Q&A: HEALTHCARE Roundtable.

• Position: Industry Outlook - Discussion

Utah's healthcare community is facing an uncertain future due to the shifting tides of health reform, an ongoing opioid crisis and a new effort to set health policy at the ballot box. Here, healthcare leaders take on these issues and more.

PARTICIPANTS

SCOTT BARLOW

Revere Health

BLAINE BENARD

Holland & Hart, LLC

BRIAN CARTER

Diversified Insurance Group

DR. EDWARD B. CLARK

University of Utah

Health Sciences

MICHELLE MCOMBER

Utah Medical

Association

DR. DONNA MILAVETZ

Onsite Care, Inc.

DR. JOSEPH MINER

Utah Department of Health

DEB ROSENHAN

Spectra Benefits

JIM SHEETS

Intermountain Healthcare

MATT SLONAKER

Utah Health Policy Project

BRENT WILLIAMS

Dental Select

PREMIER SERIES SPONSORS

BIG-D CONSTRUCTION

HOLLAND&HART

MODERATOR

A special thank you to Dave Gessel, executive vice president of the Utah Hospital Association, for moderating the discussion.

Q&A

How has the uncertainty surrounding the Affordable Care Act and healthcare reform impacted your organization?

CLARK: It was 51 years ago this fall that I started medical school, and so I have been watching this evolve over time, come through Medicare and Medicaid, through the HMOs in the 1980s, through the aborted Clinton approach to healthcare. This is the most unsettled time that I've seen in healthcare. Virtually every dimension of what we're dealing with as providers, as insurers, as teachers of the next generation, has a level of uncertainty that has not been that intense over the last 50 years.

Communities throughout the country are all approaching it differently. As I talk with my colleagues across the country, there is what I would call a Hapless Harry approach, which is where the sky is falling. Then there is a more thoughtful approach in pinpointing the dimensions we have some control over, recognizing where we have little or no control, and attempting to navigate through this. Looking at our insurance industry, looking at how to adjust and adapt to some of these changes.

This can be viewed as a threat. It also can be used as an opportunity to really coalesce and develop a system that will work for us and work for our community.

BARLOW: Any long-term plan or investment is really difficult to make right now, just because you don't know what that future is going to look like.

For us, the biggest challenge we still face is better coordination, better collaboration. But you still have a regulatory environment that precludes a lot of that--antitrust rules, anti-kickback back rules. So as we have seen ways that we believe we can make care better with better coordination and collaboration, we are bumping against regulatory statutes that haven't changed, simply because they don't want to change yet because they don't know what the future holds from that federal side.

SLONAKER: Utah Health Policy Project works on policy, but it also directly serves consumers, patients, in helping them find health insurance options. Well, we got our primary grant cut by over half, and that grant actually helped a number of community-based organizations that help vulnerable populations enroll in healthcare and also locate care. That's been pretty traumatic for that community. And these are our most vulnerable neighbors that get these services. We are doing our best to make up for the gap, but we're talking about a cut from about $750,000, which doesn't seem like a lot, but we do quite a bit with very little. We had quite a few navigators, about 17 or 18, working out in the community with that money. That funding was cut down to $290,000. We hoped to work with local partners, frankly, to try to build that back up. Because this isn't just enrolling into the Affordable Care Act, it's also enrolling into CHIP, Medicaid.

MCOMBER: We do need to focus on costs and we do need to focus on care, but with the uncertainty, we see both sides kind of not knowing where we're going. Providers are looking at it, saying, "I don't know how to plan, I don't know where I'm supposed to put my dollars, I don't know where I'm supposed to put my focus."

And on the insurance brokers' side, you are saying we need to focus on costs and everything, but again, we have this bifurcated system. Well, where do we go? Because we're looking at this uncertainty, saying, "Well, are we going to repeal the Affordable Care Act? Are we going to completely replace and repeal? Are we going to replace parts of it? Are we going to look more at cost side of things? Are we not going to look at cost side of things?"

Because of the uncertainty, we aren't focusing on things like cost and quality care. If we could have more certainty in the marketplace, we could focus on some of those things, but we don't have it, and that's why we are in this place that we're in.

MILAVETZ: I take a slightly different approach in that I look at populations. So when I look at the Medicare population, it's definitely different than the commercial market population. And within the commercial market population there are large groups and there are smaller groups. And then there is the individual market. And each of them are affected differently within that scope of what the ACA currently is now and what the future might look like.

Large groups...