Peak looks to provide healthcare in Grand County

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by Casey Malon
The Board of County Commissioners (BOCC) held a shortened, half-day meeting on July 30, the fifth Tuesday of the month.

The meeting opened up with the commissioners’ approval of up to $10,000 for two elected officials, Christina Whitmer, Treasurer, and Sara Rosene, Clerk & Recorder, to seek outside counsel to defend each in a recently-served lawsuit against the two public officials.
The Plaintiffs, Brent B and Mary E O’Donnell, are seeking Declaratory Relief from the Court, on the grounds that Whitmer and Rosene refused to accept for filing a release of deed trust against the Hale residence.

It was determined that in-house nor County Technical Services, Inc (CTSI) representation was allowable, based upon the filing, so the BOCC authorized the two public officials to seek outside counsel for the legal matter by approving two separate resolutions.

Lawsuit “dismissed with prejudice” Commissioner Chair Richard Cimino discussed the court’s “dismissal with prejudice” of an election item. While the specific case was not named during the meeting, it is likely the petition filed by Igadi Ltd in late 2018 citing the expected revenue information illustrated in Ballot Measures 1A and 1B of last November’s ballot were inaccurate and misleading. Both measures passed and are anticipated to collectively result in added revenue of approximately $450K on marijuana distribution and sales in 2019. The county had filed a motion to dismiss earlier this year and the judge’s decision was issued several months ago. A judge’s dismissal with prejudice barrs the plaintiff from bringing another action on the same claim.

BOCC considers Peak Health Alliance expansion to Grand County

Nathan Wolfe, of HUB International in Denver, the county’s Benefit Consulting firm, discussed the County’s upcoming health plan renewal and offered an option for their consideration.
Currently, the county offers their employees two plan types: a High Deductible Health Plan (HDHP) Preferred Provider Organization (PPO) plan and a standard PPO plan. Both the self-funded plans are administered and bundled with CIGNA. 2020 renewal information is anticipated to be received in late August.

New to the healthcare marketplace is Summit County’s Peak Health Alliance (Peak), a mountain-specific, locally crafted, nonprofit cooperative. Formed by the Summit Foundation, FIRC, Summit County government and other stakeholders, Peak has endeavored to create affordable healthcare plans through direct negotiations with providers, pharmacy benefit managers, insurance companies and administrators. The new plan will be available January 1, 2020.

Currently, the Peak plan is only available to residents of Summit County. However, Wolfe told the commissioners that Peak would be open to expanding the plan to Grand County, if negotiations with the Kremmling Memorial Hospital District (d/b/a Middle Park Health) were successful. He explained that while Centura has an administrative contract with the District, KMHD handles all contract negotiations directly. Wolfe told the commissioners that attempts to schedule a meeting with “the right people” at Middle Park Health had thus far been unsuccessful.

Wolfe added that Peak would be open to negotiating with smaller medical practices as well, to ensure adequate choice to covered participants. A secondary “wrap” network of providers would broaden coverage, but at a higher cost to the participant, similar to current non-network benefits. Wolfe noted that only about 3-5% of county benefits are paid to non-network providers.

The ‘wrap’ network would be tied to the selected third-party administrator. The county would have two choices: UMR, a wholly owned subsidiary of United Healthcare, coupled with United Healthcare’s national PPO network; or, EBMS, a large Third Party Administrator based in Billings, MT, paired with Aetna’s national network. An independent Pharmacy Benefit Manager and Stop Loss Carrier would also be added to the mix to further reduce overall plan costs.

In a ‘hypothetical’ plan design, Wolfe walked the commissioners through options similar to their current plans, with a third Exclusive Provider Organization (EPO) option. An EPO option requires participants to utilize Peak providers exclusively, except in the case of a life-threatening emergency, ensuring the highest level of cost savings to the plan.

Wolfe explained that, by making the move to Peak, the county could realize between 4.5% – 8.5% in annual savings. With an annual budget of about $4 million, Chairman Cimino noted that 5% could mean about $150K-200K in savings annually. “There’s a lot of variability, but I like that number,” he said.

Commissioner Kris Manguso agreed, saying, “I think this is great”. Commissioner Manguso did express concern with the inability to cover elected officials under the Peak plan.

The commissioners determined that before they could make any sort of decision on this prospect, they needed to ensure that employees and their covered dependents would be able to continue to see the same providers and obtain the same prescription medications. Wolfe assured the commissioners that he would complete a ‘disruption analysis’ to see where any fallout may occur.

“We will try for as little as possible,” said Wolfe.

County Manager Kate McIntire asked Wolfe to provide some resources to help employees and their dependents better understand what might be changing. “The more we can work together, to access the tools and get the information out” will help them be more acceptive of the changes.

In order to make this happen in time for the 2020 benefit enrollment, Wolfe outlined a very tight timeline for implementation, with much of the legwork taking place in the next six weeks. He noted that nothing could happen without successful negotiation with Middle Park Health. Chairman Cimino said he would make a few phone calls and Commissioner Manguso offered to speak with several of the KMHD board members, three of which live within one mile of her home.

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