used to compare the costs of care between providers.
“Yes, I totally agree that we need more options when it comes to more affordable insurance premiums. We absolutely must continue to work on reducing the costs of care, but without compromising the quality of care, ”said Fidler.
Brockbank said Fidler has been very open and receptive so far, which she called the “ideal scenario”.
“Your hospital’s percentage of Medicare has gone down, and that’s a real testament to a lot of work,” Brockbank said. “In fact, when we first looked at this data, I expected to see a steeper downward trend in premiums.”
Brockbank said she had not seen a reduction in premiums she expected to see based on some of the rates charged by the hospital, but it is still early in the process. While hospitals have been a hindrance in the past, Brockbank said they also had a really collaborative process with some hospitals that ended up drastically reducing premiums.
There could be a lot of care leaving the county for more expensive providers, Brockbank said, but it’s too early to know now.
Melton said the county has pledged to pay around $ 25,000 to $ 35,000 for an actuarial analysis that Peak will produce on local costs. If the process moved to the next phase, Peak would get around an additional $ 25,000 for its work, although there is no clear source of funding for it yet.
For the remainder of the year, Peak will focus on data collection and discussions with the hospital. In early 2022, stakeholders will need to decide whether or not to continue marketing a plan for early 2023. Before the end of the year, Brockbank has announced plans to form a steering committee and group. Advisory from suppliers who will help decide whether to take that next step.
“I’m not as worried about what’s going on here with the hospital as I was when we started at Summit,” Brockbank said. “Still, something is happening. There is a lag because you have very high premiums. I need to determine if there is anything we can do to resolve this issue.
To reach Dylan Anderson, call 970-871-4247 or email [email protected]