Health Policy Commissioner Paul Hattis Reflects After First Year Of Cost Control

Today marks one year since the inaugural meeting of the Health Policy Commission (see our report, Commence Cost Control), and at Wednesday’s meeting, board members will reflect on their first year, and look forward to the second year.

Dr. Paul Hattis was appointed to represent expertise in health care consumer advocacy on the HPC board. Dr. Hattis is a long-time friend of HCFA, through his leadership in GBIO, including co-chairing their health care team. We invited Paul to write his own reflections on the role of HPC in our efforts to control costs and reform our health care system, and his role as the consumer voice in its governance.

Paul HattisAs the Health Policy Commission (HPC) completes its first year of existence, HCFA has invited me to share some thoughts about this past year as well as preview what lies ahead. So here goes:

Writing to the Health Care For All community, I feel a good deal of responsibility holding the Consumer Advocate seat—a position given to me by Attorney General Coakley.  I generally see my role as worrying about the “whole” in the sense of the overall direction of access, cost and quality challenges that confront us in Massachusetts. We are also all incredibly fortunate to have Nancy TurnbulI, who serves as the Consumer representative to the Health Connector board, to be vigilantly working on relevant access, cost and quality issues that intersect with that Board’s work.

With just one year in, I would say that the 2012 health care cost law (Chapter 224) has covered some significant ground in a short period of time. That said, though, this law doesn’t rely on quick fixes. It’s designed to be for the long-term and, as such, health care reform is a work in progress with many moving parts to be developed in the coming months and years.  The same is true for the HPC.  Containing the growth in health care spending is no easy task; the attendant issues are often complex and the details matter.  Fortunately, we have a very dedicated group of Commissioners chaired by Stuart Altman from Brandeis; and an incredible HPC staff led by David Seltz.  Over its first year of work, the HPC has tackled a complex variety of issues within its charge and we continue to add staff to help us fulfill our statutory responsibilities.

It is hard to briefly summarize the broad charge given to the HPC under the 2012 law.  Suffice it to say, the Legislature created our Board and asked us to use a combination of some regulatory authority, moral suasion,  and good critical thinking to help move the health care system and its actors towards higher-value.  Specifically, the HPC from my vantage point has been asked to frame, name, tame, acclaim, shame and blame our way to a more affordable and higher quality health care system.  When I teach students at Tufts Medical School about Chapter 224, and talk about the HPC’s role, I tell them:

We are trying to navigate our way to reducing the growth in health care spending using “GPS:”

G—Global Payment:  Promoting and evaluating the evolution of the health care payment system away from fee-for-service toward value-based payment that incentivizes less wasteful care and improved quality.   Payment system reforms should also help to create a framework for improved care integration among providers with a special focus on improving behavioral health care from an access, cost and quality perspective.

P—Prices and Provider Transformation:   It is important to recognize that there are higher-priced and lower-priced providers in our state, with the challenge that some amount of this price variation is unwarranted.   This reality suggests that there are important societal gains from helping to promote a payment system that pays fairly to all for high value care, and encourages  all providers to become more efficient.  Promoting high value care also necessitates our making smart investments in challenged community hospitals to help them transform and thrive for the long-term.  The HPC is also charged with completing Cost and Market Impact Reviews of transactions which may have significant cost, quality, access or market implications.  Prices also relate to the consumer side, where, in the non-urgent care context, a goal is to make price and quality information more transparent and readily available to consumers so that they can “choose wisely.”

S—Spending Target:  The HPC is responsible for overseeing the efforts of all stakeholders  to reduce the overall growth in health care spending by creating a per-person “cost growth target”  which is tied to the overall growth rate of the economy.

Five HPC subcommittees have been delegated an array of tasks for taking the first cut at these issues and others that fall under our broad charge.  After subcommittee processing and discussion, the full HPC Board is then referred relevant matters for its review, and as appropriate, can take official action on matters before it. (BTW:  For those interested, the subcommittees are often a great place to hear more detailed discussion about issues, and also afford opportunities for public comment; all of our meeting logistics are available at or on Twitter via @Mass_HPC.)

Let me try to name some of the key areas of focus and concern which will likely occupy the attention of the HPC over the next 12 months and may be of special interest to HCFA blog readers.  I will try to categorize them under the GPS framing:

G—Global Payment

  1. Development of a Patient Centered Medical Home certification program
  2. Development of an Accountable Care Organization certification program
  3. Examination of issues tied to improved care integration with a special focus on the challenges of behavioral health care from an access, cost and quality perspective.

P – Prices and Provider Transformation

  1. Development of regulations regarding notices of “Material Change” and the Cost and Market Review process
  2. Completing Cost and Market Impact Reviews of  transactions which may have significant cost/quality/access or market implications
  3. Selection and monitoring of grantees for Phases I and II of the Community Hospital Acceleration, Revitalization, Transformation (CHART) Investment Program

S – Spending Target

  1.  Cost Trend analysis and reporting, including initial Cost Trend Report in late 2013
  2.  Later in 2014—review and commentary of initial reporting by the Center for Health Information and Analysis (CHIA) of state cost growth target data for 2013
  3. Understanding resource allocation and needs through the Health Resource Planning Council and the Registration of Provider Organizations

Let me close by emphasizing the importance of public engagement in this effort.  In order for my fellow commissioners and I to do our best we need to hear from you.  We want to know what you are experiencing – what is and isn’t working in the Massachusetts health care system and what you want our system to look like in the next year, the next five years and the next decade.  My plan, as the Chairperson of the Community Investment and Consumer Involvement Committee, is to devote some portion of our committee time over the next year to hear your perspectives on issues and challenges that are relevant to achieving a more affordable and higher quality health care system in Massachusetts.

Your participation can help educate and inform the Commissioners and our staff, so that we develop effective, meaningful and workable policies.  Take advantage of the public hearing process as we develop regulations; attend our open committee and board meetings so that we’re all helping to shape the future of Massachusetts health care reform.

I look forward to hearing from and working with you.

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