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HomeMy WebLinkAboutMountain Healthcare Coalition overview 97 Main Street, Suite E-201, Edwards, CO 81632 Mountain Healthcare Coalition Our goal is to develop a new non-profit health purchasing collaborative to develop more cost-effective, sustainable health coverage options for individuals, insured employers, and self-insured employers in Eagle County. The name of this is the Mountain Healthcare Coalition and this group will be coordinated and led by Vail Valley Partnership. The goals of the healthcare coalition are to: • Develop a health purchasing collaborative to create more stability in insurance premiums, now and in the future;
 • Provide broader accessibility to health insurance and coverage options within the community; 
 • Work to provide a community-wide wellness mind-set and culture;
 • Provide education about access to a broader range of choices to promote better healthcare decision making Structure: The Mountain Healthcare Coalition will be an Eagle County based nonprofit health purchasing collaborative, enabled by CRS Section 10-16-1000. It will not be an insurance carrier, but it will develop, implement and maintain health benefit solutions specific to the needs of our mountain communities. By changing the way that individuals and employers negotiate, purchase and manage health insurance, the Coalition will work with Vail Health and other stakeholders to create sustainable relief to the high cost of health care in Eagle County. The Coalition will seek to represent convene individuals and businesses in Eagle County in direct negotiations with health care providers. By directly negotiating the prices that it pays, the Coalition will seek to essentially buy “wholesale” from the providers. This will be an important source of savings. The Coalition will seek to work with a limited number of established insurers/third party administrators (TPA). This will streamline providers’ administrative costs by reducing the number and complexity of billing systems and administrative interfaces that providers must manage. Product: Our goal is to offer products with common benefit designs across all buyer segments and products will be administered and marketed collectively. Brokers and consultants will continue in their current role helping businesses and individuals navigate the process of buying coverage. All coverage will include pre-existing conditions, be comprehensive, and ACA-compliant for individuals and small groups. Self-insured group benefits will be similar 97 Main Street, Suite E-201, Edwards, CO 81632 to what is currently offered in Eagle County. The Coalition will seek to partner with insurers/TPAs to administer these products in the most efficient way while maintaining flexibility for the coalition and local providers to continue improving its ability to provide good cost-effective coverage in Eagle County. Sustainable Market Reform: Both Price and Utilization drivers will be addressed to ensure long-term sustainable effectiveness. Price: the Coalition will work with the provider community to negotiate an equitable pricing strategy tied to objective measures such as Medicare-based reference pricing. Utilization: the Coalition will work with providers, employers, and individuals to address ensure the right care is provided at the right time and in the right place. Together we will develop strategies to: • Identify, create, and incent desired provider behavior. • Use benefit design and payment to guide provider and member actions. • Support and incent individual’s health literacy to bolster compliance, self-care, and engagement.