Identifying Potential Overuse of Non-Evidence-Based Health Care in Utah

Reporting years:

2022 | 2021

In 2020, H.B. 195 – Identifying wasteful healthcare spending, which enacted UCA §26-33a-117 -Identifying potential overuse of non-evidence-based health care was passed. The law requires the Department to contract with a nationally-recognized health waste calculator, to use the calculator to analyze data in the state All Payer Claims Database and flag entries the calculator identifies as potential overuse of non-evidence-based care. Additionally, the Department, or a contractor, is required to:

  • Analyze the data, review scientific literature about medical services that are best practice and literature about eliminating duplication in healthcare
  • Solicit input from Utah healthcare providers, health systems, insurers and other stakeholders regarding:
    • Duplicative health care quality initiatives and instances of non-alignment in metrics used to measure health care quality required by different health systems, and
    • Methods to avoid overuse of non-evidence-based health care;
  • Present the results of the analysis, research and input obtained to the Utah Health Data Committee.

Subsequently, upon the Department’s presentation to the committee, the committee is expected to make recommendations for action and opportunities for improvement based on the results, recommendations on methods to bring into alignment the various health care quality metrics different entities across the state use, and identify priority issues and recommendations for inclusion in an annual report. Lastly, the Department is tasked with compiling a report, and submitting it to the committee for approval, ahead of submission to the Health and Human Services Interim Committee, on or prior to November 1st of each year.