The Health Policy Commission met on Wednesday, April 24, addressing a packed agenda. All the materials were just posted, here, so we can present our full report, after the break.
The meeting began with reports from the subcommittees of the commission. First, David Cutler spoke on the progress of the Cost Trends and Market Performance Committee (p. 11 of this presentation), primarily addressing preliminary drafts of two later agenda items: research topics for the cost trends report and a process for review of notices of material change. Marylou Sudders then gave a brief report on the activities of the Quality Improvement and Patient Protection Committee (p. 12), providing a brief summary of discussions about new regulations released by DOI and DMA, as well as mentioning a later agenda item discussing draft guidelines on mandatory nurse overtime.
Carole Allen from the Care Delivery and Payment System Reform Committee (p. 6) then spoke, detailing their work to register provider organizations. The committee has also been at work at listening sessions with the DOI, regarding risk-bearing and delivery systems. The committee also has worked to establish principles regulating Patient Center Medical Homes. Finally, staffer Nikhil Sahni provided an update on the recently released Report on Consumer-Driven Health Plans, (p. 7 – 10) summarizing the report’s findings for the commission. He also spoke on the committee’s work on establishing a one-time assessment of surcharge payors and acute hospitals, as well as the distressed hospital trust fund.
Next, representatives from the Attorney General’s office reported on the recently released Health Care Cost Trends and Cost Drivers report. This annual report, now in its third year, examines ways in which purchasers, health plans, and providers influence costs of health care. As CHIA and other agencies now report some of the routine quantitative data, the report now shifts its focus onto the shape of the health care market as a whole, as well as cost containment efforts put in place by each of these groups.
The commission then moved to the Cost Trends and Market Performance Committee’s proposed research topics for their upcoming research report on cost trends. (p. 16 – 19) This report, mandated by Chapter 224, requires that HPC consider data from hearings, registration data, and CHIA to compile information on important spending trends and underlying factors, recommendations for strategies to increase efficiency, and legislative language required to implement these recommendations. The ambitious research outline includes a model for setting a growth baseline, using descriptive statistics, analysis of total health expenditures, access and quality data, and market evolution, as well as a model for discovering the driving mechanisms of the cost growth. Reports will be released in December 2013, early Summer 2014, and December 2014. The commission voted to accept these guidelines for the report.
Mandatory nurse overtime guidelines (p. 29 – 35) came up next, as the commission commented on draft language regarding crisis-based exceptions to the prohibition on nurse overtime. Although there was some concern regarding the draft language, the approval of the actual regulations must wait until a hearing is held on the language – after which the HPC will take the issue up again. The commission voted to approve the draft language.
Representatives from CHIA then spoke about their work and its relation to the HPC (CHIA presentation). CHIA is in charge of releasing its own report on cost trends – this year marks the first time CHIA is conducting their survey on health care expenditures. CHIA’s first report is scheduled for release in August 2013, with a report encompassing data from 2012-2013 schedules to appear in August 2014.
The last item of business addressed the process for review of notices for material change. (p. 22 – 26, and see the adopted policy, here) Karen Tseng, the newly appointed HPC Policy Director for Market Performance, gave an overview of the proposed model for this process, which occurs when a material change is likely to affect the commonwealth’s ability to meet the health cost benchmark, or when the change will substantially affect the competitive market. Starting in 2016, these reviews may also be initiated when CHIA identifies a provider as having excessive growth. The commission expressed significant concern on the proposed model’s ability to work with the commission’s schedule, as well as concern that the commission would not be able to devote the time to given all concerning issues proper consideration.