Rich Saunders is the chief innovation officer and senior advisor to Gov. Spencer Cox. Before that, he was the executive director of the Utah Department of Health (DOH).
In this Q&A, Saunders discusses the new Utah Sustainable Health Collaborative and how that will best reduce the cost of care in Utah.
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Patrick Jones: What are you focusing your mental energy on these days?
Rich Saunders: “I think there are a lot of government inefficiencies that we as a team are really trying to root out and figure out how to serve the people of Utah in just the right way. [We are trying to] understand the citizen experience with state government and what state government’s role should be to the citizens in the various and vast array of services that are provided.
Under the Cox/Henderson administration right now, we have, for example, over 450 state websites that citizens have to figure out how to navigate to receive various services. We’re working on a very big project that will consolidate that and make all of that a seamless experience for Utah citizens. More will be coming out on that through this legislative session and in the ensuing months.
Also, [we have] a very broad effort to be able to gather citizens’ experience with state government services and to aggregate that feedback and to create targeted areas of improvement, or even improved processes, experience, and outcomes based on the data that we received from citizens. [In the coming months, we will] see a very loud and clear methodology for people to provide this feedback so that we can hear the citizens, what they’re experiencing, and what we need to do to improve.”
PJ: Can you tell me about Gov. Cox’s new initiative, the Utah Sustainable Health Collaborative? What problems does it hope to address?
RS: “I think the nation recognizes that we are in a health care crisis in terms of soaring costs. We’re on an unsustainable trajectory. Utah’s somewhere around fourth in fastest growing health care costs, but at the same time Utah is also a leader in health innovation and quality of care. Yet the costs continue to just soar. It is becoming harder and harder for employers and individuals to maintain access to health care and it continues to make it harder and harder for people that don’t have access to proper health care to ever have it.
Health care is an economic imperative as well. Over the next decade, rising healthcare costs will continue to stunt Utah’s economic growth. It is constraining employer profits, decreasing employee wages, and crowding out the other state spending priorities because these costs continue to soar. So something has to be done. I mean, we can’t continue with unsustainable cost growth. The health outcomes are not keeping pace with the rate of increasing costs.
I think if you look at the high-level, overall mission, it is to shift the mindset from health care to health, the actual health and wellbeing of individuals. So this patient-centric, neutrally managed, collaborative will focus on sustainable health care and coordinating efforts in order to reduce these costs, then at the same time improving specific health outcomes, population health, and focusing very deliberately on equity.”
PJ: Who right now has interest and who will be active in this health collaborative? How will this convening of health experts be different from other attempts made to reduce the cost of care?
RS: “We have visited many times and gained the absolute support of great and powerful organizations such as Steward Health, HCA, the University of Utah, Intermountain health care, the Utah Hospital Association, legislators, business leaders, public health experts, community-based organizations, insurance payers, and many more. We have a very broad collection of interested people that have the capability to influence this across the state.
One of the ideas that I think makes this very unique is this isn’t going to be state owned. It’s not going to be heavy-handed, top-down mandates that come down to the health systems from the state by law, it’s going to be the organization of this collaborative. There will be [some] funding from the state, but it will require funding from outside sources as well. The idea is to create this collaborative, identify the vision and the mission of this collaborative, and then figure out how to work it so that the money or the politics don’t corrupt the purity of the vision. When it becomes corrupted, then the outcomes may not be what we’re looking for.
We will gather around the table and put these [health experts] together under the purity of this vision and create priorities. These priorities then will become modeled through pilots, and then those that are successful will be able to be presented in a scalable way so that the health systems, payers, hospitals, providers, et cetera can adopt these models. These things won’t be mandated, they will be presented and the [organizations] will opt in. They’ll all be part of it.”
PJ: How does this framework lend itself to actual outcomes? Are there going to be any sort of timelines or metrics put in place to drive those meaningful outcomes?
RS: “[Right now], this is all rough, raw thinking, so it’s evolving as we go. But, the priorities are a correct and pure vision. [We will have] metrics that we will use to determine whether or not the aggregation of these solutions are actually causing the changes that are needed.
We’re anticipating that the movement from where we are to a much better place will take years. We are giving it a 15-year runway but we’re expecting outcomes to start to be realized in the immediate future as soon as next year.”
PJ: What are some other initiatives right now that you’re working on or have planned for the future of your time in this position?
RS: “When you look at the One Utah Roadmap version 2.0 from the health security aspect, the value-based care initiative is among the highest priorities to the governor. We still have a very strong emphasis on responding to the COVID-19 pandemic because it’s still upon us. With the variants that continue to hit us and with vaccinations, what policy issues need to be addressed and how do we help guide the state through that?
We also have issues of continuing to increase access to the right kind of health care that people need in the state of Utah, from expanding telehealth to improving rural access to physical and mental health. Children are a huge priority under access to care. Wherever there are deficiencies in access to care, that’s where we’re focusing.”
This interview was edited for clarity and length.