Peak Health Alliance delays Routt County expansion to 2024 citing ‘big lift’ involved in negotiating rates
Steamboat Pilot & Today
STEAMBOAT SPRINGS — Peak Health Alliance will not offer sponsored health care plans in Routt County in 2023, but is continuing talks with UCHealth in the hopes of offering plans for the start of 2024.
The health care purchasing cooperative started an effort to expand to Routt County last fall and in March, a steering committee of local stakeholders said they believed there was opportunity for lower costs.
But a crucial part of the groups’ process it has used to lower premiums elsewhere in Colorado requires negotiating a new fee schedule with local providers, and Peak CEO Anne Ladd said a new schedule wasn’t able to be ironed out with UCHealth in time to find a carrier and offer plans in 2023.
“There’s a lot that has to happen,” Ladd said.
Peak started in 2018 in Summit County and works to use claims data to negotiate lower fee schedules that they can use to entice a carrier to offer Peak-sponsored plans with lower premiums. The local steering committee said in March it had interest in the plans from 72 local businesses representing about 1,900 employees.
The regulatory timeline for insurance rate filing was earlier this year because of the Colorado Option law passed in 2021, Ladd said. That timeline is further moved up next year though, as the Colorado Option introduces public hearings for the first time. Ladd said rates for plans starting in January 2024 need to be filed in March.
“We have between now and March to get an agreement with UCHealth, find a carrier, work with other providers with the community,” Ladd said. “We have a lot of work to do, and we are hopeful that we’ll be able to get it done.”
Ladd said she has another meeting with representatives of UCHealth next week to continue discussing the fee schedule. She noted that talks with the hospital system extend beyond Yampa Valley Medical Center and also need to include services provided beyond Routt County.
While the hospital system is a big chunk of this work, Ladd said they need to be engaged with other local providers as well.
“I’m cautiously optimistic,” Ladd said, referring to the likelihood of these talks to produce a new fee schedule.
If a new fee schedule is agreed upon, the next step is to find a carrier to offer the plan, as Peak is not an insurer. The carrier then needs to submit rates to state insurance regulators. If that can’t happen by March, Ladd said they would continue to push to offer plans in 2025 if needed.
“2023 was hugely ambitious,” Ladd said. “2024 is hugely ambitious. It just is because of those moved up timelines. … It’s a big lift and we’re going to give it our best shot.”
This story is from SteamboatPilot.com.
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