OGDEN -- On the day the Utah Office of the Legislative Auditor General released findings of fraud, waste and abuse in Utah Medicaid, lobbyists for healthcare reform were meeting at Midtown Community Health Center in Ogden with area Utah lawmakers to give them ideas on how to redistribute healthcare dollars.
Judi Hilman, executive director of the Utah Health Policy Project, a nonprofit, nonpartisan community resource that organized this "legislative summit," spoke to four legislators, some concerned citizens and a handful of people who have a professional stake in the process.
Hilman said if lawmakers could create new measures to uncover and eliminate fraud in the system, she and others proposed that the money be spent on new Medicaid funding. The new funding she proposes is for audiology and eyeglasses, provider increases for timely access to care, and support for cost-containment strategies this year.
"We know we can't be lavish," Hilman said. "These are services that people will not get because it is not funded."
She said the recent findings of abuse in the system are extensive, but she's hoping they will lead to reforms.
"We want to make sure that everything we are going after for fraud prevention is doable," Hilman said. "Please don't take out your frustration on the beneficiaries. Let's be careful there, but let's be serious about going after fraud, waste and abuse."
Two of the legislators present warned Hilman that any proposals she and others offer for new programs had better be coupled with the kind of cost savings she outlined.
"We are not just going to be cutting the skin off. We are going to be cutting to the bone this year," said Rep. Gage Froerer, R-Huntsville. "I don't believe there is any hope of any increases."
Froerer said most likely any new funding proposals that will be effective will be those that show where money can be cut to fund them.
"Say 'this is where we can cut and this is a higher priority,' " he said.
Rep. Jeremy Peterson, R-Ogden, agreed that times will be tough this year.
"We have deferred maintenance on state facilities for three years," he said, noting that if officials don't start addressing problems like that, infrastructures will start to fall apart.
Other legislators present at the meeting were Rep. Lee Perry, R-Brigham City, and Rep. Brad Galvez, R-West Haven.
Hilman said she supports a state reform bill being proposed by Rep. Jim Dunnam, R-Taylorsville, that makes the following provision changes to Utah Medicaid:
* State reform key provisions moving to the Utah Department of Insurance.
* Streamlining of insurance regulations.
* Amending NetCare to align with the federal minimum threshold.
* Allowing brokers to sell any product on the Utah health exchange.
* Authorizing the Office of Consumer Health Services to create a call center.
* Improving interface between public programs and premium subsidies.
* Reauthorizing a task force for one more year.
Ray Ward, a family practice physician from Bountiful, outlined a way for legislators to realize a significant savings.
It would be for them to pass a law that allows the Utah Pharmaceuticals and Therapeutics Committee he sits on to put together a preferred-drug list for psychiatric drugs.
Currently, the committee can do so only for other types of drugs.
"The state should allow the committee to consider all medications, just like insurances consider all medications," he said.
He said the list for these drugs, which allows for lower-cost drugs when they are found to do the same thing as higher-priced medications, saved the state $20 million last year in Medicaid costs.
That amount was 17 percent of the previous $120,000 budget, he said.
The total Utah Medicaid budget for psychiatric drugs is $59 million, he said. If his committee could realize a similar savings, it would save the state $10 million a year, he said.
The 2010 audit report can be seen at http://le.utah.gov/audit/10_16rpt.pdf.