A recent discussion of the Grand County Board of County Commissioners (BOCC) ended in direction to Staff to pursue health insurance contracts with specific recommended providers, resulting in some major changes to the County employee plans as well as a potential pathway to insure more Grand County residents a lower cost.

Grand County currently acts as a self-insurer, paying money into their own account and drawing against it as County employees and their family members access health care services. An insurance company is contracted to do billing and define the network of doctors and hospitals covered under the program. That program has traditionally been contracted to a single provider, bundling benefits to result in financial savings. But for nearly the last decade, health care costs and the insurance of those costs have risen steeply and disproportionately for Western rural communities in Colorado. According to BOCC Chair Rich Cimino, 2019 health care costs are up around 19 percent from 2018 and anticipated to increase 17 percent in 2019. This creates a challenge for our local government and other employers wishing to provide benefits, as the cost to do so sky-rockets.

Grand County made its first major step in addressing the issue in 2018 when employees had to start paying for a portion of their plan and the County began offering an HDHP or High Deductible Health Plan. These plans were seen as attractive for those healthy individuals who could not anticipate any major health issues. The employee contribution was cut in half compared to those opting for a more traditional PPO or Prefered Provider Option plan. The option also allowed for the creation of a Health Savings Account, into which employees and the County could pay in order to build up a dedicated account, pre-tax. The benefit to the County came in the form of considerable savings, and in order to incentivize enrollment to the plan, Commissioners determined to contribute to the HSAs of any newly enrolled members with a one-time payment of $600 for individuals and $1,200 for family coverage.

But this was only the first of three steps being implemented in order to keep costs more sustainable for both County and employee. In 2020, the County will un-bundle its health care insurance and join the regionally-created Peak Health Alliance. Both are happening at the recommendation of the County’s health care consultant, HUB.

First, Cimino explains that, while bundling services (grouping them all together under one provider) used to offer financial discounts, such is no longer the case. By unbundling services and choosing to contract with different providers for health insurance, dental insurance, life insurance, et cetera, the County hopes 2020 costs will only increase about 10 to 11 percent, giving considerable savings to the currently anticipated budget line. Second, by choosing to work with Peak Health Alliance, a non-profit health insurance purchasing co-op, founded in Summit County as a project of the Summit Foundation, the Board hopes to not only keep health care as a benefit to employees, but to eventually make the option available to other individuals and employers throughout the county.

The program has been praised by both Colorado Governor Jared Polis and Division of Insurance Commissioner Mike Conway, who recently stated, “Peak has proven adept at building relationships across the Western Slope and are leading the way in the implementation of the alliance model.” Under the Peak Health Alliance model, those insured would only be able to receive care from within the local health care system (Middle Park Health and Centura, for those in Grand County). Emergency care would be covered as if in-system, regardless of the location of care. And any out-of-network care would not have any coverage. The model advocates both the negotiating power of working locally and the advantages of keeping health care spending local.

But there is some reluctance from employees. Allen Pulliam, Deputy Chief of Grand County EMS, spoke during public comment, saying, “I must appeal to the BOCC with utmost passion on behalf of my staff, not to focus attention on MPH and Centura alone as providers.” He continued to note that 40 percent of GCEMS employees are not residents of Grand County and that many would likely seek employment elsewhere, as the more flexible health care options provided a benefit that cannot be replaced by the often non-competitive wages of County employment. He continued to express concern, explaining that “the fact that 70 percent of County staff report going to health care services outside of Middle Park and Centura also suggests that most do not feel comfortable with the Middle Park Health hub.”

And some of that concern was acknowledged by Cimino. He noted that 1.8 percent of employees will be left without an option for equivalent care of coverage under the proposed plan. He stated that it was “unfortunate” and that he was certain “they’d prefer to stay with their current doctors. But he encouraged all managers to “work with employees for the best alternatives and equivalent care elsewhere.”

And Cimino has been particularly active in health care discussions across the state for the last three years. During that time, he has engaged with the State Legislature, the Insurance Commissioner and both Polis and former Governor Hickenlooper. The Commission has also worked in cooperation with Colorado’s Counties and Commissioners Acting Together (CCAT), in order to advocate for the Reinsurance Bill, which has passed through the Colorado legislature and awaits approval from the Federal government. The bill would create an insurance pool of $260 million from state and federal monies that the state could use to help cover some of the most expensive medical care for some of the 250,000 Coloradan’s enrolled in insurance through Connect for Health Colorado, the State’s individual health marketplace.

Cimino says approval of the Reinsurance Bill could result in Grand County Residents seeing a nearly 30 percent reduction in health care on the market place, with an average reduction of 30 percent across Western Colorado and 18 percent statewide. The ultimate goal is to see more residents with access to insurance and care. Currently, about 17 percent of Grand County residents are uninsured and he would like to “get that down.” And he hopes that the Peak Health Plan will help them do that, with the ability to offer insurance through the individual marketplace for all county residents and employers and to “benefit potentially 100 percent of the County in 2021.”

In summary, the recent discussion saw Commissioners approve the Peak Health Alliance as the County’s health insurance provider, with PPO, EPO, and High Deductible health plans offered to employees. They agreed to once again offer the $600 and $1,200 HSA contribution incentive to first-time enrollees in the HDHP, next year to be deposited through monthly deposits. United Health Care or UMR has been chosen as the provider of Wrap services, an additional administrative fee for the County. But while network choices will be more limited, employee contributions will decrease slightly under the plan, co-pays will decrease, and out-of-pocket maximums will be less. Emergency room pays will remain relatively stable.

The Board followed HUD recommendations to contract with Delta Dental, which should actually expand dental care choice, and RxBenefit Express Scripts for pharmacy coverage, which will be accepted by both Safeway and City Market pharmacies. Life insurance will be contracted with Lincoln Financial, the County’s current provider for long-term disability, something that will provide a natural cooperation with the added benefits of travel assistance, memorial planning, and ID theft resources. The Wellness Program will stay with Cigna, the prior bundled provider, for a total of $25,000 a yar. And an agreement of $50,000 total, with $5,000 already spent, was dedicated to the ongoing assessment of using Peak Health as a countywide offering.

While a gravity of tone and locution pervaded the whole preceding, both Commissioners Kris Manguso and Merrit Linke praised the work of Chair Cimino on such a difficult topic. “Is it perfect for everyone? It can’t be,” said Manguso. “People want it and people deserve it. But I don’t know how the County can continue when private can’t do it. I applaud [Cimino] for doing this. (…) I’m very enthusiastic that in 2021 this could help all Grand County residents.” And Linke echoed, “Other counties are considering the same thing. I know change can be difficult, but sometimes doing nothing is worse. We’re actively taking a look at making something better, not just for employees, but for all our citizens.”

All Board members stated that they would also be enrolling in the plan for themselves and their families, with Manguso assuring, “I don’t want to make any decision for employees that doesn’t impact me as well.” And Cimino ended the general discussion by thanking the employees for accepting the changes, “I really, really appreciate that County employees are going to trail blaze the path for the whole county, to see the potential benefits of Peak.”