Originally published on February 3, 2020 1:31 pm
One rural community in Colorado was so frustrated with high health insurance costs and government inaction that a few years ago, residents took matters into their own hands.
And their plan worked.
Locals in Summit County found a way around traditional insurance processes to lower local health care costs and save consumers an average of 20 percent on their monthly premiums.
That's according to Tamara Pogue, the CEO of the Peak Health Alliance.
The group is a non-profit empowered to negotiate directly with health care providers and insurers to get better rates. The plans launched Jan. 1 for all levels of the insurance market - people who buy their own plans, small business plans and big self-funded employers.
When factoring in Colorado's new reinsurance program, Pogue said some people are seeing premiums drop as much as 50 percent compared to last year.
Pogue said they already cover 4,500 Summit County residents, including Glenn Brady.
"I was skeptical at first because I was skeptical of the whole health care system, but it delivered," Brady said. "It was probably the quickest, most immediate savings I've ever encountered in my life."
And he could use it.
Brady has been adjusting to life as a single father after his wife, Kelly, died of cancer in 2018. A realtor in Summit County, he was paying nearly $30,000 a year for health insurance between monthly premiums and a high deductible.
Now he's saving $800 on a Peak Health plan.
Surrounded by mountain peaks drifting in and out of clouds, Summit County is a community of ski towns with significant tourist traffic and a high cost of living. Those factors also led to high health care costs.
Pogue said the local hospital, St. Anthony Summit, has to always be ready to deal with tourist injuries.
"But the challenge is that our tourists still aren't here 365 days a year," Pogue said. "It becomes this chicken and the egg thing where the hospital keeps charging more to sustain a higher level of services and that in turn drives our premiums … and our workforce can't afford that."
Before founding Peak, Pogue led the county's community resource center. It's where she heard horror stories of people choosing between paying for health insurance or childcare, or being forced out of the county altogether.
Because of the tourists and Summit County's high cost of living, Pogue said county residents were paying as much as 80 percent more than someone in Denver for the same services. A trip to the local emergency room would cost an average of eight times what Medicare would pay for the same visit.
Colorado mountain communities have dealt with some of the most expensive insurance premiums for years, despite their notably low mortality rate.
"I mean when you have moms that are essentially deciding between health insurance so they can access breast cancer care and sending their kids to college, it is a problem and it is a crisis," Pogue said.
A few years ago, Pogue and other local leaders reached out to Colorado's insurance commissioner, Michael Conway, for ideas.
"We were increasingly frustrated as a community because we felt like none of the quote decision-makers in the health care space - and I mean the federal government or the state government - really cared about the struggle that we had in our community."
How it works
Conway suggested what he calls a "community purchasing model," which happens when a non-profit can go directly to health care providers, like the hospital and independent doctors, and negotiate lower prices for each of their services. Armed with those lower prices, they can find insurance carriers who will pass those savings on to their customers.
Peak Health Alliance essentially became the middleman, inserting consumers back into the process. Historically, insurance companies are the ones negotiating prices with providers and then choosing prices for plans they offer consumers.
"[Peak Health's] process is a little bit unique because it really allows consumers to come back to the table and make decisions in the space which I personally believe is one of the biggest challenges we face in health care today," Pogue said. "Consumers feel like this is way too complicated so they just throw up their hands and walk away and that means that we have a system that's not particularly transparent and certainly not accountable to the people that are buying the products."
A main source of high prices in Summit County was the St. Anthony Summit Medical Center, a hospital run by a larger chain called Centura. Peak Health found that because of the costs, only 30 percent of residents were going to the hospital. Many residents were driving to Denver for their medical care.
Incentivizing residents to use local providers was a big part of the goal, which Pogue said is an important part of the solution in rural healthcare. But Lee Boyles, the CEO of that hospital, said negotiating with Peak Health was also the right thing to do.
"The concessions we had to make were in line for what we needed to do just to make it more affordable for the community," Boyles said. "I would say we took some pretty aggressive rate reductions, but we also felt that was appropriate and what was needed for the community."
Boyles noted that because of the many tourists outside of the county, locals only accounted for 10 percent of hospital visits anyway.
Despite Summit County's unique tourism situation, Boyles said he thinks the Peak Health model could work in other places. Others aren't so sure .
So what next?
Pogue is already working with other communities on Colorado's western slope, including Garfield County.
It's a far more rural county about a hundred miles west of Summit County. Getting to its county seat, Glenwood Springs, includes a two-hour drive along interstate 70 through the red rock walls of Glenwood Canyon and along the Colorado River.
County Commissioner Tom Jankovsky is a Republican, and he led Garfield County to pay Peak Health $50,000 to figure out whether the model might work for them, too.
"I'm cautiously optimistic about it," Jankovsky said. "There's something wrong especially in western Colorado. The prices are some of the highest in the nation. The thing that excited me about Peak is that we've had a lot of emphasis on the individual market, but they also bring in the small group market … and so they have a model that works for our population here."
Peak's emphasis on local control and working within existing systems stood out to Jankovsky. He's not so supportive of big structural changes like the statewide public option for the individual market proposed by Gov. Jared Polis.
Pogue said while she likes Peak's model better, its results take longer to achieve than something the state can do with one legislative move.
"I think long-term it might develop deeper systems change than this kind of all-at-once approach," Pogue said. "I also recognize that this is a crisis and people are struggling and literally dying because they can't access health insurance because of prices."
This report was produced in collaboration with 1A Across America. 1A Across America is funded through a grant from The Corporation for Public Broadcasting. CPB is a private, nonprofit corporation created by Congress in 1967 that is the steward of the federal government’s investment in public broadcasting.
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