La Plata County Community Needs Assessment · 2019-06-13 · La Plata County Needs Assessment, June...

LaPlataCountyCommunityNeedsAssessmentAccesstoHealthCareforSmallBusinesses

WithSupportFrom:

JUNE2019LocalFirst

POBox2058Durango,CO81302

https://foundation.local-first.org/health-care/

LaPlataCountyNeedsAssessment,June2019

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TableofContentsAcknowledgements 3Introduction 4RisingCostofHealthCareandConsolidation 5

StakeholderEngagement 7June2018MeetUp 7January2019FocusGroups 7May2019HealthCareForum 9

WestSlopeModels 9VailValleyPartnership 9PeakHealthAlliance 10

PoliciesandStatute 11EnablingLegislation 112019LegislativeSession 12

NextSteps,Solutions 13Closing 15APPENDICES 16APPENDIXA:SURVEYRESULTSFROMFOCUSGROUPS 17APPENDIXB.COMPLETEFOCUSGROUPSURVEYRESULTS 21APPENDIXC:MENTIMETERSURVEYRESULTS 24June2018Meet-Up 24May2019HealthCareForum 28


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AcknowledgementsThisCommunityNeedsAssessmentwouldnothavebeenpossiblewithoutthegeneroussupportoftheRockyMountainHealthFoundation.Wecouldneverhavetackledsuchacomplexandimportantissuesuchashealthcarewithoutthefoundation’sgrantaward.Theirfinancialsupportallowedustotaketheimportantfirststepoflisteningtoourcommunitytobetterunderstandbarriersaroundaccesstohealthcareandhowourcommunitydefineshealthcare.Becauseofourabilitytolistentothegrowingconcernsaroundhealthcare,wewereabletoidentifysomekeynextstepsthatwillallowustobuildalocalsolutiontoaddressrisinghealthcarecostsandassociatedhealthcareissuesatthelocallevel.ManythankstotheleadershipofTheDurangoNetwork,inparticularJoeTheine,whohadthevisionandunderstandingoftheimportanceofthisCommunityNeedsAssessmentandthepaththatwecouldtaketoaddresshealthcareissueslocally.WewouldalsoliketothankSanJuanBasinPublicHealthforactingasourfiscalsponsorforthegrantandbeinganimportantday-to-daypartneronthisproject.Resources,understanding,andknowledgeofhealthcareallianceswereprovidedbyDougMcCarthy,ClaireBrockbank,thePeakHealthAlliance,ChetSeward,andChrisRomeroftheVailValleyPartnership.TheDurangoChamberofCommercewasinstrumentalinhelpingusbringtogetheradiversearrayofstakeholdersatourMay2019HealthCareForum.Finally,manythankstoallofthefocusgroupparticipantsandbusinessleaderswhotooktimeoutoftheirbusydaytoengageinthisassessment.Wehopethatthisreportisanaccuratereflectionofyourthoughtsandideasandallowsustomoveforwardtogetherasacommunity.WewouldalsoliketothanktheLocalFirstandDurangoNetworkBoardofDirectorsforinvestingtheirtimeandmoneyintothispartnership:TheDurangoNetworkGregShackle,MDPresidentKarenZink,NPPhilWiley,MDJayCiotti,MDDanSchaefer,MDEllenTomsic,PT,OCS,FAAOMPTSusannePhare,CPC,SPHR,ELI-MP

LocalFirstTimWheeler,ChairSteveElias,Vice-ChairTedWright,SecretaryJohnLopez,TreasurerAmberDavisJoyMartinLisaMastnyMaryOswaldPeterSchertz

ProjectManagement:MoniqueDiGiorgio,ManagingDirector,LocalFirst

LaPlataCountyNeedsAssessment,June2019 4

IntroductionThemissionofLocalFirstistoprovidelocally-owned,independentbusinessesandorganizationsopportunitiestothriveasweworktogethertobuildaneconomythatvaluespeople,theplanetandprosperityforeveryone.Weenvisionathriving,self-reliant,andresilientcommunityinvestinginlocally-owned,independentbusinessesandorganizationsthatjointogethertoenhanceeveryone’squalityoflife.Amajorityofour274membersaresmallbusinesseswithlessthan50employees.Andmanyofthosebusinessesareentrepreneurialinnatureandjustgettingtheirbusinessunderway.Thismeansthatrevenuesareoftenlimitedwhenitcomestoprovidingemployeebenefitssuchashealthinsurance,healthandwellnessincentives,andretirementplans.Inordertocompeteforhighqualityemployees,providingsomekindofhealthpackageisstandardpracticethesedays.In2018,LocalFirstheardfromanoverwhelmingnumberofitsmembersthattherisingcostofhealthcarewasbecomingamajorobstacletorunningtheirbusiness.Therisingcostofhealthcarehasmanypotentialconsequencesforlocalbusinessesincludingincreaseddifficultyattractingandretainingemployees,decreasedinvestmentsinotherareas,andbusinessrelocationtoareaswithlowerhealthcarecosts.Rightaroundthetimeourmemberswereapproachingus,LocalFirstwasintroducedtotheDurangoNetwork.TheDurangoNetworkrepresentsapproximately200localhealthcareprovidersintheLaPlataCountyregion.ThemissionofTheDurangoNetworkis,“toprovideeducation,supportandresourcesforindependenthealthcarepractitionersinthefourcornerscommunity.”Thesehealthcareprovidersarealsolocal,independentbusinessesinadditiontowearingtheirhealthproviderhat.LocalFirstandTheDurangoNetworkrealizedthatapartnershipbetweenthetwoorganizationswouldbeastrongfoundationtoaddressbarrierstohealthcareinLaPlataCounty.Thankstoa$25,000grantfromRockyMountainHealthFoundationinSeptember2018,TheDurangoNetworkandLocalFirsthavebeendevelopingameaningfulworkingrelationshiptoaddressthehealthcareissuesinourcommunity.ThegranthasprovidedmuchneededcapacitytodevelopaCommunityNeedsAssessmenttoaddressaffordableandeffectivehealthcareforlocal,independentbusinessesinLaPlataCountyandthecommunityat-large.Thefirst,mostimportantstepoftheassessmentwastoconductdetailedfocusgroupsinordertodiscoverbarrierstoentryforsmallbusinessesinprovidingaffordablehealthcaretotheiremployees.Weexploredhowbusinessesweredefiningtheword“healthcare,”whatsmallbusinessescouldinvestintheiremployees’health,andhowtheywouldprioritizeoutcome(s)theywouldliketoachievewiththeirinvestment.Thiswasthefirstphaseofourwork.Inafuturephase,wewilltestalternativehealthcaredeliverymodelsinordertoprovideeffectiveandactionablehealthcareoptionstothelocalcommunityandarecurrentlyexploringlocalhealthcarealliancemodelsfromVailandSummitCounty,Colorado.


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Theoverallgoaloftheassessmentistoprovideinnovativehealthcaremodelsthatchangebehavior,increasethequalityandaccesstocare,increasesaffordability,andultimatelyimprovethehealthandwell-beingofLaPlataCountyresidents.

RisingCostofHealthCareandConsolidation

OneofthemostcompellingdriversbehindtheinterestinaddressinghealthcareissuesistherisingcostofhealthcareandthedisparityinhealthinsurancepremiumcostsontheWesternSlopeofColoradoincomparisontotheFrontRange.Inthe10-yearstretchbetween2008and2017,theColoradoDivisionofInsurancereportedthathealthinsurancepremiumsrose50percentforpeoplewhohadcoveragethroughanemployeronlyforthemselves(seeFigure7below)1.Forfamilieswithemployer-sponsoredinsurance,premiumsrosemorethan60percenttoanaverageofnearly$20,000peryear.ThereportdetailsthehealthinsurancemarketinColorado,includingpremiums,financialstatusofhealthinsurers,andthetrendsintheindividualandgroupmarkets.

1 TheColoradoDivisionofInsurance.MichaelConwayCommissionerofInsurance(Interim).2017HealthInsuranceCostReport.December10,2018.


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Atthesametime,spendingforoutpatientservicesontheWesternSlope’sinsuranceregionisabout87percenthigherthanthestateaverage,accordingtoanalysesbythestate’sDivisionofInsuranceandtheColoradoCommissiononAffordableHealthCare2.DataforthestudywascompiledbyusingtheColoradoAllPayerClaimsDatabaseaswellascommercialmarketdata.Coloradocountieswiththeleastcompetitionamongbothhospitalsandinsurancecarriershavethestate’shighestinsurancepremiums,accordingtoanewColoradoHealthInstituteanalysis3.Hospitalshaveconsiderablebargainingpowerinmanyplacesbecauseofhealthsystemconsolidationsandtheirpurchasesofmanyphysicianpractices.Thelow-competition,high-premiumcountiesareinruralandmountainareas,likeLaPlataCounty(seeFigure1below),wheremarketconditionsmakeitdifficulttoincreasecompetition.

2Lewis&EllisInc.ColoradoCommissiononAffordableHealthCareStudy.AnalysisofSelectedTopics.May8,2017.3ColoradoHealthInstitute.TheCompetitionConundrum.May2019.


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StakeholderEngagementAnimportantpartoftheCommunityNeedsAssessmentwasmeaningfulstakeholderparticipation.Weoptedtostartthedialoguebyfirstlisteningtotheconcernsandexperiencesofthesmallbusinesscommunityratherthanjumpintoactionbasedonassumptions.Ourassessmenthadthreepointsofstakeholderengagement:1)Ameet-upinJuneof2018wherethetopicofahealthcareassessmentwasdiscussed,2)In-depthfocusgroupsinJanuaryof2019withthesmallbusinesscommunity,and3)afinaldiscussionoffindingsandnextstepsataMay2019healthcareforumthatinvolvedabroadrepresentationfromtheentirelocalbusinesscommunity.

June2018MeetUpAccordingtodatacollectedonJune13,2018from38individualsrepresentingapproximately30businesses:1)57%oftheindividualsweredissatisfiedwiththecurrentstateofhealthcareinLaPlataCounty,2)82%sawanincreaseinhealthcarecostsinthelastyear,3)56%avoidedhealthcarebecauseofcost,4)54%madeamonthlyinvestmentof$500orlessonhealthcarebenefitsperemployeewith27%makingnoinvestment,and5)83%saidtheywereinterestedinlearningmoreabouthowourstate/nationalhealthcaresystemworks.LocalFirstandTheDurangoNetworkhostedthismeet-uptoengagewithlocal,independentbusinessesandgatherfeedbacktoprepareforthisgrantapplicationinordertodefineanappropriatescopeofworkwithdirectfeedbackfromstakeholders.Healthcaremodelsofinteresttothebusinessesinattendanceincludeddirectprimarycare,self-fundedplans,universalcarecradletograve,multi-businesspool,telemedicine,employerowned/sharedclinic,complementarymedicine,healthsharingprograms,gymmemberships,wellnessprogramsandstipend,affordablecatastrophicplans,preventativealternativemedicine,mentalhealth,andavoucherprogram.Whenaskedwhatthemostvaluableoutcomewouldbeofourworktogether,theresponsesincluded:affordablelocalhealthcareoptions,innovation,informationsharing,meaningfuloptions,sustaininglocalhealthcareprovidersandlocalbusinesses,correctinformationtoourcommunity,interdisciplinarymedicalteam,localself-insurance,improvingthevalueofhealthcarebenefits,bettermetricsforhealthcare,andaturn-keysolution.WeusedaudienceresponsesoftwarecalledMentimetertoconductthissurvey(seefullresultsinAppendixC).Thisaudienceresponsesoftwarecanbeaccessedrightfromyourcellphoneandwasagreattooltoengageourstakeholdersandencourageeveryonetorespondaswellasseewhattheircolleague’sresponseswere.

January2019FocusGroups

InJanuary2019,LocalFirstandTheDurangoNetworkconductedin-depthfocusgroupswiththeassistanceofathird-partyfacilitatorandmoderator.Theconversationfocusedonspecificquestionsinasafeandconfidentialenvironment.Overtwodaysandthreegroupmeetings,25


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individualsrepresentingavarietyoflocalbusinessesdiscussedbarrierstohealthcare,ideasforimprovingtheiremployee’shealth,andthetypeofinvestmentsemployersareabletomaketoimprovethehealthoftheiremployees.Sixkeythemesemergedduringtheconversations:1. Costisamajorbarriertoprovidingaccesstohealthcareandhealthinsurance.

Participantsexpressedthatcostisalargeobstacletoprovidinghealthcareandinsurance.Thepremiumsforhealthinsurance,inparticular,arefinanciallyoutofreachformanylocalemployers.Thosethatarenotabletoaffordthepremiumsnotedthattheybelievetheyarelesscompetitiveintryingtoattractthebestemployees.

2. Localbusinessesexpressedthatemployeehealthwasimportant,theyarecurrently

makinginvestmentsinemployeehealth,andarewillingtocontinuetoinvestinprogramsorservicesdesignedtoimprovehealth.Localbusinessesclearlyidentifiedthatemployeehealthisanimportanttopicandanareatheywouldliketoaddress.Participantsexpressedabeliefthatinvestinginemployeehealthisagoodmoveforbusinesses.

3. Localbusinessesexpressedinterestinhealthinsurance,healthcare,wellnessprograms,

healtheducationprograms,andincentivesforhealthybehaviors.Inadditiontohealthcareandhealthinsurance,localemployersarethinkingmorebroadlyabouthowtoimproveemployeehealth.Participantswereinterestedinemployeewellnessprograms(suchasPilates,yoga,acupuncture),healtheducationprograms,andincentivesforhealthybehaviorssuchasusingactivetransportationforcommutingtowork.

4. Amongparticipatingbusinesses,mostarewillingandabletoinvest$100-$400per

employeepermonthtoimproveemployeehealth.Whilethespecificamounteachemployercancontributetoemployeehealthvaried,about75%ofparticipatingemployersstatedthattheyarewillingandabletoinvest$1,200to$4,800peremployeeeachyeartoimprovehealth.

5. Localbusinessesexpressedadesiretolearnmoreaboutcollaborationsthatcouldexpand

employeehealthcare/insuranceoptions.Asasolutiontodecreaseindividualbusinesscosts,localbusinessesvoicedaninterestinexploringpoolingresourcestoprovidehealthcareandhealthinsuranceoptionstotheiremployees.

6. Participantscitedaneedforincreasedhealthliteracyamongtheiremployees.Health

literacyisthedegreetowhichindividualscanunderstandbasichealthinformationandhealthservicesneeded.Businessrepresentativesexpressedadesireforadditionaleducation,forbothemployersandemployees,regardingthecomplexlandscapeofhealthcareandhealthinsurance.

PleaseseeAppendicesAandBforafullreportofthefocusgroupresultsincludingadditionaldataandgraphs.


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May2019HealthCareForum

OnMay20,2019,75individualsjoinedusforaneducationalandinteractiveforumonhealthcaretoexplorelocalsolutionsanddiscusspotentialinterestahealthcarecooperativesimilartowhatVailandSummitCountyhaveembarkeduponinthelastyear.WeaskedthesameMentimeterquestionsaswedidinJuneof2018(seeAppendixCforresults).Fullnotesandpresentationscanbefoundonlineathttps://local-first.org/health-care.ThegroupwasadiverserepresentationofmajoremployersinLaPlataCounty,concernedcitizens,healthcareproviders,andsmallbusiness.Thedayconsistedofbotheducationalpresentationsonthestateofhealthcareandthereasonbehindrisinghealthcarecosts,alegislativeupdate,participationfromthewestslopemodelsdescribedbelow,andafacilitatedsessiontodeterminewhatthenextstepsshouldbeforourcommunity.Thosekeynextsteps,asidentifiedbythestakeholdersintheroom,include:

• ActiveCommunityEngagement:Asign-insheetwassentaroundforindividualstoactivelyparticipateinasteeringcommittee,commitin-kindresources,and/orfinancialsupport.

o FormaSteeringCommittee:LocalFirst,TheDurangoNetwork,andtheDurangoChamberofCommercecommittedtoworkingonthisissueandaskedothersteeringcommitteememberstojointhem.

• DetermineGeography:Inordertounderstandthescopeofourworkandanycorrespondingdatawewillcollect,therewasanacknowledgementthatthegroupneedstodetermineifthisisaCityofDurangoscope,LaPlataCountyscope,orbroadertoincludeMontezumaCountyandperhapsevenFarmington,NewMexico.

• DataCollection:ApplyforJuly1stCIVHCdatascholarshipthatwillallowforgreatlyreduced-costdatafromtheAllPayersClaimsDatabase(APCD).

• Fundraising:Datacollectionandworkingwithafacilitatorwillbeasignificantcost.LocalFirstcommittedtoexploringfoundationgrants,corporatesponsorships,andsupportfromthecommunitymembersandbusinessesinterestedinseeingtheinitiativemoveforward.

WestSlopeModelsLocalsolutionsaredevelopingtoaddressrisinghealthcarecostsontheWestSlopeofColorado.Thesesolutionshavemerituntilastateorfederalsolutionbecomesapparentandtoinformthosesolutions.TwohealthcaremodelsinparticularseemtohavevalueforthesouthwestregionandwereintroducedattheMay2019HealthCareForum.

VailValleyPartnership

VailValleyPartnership’sOneValleyHealthcareProgram,inpartnershipwiththeSmallAssociationLeadershipAlliance(SALA),isacomprehensiveandcost-effectivealternativetotransitionalplans.


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Thisnewprogramoffersaffordable,accessible,andeffectivehealthcareoptionsforVailValleyPartnershipmembers–bothbusinessesandindividualsalike.TheOneValleyHealthcareProgramoffersachoiceoftwoACA-compliantpreventativecareplans,eachcoupledwithamedicalcostsharingprogramtocoverunexpectedorcatastrophicevents.Healthsharingisnothealthinsurance,butanalternativetotraditionalhealthinsurance.Beforereplacinghealthinsurancewithahealthsharingplan,itisimportanttounderstandtherequirementsandrestrictionsformembers.MoreinformationcanbefoundatOneValleyHealthcareProgram.com.

PeakHealthAlliance

AteamofSummitCountyleaders,withsupportfromtheColoradoDivisionofInsurance,theColoradoBusinessGrouponHealth,SegueConsulting,andothers,recentlylaunchedthePeakHealthAlliance(Peak).Peakisdevelopingmorecost-effective,sustainablehealthcoverageoptionsforindividuals,insuredemployers,andself-insuredemployersinSummitCounty.Everydollarsavedonhealthinsurancepremiumscanbeusedtosupportthelocaleconomyandmeetothercommunityneedssuchashousingandchildcare.PeakHealthAllianceisaSummit-basednonprofithealthpurchasingcollaborative,enabledbyCRSSection10-16-1000.Itisnotaninsurancecarrier,butisimplementingandmaintaininghealthbenefitsolutionsspecifictotheneedsofSummitCounty.Bychangingthewaythatindividualsandemployersnegotiate,purchaseandmanagehealthinsurance,PeakiscreatingsustainablerelieftothehighcostofhealthcareinSummitCounty.PeakisrepresentingindividualsandbusinessesinSummitCountyindirectnegotiationswithhealthcareproviders.Bydirectlynegotiatingthepricesthatitpays,Peakiseliminatingtheinsurancecompanymiddlemantoessentiallybuy“wholesale”fromtheproviders.Thisisanimportantsourceofsavings.AfterPeakhasitsownmoreequitablepricelist,itwillnegotiatewithinsurancevendorstobuildtheproductsPeakwillofferinSummit.

•PeakPriceListXPeakBenefitDesigns+HealthPlanCharges=FinalPremiumWhileitwillhaveanopenbiddingprocess,Peakiscontractingwithalimitednumberofestablishedinsurers/thirdpartyadministrators(TPA).Thiswillstreamlineproviders’administrativecostsbyreducingthenumberandcomplexityofbillingsystemsandadministrativeinterfacesthatprovidersmustmanage.Beginningin2020,Peakwillofferproductswithcommonbenefitdesignsacrossallbuyersegmentsandproductswillbeadministeredandmarketedcollectively.Brokersandconsultantswillcontinueintheircurrentrolehelpingbusinessesandindividualsnavigatetheprocessofbuyingcoverage.Allcoveragewillincludepre-existingconditions,becomprehensive,andACA-compliantforindividualsandsmallgroups.Self-insuredgroupbenefitswillbesimilartowhatiscurrentlyofferedinSummitCounty.Peakwillpartnerwithinsurers/TPAstoadministerthese


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productsinthemostefficientwaywhilemaintainingflexibilityforPeaktocontinueimprovingitsabilitytoprovidegoodcost-effectivecoverageinSummit.BothPriceandUtilizationdriverswillbeaddressedtoensurelong-termsustainableeffectiveness.Price:SummitCounty-specificclaimsanalysisindicatesthatpricespaidforhospitalservicesareonedriverofinsuranceratesthatareamongthehighestinColorado,resultingintwiceasmanyuninsuredpeopleinSummitthanthestateaverage.PeakwillworkwiththeprovidercommunitytonegotiateanequitablepricingstrategytiedtoobjectivemeasuressuchasMedicare-basedreferencepricing.Utilization:Peakwillworkwithproviders,employers,andindividualstoensuretherightcareisprovidedattherighttimeandintherightplace.Peakisdevelopingstrategiesto:

•Identify,create,andincentdesiredproviderbehavior.•Usebenefitdesignandpaymenttoguideproviderandmemberactions.•Supportandincentindividual’shealthliteracytobolstercompliance,self-care,andengagement.

PoliciesandStatuteExistingstatestatute,aswellasrecentlegislation,providesapathforhealthcarecooperativessuchasthePeakHealthAllianceasalocalsolutiontohealthcarecostsandaccesstoservices.Thislegislativesessionoveradozenhealthrelatedbillswereconsideredbyourstatedecisionmakers.Adescriptionofthosethatpassedisbelow.

EnablingLegislationExistingColoradoRevisedStatuteenablescooperativestoformtoaddresshealthcareissuesatthelocallevel.CRS10.16.1001-1015,“HealthCareCoverageCooperatives”recognizesthat:(b)Continuedescalationofhealthcarecoststhreatenstheeconomicvitalityofthestate;(c)Healthcareisacriticalpartoftheeconomyofthisstate,(03)Thegeneralassemblydeterminesthat:(a)Comprehensivehealthcarebenefitsshouldbereadilyavailabletocitizensofthisstate;(b)Thecurrenthighqualityofhealthcareinthisstateshouldbemaintained;(c)Employersandtheiremployeesshouldbeaffordedachoiceofproviders(d)Competitionshouldensureefficiencyandreasonablepricing(e)Allindividualsshouldpaytheirfairshareofthecostsofhealthcarecoverage;and(f)Colorado'shealthcaresystemshouldbuildonemployment-basedcoveragearrangements(4)Thegeneralassemblydeclaresthepurposesofpart10areto:(a)Promotecontrolofthecostofhealthcarebypoolingpurchasingpoweramongconsumersandorganizingproviderssothathealthcareservicesaredeliveredinthemostefficientmanner;(b)Allowflexibilityinthedeterminationofplansandcoverages(c)Promoteindividualchoiceamonghealthplansandhealthcareproviders;


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(d)Ensurehighqualityhealthcare;and(e)Encourageindividualresponsibilitybybuildingonexistingemployment-basedarrangements(5)Enactedtoencouragecollaborativearrangementsandtopromotemarket-basedcompetitionamonghealthcareproviders.

2019LegislativeSession

Affordablehealthcaresolutionswereatopicofinterestinthe2019legislativesessionandhealthcareisoneofthetopfourprioritiesoftheColoradoGovernor’soffice.Whilesomeprogresswasmadethislegislativesession,muchmoreworkwillneedtobedonebeforeastatesolutionemerges.Thismakesourworkatthelocallevelevenmorecriticalasastop-gapinadvanceofstateandfederalprogressonhealthcarereform.Legislationthatpassedtohelpusmovetheneedleonhealthcareissuesinclude:SenateBill19-004modernizeslawsauthorizinghealthcarecooperativesinthestatetoincorporateconsumerprotectionssuchascoverageforpreexistingconditionsandtoencourageconsumerstohelpcontrolhealthcarecostsbynegotiatingratesonacollectivebasisdirectlywithproviders.HB19-1176createsataskforcetoanalyzehealthcarefinancingsystemsinthestate.ThetaskforcewillassessthreemodelsandevaluatehowwelleachapproachmeetstheneedsofColoradoans.Itwillevaluatethecurrenthealthcaresystem;apubliclyandprivatelyfundedmulti-payeruniversalhealthcaresystem;andapubliclyfinanced,privatelydelivereduniversalhealthcaresystemthatdirectlypaysproviders.Legislatorscanmakedecisionsaboutwhatwillworkbestaccordingtothecollecteddata.HB19-001requireshospitalstoreporttheirannualspendingunderatransparencylaw.Theresultsshouldshowwhythoseinsuredbyprivatecarriersarepayingmoreatatimewhenpublicfundstohelpcoveruncompensatedhospitalcarehavegrown.HB19-1168createsareinsuranceprograminColorado,whichwillhelptolowerinsurancepremiumssubstantiallyontheWesternSlopewherewepaysomeofthehighestpremiumsinthenation.Itputspeoplewhousetheirinsurancefrequentlyintoaseparatecategorysothattheirhighcostsdonotraisetheaverageoflower-needpatients.Thereinsuranceprogramcouldgointoeffectassoonas2020,butrequiresthestateofColoradotoapplyforawaiverundertheAffordableCareAct.Theprogramwillnotgointoeffectuntilthiswaiverisapprovedbythefederalgovernment.Belowisasnapshotofbillpassage(green)andfailureforthe2019legislativesession4.

42019LegislativeSessionWrapUpbyChetSeward.May20,2019HealthCareForum.


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NextSteps,SolutionsBasedonthefindingsoftheCommunityNeedsAssessmentandresultsoftheMay20thforum,aswellasin-depthdiscussionswithhealthcareexperts,werecommendthefollowingnextstepsbetweenJune2019andDecember2019.

1. IdentifyCommunityValues:Inordertoensurethatourlocalhealthcaresolutionresultsinoutcomesidentifiedasimportantbythecommunity,wewillidentifythevaluesthatwealignwithsuchasconsumerchoice,activelypursuinglocalandstatewideoptions,reducinghealthcarecoststoconsumers,andaddressinghealthliteracyinthecommunity.

2. FormaSteeringCommittee:LocalFirst,TheDurangoNetwork,andtheDurangoChamberofCommercecommittedtoworkingonthisissueandhaveaskedothersteeringcommitteememberstojointhem.

3. ClaimsDataCollection:Transparencyaroundcostofserviceiskeywhenforminglocalhealthcarecooperatives.Collectingclaimsdataforaregioncanhelptouncoverthetruecostofserviceandallowlocalcooperativestoenterintomeaningfulnegotiationswithhealthcareproviders.


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Accordingtothe2019StateofColoradoCostShiftAnalysisReport5,moretransparentreportingpracticesandhospital/payerdata,suchasauditedfinancialstatementsandDATABANKinformation,areneededtoidentifybusinessdecisionsandtrendsatthehospitallevelthatleadtoincreasesinhospitalcostsandprices.Majorfindingsofthereportalsoincludethattheaveragehospitalprofitperpatientdischargedroseto$1,359in2017—morethantwicetheamountin2009.Forpatientscoveredbycommercialandemployer-basedhealthplans,thehospitals'profitmarginsperdischargeroseabove$11,000in2017,comparedwith$6,800in2009.ArecentreportreleasedbyRANDCorporation6comparesthepricespaidtohospitalsforcommerciallyinsuredpatientsinrelationtotheMedicarefeeschedule.Thiscalculationreflectsthediscountedamountshospitalswereactuallypaidbyprivateplansandemployers,nottheamountthattheychargedwhichistypicallymuchhigher.ThisisthefirststudyofitskindintheU.S.KeyfindingsforColoradoin2017include:

• Coloradohadthesixthhighestoverallhospitalpricesforcommerciallyinsuredpatientsofthe25statesstudiedforthereport,

• Of65Coloradohospitals,30werepaidover300%morethanMedicareoverall,10wereover400%overall,and2wereover500%overall,

• ThecombinedratioofinpatientandoutpatientpricescomparedtoMedicarewas347%forAnimusSurgicalHospitalandwas317%forMercyRegionalMedicalCenterin2017.

AnexampleofdatafromanallpayerclaimsdatabaseforSummitCountyaspartofthePeakHealthAllianceformationcanbefoundbelow7.ThefirststepforLaPlataCounty,ortheregion,istocollectclaimsdatafromtheallpayerclaimsdatabaseaswellasself-fundedplans.WeintendtoapplyforaJuly2019scholarshiptoobtainthisdataatamorereasonablepricefromtheCenterforImprovingValueinHealthCare,orCIVHC(https://www.civhc.org).

5ColoradoHealthcareAffordability&SustainabilityEnterprise.CostShiftAnalysisReport.January2019.6RANDCorporation.PricesPaidtoHospitalsbyPrivateHealthPlansAreHigherRelativetoMedicareandVaryWidely.FindingsfromanEmployer-LedTransparencyInitiative.May2019.7ModernHealthcare.Uniquecollectivehasambitiousplantolowerhealthcarecosts.April13,2019.


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4. FormCooperativeAlliance:Thelaststep,oncedataiscollected,istoexploretheformalestablishmentofahealthcarealliance.ThisAlliancewillneedtheassistanceofahighlyskilledandknowledgeablehealthcarenegotiatortogetustothefinishlineforJanuary2021.

ClosingThecompletionofthisCommunityNeedsAssessmentisthefirststepinexploringlocalhealthcaresolutionsinLaPlataCounty,andpossiblythesouthwestregionofthestateofColorado.Welookforwardtoworkingwiththesmallbusinesscommunity,andthegreatercommunityat-large,toprovideaffordableandeffectivehealthcaresolutionstoindividuals,businesses,localgovernments,andthosemostinneedofhealthcaresupport.


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APPENDICES


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APPENDIXA:SURVEYRESULTSFROMFOCUSGROUPS

FindingsandPerspectivesLaPlataCountyCommunityNeedsAssessment:FocusGroupReport

Thepurposeofthiscommunityneedsassessmentwastoexplorewhatsmallbusinessescaninvestintheiremployee’shealthandtoprioritizewhatbusinesseswouldliketoachievewiththeirinvestments.Specifically,thisneedsassessmentwasdesignedtoincreaseunderstandingaboutthetypesofbenefitsthatcouldbeaffordabletoboththeemployeeandtheemployer.InJanuary2019,twenty-fiveindividuals,representing24localbusinesses,participatedinoneofthreediscussionsaroundtheirconcernsanddesiresrelatedtoheathcare.Themeetingsusedafocusgroupformatwheretheconversationfocusedonspecificquestionsinasafeandconfidentialenvironment.Participantswereaskedseveralopen-endedquestionstoguidetheconversationsandwereinstructedthattherewerenorightorwronganswers.Businessrepresentativesexpressedthemselvesfreelyduringthediscussionandnoindividualnamesorbusinessnamesareidentifiedinthisreport.Inadditiontoengaginginconversation,participantscompletedabriefsurveythatincludedspecificquestionsaboutcostandallowedrespondentstoindicatetheirinterestinspecificstrategiestoimprovehealth(seeAppendixAforfullsurveyresults).Topicsdiscussedincludedbarrierstohealthcare,ideasforimprovingemployee’shealth,andthetypeofinvestmentsemployersareabletomaketoimprovehealth.Describedbelowarethekeythemesandindividualperspectivesthatemergedfromtheconversations.Whatishealthcare?Conversationsopenedwitheachgroupdiscussingwhatcametomindwhentheyheardtheterm“healthcare.”Whilemanyacknowledgedthattheyfirstthoughtofhealthinsuranceandaccessinghealthcare,thegroupsalsonotedthattheconceptofhealthincludesoverallwellness,includingemotionalhealth,andthepreventionofillness.Thekeythemesidentifiedandperspectivessharedreinforcethathealthincludesmanyaspects,andisnotonlylimitedtohealthinsuranceandmedicalcare.KeyThemesandPerspectivesTheme1:CostisamajorbarriertoprovidingaccesstohealthcareandhealthinsuranceParticipantsexpressedthatcostisalargeobstacletoprovidinghealthcareandinsurance.Thepremiumsforhealthinsurance,inparticular,arefinanciallyoutofreachformanylocalemployers.

▪ “Healthcarecostsarenowequivalenttopayingamortgage”▪ “ThereisnoscenariobywhichIamabletoprovidehealthcareatanycost,andhalf

ofmyemployeeswouldmuchratherhavethemoneyintheirpocket”▪ “Healthcarehasexplodedintothiscatastrophe,butattheendofthedaywhen

someoneneedshealthcare,veryfewcompaniesinthistowncandomuchtohelp.”


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▪ “There’sacrunchtothemiddleclasswhenyoulookatwhatwearepayingindeductibles,andwhatwegetbackinreturn”

▪ “Weseepeopletakingextremeriskinnotcoveringthemselves,becausetheyareconcernedaboutcashflow”

Thosethatarenotabletoaffordthehealthinsurancepremiumsnotedthattheyarelesscompetitiveinattractingthebestemployees.

▪ “Businesseshaveleveragedhealthasabenefitforemployees”

Employersalsodiscussedwhoshouldholdtheresponsibilityofprovidinghealthinsuranceandhealthcare,questioningiftheburdentoprovideaccesstocareandhealthinsuranceshouldbetheresponsibilityofemployers:

▪ “[Healthcareshouldbe]aright-everyoneshouldhaveaccesstoit,anditshouldn’tnecessarilybesomethingthattheemployerisrequiredtoprovide”

▪ “Wealltalklikeit[healthcare]isthebusiness’responsibility,butitissociety’sresponsibility”

▪ “Aslongaswehavethisemployerbasedsystem,itisgoingtobereallytough.”▪ “Thisisapoliticaldiscussioninadditiontoasocietalandenvironmentalone”▪ “ThissystemofemployersprovidinghealthcarehastonsoflimitationsandIwould

liketoseesomethingbiggerhappen”▪ “Iamnotinterestedinnibblingaroundtheedges,weneedtothinkbig,andlooking

toemployerstoprovidethatisnotaviablesolution”Theme2:Localbusinessesexpressedthatemployeehealthwasimportant,theyarecurrentlymakinginvestmentsinemployeehealth,andarewillingtocontinuetoinvestinprogramsorservicesdesignedtoimprovehealth.Mostparticipatingbusinessescurrentlyoffersomeresourcestoimproveemployeehealth.Somebusinessesareprovidinghealthinsuranceand/orprogramstoaccessmedicalcare.Localemployeesarealsobeingofferedwellnesspromotionresources,includingprogramsandservicessuchasworksitewellness,massages,yogatraining,healthyfood,“welldays”/paidtimeoff,incentivesforhealthybehaviors,andstipendstosupporthealth-relatedneeds.

▪ “There’shealthinsuranceandthenthere’sahealthyenvironment,andtheyaretwototallydifferentthings.”

Employersexpressedthatthereisareturnoninvestmentfordedicatingresourcestoimproveemployeehealth.Participantscitedmanybenefitsofpromotingemployeehealthincludinggainsinproductivity,beingabletocompeteforthebestemployees,anincreasedlevelofengagementatwork,employeesfeelingvalued,increasedretention,andfewerworkercompclaimsandsickdays.

▪ “Thehappiertheemployeesare,thehappierthecustomersare,anditisahappierworkenvironment.”


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▪ “It[healthcare]issobroken,weneedtotakecareofthefuture,sopeoplecanseeafuture.”

Theme3:Localbusinessesexpressedspecificinterestinwellnessprograms,healtheducationprogramsandincentivesforhealthybehaviors.Whenitcomestothehealthoftheiremployees,employersarethinkingmorebroadlyabouthowtoimproveemployeehealth.Businessrepresentativeswereinterestedinemployeewellnessprograms(suchasPilates,yoga,acupuncture),healtheducationprograms,andincentivesforhealthybehaviorssuchasusingactivetransportationforcommutingtowork.Surveyresponsesshowedthatemployersareinterestedinavarietyofoptionstoimproveemployeehealth(seeFigure1).

Figure1.Responsestosurveyquestionregardinghealthcareprogramsofinteresttoemployers.

Whichofthefollowingprogramsorservicesareemployersmostinterestedinsupportingfortheiremployees?

Theme4:Amongparticipatingbusinesses,mostarewillingandabletoinvest$100-$400peremployeepermonthtoimproveemployeehealthWhilethespecificamounteachemployercancontributetoimprovingemployeehealthvaried,about75%ofparticipatingemployersstatedthattheyarewillingandabletoinvest$1,200to$4,800peremployee,peryeartoimproveemployeehealth(seeFigure2).


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Figure2.Responsestosurveyquestionregardingdollaramountwillingtoinvesttosupportemployeehealth.

Whatamount,perpersonperyearwouldyoubewillingandabletoinvesttosupportemployeehealth?

Theme5:Localbusinessesexpressedadesiretolearnmoreaboutcollaborationsthatcouldexpandemployeehealthcare/insuranceoptionsAsasolutiontodecreaseindividualbusinesscosts,businessownersareinterestedinanoptiontopoolresourcestoprovidehealthcare/insurancetotheiremployees.Strategiesdiscussedincludedcreatinglarger,self-fundedinsuranceplans,developingbusinesspartnershipswithhealthcareproviders,scalinghealthcarecoststoincentivizeappropriateuseofhealthcare,directprimarycaremodels,communityhealthclinics,andotherideasthatsupportcostsharing.Participantsexpressedaspecificdesiretolearnmoreaboutthelegalconstraintsandrealisticpossibilitiesincreatingcollaborationsamonglocalbusinessestoimproveemployeehealth.

▪ “Iwouldliketoseethisleadtoacity,county-widesinglepayer-typesolution”▪ “Justbecauseyouhavehealthinsurance,itdoesn’tmeanyougetaccesstocare.”▪ “Beingstuckinajobbecauseyouareworriedaboutyourhealthinsuranceisnotgood

foryourhealtheither.Weneedarevolution”

Theme6:Businessownersspecificallyexpressedaneedforincreasedhealthliteracyamongtheiremployees.Thisincludededucationregardinghealthinsuranceandaccessinghealthcare.Healthliteracyisthedegreetowhichindividualscanunderstandbasichealthinformationandhealthservicesneeded,includingeducationregardinghealthinsuranceandaccessinghealthcare.Businessrepresentativesexpressedadesireforadditionaleducation,forbothemployersandemployees,regardingthecomplexlandscapeofhealthcareandhealthinsurance.

▪ “Weneedtocreatealiteratepopulationthatisknowledgeableabouthealthcare.”▪ “Howdoweputthepowerandcontrolofhealth-careinthehandsofmyemployees?”▪ “Investinginhealthisfindingaguide,someoneshowmetheway!”


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APPENDIXB.COMPLETEFOCUSGROUPSURVEYRESULTSWhattypeofbusinessdoyourepresent?(25responses)

Howmanyemployeesworkatyourbusiness?(25responses)


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Approximatelyhowmuchdoesyourbusinessinvesteachyeartosupporthealth?Fillintheblank(22responses)“variable”=1respondent“noneorzero”=4respondents

Otherresponses:$5,000$5,000$8,000$10,000$10,000 $10,000$11,000$18,000$18,500$20,000$35,000$36,000 $40,000$50,000$100,000$140,000$160,000

Whatamount,perpersonperyearwouldyoubewillingandabletoinvesttosupportemployeehealth?(25responses)

“notsure”=1respondent


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Whichofthefollowingprogramsorserviceswouldyoubemostinterestedinsupportingforyouremployees?Selectupto3typesofprograms/services.(25responses)

Whatotherprograms/servicesyouwouldbemostinterestedinsupportingforyouremployees?(2responses)

● Alternativetotraditionalhealthinsurance● Accesstocounseling/psychologicalservices


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APPENDIXC:MENTIMETERSURVEYRESULTS

June2018Meet-Up


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May2019HealthCareForum


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