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Summit County health care prices force families to make desperate decisions. A new plan for how consumers buy coverage could change that.

The Peak Health Alliance could become a statewide model for how to give patients an upper hand over prices

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FRISCO — To Devon Howe-Czar, it was a nightmare scenario:

A few weeks ago, one of her twin 7-year-old daughters fell while skiing. She was raced down the hill on a toboggan to a nurse’s station at the base, but from there Howe-Czar had to make a choice that confronts far too many families living in Colorado’s mountains. What to do now?

She and her husband couldn’t afford the $1,200-a-month premiums for health insurance through his job, and the rates on the state’s health insurance exchange weren’t much better. They decided to try to get by without insurance, but now she was confronted with one of the decisions she feared the most. She listened closely as the nurse asked her daughter, “Do you think it’s broken?”

“I had to make that decision of, ‘do I go to get it X-rayed or do we wait and see if it’s a sprain?’” Howe-Czar said, her voice cracking with emotion. “I figured within a week we would know.”

This is life for many working families in Colorado’s mountains — where the uninsured rate in some counties approaches twice the statewide average. Health care premiums are among the most expensive in the country. That’s in part because the prices for health care services are well above average, too.

An analysis by Summit County leaders found that privately insured patients are, on average, charged five times more in the county for outpatient services than what Medicare pays in the same place for the same services. For emergency services, privately insured patients are charged eight times more than what Medicare pays.

“It’s to the point where some of our clients are spending 30 to 40 percent of their income on health care expenses,” said Tamara Drangstveit, the executive director of the Family and Intercultural Resource Center in Silverthorne, which helps people find health coverage, among other services.

Summit officials have tried for years to find a solution, with little success. But now they have hit on an idea they think might actually work: a radical reordering of the health care marketplace. And it also could become a statewide model for how consumers buy health coverage.

How it works

It’s called the Peak Health Alliance, and its innovation is in how it tries to flip the leverage in health care price negotiations.

In the typical system, hospitals and doctors set their prices, insurance companies negotiate the best deal they can get below those prices, and then insurers pass on those costs to consumers. The only involvement the consumer has is deciding whether to pay the premiums and deductibles sets by insurance companies.

The Peak Health Alliance brings together employers and individuals into a kind of nonprofit cooperative, overseen by a board. As a group of consumers, the alliance then goes to hospitals and doctors and negotiates prices directly. Once it has pricing agreements in place, it then asks insurers to bid for its business — meaning consumers have leverage with both hospitals and insurers. They can negotiate bargains with providers, and they can get insurers competing to offer the best deal on coverage.

The ability to create these kinds of cooperatives has existed in state law for years, but Colorado Insurance Commissioner Michael Conway said, “Everybody forgot about this law.” If it works in Summit County, Conway said, he hopes to take the idea statewide.

“There is a good opportunity if we put the consumer at the table with the hospital that we can drive that conversation and we can lower health care costs,” he said. “And if we lower health care costs, we lower premiums.”

Conway has worked with leaders in Summit County to create the Peak Health Alliance, and he says it has one big advantage over the health cost-sharing plans popping up in other Colorado mountain communities. While cost-sharing plans might deny claims if they believe the member engaged in unhealthy behavior, Conway said the Peak Health Alliance’s program is full-fledged insurance and will guarantee coverage for all the things that Obamacare plans have to cover.

So far, the town governments of Breckenridge and Silverthorne, as well as Summit County government and a Breckenridge timeshare company have signed onto the alliance for their employees’ health coverage. Sarah Vaine, an assistant county manager for Summit County, said the alliance’s negotiations with medical providers are going well — “I think we’re feeling really positive,” she said — but there is also an urgency to get deals in place within the next few weeks so that coverage through the alliance could start next year.

Other groups of businesses in Colorado have banded together before to buy health coverage, but what makes the Peak Health Alliance so unique is that it also hopes to allow individuals to buy into the alliance on their own — hopefully providing a more affordable option for health coverage than what is currently on the market.

People in Summit County are desperate for one.

“One accident away”

Inside the senior center in Frisco, every seat was taken. People crowded in the back, up against the wall, leaning into door frames.

The event earlier this month was a town hall meeting, where Gov. Jared Polis and several state lawmakers discussed their proposals for cutting health care costs. In his remarks, Polis praised the idea for the Peak Health Alliance — “It’s an exciting model,” he said — and called Summit County a hotbed of innovative health care ideas.

Colorado Gov. Jared Polis speaks on Feb. 1, 2019, at a town hall meeting in Frisco about the high cost of health care in Colorado’s mountain communities. (John Ingold, The Colorado Sun)

But local residents got their say, too, and they told the officials about annual health care bills that, between premiums and deductibles, could top $40,000. One woman said her best option to find affordable coverage was to work less and take a pay cut — dropping her earnings down enough that she would be eligible for a subsidy on the health insurance exchange.

Residents worried they would have to move elsewhere to find coverage. Health care cost them more than housing, they said. People are skipping regular doctor’s visits, neglecting preventative care.

“It really is a life-and-death situation,” resident Gini Bradley said.

Howe-Czar, who was not at the meeting, echoed that fear. A Colorado native, she said she can’t see herself leaving.

“The mountains are in my blood,” she said.

But she said many don’t realize the struggle it is for most people to live in some of Colorado’s most glamorous places. She and her husband work in Summit County, but they live on the other side of Hoosier Pass, in Park County — a treacherous commute in winter.

For awhile, her husband worked as an independent contractor, and they were on Medicaid. But since he started a new job, they fell into a common high-country limbo: making too much to qualify for meaningful assistance and too little to actually afford coverage.

They’re responsible people, she said. They pay their bills. They take good care of their kids. They’re healthy.

And, still, they’re teetering on the edge of a financial disaster.

Fortunately, Howe-Czar said, her daughter’s ankle injury wasn’t that. After about a week and a half on crutches, her daughter is putting weight on the ankle again. It was just a sprain.

“So I’m thankful,” she said, hesitantly. “But that’s one of my concerns. We don’t make enough money to have medical bills. We’re current on all of our bills. But we are one accident away from having a really tough time.

“And that’s really scary.”

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