Executives at Southwest Memorial Hospital will burn the midnight oil for the next week to meet a deadline to join a regional effort to develop a health insurance plan that could substantially lower rates.
The Southwest Health Alliance is tailoring its plan to Southwest Coloradans using existing regional health care providers. The alliance of providers and businesses started in La Plata County and is expanding to Archuleta, Dolores, San Juan and Montezuma counties.
The alliance is based on the Peak Health Alliance in Summit County, which lowered health insurance costs for individuals and businesses by about 20%. It is being organized by Local First, a Durango nonprofit.
Local First led a two-year study of alternative models to provide more affordable and comprehensive insurance to Southwest Colorado.
Local First Executive Director Monique DiGiorgio and Doug McCarthy, a Durango businessman working with the alliance, briefed about 50 residents about the insurance plan Monday at Cortez City Hall.
“We like that the local community is in the driver’s seat,” DiGiorgio said of the Southwest Health Alliance model. “I think that is the unique attribute, the point of value that we are able to offer.”
About 4,875 businesses and medical providers have signed nonbinding letters of interest to participate in the alliance, she said.
The Southwest Health Alliance faces a Feb. 18 deadline to submit paperwork to the Colorado Division of Insurance to create the plan and bring it to market Jan. 1, 2021.
The alliance needs proposals from providers before it submits its application to the state. Animas Surgical Hospital has signed on, and Mercy Regional Medical Center is finishing its proposal, but Southwest Memorial Hospital, which was busy with its recertification, had not yet begun a proposal as of Monday.
Since fall, the alliance’s efforts to meet with Southwest Memorial have failed, including a meeting in January that Southwest Health System canceled because the hospital was undergoing a recertification.
“We’re open to look into this. We’ll meet as soon as we possibly can,” Southwest Health System CEO Tony Sudduth told the group Monday.
He added that Southwest Memorial Hospital offers low rates and residents benefit by staying in Cortez for medical services.
“I don’t understand insurance rates on the Western Slope. We’re not the problem (behind the high health insurance rates).”
Claire Brockbank, who represented the Peak Health Alliance, which is working with Southwest Health Alliance on the plan, said via a telephone connection that she saw the same viewpoint expressed by hospitals in Summit County.
“Our hospitals felt they worked hard to lower costs, and those costs were not reflected in insurance rates. The insurance companies used it (the lower costs) to pad their bottom lines.”
To participate, Sudduth said, the plan would have to provide incentives to residents of Montezuma County to use Southwest Memorial as opposed to going for care in Durango.
“It’s costing you money now (to go to Durango for medical services),” he told the group.
Brockbank said establishing tier levels in the Peak Health Alliance plan for providers with lower costs rewarded those providers by funneling business to them, and that structure would be followed in the Southwest Health Alliance plan.
“Our intent is not to drive care from a county, but how to incentivize care in a county,” she said.
Southwest Health Alliance would be willing to work with Southwest Health Systems to facilitate its work on a proposal for participation so that it would be ready by the Feb. 18 deadline, Brockbank said.
Montezuma-Cortez School District Superintendent Lori Haukeness and Montezuma County Commissioners Keenan Ertel and Jim Candelaria emphasized they would not commit to the alliance unless Southwest Health Systems did.
“I need for our hospital to be on board with this before I can be on board,” Ertel said.
Candelaria added that Southwest Health System’s participation is vital.
“We have to make sure Southwest Health System is on board because we have to keep our local hospital. We can’t hurt our local hospital,” he said.
Sudduth also said Southwest Health has been working on offering its own insurance option.
Whether an insurance option emerges from Southwest Health or from the alliance, consumers would benefit, Sudduth said.
“Either way, it will be good for the community if other plans are available,” he said.