Q&A: U of U medical director discusses clinic successfully addressing SDOH  –

Peter Weir is the executive medical director of population health at University of Utah Health (U of U Health). Weir helps lead the Intensive Outpatient Clinic (IOC), a clinic focused on addressing the social determinants of health by integrating physical and behavioral health. 

Weir will speak about Utah’s continuing effort to address social determinants of health at our upcoming 2022 Utah State of Reform Health Policy Conference on April 7th in Salt Lake City. U of U Health also recently released a short film highlighting the key strategies and holistic care of the IOC. 

In this Q&A, Weir discusses the IOC, how the clinic addressed the social determinants of health, and how other health systems can model their clinics after what they have learned. 

Get the latest state-specific policy intelligence for the health care sector delivered to your inbox.

State of Reform: What are you spending your mental energy on? What is the most important thing happening in health care in Utah from where you sit?

Peter Weir: “I’m a big advocate of having health systems deliver health care with a population health orientation. People get tripped up on the term ‘population health.’ It’s really about a few key principles. At a high level, the first is being able to stratify a population in terms of risk – that risk can be practically anything – age, disease state, race, utilization patterns, etc…. Next, you design interventions that focus on improving the health outcomes of interest in your population.  Lastly, you measure those outcomes, learn from them, and adjust to improve”.

SOR: So tell me a little bit about the IOC. What does it do and what is its purpose?

PW: “The premise of the clinic is to partner with our own Medicaid plan managed by the University of Utah Health Plans.  We wanted to find members that have a constellation of risks that include medical, mental health, and substance abuse problems. The concept was to create a clinic that could care for people with those risk factors and move the needle on improving their outcomes and reduce their unnecessary costs. Our hypothesis was that we could reduce unnecessary costs by more than what we would internally cost to function. That’s what ended up working out.

We learned a lot of things on the way. For example, it was always my assumption that [patients] would be medically very complex and fragile. What we learned quickly was we were selecting for patients that had significant trauma during their childhood and adulthood. I began to read more literature about how adverse childhood experiences (ACE’s) lead to adult manifestations like early chronic disease onset, behavioral health problems, substance abuse problems, high risk behavior, and ultimately premature death. We realized that we had kind of tapped into a population that we hadn’t totally expected.

So, we began to hire people in the clinic that had expertise for caring for these populations, like social workers that were steeped in trauma informed care, substance abuse treatment, and harm reduction principles. We brought on…