Payers, providers, and thought leaders discuss value-based care’s future in Utah

With the formation of the One Utah Health Collaborative, the transition to a value-based care (VBC) model in Utah is quickly becoming the most important issue in state health care. 

At our 2022 Utah State of Reform Health Policy Conference, our panel entitled “The progress and future of value-based care in Utah” highlighted the goals of the collaborative, the initiatives being developed right now on the ground, and the future outlook of VBC in the state. 

The panelists were Rich Saunders, Chief Innovation Officer for the Office of Governor Spencer Cox, Donna Milavetz, M.D., Executive Medical Director for Regence Blue Cross Blue Shield of Utah, Ryan Morely, Partner at SpringTide Ventures, and Mary Jane Pennington, President & CEO of Granger Medical Clinic. 

 

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Saunders started the discussion by outlining the problem of growing Medicaid spending due to rising costs and the effect these rising costs are continuing to have on payers, providers, and patients. “We don’t know where the end is,” said Saunders.

He continued to say that although Utah is the 5th healthiest state in the country, chronic diseases are still increasing, racial and rural health disparities persist, and access to quality care is still a challenge for everyday Utahns. 

The One Utah Health Collaborative seeks to convene all silos and communities in health care to use collaboration and innovation to find the best solutions to these health challenges through a VBC model. 

“The governor’s vision with this is to convene people and organizations to actually have the tough conversations about what to do with this. What do we need to change and how do we do it?” said Saunders.

Morley continued by saying the collaborative will seek to be a resource for the community-aligned goals of improving affordability, outcomes, and equity through a VBC lens. Morley hopes the collaborative can serve as a mechanism for incentivizing providers and payers to continue to rapidly innovate in the VBC space. 

“We are trying to position Utah as a national leader in cost efficient innovative health care that strengthens our economy,” said Morley. 

Morley used the University of Utah Health’s intensive outpatient clinic (IOC) as an example of the accelerated innovation in VBC that the collaborative aims to support. The IOC attempts to address the social determinants of health through focusing on assisting higher cost patients with addressing their social needs. 

He said the IOC was able to take an average annual patient cost of $55,000 while reducing emergency department boarding by 80%, hospitalizations by 30%, and overall costs by 80%. 

Pennington drew from her experience as a provider working to transition to VBC at the Granger Medical Clinic. The programs the clinic has launched and maintained revolve around transitional care management, which focuses on assisting patients with their care after their visit to keep them out of the hospital and to continue taking medical precautions. 

The program dedicated pharmacist staff at the clinic to give a follow-up call to patients after their visit so that they understand their next steps and medication within one to two days. This program resulted in a 15% decrease in the readmission rate of Medicaid patients its first year. 

Pennington said they also instituted home care visits for those who cannot make it to in-person follow-up care. Granger also pursued pharmacy support services, which involved pharmacists meeting with patients to educate about medication, find more cost effective medications, and connect them to more resources to assist them with their prescriptions. 

She said a VBC model is better for payers, providers, and patients. “So it is really helping everybody in the whole system. It works more effectively and is better for the patients,” said Pennington. “Some of our chronic care programs are really helping our patients stay healthier, so they have the energy to do the things they want to do and not feel sick all the time. Everybody wins with these programs.”

Lastly, Milavetz highlighted some of the challenges from the side of the payer. She spoke about the challenge of lacking coordination between health information networks that facilitate the VBC model.  

“You have all of this disparate data that needs to get aggregated, and the challenge is doing that in real time because patients get sick today and they don’t wait three months for the claim to hit,” said Milavetz. 

She also said infrastructure and paying for appropriate care continues to be an issue with transitioning to a VBC model. Appropriate care refers to the right care or treatment for the right condition or complication instead of what the patient believes they need. She said this is challenging especially when providers get paid based on satisfaction scores with CMS VBC models. 

With that said, she described how hard moving to a VBC model will be for Utah. 

“I am a huge proponent of [value-based care] and Regence is betting long on it, but it is hard, ladies and gentlemen, to do this,” said Milavetz. “We need all those voices to come together to make those baby steps forward because I think that is the only way we are going to get there.”