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Is banding together the answer to lowering health costs?

Nonprofit leads effort to adopt successful model for La Plata County
A nonprofit cooperative founded in Summit County may have set an example for lowering health care costs that La Plata County groups can follow.

Ballooning health care prices in Southwest Colorado have outpaced other areas of the state for years. Now, an effort led by Local First is working to bring down health insurance costs across La Plata County for businesses and employees.

The fledging group is investigating a nonprofit cooperative model founded in Summit County and whether that model could be applied locally, said Monique DiGiorgio, managing director of Local First, a nonprofit representing independent businesses and nonprofits.

“It’s really a community effort to address the rising cost of health care issues,” she said.

The Summit County nonprofit cooperative, called Peak Health Alliance, is expected to lower costs for individuals and small businesses by about 20% next year, said Claire Brockbank, a principal with Segue Consulting, who worked with the cooperative. Brockbank is now assisting the La Plata County group.

The Peak Health Alliance’s results and its unique model caught the attention of those working with Local First to find ways to lower health care costs, said Doug McCarthy, an independent health insurance expert working on the Local First effort.

“We said, ‘Wow. Could we learn from that experience here?’” McCarthy said.

Local First came across the Summit County model last year after it started exploring health care needs in the community. The group tackled the issue at the request of local businesses that were struggling with the rising costs of insurance and were interested in collaborative solutions, DiGiorgio said.

A health care needs assessment found that spending on outpatient services across the Western Slope is about 87% higher than the state average.

Summit County faced even higher prices than those on the Western Slope.

For example, emergency room costs for private payers in Summit County were about 840% higher than what Medicare pays for care, Brockbank said.

To address high prices, community members in Summit County worked with the state insurance commissioner to form a nonprofit cooperative to negotiate lower prices directly with health care providers, and then contract with insurance companies to provide the coverage at lower prices, she said. The work started in 2018.

“It has been a sprint,” Brockbank said.

Gov. Jared Polis said he sees potential in the Summit County model to lower prices for consumers during a meeting for statewide municipal officials in Breckenridge last week. He also acknowledged efforts to replicate it in Eagle and La Plata counties, according to The Denver Post.

The governor’s office is interested in using a similar model for state employees and will be talking with the leaders of cities, counties, school districts and other public employers directly to see if they are interested in joining the state’s pool as well, Polis said according to The Post.

In addition to negotiating prices, the Peak Health Alliance also worked to improve the quality of insurance available. For example, Summit County customers will be able to visit a primary care doctor three times without paying a deductible or co-insurance, she said.

“This isn’t just about getting as bare bones as you can,” Brockbank said.

The cooperative improved health insurance plans by negotiating with health care providers on behalf of the 20,000 individuals who could potentially purchase insurance as residents or employees in the county, she said. The negotiations included some of the largest employers, such as the school district, she said.

As part of the negotiations, Peak Health Alliance gathered data from 92% of those eligible for insurance coverage, Brockbank said. The data showed many people were leaving the community for care, she said.

It also revealed large employers were paying many times more than Medicare for care, even though they believed they were getting a good deal, she said.

The nonprofit negotiated with St. Anthony Summit Medical Center, a hospital in the Centura Health System for lower prices, she said. The extremely high costs and the number of people leaving the area helped in those talks, she said.

“Centura recognized that they needed to do something different,” Brockbank said.

Mercy Regional Medical Center in La Plata County is also part of the Centura system.

After negotiating prices, the Peak Health Alliance went out to contract with insurance companies that will sell the lower-priced coverage to residents, she said.

In January, customers will purchase insurance as they always have – either through their employer or on the state health exchange, she said. Large corporate employers, such as Walmart, will continue to offer insurance outside of the newly negotiated plans, Brockbank said.

In La Plata County, employers and residents are facing some of the same high pricing as Summit County, in part, because hospital costs in Colorado are higher than they are elsewhere in the nation, McCarthy said.

Hospitals in rural areas aren’t forced to be as cost competitive as those on the Front Range, which have more competition. Some rural hospitals have monopolies over the areas they serve, he said.

For example, private insurers are paying 317% more for care at Mercy Regional Medical Center than what Medicare would pay, according to a study by The RAND Corp.

The new La Plata County group expects to gather local data about insurance claims this summer to better understand the cost of health care and what consumers are paying for care, DiGiorgio said. The data will help the group make an informed decision about whether to go forward with a cooperative, she said.

Decisions will be made by the group’s newly formed steering committee. The group includes Durango Chamber of Commerce; Local First; Doug McCarthy; and the Durango Network, a group representing local independent health care providers. Membership of the committee is likely to expand over time, DiGiorgio said.

While the steering committee is exploring a cooperative, the state Legislature is exploring other options for lowering health care costs. For example, the state could allow consumers to purchase Medicaid insurance as part of a new public health insurance option, McCarthy said.

However, a local cooperative might allow the community to lower its own insurance costs, he said.

“We just want to continue to broaden the conversation and just see what people want to do,” he said.

Those interested in following the steering committee’s progress may sign up for Local First’s e-newsletter at local-first.org.

mshinn@durangoherald.com

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