Q&A: U of U medical director discusses clinic successfully addressing SDOH
Peter Weir, M.D. is the executive medical director of population health at University of Utah Health (U of U Health). Weir helps lead the Intensive Outpatient Clinic (IOC), a clinic focused on addressing the social determinants of health by integrating physical and behavioral health.
Weir will speak about Utah’s continuing effort to address social determinants of health at our upcoming 2022 Utah State of Reform Health Policy Conference on April 7th in Salt Lake City. U of U Health also recently released a short film highlighting the key strategies and holistic care of the IOC.
In this Q&A, Weir discusses the IOC, how the clinic addressed the social determinants of health, and how other health systems can model their clinics after what they have learned.
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State of Reform: What are you spending your mental energy on? What is the most important thing happening in health care in Utah from where you sit?
Peter Weir: “I’m a big advocate of having health systems deliver health care with a population health orientation. People get tripped up on the term ‘population health.’ It’s really about a few key principles. At a high level, the first is being able to stratify a population in terms of risk–that risk can be practically anything–age, disease state, race, utilization patterns, etc…. Next, you design interventions that focus on improving the health outcomes of interest in your population. Lastly, you measure those outcomes, learn from them, and adjust to improve”.
SOR: So tell me a little bit about the IOC. What does it do and what is its purpose?
PW: “The premise of the clinic is to partner with our own Medicaid plan managed by the University of Utah Health Plans. We wanted to find members that have a constellation of risks that include medical, mental health, and substance abuse problems. The concept was to create a clinic that could care for people with those risk factors and move the needle on improving their outcomes and reduce their unnecessary costs. Our hypothesis was that we could reduce unnecessary costs by more than what we would internally cost to function. That’s what ended up working out.
We learned a lot of things on the way. For example, it was always my assumption that [patients] would be medically very complex and fragile. What we learned quickly was we were selecting for patients that had significant trauma during their childhood and adulthood. I began to read more literature about how adverse childhood experiences (ACE’s) lead to adult manifestations like early chronic disease onset, behavioral health problems, substance abuse problems, high risk behavior, and ultimately premature death. We realized that we had kind of tapped into a population that we hadn’t totally expected.
So, we began to hire people in the clinic that had expertise for caring for these populations, like social workers that were steeped in trauma informed care, substance abuse treatment, and harm reduction principles. We brought on primary care providers that were team-oriented and had an interest in attending to the behavioral health needs of patients. We created a clinic that provided services the matched the needs of our patients.”
SOR: How does the clinic attempt to address the social determinants of health?
PW: “To me, that’s really the key question. When you set up a clinic like we did, you’re incentivized to address the social determinants of health. In a normal fee-for-service environment, you don’t have the resources or the staff to be able to adequately address the social determinants of health. It’s a mismatch between the payment model and the care model.
We flipped the equation. We changed it, so that success is improving health and reducing costs, not generating revenue. If you’re going to reduce cost and improve health, then you’re incentivized to address things like transportation issues, food scarcity, precarious housing, and all these critical social needs that patients have that would impact and affect their physical health and mental health.”
SOR: What do you think is the importance of a clinic like this to overall population health and to achieving better health outcomes for underserved Utahns?
PW: “The purpose of the clinic was to demonstrate that this model can be successful. It has a population health orientation and is focused on improving the outcomes of a population of people. What I love about it is we got to focus on a Medicaid population that by definition has socio-economic challenges that a commercial population wouldn’t necessarily have.
It was always meant to be a focused effort that could demonstrate financial sustainability in the long-term while meeting our patient’s needs.”
SOR: What is the University of Utah’s plan to incorporate more of these IOC-type facilities to engage deeper into Utah’s communities? What have you learned from the IOC?
PW: “There is an opportunity to increase the size of the IOC–it’s just a matter of creating strong partnerships with other payers. We know the model works well with Medicaid. It would be interesting to see a model like the IOC with a Medicare population and/or a commercial population. We have also started to look at other populations that we could impact across our health system. I am working on a few projects that focus on a specific disease states like kidney failure, depression, and finding opportunities to provide home-based rather than facility-based care. The theme of all the projects is focused on how we can improve patient outcomes, their experience and reduce costs.”
This interview was edited for clarity and length.