Were Better Together The Case for LocallyLed Health

We’re Better Together. The Case for Locally-Led Health Insurance

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3 Peak’s alliance model provides existing community-based efforts with access to expertise and resources while maintaining local control.

4 § Non-profit purchasing collaborative § Governed by the local community § Enabled by Colorado statute 10 -16 -1000 -1015

Insurers Negotiate Prices with Hospitals and Providers The Traditional Model Insurers Set Prices Consumers Will Pay Based on Negotiation with Providers Employers and Individuals Enroll Chart design in collaboration with CHI

Gather Community Buy-In and Support Collect and Analyze Local Claims Data The Peak Model Negotiate Rates Directly with Hospitals & Providers Solicit Bids from Carriers for Group & Individual Markets Employers & Individuals Enroll in Peak-Designed and Negotiated Plans Chart design in collaboration with CHI

The Summit County Challenge

Summit County Claims Analysis Outpatient Place of Service % of Medicare Ambulatory Surgery Center 395. 1% Inpatient Services Minimum Cost/Day Number of Admissions None 434 195. 6% Emergency Room 841. 9% $500 389 220. 6% Other Outpatient 336. 1% $1, 000 354 233. 5% $2, 000 302 247. 4% Combined Professional Services % of Medicare 197% 504. 7%

Putting Savings to Work Peak Rates (total including copays etc. ) Discount from Average PPO Rate $5, 716 per case 20 -30% $12, 511 per case 5 -10% Normal newborn (Baby only) $1, 144 per day 55 -65% Laparoscopic appendectomy $11, 831 per case 45 -55% Treatment of tibial shaft fracture (broken leg) $11, 831 per case >70% MRI scan $600 15 -25% CT scan $450 25 -35% Mammogram $156 45 -55% $530 per case 60 -70% Service/Procedure Vaginal Delivery (Mom only, up to 2 days) C-Section Delivery (Mom only, up to 4 days) Emergency Department Level 1

§ Centura has offered Peak the lowest rates of any carrier or TPA in Colorado § No discounts off billed charges— everything has a set price Finding Solutions for Families § Independent analysis shows Peak’s negotiated rates between 250 -300% of Medicare § Risk-bearing carriers believe this is significant enough to have dropped rates by at least 20%

Creating More Options for Small Business § Benefit designs similar or better to current coverage in Summit County § Peak-negotiated provider networks § Better Preventative Health Benefits § Products are more comprehensive § The same kind of insurance people are used to buying

Peak Health Moving Broadening Forward Our Approach

§ Garfield County: 423% (291% inpatient) There’s Still Work to Be Done in Colorado § Archuleta: 200% (67%) § La Plata: 421% (232%) § Routt: 291% (190%) Source: CIVHC/RAND

2021 Counties § Grand § Garfield § La Plata § San Juan § Dolores § Chaffee § Lake § Montezuma We’re sharing our vision for partnerships with other communities and the infrastructure that can make it work.

Core Values § Protect Local Health Care § Recognize unique challenges of rural health care § Empower consumers and communities § Use data, not anecdotes § Prioritize collaboration We’re sharing our vision for partnerships with other communities and the infrastructure that can make it work.

Thank You. peakhealthalliance. org tamara@peakhealthalliance. org