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Utah Business

Healthcare Roundtable

Healthcare Roundtable

Every month, Utah Business partners with Holland & Hart and Big-D Construction to host roundtable events featuring industry insiders. This month we invited the top healthcare specialists to discuss medical marijuana, mental health resources, and transparency in the industry. Moderated by Dave Gessel, executive vice president of the Utah Hospital Association, here are a few highlights from the event.

If the Medicaid expansion passes, what will it do for our state and who will it affect?

 

Jeana Hutchings | Benefits Practice Leader, Principal | Diversified Insurance Group

The purpose of the ACA was to provide subsidized insurance to this population that was not getting it from their employer. We still have that gap now, this many years later. So for groups that are under, that are not required to provide insurance, if they have lower-income workers, they probably aren’t offering coverage. Many employers have moved their employees to part-time, they have two part-time jobs, and they don’t qualify for employer-subsidized insurance anywhere. But if a group is over, they are still required to provide affordable coverage to their employees. But they still have to pay a certain percent of a single premium, so for the rest of their family it’s still unaffordable. And so the family is going without coverage as well.

Dr. Donna Milavetz | CEO | OnsiteCare

The big challenge is that reimbursements for Medicaid traditionally have been really low, and primary care providers specifically have really been reimbursed at a loss for their services, which makes it really challenging to actually see the existing number of Medicaid patients. So the question that I have for the group is how does that impact Medicaid expansion for our state?

Alan Pruhs | Executive Director | Association for Utah Community Health

It’s going to require some different ways of thinking between Medicaid, ACOs, and the system. So whether it gets down to different types of payment structures, whether it’s taking risk on at the primary care level, whether it’s upstream or downstream risk, and are you going to pay them to manage the patient and what does that mean? Primary care is typically the last to be thought of when it comes to those bundled payments or different ways of looking at that, but that’s an area that has to be discussed in the future.

Matt Slonaker | Executive Director | Utah Health Policy Project

More importantly for me is the financial protection aspects of having insurance, something like Medicaid, as a backstop for families that are uninsured and experience something like a cancer diagnosis and have ongoing care that gets into the tens of thousands of dollars―it’s the leading cause of bankruptcy. We think about healthcare access, but, really, it’s about financial protection and protecting our workforce from going bankrupt and just having catastrophic events in their families.

What does the legalization of medical marijuana mean for citizens, providers, and the business community?

 

Marc Bennett | CEO | HealthInsight

Federal law still says I can’t employ anybody who is using marijuana. So for the federal government to sort of just abdicate this to the states is an irresponsible position in relation to the challenges that we’re going to face here in Utah, going forward. We can do what we can do at the community level, but we still need to push our delegations and Congress to take a more responsible federal position.

Dr. Donna Milavetz | CEO | OnsiteCare

There needs to be a lot more education. So just from drug screening, as an example. So I’m an employer. I have a lot of doctors and a lot of advanced practitioners, and I do drug screens, both pre-employment and random. And what happens if one of my doctors, who has medically prescribed marijuana, tests positive? This is uncharted territory for our state just from an employment law standpoint that we are just scratching the surface on.

Scott Schneider | President | GBS Benefits

We consult in Colorado, Arizona, and Nevada, three areas that have just added this, and it’s gray, so employers don’t know what to do for an employment law. So we’re trying to build guidance, but also you’re caught in the middle between federal and state. You really can’t give guidance that tells you how to operate when the federal and the state laws conflict with each other.

Brent Williams | CEO | Dental Select

From an insurance company employer’s perspective, we have a zero tolerance policy, because it really conflicts with HIPAA. We have so many federal laws that we have to comply with, and this is against federal law. And if we allow it, and a federal law is broken, it’s going to fall on us.

Michelle McOmber | CEO | Utah Medical Association

In our coalition and in this issue, we have a lot of businesses that have participated and said the issue is what do I do exactly with this drug testing? And if we have zero tolerance, what do we do? And that’s why they have pushed back against even bringing it into the state, because of this whole issue. So the businesses have said, as long as I have the right to still say that we have no tolerance and that we have the right to drug test, et cetera, then that’s when we would go along with saying that you still have the right to say that as an employer.

What are you doing in your organizations to improve the opioid crisis?

Dr. Joseph K. Miner | Executive Director | Utah Department of Health

Last week we had a news conference where we announced that, for the first time, we’ve had a reduction in not just prescription opioid overdose deaths but also heroin overdose deaths.

Alan Pruhs | Executive Director | Association for Utah Community Health

A lot of it was just creating a heightened awareness and then providing the training to the providers; first of all, taking a look at your own prescribing habits. And then, really, we took it upon ourselves to start to look at what do we do as a system to actually treat those individuals who are addicted and want a different approach. Not everybody needs inpatient treatment and intensive stays. So we’ve trained our eligible workforce to become MAT waiver trained and certified.

Mark Robinson | CEO | St. Mark’s Hospital

A lot of people utilize ERs as that place to say, “I lost my medications, I need a refill,” and we redirect those folks. We won’t give those refills anymore or just prescribe them a med as a quick solution to get them out of the ER. We’ll redirect to those specialists that are trained in chronic pain care over time.

Christopher Steen | COO | Revere Health

We’re pulling in all the sources of information so that when a doctor is looking at that patient, he can really see where they’ve been over the course of the last six months, one year. But we’re still struggling with the technology to actually pull all that together so they can actually see this is a challenge.

Dr. Joseph K. Miner | Executive Director | Utah Department of Health

Many people who are dependent or addicted to opioids initially became dependent on someone else’s prescription. These are just pills out there sitting in peoples’ cabinets. So just having less pills out there. And if you don’t use them up, have them disposed of and taken back. It is critical to not cut people off cold turkey either. Get them into medication-assisted treatment. Otherwise you are driving them to the streets and onto heroin and many worse problems and then you lose contact with them. You’ve got to keep them close to you to help them with this disorder.

Dr. Donna Milavetz | CEO | OnsiteCare

Not all pain also is physical pain. I think it’s important to note that there is a lot of pain that needs to be treated in our behavioral health sort of community, that we have a dire need of resources. And until we marry the two of those, and take them out of those silos, I think we will continue to have a challenge.

What would you tell employers as to what resources are out there?

Dr. Joseph K. Miner | Executive Director | Utah Department of Health

Utah has the fifth-highest suicide rate in the nation per capita. We need to include the brain with the rest of the body in primary care clinics and not separate those.

Alan Pruhs | Executive Director | Association for Utah Community Health

We’ve been working just recently on a push to really promote greater integration of services, meaning how does the provider and the behavioral health staff work together, how are they both screening. It’s also added pressure for the primary care physicians. Now we want them to be mental health experts, substance use disorder treatment experts, and the burden just continues to be falling onto their shoulders. We’re experiencing a sort of physician wellness burnout.

Dr. Donna Milavetz | CEO | OnsiteCare

One in three diagnoses is for mental health-related issues. So we have taken the employee assistance programs (EAP), and we’ve brought our counselors right into our clinics to case manage with, to see patients alongside of. Because if you can manage life skills management issues with patients right from the beginning, then you can avert a fair amount of issues that go a long way in terms of that co-management. Most employers support EAP programs. Why not leverage that resource that employers are already paying for, that are widely underutilized and lets bring them in-house and advocate and continue to push this as an enhanced benefit in the employer-based space. Put it in every bathroom stall in your business to let people know that there are resources that are out there that are a huge benefit to them that has cost as a non-barrier.

Michelle McOmber | CEO | Utah Medical Association

One of the things that we are trying to do in Utah is to expand the psychiatrist shortage that we have through Telehealth. So if the patients can’t come to them and if the psychiatrists can’t go to them, to at least have the psychiatrists available through Telehealth to help.

Jeana Hutchings | Benefits Practice Leader, Principal | Diversified Insurance Group

In one of our onsite clinics, every visit you see mental health at the same time, they have put it right in and working tandemly together. If you are accessing mental health in your primary care office, there is less stigma, because it’s just part of your overall treatment versus having to leave work during the middle of the day, go to a mental health provider. We have to be innovative with solutions.

What are we noticing in regards to health insurance?

Matt Spencer | Founder | Association Health Plans

Carriers are withdrawing from the market. We have fewer players. Some carriers are refusing to write individual plans. Small carriers are struggling and selling to medium-size carriers, who sell to larger carriers. There is less need to be competitive, and prices can rise. But I see innovation coming because of that. The Association Health Plans is one idea in that regard.

Dr. Stephen Neeleman | Founder & Vice Chairman | HealthEquity

We’ve done a little bit better at trying to spread the message that HSAs aren’t the cause of all these high deductibles; they are actually the antidote. The HSA has these unique tax benefits better than a 401k or a Roth IRA. It’s truly tax free on both what you put in on a growth and on a spend, provided you spend it on healthcare.

Jeana Hutchings | Benefits Practice Leader, Principal | Diversified Insurance Group

Providers need to compete on cost and quality. And we’re seeing some of that with the transparency tools that we have, but we’re not allowed to do it because of these preferred provider organization (PPO) networks protecting everyone and protecting their discounts as medical groups. It’s causing increases and not allowing employer groups and employees to be able to make better healthcare decisions.

Tricia Schumann | CEO | PitchHealth

We talk about the consumerization of healthcare. One of the most critical aspects of that is access to your own health record. HSAs were really a catalyst to not only allowing that shift to the consumers so that their behavior changes, but they also have the ability to access different types of care, different points of care.

Jeana Hutchings | Benefits Practice Leader, Principal | Diversified Insurance Group

But it’s not trickling down to us to be able to use as employer groups.

Dr. Stephen Neeleman | Founder & Vice Chairman | HealthEquity

We have this debate, should people be making money off of Utah’s all-payer plan database. The general attitude is anything that we can do to help the consumer make better choices. And so I’m sure that makes the proponents of PPO price a little nervous.

Scott Schneider | President | GBS Benefits

With larger employers, they’ve had access to their data for many years, but they don’t know what to do with it. You’ve got to have a team that comes together with real goals that says, “okay, we’re going to analyze the data at analyst level, find those unique outliers, and then bring in physicians, other experts to look at it.” You can get a handle on where the things are that need to be improved. And then if you actually take those actionable steps, you can have a real great outcome on your healthcare costs.

Dr. Donna Milavetz | CEO | OnsiteCare

We really need to come together as a business community and demand better data. Why is it that the largest insurance company in our state doesn’t have a transparency tool on cost? It has it on provider quality, but I can’t get anything on pricing. The second thing is that we need to arm our clinicians with, is what a transparency tool does. And we need to have time in our day to be actually able to digest this data.

Dave Gessel | EVP | Utah Hospital Association

With the all-payer database, it’s already there. It gets to the question of, are we just back-dooring a single payer system by doing that, because if that information came out to the public, you are essentially setting a rate of what it’s going to be for a doctor or a hospital. That’s why there is such a lot of foment on that. But I don’t know of another industry where the government is directly saying, this is what you will pay for a car; this is what you will pay for your groceries.

Dr. Stephen Neeleman | Founder & Vice Chairman | HealthEquity

I mean, gas stations, you know what the price is.

Dave Gessel | EVP | Utah Hospital Association

Do we? Just yesterday I found a difference in a mile. They are not really setting the prices.

Dr. Stephen Neeleman | Founder & Vice Chairman | HealthEquity

But it’s up on the billboard. You can choose. If you want to drive a little further to Costco, you can make that choice. But I think the point is you can’t make the choice now because you don’t know what the price is.

Marc Bennett | CEO | HealthInsight

The way we are thinking about the solution in Utah is to do sort of total cost of care measurement instead of just trying to measure individual prices but actually measuring by person and by provider how much it costs to provide the care for their population or for that individual, and measure it up so it’s actually a metric that we can see whether we’re impacting total cost at the individual provide level, at the state level, at the community level.

David Tanner | CEO | Granger Medical Clinic

Transparency also requires a little more data sharing on patient activity at the physician level. We’ve got software and capabilities that has helped on discharge planning, but interoperability at the time of and the point of care would solve so many crises.

Michelle McOmber | CEO | Utah Medical Association

There is a difference between cost versus payment. Physicians don’t know how much drugs cost when they send a patient to get a prescription. In order for providers, for physicians, to make good choices, we need that information. But if you are on a plan, you only have particular places to go. And sometimes it is not lowest cost or anything else, it’s just you have these three places that you can go to. Transparency isn’t necessarily that you have the lowest cost. But transparency is very important in terms of making choices.

Dr. Donna Milavetz | CEO | OnsiteCare

If we don’t arm our clinical providers with data in knowing what the cost of care is, we can’t be part of the solution. We continue to be part of the problem. And there is nowhere in medical education that we talk about basic business principles in medical school, nor do we talk about pricing. As a business community, we need to come together and push that agenda along. It has nothing to do with HIPAA; it has everything to do with money.

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