Cost Trends Hearings: Day One Affirms and Confirms

Yesterday’s initial day of the DCHFP Cost Trends Hearing (background: confirmed the serious issues with our health care cost structure, and reaffirmed the need to take comprehensive action for health care cost containment.

Several themes raised up by the most of the participants in the hearing: the need to act now, the need for short-term and long-term solutions, the unsustainable status quo, an appreciation for the information provided and a willingness to work together to solve this problem. The Division has posted online all of the hearing presentations and statements.

The day opened with a welcome from Commissioner Morales and the first hour included testimony from Governor Patrick, Senate President Murray, Health Care Finance Committee Chairs Senator Moore and Representative Stanley, committee Vice-Chair Grant, and EOHHS Secretary Bigby.

The Senate President opened and said that “failure to act is not acceptable” and that health care cost control is one of her number one priorities for 2010. Secretary Bigby said that once the hearings were over, “we must act quickly and decisively” to promote better care coordination and reorient our health care delivery system. Governor Patrick spoke next and highlighted the need for both short-term and long-term solutions as the key to economic recovery for our state. Senator Moore reminded us that our mission will not be accomplished until we have the highest quality care. Representative Stanley was brief, but to the point: enough is enough – we need to act now. Representative Grant spoke next from the perspective of a mental health clinician and remarked that full transparency is critical to any payment reform.

The next hour was moderated by Stan Wallack of the Brandeis Heller School and included discussions of the three DHCFP reports by the consultants (Cindy Parks, Dianna Welch and Deborah Chollet) who worked on them (see our earlier blog for more on the reports). In an interesting tactic, Stan Wallack asked each panelist what was most surprising or most concerning to them through this research. For Parks it was the impact of our academic medical centers. For Welch and Chollet, the wide price variations was most surprising.

Representative Sanchez, House chair of the Public Health Committee, spoke next and reminded all parties that preventive health policies must be an integral part of any cost containment effort. Commissioner Murphy, from DOI, then provided a preview of the DOI report on small business health insurance (the report should come out within the next month). Commissioner Murphy said that DOI is actively reviewing the small group premium filings for April, 2010 and is working with carriers to make sure that they are in compliance with the Division’s requirements.

Economist Len Nichols, spoke on the “cost of inaction.” According to Len Nichols, MA is currently spending 16% of our median income for health care. This will jump to a remarkable 30% in just a decade. He said that we must signal that business as usual us over and we need to change medical education, change our payment mechanism and include more prevention.

We came back from lunch with a presentation by the Attorney General on her report. This presentation, done jointly by the Attorney General Coakley, Lois Johnson from the AG’s office, and two of their consultants provided one of the high points of the day. The preliminary report, released in January (check out our blog report), showed that the Bay State health care market is primarily rewards market power, but did not provide any specific details. The final report (pdf), released at the hearing, included the names of the providers and their relative payment levels. In a lighter moment to the day, the entire audience tipped their heads to read the slides as the names of the hospitals and physician groups, which were printed sideways on the charts. The AG thankfully handed out copies of the report at the conclusion of the presentation so everyone could pour over the details.

The last two panels of the day were of a different tenor: these were larger panels of employers and consumers who spoke of the impact of health care costs on their constituencies. As Commissioner Morales notes in his blog summary, these panels took the issue out of the policy-wonk world and into the real world. The employers discussed the oppressive health costs and the need for change in the system as well as some innovative programs being done at EMC and John Hancock.

The consumer panel was the last (and possibly funniest) panel of the day. Amy Whitcomb Slemmer from HCFA testified about the need for patient engagement, transparency, coordinated care and more public health. Deborah Banda from AARP reminded us of the heart-break experienced daily by our seniors and the need to provide more support and coordination. Matt Selig, from Health Law Advocates discussed medical debt and the need to fill in gaps in the system. Nancy Turnbull, from Harvard School of Public Health, spoke next and told us all “Do not be afraid and don’t be a chicken” as she wove the story of Chicken Little into her testimony. Cheri Andes, from GBIO, was next to speak. She firmly reminded all that health care costs are about justice and we need to make sure people are cared for. Finally, Rob Restuccia, from Community Catalyst, delivered the last formal testimony and said that Massachusetts must lead the nation on cost and quality in the same way that we led the nation on access.

The panel, moderated by DPH Commissioner John Auerbach, fielded several questions about the role of consumers in health care including one about increased cost sharing for consumers (one of the ideas that is always raised). To a one, the panel members raised up the vulnerability of consumers and the regressive nature of cost-sharing as well as research that shows decreasing cost-sharing for preventive and chronic disease can save the health care system money in reduced inpatient admissions.

The hearings will resume on Thursday at 9am, with the final session starting on Friday at 9. Follow along – HCFA will be tweeting, as will DHCFP.
-Georgia Maheras

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