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January 2010 St@teside

Utah Demonstration Project to Address Overuse of Health Care Services and Payment Reforms

In early 2010, Utah will begin a demonstration project that is designed to prevent the overuse of health care and guarantee that providers are delivering the appropriate care for their patients.  The project stems from a health reform act (H.B. 165) which passed in March 2009 and directed the Office of Consumer Health Services of the Governor’s Office of Economic Development to facilitate meetings between “health care providers and health care payers” in order to organize “demonstration projects for health care delivery and payment reform.”

The goals of the project include:

  • Reducing the health care cost growth rate;
  • Improving health outcomes;
  • Reducing overuse, defects and waste in the system; and
  • Improving the satisfaction of all stakeholders.

While the details of the demonstration still need to be defined, the project will start by examining the treatment of diabetics and pregnant women.  A health care quality improvement organization called HealthInsight is charged with managing the project.

Doctors who care for patients with chronic illnesses, such as diabetes, will receive a monthly retainer fee so they may focus on deciding how best to serve the patient without concern for whether they will be paid by an insurance company.  Christie North, vice president of Utah Programs for HealthInsight, noted that sometimes the best care might involve calling the patient to make sure they are taking their medications.  North also explained that payers and providers in Utah have a “collegial relationship” and that providers are interested in participating in the demonstration project because they hope it will “transition payment systems to something that more closely reflects the value the provider brings.”  The demonstration will publish information about best care, but the manner in which best practices will be conveyed is something that still needs to be defined.  Other key elements that have yet to be defined include quality measurements and benchmarks.

H.B. 165 was one of four bills focused on health care reform that passed during the 2009 general session of the Utah legislature.  The other three bills were focused on medical malpractice reforms, health insurance coverage in state contracts, and reforms to the state’s insurance market.

Source:  “Utah—Demonstration Project to Test Overuse of Medication Services, Payment Reforms,” BNA’s Health Care Policy Report, January 11, 2009.