A Case for a Southern Oregon Community Purchasing Alliance
The Problem We Keep Talking Around
Southern Oregon has a well-documented healthcare provider shortage. Jackson and Josephine counties have fewer than 60 primary care providers per 100,000 residents — well below Oregon’s statewide average of 83. Rural and remote areas across the region have a primary care capacity ratio of 0.69, meaning the workforce is roughly 30% short of what’s needed to meet current demand. La Clinica’s waitlist for primary care runs six to nine months. Most Asante family medicine clinics are closed to new patients.
We have federal designations for this. We have loan repayment programs. We have policy papers. And the shortage persists.
What the policy conversation has mostly avoided is a direct answer to the question providers themselves give when asked why they don’t come here: the cost of living is too high, and the housing market doesn’t reward the risk of buying.
Medford’s median home price sits above $415,000. Home appreciation rates are lower than 90% of other Oregon cities. Insurance premiums for homes in wildfire-risk areas — which includes much of the housing stock accessible to new residents — have increased more than 27% since 2020, with major carriers pulling out of rural areas entirely. A physician or nurse practitioner weighing Southern Oregon against Portland or Eugene is not just comparing salaries. They are comparing the full financial picture of building a life here. That picture is not favorable.
Loan forgiveness helps with educational debt. It does not solve the cost of housing, the unavailability of affordable homeowners insurance, or the calculation that buying a home here may not pay off financially. These are the structural barriers that existing programs do not address.
What We’re Proposing
We are proposing that Southern Oregon develop a Community Purchasing Alliance — a nonprofit, community-governed entity modeled closely on the Peak Health Alliance in Summit County, Colorado — with a mandate that extends beyond health insurance to include housing support for healthcare workers and, eventually, collective negotiating power on wildfire property insurance.
This is not a new idea applied to a new problem. The Peak Health Alliance is a documented, peer-reviewed success story. A 2025 study published in the Journal of Risk and Insurance found that Peak reduced health insurance premiums by 13–17% — more than $1,000 per person per year — primarily by negotiating directly with providers and carriers rather than accepting insurer-set rates. In its first three years, Peak saved members more than $16 million, money that stayed in the local economy.
Peak works because it represents enough purchasing volume to have real negotiating leverage, because it operates transparently (publicly disclosing negotiated prices), and because it is governed by the community it serves rather than by insurers or health systems.
Southern Oregon has analogous market conditions to Summit County when Peak launched: high insurance costs, thin employer markets, high uninsured rates relative to health status, and a hospital market with limited competitive pressure. The structural case for a similar alliance is strong.
The Three-Part Framework
We are proposing that a Southern Oregon alliance be built with three connected components:
1. Health Insurance Purchasing
Following the Peak model directly: the alliance pools individuals, small employers, and self-insured organizations to negotiate rates directly with providers and carriers, bypassing the standard insurer-set pricing that currently drives up costs. This benefits the entire community — not just healthcare workers — but it creates a foundation of cost reduction that makes Southern Oregon more financially viable for people weighing relocation.
2. Healthcare Workforce Housing Support
A healthcare worker housing fund — seeded by contributions from health systems, CCOs, and potentially federal rural health dollars — would provide forgivable loan assistance to nurses, behavioral health providers, physician assistants, and physicians who commit to practicing in the region for a defined period. This directly addresses the financial risk of buying into a flat-appreciation housing market. Critically, it should prioritize mid-level and behavioral health providers, not only physicians, because those are the workers for whom housing cost is genuinely prohibitive and for whom Southern Oregon’s shortage is most acute.
3. Wildfire Insurance Collective Negotiation
This is the most novel component, but it has direct legislative precedent. State Sen. Jeff Golden of Ashland has introduced legislation in consecutive sessions requiring insurers to account for community-level wildfire mitigation in their rate-setting — a bill modeled after a Colorado law. The underlying logic is that insurers price by area, not by individual home. A community that collectively demonstrates fire resilience and presents as a unified purchasing bloc has more leverage than any individual homeowner. An alliance structure that can negotiate health insurance rates can eventually apply the same model to property insurance.
Anticipated Objections
“This is outside the mission of our organization / CCO / health system.”
Jackson Care Connect and AllCare already invest in housing for patients as a social determinant of health. Asante and Providence are directly affected by the provider shortage — it is their operational problem, not an abstract policy concern. Large employers in the region pay insurance premiums that a purchasing alliance could reduce by 13–17%. The question is not whether this intersects with existing missions. The question is who has the convening authority to bring these parties together.
“CCO flex funds can’t legally be used for provider recruitment.”
Correct — and we are not proposing that they be. We are proposing that CCOs, health systems, and employers contribute to a standalone community fund governed separately from any single organization. This is analogous to how CCOs fund community health worker programs: as a community health infrastructure investment, not a direct member benefit. The legal pathway is cleaner through a coalition structure than through any single organization’s existing programs.
“The Peak model worked in Colorado. That doesn’t mean it works here.”
Peak’s researchers explicitly note that replication requires attention to local market conditions. The key factors that made Peak viable — a concentrated provider market, high baseline insurance costs, and strong community civic capacity — are present in Southern Oregon. The honest caveat is that no alliance has been formally replicated in Oregon yet. That is an argument for doing the analysis, not for dismissing the model.
“Wildfire insurance is a regulatory problem, not a purchasing problem.”
It is both. Regulatory reform addresses what insurers must do. Collective purchasing addresses what communities can negotiate. Sen. Golden’s legislative work and a coalition purchasing structure are not competing solutions — they are complementary ones. The legislation creates the framework; the alliance creates the leverage.
“Who runs this?”
Not us. ReImagine Healthcare is a research and advocacy organization. We have identified the model, made the evidence-based case, and laid out the framework. Building and operating a purchasing alliance requires organizational infrastructure, legal formation, actuarial analysis, and institutional partnerships that are beyond our scope. We are making this case publicly because we believe the right people to convene this already exist in Southern Oregon — and we want to put the idea, the evidence, and the objections in front of them.
Who Needs to Be at the Table
Based on the Peak model and the specific dynamics of Southern Oregon, a viable alliance would require early commitment from:
- Jackson Care Connect and AllCare — as CCOs with direct financial interest in workforce availability and community health infrastructure
- Asante Health System and Providence Medical Group — as the region’s dominant health systems, whose provider shortage is both the problem and the lever for negotiation
- Jackson and Josephine County governments — as large employers and as the entities with public accountability for community health
- Southern Oregon University — as a training pipeline and large employer with direct workforce development interests
- The Oregon Health Authority — whose rural workforce programs and CCO contracting authority make them an essential policy partner
- Large regional employers — whose insurance costs would be directly reduced by the purchasing model
This is not a comprehensive list. It is a starting coalition.
The Cost of Inaction
Oregon will need more than a 40% increase in primary care practitioners in the next decade to meet demand. The region already has a 30% deficit in primary care capacity. La Clinica’s six-to-nine-month waitlist is not a policy abstraction — it is what happens when a community cannot recruit and retain providers, and it falls hardest on the patients who can least afford to go without care.
The programs we have are insufficient. That is not a criticism of the people running them. It is a structural observation: loan repayment addresses educational debt, but it does not address the full cost calculus of relocating to a region with high housing costs, flat appreciation, and a deteriorating insurance market. A provider who takes a loan repayment commitment and then cannot afford a home, cannot get wildfire insurance, and watches their colleagues leave for better-resourced environments will leave when their commitment ends.
The purchasing alliance model addresses multiple components of that calculus simultaneously. It is not a complete solution. But it is a structural intervention of the kind that existing programs are not.
ReImagine Healthcare is a subsidiary of Flourish Charity, a 501(c)(3) nonprofit. We publish research, analysis, and advocacy on healthcare system design in Southern Oregon. We welcome responses, corrections, and partnership inquiries from organizations with the capacity to act on this proposal., a physician-owned organization structured around a fundamentally different model has been quietly doing it another way for more than 30 years.