by Marissa Lorenz
A second community meeting was held last Thursday in Granby, presenting details and answering questions about Peak Health Alliance, a novel initiative begun in Summit County to negotiate directly with insurance carriers and medical providers, in order to “lower healthcare rates by using the purchasing power of the community.”
Success of the program has been so great that individual members in Summit saw an average 20 percent decrease in their insurance premiums over the last year, the initiative was profiled in a recent podcast on National Public Radio, and nine other Colorado counties are now interested in participating in the Alliance to bring more affordable medical insurance to their own communities.
Grand County was the first of these other counties to partner with Peak Health, an association championed by Grand County Commissioner Rich Cimino and supported by Commissioners Kris Manguso and Merrit Linke with a $50,000 budget for initial exploration in 2019. Cimino was present at Thursday’s meeting, hosted at the Granby Library by Jen Fanning, Executive Director
of the Grand County Rural Health Network. Tamara Pogue, Executive Director of Peak Health, was present by teleconference, with a PowerPoint presentation about the project goals and planned features of benefits.
Pogue offered two main objectives of the Alliance, to bring consumers back to healthcare through lower cost insurance options and to ensure that members could get high-quality health care locally. She outlined a multi-step model used by Peak Health to achieve those outcomes, including examining Medicare Cost Reports to gather data on health care costs, as well as what care locals are seeking and where; negotiating with local healthcare providers to lower fee schedules for members, providing incentives for consumers to seek their care locally; and taking proposals from insurance carriers offering lower premiums for increased consumer enrollement, thereby lowering risk to the carriers as well. It has been called a “win-win-win” solution to the health care crisis.
Pogue explained that Peak Health had worked with Centura Health in Summit County to keep care local and reduce fees to members, both individual and small-group. In Grand County, she indicated that they were currently in discussion with Middle Park Health, all of the independent medical providers in the county, and providers in neighboring communities, like Steamboat and Summit, to create favorable tiered option plans. Employees of Grand County Government will be eligible for 2020 plans, and the hope is to design plans and benefits that will be offered to all county residents and businesses for the 2021 plan year.
Nearly 20 attendees gathered for the presentation, both in-person and online, and representing both individual interest and the interests of business owners, non-profit staff, and town employees. Pogue’s formal presentation was followed by robust Q&A in which many details were addressed.
The process revealed that Peak anticipated four or five carriers to bid for the contract, including new entities that are not currently operating in Grand County. The final carriers for individual and small-group plans could be different, depending on what is best for each group. At present, the Alliance is renegotiating with carriers and providers on an annual basis, to allow for learning in this early time period, but would like to eventually go to five-year contracts.
Polly Gallagher of the Grand County Library District asked about access to statewide networks and specialty care. Pogue responded that all plans have
“network adequacy,” meaning that there would be contracted providers for all medical care, even for “the times where care does have to leave [the area].” She pointed to current Peak contracts with Children’s Hospital and CU Health services for “high acuity pediatric needs or cancer treatment.” She also indicated ongoing effort to increase access to preventative health, behavioral health care management, and telehealth options through the Peak plans.
Eden Recor, owner of Grand County Internet Services, asked about potential expansion of the Kremmling Memorial Hospital District tax base to include East Grand County. “I would think that if you had a larger tax base behind the Hospital District, you could reduce hospital costs fairly drastically, because the property taxes in eastern Grand County could be a driving force to reduce costs in all of Grand County.”
Cimino responded that the current Hospital District Board is opposed to expansion, but that a non-profit may be one way to supplement local hospital costs.
Beth Williams from the Town of Fraser asked about other health-related services, such as dental and vision. Pogue indicated that Peak will be piloting a dental initiative in Summit in 2021, which will expand to other partner counties in 2022 upon proven success. A vision pilot would then be initiated in a single community in 2022, for anticipated full rollout in 2023. She encouraged all interested to advocate for program participation among local dental and vision providers.
In a similar vein, Patrick Brower, small business proponent with the Grand Enterprise Initiative, expressed “worry” over the actual weight possible from enrolled participants in a county with only 14,000 permanent residents. Pogue, Fanning, and Cimino recommended getting individuals and businesses in the county to sign either a letter-of-intent or petition, expressing their interest in and willingness to consider Peak Health Alliance participation. They stated that a greater expressed interest in the area, or greater volume of potential participation, would result in more bids, more competition, and greater success of the program.
“I’m very confident that if we offer Peak plans on the individual marketplace in 2021–” said Cimino,
“I’m confident it will be additive.
I’m confident it will be cheaper. (…) I’m not saying that we will have fixed healthcare. This is going to be a years and years and decades long fight. But we’re in it. And we will have something better in 2021.”
For more information about the Alliance, go to PeakHealthAlliance. org. To sign a letter of intent or a petition declaring interest in the Peak Health Alliance and potential plan participation, contact the Grand County Rural Health Network at 970-725-3477.