An effort by a coalition of Roaring Fork Valley employers to provide better and more affordable health care to their employees on a long-term basis is about to come to life starting next year.
And provided the Valley Healthcare Alliance works as advertised, organizers hope to be able to offer the paradigm-shifting model to small businesses throughout the area starting in 2021.
“The beauty of what we’re doing is the quality of care (we aim to provide),” said Chris McDowell, executive director of the Valley Health Alliance. “I think you will start seeing a lot of fruit for the work we’ve been doing.”
The alliance — which includes Pitkin County, the city of Aspen, the Aspen Skiing Co., Aspen Valley Hospital, Valley View Hospital and Mountain Family Health Centers — aims for nothing less than a transformation of the standard U.S. health care model, said Dave Ressler, CEO at Aspen Valley Hospital. That means rather than focusing on a model that emphasizes the financial bottom line, hospitals and providers will concentrate on keeping communities healthy.
“(It’s) a shift from volume to value,” Ressler said. “It’s a whole new world for us.”
Pitkin County Manager Jon Peacock said part of the idea is to develop a series of incentives that reward providers for keeping people healthy. That can include rewards for successfully managing people’s chronic conditions like diabetes or obesity, McDowell said.
“(The idea is) to transform how health care not only is delivered, but how it is paid for and how to make quality and affordable health care a sustainable commodity in our community,” Peacock said.
One of the keys to the new system is transparency, Ressler said. Sharing information about prices for services and medicine and a patient’s past data and current clinical information — while also maintaining legal privacy standards — is essential to the effort, he said.
That spirit of sharing is also present in the way Aspen Valley Hospital and Valley View Hospital work together, Ressler said. Rather than perceiving each other as rivals under the volume-based model, the two hospitals work collaboratively so as not to duplicate expensive services that contribute to increasing area health care costs, he said.
The Valley Health Alliance includes about 6,500 Roaring Fork Valley employees — roughly 20 percent of the valley workforce — who live between Aspen and Parachute, McDowell said. Approximately 500 of those employees are responsible for a majority of the health care claims filed by the organizations, he said.
There are about 15 private, primary care medical practices between Aspen and Glenwood Springs, all of which are “at the table” talking to the VHA about transformation to a value-based model, McDowell said.
The employees of the six VHA members will begin receiving benefits under the new plan starting Jan. 1. Next year will serve as a “benchmark year” for the program, which will establish data baselines for the program, McDowell said. During that time, VHA officials will also begin looking at offering the network they built to small businesses in the Roaring Fork Valley starting in 2021.
“We intend to create a product for small businesses …” Ressler said. “We will adapt the VHA to create a second tier for those small employers.”
In order for that to happen, however, the alliance must find an insurance company with which to contract, Ressler said. However, it can’t be just any insurance company. The alliance will look for an insurer willing to share claims data, which is unusual, Ressler said.
“(We need to know) why are prices the way they are,” he said. “You will see transparency in the process.”
The VHA effort echoes a similar program already up and running in Summit County called the Peak Health Alliance. That alliance features a number of area employers who banded together to negotiate lower health insurance prices, Peacock said.
Commissioner Patti Clapper on Tuesday wanted to know why Pitkin County’s program is not yet up and running, why it has taken so long to get going and why it won’t be available to small businesses until 2021.
“Two years out is difficult for some people,” she said.
Peacock, a former Mesa County manager, said he’s attempted in the past to create health care networks where groups band together and hire and pay doctors themselves or use their collective power to negotiate better rates. The problem is those alliances only work for a year or two before they fall apart, he said.
The VHA is different because officials have taken a long time to create an infrastructure that is built to last, he said.
“We really want to make whatever we create sustainable,” Peacock said. “We’ve done the R&D (research and development) on what works and what doesn’t. We’re ready now to bring that infrastructure forward.”