5 Things Utah: Rep. Jim Dunnigan, Premium supports, Tele-health

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With help from Emily Viles

1. Employee premium support could see big growth

One of the elements of the “Fallback Plan” waiver, is a requirement that Medicaid expansion beneficiaries who are employed should stay enrolled in their employer-sponsored health plan. If they can’t afford any part of that, from premiums to co-pays, or even “wrap around” services that would otherwise be available through Medicaid, then the state will pay the employee’s share of costs.

The plan is similar in intent to the Utah’s Premier Partnership program (UPP), but is a different program with different eligibility.  Where UPP covers only 200 Utahns, the Dept. of Health foresees as many as 19,000 beneficiaries in this new program, saving up to $54m in Medicaid funds. A description of the program begins on page 7 here.


2. Video: Rep. Jim Dunnigan on balance billing

Rep. Jim Dunnigan is the Chair of the Health Reform Task Force, a legislative interim committee that works to address issues in health care and determine legislative priorities. Rep. Dunnigan is one of the central figures on our Convening Panel, a group of folks that helps to shape our annual conference agneda. He joins us in this edition of “What They’re Watching” to discuss balanced billing.

“Two years ago I sponsored legislation – it passed the House, did not pass the Senate. We worked on it again this session and we’ll work on it this interim. One of the things we’re looking at now is an arbitration model where we get two different stakeholders together and it goes to an arbitrator and they decide what’s fair payment. The whole point of it is to get the patient out of the middle.”

3. PEHP telehealth report urges more utilization

A telemedicine report released this month from PEHP, a branch of the state’s retirement system that provides public employees with health insurance, makes a series of recommendations to the Health Reform Task Force. PEHP suggests that Utahns should increase the utilization of telehealth in a number of sectors including psychiatric care and specialty care.

Telehealth is most utilized in urgent care centers where PEHP paid for a total of 1,168 e-visits at a rate of $49.50 per visit. This was much less than the average cost of an urgent care visit of about $180 and an ER Visit of about $1500. The report suggests that technology is an important aspect of care, but that it has developed slowly in the state and could be utilized more frequently.

4. Updates to the 2020 individual marketplace

Beginning January 1, 2020, the Utah health insurance marketplace will witness a number of changes. After rejoining the market in 2019, Molina is planning to expand coverage to 13 counties in 2020 including Rich, Box Elder, Wasatch, and Morgan. Both BridgeSpan and Cigna will expand health care exchange offerings into select counties as well.

These additions to the market are expected to decrease rates by an average of 6%. The marketplace expansion features a number of key initiatives including the ability for customers to access preventive care services that will expand online access to doctors through telehealth services at no additional cost. Open enrollment begins November 1.

5. Behavioral health system challenges, opportunities

A recent report conducted by the Kem C. Gardner Policy Institute and the Utah Hospital Association ranked Utah 51st in the nation for adult mental health care. The report finds that there are significant gaps in mental health treatment in the state, and that less than half of those with mental illness seek care.

The current carve out model for mental health is hard to justify with these outcomes. While “Almost no one is doing case management anymore,” according to the Gardner study, it means the payment model will need to change in order to drive system change. It’ll also probably save some money.  This will be a central topic we’ll be covering at State of Reform in the months ahead.