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.