Health care costs, public option discussed at health care forum in Frisco
FRISCO — The complex, sometimes thorny and frequently contentious issue of health care was the topic of discussion during a “Pizza and Politics” forum held at the Summit County Community and Senior Center in Frisco on Friday. The forum was hosted by Summit County’s community health care purchasing collaborative, Peak Health Alliance, and featured a panel of executives and experts integral to shaping Peak Health and its first-in-the-nation insurance purchasing model.
The panel featured Tamara Pogue, CEO of Peak Health Alliance; Michael Conway, the state’s insurance commissioner; Patrick Gordon, CEO of Rocky Mountain Health Plans, the carrier for Peak’s small group health plans; Lee Boyles, CEO of St. Anthony Summit Medical Center; and Mara Baer, health care consultant and president of AgoHealth, LLC, who served as moderator of the panel.
The discussion for the panel centered on the most difficult issue to tackle when it comes to health care in America: cost. The United States spends the most on health care per capita than any other country on the planet, and the costs are even more exorbitant for Summit County and Western Slope residents, who pay among the highest premiums in the nation.
Pogue, who has worked on building Peak Health Alliance from the ground up after meeting Conway during the first Pizza and Politics forum held two years ago, contended that price transparency and consumer knowledge of actual health care costs is “ultimately the only thing that will solve health care crisis in this country.”
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Pogue illustrated this point by comparing purchasing health care to purchasing a car. When a consumer tries to buy a car, they have a plethora of information available to them: the Blue Book value, information about the satisfaction and reliability of the dealership and other data points that allow them to negotiate the purchase price.
Until now, buying health insurance has not had that kind of transparency. Even when they receive the mountains of bills after receiving care, many things are unknown to a consumer, like administrative costs and the actual cost of medical supplies, pharmaceuticals, equipment and procedures, which are often inflated and negotiated with insurance providers. What those items actually cost the hospital is often a mystery to consumers, who are forced to pay what they’re told to with little say in the matter.
Given that Colorado hospitals have the second highest per-patient profit margin in the nation, the question of what consumers are actually paying for appears to be an important one. Pogue contended that Peak’s community purchasing alliance model has started tackling the issue of transparency, and is thus the best way to ultimately tackle the health care cost crisis.
Commissioner Conway said that while the community purchasing alliance model is revolutionary, and that price transparency is critical, they can’t be the only tools to bring costs down.
“I’m a big believer in transparency, but it’s only as good as what you do with that information next,” Conway said. “Unless we do something with that transparency, from the community standpoint, you won’t do much to lower prices.”
That’s why Conway sees legislation allowing for a “public option” to be the way forward on reducing costs, as it combines data with enforcement. The public insurance option, run by the state, would see it compete with private insurers on the marketplace, instead of replacing private carriers outright. Conway said that analyses have shown that insurance premiums in Colorado would go down 9 to 18% with a public option.
At the forum Conway was alone in seeing the public option as the way forward on driving down health care costs. Pogue did not see a “one size fits all” approach as being one that could work for Colorado, with its disparate regions, health care payment models and needs.
Gordon, CEO of Rocky Mountain Health Plans, said that “not a single major health care interest” was supportive of the public option.
“That’s because it’s a sweeping change, and it’s disruptive,” Gordon said. “There are any number of current business models, partnerships, contracts and regulatory framework that would have to be changed. It’s not a surprise that folks have a lot of questions.”
Boyles, CEO of St. Anthony Summit, chimed in on the public option issue, saying he saw too many unknowns about how a public option would help or hurt locally, in Summit County, to be able to endorse it. He also balked at the notion that health care prices would be capped to 175% to 200% of Medicare rates, saying the costs of health care in Summit made accepting Medicare rates already untenable, and that capping costs would have “drastic implications” on services the hospital provides.
Conway was nonetheless unfazed on his optimistic view on a public option model, saying it could work with Peak Health’s alliance model and other transparency and cost cutting measures to produce a viable option for Coloradans. And, he said, it would be magnitudes better than the current health care cost situation.
“The response to something like this affordability crisis is, continuously, to do something big and bold to make the world better,” Conway said. “This is a big and bold proposal because it has to be. We have to make change in the system, because it’s broken and is not good enough any longer. What we’re driving for, and the governor’s number one priority, is to stop people from being ripped off. That’s what we’re going to continue to do.”
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