Mountain Healthcare Coalition

About Mountain Healthcare Coalition

Our Goal:

Our goal is to develop a new non-profit Healthcare Coalition that will possibly include a health purchasing collaborative. The Coalition seeks to develop more cost-effective, sustainable health coverage options for individuals, insured employers, and self-insured employers in Eagle County. The  Mountain Healthcare Coalition will be coordinated and led by Vail Valley Partnership.

Our goals include:

  • Develop a comprehensive Community Healthcare Program 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;
  • Provide ongoing support to community health programming including but not limited to MIRA bus, health fairs, and related community health education efforts

Our Position:

The high cost of health insurance has been an ongoing and increasingly impactful issue in Eagle County. The difference today is the demographic data clearly shows an increased need for more health insurance options for the current and future Eagle County workforce. Addressing the high cost of health insurance is essential to the continued success and growth of our business community across industry sectors. A “yes, and…” approach is needed to fundamentally address the issue of health insurance cost; providers, insurance companies, and the government all need to be part of the solution and niche programs need to build on each other to support community needs.

Hear from the Vail Valley Businesses

Member Minute: Zack Cole

Venture Sports - Avon

Our business model

Structure:

The Mountain Healthcare Coalition (“Coalition”, or MHC) 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 rather an organization to lead community health efforts. As such, it will develop, implement and maintain health benefit solutions specific to the needs of our mountain communities. Mountain Health Coalition will work with Vail Health and the provider community to create sustainable relief to the high cost of health care in Eagle County by changing the way that individuals and employers negotiate, purchase and manage health insurance and educate the community on health-related issues.

Mountain Healthcare Coalition will represent individuals and businesses in Eagle County in direct negotiations with health care providers. This will be an important source of savings.

  • MHC Price List X MHC Benefit Designs + Health Plan Charges = Final Premium

The Coalition will contract 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:

While we are working to impact pricing and options in 2020, our target launch date is 2021. MHC will work with insurers to provide 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 to what is currently offered in Eagle County. MHC will partner with insurers/TPAs to administer these products in the most efficient way while maintaining flexibility for MHC 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: MHC will work with the provider community to negotiate an equitable pricing strategy tied to objective measures such as Medicare-based reference pricing.

Utilization: MHC 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.

 

Hear from the Vail Valley Businesses

Member Minute: Iliana Salazar

The Sebastian - Vail

Our why: background

Background and Situation Analysis:

With 55,148 people, Eagle County is the 15th most populated county in the state of Colorado out of 64 counties.

Tackling big issues such as health care and health insurance costs require an intentional, coordinated effort. We are thrilled to help lead efforts to bring an innovative plan to the community and are committed to building a program to support both our residents and our businesses. This is not an easy fix; it is a process. We’re fortunate to have the right organizations at the table to address it.

Vail Valley Partnership will serve as the convener of numerous community partners including Vail Health, local governments & special districts, self-insured employers, and the greater business community to launch an innovative health care program in Eagle County. The Vail Valley is well positioned to take an innovative yet pragmatic approach to addressing this issue.

The cost of health care started to resonate in our business surveys in 2014-15 and have continued to increase as a pain point for the community.

Hear from the Vail Valley Businesses

Member Minute: Ruthie Hamrick

Vilar Performing Arts Center (VPAC)

Why do we need to address healthcare and health insurance costs?

Why Do We Need to Address Health Insurance Costs – and more importantly, Community Healthcare?

Are we able to implement a localized health care solution within Eagle County to support businesses and community by creating an environment that lowers health insurance costs for our residents in order to support our current and future workforce in a meaningful way and which also supports our local health care providers?

Eagle County’s population is currently one of Colorado’s youngest, but is rapidly aging. While the youth, 18 to 25, and 46 to 60-year-old segments of the population remain constant at 25%, 8%, and 19% of the total population, respectively, state demographers are predicting a decline in the “family age” group of 26 to 45-year-olds, from almost 40% of the total in 2005 to about 24% by the year 2035. The older population, 61 and above, grows markedly, forecasted to comprise 22% of the total by 2035.

Our aging population, and an increasing demand for lower cost insurance projects across industry sectors, requires a concerted community approach to insurance products. It is incumbent upon the community to continue to build a business-friendly environment, making Eagle County an attractive place to conduct business by creating an innovative health care group product that works for all stakeholders.

There are only two health insurance companies (payers) on the ACA exchange (the number of payers has dropped each year since launch) – only Kaiser Permanente and Anthem BlueCross Blue Shield offer plans in our market, and Kaiser is leaving the market. People want to stay local for their health care, but the individual market is increasingly limited and 80% of our business community consists of businesses with less than 10 employees (90% have less than 20 employees).

 

Hear from the Vail Valley Businesses

Katie Kukar

Vail Vitality Center