Utah health-care plan to get trial run

One of the key fundamental shifts in the way medical care is given and obtained in Utah will get a trial run with low-income Utahns covered by Medicaid, the state's third-largest insurance plan.

Taking a basic proposed change deemed vital by those leading a statewide health-care reformation project, a first-time partnership of physicians, pediatricians, employers, insurers and government agencies are launching the Medical Home Pilot Project for low-income Utahns covered by Medicaid and the Utah doctors who still treat them.

The outline of the pilot project was given to members of the Legislature's Health and Human Services Appropriations Committee on Wednesday. Establishing a medical home for health-care consumers is a throwback to the old notion of the family doctor as both primary care provider and also as gatekeeper to specialized procedures.

Health-care reformers have said that making an ongoing doctor-patient relationship is key to improving the overall quality of care, lowering through-the-roof medical costs and inducing much more patient involvement in staying well.

"Medical homes have become a popular notion among a lot of service providers lately," Michael Hales, director of Health Care Financing in the state Department of Health. "It's becoming both the latest approach and the latest buzzword that has a lot of different definitions."

In Utah, a medical home means a consumer chooses a doctor who becomes a personal health coach — coordinating care and providing personalized education support, Hales said. The idea is that instead of paying the doctor to treat a health problem, the medical home pays the doctor to keep patients healthy.

With the walls and the foundation coming apart under the current sick care system, the intent is to induce a broad-based paradigm shift away from payments for procedures — particularly specialized surgeries — to rewarding entry-point primary care providers, designers of the pilot project told the committee.

Dr. David Sundwall, health department director, has been calling for just such a shift for years.

Patients have been separated from the real cost of the services they seek that are in many cases the result of unhealthy lifestyles. The medical home ultimately gets people involved by establishing personal health goals with the emphasis not just on reducing incidents of care but preventing illness as much as possible, he said.

Committee members said the pilot project will lead to unanticipated results, along with some that are expected now such as doctors' resistance to promote wellness over treatment when the current system rewards for procedures.