Legislators target IHC's market dominance

Lawmakers continued to narrow their focus Thursday in the examination of Intermountain Health Care and its dominance of the Utah health-care market.

A three-hour panel discussion with members of the Privately Owned Health Care Organization Task Force and representatives from health care providers that operate in Utah, including IHC, focused primarily on two issues — IHC's stronghold in rural counties and the way in which its hospital and insurance operations work together.

IHC insures about one-fifth of all Utahns and owns or manages 36 percent of the hospitals in the state. That kind of monopoly, said many who testified Thursday, makes it difficult for other companies to provide adequate coverage to their customers.

Insurance providers must contract with IHC to use their hospitals and clinics, meaning they must play the difficult role of both competitor and collaborator, said Dee Brewer, representing Altius Heath Plans.

"In order for us to compete with IHC, we must contract with IHC," Brewer said.

The problem is especially prevalent in rural areas of the state, where the only hospitals are owned by IHC. Without outside competition, IHC can set costs and control access to the facilities, he said.

"The health care machine is so complex," Brewer said. "When one is vertically integrated there are so many levers . . . that can be maneuvered to limit competition in certain geographic areas."

The 15-member legislative task force was created in the last legislative session as a result of a debate over IHC's tax-exempt status and its delivery of health care. Over the next two years, it will review things such as market penetration and business and financial practices of health care organizations, as well as the tax-exempt status of IHC.

Another issue is IHC's refusal to cover many services at hospitals other than its own, said Kim Wirthlin, associate health sciences vice president for marketing and communication for the University of Utah.

"IHC health plans is a large carrier and, in most instances, is unwilling to contract with the university," Wirthlin said.

That means U. doctors can be listed on IHC insurance plans and IHC would cover regular office visits, but it will not cover any services offered through U. hospital facilities. For that reason, the U. has been reluctant to list most of its 900-plus physicians on IHC insurance plans.

"We have to work as a system in order to deliver the best care," she said.