Advancing Health Podcast Summary

Episode: Rethinking Primary Care to Support Medically Complex Patients

Date: March 23, 2026
Host: Julia Resnick, American Hospital Association
Guests:

• Dr. Peter Weir, Chief Population Health Officer, University of Utah Health
• Dr. Erica Baden, Medical Director, Intensive Outpatient Clinic (IOC), University of Utah Health
• Carrie Burns, Behavioral Health Lead, Intensive Outpatient Clinic, University of Utah Health

Overview

This episode explores how University of Utah Health is transforming primary care to better serve medically complex patients whose needs extend far beyond traditional medical care. Focusing on a new model called the Intensive Outpatient Clinic (IOC), the conversation uncovers how interlocking medical, behavioral, and social supports are reducing emergency department dependence and better meeting the real needs of vulnerable patient populations.

Key Discussion Points & Insights

1. Genesis of the Intensive Outpatient Clinic (IOC) [01:07]

• Dr. Peter Weir recounts how University of Utah Health identified a small but high-utilizing subset of Medicaid patients frequently using ED and hospital services. The leadership hypothesized that creating a custom clinic staffed by the right people could better address the drivers of this overuse—even though "we didn't know how to do it or what we were doing honestly when we first got started." ([01:07], Dr. Weir)
• Early data analysis revealed that frequent utilization was strongly associated with “needs that extended way beyond medical needs: social needs, behavioral health needs, substance use, precarious housing,” and—most notably—high levels of trauma stemming from adverse childhood experiences. ([02:44], Dr. Weir)

“What really bound our patients together was this idea of having had significant trauma that led to...challenging coping strategies and skills.” – Dr. Peter Weir [03:31]

2. The Multidisciplinary, Trauma-Informed Team Approach [05:47]

• The team is intentionally small and highly integrated – including physicians, behavioral health clinicians, care managers, medical assistants, and front desk staff.
• Building trust, rapport, and truly "seeing" the patient as a whole person are core tenets. The goal is to patiently understand the root causes of utilization, not just respond to acute medical events. ([05:47], Dr. Erica Baden)

“There’s something inherent within the team...this beautiful and innate ability to just see people, and I mean see people through that surface, that utilization, and really get to the heart of the matter.” – Dr. Erica Baden [06:39]

• Burns and Baden highlight how team consistency supports coordinated care: “It’s really important that we’re all on the same page. For instance...when she feels pain, her mental health declines. So us all giving the same message, all helping her in the same ways is really important.” ([07:07], Carrie Burns)
• Both clinicians describe the need for humility and continuous learning—behavioral health specialists get exposure to medical issues, and vice versa.

“Medically, I don't know how to practice any other way without this interdisciplinary team.” – Dr. Erica Baden [07:53]
“As a clinician, oh man, I know way more medical things than I ever wanted to know working in this field, in this clinic.” – Carrie Burns [08:31]

3. What Care Feels Like for Patients: Understanding Root Causes [08:46]

• Care teams look beyond “frequent ED user” labels to explore deeper needs.
• Example: One patient with a background of childhood neglect found the ED a place for attention, respite, and care—his or her coping mechanism for overwhelming life circumstances. The team worked with her to identify triggers and alternatives for support, validating her feelings and helping her find healthier coping strategies. ([08:56], Dr. Erica Baden)

4. Operational & Financial Model: Challenges and Innovations [10:23]

• Success depends on a strong payer partnership—here, the University of Utah Health Plans (UUHP) was vital, supporting alternative payment models that incentivize outcomes, care coordination, and integration.
• Fee-for-service reimbursement alone is insufficient. Instead, a blend of payments includes quality incentives, HCC coding, and direct compensation for care coordination and utilization reduction.
• Tracking impact can be complex: small patient population (about 150), utilization impact may not show until year two, and insurance frameworks typically expect 12-month return cycles.

“You need a novel payment mechanism to reward this type of work because it doesn’t fit in a fee for service world. ...You literally cannot do it in a fee for service manner.” – Dr. Peter Weir [10:44]

5. Measuring Impact and Defining Success [13:33]

• Traditional outcome measures (e.g., number of therapy sessions, ED visits) don’t always capture meaningful progress.
• Progress is measured in “small wins”: reductions in hospitalizations, attendance at appointments, increased social connectedness, establishing contact with providers during a crisis, or moving from chaos to stability.

“In the regular therapeutic community, you will see a patient for six to eight visits…That’s not how we look at things in our clinic. ...They were hospitalized for suicidal ideations 10 times last year, and now they’ve only been hospitalized once.” – Carrie Burns [13:33]
“It starts with trust and rapport, and then that slowly leads to engagement...and then sort of last to move is the utilization.” – Dr. Peter Weir [15:05]

• Establishing trust is viewed as the essential foundation (“Trust is our currency...they often start off very skittish...Is this thing for real?...They’ve been burned so many times and retraumatized...We have this very trauma-informed care model that gently begins to build that trust back up again.” – Dr. Peter Weir [15:32])

Memorable Quotes

• On Patient Selection and Realization:
  “Wow, what a coincidence.”
  “No, it’s not a coincidence at all.”
  – Dr. Peter Weir recalling a conversation with a social worker about patients’ trauma histories [03:13]
• On Team Culture:
  “We are all on the same page ... all giving the same message, all helping her in the same ways ... is really important.” – Carrie Burns [07:33]
• On the Nature of Impact:
  “It’s the small wins that we look at every day.” – Dr. Erica Baden [14:04]
  “Trust is our currency. It’s everything.” – Dr. Peter Weir [15:17]

Important Timestamps

• [01:07] – Origin of the IOC and identification of high-utilizer group
• [02:44] – Discovery of root causes: trauma and social needs
• [05:47] – Structure and function of multidisciplinary team
• [07:53] – Value and necessity of interdisciplinary approach
• [08:56] – Illustrative patient story: moving beyond the “frequent ED flyer” lens
• [10:23] – Financial and operational model
• [13:33] – Measuring success: small wins and trust-building
• [15:05] – “Trust is our currency”—how real progress unfolds

Conclusion

This episode demonstrates the potential of reimagined, trauma-informed, team-based primary care for medically complex populations. By working beyond traditional structures—rethinking team roles, payment models, and definitions of success—the University of Utah Health IOC is forging pathways to stability and health with deep respect for each person's lived experience. The small, daily wins, grounded in trust, mark the real progress in patients’ journeys.