Identify Opportunities
RESEARCH
We conduct thorough research and analysis to pinpoint areas for individual and collective action.
Quality and Patient Experience Measures
We track key trends in healthcare quality and patient trust, two of the core goals of the Utah Model of Care.
Explore the HEDIS/CAHPS Dashboard here
Read the Trust and Cost Report here.
Cost Driver Analysis
We analyze health care spending across the state to identify what is driving up the cost of care. Using Utah’s All-Payer Claims Database, the Medicare database and the HealthCare Facility Database, we look at spending, price and utilization by major service category, chronic conditions, and by market, year, geography, and socio-demographic factors (e.g. age, gender).
Spending Growth Measurement
Each year, we publish the Utah Healthcare Spending Growth Report which tracks healthcare spending patterns and trends across the state.
The Transparency Advisory Committee (TAC)
Hospitals and health plans are required to publish prices for medical services. This kind of price transparency empowers consumers and encourages competition, but it is not always easy to use. The TAC will guide the development of a tool that combines price data from Utah's health care plans and provides data captured in the All-Payer Claims Database and healthcare outcomes/quality performance metrics so that patients can compare the price and quality of providers as they shop for care.
Participating insurers include:
- Aetna/CVS Health
- Cigna
- Health Choice Utah
- Molina Healthcare of Utah
- Public Employment Health Plan (PEHP)
- Regence BlueCross BlueShield of Utah
- Select Health
- UnitedHealthcare (UHC)
- Utah Medicaid
- University of Utah Health Plans
FROM EVIDENCE TO ACTION
Our research has uncovered several areas to reduce costs and improve access for Utahns.
Emergency Care
Research points to a surge in use of the emergency department (ED) for non-urgent care as a key cause of high healthcare spending. We are addressing drivers of inappropriate ED use through patient education; strengthening alternatives to emergency care, including virtual care, primary care and behavioral health care; and assessing payment and benefit design. This initiative aims to create a "right care, right place" model that preserves ED resources for true emergencies while ensuring 24/7 reliability for all patients.
Behavioral Health
Timely access to mental health and substance use treatments can help keep costs low by meeting health needs before they escalate. We are developing the Utah Behavioral Health Payment and Access Parity Dashboard to provide an oversight tool that resolves critical transparency gaps in network adequacy, including identifying 'ghost providers’ which don’t accept insurance or new patients, and reimbursement parity, which requires plans to cover mental health at the same rate as physical health. This work will transform abstract parity requirements into a precise, verifiable safeguard for behavioral health access and pricing across all payers.
Prescription Costs
Rising prescription drug prices and use—especially specialty drugs—are key drivers of overall spending growth. We are conducting a high-level research study of pharmacy benefit managers, examining the flow of drug rebates and discounts, the use of spread pricing and the impact of vertical integration on drug prices. This research will shed light on misaligned incentives in the pharmacy supply chain and opportunities for cost-savings.
Other Initiatives
Dignity in Dying
We have launched a statewide initiative to better align end of life care with patient preferences by improving public understanding, strengthening clinical workflows, and increasing the accessibility of advance care planning tools. An initial workgroup convened in March, and we are now narrowing focus to high-impact workstreams to launch this summer.
Digital Health Interoperability
We’re working to improve real-world application of data to improve healthcare decision-making. These efforts are focused on reducing administrative burden, empowering patients, and improving healthcare data exchange.
Learn more about the Digital Health Interoperability Pilot here.
Colorectal Cancer Screening
Preventative screenings not only save lives they save dollars by catching serious problems early, before they need expensive treatments. We’re working with Screen Utah Initiative to monitor screening rates for colorectal cancer.