Peak Health enters negotiations with UCHealth, insurers
The steering committee exploring bringing Peak Health Alliance into the Routt County insurance market is moving to the next step — negotiating with providers and carriers.
This is a crucial point on the road to Peak offering plans locally starting in 2023, and one that has derailed previous efforts for Peak to enter a market, with some hospital systems opting not to participate.
But Peak CEO Claire Brockbank said that has not been the case with UCHealth Yampa Valley Medical Center at this point, speaking highly of hospital president Soniya Fidler.
“(Fidler) has been great,” Brockbank said. “Where the rubber meets the road is how the system is. … I am optimistic, but we’ve got some really important conversations ahead of us.”
Peak is a health care purchasing cooperative created in Summit County in 2018 that aims to lower premiums by harnessing the negotiating power of the community and data they say helps them find inefficiencies in the system.
In addition to developing a steering committee for the group, David Rossi, Peak’s chief marketing officer, said they have been studying claims data to get a sense of what people are paying for care in Routt County. This, the company hopes, will give them a good sense of what feels right for various medical costs.
“Then we go into negotiations with the hospital. That’s going to involve fee schedules, which is essentially the menu of services that a provider offers,” Rossi said. “Everybody’s going to lay their cards out on the table and say, ‘OK, where can we find some savings?'”
But hospital systems are often not eager to enter a negotiation that aims to cut what they get paid for various medical procedures. Both hospital systems in Garfield County didn’t participate when Peak tried to enter in 2019, essentially killing the effort.
Fidler, the hospital’s president, said Peak and the hospital hold the same goal: lower health care costs.
“(That) is why we’re in this dialogue, and why we want to cooperate and collaborate as much as possible,” Fidler said. “We do feel we have done a great job in reducing costs.”
Fidler said the hospital is below average when it comes to cost relative to Medicare, which is a different dynamic than other counties had when Peak arrived.
“We want to ensure that we can maintain the high quality care that we provide today,” Fidler said, noting Steamboat has access to many services communities of a similar size do not. “We set our overall structure from a cost perspective in order to continue to provide those services that essentially don’t make a profit or even break even.”
Fidler said a small team of UCHealth pricing experts will be in on the negotiations with Peak, with her participating alongside. In her mind, a win-win situation would to lower premiums, get another insurer into the market and ensure the hospital will be able to maintain service levels.
“That would be an amazing outcome, but not at the detriment of our operations and the detriment of the high quality and high service,” Fidler said.
Rossi said Peak also needs to identify a carrier to provide plans locally at a lower rate based on renegotiated fee schedules, as Peak itself does not provide insurance. In many counties, Peak has partnered with Bright Health to provide plans — an insurer that independent providers in Summit County have expressed concern about after some claims went unpaid for months.
The negotiations will continue over the next few months with the endpoint being the end of May when insurance companies need to file their rates with state regulators.
“That end of May is sort of the big make or break moment, if you will,” Brockbank said.
To reach Dylan Anderson, call 970-871-4247 or email danderson@SteamboatPilot.com.
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