Part Three of a Three-Part Series
This series makes the case for a Southern Oregon Community Purchasing Alliance. ReImagine Healthcare is a research and advocacy organization. We do not have the organizational infrastructure to build or operate what we are describing. 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 evidence, the framework, and the direct argument in front of them.
The first two articles in this series established the problem and the model. Southern Oregon has a provider shortage driven in part by a cost-of-living environment that existing incentive programs structurally cannot address. A community purchasing alliance — modeled on Colorado’s Peak Health Alliance, which produced peer-reviewed evidence of 13–17% health insurance premium reductions — offers a mechanism for changing that environment at scale. An extended version of that alliance could include a healthcare workforce housing fund and a long-term mandate to address the wildfire property insurance crisis.
This article asks the harder question: who does this, how does it actually get built, and what are the real obstacles to making it happen?
The honest answer is that we do not know exactly who should convene this. What we can do is identify the institutions whose interests are most directly implicated, describe the roles they would need to play, examine the objections that will arise in each institutional context, and make the case for why a coalition structure is not just preferable but necessary.
Why No Single Institution Can Do This Alone
The temptation, when proposing a new initiative, is to identify the most obvious institutional home and suggest that organization take the lead. In this case, the tempting candidates are AllCare Health, Jackson Care Connect, Asante Health System, or the county governments.
Each of them is the wrong choice to act alone — not because they lack capacity or commitment, but because the model requires what none of them can provide individually: credibility as a community advocate rather than an institutional actor with its own interests.
A purchasing alliance that is perceived as a health system initiative will be seen by insurers and other providers as an extension of the health system’s market position. A purchasing alliance convened by a CCO will raise immediate questions about whether its purpose is to serve OHP members or the broader community — and will trigger regulatory scrutiny about the appropriate use of Medicaid infrastructure. A purchasing alliance hosted by a single large employer will be governed in that employer’s interest, not the community’s.
Peak Health Alliance was explicit about this. Its community governance structure — members elect the board, the majority of board members must be members themselves — was not a procedural nicety. It was the mechanism that gave Peak the credibility to negotiate on behalf of the whole community rather than a particular interest. Insurers and providers engaged with Peak differently than they would have engaged with a hospital system asking for better rates.
A Southern Oregon alliance has to be governed by its community from the beginning, or it will not be Peak. It will be something smaller — another institutional negotiating effort with limited reach and limited durability.
This means the founding question is not “which institution should lead this?” It is “which institutions are willing to subordinate their individual interests to a community-governed structure?” That is a harder ask, and it is why the third article is the hardest to write.
Jackson Care Connect and AllCare: The Case for CCO Involvement
Jackson Care Connect covers roughly 67,000 people — about one in four Jackson County residents. AllCare Health covers a comparable population across Josephine, Curry, and Josephine counties. Together, they represent the largest organized insurance purchasers in the region, and they have direct financial accountability for the health outcomes of the populations most affected by the provider shortage.
When OHP members cannot access primary care and present instead in emergency settings, CCO costs rise. When behavioral health providers are unavailable and members cycle through crisis intervention rather than ongoing treatment, CCO quality metrics fall. When the provider network is so thin that members cannot establish care, the CCO’s performance contract with OHA is at risk. The provider shortage is not a peripheral concern for AllCare and JCC — it is a core operational risk.
Both organizations have also demonstrated willingness to invest in upstream determinants of health. JCC has funded supportive and transitional housing for members with behavioral health needs. AllCare has invested in community health worker programs, food security, and other social determinants. The philosophical and operational precedent for investing outside the traditional medical benefit exists in both organizations.
The ask of the CCOs is specific: contribute to a standalone community workforce housing fund, separate from Medicaid-regulated programs, as a community health infrastructure investment. Not as a flexible services benefit. Not as a member program. As a community investment analogous to other community resilience investments they already make.
This requires explicit legal review. OHA has authority over how CCO funds are deployed, and any participation in a workforce housing fund needs to be structured in a way that is clearly outside the CCO’s capitation-funded programs. We are not suggesting this is simple. We are suggesting it is feasible and worth the legal analysis, because the alternative — a continuing provider shortage that directly degrades member outcomes — is measurably more expensive.
The CCOs also need to be members of the purchasing alliance’s insurance negotiation function, not just contributors to the housing fund. Their combined purchasing volume, added to the employer coalition, increases the leverage available for negotiations with carriers and providers. Their presence signals to OHA and to the legislative community that this is a serious community initiative with institutional backing.
Asante Health System and Providence Medical Group: The Counterintuitive Case
Health systems are the most complicated actors in a purchasing alliance — for an obvious reason. The Peak model reduces costs to employers and individuals by negotiating lower rates with providers. Asante and Providence are providers. Asking them to participate in an alliance that will negotiate their rates down requires them to accept a financial trade-off in exchange for other benefits.
This is not a hypothetical obstacle. It is the precise tension that Peak navigated in Summit County, where St. Anthony Summit Medical Center had to decide whether a lower negotiated rate with the alliance was preferable to the status quo of an uninsured community and a destabilized market. They concluded it was. The reasons are instructive.
A community where insurance is unaffordable and the uninsured rate is high is a community where providers absorb more uncompensated care. A community where employers leave because costs are unmanageable shrinks the commercial insurance pool, increasing the proportion of lower-reimbursing Medicaid and Medicare patients. A community that cannot recruit providers means that existing health system operations are stressed, locum costs are high, and clinical capacity is degraded. The status quo is not free for Asante and Providence. It has costs that don’t show up in a rate negotiation but show up everywhere else.
What makes this argument more than theoretical in Asante’s case is the scale of its existing community investment. In fiscal year 2022, Asante spent $177 million in community benefit spending across its three-hospital system — 202% of the minimum floor OHA assigned it, the highest percentage of any regional health system in Oregon. No other health system in the state crossed the 200% mark that year. Asante already operates financial assistance programs that provide an automatic 35% discount to uninsured patients for medically necessary services with no application required, and partners with a patient financial advocacy firm to help underinsured patients navigate billing. Community resource coordinators across the system assist patients with housing, food, transportation, and insurance navigation — more than 852 individuals in Grants Pass alone in a single reporting year. Asante’s AsanteForward2030 philanthropic campaign, which expanded from an original $50 million goal to $100 million after surpassing the initial target with nearly 10,000 donors, explicitly frames community ownership as the foundation of Asante’s identity: unlike large institutions, Asante only transforms and progresses because of local leadership and community support.
An institution that already spends twice its mandated community benefit floor, that has built financial assistance programs for uninsured patients into its core operations, and that runs a $100 million philanthropic campaign explicitly premised on community ownership is not being asked to adopt an unfamiliar philosophy when invited to participate in a purchasing alliance. It is being asked to extend that philosophy to the workforce supply problem that is currently degrading its own operational capacity.
The specific offer to the health systems is this: participate in the purchasing alliance as a provider negotiating partner, accept rates that are lower than current commercial rates but higher than Medicare, and in exchange receive a more stable insurance market, a larger insured patient population, and a functional provider recruitment environment that reduces the operational crisis they are already in.
This requires Asante and Providence leadership to think about the problem at a system level rather than a revenue-per-encounter level. That is a specific kind of institutional leadership that is not guaranteed. But it is worth asking for explicitly, because the alternative — continuing to operate a healthcare system that cannot staff itself — is not a stable equilibrium.
There is one more thing to ask of the health systems, separate from the rate negotiation: direct contribution to the workforce housing fund. Asante and Providence have the most direct operational interest in provider recruitment and retention. A housing fund that reduces the barrier to recruitment is, from their perspective, a recruitment subsidy that costs them less than the locum and overtime costs they currently absorb to cover vacant positions. The ROI case is not difficult to make.
Oregon Legislators and OHA: The Policy Infrastructure
A Southern Oregon purchasing alliance needs two things from the Oregon legislative and regulatory environment: enabling legal structure and OHA partnership.
On the legal structure: Colorado’s Senate Bill 4, passed in 2019, modernized existing statute to explicitly enable health care cooperatives of the kind that Peak operates. Oregon does not currently have equivalent legislation. A Southern Oregon alliance may be able to operate under existing nonprofit and insurance cooperative law, but a formal legal analysis is required, and there is a reasonable possibility that enabling legislation would clarify and strengthen the alliance’s authority. Sen. Golden, who has already worked on both the wildfire insurance legislation and the provider shortage issue, is the natural legislative champion. His work on neighborhood protection cooperatives for wildfire resilience is structurally adjacent to what a purchasing alliance would do — in both cases, the mechanism is collective community action to change what individual action cannot.
The specific legislative ask is modest: an enabling statute for health care purchasing cooperatives, modeled on Colorado SB 4, that explicitly authorizes the cooperative structure under Oregon insurance law. This does not create a new regulatory burden. It provides the legal clarity that allows a community to act.
On OHA partnership: the Oregon Health Authority administers the All-Payer Claims Database that is the essential data infrastructure for the foundational analysis. Without claims data, the alliance cannot commission the market analysis equivalent to what Peak did in Summit County — and without that analysis, it cannot negotiate from evidence rather than assertion.
OHA also administers CCO contracts and has authority over the Coordinated Care model that JCC and AllCare operate under. OHA’s posture toward a Southern Oregon alliance — whether they treat it as an aligned community health infrastructure investment or as a potential complication to CCO regulation — will significantly shape what is possible. An early OHA conversation, framed around rural workforce development and healthcare access, is a prerequisite, not an afterthought.
The pitch to OHA is direct. Oregon will need more than a 40% increase in primary care practitioners in the next decade. Rural and remote areas already have a primary care capacity ratio of 0.69. The existing loan repayment and incentive programs are not closing that gap. A community purchasing alliance that reduces the cost of living barrier to provider recruitment — and that produces documented premium savings for residents and employers across the region — is an aligned investment in the rural health goals that OHA is already committed to. Oregon’s per capita healthcare costs are rising faster than OHA’s cost growth targets. A model that has demonstrably lowered premiums by 13–17% in analogous Colorado markets deserves at minimum a serious pilot analysis.
Large Employers: The Underutilized Leverage
The piece of this puzzle that receives the least attention in healthcare policy discussions is the role of large employers outside the healthcare sector.
Southern Oregon’s large employers — the school districts, Jackson County itself, Josephine County, Southern Oregon University, the major retailers, agricultural operations, and manufacturers in the region — pay health insurance premiums for their employees in a market that is not being negotiated effectively on their behalf. They are the exact constituency that a purchasing alliance is designed to serve, and they currently have no vehicle for collective action at the regional level.
It is worth being precise about what already exists — and what it cannot do. Oregon Business & Industry runs OBI HealthChoice, a statewide program specifically designed to help businesses with fewer than 100 employees access benefit programs normally available only to much larger entities, through a Regence-backed network. This is a real and useful program. But it is statewide in scope, it routes purchasing through insurer-set rates rather than negotiating directly with providers, and it does not address the specific market conditions of Southern Oregon’s concentrated provider environment. The distinction matters: the Peak model’s 13–17% premium reductions came from going around insurers to negotiate directly with providers. OBI HealthChoice, however useful for small employers across Oregon, is doing something structurally different. A Southern Oregon purchasing alliance is not a competitor to OBI HealthChoice. It is a geographically specific, provider-level negotiation that no statewide insurer-based program is designed to accomplish.
The research on individual employer limitations is clear: large employers generally lack the ability to negotiate lower prices on their own, and the problem is worse in concentrated provider markets. A coalition of Southern Oregon’s major employers aggregated into a purchasing bloc has leverage that none of them have individually. If the region’s major employers collectively spend $50 million annually on employee health insurance, a 13–17% reduction — the range documented by Peak’s researchers — represents $6.5 to $8.5 million per year in savings. That is money that stays in the region, in employee paychecks and organizational operating budgets.
Southern Oregon University deserves particular and urgent attention — and the stakes have changed substantially from what we described in earlier drafts of this argument.
SOU is no longer simply a potential partner with an institutional interest in healthcare workforce development. It is an institution in active financial crisis. Between 2015 and 2024, SOU’s full-time equivalent enrollment fell nearly 22%, from 4,108 to 3,209 students — declines that directly reduce both tuition revenue and state funding tied to credit hours completed. In 2023, SOU cut 82 full-time equivalent positions. In August 2025, President Rick Bailey declared financial exigency — a formal emergency designation that allows more aggressive budget cuts outside standard collective bargaining procedures. In September 2025, the board of trustees voted to eliminate $10 million over four years, cutting 10 bachelor’s degree programs, 12 minors, and roughly 70 positions. By early 2026, Bailey was asking the state legislature for $15 million in emergency funding, warning that without intervention SOU could face a cash crisis affecting payroll.
Bailey put it plainly: between the two restructuring plans, SOU had cut one quarter of its faculty and staff. This is the biggest challenge the university has faced since 1926, when it reopened after closing due to a lack of funding.
This context completely reframes SOU’s relationship to a purchasing alliance. A reduction in employee health insurance costs of 13–17% on a $71 million budget — where every 1% increase in revenue amounts to $400,000 — would represent a material contribution to financial stability. But the more important argument is strategic. SOU already hosts an OHSU School of Nursing program on its Ashland campus, and already offers a pre-nursing pathway and a Physician Assistant and Chiropractic certificate designed to prepare students for advanced health professional training. An institution that has cut mathematics, chemistry, and Spanish but retained its health sciences and pre-professional health pathways is an institution that is, consciously or not, betting its future on health workforce education.
A purchasing alliance that formally connects SOU’s health sciences programs to a regional workforce housing fund and provider pipeline — where SOU graduates who enter health professions and stay in Southern Oregon become eligible for housing support — is not a peripheral benefit for a university in crisis. It is a mission-critical partnership that could help justify the health-focused direction SOU is already moving in, provide a concrete return on its remaining academic programs, and make a compelling case to the legislature that SOU’s investment in healthcare education is producing tangible regional health outcomes. That is the kind of argument that moves emergency funding conversations.
Why Fragmented Parallel Efforts Are Not Enough
Before turning to governance, it is worth naming directly what will happen if the purchasing alliance is not built: the problems it addresses will continue to be worked on in pieces, by organizations doing their best, without the structural intervention that changes the underlying dynamics.
Southern Oregon already has a substantial coalition landscape. The Jefferson Regional Health Alliance leads the All In for Health initiative — a community-wide collaborative involving organizations from multiple sectors across Jackson and Josephine counties, responsible for the regional Community Health Assessment and Improvement Plan. The Health Care Coalition of Southern Oregon has been building partnerships among public health agencies and community health centers since 1990. SO Health-E, the Southern Oregon Regional Health Equity Coalition founded in 2014, works on health disparities across race, income, and sexual orientation with AllCare actively represented on its steering committee, and maintains a Housing and Transit Coalition workgroup. The Rogue Workforce Partnership brings together major employers around workforce and economic development. The Southern Oregon Higher Education Consortium links SOU, Rogue Community College, Oregon Institute of Technology, and Klamath Community College around educational pathways and regional workforce needs.
Every one of these organizations is doing legitimate and necessary work. None of them is solving the structural problem.
The Jefferson Regional Health Alliance and All In for Health identify needs and coordinate responses — they are assessment and planning infrastructure. The Health Care Coalition builds partnerships — it is relationship infrastructure. SO Health-E advocates for equity — it is a policy and advocacy voice. The Rogue Workforce Partnership focuses on economic development — it is a business coalition without a health purchasing mandate. The Higher Education Consortium coordinates academic pathways — it is an educational pipeline, not a financial intervention.
What none of them does is aggregate purchasing power, negotiate rates directly with providers and carriers, and use that leverage to change the financial environment that makes Southern Oregon less competitive as a place to build a healthcare career. That function is missing. And because it is missing, each of these organizations is doing its work in a cost environment it cannot change.
The healthcare workforce shortage cannot be solved by better assessment, stronger relationships, sharper equity advocacy, or more coordinated academic pathways alone. All of those things are necessary. None of them is sufficient without a mechanism for addressing the cost-of-living barriers that make Southern Oregon a harder financial choice for prospective providers than better-resourced markets. The purchasing alliance is that mechanism. It is not a replacement for the existing coalition landscape. It is the structural component without which the existing landscape’s good work cannot fully take hold.
The argument for a coalition rather than separate parallel efforts is ultimately the same argument that makes Peak work: the leverage to change outcomes at the community level exists only when the community acts together. Fragmented efforts, however well-resourced and well-intentioned, cannot produce the negotiating weight that changes market behavior. That requires aggregation — of purchasing volume, of institutional commitment, and of community voice — that only a unified structure can provide.
The Governance Question
The founding governance design of a Southern Oregon alliance will determine whether it replicates Peak’s success or becomes another institutional initiative with limited reach.
Peak’s governance model is worth studying in detail. Members elect the board. The majority of board members must be members — not institutional representatives, not health system executives, not government officials, but the individuals and small employers who use the alliance’s plans. Local steering committees in each county provide community accountability and local problem-solving. The CEO reports to a board that is constitutionally required to be community-controlled.
This structure was not accidental. Peak’s leadership understood that the alliance’s negotiating credibility depended on its ability to claim, plausibly, that it represented the community rather than any particular institutional interest. When Peak sat across the table from St. Anthony Summit Medical Center and negotiated rates, the hospital’s leadership knew that Peak’s board was made up of the community members whose premiums they were negotiating. That is different from a negotiation conducted by an insurer or a large employer.
A Southern Oregon alliance should adopt the same structure. Institutional partners — CCOs, health systems, county governments, employers — are contributors and stakeholders. They are not, in themselves, the governing body. The governing body is constituted by and accountable to the community members the alliance serves.
This is the hardest governance sell to institutional partners who are accustomed to governance commensurate with financial contribution. It requires asking them to fund an initiative they do not control. The answer to that objection is the same answer Peak gave: the alliance’s value depends on its independence. An alliance controlled by any single institution is not an alliance. It is a negotiating arm.
The Cost of Doing Nothing
The case for a purchasing alliance ultimately rests on a simple observation: the status quo is not stable, and its costs are not evenly distributed.
The provider shortage will worsen. Oregon’s primary care workforce needs to grow by more than 40% in the next decade to meet projected demand. The region already has a 30% deficit. The national pipeline is not producing providers fast enough to close that gap, and Southern Oregon’s cost-of-living barriers mean it will continue to lose potential recruits to better-positioned markets.
The wildfire insurance crisis will worsen. Oregon’s 2024 wildfire season burned 1.2 million acres. The trajectory of climate-driven fire risk in Southern Oregon is not reversing. More insurers will exit the market, more homeowners will be forced to the FAIR Plan, and the cost of homeownership in the region will continue to rise as insurance becomes more expensive and less available.
Health insurance costs will continue to rise in a market without effective purchasing pressure. Without a mechanism for collective negotiation, Southern Oregon’s employers and individuals will continue to absorb insurer-set rates in a concentrated provider market.
The costs of this trajectory fall hardest on the people who can least absorb them: OHP members who cannot access primary care, small employers who cannot afford to provide competitive benefits, workers who are underinsured, and the providers who remain in the region and carry an increasingly unsustainable load.
The purchasing alliance model does not solve all of this. It addresses the cost-of-living dimension of the problem in a way that existing programs structurally cannot. It creates a community institution with the leverage and the mission to advocate for Southern Oregon’s interests in insurance markets that currently treat the region as an afterthought. It builds the financial foundation — stable housing, affordable health insurance — without which every other retention and recruitment strategy has limited durability.
What We Are Asking For
This three-part series is not a strategic plan. It does not contain a budget, a timeline, a legal structure, or an operational model. ReImagine Healthcare does not have the organizational infrastructure to build those things, and we want to be direct about that rather than imply otherwise.
What we are asking for is an organized response from the institutions that do have that infrastructure.
Specifically: we are asking Jackson Care Connect and AllCare to engage with the question of whether CCO participation in a community workforce housing fund is legally feasible and organizationally appropriate — and to commission the legal analysis required to answer that question.
We are asking Asante Health System and Providence Medical Group to calculate what the current provider shortage is costing them operationally — in locum expenses, in clinical capacity loss, in the downstream costs of the emergency care that replaces deferred primary care — and to ask whether a purchasing alliance that addresses recruitment barriers is a more efficient investment than continuing to absorb those costs.
We are asking Oregon legislators, and Sen. Golden in particular, to examine whether an enabling statute for health care purchasing cooperatives belongs in the same legislative package as the wildfire insurance legislation he has already championed — and whether the two initiatives reinforce each other in ways that strengthen both.
We are asking OHA to open a conversation about what APCD data access and policy partnership would look like for a Southern Oregon purchasing alliance pilot, and how such a pilot fits within Oregon’s rural health strategy.
We are asking Southern Oregon University to recognize that a purchasing alliance is not a peripheral benefit for an institution in financial crisis — it is a strategic partnership that reduces operating costs, creates a concrete return on its health sciences programs, and builds the case to the legislature that SOU’s investment in healthcare education is producing measurable regional health outcomes. The university that declares financial exigency and then helps launch the infrastructure that connects its nursing and health professional graduates to housing support and regional practice is telling a very different story to the legislature than the university that simply asks for emergency funding.
We are not asking any single institution to do this alone. The entire argument of this series is that doing it alone is not possible. The model requires a coalition, community governance, and shared investment. What we are asking is that the right institutions take the first step: agree that the analysis is worth doing, and commit the resources to find out whether Southern Oregon’s market conditions support the model.
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 timeline if the institutions that need to be at the table decide to sit down.
We are making this case publicly because we believe that transparency about the problem, the model, and the ask is more likely to produce action than private conversations that never surface to where the community can see them. If this proposal has flaws we haven’t identified, we want to hear them. If it has merit, we want the institutions who can act on it to do so.
The shortage is not new. The housing crisis is not new. The insurance market contraction is not new. What is new is a documented model for addressing all three, an existing legislative champion for parts of the problem, and a moment when the costs of inaction are visible enough that the case for action can finally be made plainly.
We have tried to make it.
This concludes the three-part series. Part One: “The Compounding Cost Problem: Why Southern Oregon’s Provider Shortage Isn’t Just About Doctors.” Part Two: “The Peak Model: What Colorado Figured Out and What Southern Oregon Could Borrow.”
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 welcome responses, corrections, and partnership inquiries.