Opinion: A Summit County solution for the high costs of health care
The high cost of health care is well known to the residents of Summit County. Eight years ago locals were spending 10-20 percent of their income on health insurance. Today, that figure has risen to 30-40 percent of take-home pay with deductibles over $6,000 per individual and $13,000 per family. The cost of health care is out of control with seemingly no end in sight.
This is the first in a series of articles to discuss health care costs in Summit County and what is being done to deal with this complicated issue. This article focuses on the creation of The Peak Health Alliance, the best local hope to tackle ever-increasing insurance premiums.
In the fall of 2017 a group of local individuals including Tamara Drangstveit, representing the Family Intercultural Resource Center, county officials Sarah Vaine and Dan Gibbs and Mark Spiers with The Summit Foundation began discussions on how to address the situation and find ways of understanding the drivers of cost in Summit County.
Last year, The Summit Foundation took on the project as a special initiative and commissioned a Denver actuarial firm to answer a series of questions including: Where do patients actually receive care? How many stay in Summit and how many go to Denver and elsewhere? How do the prices Summit residents pay for common procedures compare to Denver prices?
Approximately 90 percent of insurance claims for 2015 and 2016 were reviewed with self-insured organizations the Summit School District, Summit County government, Breckenridge Grand Vacations, the town of Breckenridge and the town of Silverthorne all submitting their data for review. The results were enlightening.
While 38 percent of patients stayed in Summit for care, 32 percent migrated to Denver, and 13 percent found care in even higher cost Eagle County. Compared to Denver, inpatient, outpatient and ambulatory (non-hospital outpatient care) services ranged from 30-80 percent higher with certain procedures exceeding a 500 percent differential. Now that the facts were known the question became how to best address the situation.
In the summer of 2018 the efforts of the local Summit team caught the eye of then-interim insurance commissioner Mike Conway. Conway was looking for a model to lower costs on the Western Slope and The Summit Foundation special initiative was ahead of any efforts currently underway. He met with the Summit team and the concept of The Peak Health Alliance was born. Peak Health’s mission is to create a buying collaborative that will negotiate with local providers (hospitals, physician groups, etc.) to establish a reduced fee schedule for individuals, small businesses and self-insured entities. Once the reduced-fee schedule is established, Peak Health will ask insurance companies to bid on the business using the new schedule. The result will be a fully insured product available for Summit residents, with significantly lower premiums than currently available, and launch in January 2020.
Conway is now Insurance Commissioner under Governor Polis and the governor and commissioner have touted Peak as a model that can work and be used in other counties. Peak Health has also garnered the support of Rep. Julie McCluskie and Sen.Bob Rankin. Negotiations with providers are currently underway and discussions with insurance companies will commence in the spring.
The Peak Health Executive Committee consists of Tamara Drangstveit, Julie McCluskie, Mark Spiers and Sarah Vaine. If you would like to know more about Peak Health or have a presentation to your local group or organization, contact The Summit Foundation at Nicole@summitfoundation.org.
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