Press Release  2022 HEALTH CARE COST TRENDS HEARING: HEALTH CARE INDUSTRY CHARTS PATH FORWARD FOR MASSACHUSETTS AT ANNUAL EVENT

BOSTON — On Wednesday, November 2, 2022, the Massachusetts Health Policy Commission (HPC) hosted its 10^th Annual Health Care Cost Trends Hearing, titled “Ten Years of Cost Containment in Massachusetts: Charting the Path to Affordability and Equity for the Next Decade.” The hearing coincided with the tenth anniversary of the Commonwealth’s landmark health care cost containment legislation (Chapter 224 of the Acts of 2012), which created the Health Policy Commission. Health care experts, public officials, industry leaders, and stakeholders convened to discuss health care affordability challenges facing Massachusetts residents and opportunities to improve health care delivery in the Commonwealth. Materials from the hearing are available on the HPC's website and a full recording is available on the HPC's YouTube Channel, including remarks from Governor Charlie Baker, U.S. Senator Edward Markey, and Attorney General Maura Healey.

The discussions at the hearing focused on the persistent challenges still facing the health care system after the onset of the COVID-19 pandemic, including workforce and staffing issues, and policy solutions to increase health care affordability and advance health equity in the coming years. The HPC’s six bold policy recommendations, which were a focal point of the day, can be found in the recently released Annual Health Care Cost Trends Report.

Opening Remarks and Keynote Address

Governor Charlie Baker and U.S. Senator Edward Markey provided opening remarks in-person at the hearing and Attorney General Maura Healey shared a pre-recorded video.

Governor Baker discussed the challenges health care systems have faced during the pandemic, including staffing concerns, and spotlighted how the pandemic exacerbated the mental health and addiction crisis in the Commonwealth, as too many residents in need are struggling to access services. He also provided an overview of the recently approved $67 billion MassHealth 1115 waiver, which will promote accountable, value-based care, move away from a fee-for-service model and toward a system centered around primary care and behavioral health, and promote health equity and address disparities in the system.

U.S. Senator Edward Markey highlighted the work the federal government has done to support the Massachusetts health care system, including the CARES and ARPA acts, which provided approximately $115 billion in federal COVID-19 aid for Massachusetts to support public health institutions, hospitals, home and community-based services, and nursing facilities. Senator Markey called on Massachusetts to lead the way to achieve a more affordable, equitable, and innovative health care system.

Attorney General Healey reflected on the achievements of the HPC over the past ten years. She acknowledged that the state’s health care infrastructure is stretched thin due to burnout and stress among providers, which has contributed to a workforce crisis. The Attorney General outlined goals for the future of the health care system, including a workforce that reflects its patient population, accessible and affordable health care for individuals and businesses, support for safety net hospitals and academic medical centers, and aligning health spending with health need. Attorney General Healey highlighted the HPC’s recent Cost Trends Report recommendations to achieve health equity for all and recommended they be given serious consideration as the Commonwealth embarks on the next decade.

Dr. Barak D. Richman, the Katherine T. Bartlett Professor of Law and Professor of Business Administration at the Duke University School of Law, delivered a keynote presentation entitled “Provider Consolidation and the Limits of Antitrust Law.” Dr. Richman’s research focused on the effect of regulation on markets, the operation of the legal process on regulation, and examined both the potential, and the shortcomings, of regulatory processes. Dr. Richman hailed the HPC as a success story in transforming the discussion about the health care market and called for the further mobilization of health care purchasers, and enhanced transparency of Massachusetts competitors. Dr. Richman’s full presentation can be found here.

Dr. David Auerbach, the HPC’s Senior Director of Research and Cost Trends, shared recent data findings which laid the foundation for the panel discussions. Dr. Auerbach’s presentation, The Impact of Price and Spending Trends on Health Care Affordability and Equity in Massachusetts, highlighted trends over the past decade, including increased consolidation amongst the largest hospital systems, increases to commercial prices per discharge, and continued growth in pharmaceutical prices. David Seltz, Executive Director of the HPC, reviewed the bold new recommendations made by the HPC to combat these issues, including strengthened accountability around the cost growth benchmark, strategies to constrain provider prices, enhanced oversight of pharmaceutical spending, and continued advancement of health equity. The full data presentation can be found here and the full policy presentation, State Policy Solutions to Advance Affordability, can be found here.

Witness Panels

The hearing included two witness panels, moderated by HPC Board Chair Deborah Devaux.

Panel 1:

The first panel, Implications of Persistent Health Care Affordability Challenges in the Commonwealth, comprised of Michael Curry, President and CEO of the MassLeague of Community Health Centers, Bill Grant, the CFO and Senior Vice President of Cummings Properties, Colin Killick, the Executive Director of the Disability Policy Consortium, and Amy Rosenthal, the Executive Director of Health Care For All.

Key themes:

• Workforce challenges, specifically provider and staff vacancies and the disproportionate impact of clinic closures and staff shortages on people of color, people who are unhoused, people who live in rural communities and people with less means.
• High cost of care, including pharmaceuticals, medical supplies and insurance, the impact of high cost on people with disabilities, and the “costs of discrimination”, which leads to patients with disabilities not being taken seriously and their lives and quality of life being considered inherently low quality.
• Taking steps to mitigate cost and quality problems and promote equity, including utilizing peer supports, clearing unnecessary and inappropriate denials of care, collecting data to better understand the true impacts of the costs of care, hiring the “right people” to ensure there are diverse perspectives and voices at the table and that staff are representative of the communities they serve.
• Shared responsibility, including different industry groups and consumer advocates aligning on goals and working to develop proposals to reduce cost and improve access and quality.
• Addressing systemic racism and other forms of discrimination.

Panel 2:

The second panel, Health System Leaders: What is the Path Forward for Massachusetts?, comprised of Dr. Kevin Churchwell, President and CEO of Boston Children’s Hospital, Dr. Eric Dickson, President and CEO of UMass Memorial Medical Center, Andrew Dreyfus, President and CEO, Blue Cross Blue Shield of Massachusetts, Cain Hayes, President and CEO of Point32Health, and Dr. Anne Klibanski, President and CEO of Mass General Brigham, and focused on challenges facing providers, including staffing challenges, emergency department boarding, and the population's increasing behavioral health needs.

Key themes:

• Workforce challenges, including the rising labor cost and high salaries of agency nurses and staffing shortages in post-acute care settings that have led to discharge delays in hospitals.
• Capacity constraints, including unprecedented behavioral healthcare needs that the systems are unprepared to handle, high emergency department boarding rates, and physician burnout.
• Increased behavioral healthcare needs, including high rate of emergency department boarding for behavioral health patients, a pediatric behavioral health crisis driven by the COVID-19 pandemic, and telehealth, which has reduced patient burden but remains difficult to access for some.
• Affordability and potential solutions, including incentivizing primary care to integrate behavioral health into practices, transitioning to an episode-based payment model for large employers, deploying technology to reduce administrative complexity, increasing flexibility with licensure to allow cross-state behavioral health telehealth visits, managing people more in the community and moving patients to the right care setting, and requiring pharmaceutical companies and pharmacy benefit managers to undergo the same transparency as the rest of the health care system.
• Addressing health equity and social determinants of health.

A recording of the hearing can be found on the HPC's YouTube Channel.

Pre-Filed Testimony

In advance of the hearing, 29 health care organizations – 20 provider organizations and 9 payers – were required to submit written testimony, responding to questions from the HPC and the Office of the Attorney General. The recurring response from provider organizations concerned the ongoing challenge of maintaining and supporting a robust health care workforce.

Most providers responded that they are increasing recruitment efforts and attempting to address clinician burnout through administrative simplification, professional development, and increased pay. Providers also expressed the need for increased investments in the health care workforce at the state level. Key themes from health plan responses included support for enhanced oversight of pharmaceutical spending and constraining drug costs, initiatives to steer members to low-cost, high-value sites of care, and financial investments toward health equity. Both providers and payers discussed the ongoing challenges of the COVID-19 pandemic. Full text responses from all 28 organizations are available here.

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