5 Things Utah: DOH merger update, Greg Bell, Federal coverage gap

Thanks to the team for holding things down while I stepped away on vacation. Our managing editor, Emily Boerger, leads a team of reporters covering Utah and fourteen other states as they navigate the shoals of health reform. This week, we tee up conversations with Greg Bell, with Eric Cannon and Allison Heffernan, among others. So, you’ll hear directly from some of the folks leading reform efforts in Utah.

Finally, thank you, as always, for letting us play this role in Utah health care. We’re honored to be in your inbox.

 

 

 

                                                                                                                                                                               

1. Hospitals continue to face challenges

Greg Bell, President and CEO of the Utah Hospital Association, says ICUs in Utah are currently “bursting at the seams” due to the spread of the Delta COVID variant and the impacts of deferred care during the pandemic. At the same time, hospitals continue to face workforce challenges, where Bell says 10% or more of hospital employees have left since the start of the pandemic.

“Consequently, the number of beds we are able to staff is not about physical beds, it’s the number of…staff,” he says. To address these workforce challenges, Bell says UHA is starting a program to encourage lower-paid employees – like clerks and housekeepers – to pursue education in fields like medical technology and nursing.

 

2. Q&A: Eric Cannon on Scripius’s commitment to transparency

Select Health’s PBM, Scripius, pursues their commitment to controlling costs by providing financial clarity to members concerning their Rx purchasing process. Eric Cannon, Chief Pharmacy Officer at Scripius, spoke with State of Reform about Scripius’s efforts to create a clinical, non-rebate-driven formulary.
Cannon said Scripius is also hyper-focused on transparency. Members can search Scripius’s formulary from their phones and easily see the costs of their medications. “One of the things that you don’t get in the market today for anybody in terms of rebates, is a claim-line detail of your rebate payments. And so, we will line-item for an employer, ‘Here’s the prescriptions, and here’s how much you got in rebate on each one of those prescriptions,’” he said.

3. Utah’s BH system in “crisis response”

Allison Heffernan, Program Director at Utah Health Policy Project, says Utah is in crisis response mode when it comes to caring for behavioral health needs. In this conversation with State of Reform Reporter Patrick Jones, Heffernan outlines barriers to care in the system, as well as the policies and programs that may offer solutions.

Part of the problem, says Heffernan, are administrative barriers to care and difficulties in navigating the behavioral health system. To address this, UHPP uses health access assisters who help uninsured individuals acquire health insurance and understand the complexities of accessing care.

4. Progress on DHS-DOH merger

In what DHS Executive Director Tracy Gruber described as a “critical milestone” in Utah’s merger of DHS and DOH, the two entities released a draft organizational chart detailing the planned structure of the new department. Gruber – who will soon become Executive Director of the consolidated Department of Health and Human Services (DHHS) – said the plan incorporates the input of workgroups and stakeholders.

The department will have an Executive Medical Director who reports directly to Gruber, as well as three main branches: Operations, Health Care Administration, and Community Health & Well-Being. While administrative aspects are still being hashed out, Gruber said she hopes the chart “provides a clearer picture of what our combined department will look like.”

5. Federal “coverage gap” workarounds

Senate Congressional Democrats recently reached an agreement to pursue a $3.5 trillion reconciliation package (different than and in addition to the $1T bi-partisan package moving this week) that will contain a broad array of health-related provisions including funding to cover individuals in the “coverage gap” in non-Medicaid expansion states. In this piece, State of Reform columnist Jim Capretta outlines the federal workarounds that lawmakers may pursue to address the coverage gap.

Capretta says Congressional Democrats have a few options including the creation of a national public option, or the creation of a federally financed Medicaid option. He says a federally-run Medicaid offering wouldn’t generate as much opposition from hospital and insurance industries, but it would still be controversial. “Officials in the Biden administration and Democrats in Congress see 2021 as a historic opportunity to enact a substantial portion of their agenda, and closing the coverage gap is near the top of their list of priorities.”