5 Things Utah: Hospitals & COVID, Crisis response, VBC recommendations


Eli Kirshbaum


This newsletter features an update from Utah hospitals, a report detailing successful crisis intervention efforts, and some counsel on transitioning to value-based care from Castell Health.

As always, thanks for reading!

Eli Kirshbaum
State of Reform 


1. Hospital workforce challenges persist

Despite postponing elective surgeries, raising salaries, and calling in retired health professionals, UHA CEO Greg Bell says hospitals are still facing a crippling workforce shortage—largely the result of staff (many of whom are vaccinated) getting COVID. He says around 20% of staff in every facility across the state are sidelined because they have COVID.

Since travel nurses’ higher salaries place a significant financial burden on hospitals, Bell says facilities have done “everything possible” to train and recruit more health care workers in Utah. “It’s not like there is some untapped pool of nurses or techs out there who are just waiting to get a call,” he says. Helping local universities expand their nursing programs, Bell added, might help alleviate the issue.


2. Registration for 2022 Utah State of Reform now open!

We’re thrilled to have recently opened registration for the 2022 Utah State of Reform Health Policy Conference. The event will be held in person at the Salt Lake Marriott Downtown at City Creek on April 7.

After meeting with the experts on our Convening Panel earlier this month, we are currently in the process of developing our Topical Agenda for this conference. So, keep your eyes out for a breakdown of the event’s panels in the near future. If you already know you would like to join us, you can register here!

3. Report shows success in crisis intervention

Calls to the Utah Crisis Line grew 32% over the past year, during which time it provided 1,353 life-saving suicide interventions. In its recent annual report, the Huntsman Mental Health Institute explains how the Utah Crisis Line and its several other crisis intervention programs saw increased utilization in FY 2021-2022, as well as their role in decreasing the state’s suicide rate.

The report says 79% of adults and 85% of youth contacted by Utah’s Mobile Crisis Response Units had their crisis resolved after engaging with the unit. 92% of the 2,085 Self Care Transition Follow-Up Program enrollees in the past year were referred to services upon discharge, according to the report.

4. Castell offers guidance for value-based care

Intermountain subsidiary Castell Health recently released six recommendations to help Utah transition from a fee-for-service to a value-based care delivery model. These include having providers acquire more at-risk patients to treat under VBC models, restructuring teams and workflows to close care gaps, and using new technology to integrate data sets and overlay them with algorithms to use the data most effectively.

Another one of Castell’s recommendations is to align financial incentives for payers, providers, and patients. “You can educate all you want, you can redesign workflow, but all that stuff is contingent upon changing the way that people are paid,” said Dave Henriksen, VP of clinical operations at Castell.


5. Budget neutrality rules for 1115 waivers

Now an integral part of 1115 waiver consideration, the requirement that state waiver proposals don’t exceed federal spending that would have occurred without the waiver hasn’t always been the norm. In this analysis, State of Reform columnist Jim Capretta breaks down the “budget neutrality” rule that CMS uses in its waiver approval process, explaining that federal statute doesn’t mention this criterion at all.

Budget neutrality first became a standard during the Reagan administration, Capretta says, due to concerns that states would use waivers to leverage more federal funding. He also explains that many states apply for 1115 waivers to pursue programs that don’t need waiver authority, like managed care initiatives, because using a waiver is the only way to direct the saved money from the program to cover additional services and populations under Medicaid.