Healthcare Industry Looking for Reform

The healthcare system is unsustainable as it currently stands and needs reform from a provider, policy and patient standpoint. Costs are rising faster than inflation, patients need to take more responsibility, more transparency is needed and healthcare delivery has to change, said a group of industry insiders at Utah Business magazine’s healthcare roundtable Tuesday morning.

There’s a love/hate relationship with the Affordable Care Act (ACA), said Ryan Bingham, Spectra Management partner and benefits advisor. He said the legislation creates opportunities for some people, but the potential for increases in healthcare costs for employers is causing many people to waver between support and non-support.

While the election could change some things about the healthcare legislation, Dean Sanpei said reform is still ultimately needed and momentum for it is growing. Sanpei is a state representative and vice president of strategy at Intermountain Healthcare.

“If you get past all the reform elements, there are still the underlying issues with healthcare access, there are the underlying issues associated with healthcare expenses and the healthcare growth current,” Sanpei said. “And all those things the industry is going to have to respond to regardless of who’s in the White House. So much of this evolution that’s begun is going to continue…Those kinds of shifts in the industry are going to continue.”

Scott Barlow, Central Utah Clinic CEO, said there is still a lot of confusion in regards to the regulation and fraud abuse side of the ACA that will have to be made clearer before it can be implemented properly.

From an overall health standpoint, providing more people with care is a good thing, however the legislation brings other challenges, said Vivian Lee, senior vice president and CEO of the University of Utah Health Services. The ACA will create a larger demand on services at the same time as healthcare providers are being pressured to reduce costs.

She said the hope is care will shift from emergency rooms and other urgent care facilities to primary care. But there currently are not enough primary care physicians to manage that increase. “There’s going to be an enormous shift and whether or not the system is able to manage that shift fast enough and effectively enough is the question,” Lee said.

At the same time that healthcare policy and providers are changing, patients also have to get more involved and take more responsibility for care, the attendees said. Barlow said employees who have started to use a health savings account (HSA) have discovered what their healthcare really costs and started taking steps to reduce those costs. If more people understood the costs and tried to reduce them, he said it would reduce costs for everyone.

Michelle McOmber, Utah Medical Association CEO, said people also have to take responsibility for decisions that affect their health, like good diet and exercise. Healthcare providers can only do so much if patients don’t also work to stay healthy, she said.

Lee agreed, but added that unhealthy temptations are everywhere and employers could do a lot to help by having healthy vending choices, onsite clinics and encouraging other healthy choices.

The expansion of Medicaid is a hot topic, with most attendees agreeing that having more people with access to primary care is good, but the financial implications are problematic.

Sanpei said, “The notion that expanding Medicaid by 56 percent, which is what it would equate to for Utah, is free is ridiculous. That expansion has a significant cost associated with it…Generally speaking, I would boil it down to this: we ought to reform the system that we have in place, curb that cost trajectory and then add individuals to that as we can.”

Lee said the national and state healthcare system also needs to look to the future supply of healthcare providers. “The demand in the system far exceeds capacity right now,” she said. Utah is one of the lowest in the country for primary care physicians per capita, while having the country’s highest population growth. The University of Utah is looking to expand medical school class sizes and promote other mid-level care providers, like medical assistants, to help doctors.

The Healthcare Industry Outlook will be in the December issue of Utah Business.