A local problem
Healthcare services, unlike most products, are not priced in a transparent or consistent manner from community to community, especially in rural regions and areas like Summit County. Compared to Denver, the cost for services has ranged from 30-80% higher for Summit County residents. This drives up insurance premiums, which then leaves twice as many of our residents uninsured as the state average, less able to access cost savings available through the Colorado state-based marketplace, Connect for Health Colorado, and spending nearly 40% of total income on healthcare expenses alone.
Compared to what providers are paid by Medicare, which sets locally-adjusted rates to allow an efficient hospital to make a small profit, residents who are not on Medicare or Medicaid pay a lot more. For a service that Medicare pays $1,000 for in Summit County, here is what gets paid by Summit residents to Summit healthcare providers (e.g. doctors and hospitals):
· Emergency room: $8,419 • Inpatient stay: Between $2,335 - $2,447
· Ambulatory surgery: 3,951 • Professional (e.g. doctor): $1,970
· Other outpatient services: $3,361
A local solution
The status quo is unmanageable, driving healthcare coverage out of reach for far too many and furthering the income inequality divide. A team of Summit County leaders, with support from the Colorado Division of Insurance, The Summit Foundation, FIRC, Summit County Government and others, is launching a local non-profit, Peak Health Alliance (Peak) to finally tackle this issue and rein in costs. Peak’s sole mission is to find ways to provide more affordable, high quality health insurance Peak will be structured as a cooperative, which means that the businesses and individuals who buy their coverage through Peak will have a say in how Peak is managed. Peak’s sole mission is to find ways to provide more affordable, high quality health insurance coverage. Peak wants to turn the way we purchase and manage health insurance on its head.
Our current healthcare system excludes individuals and employers from the process when prices are negotiated between healthcare providers and insurance companies. In the typical system, hospitals and providers set their prices, insurance companies negotiate the best deal for lower prices from those providers, then insurers pass on those costs to consumers. The only thing consumers and employers have control of is what premium and deductibles they’re willing to pay. This approach has disadvantaged our businesses and residents for far too long.
In contrast, Peak will negotiate directly with providers and hospitals for lower and more transparent prices. Then, insurance companies will be invited to compete for the opportunity to cover all Peak members. Peak will require the insurers to propose premiums based on a defined set of benefit designs and Peak’s lower negotiated provider prices – guaranteeing an “apples-to-apples” comparison.
This sounds simple but the truth is that Peak is breaking new ground by bringing the entire community together to speak with one voice. Peak has pooled data from large, small businesses to give it unprecedented information. This allows Peak to speak with authority and insight rarely available to employers or individuals. For the first time, there is a more level playing field between the people buying coverage, the companies selling coverage, and the providers giving services.
Locally Crafted Health Insurance Solutions for Individuals and Employers
Ultimately, Summit County individuals and employers will have access to health insurance plans that are:
· Comprehensive, ACA-compliant, and ensure residents with pre-existing conditions are covered
· Inclusive of Summit county providers so care can be accessed locally, but with providers throughout Colorado to ensure access to services that are not provided in Summit County
· More affordable and reflective of the unique needs of our community, with incentives for consumer engagement and rewards to incentivize quality care
· Purchased with the support of a broker and available through Connect for Health Colorado for individuals
· Available starting in the Fall of 2019 for coverage beginning January 1, 2020
Peak is working aggressively to provide high quality and affordable health insurance plans to individuals and employers for coverage beginning on January 1, 2020.
Peak is governed by a Board of Directors with executive leadership from Tamara Drangstveit, Julie McCluskie, Mark Spiers, and Sarah Vaine.
For more information, please email us.