Health care: as health care continues to play a leading role on the national stage, Utah's industry leaders gathered to discuss local solutions. The group tackled tough issues such as paying for uninsured patients, overutilization of the system and ways to keep top talent practicing in Utah. The leaders also discussed the Affordable Care Act and the Utah Health Exchange.

• Position: Industry Outlook - Interview

We'd like to give a special thank you to Dave Gessel, vice president of government relations and legal affairs of the Utah Hospitals and Health Systems Association, for moderating the discussion and to Holland and Hart for hosting the event.

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What is the state of health care in Utah?

SUNDWALL: Utah's a healthy state. The United Health Foundation ranks states according to their health every year, and while we've been fifth, sixth or seventh in the past, last year we were ranked second. And the No. 1 state was Vermont, and I jokingly say they shouldn't count--they're not as big as San Juan County. Utah is a healthy state for a variety of reasons--our culture, our heritage and the dominant religion health code helps, of course. I jokingly say that it's helpful to be the health officer in a state where half of the people think they may go to hell if they smoke, because those things do impact our health. Regardless, we do have lots to be proud of and be grateful for because of our health status, and it has a lot to do with public health as well as the health care system that we have here.

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JOHNSON: From the workforce side of things, folks in the health care industry are coming back to work, but at the same time the demand in our programs at the universities is just as strong as ever. This year we have more students than we have seen in the past, which means those students are then going to want to get into our other programs, like nursing and respiratory therapy and radiology. So that demand is still really very strong in our state. We still turn people away, unfortunately, who want those degrees.

SANPEI: The economy also has affected health care. We often think that health care is a very resilient industry relative to economic change, and that's true, generally. However, we know that throughout the system, the state volumes are down relative to historical rates. We have had a softening in a lot of elective areas. Even the birthrate in Utah has slowed pretty significantly, much more so than I think we would have thought a couple years ago. As a result of the softening volumes, we're being very cautious about hiring. We are being much more cautious about building, relative to some of our historical trends.

ENTWISTLE: We have a tremendous amount of health care resources in Utah. We have some great systems and great providers. I remember when the recession first hit, I was interviewed by one of the local newspapers and was asked, "Why is health care immune to the recession?" Well, health care is not immune to the recession. Volumes are down. We're seeing fewer patients, maybe because they're making healthy choices, but they're choosing not to seek as much health care as they have before. It's good if they're healthier, but it's not good if they're choosing to defer care.

We're also seeing that even those patients who are coming, who perhaps even if they do have insurance, they don't have as much insurance as opposed to what they had before. More of the onus is being put onto the individual patients, so they're having higher co-pays and higher deductibles, which has resulted, at least at the University Hospital, in a tremendous increase in the patient's portion that they pay, which they haven't been able to pay.

RICHARDS: One thing that I've noticed is that Utah does have a very good health status that we're starting with, but we're also heading into a very tenuous time. And by that I mean the demographics are shifting. We're seeing a greater increase in the levels of obesity. So there's a concern about health status and about some of the increase in chronic illnesses that we're seeing. Also with the demographic shifts, we're starting to see an older population emerge. Overall, I think Utah is in a very good position, but I think it's a very tenuous time. Employers should focus on work site wellness, health and wellness education, and activity levels.

Are you seeing more underinsured or more uninsured patients?

ENTWISTLE: At the University Hospital, we're seeing more underinsured as opposed to uninsured. It's people who come in who may have gone to a high-deductible, high-co-pay health plan who thought they wouldn't ever need to use their health care benefits. And when they do have an incident in their lives, they just don't have the ability to be able to pay that portion that they're now obligated to pay.

McOMBER: We have seen decreases in volumes, too. I think people put off health care when times are hard. A lot of what you do in health care is elective, so people may be going in through emergency rooms or to urgent care centers when something more acute comes up, but they definitely aren't going in for preventative care or other things.

BARLOW: We saw volumes drop for the first three-and-a-half months of the year, but then they spiked again. At this point we're ahead of last year's volume. So our overall volume trends are up this year. However, we are seeing a greater increase in the inability to pay, both underinsured, high-deductible plans--people just don't have the wherewithal to meet those deductible obligations. So there's no question the financial element is getting more difficult.

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MOSER: DentalSelect has noticed almost the opposite in the fact that during the economy our utilization has gone up. Dental preventative care is paid at 100 percent; however, electives and cosmetics have gone down in utilization.

Are Utah's health insurance companies losing business or are businesses not offering insurance to their employees?

RICHARDS: I think over the last two years there's actually been a decline in both, and especially since the economic collapse. Though, we have actually maintained a very high level of our employer groups that renewed. But there's a large number of people who lost jobs, so SelectHealth saw a dip in enrollment. Right now we're seeing that level off and actually increase as we're starting to see more of the stabilization in growth.

HURST: In regards to higher deductible plans--I think that's probably one of the issues facing our economy and how the economy has impacted health care. Employers want to provide insurance to their employees, and with the cost of health care and the cost of...