Press Release  HEALTH CARE LEADERS ADVISE ON POLICY SOLUTIONS TO ADDRESS ACCESS AND AFFORDABILITY CHALLENGES

BOSTON — Today, the Massachusetts Health Policy Commission’s (HPC) Advisory Council met and discussed policy actions needed to address ongoing access and affordability challenges across the health care system.

HPC staff presented data showing that, for a Massachusetts family earning $90,699 with family health care coverage, average health care spending comprised nearly 30% of total household compensation in 2022. In light of ongoing affordability challenges facing Massachusetts residents and businesses, the HPC Advisory Council considered how to develop a new affordability index, recommended by the HPC to complement the existing health care cost growth benchmark.

This recommendation, which originated in the Health Policy Commission’s 2023 Health Care Cost Trends Report, directs the legislature to modernize the Commonwealth’s benchmark framework to prioritize health care affordability and equity for all through the establishment of an affordability index and accountability framework for health care entities. This new process would include annually measuring an affordability index through the existing oversight activities of the HPC and the Center for Health Information and Analysis (CHIA).

The new affordability index would be used to measure and track how health care costs impact residents by examining how much of Massachusetts family incomes are dedicated to health care spending across income levels. The goal is to measure total family health care cost burden (including deductibles, employer-paid portions of premiums, and excess costs for chronic conditions, etc.) in the context of income or wages.

The Advisory Council also shared perspectives on potential policy options to address ongoing access challenges as delays in care and barriers to patient flow have been exacerbated by workforce shortages throughout the health care system. HPC presented data showing that between 2020 and 2023, the percentage of emergency department (ED) visits that boarded, or stayed longer than 12 hours, increased from 6.1% to 10.2%. Average ED “treat and release” wait times have increased from 4.2 hours in late 2018 to 5.5 hours in mid 2023.

While total ED visits remain below pre-pandemic levels, the proportion of avoidable visits has remained consistent at roughly 40%, likely due in part to workforce shortages, delays in care, and the lack of availability for care in more appropriate settings.

The average length of stay for admitted ED patients has increased by roughly half a day since 2019, but the increase has been almost entirely among stays discharged to skilled nursing facilities and home health care. Massachusetts total employment in nursing care facilities remained 23% below pre-pandemic levels by mid-2023.

Advisory Council members discussed how these system-wide challenges can be addressed through policy action. HPC policy recommendations that could reduce these negative impacts include: (1) strengthening tools to monitor the provider market and align the supply and distribution of services with community need through focused assessments, strengthened monitoring and regulation of service supply, (2) enhanced HPC market oversight of for-profit investment, (3) reducing administrative complexity through greater standardization in payer processes, automating prior authorization, and mandating adoption of the Aligned Quality Measure Set, (4) supporting and investing in the Commonwealth’s health care workforce through increased public and organizational investment, ensuring adequate compensation for non-clinical workforces, and supporting workforce diversity, and (5) strengthening primary and behavioral health care through focused investment, increased access to behavioral health services, and improved access to Opioid Use Disorder treatment.

“Access challenges and affordability challenges are top of mind for stakeholders across this Commonwealth,” said David Seltz, HPC Executive Director. “The HPC Advisory Council is a unique and special group of individuals, reflecting so many parts of the health care continuum. I felt that bringing these topics to this group would help solicit new insights and potentially some new solutions for these significant challenges.”

These policy recommendations and additional reforms to reduce health care cost growth, promote affordability, and advance equity, are outlined in the 2023 Health Care Cost Trends Report.

RELATED 2023 HEALTH CARE COST TRENDS REPORT POLICY RECOMMENDATIONS

The HPC recommends reforms to reduce health care cost growth, promote affordability, and advance equity, with an emphasis on modernizing the state’s nation-leading benchmark framework.

1. Modernize the Commonwealth’s benchmark framework to prioritize health care affordability and equity for all. As recommended in past years, the Commonwealth should strengthen the accountability mechanisms of the benchmark such as by updating the metrics and referral standards used in the performance improvement plan (PIP) process and enhancing transparency and PIP enforcement tools. The state should also modernize its health care policy framework to promote affordability and equity including through the establishment of affordability and equity benchmarks.
2. Reduce administrative complexity. The Legislature should require standardization in payer claims administration and processing, build upon the momentum from recent federal initiatives to require automation of prior authorization processes, and mandate the adoption of a standardized measure set to reduce reporting burdens and ensure consistency.
3. Strengthen tools to monitor the provider market and align the supply and distribution of services with community need. The HPC recommends enhanced regulatory measures including focused, data-driven assessments of service supply and distribution based on identified needs and updates to the state's existing regulatory tools such as the Essential Services Closures process, the Determination of Need (DoN) program, and the HPC's material change notice (MCN) oversight authority.
4. Support and invest in the Commonwealth’s health care workforce. The state and health care organizations should build on recent state investments to stabilize and strengthen the health care workforce. The Commonwealth should offer initial financial assistance to ease the costs of education and training, minimize entry barriers, explore policy adjustments for improved wages in underserved areas, and adopt the Nurse Licensure Compact to simplify hiring from other states. Health care delivery organizations should invest in their workforces, improve working conditions, provide opportunities for advancement, improve compensation for non-clinical staff (e.g., community health workers, community navigators, and peer recovery coaches) and take collaborative steps to enhance workforce diversity.
5. Strengthen primary and behavioral health care. Payers and providers should increase investment in primary care and behavioral health while adhering to cost growth benchmarks. Addressing the need for behavioral health services involves measures such as enhancing access to appropriate care, expanding inpatient beds, investing in community-based alternatives, aligning the behavioral health workforce to current needs, employing telehealth, and improving access to treatment for opioid use disorder particularly in places where existing inequities present barriers.

The full text of all policy recommendations can be found in the report. A recording of the Advisory Council meeting can be found on the HPC’s YouTube page and presentation materials from the meeting are available on the HPC’s website.

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