Utah has pursued strategies to address healthcare affordability, price transparency and access for its residents, but still needs to take important steps to address these issues. While 2018 voters approved Medicaid expansion in the state, in 2019 the Utah governor signed a bill that limited the number of individuals covered by Medicaid expansion. However, full Medicaid expansion took effect in January 2020. Additionally, Utah does not have any protections to address surprise medical bills for its residents. However, state legislators have been working on efforts to increase consumer protections by proposing balanced billing protections in bipartisan bills.
Although Utah needs to take steps to address access and affordability issues in the state, the state is ranked favorably in regards to social determinants of health. In 2022, Utah ranked among the best in the nation for hospital safety, according to Leapfrog’s 2022 Hospital Safety Grade report, and ranked the fifth healthiest state in the country. Furthermore, a 2020 Commonwealth Fund report notes that Utah has improved in addressing disparities and increasing healthy lives.
Utah ranked 25 out of 47 states plus DC, with a score of 32.5 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.
A survey of people who lost Medicaid coverage in Utah last year found just over half made no
effort to renew their coverage, in many cases due to difficulties with paperwork requirements,
reports KFF Health News. While many found insurance elsewhere—39 percent through an
employer and 15 percent through the Marketplace—thirty percent became uninsured and many
reported obstacles in reapplying for Medicaid. Nineteen percent said they never received
renewal documents from the Utah Medicaid enrollment agency, the Department of Workforce
Services. Fourteen percent said they didn’t get around to the paperwork, 13 percent said it was
too difficult, and 7 percent said they didn’t have the necessary documents to prove their
eligibility.
A 2023 survey found nearly seventy percent of Utahns experienced at least one health are
affordability burden in the previous year, up from 27 percent in 2020, reports The Salt Lake
Tribune. Utahns’ opinions of health care costs are similarly pessimistic — 86% worry about
affording health care in the future. Utah is working towards some of the recommended policies
in the survey, including working on setting a cost growth target by consensus through the One
Utah Health Collaborative.
The Salt Lake City Council and Mayor signed a joint resolution declaring racism a public health crisis, reports KSL.com. The resolution commits the city to be conscious of the policies and ordinances created to ensure that inequities are not furthered and that the damage from structural racism is addressed. Additionally, Salt Lake City officials will continue to work with the county health officials to review and report public health data to determine the next steps, current tasks, make the data available online to increase transparency and utilize staff from multiple agencies to address public health barriers.
Utah’s governor signed the Mental Health Access Amendments into law, which now require remote mental health visits to be reimbursed at the same rate as in-person visits, reports State of Reform. This law makes permanent some of the temporary telehealth measures enacted during the coronavirus pandemic. Utah now joins the ranks of only a few states who have permanently enacted payment parity for mental health visits.
Several of Utah’s healthcare leaders have declared racism a public health crisis and developed a plan to eliminate it, reports The Salt Lake Tribune. Several of Utah’s large healthcare providers have committed to providing educational programs, services and personal protective equipment (PPE) to marginalized communities and creating avenues for hiring people of color in healthcare careers. The leaders noted several health inequities that people of color in Utah experience, especially from COVID-19, and their desire to achieve equitable healthcare for all Utahns.
Intermountain Healthcare, United Way of Salt Lake and several other healthcare stakeholders in Utah have collaborated to create scalable programs to address social determinants of health throughout Utah, reports Healthcare Finance News. The organizations will collaborate to improve the health and wellbeing of communities, improve coordination across health systems and reduce healthcare costs by addressing the upstream economic, education and social factors that impact people's health. This program builds on Intermountain Healthcare’s work to address social determinants of health in St. George and Ogden to create a state-wide network that addresses upstream factors of health.
Telehealth visits during March grew significantly from the previous year and approximately half of all telehealth visits were for mental health services, according to a preliminary report on COVID-19 healthcare trends from the Utah Department of Health. Using APCD data, the report shows that medication “days supplied” was 12.3 percent above average in March 2020, with a significant increase for anti-depressant and anti-anxiety medications. The report also noted a sharp decline in the number of child and adolescent immunizations provided in March 2020 as compared to 2019 trends.
Utah is implementing an insulin cost savings program that will allow every Utahn to purchase insulin at a 60 percent discount through the state Public Employee Health Plan (PEHP), according to KUTV. PEHP will purchase insulin at a higher rate, but Utahns will only have to pay the wholesale cost—about a 60 percent discount. The law also caps health insurance copays for insulin at $30 for a 30-day supply. Additionally, this law enables pharmacists to dispense a 90-day supply of insulin on an emergency basis for patients having difficulties with their prescription.
Utah’s Medicaid program will cover COVID-19 testing for both active infections and antibodies for uninsured Utahns, according to The Salt Lake Tribune. Providers will now be reimbursed through the Medicaid program, which has greater funding availability than the federal Health Resources and Services Administration, the previous funding source. The funding will last through the public health emergency period and will cover testing for active infections, testing for antibodies and further diagnostic tests for Utah residents and citizens without health insurance.
All-payer claims databases (APCDs) are a promising, high-quality tool for cancer surveillance, according to a Utah study published in Health Services Research. Medicare data has previously proven beneficial in capturing cancer treatment that is under-reported to cancer registries for the 65 and over population. Researchers looked at the Utah APCD to assess the potential of these databases to offer similar benefit to cancer surveillance, including information on comorbidities at diagnosis, recurrence and late effects of treatment. The study concluded that an APCD can act as a high-quality surveillance tool when accurate identifiers exist to support linkage to cancer registry data, if claims for the same patient can successfully be linked in the ACPD, and if the population of patients diagnosed with cancer have adequate coverage.
Utah Gov. Gary Herbert signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot, according to Politico. Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more.
Intermountain Healthcare together with four other partners will form a nonprofit company that will supply about 20 generic drugs to their hospitals, according to a news story in The Salt Lake Tribune. The goal is to prevent price-gouging from certain pharmaceutical companies and deal with drug shortage issues.
Legislation proposed in Utah would provide for a wholesale importation program with Canada for higher-cost drugs, according to NASHP. The program would become the first in the nation to import drugs that are already licensed for sale in Canada where high cost drugs can be 30 percent less than in the United States. The legislation promises to generate significant cost savings for the state of Utah and its residents.
People in Utah spend less per capita on health care than any other state, which in part could be due to behavioral characteristics and certain demographics according to a recent report by Utah Foundation. Examining total spending in the state of Utah is the focus of this report and other findings include that Utah has the shortest length of hospital stay in the country, that while health care spending is growing in Utah it is attributable more to population growth than overutilization, and that two- thirds of healthcare expenditures come from hospital services and physician and clinical services.
Wasatch Educational would like to build a private medical school on a public golf course covering holes 10, 11 and 12, according to The Salt Lake Tribune. While the school argues that building the private medical program could help alleviate a severe shortage in physicians in the state of Utah, residents are not as enthusiastic. Residents argue for a much more transparent process in determining approval of a plan to remove, and replace, part of the 100-year-old golf course.
Leaders from Intermountain Healthcare and University of Utah Health Plans support the idea of high-risk insurance pools as a way to control premium costs, according to Deseret News. A high-risk insurance pool would take those that have pre-existing conditions or predictably high medical expenses and place them one category while keeping relatively healthy individuals in another. The premium costs for healthier individuals would be lower, and therefore entice younger, healthier people to enroll. Individuals that are more frequent users of the healthcare system would have higher premiums and higher out-of-pocket costs.
Utah has an initiative focusing on the behavioral health needs of the justice-involved population that aims to prevent individuals from cycling in and out of incarceration, according to NASHP. In 2014, Utah created the Utah Commission on Criminal and Juvenile Justice (CCJJ) to conduct a review of the state’s correctional system. It found that the state’s incarceration rate was quickly increasing. In response, Utah revised drug court eligibility to be based on risk and need and passed legislation to revise sentencing guidelines for minor drug offenses and establish treatment standards for individuals required by the judicial system to participate in behavioral health services. Utah’s experiences were discussed at NASHP’s Annual Conference.
Iris Plans, an innovator in Advance Care Planning (ACP) for people with serious medical conditions, has partnered with the University of Utah Health Plans to improve the quality of care and member experience while lowering cost, according to EconoTimes. Iris Plans connects healthcare professionals to people with serious medical conditions, along with their families, to provide disease education, resolve conflicts, and help people document which future healthcare decisions are best aligned with their goals and preferences. These documents are then sent to their doctors’ offices to ensure they receive the care they need.
Integrating medical homes and accountable care with physical and mental health had mixed effects on quality of care and costs, according to a study released in JAMA. The study included nearly 114,000 adults who received care at 113 Utah practices from 2003-2005 and had yearly encounters with the practices through 2013. Compared with patients in traditional practices, patients in the study had better adherence to diabetes care and substantial reductions in emergency department visits, hospital admissions, and primary care visits. However, there was no difference in urgent care or specialty physician visits. The investment costs of the program were lower than the reduction in payments received by the delivery system; however, the implementation of the team-based care was still resource intensive.
In some healthcare cost measures, Utah has both the healthiest population and the lowest per-capita health carecosts, according to an article in NEJM Catalyst. While it is not entirely clear as to how and why Utah is able to hold this unique distinction, it is certainly important to understand the state’s people, systems, dollars and data according to Elizabeth Gardner, author of the article. Utah is looking for more analysis to better understand and identify a definitive explanation on what makes their state different.
The United Health Foundation released a report focused on preventative healthcare with Utah ranking as average with mixed scores in various thematic prevention measures, including annual dental visits, healthcare coverage, dedicated healthcare providers, cholesterol checks and colorectal cancer screenings. Utah ranked 27th overall with a score based on access to health care, immunizations, and chronic disease prevention, according to the report.
Intermountain Healthcare, a nonprofit health system in Salt Lake City, is promising to sharply cut costs rather than pass them on, according to The New York Times. Its new health plan, SelectHealth Share, is guaranteeing to hold yearly rate increases to one-third to one-half less than what many employers across the country typically face. Under the Intermountain plan, employees also are required to take more responsibility for their health by agreeing to participate in programs like a health risk assessment or have a health screening like a cholesterol check or colonoscopy if they are over 50.
The Utah Department of Health released a summary report on healthcare costs based on data from the state’s all-payer claims database. The report examines health claims information including per capita costs, total payments made per claim type and amounts paid by insurers and its members.
This Deseret News editorial focuses on the possibility of healthcare transformation and overall economic development in the state of Utah. The author praises the collaborative work between different stakeholders to continue their work in value-based care and other progressive health transformation ideas in the state.
As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This Annals of Family Medicine study assessed direct personnel costs to practices associated with the staffing necessary to deliver PCMH function in Colorado ($9,658 per month) and Utah ($7,691 per month). Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.
Hospitals know what they are paid by insurers, but it bears little relationship to their costs, according to The New York Times. In fact, hospitals don’t know what things cost. Utah is getting answers, information that is not only saving money but also improving care. New data systems allow the University of Utah Healthcare to measure what they spend, lower costs and improve outcomes.
Intermountain Healthcare introduced a new telemedicine system that enables rural hospitals to consult with specialists in its larger, urban hospitals, according to television station KSL. The tool has proven to be valuable for diagnosing illnesses and gives patients the flexibility to be treated in their local hospital.