As Utah pushes to contain the coronavirus between mass vaccination sites and widespread testing to find and stop outbreaks, it’s putting into operation more TestUtah sites run by Nomi Health.
An analysis by The Salt Lake Tribune shows that each test conducted by TestUtah costs more than double the cost of similar tests performed by public agencies — and more than many tests in hospitals.
In January, for example, the state enlisted Orem-based Nomi Health to run 18 TestUtah sites around the state for at least $2,500 per day per site, based on figures in Nomi’s contract, with adjustments for sites that weren’t open the entire month. There also were five “sprinter van” mobile sites, each costing $125,000; a per-test fee of $8 to $13; and $32,000 for a TestUtah call center and the TestUtah.com website.
For an estimated total of more than $2 million in January, Nomi performed 38,029 tests, the Utah Department of Health reported. But that doesn’t include money the state spent on the physical tests — $18 each for “rapid” antigen tests or $50 each for lab-processed tests, according to Utah Department of Health spokesman Tom Hudachko.
The state had not calculated the cost per test performed by TestUtah, Hudachko said — a figure that varies between TestUtah sites and depending on the type of test.
But based on contracted prices and site data provided by health officials, The Tribune estimates TestUtah’s rapid antigen tests cost at least $80 in January, while the more-sensitive but lab intensive PCR tests performed at TestUtah sites cost more than $100.
In an email, a spokeswoman for Nomi Health stated the cost per TestUtah test in January was “approximately $58.22.” But that doesn’t appear to distinguish between the costs of different types of tests, and she did not specify whether that calculation accounts for the state’s separate spending on the physical tests.
With the state emphasizing testing to control the virus as Utahns wait to get vaccinated, every testing option needs to be available, said Jennifer Napier-Pearce, spokesperson for Gov. Spencer Cox.
“State leaders decided they needed to deploy all options in order to reach the state’s testing goals. Community testing contractors are helping us reach even more people,” Napier-Pearce wrote in an email.
“We have to make getting tested as easy as possible so people are more likely to get tested,” she said. “Remember, testing is the only way we have to find positive cases, so they can be isolated to stop spreading the virus.”
But TestUtah isn’t Utah’s only publicly funded testing operation, or even the biggest; the state health department has teamed up with the Utah National Guard to offer testing events and sites in communities around the state.
Those sites are conducting more tests, by far, than TestUtah is — and at a lower price.
Breaking down the costs
In January, the Utah National Guard sites performed 54,272 tests, Hudachko said, with the state paying about $351,000 and the Guard reporting costs of about $1,060,000, mostly in staffing costs. That averages out to about $30 per test.
The state has received 1 million antigen tests in a federal grant and has contracted to pay $5 per test once that supply is used, Hudachko said. Meanwhile, he added, “the few PCR tests they are doing are processed in-house” at the Utah Public Health Lab, so there is no fixed price per test.
By comparison, Intermountain Healthcare is charging $75 per antigen test and $100 per PCR test, typically billed to insurance, said Jess Gomez, spokesman for the hospital system.
University of Utah Health is charging $94 per PCR test, said hospital spokeswoman Kathy Wilets. However, Walgreen’s, for example, charges $129 for either type of test, also typically billed to insurance.
Neither the TestUtah sites nor the Guard sites ask about a patient’s insurance status, which means the state is skipping the opportunity to recoup some costs from insurers or various federal government programs.
In a prepared statement, Nomi said TestUtah provides services that hospitals and pharmacies can’t do.
“Nomi opens sites at the request of the state to ensure access across geographies and communities, and the sprinter vans have traveled thousands of miles across rural Utah to ensure as much access as possible,” wrote Nomi spokeswoman Jenny Olson.
She also noted that TestUtah, last spring, helped the state create “one of this country’s very few burden-free testing programs,” which differed from other sites early in the pandemic by “not requiring a doctor’s note, the presence of symptoms, cost or insurance — a distinct difference from the other programs you mention.”
Many sites today do not have those restrictions in place. In fact, healthy Utahns are being tested for school or work, and state health officials are urging Utahns to get tested to help contain the virus.
Additionally, the cost per test by TestUtah may have been abnormally high in January, when the state had scheduled more test sites during a surge in cases the previous month, health officials said.
“January testing was lower than anticipated,” Hudachko said. “In November and December when we were planning TestUtah’s January assignments, we were in the midst of a significant spike in cases and were testing record numbers of people. It would have been irresponsible to scale back on testing capacity in that environment.”
The state added three more TestUtah sites in February.
Since TestUtah launched in April, with the initial promise it would be an entirely philanthropic effort, Nomi has received at least $17.5 million from the state for the 212,000 tests it performed in 2020, according to the state’s fiscal transparency website. Its state-assigned lab partner, California-based Fulgent Therapeutics, has received at least $6.2 million to process TestUtah’s tests since August.
That means an average cost of at least $112 per TestUtah test from April to December — and still that doesn’t include the cost of any antigen tests, which the state has bought separately and supplied to Nomi. State officials could not immediately specify the number of antigen tests the state provided prior to January.
Supporting wider access to tests
Part of the reason for the relatively high TestUtah cost per test, Hudachko said, is that the company is “able to offer testing in underserved areas other providers are not testing in, including areas in rural or frontier communities.”
“We know turnout at these events is sometimes low, which drives costs up,” Hudachko said. “But, we believe it is still important to get testing into these communities.”
However, the state’s website shows that TestUtah had 23 fixed sites and 10 mobile events last week — and all but one had at least one other testing option less than five miles away. In fact, the majority of TestUtah’s sites had multiple alternatives that close by.
Most of TestUtah’s sites are along the Wasatch Front, and some have eight or nine other testing options within five miles. One mobile event this week is within five miles of 11 other testing sites.
“In some communities, especially underserved communities,” Hudachko said, “five miles is literally the difference in someone seeking testing or not.”
But most of TestUtah’s fixed sites are within just two miles of the nearest alternative testing sites.
With 18 fixed sites in January, TestUtah’s sites averaged fewer than 100 tests per day — even though Nomi’s lowest pricing tier under the contract charges the state $75,000 for up to 200 samples per day.
Only one TestUtah site — in Provo — tested enough people to reach the next tier, which costs $90,000 a month, Hudachko said. That means the average daily test load across the other 17 sites could not have exceeded 90 tests per day, even with three of those sites operating for just part of the month.
“We are exploring options for scaling [TestUtah] sites in the future that would give us flexibility to address current testing demand,” Hudachko said, explaining that such a change would give the state an option to pay less for sites that are testing few people.
In addition to charging more than the cost of hospitals’ tests, TestUtah is billing the state directly, rather than seeking reimbursement from patients’ health insurance or other options, such as a federal fund that is paying for tests for the uninsured.
State testing data show that a significant number of the insured patients tested by TestUtah were symptomatic and therefore likely would have been eligible for insurance coverage, had the patient gone to a test site run by a health care provider.
Since the pandemic began, Utah has paid for tests by TestUtah and at the National Guard sites with federal relief funding through the CARES Act — money Congress gave to states to pay for any pandemic-related expenses, from rental assistance to personal protective gear.
Another pending grant is expected to cover testing in the future, Hudachko said.