Friday’s final day of the Cost Trends hearings focused on solutions. We covered the event minute by minute on our twitter feed, as did the DHCFP, and you can go back to the feeds to get the details. Throughout the three days, it seems a significant consensus has emerged that the cost and payment issues highlighted by the AG and DHCFP reports are real, and that state government must take responsibility and leadership for short-term fixes and long-term payment reform. While there is disagreement on the details, we think a hurdle has been cleared and all stakeholders are primed to see real, effective steps this year.
The day began with a presentation by Stuart Altman of the Brandeis University Heller School. He started off with the admonition that we must change the delivery system or we will never get the results we want. He made bold recommendations about the need for a governmental or quasi-governmental oversight entity to make sure we set appropriate financial and quality targets over the next five years. He also noted that consumers need to be involved in the health care system in a different way than they are now and that they need incentives to get them there. The plan outlined by Altman (see his slides)was intentionally designed to be conservative and fair to providers. His three tiered plan gives providers significant choice in how they transition to a better delivery system. Altman also noted that Medicare is a big part of the problem and that while we do not need 100% of payers paying in a different way, we need a critical mass to move the rest of the delivery system.
The next panel was the much anticipated panel of: Dr. Ralph de la Torre, CEO of Caritas Christi Health Care, Deb Enos, CEO of Neighborhood Health Plan, Dr. Gary Gottlieb, CEO of Partners Healthcare, George Gresham, President of Local 1199 SEIU, Dr. Richard Lopez, Chief Physician Executive of Atrius Health, Dolores Mitchell (who provided the humor for today), Executive Director of the Group Insurance Commission and Ellen Zane, President and CEO of Tufts Medical Center. Alan Weil of the National Academy for State Health Policy moderated this panel whose task was simple – provide the solutions for cost containment both short-term and long-term. While they did not come to any consensus about where to start, they did provide many options for us all to think about including: limited networks, provider tiering, redirecting of money from the higher paid providers to those who need to build infrastructure, and more. The final question from Dr. Weil asked the panelists to offer guidance to the leadership in the room about where to go first to solve the short-term problem. There was significant pushback from the panelists, who emphasized that we cannot address any short-term solutions without first laying out the long-term solutions. They also were emphatic that they had provided numerous solutions through the course of their testimony and tried to put the ball back in the court of the Legislature and the Administration. Weil neatly summarized the panel into the following points: we need incremental change, it needs to be simple, and it needs to be in line with the long-term goal. Weil also made sure to say that he took offense that he heard the panel reference ‘the public’ so often. He believes the argument is destructive and that for himself, his provider directs his care and he does not demand any specific service over another.
After a lunch break, the hearing began with the Inspector General Greg Sullivan. He proposed that the state procure all Medicaid and CommCare services through a competitive bidding process. The hearing then proceeded with the public testimony, including Dr. Amy Klein from the American Physical Therapy Association, Dr. Judith Rothchild from the Boston College School of Nursing, Dr. Carol Allen from the American Academy of Pediatrics, Robert Simmons from Boston Home Infusion, David Matteodo from MA Association of Behavioral Health Systems, Karen Estrella from the New England Home Medical Equipment Association, Julie Lynch, a PhD student at UMass Boston, Ben Day from MassCare, and Eric Linzer from Mass Association of Health Plans.
Next, the Attorney General’s Office solicited more testimony from Ellen Zane of Tufts Medical Center and Paul Levy from BIDMC for over two hours. First was Levy, and the AG Division Chief, Tom O’Brien first asked him about his experience as a rate-setter of utilities. The rest of the discussion ranged from quality metrics to evaluation of social determinants to the role of transparency for price and cost information. Levy recommended full disclosure of as much information as possible especially pricing information. He boldly recommended that the AG’s office participate in contract negotiations between providers and insurers or a formal rate-setting process. Ellen Zane offered the last testimony of the day. Zane drilled home her previous point that all solutions point to dealing with the price variation in the market. She and O’Brien discussed the same topics he discussed with Levy. Zane also emphasized the critical role of data in making sure that you have a more integrated care system. She also brought up the issue of government’s role in the dysfunctionality in the system- it is not all about the providers and the commercial market.
Commissioner Morales provided a summary and closing to the hearings by saying that he thinks DHCFP and the AG were able to encourage an honest discussion on health care costs. Next steps are a final report from DHCFP in the next 3-4 weeks.