January 11, 2016

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Article

HEALTHCARE ROUNDTABLE

January 11, 2016

BINGHAM: I see it in two different areas. You've got the large employer, which has been discussed quite a bit, because potentially there is that data sharing for some of the level funded or partial self-funded plans. But there's also a concern with the community rated groups, which is we've seen a dramatic shift in those employers not wanting to initiate or participate in some of these wellness initiatives because they think, well, what does it matter now? I'm just going to get what everybody else is. So that's definitely a huge concern. It’s trying to educate that you are part of a bigger pool—you are part of probably the largest pool in that community rated plan. Maybe it's not going to shift dramatically; you aren't going to see a 10 percent cost savings next year. But 1 percent is 1 percent each and every year.

One of the things we've seen is the stick and the carrot. The stick tends to work a whole lot better for premium reductions and those changes there than just dangling something and hoping people take it. We're seeing more of a success when people are actually adjusting the premiums as an employer, based within the parameters. We're going to have to see more of that if we're going to see more dramatic change or quicker change in some of these programs.

McOMBER: Population health is key, getting patients involved in their healthcare. We know that things people do cause healthcare costs to increase. Obesity causes a lot of healthcare costs. Not controlling your diabetes causes a lot of costs. Not controlling your high blood pressure. So if we can have patients who are participating in their healthcare, who are following instructions, who are doing what they need to do to help increase their health and decrease their costs, we can control healthcare costs a lot better. Population health and having the whole picture, having the provider side of things, but also having the patient participate in that, is the key to really where we want to go in healthcare.

BABITZ: Population health to me means everybody in the state of Utah. I see a lot of folks who aren't in your systems of care. One of the ambitious, strategic goals of the Department of Health is that we should be the healthiest state in the nation. When you think about it, there's no reason Utah shouldn't be the healthiest. We're at number five, which is pretty good. Why aren't we the healthiest? It's because we have about 20 percent of the population who are left out of your systems, and their health is horrible. Their infant mortality, their mortality, their death from cancer, their chronic diseases.

One of the challenges for Utah as a state, which will include all of us in this room, is what can we do to impact the health of our whole population, as well as those in my business, as well as those in my insured group. I don't have an answer for it, but it's a challenge.

SLONAKER: What we see on the frontlines are folks that really just don't understand their insurance. There's a huge deficit in the comprehension in the basics of how to use the insurance. How do I manage my diabetes? How does my insurance work? So are insurers doing enough to educate their members? I think they do a lot, but from what we can tell, especially with these new insurances, it's confusing and they really don't understand some of the basics. And we try to do our best. We have a little packet that we walk through. But time will tell as to whether or not that's going to work.

That includes empowering consumers so they know the questions they should ask of their doctors. You know, it's not all based upon how your insurance works or what their physician does, but rather how they interface. So, for example, asking the simple question: Do I really need this hip surgery? What's the alternative? One of the biggest waste elements is some of these unneeded surgeries.

SHEETS: I was interested in Dr. Babitz's comment about those that aren't in our networks. The perspective from the hospital is everyone's in our network because of our emergency room. People come to my emergency room whether they're SelectHealth, Medicaid, Medicare or uninsured and we've got to treat them. And then they're in our network.

So population health management is very important and it's really needed. And from the hospital standpoint, it's changing. Where in the past we used to think as a hospital, let's just worry about taking care of the patient when they enter the door and when the leave. Didn't really think about where we're discharging them to or what they were doing before they got there. But now, with readmission penalties, possible prior complications that we're monitoring, repeat visitors and frequent flyers in our emergency rooms, we have really got to consider our population.

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