Intermountain Healthcare

Summary

Established in 1975, Intermountain Healthcare is the largest healthcare provider in the Intermountain West, providing both care and coverage in Utah and southeastern Idaho. Intermountain operates 22 hospitals and over 185 clinics in the region. It also operates SelectHealth, which provides insurance coverage in the region.^[1]

Intermountain operates with a dedicated emphasis on innovating to create an affordable and sustainable health system. In operating both as a healthcare system and as the insurance provider for a large fraction of the people they treat, Intermountain Healthcare takes accountability for its own costs, and reaps the benefits of any health improvements and cost-savings that it can achieve among its population. One way SelectHealth promotes cost-savings is by requiring health screenings, therefore avoiding delays in care that can lead to later high costs. In exchange, SelectHealth is able to guarantee its members that health insurance premiums will rise at a substantially lower rate than most major insurers.^[2]

Because it has taken on a model based on lowering or preventing costs, rather than a strictly fee-for-service model, Intermountain places a strong emphasis on population health, focusing more heavily on “upstream” factors to maintain health, prevent disease, and reduce long-term costs.^[3]

One of Intermountain’s most prominent examples of its population health approach is its LiVe Well initiative, a comprehensive wellness promotion effort that uses a variety of educational resources, games, and online tools to encourage and support everything from healthy eating to pregnancy to health in schools in workplaces.^[4]

Keys to Success

Emphasis on prevention

Through its LiVe Well initiative, and its focus on population health more broadly, Intermountain Healthcare puts effort into disease prevention to a degree far beyond most U.S. hospital systems. Beyond just treating individual patients, Intermountain Healthcare’s central goal is to sustain the health of its entire patient population, working to keep patients out of its hospitals and clinics whenever possible. This focus on avoiding the need for care at scale, not just delivering care, makes Intermountain a leader in the effort to design a more affordable, sustainable healthcare system.

Accountability for cost reduction

While most healthcare systems in the United States operate on a fee-for-service model that, many argue, incentivizes care rather than health, Intermountain, through SelectHealth, sets overall cost limits regardless of services provided, thereby establishing a model where the incentive is all about minimizing healthcare costs. The most important means to accomplish this is by avoiding unnecessary treatment, and preventing or delaying costly conditions or complications whenever possible. In this way, the same things that are good for the patient – sustained health, prevention of disease, lower costs, and avoidance of unnecessary treatment – are also good for the healthcare system.

Focus on patient engagement

There is a heavy emphasis on making care easy and convenient for patients when they are receiving care, and engaging patients in healthy behavior when they are outside of the care setting. Intermountain offers Connect Care, which allows patients to have 24/7 digital access to urgent care through their computer or mobile device. Intermountain’s TeleHealth offerings range from diabetes education to newborn care.^[5]

When patients aren’t receiving care, Intermountain still works to encourage health engagement through their LiVe Well initiative.^[6] The LiVe Well Health Library, freely accessible online, offers extensive educational resources. Likewise, the LiVe Well campaign offers information on everything from healthy recipes to directories of weight management classes to recommendations for local hiking and biking routes in Utah.^[7] Intermountain Health’s SelectHealth plans require patients to engage in healthy behaviors, and the LiVe Well resources give patients the tools to do exactly that.

Ability to Inspire

Intermountain Healthcare has received numerous awards for innovation in healthcare, including a Microsoft Health Innovation Award in 2015 and the Hearst Health Prize – recognizing outstanding achievement in managing or improving health – in 2017.^[8] In 2016, the SelectHealth models were featured in the New York Times in an article titled, “A Novel Plan for Health Care: Cutting Costs, Not Raising Them,” which highlighted SelectHealth as an innovative model for higher quality, more cost-effective healthcare.

Cost Effectiveness

Many of Intermountain’s strategies have already been demonstrated as cost-saving in significant ways. One example – a protocol intended to reduce C-sections and elective induced deliveries by creating a defined set of criteria for when an elective delivery is appropriate – saves an estimated $50 million per year in Utah and could potentially save $3.5 billion per year if applied to the entire United States.^[9] While the long-term cost savings of SelectHealth plans are yet to be determined, Intermountain Health has estimated that its methods, which aim to prevent the need for high cost care, will result in $2 billion of savings over the next five years.^[10]While this cannot be traced or credited to Intermountain’s efforts alone, the state of Utah had, in 2014, the lowest healthcare expenditure per capita of any state in the U.S., fully 25% lower than the national average.^[11]

Drawbacks & Limitations

SelectHealth is Utah’s largest insurer, making up over 40% of all group health plans and over 50% of all individual plans.^[12] Because SelectHealth, not to mention Intermountain’s 22 hospitals and 185 clinics, serve such a substantial proportion of the region’s population, Intermountain and SelectHealth are likely to reap the benefits of their own investment in overall population health. By contrast, a health system with only a small market share of any given region may have less incentive to invest in the health of the region’s entire population, as a different hospital system and/or insurer is more likely to reap the benefits of long-term cost-savings.