Part Two of a Three-Part Series
Part One of this series argued that Southern Oregon’s provider shortage is a compounding structural problem — driven not just by a national physician deficit, but by a cost-of-living environment that existing incentive programs are not designed to address. High housing costs, poor home appreciation, and a deteriorating wildfire insurance market create a financial picture for prospective providers that is materially worse than comparably-priced Oregon markets — and no current program changes that picture at scale.
This article describes a model that does. It is not theoretical. It has been built, studied, and validated. The questions are whether the model translates to Southern Oregon’s specific conditions and what an adapted version would look like.
The Summit County Problem
To understand why Peak Health Alliance exists, you need to understand what Summit County, Colorado looked like in 2017.
Summit County was, by almost every health measure, one of the healthiest communities in the United States. US News and World Report ranked it among the top counties in the nation for health outcomes and life expectancy. And yet its health insurance premiums were the highest in the country. The Kaiser Family Foundation identified Summit County as the single most expensive insurance market in the United States in 2014. FiveThirtyEight covered what it called “the Summit County paradox” — a healthy, high-income community that nonetheless had an uninsured rate more than twice the state average, because insurance was simply unaffordable for many residents.
The cause was structural. Summit County had one dominant hospital — St. Anthony Summit Medical Center — and a limited network of physicians and specialists. Insurers, lacking meaningful price pressure from competitive provider markets, set rates that reflected the market’s limited alternatives. Large employers, despite having significant purchasing volume individually, lacked the scale to negotiate effectively on their own. A study published in the American Journal of Managed Care found that large individual employers generally lack the ability to negotiate lower prices for their employees. The problem was not any single actor behaving badly. It was a market structure that produced bad outcomes by default.
The insight that produced Peak was this: the leverage that no individual employer possessed, a community acting as a unified purchasing bloc might actually have.
What Peak Did Differently
Most employer coalitions and purchasing collaboratives focus on negotiating with insurers. Peak went around insurers to the source of the cost: the providers themselves. Peak’s leadership went directly to both carriers and providers, negotiated rates, and then publicly disclosed the prices they had reached. That transparency was strategic — it made the usual dynamic, in which hospitals and insurers blame each other when consumers complain about costs, much harder to sustain.
The organizational structure was equally deliberate. Peak was formed as a nonprofit, community-governed entity. Members elect the board. The majority of board members must themselves be Peak members. This governance structure was not incidental — it was the mechanism by which Peak maintained its identity as a community advocate rather than another market intermediary.
The data infrastructure mattered as well. Before Peak could negotiate, it needed to know what was actually being paid for care in Summit County. Working with Colorado’s All-Payer Claims Database, Peak acquired more than 60% of the county’s claims data. Combined with data from the five largest self-insured employers — which covered more than 90% of insured residents — Peak commissioned a market analysis that documented precisely what Summit County businesses and residents could save if inpatient and outpatient payments were brought to more reasonable benchmarks relative to Medicare rates.
That analysis, funded by the Summit Foundation and released in 2018, became the evidentiary foundation for everything that followed. Peak was not asking providers and carriers to accept lower rates on faith. It was presenting a documented market analysis showing what the current rate structure was costing the community, and proposing a negotiated alternative.
Peak launched for the 2020 plan year in Summit County. In 2021, it expanded to seven additional rural Colorado counties. By 2024, it was serving members in nine counties across Colorado’s Western Slope and Southwest.
What the Evidence Shows
The results of Peak’s model have now been formally evaluated in peer-reviewed research.
A 2025 study published in the Journal of Risk and Insurance, using difference-in-differences, event study, and synthetic control methods to compare premium changes in Peak counties versus non-Peak counties between 2017 and 2021, found that Peak was associated with a 13–17% decrease in average premiums. The mechanism was direct: lower prices paid to healthcare providers, not changes in benefit design or cost-shifting. At 2024 national average premium levels of roughly $9,000 per year for individual coverage, that translates to more than $1,000 in annual savings per enrolled person. Premiums also dropped in the seven counties that Peak expanded to in 2021, suggesting the model was not unique to Summit County’s specific market dynamics.
In its first three years of operation, Peak saved members more than $16.1 million — money that, as Peak explicitly notes, stayed in local communities supporting other economic activity rather than flowing to insurers and large health systems.
The researchers noted that replication cannot be assumed: it is not yet clear whether similar alliances can achieve the same results in different market conditions and geographic regions. That is an honest caveat. It is also an argument for doing the analysis in Southern Oregon, not for dismissing the model.
The Southern Oregon Parallel
Southern Oregon and Summit County are not identical markets. But the structural conditions that made Peak viable are present here in recognizable form.
Summit County had high insurance costs driven by a concentrated provider market with limited competitive pressure. Southern Oregon has Asante as the dominant health system in Jackson County, with Providence playing a secondary role — a market structure with limited competitive dynamics that affects the rates that employers and individuals pay. The Oregon Health Authority has documented this: its cost growth target program has been explicitly criticized for failing to account for the market concentration dynamics that drive costs in rural and semi-rural markets.
Summit County had an uninsured rate more than twice the state average despite being relatively healthy and affluent, because insurance was simply unaffordable. Southern Oregon has a population with high chronic disease burden, lower incomes, and insurance costs that are rising faster than wages — a combination that quietly raises effective uninsurance through underutilization even among people who are technically covered.
Summit County had large employers who lacked individual negotiating leverage. The region’s hospital systems, county governments, Southern Oregon University, and larger private employers face the same dynamic. None of them individually has the purchasing volume to negotiate meaningfully different rates. Together, they might.
And Summit County, critically, had a civic capacity to act — a foundation willing to fund the initial analysis, community leaders willing to do the hard work of negotiation, and a political environment that valued the experiment. Southern Oregon has analogous institutional players. The question is whether they can be brought to the table under a shared structure.
Extending the Model: Healthcare Workforce Housing
The Peak model, applied directly, addresses health insurance cost. But Southern Oregon’s provider recruitment problem requires a second component that Peak did not need to address: the housing calculus.
We are proposing that a Southern Oregon alliance include a dedicated healthcare workforce housing fund — not as a CCO program or a health system benefit, but as a community investment vehicle governed alongside the purchasing alliance.
The mechanism is straightforward. Health systems, CCOs, county governments, and potentially federal rural development funds seed a revolving loan fund. Healthcare workers — with explicit priority for behavioral health providers, nurses, physician assistants, and other mid-level clinicians, not only physicians — can access forgivable loans for down payment assistance. The loan forgiveness is tied to a service commitment: five years of practice in the region makes the loan a grant.
This addresses the specific financial deterrent that loan repayment programs do not. A provider who has retired their educational debt through state or federal loan repayment still faces a housing market where the financial risk of buying is high. A forgivable loan reduces that risk directly. It does not eliminate the fact that Southern Oregon’s home appreciation is lower than 90% of Oregon markets. But it reduces the downside exposure enough to change the calculation for a provider who is otherwise committed to rural practice.
There is substantial evidence that financial instruments tied to service commitments increase retention duration. A Maryland study found that physicians in rural areas who received loan repayments remained beyond their formal service commitment at higher rates than comparable providers who did not. Housing assistance works through the same mechanism — it creates financial roots that make departure more costly and staying more viable.
Critically, the priority should be mid-level and behavioral health providers, not primarily physicians. These are the workers for whom housing cost is genuinely prohibitive rather than merely inconvenient, and they represent the most acute gap in Southern Oregon’s provider landscape. A behavioral health counselor earning $60,000 annually faces a categorically different housing affordability problem than a physician earning $200,000. The program should be designed for the former, with the latter as a secondary beneficiary.
The legal pathway for CCO participation matters here and requires explicit attention. OHA’s flexible services framework was designed for member needs, not provider workforce development. We are not proposing that CCO member funds be redirected. We are proposing that CCOs, health systems, and employers contribute to a standalone community fund — analogous to how CCOs fund community health worker programs and community resilience investments — that sits outside any single organization’s Medicaid-regulated programs. This requires explicit legal review before implementation. It is not a structural barrier; it is a design requirement.
The Wildfire Insurance Extension
The third component of the proposed alliance is the most novel, but it follows directly from the logic that makes Peak work.
As Part One documented, Southern Oregon’s homeowners insurance market is in active contraction. Oregon’s 2024 wildfire season burned through 1.2 million acres. Major carriers — State Farm, Travelers, Nationwide — have limited or ceased new policy writing in rural areas around Ashland, Medford, and Grants Pass. Homeowners who lose coverage are forced to the FAIR Plan, an insurer of last resort with limited coverage and no competitive pricing. An Ashland homeowner saw her annual premium increase by more than 150% in four years.
The critical structural fact, noted in Part One, is that insurers make coverage decisions at the area level, not the property level. As broker Jeff Melville explained, insurers “look at entire areas and decide to insure or not insure whole neighborhoods.” Individual mitigation efforts — installing fire-resistant roofing, clearing defensible space — have limited effect on coverage availability because the insurer’s risk assessment is community-wide, not home-specific.
This is precisely the same market structure failure that Peak addressed in health insurance: individual actors lack the leverage to change outcomes because the pricing decision is made at a level above the individual. The solution Peak applied — aggregate purchasing power, community-level negotiation, transparent pricing — is structurally applicable to the property insurance problem as well.
The legislative infrastructure is beginning to take shape. 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 explicitly modeled after a Colorado law. In January 2026, he introduced new legislation requiring insurers who use wildfire risk modeling to demonstrate that their models account for policyholders’ mitigation investments. Oregon’s State Fire Marshal has signed an agreement with the Insurance Institute to offer homeowners certificates for undertaking wildfire prevention work in exchange for lower premiums.
The logic is converging from multiple directions toward the same conclusion: community-level resilience, demonstrated collectively and presented to insurers as a unified purchasing proposition, is the mechanism by which property insurance costs can be reduced and coverage availability can be stabilized. A purchasing alliance that already exists to negotiate health insurance rates is a natural institutional home for extending that logic to property insurance.
This extension is not a short-term deliverable. Building the legal and actuarial framework for collective property insurance negotiation is more complex than health insurance purchasing, and the legislative environment is still developing. We are proposing that it be built into the alliance’s mandate from the beginning — as a near-term health insurance and housing mission with a medium-term property insurance ambition — rather than added as an afterthought.
What the Model Is Not
Clarity about scope is necessary to prevent misunderstanding.
A purchasing alliance is not a health system. It does not employ providers, operate clinics, or deliver care. It is a negotiating entity — a mechanism for aggregating purchasing power that individual community members and employers cannot exercise on their own.
It is also not a substitute for the professional environment investments that matter for retention. A provider who arrives in Southern Oregon with reduced housing costs and affordable health insurance will still leave if they are professionally isolated, if they lack specialist backup, if they are carrying a caseload that no human being can sustain, and if their partner cannot find professional employment. The purchasing alliance addresses financial barriers to living here. It does not address all the reasons providers leave.
It is not a government program, though government participation — county governments as employers, OHA as a policy partner — is essential. It is a nonprofit, community-governed entity whose accountability runs to its members.
And it is not a guarantee. The researchers who studied Peak were explicit: it is not yet clear whether the model replicates in different markets. Southern Oregon needs to do the foundational analytical work — claims data analysis, employer purchasing volume assessment, provider market analysis — before it can know with confidence what a similar model would produce here. That analysis is a precondition for the alliance, not a byproduct of it.
The Practical Starting Point
Based on Peak’s own history, the foundational steps for a Southern Oregon alliance are:
First, the data. Oregon has an All-Payer Claims Database administered by the Oregon Health Authority. A Southern Oregon alliance could commission an analysis equivalent to what Peak did in Summit County — acquiring claims data for the major population centers in Jackson, Josephine, and potentially Klamath counties, combined with data from the five to ten largest self-insured employers in the region, to document what the current market structure costs the community and what alternative rate structures would save.
Second, the legal structure. Oregon law does not currently have an enabling statute equivalent to Colorado Senate Bill 4, which Peak used to formalize its cooperative structure. Oregon may need legislation — or a careful legal analysis of whether an alliance can operate under existing nonprofit and insurance cooperative law. This is a design question that requires legal counsel familiar with Oregon insurance regulation, not a barrier to the concept.
Third, the founding coalition. Peak’s leadership was explicit that community governance was not peripheral — it was the mechanism that distinguished the alliance from another market intermediary. The founding coalition for a Southern Oregon alliance should include not just the large institutional players but community representatives, patient advocates, and the small employers whose workers would most benefit from lower-cost coverage.
Fourth, the housing fund design. The workforce housing component requires parallel development: a fund structure, an eligibility framework, a service commitment structure, and explicit legal review of CCO and health system participation. This can be developed concurrently with the purchasing alliance formation, with the goal of launching them together.
The Ground That Has Already Been Broken
It would be a mistake to read the four steps above and conclude that Southern Oregon is starting from zero. It is not. Several threads of work — at the state level, in the legislature, and in the region itself — are already pointed in the direction this proposal requires. The purchasing alliance is not a new idea being introduced into a vacuum. It is the missing structural piece in a policy environment that has been building toward it.
Oregon’s state-level policy infrastructure is actively moving toward purchaser accountability. In 2025, the Oregon Health Policy Board established the Committee on Health Care Affordability with an explicit mandate to develop cost reduction policies and amplify the voice of purchasers — defined as employers, business coalitions, labor organizations, and government agencies that negotiate health coverage — in healthcare policy decisions. As of early 2026, the committee was actively recruiting for a member with a purchaser perspective. That seat is open. A Southern Oregon employer coalition engaged in the kind of purchasing work described in this series would have a natural, formal voice in that process.
Oregon’s cost growth target program — which sets annual benchmarks for how fast healthcare spending can grow — has also entered a new enforcement phase. In 2025, OHA identified five health organizations that exceeded spending limits without justification and required them to file performance improvement plans. Beginning in 2028, OHA will begin issuing fines to organizations that consistently miss their targets. The regulatory environment is shifting toward accountability in a way that creates real leverage for a purchasing alliance. An alliance that can demonstrate it is actively reducing per-member costs in a region that would otherwise face enforcement action gives both providers and CCOs a constructive path to compliance.
The legislative window on purchasing cooperatives is open. Price transparency legislation — SB 1060, which would have codified federal hospital price transparency rules into state law — failed in the 2025 session after opposition from the Hospital Association of Oregon and rural hospitals including Sky Lakes in Klamath Falls. The rural hospital lobby argued it would impose costly requirements on already financially strained organizations. That opposition is worth noting carefully, because it signals the path that will not work: mandated transparency through legislation will face organized institutional resistance in Oregon, just as it did in Colorado before Peak found a different route.
Peak’s approach is precisely the alternative: voluntary negotiated transparency, driven by purchasing power rather than legislative mandate. A Southern Oregon purchasing alliance does not need SB 1060 to pass. It needs claims data, organizational will, and a coalition large enough to make the negotiation worthwhile for providers. The legislative failure of SB 1060 is not an obstacle to the alliance model. It is an argument for it.
Sen. Jeff Golden of Ashland, who has already authored consecutive bills on wildfire insurance and community fire resilience, is the most natural legislative champion for an enabling cooperative statute. His wildfire insurance work and the purchasing alliance concept are not separate legislative projects — they share the same underlying logic of collective community action changing outcomes that individual action cannot. The enabling statute, modeled on Colorado SB 4, would give a Southern Oregon alliance the legal clarity to operate as a formal cooperative rather than navigating existing nonprofit and insurance law case by case. That is a modest legislative ask with high practical value, and it belongs in the same conversation as the wildfire insurance legislation Golden is already pursuing.
Southern Oregon already has the coalition relationships — they just haven’t been pointed at purchasing yet. The Southern Oregon Regional Health Equity Coalition, known as SO Health-E, has operated since 2014 with cross-sector membership spanning healthcare, education, law enforcement, and community organizations across Jackson and Josephine counties. AllCare Health holds a leadership position on its steering committee. Its Housing and Transit Coalition workgroup is already advocating for healthier housing strategies — the exact intersection where a workforce housing fund would operate.
The Health Care Coalition of Southern Oregon has been building partnerships between public health agencies and community health centers since 1990. The Rogue Workforce Partnership brings together the region’s major employers around workforce and economic development — the precise constituency that a purchasing alliance needs at its founding table.
None of these organizations is currently doing purchasing. That is the gap. But the relationships that a purchasing alliance would need to cultivate — between CCOs, employers, health systems, community organizations, and county governments — already exist in recognizable form across Southern Oregon’s existing coalition landscape. The purchasing alliance does not need to build trust from scratch. It needs to redirect trust that has already been established toward a new and specific function.
The Asante wage settlement is an instructive data point. In 2023, Asante Rogue Regional nurses settled a labor contract that secured an immediate $10 per hour raise after the Oregon Nurses Association documented that wages at Rogue Regional were far below comparable hospitals. The ONA spokesperson noted that it was “difficult to even get into the conversation, to show providers what’s great about the Rogue Valley if you’re so far behind the market.” That dynamic — providers leaving not because of any particular failure but because the full compensation picture doesn’t compare favorably to other markets — is identical to the physician recruitment problem. The nurse settlement was resolved through collective bargaining. The provider recruitment problem has no equivalent collective mechanism yet. A purchasing alliance, paired with a workforce housing fund, begins to create one.
What This Means for the Path Forward
The purchasing alliance concept is not waiting for Oregon to develop an appetite for this kind of intervention. Oregon has already developed that appetite. What it is waiting for is a specific proposal, backed by evidence, aimed at a specific region where the problem is acute and the institutional relationships are already in place.
Peak Health Alliance began with a task force, a foundation grant, and a claims data analysis. It was two years from that starting point to the first enrolled members. Southern Oregon could be on that same timeline — but only if the institutions that need to be at the table decide to sit down.
That is the question Article 3 asks directly. Not whether the model is right — the evidence suggests it is. Not whether the policy environment is receptive — it demonstrably is. But who, specifically, needs to act, and what does the first step actually look like for each of them.
Part Three: Who Can Build This and Why It Has to Be a Coalition
ReImagine Healthcare publishes research and analysis on healthcare system design in Southern Oregon. We are a subsidiary of Flourish Charity, a 501(c)(3) nonprofit. We do not have the infrastructure to implement the proposals in this series. We welcome responses and partnership inquiries from organizations that do.