January 11, 2016

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Article

HEALTHCARE ROUNDTABLE

January 11, 2016

SHEETS: For us, at the hospital, we run into situations where we don't recruit because we feel there's an over-supply or there's enough physicians per capita, especially with some of the specialists. I'm actually under the impression, at least in the Salt Lake area, that there's more physicians per capita than we have a demand for. Might not be in the rural areas. And that might be not in certain specialties. But at least the data I've looked at shows that.

BARLOW: The bigger worry I have is the large portion of the physician population that's over 55. What I normally see with physicians is the retirement decision is usually a sudden one; they're just fed up with the hassles of medicine. As we get into these new eras with a lot of unknowns, the bigger worry is creating a negative work environment to the point where a large cadre of that 55 to 65 is going to say, "You know what? I'm done. I've had enough of this.”

BABITZ: If I go into a large clinic that's well covered with insured patients and I say, "Do you need more doctors?" They say, "No. We're fine. We're great." Got everything they need.

But I go down to a community health center or the homeless clinic or talk to people who are on Medicaid and say, "Do you have enough doctors? Do you have healthcare?" The answer is absolutely not. And I go to some rural areas. Absolutely not. Where you stand will determine your view of the manpower supply in Utah.

Where I sit in the Department of Health, looking at the whole state, I will say we are horribly short, especially in primary care, general medicine and general internal medicine, and in some subspecialities: general surgery, neurology, cardiology. In Salt Lake, yeah, we’re pretty well served. Get out of Salt Lake and Utah County, boy, you've got some problems.

CLAWSON: For primary care physicians, if you're not with some of the bigger organizations, whether it be Intermountain or Revere or Granger, even with us, Physician Group of Utah, there's a lot of independents that are trying to find that relationship and align with someone. So we've developed an independent practice association with around 750 physicians in it, up and down the Wasatch Front. So there are opportunities to get some of these individuals aligned with their practices in organizations.

What do you see happening in population health initiatives? Are we educating the public enough? Are they engaging enough?

BELL: I think this is an exciting new opportunity. From an employer perspective, we're asking ourselves: Maybe there's an undersupply of physicians? But maybe we have over demand for physicians. Maybe we can find ways to be more efficient. Maybe we can utilize physician assistants in a more effective way. Maybe we can install onsite clinics. If  there is waste in the system, maybe we can find ways through better partnerships, partnering with the health plans, to help drive out some of that inefficiency.

I had a meeting with the chair of the department of medicine up at the University who said, "Today about 40 to 45 percent of healthcare delivery is waste." And it's never going to be perfect. It's an art and a science that needs a whole lot of work for sure. But population health, this is really the exciting part of it for us. I would compliment those of you here in the room who are involved with respect to the health plans and providing data to us on behalf of larger employers. Because with the data and with really good analytics we can help employers improve health, reduce risk and lower costs. And that's where it starts, with health improvement. How can you improve health if you don't understand what's occurring within the population, if you don't understand or have a feel for the chronic conditions and whether or not people are managing their health, compliant with their medications, avoiding any gaps in care?

There's a tremendous opportunity with the data to assess an employer's situation, the risk of the population, and help employers develop strategies that improve the health. I've heard that about 75 percent of healthcare costs can be attributed to chronic care conditions. So there's a huge opportunity, and employers are seeing it. And with the availability of data, we can start working on that.

TANNER: In a fee-for-service world, it really compartmentalizes the delivery of care, the trials and errors that we had in the HMO world of the '90s, where it was more about controlling utilization than it was about the delivery mechanism. Population health is really an exciting field. Because now, with data, we're looking at how to keep patients healthier longer and not have the high utilization or the high costs. And really improving the delivery using the total cost of care, using all providers and all information in what is being coordinated for the delivery of that. And it requires that coordination.

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