What's Working

Memo to Business
You Can Help Change Health Care

  What's Working: Memo to Business

Annette Quintana, CEO of Istonish, chairs the business engagement group of the Center for Improving Value in Health Care.

By Sandy Graham
Photograph by James Chance

In the 20 years since sisters Annette and Victoria Quintana founded their information technology services company, they have tried health plan after health plan. Yet their insurance costs have jumped by as much as 15 percent a year.

"It's crazy bad," says Annette Quintana, CEO of Istonish Inc., an IT services firm based in Denver. "It has always felt like something we could never do anything about – and it's not from lack of creativity. We're probably on the fifth model for how we get health care coverage."

Quintana knows Istonish is not alone and wants to help other business owners who also struggle with rising health premiums and costs and less-than-high quality. That's why she serves on the board of the Center for Improving Value in Health Care (CIVHC) and co-chairs its business engagement group with Bill Lindsay, who headed Colorado's Blue Ribbon Commission for Health Care Reform.

Gov. Bill Ritter created CIVHC in 2008 as part of his Building Blocks to Health Care Reform initiative, based on the commission's report. Soon to be an independent nonprofit, CIVHC's role is to lead and help integrate efforts to contain rising health care costs, reduce insurance premiums, improve Coloradans' health and quality of care and make data available so employers and individuals can make good decisions about quality and cost. It plans to gather support from consumers, health care providers, insurers and everyone else with a stake in changing health care. But business, as the sector that insures most Coloradans, is a major focus.

"Access to health care and affordable health care are issues we're going to have to deal with on a local level. I want to be part of influencing those issues where I can," Quintana explains. "I believe that employers can influence the [insurance] market."

Phil Kalin, CIVHC's executive director, agrees that employers have a big role to play as CIVHC begins to move toward its goal of improving the value derived from the premium paid. He also knows it can be difficult for entrepreneurs already wrestling with day-to-day business issues to delve into the complexities of health care and insurance.

"Having been in private business for many years," Kalin says, "I know the frustration that employers feel when confronted with year after year of double-digit premium increases and no sense that they can impact that ever-growing line item in their budget."

One of CIVHC's five key strategies involves partnering with business leaders to engage in very specific ways to help change the unrelenting and unsustainable rise in costs and premiums. The first step is helping businesses understand why the entire system must improve – cost, quality, the payment system and delivery of care. CIVHC also strives to give business leaders the data they need to make good decisions.

"Business owners need to understand why all these pieces of reforming health care are important," Kalin says. "We can't deal with them piecemeal or tinker around the edges."

Perhaps most importantly, he hopes that CIVHC's business initiatives will galvanize the business community "to put pressure on the system... through pushing for the same value-based, data-driven approaches they use for any other line items in their budget. We want to equip them with the questions and information they need when they're going to their brokers and insurers."

These might include asking for health plans that include "medical homes" in which employees' total care – physical, mental and dental – is coordinated (See story, Going Home...), or signing up with networks that can prove that patients receive high-quality care for the best price.

At Istonish, Quintana hopes to become one of those Colorado business leaders who press to change the system. But she admits in recent years, her focus has been on simply trying to curb the 10 percent to 15 percent annual increases in company insurance premiums.

Two years ago, Istonish joined a professional employer organization, or PEO. A PEO becomes the co-employer of its clients' workers and handles all benefits, payroll, human resources and workers' compensation. Istonish's total health insurance premiums dropped 35 percent, thanks to the combined negotiating power of the PEO's clients.

"That was huge for us," Quintana says. "And rates are not increasing as they have before."

Established in 2008 by Colorado Gov. Bill Ritter, CIVHC is operating as part of the Colorado Department of Health Care Policy and Financing until it fully establishes itself as an independent nonprofit. The Colorado Health Foundation provided $225,000 in financial support to CIVHC. It also provides office space for CIVHC's staff. The Foundation believes the group has enormous potential to ensure all Coloradans have access to cost-effective, coordinated, high-quality care.