Utah Gov. Gary Herbert's health reform summit on Friday repeated well-worn themes.
Rising health care costs are undermining America's economic stability. Growing entitlement programs such as Medicare and Medicaid are part of the problem and the solution. But fixes with any staying power must be state-incubated, private market-based and industry-led.
"By harnessing the collective intelligence and good will of the stakeholders in the health care realm, we can improve upon our current reform efforts, continue to guide the national debate and find new solutions [to] improve the lives of Utahns," said Herbert, recapping his health vision for 500 attendees of a daylong summit at the Grand America Hotel in Salt Lake City.
State employees were there in force, as were hospital and health insurance executives. The event also drew a bevy of consultants, including Mike Leavitt, former Utah governor and U.S. Health and Human Services secretary and founder of the advisory firm Leavitt Partners.
There was no shortage of griping about the "one-size-fits-all" regulations and uncertainties of federal health reform.
But Herbert said, "We're not here to whine or complain ... but to roll up our sleeves and find Utah solutions."
Until now the governor has said little on the politically toxic subject of health reform. On Friday he made clear that his focus will be to build on state-based reforms started years ago:
• A data superhighway that will one day allow a doctor in Moab to share critical patient information with an ER in Salt Lake.
• Plans to steer low-income Medicaid patients into Accountable Care Organizations that pay doctors to keep patients out of the hospital instead of for services billed.
• Creation of an online insurance shopping tool, one of the nation's first health exchanges.
Herbert signaled a willingness to revisit tort reform and open Utah's Health Insurance Exchange to large employers. The web portal is now reserved for small business owners and their employees.
But he left the brain-storming of next-generation reforms to panels of industry leaders. The governor set no deadline, asking only that panelists focus on payment reform, health information technology innovations and efforts to contain costs through promoting healthy lifestyles.
Utah's reforms focusing on expanding private insurance options for consumers have been painted as a foil to President Barack Obama's signature overhaul. But they share the same goals and some of the means for achieving them.
Pooled insurance markets, or exchanges, for example, originated with the conservative think tank the Heritage Foundation but morphed under Democrats, said the foundation's senior health policy analyst, Edmund Haislmaier, who attended Friday's event.
"It isn't whether exchanges are good or bad. That's like asking if a hammer is good or bad," Haislmaier said. In Utah's hands the tool continues to hold promise, he said, referring to its design that allows employers to make defined contributions toward workers' insurance costs.
But the exchange hasn't yet delivered on the three pillars of health reform: reducing cost and improving the quality of care and access to care. Though enrollment has picked up, surpassing 4,000 customers this year, that's fewer than 1 percent of Utah's 400,000 uninsured.
Herbert said the initial plan was to start slow and experiment with what works before scaling up to accept more shoppers. The time for adding large employers is now, he said.
He stressed the exchange will not be government-run. The tentative plan is to hand it to a nonprofit or quasi-public agency.
Doing so shields state politicians from having to enforce unpopular provisions of federal health reform, such as the requirement that people purchase health coverage or face a penalty.
All signs point to Utah having to bend its exchange to meet federal standards, a transition that Herbert has entrusted to an advisory board wholly composed of industry executives. It replaces the exchange's original advisory panel, which under state law is supposed to reserve two seats for "community-based, nonprofit organizations" representing consumer interests.
There are still plans to add a consumer, said the exchange's director, Patty Conner.
Filling that role now, she said, are executives from Utah's two largest nonprofit hospital chains, Intermountain Healthcare and University of Utah Health Care. Chairing the committee, which met for the first time on Wednesday, is Greg Paulson, Intermountain's vice president of strategy.
Reporter Robert Gehrke contributed to this report.
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About the Utah Health Exchange
The exchange is an online portal where consumers can shop for insurance bargains much like travelers hunt for deals on Travelocity. The site Exchange.utah.gov is now open only to small businesses with 2 to 50 employees, who comprise a large share of the state's uninsured.
How it works
The company must be headquartered in Utah with buy-in from 75 percent of its employees.
Employers make deposits called defined contributions into an account. Workers can couple that amount with other funds, such as a contribution from a spouse's employer.