With the cost of health care premiums rising faster than salaries, public officials say Utah — like much of the nation — is on an unsustainable trajectory without action to manage both care costs and the need for it.
With that concern in mind, in 2022, Utah Gov. Spencer Cox launched the One Utah Health Collaborative, a community-owned 501(c)(3) nonprofit with a goal over the next 15 years to build an affordable and high-caliber health care system by bringing together providers, the public, government and funders in a quest to create a model care system the nation could emulate. One rooted in solid research and driven by innovation.
Tuesday, surrounded by board members of the collaborative, patients, legislators and health care partners, Cox said the state has adopted what’s being called the Utah Model of Care, with three priorities: affordability, high quality and trust.
“This may seem idealistic, but I promise you it’s well within reach,” Cox said of creating a health care system for the state that is a model and envy of the nation.
The effort is expected to evolve over 15 years or more in order to reach its full potential.
“We do not look in two-year time frames” in Utah, Cox said. “We are committed to looking 20 to 30 years down the road.” He added that everything guiding the progress within the new framework will be “innovation-centric.”
The model, which is based on a year’s work already by the collaborative — from a statewide needs survey to public and health expert input, as well as extensive research — focuses on seven attributes the group has settled on as absolutely essential for a health system that meets the goals: being accessible, efficient, person-centered and prevention-oriented, while involving an optimal workforce, and providing transparency. It should also be designed to reward outcomes, per collaborative members.
For each attribute, the group has made some preliminary suggestions on how it might be accomplished. For instance, to improve accessibility, clinics and hospitals could implement convenient operating hours and expand locations or bolster access to rural populations by using telehealth. Limiting waste and boosting productivity with technology could make the health care system more efficient. The group offers three suggestions under each of the seven attributes. But that list is not stagnant. The goal is to spark other ideas, as well.
Rather than a plan, the model’s framework is described as a compass that indicates whether health care in Utah is going in the right direction. Stakeholders — including patients, providers, policymakers, insurers and employers — are encouraged to do their part and actively help achieve the goals.
Innovation is built into the model, serving as a driver of ongoing improvement and adaptability, according to the group’s news briefing. In background material, the collaborative acknowledges Utah is certainly not the first state to tackle health care’s challenges. But it notes the collaborative itself is quite unique as it “aligns the community, identifies opportunities and speeds up innovation.”
“We are grateful to stand with Gov. Cox in announcing the adoption of the Utah Model of Care,” said James Wissler, executive director of the One Utah Health Collaborative. “This model is the product of extensive research, interviews and collaboration across the health care landscape. It represents the collective effort of stakeholder executives who are committed to changing the trajectory of health care in Utah for the long term. By aligning our goals and working together, we’ve laid the foundation for a system that will deliver real, lasting improvements for all Utahns.”
What Utahns said they need
The collaborative found that 71% of Utahns live in a household where at least one “persistent” health condition is present, whether it’s a disability, substance use disorder, mental health challenge or chronic medical condition.
Cox said that collaboration would make an innovative health system that responds to all Utahns’ needs, including those.
This week, KSL reported on a Health Care Cost Institute study that shows health care costs in Utah rose as much as 20% between 2017 and 2021, which Katie Martin, the CEO of the institute, said is being driven largely by the price of services rising, not demand or overall inflation. She noted that Utah’s average health care spending per person is $5,000 a year, not including insurance premiums.
Health care premiums have increased three times faster than incomes, per data from the Kem C. Gardner Policy Institute, which gathered data for the collaborative.
In the collaborative’s survey, 86% of Utahns said they worry about future health care costs and whether they can afford them.
One of the efforts, discussed in the board’s fall meeting after the news conference, is to gather the metrics that matter in order to measure progress. It’s an effort that sparked a caution from Rep. Ray Ward, R-Bountiful. He noted that some desired metrics simply aren’t measurable, such as how many Utahns with mental illness access or don’t access care. You have to define mental illness. And what amounts to “care”? Is it one therapy session? Medication? Four sessions?
He told Deseret News that efforts to measure metrics sometimes mean that whatever number is available becomes the metric that’s measured, rather than the numbers that would make significant difference.
The board now has two co-chairs: Scott Barlow, the CEO of Revere Health, and R. Chet Loftus, managing director of PEHP Health & Benefits. In his remarks, Loftus said the effort to improve Utah’s health care landscape would not be “crisis to crisis” linear, but would be “centered on what’s good for the community and how to do it.”
One of the challenges will be time, as Wissler noted, looking at the packed conference room in one of the Senate Building chambers. “In 15 years, we don’t know how many of the same people will be in this room.” The needs and those helping to shape what meets those needs will inevitably change.
Much of the work to be done will be the job of individuals or groups, but not the whole collaborative, Wissler added. “Everyone needs to come up with their own high-level strategies. There are only a few we can do together.”
Will it work?
As part of the model, the group has created an outline to assess progress in reaching goals, noting factors such as whether health care spending is growing or patients are avoiding care because they can’t afford it. The group will examine hospital readmissions, avoidable emergency department visits and the share of those with mental illness who don’t receive treatment. Some of the potential signs the innovative model works are patient satisfaction with their hospital experience, whether minors get their wellness visits, the tying of provider compensation to quality and whether there are enough primary care doctors to meet needs.
A lot of it hinges on whether stakeholders buy in with effective actions. The model offers some possibilities: Employers could promote healthy lifestyles, provide flexible schedules to allow wellness visits and offer health benefits to drive patient engagement, the outline says.
Policymakers could put more funding into programs that train health care providers and reduce shortages. They could also simplify regulations to make medical costs more affordable and efficient.
Patients could make healthy lifestyle choices, follow health provider guidance and choose high-value, lower cost care when possible.
Dozens of local organizations have contributed to the model and signed onto its goals, including health systems, clinics, nonprofits, research groups, insurers, physicians, public health experts and advocacy groups. So have the leaders of major insurance companies, government programs, physician groups, foundations, researchers and substance use disorder treatment programs, among others.
The press conference included a panel discussion by health industry experts on the seven attributes that form the model’s framework and how it’s already being implemented, followed by a board meeting of the collaborative.
