Utah may have 'blind spots' in addressing mental health concerns, new audit finds

SALT LAKE CITY — As spending on mental health-related emergency room visits has increased in recent years, a new report says Utah policymakers have underutilized a database of insurance claims that could be used to shape policy around public health, potentially leading to "blind spots" in addressing mental health issues.

The audit, presented to state lawmakers Tuesday, is the latest in a series looking at the state's behavioral health system and follows recommendations that the state adopt a central oversight authority and create a strategic plan to reform the system.

Legislative auditors focused on the state's All-Payers Claims Database, a statewide collection of health care claims from private and public insurers, and recommended better data sharing within the state Department of Health and Human Services to guide policy to protect public health.

"The All-Payers Claims Database could support more informed behavioral health policymaking and decision-making," auditors wrote. "However, the Behavioral Health Commission and the Department of Health and Human Services lack a strategic approach to utilizing the data. Without a more informed approach, the department and commission risk making decisions with significant blind spots."

Utah created its claims database in 2007, but the state is one of only two with similar databases that don't define the purpose of the database in state code, auditors note. Colorado code states that its database be used to "improve health outcomes, patient experience and cost control," the report states, while Oregon's is designed to "help health care policymakers make informed choices, identify demands for health care and evaluate the impact of health intervention programs."

"Behavioral health is something that can be tricky to measure, and there's a lot of great information that can be used within the (database) to help get at some of these measurements, to help us progress monitor on some of the initiatives and policies in the state," Nick Varney, audit methodologist, told lawmakers Tuesday. "This can help the Legislature really examine the trends that exist, look at the policies that have been passed and initiatives that have been created and see if the trends that we're trying to bring down are in fact coming down."

Colorado has also used its database to estimate changes in visits to the emergency department for mental health and self-harm and auditors replicated the study in Utah, finding that the spending on emergency room visits related to mental health has steadily increased since 2016. They found that depression, anxiety, alcohol related disorders and "suicide-related encounters" are the primary diagnoses leading people to visit the emergency room with mental health concerns and that substance use is the most common method of self-harm for those who end up there.

But that data and similar studies are not regularly presented to lawmakers, meaning they may lack a full picture of what's going on, the audit says. The Legislature directed health officials to track wasteful spending using the insurance data in 2020, which identified wasteful spending on "anti-psychotic medications and opiates for lower back pain," but that was the only instance in which auditors were able to locate lawmakers using the database to set policy.

"Eventually, wasteful medical spending reports were discontinued after the Legislature removed their funding," they wrote.

Lawmakers seemed surprised to read how much information sits just out of reach, and seemed to agree with the idea of using existing information to shape policy.

"I think it's helpful to understand that we have access to a lot of information, and we're not utilizing it correctly," said Senate Minority Leader Luz Escamilla, D-Salt Lake City. "I think if anything I'm learning from this audit is that we're sitting in a mine of gold."

"We are sitting on all this info ... that this could completely change the way we're tackling some of these very complex issues," she added.

The report also found that state law allows database information to be shared only for a few reasons, and auditors recommended that lawmakers consider allowing broader sharing within the Department of Health and Human Services for public health cases.

Varney said current law makes it easier for the department to share information with outside agencies, such as researchers with a state university, than it is to fulfill internal data requests.

"The Legislature has opportunities to consider changes to Utah Code if it desires more robust behavioral health metrics and more efficient data sharing processes within DHHS," the report states. "The Department of Health and Human Services should also review the potential to expedite internal department data requests within effective data privacy protections."

Executive Director Tracy Gruber said she "enthusiastically agreed," writing in a response letter that "the data is critical to serving the public in a result-driven and cost-effective manner while balancing the need to maintain the privacy of those we serve."

The agency responded, saying it would work to achieve each recommendation by next year and would plan to work with lawmakers throughout the 2026 general legislative session to address any statutory changes.

Below is a full list of 14 recommendations made by state auditors:

1. We recommend the Legislature consider policy options allowing for more data sharing within the Department of Health and Human Services for public health cases.
2. We recommend that the Department of Health and Human Services should explore the potential for creating an expedited review process for internal data requests.
3. We recommend the Legislature should consider balancing the need for more robust behavioral health metrics with data privacy principles.
4. If the Legislature desires more robust behavioral health metrics, we recommend it should consider which entity should be charged with connecting, protecting and analyzing inter-agency data.
5. We recommend the Department of Health and Human Services should ensure the Healthcare Statistics program follows the guidance of Governor's Office of Planning and Budgeting's Guide to Strategic Planning to create and implement a strategic plan for the All-Payers Claims Database.
6. We recommend that the Department of Health and Human Services should ensure that the Health Data Plan includes a clear vision for the role of the Healthcare Statistics program in processing and analyzing data to inform decisions and support behavioral health.
7. We recommend that the Department of Health and Human Services should ensure that the Healthcare Statistics program adopt and implement performance metrics that include revenue, customer retention and growth, data quality and public engagement.
8. We recommend the Legislature should consider establishing a defined purpose for the All-Payers Claims Database in state statute.
9. We recommend the Department of Health and Human Services should ensure that the Healthcare Statistics program explores renegotiating vendor contracts to invest more resources into Healthcare Statistics staff.
10. We recommend the Legislature should decide whether to require that the Healthcare Statistics program prioritize improving operational revenue through data user fees.
11. We recommend that the Department of Health and Human Services should redefine staff roles and responsibilities to better align with the program's redefined vision.
12. We recommend the Department of Health and Human Services should determine whether monthly submissions of claims data to Healthcare Statistics are necessary.
13. We recommend the Department of Health and Human Services should work with Healthcare Statistics staff to automate all possible data submission and delivery processes.
14. We recommend the Department of Health and Human Services should update the All-Payers Claims Database data dictionary to include better descriptions of data variables, how to interpret data values and their limitations.

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