AIMBlog_Logo_Resized

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

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 Insurance, Controlling Health Care Costs, Health Care Costs

Health-Care Costs Burden Small Employers

Posted by Jessica Bartlett on Oct 19, 2018 4:06:22 PM

Editor's Note - The following article appeared in the Boston Business Journal. It was written by reporter Jessica Bartlett and is re-posted here with permission.

health_careHealth care costs are hammering small employers, with premiums for small businesses coming in as the second highest in the country.

That's according to a report presented by the state’s health care oversight group, the Health Policy Commission, on Tuesday during the first day of the state’s annual Cost Trends Hearing. According to the data, small employers with fewer than 50 employees paid close to $8,000 for the average premium. Large employers in Massachusetts — those with more than 50 employees — paid closer to $7,000 for the average premium, the 10th highest in the U.S.

The U.S. average pegs average premiums at approximately $6,250 for both small employers and large employers.

Massachusetts premiums have gone up drastically since 2013, when the average for Massachusetts-based small and large businesses was close to $6,500. In 2013, the U.S. average for small and large employers was around $5,500.

“It’s tough to balance cost increases of 10 percent every year, and whether it’s premium increases… or increasing copays or deductibles, we don’t have the resources,” said Liora Stone, owner and president of Uxbridge-based Precision Engineering, Inc., who testified Tuesday morning as a representative of the state’s small business community.

Read the Full Article

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

Health Care, Energy, Non-Competes on Table in Final Days for Legislature

Posted by John Regan on Jul 30, 2018 9:12:20 AM

Beacon Hill lawmakers will complete their version of final-exam week Tuesday at midnight as the Legislature races to complete bills before the end of formal meetings for 2017-2018 Beacon Hill session.

State House 2015The conclusion of formal sessions on July 31 of even-numbered years generally means the end of the line for controversial bills. Lawmakers will meet for the remainder of 2018 in informal sessions, when a single lawmaker may stop any measure with an objection.

The most important issues to employers have already been resolved in advance of this year’s end-of-session rush. The Massachusetts Supreme Judicial Court last month invalidated a potential income-tax surcharge constitutional amendment, while negotiations over three other ballot questions produced agreement on a compromise paid family and medical leave law, as well as a minimum-wage increase.

Three key employer issues remain on the table during the waning hours of debate:

  • Health care reform – The House and Senate passed different versions of health reform and a conference committee is working to hammer out a consensus bill. AIM remains concerned about both bills because they include expensive assessment. Neither bill reforms the MassHealth program for low income residents, where employers are paying a $200 million assessment to close a funding gap.
  • Energy – Measures passed by both the House and Senate could significantly increase the percentage of clean-source electricity used by Massachusetts consumers. AIM believes the bills could have the perverse effect of squeezing out clean hydro power and interrupting the successful roll-out of the 2016 energy law.
  • Non-compete agreements – The Senate, as part of an economic development bill, largely adopted the same modest restrictions on non-competes that AIM and other business groups supported two years ago as part of a compromise with House Speaker Robert DeLeo. But deep-pocketed venture capitalists continue to press for an outright ban and prospects for passage remain uncertain.

Employers also received some good news last week when Governor Charlie Baker signed the budget for the fiscal year that began July 1. The budget authorizes the administration to develop a hardship waiver for employers liable for the MassHealth surtax. Details remain to be developed.

The budget also provided full funding for the Massachusetts Manufacturing Extension Partnership.

Please contact me at 617.262.1180, or jregan@aimnet.org if you need more information on any of these issues. 

Topics: Massachusetts Legislature, Non-Compete Agreements, Energy, Controlling Health Care Costs

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

State Issues Regulations on Employer Health Assessment

Posted by Katie Holahan on Nov 6, 2017 4:08:53 PM

The Baker Administration today released draft regulations for the new employer health assessment designed to close a budget shortfall in the state's MassHealth program.

Read the Draft Regulations

The regulations, published by the Massachusetts Department of Unemployment Assistance (DUA), explain details of how the new Employer Medical Assistance Contribution (EMAC) supplement will be administered. The EMAC supplement is a new wage tax, levied on employers who have certain workers enrolled in either the MassHealth program or subsidized Health Connector coverage. 

  1. Employers with six or more employees will access their estimated liability for the EMAC supplement quarterly, via their DUA online account when they provide their quarterly wage filing;
  2. Detailed information will be provided as to the number of their employees on MassHealth or subsidized Connector coverage;
  3. Employers have 10 days from receipt of this information to appeal their determination of liability to the DUA.

The draft regulationsare available for public review and response. The Department will hold five listening sessions, across the state, to allow employers and interested parties to provide in-person feedback:

  • Boston | November 13 | 1-3 pm | Hurley Building
  • Springfield | November 14 | 10 am - nooon | Department of Industrial Accidents office
  • Worcester | November 15 | 2-4 pm | Department of Industrial Accidents office
  • Lawrence | November 16 | 10 am - noon | Department of Transitional Assistance.

A fifth session will be scheduled on Cape Cod.

Questions and suggestions may also be shared with the Department electronically.

 

Topics: Employer Health Assessment, Controlling Health Care Costs

Health Reform Must Address Employer Costs

Posted by Katie Holahan on Oct 24, 2017 11:33:45 AM

Associated Industries of Massachusetts (AIM) is pleased that the state Senate on Monday conducted a hearing on a proposal to address the challenging issue of healthcare affordability. The primary question for AIM in evaluating any such proposed legislation is whether it eases the burden of employers struggling to provide good health insurance to workers.

health_care.jpgIn 2006, employers joined with doctors, hospitals, patient advocates, and lawmakers to forge a health-reform law that required everyone to share the responsibility for improving access to health care. Eleven years later, Massachusetts residents enjoy the highest levels of health-insurance coverage in the nation.

Yet we have failed to make progress to contain the unsustainable increases in health-care costs.

According to the most recent data available from the Centers for Medicare and Medicaid Services (CMMS), Massachusetts was the second highest-spending state for health care in 2014, shelling out 30 percent more than the national average.

Personal health-care spending in Massachusetts, per capita, has increased more than 12 percent in five years – from $9,417 in 2009 to $10,559 in 2014. Cost growth like this is unsustainable and has increased unabated in the face of attempts by both employers and the commonwealth to contain it.

Businesses, in fact, have almost nothing to show in the way of cost savings and efficiencies five years after Massachusetts made a major push toward health-care cost containment in 2012. The commonwealth has exceeded the 3.6 percent spending growth benchmark established as part of the health-cost control law of 2012 in two of the past four 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 cost increases are occurring in an industry in which experts agree that at least one-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.

Massachusetts employers have strong ideas about some of the policies included in the draft Senate health-reform legislation:

MassHealth Reforms

In a state facing an alarming deficit in its Medicaid program, employers are currently shouldering the escalating costs of the public health-care system. For the next two years, employers statewide will provide at least $200 million annually in funding for MassHealth in addition to the cost of providing commercial health insurance to their workers.

More importantly, employers are being asked to close a funding deficit absent any of the long-term structural reforms needed to solve the underlying financial problems with the program. Action must be taken to improve the efficiency and cost-effectiveness of this currently unsustainable program.

Optional expanded Medicaid plan

AIM must raise grave concerns with the notion of expanding the MassHealth program through an optional Medicaid plan (SECTION 123) without first addressing existing policies that encourage and sustain needlessly expensive health-care habits.

Employers have long sought to contain costs in commercial health insurance by encouraging cost-effective habits like relying on primary care physicians for non-emergency care. The same cannot be said for the MassHealth program. The inappropriate use of emergency rooms is an example of one major cost driver identified by the Health Policy Commission. To contain costs and facilitate coverage, we must address our greatest cost-drivers in health-care utilization across the entire spectrum of both commercial and public health insurance before we implement any sort of further programmatic expansion.

“Name and Shame” List

AIM also opposes the so-called “Name and Shame” list (SECTION 38), highlighting employers with workers in the MassHealth program. The 2006 health-reform law made employees who were offered employer-sponsored health insurance ineligible for MassHealth. The intent was to balance the requirement that employers do their “fair share” with concerns about the financial burden on the MassHealth system.

The Affordable Care Act (ACA) reversed that policy and allowed income-eligible employees to decline employer coverage and 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. The ACA made public health insurance an economically rational choice for eligible residents in a state known for its expensive health-care system.

Provider Price Variation

Provider price variation includes both reasonable and unreasonable variation in the pricing of health care services. Reasonable variation in pricing should be supported and limited by a transparent marketplace in which consumers have access to clear cost and quality metrics. By mandating a minimum increase in provider prices (SECTION 111) without alleviating existing high-cost drivers, we facilitate the continued increase in price variation without seeking to understand and differentiate among the cost-drivers that result in both reasonable and unreasonable price variation.

Innovative Insurance Products

While we support market-based solutions through innovative insurance products like limited and tiered-network products, we are concerned that the differential limitations alone will be insufficient to leverage this new approach. Without a requirement that all providers participate in the contracting for such products, insurers will not always have the negotiating power to construct products in all regions of the commonwealth.

Scope-of-Practice Expansions

AIM supports the various scope-of-practice expansions included in the draft legislation. Expanding access to vital care from qualified providers for all residents of the commonwealth is a common-sense reform that helps to move us closer to a healthcare system that is efficient and effective.

Telemedicine

AIM supports the inclusion of telemedicine services (SECTION 94) to facilitate innovative, cost-effective health-care services for consumers across the commonwealth. Telemedicine services could provide additional care options for consumers with limited access, preserve productivity, and reduce time lost traveling great distances to providers. A vital component of this policy is requirement that payment for telemedicine services cannot exceed the costs related to an in-person visit. We must prioritize innovative policies that both increase access and decrease costs for residents statewide. Telemedicine should and could do exactly that.

AIM-member employers are active participants in providing health insurance to the majority of residents in the commonwealth. Moderating the cost of that insurance and putting health care on a financially sustainable business is critical to the future of the Massachusetts economy.

Please contact me at kholahan@aimnet.org if you would like to be updated on the progress of health reform in Massachusetts.

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

AIM Calls for Long-Term Cost Changes to MassHealth

Posted by Rick Lord on Jul 25, 2017 2:19:20 PM

Editor's note - Associated Industries of Massachusetts President Richard C. Lord submitted the following testimony today to the Legislature's Joint Committee on Ways & Means and Joint Committee on Health Care Financing urging lawmakers to approve long-term structural changes to the state Medicaid program. AIM's Katie Holahan (above) delivered the same message in testimony before the committees.

On behalf of Associated Industries of Massachusetts (AIM) and its 4,000 employer-members statewide, thank you for your continued engagement with the employer community on the difficult issues before you today. We are pleased that both committees have so promptly scheduled this hearing and the second hearing scheduled for this afternoon. 

AIM supports the language contained in Governor Baker’s amendment to the Fiscal Year 2018 budget, returned to you within Attachment F.  The amendment contains a complex agreement that was developed after months of intensive negotiations between the Baker Administration and the business community. We believe the comprehensive plan moderates the proposed employer assessment by coupling it with meaningful structural reforms to the public health insurance system and rate relief within the Unemployment Insurance system.   

It is vital to maintain all aspects of this package so we will not find ourselves addressing an even larger MassHealth budget deficit in two years than the one we confront today. 

AIM likewise supports language authorizing the Baker Administration to seek a federal waiver allowing Massachusetts to return to policies implemented within the 2006 Health Care Reform law, and to expand the scope of practice for certain health-care providers to facilitate lower-cost care. 

The 2006 reform law made employees who were offered employer-sponsored health insurance ineligible for MassHealth.  The intent was to balance the requirement that employers do their “fair share” in offering health insurance with concerns about the financial burden on the MassHealth system.  The Affordable Care Act (ACA) reversed that policy and allowed income-eligible employees to decline employer coverage and 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.  The ACA made public health insurance an economically rational choice for eligible residents in a state known for its expensive health-care system.   

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 our economy.  Policymakers who have concentrated almost exclusively on access and coverage now face a renewed imperative to lower the cost of health insurance for everyone in Massachusetts. 

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.1 

The 4,000 member employers of AIM provide health insurance to the majority of residents in the commonwealth. 

But providing that coverage has financial consequences. 

According to the most recent data available from the Centers for Medicare and Medicaid Services (CMMS), Massachusetts was the second highest-spending state for health care in 2014, 30 percent more than the national average. Personal health-care spending in Massachusetts, per capita, has increased more than 12 percent in five years – from $9,417 in 2009 to $10,559 in 2014. Cost growth like this is unsustainable and has accelerated in the face of attempts by both employers and the commonwealth to contain it. 

Businesses, in fact, have almost nothing to show in the way of cost savings and efficiencies five years after Massachusetts’ major push toward health care cost containment. 

The commonwealth has exceeded the 3.6 percent health spending growth 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. 2 

These cost increases are occurring in an industry in which 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.  

Now, the employer assessment means that business is expected to shoulder the escalating costs of the public healthcare system, as well.  More importantly, they are being asked to close the MassHealth deficit absent any of the  long-term structural reforms needed to solve the underlying financial problems with the program. 

Eleven years ago, employers joined with doctors, hospitals, patient advocates and lawmakers to forge a health-reform law that required all parties to share the responsibility for improving access to health care. The employer community calls for that same sense of shared responsibility now to solve the MassHealth shortfall. 

Thank you for considering AIM’s views and please feel free to contact me if you have any questions or need any further information.  

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

Subscribe to our blog

Posts by popularity

Browse by Tag