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Katie Holahan

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Budget Assumes EMAC Assessment Will End in December

Posted by Katie Holahan on Jul 25, 2019 12:01:35 PM

Sometimes the real value of legislation is found in the things left out of a bill.

StateHouse-resized-600Such was the case this week as the Massachusetts Legislature passed a $43.1 billion budget for the fiscal year that began July 1. The spending blueprint included important elements ranging from curbs on the cost of prescription drugs in the state Medicaid program to increased aid for public schools.

But the most significant part of the budget for employers lies in what was left out – an extension of the onerous two-year assessment on Massachusetts businesses to fund a budget shortfall in the MassHealth insurance program for low-income people.

The Legislature passed  an increase to the Employer Medical Assistance Contribution (EMAC) in 2017.  Employers have already paid tens of millions of dollars more than anticipated under the levy, some $519 million by the time the assessment sunsets at the end of this year instead of the $400 million envisioned under the legislation.

AIM in January called for an immediate end to the so-called EMAC assessment. The association also engaged a diverse coalition of organizations ranging from human services providers to home-care aides and trade associations to urge key legislators not to extend the two-year assessment in the Fiscal Year 2020 budget.

Employers are gratified that the Legislature is sticking to the original plan to sunset the tax at the end of 2019.

The assessment falls most heavily upon companies in which employees elect to use MassHealth rather than the employer-sponsored health plan. The assessment has increased EMAC from $51 to $77 per employee, while employers are also required to pay up to $750 for each worker who receives public health benefits.

AIM member employers are proud to lead the nation in providing health care coverage to their employees. Sixty-five percent of Bay State companies offer health insurance coverage to their workers, compared with 56 percent of employers nationwide. A full 100 percent of Massachusetts employers with 200 or more employees offer coverage. 

Employers stand ready to work with policymakers to make long-term structural reforms to both the MassHealth program and the commercial insurance markets to make the financing of health care for all Massachusetts residents sustainable.

Topics: Massachusetts state budget, Health Care, Employer Health Assessment

Report: More Massachusetts Employers Offering Health Insurance

Posted by Katie Holahan on Jun 26, 2019 10:28:35 AM

More Massachusetts companies of all sizes are offering health insurance to their workers but fewer employees are enrolling as costs accelerate, according to a new state study released this morning.

The report from the Center for Health Information and Analysis (CHIA) finds that the percentage of Bay State employers who provide health insurance increased from 65 percent in 2016 to 71 percent in 2018. Only 57 percent of employers nationally provide health coverage.

2019ChiaInforgraphicAt the same time, the percentage of eligible employees who accepted employer health insurance declined from 74 percent to 67 percent during the same period.

Part of the explanation could be the relentless increase in the cost of health insurance faced by both companies and their workers. The CHIA report says that average health-insurance premiums rose 12 percent for single policies from 2016 to 2018 and 13 percent for family plans. Employer contributions remained steady at 74 percent, but the average annual deductible soared 42 percent.

“Massachusetts employers deserve tremendous credit for expanding health insurance options at a time when the cost and complexity of health care continue to increase,” said John R. Regan, President and Chief Executive Officer of Associated Industries of Massachusetts.

“AIM members last year identified the cost of health insurance as the most important issue facing their companies. The numbers underscore the importance of our efforts to ensure that employers have the ability to provide affordable health insurance to their workers.”

CHIA is the primary center for the collection and analysis of information about the Massachusetts health-care market.  The agency’s biennial Massachusetts Employer Survey (MES) tracks and monitors employer health insurance offerings, employee take-up rates, health-insurance premiums, employer contribution amounts, plan characteristics, and employer decision making.

The most eye-opening conclusion of the study is that even small companies remain committed to offering health-insurance benefits. Although employers with fewer than 50 employees are no longer required by law to offer health insurance, 65 percent of these employers do. Seventy percent of small firms (3-199 employees) offered insurance, versus 99 percent of large firms (200 or more employees). 

Other key findings of the CHIA survey include:

  • The 2018 average total monthly premium was $617 for single coverage and $1,687 for family coverage.
  • The average employee contribution to health insurance in 2018 was 26 percent for single coverage and 30 percent for family coverage, unchanged from 2016. Employers continue to cover an average of 74 percent of monthly premium costs.
  • The average annual deductible for single coverage in 2018 was $1,508, slightly lower than the national average of $1,573, but more than the $1,065 average for 2016.
  • Massachusetts employees overall faced lower out-of-pocket limits than their national counterparts. The average out-of-pocket limit for single coverage in Massachusetts was $3,461 compared to $3,872 nationally.
  • Almost three quarters (70 percent) of Massachusetts employees were offered a High Deductible Health Plan (HDHP) in 2018. Thirty-nine percent were offered an HDHP with a savings option.
  • The most common reason given by employers (48 percent) for not offering health insurance was that they were not required to do so because of their firms’ small size. Thirty-eight percent cited the cost as being too high. The most common reason given by employers as to why they were offering health insurance was to retain employees (66 percent) and recruit new employees (63 percent).
  • Large companies were more likely than small ones to reduce their contributions toward employee premiums as a way to contain costs.

 

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

AIM, Coalition Ask Legislature to Limit MassHealth Assessment

Posted by Katie Holahan on Apr 8, 2019 3:34:04 PM

A diverse coalition of organizations ranging from AIM to groups representing human services providers and home-care aides urged key legislators today not to extend the two-year assessment imposed on employers last year to close a financial gap at the state’s MassHealth insurance program.

State House 2015In a letter to House Ways and Means Committee Chair Aaron M. Michlewitz and Vice Chair Denise C. Garlick, the coalition says that  the “burden of the (Employer Medical Assistance Contribution) EMAC Supplement falls particularly on certain industries, especially small employers with lower wage workers, many of whom are paid via state contracts.”

“This unbudgeted and unanticipated expense is threatening employers’ ability to make critically needed investments in our workforce and to maintain vital programs that support vulnerable members of our communities.”

The Ways and Means Committee is currently developing the state budget for the fiscal year that begins on July 1.

AIM has already urged the Legislature to end the EMAC assessment immediately because employers last year paid tens of millions of dollars more than anticipated under the levy. Businesses are on track to contribute some $519 million by the time the assessment sunsets at the end of this year instead of the $400 million envisioned under the 2017 legislation.

At the same time, enrollment in MassHealth has fallen as the Baker Administration has initiated steps to ensure that only people eligible for benefits receive them. 

The Center for Health Information and Analysis (CHIA) recently indicated that, in calendar year 2017, total MassHealth spending decreased by 0.2 percent, driven in part by a 2.4 percent decrease in enrollment. The trend indicates relief from the pressures of enrollment increases that have plagued the MassHealth program in recent years and produced the fiscal deficit that resulted in the EMAC Supplement policy.

“The conditions that led to the imposition of the surcharge no longer exist. Employers who have paid hundreds of millions of dollars in assessments believe it is fair to look at ending the surcharge in year two,” said John Regan, Executive Vice President of Government Affairs at AIM.

The next round of EMAC supplement billings will be delivered to employers in the next week.

The members of the coalition include BAMSI (Brockton Area Multi-Services, Inc.), Building Trades Employers’ Association, Home Care Aide Council, MAB Community Services, Massachusetts Staffing Association, New England MCA/MSCA, Providers’ Council, The ERISA Industry Committee, Italian Home for Children, Massachusetts Senior Care Association, the Nashoba Valley Chamber of Commerce and the Springfield Chamber of Commerce.

The coalition said the EMAC supplement has raised costs for Massachusetts nursing facilities alone by more than $16 million.

“As a Commonwealth, we face a renewed imperative to lower the cost of health insurance for everyone in Massachusetts via long-term, efficient strategies. Short-term, unpredictable financial obligations like the EMAC Supplement tax serve only to deter business expansion and employee recruitment, and to reduce our ability to provide vital services,” the group wrote.

The Legislature passed the assessment in July 2017 minus a set of structural reforms proposed by Governor Baker to place the MassHealth/Medicaid program on a firm financial footing. The surcharge raised the EMAC assessment from $51 to $77 per employee. Employers also were required to pay up to $750 for each worker who receives public health benefits.

Employers may request a waiver from the fees if they prove a hardship. Of 246 such waiver requests, administration officials said they have allowed 99.

Topics: Massachusetts House of Representatives, Employer Health Assessment, EMAC Surcharge

AIM Calls on Legislature to End MassHealth Assessment on Employers

Posted by Katie Holahan on Mar 26, 2019 1:52:06 PM

Editor's note - AIM Vice President of Government Affairs Katie Holahan today delivered the following testimony to the Legislature's Joint  Committee on Labor and Workforce Development in favor of ending the MassHealth employer assessment.

State House 2015Associated Industries of Massachusetts (AIM), on behalf of its member companies, supports H.1647, An Act relative to repealing the employer medical assistance contribution tax. We support an end to the two-year assessment imposed on employers to close a financial gap at the state’s MassHealth insurance program for low-income residents.

AIM believes the assessment is no longer necessary as employers last year paid tens of millions of dollars more than anticipated originally under the levy.

The prior, existing Employer Medical Assistance Contribution (EMAC) assessment increased from $51 to $77 per employee, and employers were required to pay up to $750 for each worker receiving public health benefits. By the time the EMAC assessment sunsets in 2019, Massachusetts businesses are on track to contribute $519 million instead of the $400 million envisioned under the 2017 legislation – or 30 percent more than originally estimated.

At the same time, enrollment in MassHealth has fallen as the administration has initiated steps to ensure that only those eligible for benefits receive them.

The Legislature passed the assessment in July 2017, minus a set of structural reforms proposed by the governor to place the MassHealth/Medicaid program on a firm financial footing. The assessment fell most heavily upon companies whose employees elect to use MassHealth rather than the employer-sponsored health plan.

AIM member employers are proud to lead the nation in providing health care coverage to their employees. Sixty-five percent of Bay State companies offer health insurance coverage to their workers, compared with 56 percent of employers nationwide. A full 100 percent of Massachusetts employers with 200 or more employees offer coverage.

As health-care premium and utilization costs continue to grow, employers have fewer options and less flexibility to keep year-over-year increases in check, raising important concerns about their ability to offer comprehensive insurance to their employees. Adding the cost of the state’s public health insurance program is not a sustainable financial plan, long-term.

Employers stand ready to work with policymakers to make comprehensive structural reforms to both the MassHealth program and commercial insurance markets to make the financing of health care for all Massachusetts residents sustainable this year and for many years to come.

Topics: Massachusetts Legislature, Health Care Costs, Health Insurance

Health Spending Moderates, But Employers Still Waiting to See Benefits

Posted by Katie Holahan on Feb 13, 2019 2:35:28 PM

Health-care spending in Massachusetts grew less than a key state benchmark and less than the national average during 2017, but employers and workers are not yet seeing the benefits.

health_careThe annual Health-Care Cost Trends Report issued today by the state Health Policy Commission (HPC) indicates that total per-capita health-care expenditures in Massachusetts rose 1.6 percent during 2016, significantly less than the 3.6 percent benchmark set by the commission. The Massachusetts growth rate also fell below the national rate - 3.1 percent – for the eighth consecutive year.

But the health-insurance premiums paid by Massachusetts employers and employees increased 5.8 percent in 2017, leaving the average total premium for employer-based coverage among the highest in the country at $21,000 per year for a family plan and $7,000 for a single employee. These figures do not include out-of-pocket spending such as co-payments and deductible spending, which grew 5.9 percent in 2017 for commercially-insured enrollees.

Premiums for smaller employers increased 6.9 percent and are now the second highest in the country, according to the HPC. Fifty-seven percent of small-firm (1-50 employees) employees are enrolled in high-deductible health plans.

“AIM-member employers told us in a recent survey that the rising cost of providing health insurance to employees is their biggest concern,” said Richard C. Lord, President and Chief Executive Officer of Associated Industries of Massachusetts and a member of the Health Policy Commission.

“The HPC report contains good news about health-care expenditures, but also underscores the need to look at issues such as price variations among doctors and hospitals that are driving up insurance premiums.”

Part of the reason that employers are not seeing more benefit from moderating health spending may be the fact that commercial insurers in Massachusetts pay higher prices to providers than Medicare pays for the same services. For hospital inpatient care, average prices among the three largest Massachusetts insurers were 57 percent higher than Medicare prices for similar patients ($15,913 versus $10,117, respectively).

Commercial insurers also paid considerably more for typical outpatient services, including brain MRIs, emergency department visits, and physician office visits.

The HPC attributed much of the overall increase health-care expenditures to spending on prescription drugs (4.1 percent) and hospital outpatient services (4.9 percent). The commission also found that medical bills can vary as much as 30 percent from one hospital or medical group to another with no measurable different in quality of care.

The HPC makes 11 policy recommendations to continue health spending moderation. Highlights include:

Unnecessary utilization: The Commonwealth should focus on reducing unnecessary utilization and increasing the provision of coordinated care in high-value, low-cost settings. Payers and providers should reduce the use of avoidable high-cost care such as emer­gency department (ED) visits, behavioral health-related ED visits, readmissions, use of teaching hospitals and academic medical centers for community-appropri­ate inpatient care, and institutional post-acute care by ensuring access to high-value, low cost settings, and for shifting care, as appropriate, to these settings.

Provider price variation: Policymakers should advance specific, data-driven interventions to address the press­ing issue of continued provider price variation in the coming year.

Alternative payment methods: The Commonwealth should continue to promote the increased adoption of alternative payment methods (APMs). Also, as part of a strategy to reduce spending, payers should develop plans to lessen the unwarranted disparities in global budgets paid to different providers by establishing stricter targets for spending growth for highly paid providers, by moving away from historical spending as the basis of global budgets, and by using bundled payments for certain care episodes where evidence has shown effectiveness.

Pharmaceutical spending: The Commonwealth should act to reduce drug spending growth. Specific areas of focus should include authorizing the Executive Office of Health and Human Services to establish a process that allows for a rigorous review of certain high-cost drugs, increasing the ability of MassHealth to negotiate directly with drug manufacturers for additional supplemental rebates and outcomes-based contracts, and increasing public transparency and public oversight for pharmaceutical manufacturers, medical device companies, and pharmacy benefit managers.

As a leader of the Massachusetts Employer Health Coalition, AIM is working with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members. Please check out our website for resources and information.

Topics: Health Care Costs, Health Insurance, Health Care

How to Help Employees Find Appropriate Health Care

Posted by Katie Holahan on Dec 11, 2018 3:10:01 PM

A coalition of employers led by AIM and the Massachusetts Taxpayers Foundation today unveiled resources to help employers speak to workers about the benefits of receiving medical care outside of hospital emergency rooms.

ER.2018The Massachusetts Employer Health Coalition plans to work with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members.

At a kickoff breakfast in Boston, Coalition officials previewed sample social media posts, newsletter articles and posters that employers might use to help employees obtain “the right care, in the right place at the right price at the right time.” Also among the resources is a document called “My Care, My Options” that allows workers to identify alternatives to emergency rooms, including their primary care physician, urgent-care center and retail clinic.

The Massachusetts Health Policy Commission says that one out of three Massachusetts residents who get health insurance through their employers reported that their last visit to an emergency room was for a non-emergency condition. The most common non-emergency conditions for which people seek treatment in the ER were neck pain, hives, sciatica, sinus infections and bronchitis.

Download the Employer Resources

Almost three-quarters of non-emergency visits to the ER are for care needed outside the normal operating house at the doctor’s office. The average visit to an emergency room costs $1,220, while the average bill for treatment at a doctor’s office is $165.

Companies such as AIM member Cummings Properties of Woburn have successfully worked with their employees for many years to create a system in which 80 percent of all medical care is delivered by high-quality community health organizations.

Bill Grant, CFO of Cummings, an AIM director and chair of the association's Health Care Committee, said the company also offers a wellness program that identifies issues such as high cholesterol that need additional attention.

But employers also acknowledge the challenge of communicating the importance of seeking care in appropriate settings.

“For us, it’s about communicating the value proposition for the individual employee…what’s in it for them,” said Lisa Collentro, Chief Administrative Officer, Chestnut Hill Realty another AIM member.

Employer coalitions in other areas of the country have already made progress curbing unnecessary use of emergency departments. Louise Probst, Executive Director of a regional health improvement collaborative serving the state of Missouri, and the St. Louis Area Business Health Coalition, told 150 people at this morning’s coalition kickoff that her organizations saw a 5 percent decrease in emergency-room visits from 2016 to 2017.

“There was a lot of shared interest” among employers, physicians, insurers, hospitals and others seeking to control the cost of health insurance, she said.

The St. Louis effort is paying measurable dividends,” Probst said:

  • Employers are talking about their emergency department usage rates and avoidable visits.
  • New worksite clinics are emerging, and roles of established clinics being reconsidered.
  • Primary care physicians are working with patients to develop alternatives to ER visits. Some medical groups have implemented condition-specific action plans for chronic diseases such as urinary tract infections or chronic obstructive pulmonary disease.
  • Two orthopedic practices have walk-in hours each evening.

The Employer Health Coalition is made up of 22 business organizations and five “strategic partners’ from the health-care industry.

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Launch Effort to Reduce Unnecessary ER Use

Posted by Katie Holahan on Dec 4, 2018 9:00:00 AM

A coalition of employers led by AIM and the Massachusetts Taxpayers Foundation will formally initiate a campaign on December 11 to moderate the cost of health care by reducing avoidable use of hospital emergency departments (EDs).

EmergencyThe Massachusetts Employer Health Coalition will work with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members.

The good news is that employer coalitions in other areas of the country have already succeeded in curbing unnecessary use of emergency departments. The Massachusetts groups plan to kick off their initiative on the 11th with a breakfast at which they will hear comments from Louise Probst, Executive Director of a regional health improvement collaborative serving the state of Missouri, and the St. Louis Area Business Health Coalition, an employer coalition supporting more than 60 leading, self-insured employers.

In addition to Ms. Probst, a panel including AIM members will discuss cost savings initiatives they have implemented, as well as the challenges to reducing health-care costs for both large and small employers.

Register for the Coalition Kickoff

“The rising cost of providing health insurance to employees remains the most pressing issue facing the 4,000 employers who are members of Associated Industries of Massachusetts,” said Richard C. Lord, President and Chief Executive Officer of AIM.

“The Massachusetts Employer Health Coalition is a great example of employers stepping up and taking action to ensure that their workers can access the right care in the right place, maximizing both health care quality and affordability.”

The objective, according to Lord, is to reduce health-care costs and provide rate relief for small businesses and patients, while optimizing resources to ensure quality care for those in need of emergency care.

Most ED use is necessary, appropriate, and in many cases life-saving. However, providers and payers broadly agree that shifting ED use for non-urgent health problems to more timely, appropriate settings will improve quality and patient experience, and lower the cost of care.

The cost of an ED visit can be five times that of care provided in a primary care or urgent care setting. Upper respiratory infections, skin rashes, allergies, and back pain are among the most common conditions for which Massachusetts patients seek care in the ED unnecessarily.

The Coalition is expected to use the December 11 event to unveil resources that employers will use to engage with their workers about the importance of seeking medical care in appropriate settings. These resources will include educational materials, along with procedures to help employers and employees identify local care options.

AIM plans to provide links to the resources for its employer members.

The Coalition plans to focus on four tactics for change:

  1. Educating Employees: Work with employers to communicate information about avoidable ED use with employees and families so they can get the best possible care in settings such as primary care practices, retail clinics, and urgent care centers.
  2. Learning from Data: Track and publicly report the rate of avoidable ED visits so employers, stakeholders, and the public may understand and tackle the scope of the issue.
  3. Collaborating Across the Health Care System: Work with labor unions, health care providers, health plans, employers, and employees to reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.
  4. Advocating for Policy Change: Advocate for policy changes that will advance new care delivery and payment models, such as Accountable Care Organizations (ACOs), telemedicine, and mobile integrated health, which combined, can improve access to timely care in the right setting.

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Face New HIRD Form Tomorrow

Posted by Katie Holahan on Oct 31, 2018 11:14:31 AM

Starting tomorrow, the Commonwealth of Massachusetts will implement a new Health Insurance Responsibility Disclosure (HIRD) form for employers.

Health.EnergyThe new form is different than the HIRD form established under the 2006 Massachusetts Health Care Reform law and later repealed in 2013. 

The purpose of the new HIRD form is to collect employer-level information about company-sponsored insurance offerings, to assist the state in identifying individuals with access to employer-sponsored insurance who may be eligible for MassHealth’s Premium Assistance Program.

MassHealth is the state's Medicaid health-insurance program for low-income residents.

This will help some employers to avoid the EMAC Supplement tax, while still ensuring comprehensive insurance coverage for employees.

  • Employers will have to complete the HIRD form once – annually, in November – detailing the health insurance benefits that they offer their employees.
  • The form will be accessible through the Department of Revenue’s MassTaxConnect online portal.
  • Employers have until November 30 to complete the form. There will be no penalty this year for employers who fail to complete the new HIRD form.

Unlike the old HIRD form, employees do not have to fill out the document. Only the employer is required to fill it out.

Here is an overview of the Premium Assistance Program and additional details for employers who are interested in the program.

Read HIRD Form FAQs

Need more information? Contact Katie Holahan at kholahan@aimnet.org.  

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

Employers Announce Initiative to Reduce Health Costs

Posted by Katie Holahan on May 30, 2018 11:30:32 AM

AIM and 19 other prominent Massachusetts business organizations today announced an initiative to save $100 million in health care costs by reducing avoidable use of hospital emergency departments (EDs).

Health.EnergyThe newly formed Massachusetts Employer-Led Coalition to Reduce Health Care Costs will work with doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that 40 percent of ED visits are avoidable, a pattern that costs $300-$350 million annually for commercially insured members alone.

Coalition leaders Richard C. Lord, President and CEO of the Associated Industries of Massachusetts (AIM), and Eileen McAnneny, President of the Massachusetts Taxpayers Foundation (MTF), say the group will help employers take a direct role in the health and health care of their employees and beneficiaries.

(Read the full statement of the Massachusetts Employer-Led Coalition to Reduce Health Care Costs here).

Health care industry organizations – including the Massachusetts Health and Hospital Association (MHA), Blue Cross Blue Shield of Massachusetts (BCBSMA), the Massachusetts Association of Health Plans (MAHP), and the Massachusetts College of Emergency Physicians (MACEP) – are committed to be strategic partners with the Coalition.

The Coalition’s goal is to shift as many avoidable ED visits as possible to high-value, lower-cost settings to relieve crowded EDs, reduce the cost of care, and improve quality. The vision is a health care system that delivers the right care, in the right place, at the right time.

“The rising cost of providing health insurance to employees remains one of the most troublesome issues facing the 4,000 employers who are members of Associated Industries of Massachusetts,” said Lord.

“AIM has always been active in the health care policy arena, advocating for changes to our delivery system that balance access to care and efficiency. Today, we are taking this collaborative step to ensure that employers and their workers can access the right care in the right place, maximizing both health care quality and affordability.”

McAnneny stated, “As an organization dedicated to the long-term economic and fiscal health of the commonwealth, the Foundation recognizes the need to address the costs of health care by taking unnecessary cost out of the system. I am proud to co-chair this newly formed coalition that will provide employers with the tools they need to educate their employees on getting appropriate care at the appropriate setting.”

McAnneny added, “Not only will this reduce health care costs and provide rate relief for small businesses and patients, it also allows us to optimize resources to ensure quality care for those in need of emergency care.”

Most ED use is necessary, appropriate, and in many cases life-saving. However, providers and payers broadly agree that shifting ED use for non-urgent health problems to more timely, appropriate settings will improve quality and patient experience, and lower the cost of care. Upper respiratory infections, skin rashes, allergies, and back pain are among the most common conditions for which Massachusetts patients seek care in the ED unnecessarily and the cost of an ED visit can be five times that of care provided in a primary care or urgent care setting.

“For several years the HPC has identified reducing avoidable ED use as a target area for health care improvement and has recommended coordinated action to address it,” said David Seltz, Executive Director of the Massachusetts Health Policy Commission. “This new coalition represents an exciting commitment by employers to work collaboratively to address one of the underlying drivers of health care costs. We are excited to be a strategic partner in this effort, consistent with the HPC’s goal of reducing health care cost growth without compromising quality or access.”

The strategic partners, MHA, BCBSMA, MAHP, and MACEP, will engage with the Coalition in a collaborative process to uncover solutions and support changes in the health care delivery system. Additionally, the Coalition intends to engage collaboratively with other important health care stakeholders, including health plans, hospitals, physicians, consumer advocates, labor unions, government agencies, and community organizations.

The Coalition will focus on four tactics for change:

  1. Educating Employees: Work with employers to communicate information about avoidable ED use with employees and families so they can get the best possible care in settings such as primary care practices, retail clinics, and urgent care centers.
  1. Learning from Data: Track and publicly report the rate of avoidable ED visits so employers, stakeholders, and the public may understand and tackle the scope of the issue.
  1. Collaborating Across the Health Care System: Work with labor unions, health care providers, health plans, employers, and employees to reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.
  1. Advocating for Policy Change: Advocate for policy changes that will advance new care delivery and payment models, such as Accountable Care Organizations (ACOs), telemedicine, and mobile integrated health, which combined, can improve access to timely care in the right setting.

More details on the Coalition’s framework to reduce avoidable ED use are included in the statement here.

The Coalition was built and organized throughout the beginning of 2018, and plans to kick off its public activities in September. The rest of the major initiatives are planned to begin in early 2019. If successful, this collaborative effort will provide a model for future coordinated efforts to tackle other drivers of health care costs.

“I urge employers of any size to participate in the Coalition’s initiatives,” added Lord. “These efforts are an opportunity to engage with each other by sharing our successes and difficulties in managing health care costs – while also actively educating our employees about their ability to drive down health care costs through patient choice. We want to raise the bar for all employers in Massachusetts.”

The Employer Members of the Coalition are:

Associated Industries of Massachusetts
Associated Subcontractors of Massachusetts
Boston Municipal Research Bureau
Greater Boston Chamber of Commerce
Massachusetts Bankers Association
Massachusetts Business Roundtable
Massachusetts Competitive Partnership
Massachusetts Food Association
Massachusetts High Technology Council
Massachusetts Package Stores Association
Massachusetts Restaurant Association
Massachusetts Society of CPAs
Massachusetts Taxpayers Foundation
NAIOP Massachusetts
National Federation of Independent Business
North Shore Chamber of Commerce
Retailers Association of Massachusetts
South Shore Chamber of Commerce
Springfield Regional Chamber of Commerce
Worcester Regional Chamber of Commerce 

The Strategic Partners are:

Blue Cross Blue Shield of Massachusetts
Massachusetts Association of Health Plans
Massachusetts College of Emergency Physicians
Massachusetts Health and Hospital Association
Massachusetts Health Policy Commission

Topics: Health Care Costs, Controlling Health Care Costs, Health Insurance

AIM Urges State to Maintain Aggressive Health-Cost Benchmark

Posted by Katie Holahan on Mar 28, 2018 1:30:00 PM

Massachusetts should retain its 3.1 percent health-care cost growth benchmark because employers continue to struggle to provide quality health insurance coverage to their workers, AIM told a state panel today.

health_care.jpgThe state’s largest employer association told the Massachusetts Health Policy Commission that the current benchmark is necessary to moderate health-care costs that remain well above national averages. The Massachusetts Legislature established the health-cost benchmark as part of a 2012 health-care reform law.

The benchmark was 3.6 percent from 2012 until 2017, when it was lowered to 3.1 percent. AIM is recommending that the Commission retain the 3.1 percent mark for 2019.

“As we continue to track trends in health-care cost and utilization, the cost-growth benchmark has become a critical component for understanding year-over-year changes in health-care spending,” said Richard C. Lord, President and Chief Executive Officer of AIM.

“More than 10 years after the implementation of Massachusetts’ universal health care law, employers, consumers and the public sector continue to struggle with escalating costs of comprehensive health care.”

Massachusetts doctors and hospitals have a mixed record of meeting the heath-cost benchmark. Total Health Care Expenditures (THCE) grew by 2.3 percent from 2012 to 2013; 4.2 percent from 2013 to 2014; by 4.1 percent from 2014 to 2015; and by 2.8 percent from 2015 to 2016.

Lord told the Health Policy Commission that consumer behavior plays a large role in accelerating health-care costs, especially the tendency of patients to use of high-cost settings to receive care. According to estimates provided by the Commission, reducing just some of these factors by 10 percent could save tens of millions of dollars in unnecessary health-care spending.

The hospital outpatient utilization rate in Massachusetts is 50 percent higher than the national average. The rate of emergency room visits and inpatient discharges are 10 percent and 8 percent higher than the national average, respectively. And post-acute care discharges in the Bay State are 27 percent higher than the national average.

“And as premium and utilization costs continue to grow, employers have fewer options and less flexibility to keep year-over-year increases in check, raising important concerns about their ability to offer comprehensive insurance to their employees. Without comprehensive insurance, employees have less ready access to the type of coordinated and preventative care that leads to long-term health and productivity,” Lord testified. 

“As an advocate for employers in the commonwealth, we believe that the appropriate role of government in controlling health insurance costs should be to establish reasonable health care spending targets, like the 3.1 percent benchmark, instead of proscribing regulatory solutions. The market should be given the chance to correct itself, and the commonwealth’s function should continue to be the monitoring of the industry’s progress in achieving this goal.”

The 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.

Topics: Controlling Health Care Costs, Health Care

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