Commence Cost Control: Health Policy Commission's Initial Meeting
All of the state’s diverse health care hangers-on were present at 9:30 am on Friday for the first meeting of the Health Policy Commission (HPC), with all of the board members in attendance: Chair Dr. Stuart Altman, Marylou Sudders, Dr. David Cutler, Dr. Carole Allen, Jean Yang, Sec. JudyAnn Bigby, Dr. Paul Hattis, Richard Lord, Veronica Turner, Dr. Wendy Everett, and Sec. Jay Gonzalez.
Gardner Auditorium was crowded, but not full, as the eleven board members stood for a photo and to be sworn in by Governor Patrick. Gov. Patrick welcomed everyone and noted that this meeting was the beginning of the future of health reform. The HPC is central to the cost containment law and vital to sustaining the Commonwealth’s central value statement: health is a public good and everyone deserves access to affordable care. Gov. Patrick acknowledged the difficulty of health care cost containment but noted that the administration will not be defeated by the difficulty of this endeavor. He then swore in the commission, and the members took their seats.
(For a few of us, it contrasted dramatically with the first meeting of the Health Connector Board, which the Romney administration scheduled for a cramped, windowless basement room of 1 Ashburton, without enough chairs and with the members facing away from the public.)
The Commission has a web page at at www.mass.gov/anf/hpc, and the main presentation from the meeting is here (pdf), including an overview of Chapter 224, the HPC, and CHIA. Our full report on the meeting is after the flip.
After the members took their seats, Dr. Altman then addressed the commission. He noted that the world and country will be watching HPC as they try to contain costs. Then, each of the board members introduced themselves and their backgrounds.
A representative from the Attorney General’s office reviewed the open meeting law with the HPC. He noted that all deliberations are subject to the open meeting law, and all substantive discussions, need to occur in a majority of members are meeting. The commission may establish subcommittees, but those subcommittees are also subject to the open meeting law. The public has a right to view and record the meeting, but does not have the right to address the commission, except at the discretion of the Chair. However, Altman indicated that he hope to allow the public to speak at future meetings.
Next, A&F Deputy General Counsel Jan Fogel reviewed the public records law with the HPC. In addition to official records, email correspondence must also be retained as part of the official record. Commissioners will have special email addresses set up for this purpose and these will be made available to the public as soon as they are created.
David Seltz, the Governor’s point person for health cost issues, gave an overview of Chapter 224, using the slides linked above. Chapter 224 established a healthcare cost growth goal, based on total health expenditures. It is aggressive but attainable, and is set initially at the rate of potential overall economic growth. Seltz went over some key provisions of Chapter 224. If successful, the law will greatly reduce health care expenditures. In total, a $200 billion dollar savings will accrue to all purchasers of health care over 15 years (2012 to 2026). He clarified that the cap relates to per capita health expenditures, which takes into account population growth.
Then the Center for Health Information and Analysis (CHIA) Executive Director (and former DHCFP Commissioner) Áron Boros gave an overview of his agency. CHIA will be HPC’s partner. The commission is required to work with CHIA on the health care cost growth benchmark, cost trends analysis and hearings, and provider organization registration and analysis. HPC and CHIA are also permitted to work together on: market impact reviews, quality, performance, access, ACO’s and PCMHs, and alternative payment methods. The two agencies will share space to facilitate their work together.
David Seltz gave an overview of the HPC and its responsibilities. HPC is the policy hub to CHIA’s information hub. HPC is an independent agency that exists under the Executive Office of Administration and Finance, though HPC is not under its direct control. The Commission needs to appoint an executive director. The executive director will be secretary of the board and help them prepare a budget. Seltz went through the slides detailing the myriad responsibilities for the Commission.
Dr. Altman then said that he will establish several subcommittees and that the HPC will be hiring a fairly large staff (as large as 60) to help with the above tasks. Altman is especially eager to hire an executive director. Altman named himself, Everett, Lord, and Hattis to a subcommittee charged with initial screening for the executive director. He said that if the public wants to suggest a qualified individual, they should send all suggestions to David Seltz.
The commission approved an ISA with DPH to allow it to continue to operate the Office of Patient Protection during this transition. The contract will go for 4 months. Members of the Commission were distributed draft bylaws based on the Connector’s, and Altman asked members to review them and suggest any recommendations. He also announced that the HPC has secured office space at 2 Boylston Street, next to the CHIA offices.
Kevin Beagan from the Division of Insurance (DOI) then discussed risk bearing provider organizations. He noted that the Commonwealth was moving toward risk bearing provider organizations as one alternative to fee for service. DOI needs to make sure that providers are ready to take on risk. He acknowledged that certifying risk for a variety of providers was difficult. As such, he said the DOI is finalizing regulatory guidance for a first year waiver process to help providers with the transition. Beagan explained that DOI focuses on certifying downside risk—a situation where bundled payments may not be enough to cover the entire cost of treatment for a patient for a given year, and the provider organization bears the risk of absorbing that cost. Members agreed that the transition period/waiver period was a good idea and that they want to make sure that providers are not financially ruined because of the new alternative payment arrangements. Sec. Bigby added that there will have to be a huge educational campaign surrounding this idea to make sure that providers are in the know. Beagan agreed and said that he would be looking to carriers to help him educate providers.
Altman urged the Commissioners to keep the public interest in mind, rather than the individual constituency that one represents. He emphasized that the law leaves most decisions to the marketplace, with the Commission’s role to watch closely and make recommendations.
The HPC meeting concluded just after noon. The Commission intends to meet in December, possibly on a Friday, but no date was set.
-Jessica Sanchez and Brian Rosman