Healthcare Roundtable 2019
This month, Utah Business partnered with Holland & Hart to host a roundtable event featuring Utah healthcare leaders to discuss medical marijuana, mental illness, and innovation in healthcare. Moderated by Dave Gessel, executive vice president at the Utah Hospital Association, here are a few highlights from the event.
What are businesses doing to adjust to medical marijuana use?
Scott Barlow | CEO | Revere Health
We developed the clinical protocols of the mechanics of how to handle it if a patient requests such and has the right indicators. I don’t think anyone’s doing it yet, because there’s still disconcert about their national DEA license through exposure. So, we’re stuck in this middle of where we have the VA licenses and it’s still illegal federally.
The other thing we’ve actually done is we’ve created a clinical pathway in our digestive disease research. The use of marijuana causes tremendous digestive issues actually. So, literally, we’ve created some clinical protocols now and even that some training of our gastroenterology teams, getting prepared for what we think is going to be a significant amount of increase in digestive disease problems that could be a byproduct of marijuana usage.
Jim Swayze | President | Regence BlueCross BlueShield of Utah
I came from Colorado two and a half years ago. In Colorado, there were packaging and dosage type issues. There was what was called “pot tourism.” People coming into the area that maybe smoked pot in college and haven’t done it in years and tried it, and were ingesting gummies and other things like that, and all of a sudden got themselves in trouble because they didn’t realize [how potent they were.] So we need the public service announcements, which was almost funny to see those types of things being publicized. So, I think Colorado did a pretty good job of adjusting to the issues pretty fast.
Because [of the] federal and state laws, most employers still [follow federal law] and do drug screening. That’s probably my biggest concern as an employer. There’s a lot of social issues to work out as well. In a dense area like downtown, if someone is smoking marijuana on their porch, and it’s blowing over into someone else’s area, what should you do with that? I could go on and on as far as all of the types of learnings and things. But I think that it’s good to move forward and I think we need to react quickly to make the changes that are necessary to kind of support it and be very nimble with it.
Bruce Bartholomew | Business Development Officer | OnSite Care
I think that OnSite Care, the clinics that we operate for employers, tend to reflect some of the thinking of the senior management of those employers. But for the time being, we’re currently not prescribing medical marijuana in our clinics, just because of the safety and liability questions that still surround use of medical marijuana in the workplace.
Joe Miner | Executive Director | Utah Department of Health
Utah originally was going to have their own state-central fill pharmacy. That was changed with the special session to be a state central patient portal, but not a pharmacy. So it will be done entirely with private pharmacies, but they have to all go through our state-central portal, the pharmacies, the individuals, the recommending physicians. They can’t prescribe, it’s just a recommendation with some qualifying medical diagnosis that that qualifies [for usage].
If they don’t have a qualifying medical condition, they can go before our Compassionate Use board to determine if an exception should be made for those individuals. Plus, all individuals under age 21 have to go through our compassionate use board, which is a panel of seven physicians that review their diagnosis and whether or not it should be available to these individuals. Obviously, no one should be impaired at work, but they could be impaired from other medications just as easily, maybe even more easily, than from medical cannabis. So, there are some conditions that it definitely could be healthy for.
No one’s going to be allowed to smoke it in Utah. It’ll be pills, capsules, creams, lotions, tincture drops. And there is an inhalant, not the dangerous one that’s causing this lung disease, but an inhaled product that will be available as medical cannabis in Utah. Utah has much stricter controls over it. And so many other states have had medical cannabis, but they quickly transitioned to recreational marijuana. Utah will not do that. I can’t see them ever going to recreational, and we want to control the medical cannabis to a point that it doesn’t become recreational.
What is your organization doing to address mental illness?
Michelle McOmber | CEO | Utah Medical Association
It’s hard to get mental health services anywhere in the state of Utah. We’ve been working to expand out to rural areas to see how we can train primary care physicians better in mental health, etc. Telehealth is an area that we’re looking at and looking to expand to see if we can just expand the resources that we have, but we do need to bring more mental health providers into the state of Utah.
Jenifer Lloyd | Deputy Director | Association for Utah Community Health
The health centers in Utah are working on behavioral health integration, where patients have access to behavioral health services as part of the scope of care that they provide. A lot of them have taken their medical teams and they’re working to integrate the mental health care into the physical healthcare for a couple of reasons. First off, it reduces the stigma for patients in case they’re embarrassed to say, I need mental health treatment. And secondly, for folks with mental health issues, particularly severely mentally ill folks, they’re on medications that impact their physical bodies. [The medications] might affect their liver, kidneys, you name it. So having them get more comfortable being seen in a provider’s office for their physical care makes a big difference.
Brian Carter | Partner | Diversified Insurance Group
Many employers are now embracing technology solutions to provide better access to mental health benefits. We’ve even had employers that bring providers on-site to meet with employees on-site, which at first they were concerned about the stigma of that, but the stigma is being lifted as we see more and more discussion around it.
Scott Schneider | President | GBS Benefits
Our consultants have noticed HR professionals dealing with mental health problems, but they’re not equipped to handle it. They’re not clinicians, they’re not trained, they don’t know what resources are available. So we added a mental health clinician in a partnership with a provider organization here to bring that resource to the table.
We’re starting to analyze the data so they know what areas they have an overall challenge with, but it’s really an educational piece that needs to come to the HR professionals and then the employees. So when they’re faced with a challenge, they know what resource they can point people to. Could be telehealth, could be an onsite clinician, but also it could be some community resources that can help deal with those challenges.
Scott Barlow | CEO | Revere Health
As we look at the gaps here, the access to counselors has gotten much better, but what’s not gotten better is that medical needs to manage the medicinal needs of these patients. We’re kind of in this vicious circle of not having the resources to train the personnel in the medication space. The other thing is how do we teach resiliency? United Way of Utah County has developed a very fascinating program called Everyday Strong, that gives parents and families and school leaders and neighbors just very basic skillsets, on how to start strengthening kids at very early ages so that the resource demands may be within their own homes to a certain degree.
I think there are things like that that we’ve got to get outside of the healthcare system as ways to help build those skills, so that what is really needed is real need, versus skillsets that could be developed in the teenage years and become a strength they have to carry them through some of the challenges of life that we all face at different times.
Marc Bennett | President & CEO | Comagine Health
We do a lot of work at Comagine Health with the Medicare-aged population, and in that population it’s clear that the solutions that work are engaging primary care and helping people with mental illnesses. They don’t want to want to go to a separate counselor. They feel safer in general in that population and so the key is in that integration, making a more integrated experience where people feel connected and have a relationship they can build on. A lot of the effort that we’re engaged in is trying to build the capacity of the primary care provider to be that effective first line of diagnosis and treatment for mild to moderate mental illness and then have a good referral network.
LaTonya Pegues | VP of Operations | Dental Select
I’m coming from the perspective of an employer, and we’re a smaller employer, and so what we try to do are very practical things, right? Because you know your staff when you’re a small employer and you can see people’s behaviors changing, so we do very practical things. For example, I’ve got an employee who has migraines and who has anxiety because of the migraines. So we adjust her schedule. We work with her in coordination to figure out, “Where is it best for you to be the most capable?” So I think sometimes we think about it from such a high-level perspective that we don’t think about it at just the practical level.
What can you do as an employer for your employees? Sometimes it’s removing the stigma. Sometimes it’s having those conversations with people. Sometimes it’s acknowledging your own inabilities, which then make other people feel more comfortable to acknowledge [their own.]
What are some of the most exciting advances in healthcare this last year?
Tricia Schumann | CEO | PitchHealth
From a technology perspective, we’re seeing some AI tools that are as simple as text-based solutions that identify how you’re feeling that day and have some early intervention and preventative tools in place to help people kind of manage on a daily basis, with respect to the younger generation, some social media oversight, and watching the language that some of these young high school students or folks like that might display can also be some early intervention. And this is really critical because most of those people are not going to self-identify. And I think the challenge for providers is patients don’t self-identify. They’re not typically going to walk into a primary care physician and say, “I’m depressed.”
Martin Lipsky | Chancellor | Roseman University
AI is really exciting. So for example, in the dental world, I was trained as a family physician. So I’ve learned a lot about oral health. But I was always told you should go to the dentist twice a year. It turns out some people should probably go four times a year, and some should go once a year. We’re not very good at developing algorithms for identifying that. It’s about personalizing those recommendations.
Kelvyn Cullimore | President | BioUtah
Utah had the fastest growing life science community in the country. That has continued since 2017. We are contributing significantly to the innovation atmosphere that is in life sciences right now. We’re seeing a lot of exciting products come out because we believe one of the ways of helping to contain healthcare costs is innovation. Some companies have come out with new products for artificial skin, which really isn’t artificial, it’s your own skin―an autologous product. We’ve got drug discovery going on here, a company named Recursion is using artificial intelligence and machine learning, advanced technologies, to come out with new products. We’re seeing a lot of really exciting things happening in the state.
Michelle McOmber | CEO | Utah Medical Association
There are a lot of tools that are being used by physicians so that their patients don’t have to come in to see them, so that they can track what is happening to their patients while they’re patients are out. Cardiologists can track what is happening to their patients instead of them having to come into the office.
Mark Robinson | CEO | St. Mark’s Hospital, HCA Healthcare
We’re looking at things that reduce mortality. You take sepsis, for example, in the past you could go into a hospital, aseptic, very, very sick, and you had a 50 percent chance of dying. We’ve put early detection monitors in place to where across our company. At St. Mark’s specifically, we’re right at 30 percent or sub 30 percent right now. We’re doing things that keep the patient at the forefront. You take things talking about innovation and technology, minimally invasive surgery. It’s extremely important to people, but it’s also proven to have less blood loss, get people back on their feet faster, keep people at work, which is what our employers want.
So we opened and created the Utah Institute for Robotic Surgery. And that’s not just so we can say we have a bunch of robots. It’s sticking 25 robotic surgeons that work at St. Mark’s Hospital around the table who have chosen this as the way by which they do surgery to say, how can we be better? How can we share best practices? How can we ensure that we’re working with industry and giving them feedback on these technologies, so the screws are placed correctly, so the robotic arms are going in through one port instead of four ports.
Bart Preston | Director | HCA Healthcare
We’re doing well at investing in lower-cost centers of delivery and care. So it’s not just about the hospital and that, but the investment in urgent care centers across the country as well as outpatient surgical centers and telehealth. So making sure that we’re invested in lower-cost centers to deliver care, we think is also going to be key for the future and making sure that it’s not just about hospital, that there’s a lot of ways of delivering care. We want to make sure we’re doing the most efficient way possible.
Kristy Kimball | Partner | Holland & Hart
Data says that most patients don’t absorb information unless it’s given to them at a fourth-grade level. Not all physicians can communicate that information in a way that patients can really absorb the information. When patients are nervous, they’re not absorbing that information. There needs to be a lot more patient education materials created.
I think in video format, graphics, and almost this animated way that’s tested to make sure that the average patient can sort the information, start to understand what’s happening with their body and their disease state, and the importance of managing their HbA1c, what does that mean? What’s the importance of exercise, managing your weight? How does that affect your health?
How can we improve healthcare in our community?
Cory Moss | Program Director | Weber State University
I think there’s significant opportunity in areas of improvement on the side of patient education. Obviously, for me, as an instructor, and academic, I meet with young students every day. I see them face to face. These are not only potential, and prospective leaders in the industry that we’re in, but also consumers, and we’re taking that approach with them. Healthcare is now a commodity, and these are smart young people. If we don’t help them understand that concept of being preemptive in their delivery of health, and planning, and strategizing for that, the costs associated with what we do are going to destroy our communities, our country, and our economic system. I think we need to focus―instead of on the cost, and the things that we’ve talked about today―on being way more preemptive in education. Education is the key.
Marc Bennett | President & CEO | Comagine Health
Healthcare is approaching a $4 trillion per year industry [in the United States]. It’s still growing rapidly as our population ages, and their healthcare needs increase. This last week there was an article out that said of that four trillion dollars spent, about a trillion is wasted. So, we still have a lot of room to get better in our system. That’s kind of a meta-analysis of the averages, but ranges go a lot higher than that if you look at the more aggressive analyses.
The good news is, because it’s a rapidly growing industry still, and the population has greater needs, there are ways to work on that waste without us feeling like we have to have 20 percent fewer people working in healthcare. We just need to control the pace of growth, as we weed out the waste, and things that aren’t adding value because we still do a lot that doesn’t have value in the system.