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State Tightens Standard for Health Cost Growth

Posted by Katie Holahan on Mar 29, 2017 1:21:55 PM

The Massachusetts Health Policy Commission voted unanimously today to lower the state’s objective for the growth of health-care expenditures from 3.6 percent to 3.1 percent beginning in 2018.

HPC.jpgThe vote marks a significant milestone for employers and consumers struggling with the soaring cost of health insurance. AIM President and Chief Executive Officer Richard C. Lord, who represents employers on the Health Policy Commission, has been a vocal supporter of lowering the benchmark and voted in favor of the 3.1 percent level.

“Today’s vote represents a concrete, measurable step toward moderating the type of premium increases that give employers a knot in their stomachs when they look at their insurance renewals,” Lord said.

“The action will ultimately mean more than all the sound and fury over national health reform in Washington."

The spending growth benchmark, established as part of the health-cost control law of 2012, is a critical component for understanding year-over-year increases in health-care spending. AIM has always favored an aggressive goal – the organization joined with the Greater Boston Interfaith Organization in 2012 to support setting the health-care cost growth benchmark at two percentage points below the growth in the state’s economy.

The association ultimately supported the establishment of a 3.6 percent benchmark because it recognized the vital importance of creating a standard to measure cost-containment efforts.

But Massachusetts has not yet seen sufficient progress. The commonwealth has exceeded the 3.6 percent benchmark in two of the past three measurement periods. Total Health Care Expenditures (THCE) grew by 4.2 percent from 2013 to 2014, and by 4.1 percent from 2014 to 2015.

“These unsustainable cost increases are occurring in an industry where experts agree that at least a third of all care is unnecessary – delivered in the wrong setting; marked by a lack of coordination; provided with an inadequate emphasis on prevention; harmed by medical errors; burdened with rules and fraud; or just plain excessive,” Lord said.

AIM is also addressing the health cost issue by supporting new research conducted by the Health Policy Commission suggesting that Massachusetts could reduce total health-care expenditures anywhere from $279 million per year to $794 million per year, or 0.5 to 1.3 percent, by making seven improvements to the health-care system.

The improvements:

  • Shift community appropriate care to community hospitals – Reduce by 5-10 percent the number of cases treated at teaching hospitals that would be more appropriately treated at community hospitals. Savings: $43 million to $86 million.
  • Reduce hospital readmissions – Cut the 2015 hospital readmission rate from 15.8 percent (78,000 readmissions) to a range of 15 to 13 percent. Savings: $61 million to $245 million.
  • Reduce avoidable emergency room visits – More than 900,000 emergency room visits during 2015 were considered avoidable. Shift 5-10 percent of those avoidable visits to lower-cost settings. Savings: $12 million to $24 million.
  • Reduce use of institutional post-acute care – Redirect 5-21 percent of the patients who currently leave hospitals to go to institutional rehabilitation facilities into home care. Savings: $46.6 million to $186 million.
  • Provide incentives for consumers to choose high-value primary care providers.
  • Increase the use of alternative payment methods -The commonwealth wants to increase the percentage of HMO participants covered by alternative payment methods from 58.5 percent in 2015 to 80 percent this year. Savings: $23 million to $68 million.
  • Reduce the growth of prescription-drug spending – Cut the growth-rate of spending on prescriptions from 5.0 percent in 2016 to 3.6 percent to 4.3 percent. Savings: $57 million to $113 million.

Topics: Health Care Costs, Health Insurance, Health Care

Never Mind Washington; Here's How to Moderate Health Insurance Premiums

Posted by Rick Lord on Mar 12, 2017 3:09:56 PM

You’ll excuse Massachusetts employers for being cynical as they watch the health-care debate in Washington unfold while they struggle to manage the crushing financial burden of providing good medical insurance to their employees.

health_care.jpgThe truth is that federal health-care reform, whatever its final structure, will do little to moderate the accelerating premium increases that employers and workers alike now face. Trumpcare, like Obamacare and Romneycare before it, is primarily about extending coverage rather than addressing the underlying drivers making health insurance more expensive for companies.

That’s why employers – a results driven group if ever there was one – want to know how the nation is going to solve the cost problem so that business owners don’t get knots in their stomachs every time they receive their insurance premium renewals.

The good news is that Massachusetts is beginning to identify some answers. And there appears to be enough common ground and political will on the issue to pursue some solutions.

New research conducted by the Massachusetts Health Policy Commission suggests that Massachusetts employers, insurers and policymakers could reduce total health-care expenditures anywhere from $279 million per year to $794 million per year, or 0.5 to 1.3 percent, by making seven improvements to the health-care system.

The improvements:

  • Shift community appropriate care to community hospitals – Reduce by 5-10 percent the number of cases treated at teaching hospitals that would be more appropriately treated at community hospitals. Savings: $43 million to $86 million.
  • Reduce hospital readmissions – Cut the 2015 hospital readmission rate from 15.8 percent (78,000 readmissions) to a range of 15 to 13 percent. Savings: $61 million to $245 million.
  • Reduce avoidable emergency room visits – More than 900,000 emergency room visits during 2015 were considered avoidable. Shift 5-10 percent of those avoidable visits to lower-cost settings. Savings: $12 million to $24 million.
  • Reduce use of institutional post-acute care – Redirect 5-21 percent of the patients who currently leave hospitals to go to institutional rehabilitation facilities into home care. Savings: $46.6 million to $186 million.
  • Provide incentives for consumers to choose high-value primary care providers.
  • Increase the use of alternative payment methods -The commonwealth wants to increase the percentage of HMO participants covered by alternative payment methods from 58.5 percent in 2015 to 80 percent this year. Savings: $23 million to $68 million.
  • Reduce the growth of prescription-drug spending – Cut the growth-rate of spending on prescriptions from 5.0 percent in 2016 to 3.6 percent to 4.3 percent. Savings: $57 million to $113 million.

The Health Policy Commission is considering one major proposal that would encourage these improvements. The proposal would tighten the state’s benchmark for health-care spending growth from 3.6 percent to 3.1 percent annually. AIM supports the measure.

The spending growth benchmark, established as part of the health-cost control law of 2012, is a critical component for understanding year-over-year increases in health- care spending. AIM has always favored an aggressive goal – the organization joined with the Greater Boston Interfaith Organization in 2012 to support setting the health-care cost growth benchmark at two percentage points below the growth in the state’s economy.

The association ultimately supported the establishment of a 3.6 percent benchmark because we recognized the vital importance of creating a standard to measure cost-containment efforts.

But we have not yet seen sufficient progress. Massachusetts has exceeded the 3.6 percent benchmark in two of the past three measurement periods. Total Health Care Expenditures (THCE) grew by 4.2 percent from 2013 to 2014, and by 4.1 percent from 2014 to 2015.

These unsustainable cost increases are occurring in an industry where experts agree that at least a third of all care is unnecessary – delivered in the wrong setting; marked by a lack of coordination; provided with an inadequate emphasis on prevention; harmed by medical errors; burdened with rules and fraud; or just plain excessive.

AIM remains committed to pursuing the seven solutions outlined by the Health Policy Commission as a method of addressing the health-insurance premium crisis facing employers. It’s an approach that is sure to pay more immediate dividends than anything that will come out of Washington.

 

Topics: Health Care Reform, Health Care Costs, Health Insurance

Health Reform Repeal and Replace - What Does It Mean to Employers?

Posted by Russ Sullivan on Mar 7, 2017 11:33:38 AM

Republican members of the U.S. House of Representatives yesterday released their long-awaited alternative to the Affordable Care Act (ACA).  The proposed law retains some of the more popular features of the ACA while modifying or outright repealing others.

Health.Energy.jpgWhat would the proposal mean for employers in Massachusetts? Here is a quick, initial review of key provisions:

Employer-Provided Health Insurance:

  • Eliminates the employer mandate retroactive to December 31, 2015.
  • Eliminates taxes on prescription drugs, over-the-counter medications, health-insurance premiums, and medical devices.

Employer-Provided Health Insurance and the Individual Health Insurance Market

  • Retains ACA provision allowing parents to retain dependents on their plan until they are 26. 
  • Health Savings Accounts - Allows individuals to contribute at the current family amount and allows families to contribute at twice the current family amount

Individual insurance market

  • Eliminates the individual mandate retroactive to December 31, 2015. 
  • Retains ACA prohibitions on pre-existing conditions, but effective in 2019 imposes a 12- month surcharge equal to 30 percent of the premium for enrollees in individual market who had a 63-day or more lapse of coverage in prior 12 months.
  • Effective January 1, 2020, repeals cost-sharing subsidies, currently available to individuals with incomes from 100 percent to 250 percent of the federal poverty level (FPL) to assist with out-of-pocket expenses
  • Effective January 1, 2020, eliminates the Premium Tax Credit for individuals purchasing health insurance in state exchanges, replacing that credit with tax credits for qualified plans on individual market.
  • Repeal of plan tiers based on actuarial value.
  • Increase age ratio for plan costing from 3:1 to 5:1, allowing aged-based cost variations to differ by as much as five times based on enrollee’s age.

Tax credits for Qualified Plans on the Individual Market

  • Annual credits begin at $2,000 for 20 year olds, and increase by $500 per decade, capping at $4,000 for people in their 60s; reduced by 10 percent of modified adjusted gross income (MAGI) over $75,000 ($150,000 for joint filers); reduced by amount received under a small-employer health reimbursement plan; penalties on erroneous filers.
  • Effective January 1, 2020 payments may be made in advance and on behalf of eligible individuals directly to health plan provider.
  • Applies to plans on individual health insurance market and COBRA.
  • Qualified plans do not include those that cover abortion, except in case of rape, incest or when mother’s life is threatened.

The bill also establishes a Patient and State Stability Fund, which provides states with $100 billion over nine years to design programs promote participation and stabilize risks in the individual health insurance market.

That provision has a down side for Massachusetts -15 percent of the funds are available only to states that either experienced an increase in the uninsured population from 2013-2015 among people below the poverty level; or to states that have fewer than three health insurance plans available on their state exchange in 2017.  Massachusetts would forfeit 15 percent of the available funds for not meeting either of these requirements.

There are also provisions that would roll back the expansion of Medicaid, the federal health insurance program for low-income people, and change the manner in which Medicaid funds are allocated to states:

  • Effective January 1, 2020, repeals Medicaid eligibility expansion from individuals with incomes at or below 138 percent of federal poverty level; and to children, pregnant women, and breast cancer and cervical cancer patients with incomes at or below poverty level.
  • Effective January 1, 2020, changes state funding from claims-based allocations to “per capita” allocations, potentially reducing funding to eligible recipients in Massachusetts.
  • Eliminates ACA requirement that Medicaid provide “essential health benefits.”
  • Requires state to verify Medicaid eligibility every six months.

Expect animated discussion and debate on both the federal and state level as advocates and opponents dig into the details over the coming weeks.

Topics: Health Care Reform, Health Care Costs, Health Insurance

Employers: Federal Health Reform Must Change

Posted by Katie Holahan on Feb 8, 2017 10:00:00 AM

Massachusetts employers believe overwhelmingly that federal health-care reform must change, but their opinions about how to do so vary widely.

Health_Care_Reform.jpgA new AIM survey finds that 43 percent of Bay State employers think that Congress and President Donald Trump should make changes to the existing Affordable Care Act, or Obamacare. Forty percent favor repealing the law and replacing it with an alternative program.

Eleven percent want to leave the current system in place while seven percent would repeal the reform law without an alternative.

The president and the Republican-controlled Congress have made “repeal and replace” a centerpiece of their governing priorities for the first 100 days. Republicans have yet to agree upon an alternative, but appear to favor eliminating the tax penalties imposed on people who go without insurance and on larger employers who do not offer coverage to employees.

The AIM survey was taken in January and is based upon responses from 162 employers from all sectors of the Massachusetts economy.

“The paperwork for Obamacare is ridiculous and terrifying for the regular person,” wrote one employer.

“We used to get one bill and now you get a bill from each doctor and have to wait for explanation of benefits and pre-register for everything. They have made health care so many layers it's no wonder the prices are through the roof.”

Another employer echoed that frustration.

“Trying to make changes to a 2,700-page bill with over 40,000 pages of accompanying regulations is bizarre. Start over,” the employer wrote.

Richard C. Lord, President and Chief Executive Officer of AIM, said employers supported the 2006 Massachusetts health-care reform as a first step to controlling the cost of providing health insurance to workers. Federal reform caused upheaval for many small employers in Massachusetts, but Lord also warns that an ill-considered repeal might put at risk billions of dollars in federal Medicaid funding that made the Bay State reform so successful.

“The expansion of Medicaid is exerting significant financial pressure on the state budget. Our hope is that policymakers in Washington can agree on some common-sense tweaks to Obamacare that would work to everyone’s benefit.”

Republican leaders formulating a replacement health reform have talked about eliminating tens of billions of dollars provided each year to states that have expanded eligibility for Medicaid. They have also discussed repealing subsidies for private health insurance coverage obtained through the public marketplaces known as exchanges.

The 2010 federal reform imposed taxes and fees on certain high-income people and on health insurers and manufacturers of brand-name prescription drugs and medical devices, among others. Republicans have not said for sure which taxes they will scrap and which they may keep.

The policy debate in playing out amid growing signs of accelerating health-insurance premium costs.

“My insurance premiums increased 24 percent this year. That is a little excessive,” one employer wrote.

Topics: Health Care Reform, Health Care Costs, Health Insurance

Proposed Assessment Will Hurt Employers Who Provide Health Insurance

Posted by Rick Lord on Jan 26, 2017 3:00:40 PM

Governor Charlie Baker yesterday described his proposal for a $300 million health assessment on employers as an attempt “to wrestle with the fact that a huge portion of people who are working full-time are either not taking coverage that's available through their employer and going on MassHealth, or are working for people who aren't offering them coverage at all, and going on MassHealth."

health_care.jpgHe added, according to State House News Service, that “the centerpiece of this budget really is a smart and common-sense approach to address the problem of costs being shifted from private sector employers for their employees onto state government."

Set aside for the moment the questionable premise of rampant cost shifting in a commonwealth where 76 percent of employers offer health insurance compared to 55 percent in the rest of the country.

The important point is that the governor’s sweeping proposal goes far beyond targeting employers who offer no health insurance, and instead penalizes employers who already offer high-quality insurance coverage to their employees.

It appears that money, not fairness, is driving the new fair-share assessment.

The administration plan would impose a $2,000-per-employee fee upon companies at which at least 80 percent of full-time worker equivalents do not take the company’s offer of health insurance, and that do not make a minimum contribution of $4,950 annual contribution for each full-time worker. If 70 percent of a company’s employees accept company health insurance, the company would be assessed $2,000 per employee for the number of employees represented by the 10 percent difference.

The employer assessment, which would bring an estimated $300 million into state coffers, represents a revival of the so-called fair share contribution plan that was a linchpin of the 2006 universal health care law in Massachusetts before it was repealed to make way for the federal Affordable Care Act. The state employer mandate was repealed in 2013 as lawmakers and former Gov. Deval Patrick worked to bring Massachusetts into compliance with federal health-care reform.

AIM asked multiple employers of varying sizes to determine whether they would be subject to an assessment under the governor’s plan. Every one of the companies, from small manufacturers to international financial institutions to corner retailers, reported that they would face assessments. Most fell short of the 80 percent threshold because of employees using spousal health plans or because of the calculation of full-time equivalent employees.

“There is widespread concern among responsible employers that they are being dragged into an assessment intended for companies that provide no health coverage,” said Katie Holahan, Vice President of Government Affairs at AIM.

Holahan said AIM has developed an online calculator that will allow employers to determine how much they might owe under the governor’s proposal.

AIM opposes the employer assessment because the growing shortfall at Masshealth, which provides health insurance to 1.9 million low-income Massachusetts residents, is attributable solely to problems arising from the federal Affordable Care Act (ACA), a law that may well be repealed by the time Massachusetts solves its Medicaid problems. 

ACA made access to health insurance an entitlement based on expanded income eligibility.  Under the Massachusetts health care reform law of 2006, employees who were offered employer-sponsored health insurance were ineligible for MassHealth.  The ACA reversed that policy and allowed employees to decline employer coverage and still seek insurance through MassHealth.

The change created a migration of newly-eligible individuals from their employer-sponsored insurance to MassHealth, substantially increasing the commonwealth’s financial burden.  ACA made it an economically rational choice for eligible residents.

As MassHealth enrollment grows, the commonwealth experiences the reality that employers have faced for years - the high cost of health care coverage in this state threatens the underpinnings of the state economy.  This challenging moment underscores the fact that policymakers have concentrated too heavily on access issues instead of controlling the cost of health insurance, and now face a renewed imperative to lower costs for everyone in Massachusetts.

AIM looks forward to working with the administration and the Legislature to find a fair solution to the commonwealth’s challenging health-care financing issues.

Topics: Health Care Costs, Health Insurance, Charlie Baker

Infographic: The Governor's Proposed Health Assessment

Posted by Katie Holahan on Jan 25, 2017 4:21:34 PM

The Baker Administration filed a budget proposal today that, as expected, would impose a $2,000-per-employee tax on some employers to close a deficit in MassHealth. AIM opposes the assessment as unfairly burdening employers for a problem they did not create.

Which employers will be subject to the assessment? Here is an infographic that summarizes the administration proposal. AIM is developing a calculator that will allow employers to determine exactly what their costs will be under the new assessment.

If you have any feedback or questions about this proposal, please contact Katie Holahan at keh@aimnet.org or 617.262.1180.

Fair Share 2017.jpg

 

Topics: Health Care Costs, Health Insurance, Charlie Baker

Proposal to Revive Fair-Share Assessment Raises Concerns

Posted by Katie Holahan on Jan 17, 2017 8:17:07 AM

The 4,000 member employers of Associated Industries of Massachusetts (AIM) believe that the Baker Administration’s proposal to impose a $2,000-per-employee tax on some employers is an unfair way to close a deficit in MassHealth.

health_care.jpgThe proposal would force employers to foot the bill for a problem they did not create. The $600 million shortfall at Masshealth, which provides health insurance to 1.9 million low-income Massachusetts residents, is attributable solely to problems arising from the federal Affordable Care Act, a law that may well be repealed by the time Massachusetts solves its Medicaid problems 

AIM acknowledges that the ACA-generated deficit at MassHealth is not the creation or responsibility of the Baker Administration.

The Affordable Care Act (ACA) made access to health insurance an entitlement based on expanded income eligibility.  Under the Massachusetts health care reform law of 2006, employees who were offered employer-sponsored health insurance were ineligible for MassHealth.  The ACA reversed that policy and allowed employees to decline employer coverage and still seek insurance through MassHealth.

The change created a migration of newly-eligible individuals from their employer-sponsored insurance to MassHealth, substantially increasing the commonwealth’s financial burden.  ACA made it an economically rational choice for eligible residents.

As MassHealth enrollment grows, the commonwealth experiences the reality that employers have faced for years - the high cost of health care coverage in this state threatens the underpinnings of the state economy.  This challenging moment underscores the fact that policymakers have concentrated too heavily on access issues instead of controlling the cost of health insurance, and now face a renewed imperative to lower costs for everyone in Massachusetts.

State House News Service reports that the administration plan would impose a $2,000 fee for all full-time workers - defined as someone who works 35 hours or more - upon businesses that don't cover at least 80 percent of their workers and share at least 60 percent of the premium cost with employees.

The employer assessment, which would bring an estimated $300 million into state coffers, represents a revival of the so-called fair share contribution plan that was a linchpin of the 2006 universal health care law in Massachusetts before it was repealed to make way for the federal Affordable Care Act. The state employer mandate was repealed in 2013 as lawmakers and former Gov. Deval Patrick worked to bring Massachusetts into compliance with the ACA.

There are positive elements to the administration’s proposal as well. AIM supports a freeze on new mandated health-insurance benefits and a cap on provider rates.

AIM recognizes that the administration’s proposal is the opening bid in what will be a protracted debate. We look forward to productive discussions with the administration and the Legislature to find a solution that does not wreak irreparable harm on the Massachusetts economy.

Topics: Health Care Reform, Health Care Costs, Health Insurance

Health-Insurance Costs Remain Concern for Employers

Posted by Karen Choi on Mar 28, 2016 2:58:15 PM

Massachusetts employers have apparently decided that increasing deductibles and co-pays is a better way to control health-insurance costs than providing financial incentives for employees to seek care from low-cost, high-quality doctors.

2016_AIM_Benefits_Report_Cover.thm.pngThe 2016 AIM Benefits Report from Associated Industries of Massachusetts finds that controlling the cost of providing health insurance for employees remains the dominant benefits concern for Bay State companies. Ninety-four percent of the 197 employers who participated in the survey remain “very concerned” about escalating health insurance costs, while 76 percent are concerned about increased employee cost-sharing for benefits.

Employers are addressing those escalating health insurance costs by adopting high-deductible, consumer-driven health plans. Half of survey participants offer a consumer-driven health plan, with the most common cost-containment strategies being increased deductibles (28 percent), increased employee premiums (26 percent) and increased out-of-pocket maximums (21 percent).

There is far less enthusiasm for tiered networks, which health-care economists tout as an effective method of managing costs by paying more for medical care rendered in lower-cost settings and less for care delivered in high-cost academic medical centers. Just nine percent of survey participants offer a tiered network plan, even though a third of those companies have experienced a decrease in premiums.

Seventy-one percent of companies say they have no plans to offer a tiered network product in the future. Companies that have declined to adopt tiered networks most often cite not wanting to change the levels of benefits for employees as the reason.

“The survey seems to illustrate the ‘hallway effect,' ” said Russ Sullivan, Vice President of Health-Care Solutions at AIM.

“It is difficult to potentially disrupt the health-care choices or increase out-of-pocket costs of someone with significant medical expenses who you see each day.  Incremental changes to payroll contributions and co-pays are a more comfortable decision.”

Other structural changes face similar resistance. More than three-quarters of employers do not use health risk assessments to identify opportunities to improve the health of workers.

The share of employers who say they are “very concerned” about establishing a wellness program dropped to 31 from 37 percent in 2014 and 40 percent in 2012. Almost two-thirds of employers with 200 or fewer employees eligible for the Massachusetts Wellness Tax Credit said they did not know about the program.

Management of health-insurance costs will take on renewed significance for employers in 2016 as premium inflation in Massachusetts accelerates after several years of muted growth. Health insurance rates paid by small employers and individuals in Massachusetts surged 6.3 percent during the first quarter while major insurance companies are raising overall average premium rates anywhere from 3 to 13 percent. 

The AIM Benefits Survey found that the average premium for coverage through a health maintenance organization (HMO) rose 9 percent this year versus 7 percent in 2014. Premiums at preferred provider organizations (PPO) will also increase 9 percent in 2016, up from 6 percent two years ago, while rate increases for high-deductible plans have almost doubled from 2014 to now.

Insurance carriers attribute the premium increases to increases in drug costs, increased levels of plan utilization and costs associated with the implementation of federal health-care reform.

The average cost to provide health insurance to a family ranges from $1,011 per month for a high-deductible plan to $1,494 per month for an HMO, according to the AIM survey. Employers, on average, pay anywhere from $607 to $986 of those premiums depending on the insurance product.

The trend toward increased deductibles and co-pays is national. Research by the Kaiser Family Foundation indicates that deductibles for all workers have risen almost three times as fast as premiums and about seven times as fast as wages and inflation since 2010.

Other highlights of the survey include:

  • 87% of employers offer short-term disability benefits;
  • 93% of employers offer life insurance benefits;
  • 13% of survey participants still offer a defined-benefit pension plan, through 14 percent of those companies have closed to new participants;
  • Two-thirds of employees, on average, participate in their company’s 401(k) plan;
  • 58% of employers offer a paid time-off bank; and
  • 80% of employers with a work force outside of Massachusetts plan to offer the same earned sick-time benefits required for employees who work a majority of the time in state.

Purchase the 2016/2017 AIM Benefits Report

Topics: Health Care Costs, Health Insurance, Benefits

Why Are Health-Care Costs Rising?

Posted by Katie Holahan on Feb 9, 2016 2:33:45 PM

A study released today by the Massachusetts Association of Health Plans, Associated Industries of Massachusetts (AIM), the National Federation of Independent Business (NFIB), and the Retailers Association of Massachusetts (RAM), identifies 14 key factors in the rising cost of health care.

HealthCost.jpgThe report is based on a review by Freedman HealthCare (FHC) of nine recent studies of the Massachusetts health-care marketplace.

"The rising cost of health care is a significant challenge for Massachusetts employers. These reports shed light on the factors driving health care costs and will inform the conversation on measures to contain the cost of health care," said Rick Lord, President and Chief Executive Officer of Associated Industries of Massachusetts.

Here are the 14 factors:

  1. Provider price, not utilization of health care services, is the biggest cost
    driver in the Massachusetts market. (Providers are doctors, hospitals and other entities that render medical care.)
  2. There is a significant gap between the highest and lowest paid providers.
  3. Health care is most often delivered in higher priced settings.
  4. High prices do not directly correlate with high quality of care – in other
    words, the highest paid providers do not necessarily provide the highest
    quality of care.
  5. Providers with the highest public payer case mix have the lowest
    commercial reimbursement.
  6. Academic medical centers are associated with higher health care costs.
  7. In response to increasing provider prices, the commercial market is seeing
    increased consumer cost sharing.
  8. Market share impacts health care costs by influencing price, utilization,
    and available resources.
  9. There is growing policy concern that provider consolidation may lead to
    higher prices, rather than savings from integration of care or improved
    efficiency.
  10. Despite its increasing promotion, the widespread adoption of global
    payments faces significant challenges, and there is limited evidence to
    suggest that global payments produce cost savings.
  11. Performance against the cost growth benchmark is mixed.
  12. Pharmaceutical costs have been increasing and are expected to increase
    in the future.
  13. The state is increasingly focused on behavioral health – specifically, the
    high cost associated with behavioral health conditions, the challenges of
    clinical and administrative integration of care, and the need for better data.
  14. Due to persistent and increasing disparities in provider prices over the
    past several years, the state is recommending policy action be taken to
    reduce excessive price variation.

Topics: Health Care Reform, Health Care Costs, Health Insurance

Attorney General Cites Dysfunctional Health-Care Market

Posted by Katie Holahan on Sep 21, 2015 9:25:00 AM

A continued migration of patients to high-priced doctors and hospitals means that Massachusetts is unlikely to meet its benchmark for health-care cost increases in 2015, according to a new report by Attorney General Maura Healey.

AG.Maura.HealeyThe report finds that widely disparate prices paid to medical providers – differences unexplained by provider quality – have created a market in which patients continue to utilize higher cost providers, driving up health care costs.  The effects of the market dysfunction, coupled with anticipated growth in pharmacy costs and utilization of health care services, raise serious concerns about the commonwealth's ability to meet the 3.6 percent benchmark for increases in health costs.

“Not enough has changed and it certainly has not changed fast enough,” Healey said Friday during a meeting with the Associated Industries of Massachusetts Board of Directors.

“We need to do more. We have to act now.”

The report finds that the most highly-paid doctors and hospitals continue to grow market share, further increasing costs. And global payments, while having positive effects, have tended to lock in historic payment differentials, thus sustaining disparities in the resources available to different providers to carry out their mission.

The report recommends encouraging innovation in the health-care industry and strengthening and expanding consumer incentives - initiatives that will necessarily involve employers.

The report points to the importance of simplifying the cost and quality information provided to employers when they are choosing coverage, especially across providers. Clear information should also be provided to employees during enrollment and when they are choosing their primary care group.

On the "supply side" – doctors, hospitals and insurers -  the attorney general’s report suggests implementing incentives and penalties evenly by giving efficient providers more room to grow (under the benchmark) than less efficient providers. The report also points to different ways of monitoring and understanding disparities in health care resources, whether that be directly regulating variation in provider prices or tracking income/health adjusted status by zip code.

“This latest in a series of reports on health-care by the Massachusetts attorney general raises concerns about rising costs for employers who provide health insurance to workers,” said Richard C. Lord, President and Chief Executive Officer of Associated Industries of Massachusetts and a member of the Massachusetts Health Policy Commission.

“The data and graphs in the report have real consequences for real employers and real workers. The cost of health insurance remains a central issue for the Massachusetts economy.”

The report found that enrollment in tiered insurance products has increased, but the presence of these products has not resulted in an overall shift in patient volume away from higher priced providers. Current approaches appear hampered by inconsistent incentives for consumers to obtain care at higher value providers.

The Health Policy Commission will conduct its annual hearing on health-care costs in Massachusetts October 5 and 6.

 

Topics: Health Care Costs, Health Insurance, Attorney General Maura Healey

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