A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

The HPC wants bold and meaningful change

HPC Agenda slide

The HPC wants bold and meaningful change

May 28, 2014


The Health Policy Commission (HPC) met on Thursday, May 22 to cover a range of HPC activities including updates on the patient-centered medical home certification program, the registration of provider organization program, and the CHART Phase 2 investments. Slides from the meeting (pdf) have lots of details on the discussion. Keep reading for our detailed summary of the agenda points and discussion.

The meeting opened with Executive Director David Seltz giving his report to the Board commending the Commission and HPC staff for its important work reviewing the cost and market impact of the proposed Partners acquisition of South Shore Hospital and providing an overview of the recently announced agreement between Attorney General Martha Coakley and Partners.

In response, Commissioner Paul Hattis shared what he described as "three hopes" for the agreement. First, that the HPC have the opportunity to review the draft agreement and have a discussion with the Attorney General and Partners before the parties submit it to a judge as a part of a consent decree process. Second, that the agreement expressly allow the Attorney General to pursue modifications of the consent decree if the HPC cost and market impact review (CMIR) of the proposed Partners and Hallmark Health affiliation identifies significant findings such that the Attorney General determines that pursuit of modifications are warranted. Finally, that the agreement expressly allow the Attorney General to pursue modifications of the agreement if any future HPC CMIRs identify issues of concern that warrant changing the agreement. A number of the Commissioners responded to these hopes, with the HPC ultimately determining that further discussion and any proposed action should be explored with the entire commission at a later date.


HPC Approach to PCMH Certification

Next, Commissioner Carole Allen, Chair of the Care Delivery and Payment System Transformation (CDPST) Committee, provided an update on the development of the patient-centered medical home certification program (slides 6-9). The CDPST Committee is working to incorporate suggestions from the public comment process in its certification program and announced a 2-tier certification pathway would be pursued. Commission Allen reaffirmed the Committee's dedication to develop a certification process that is both achievable for provider organizations and meaningful to consumers and payers. Next steps for the PCMH certification program include refining and finalizing the certification criteria and process, and develop a plan to promote HPC PCMH certification to providers.

Iyah Romm, Director for System Performance and Strategic Investment then provided an update on the Registration of Provider Organizations (RPO) Program and a summary of the January 8th to April 25th public comment period (slides 10-15). The HPC received comment from 17 organizations and has already incorporated some of the early feedback, and a summary of the high-level themes is provided on slides 13 and 14. The RPO Program is on track to receive Initial Registration: Part 1 materials in the Fall of 2014 (slide 15).

David Seltz, on behalf of Commissioner Marylou Sudders, then reported that the Quality Improvement and Patient Protection (QIPP) Committee continues to meet and work on its behavioral health integration agenda (slide 16). Seltz also noted that the Committee is monitoring the Senate budget debate for developments affecting its activity.

Chart 2 program parameters

Commissioner Paul Hattis, Community Health Care Investment and Consumer Involvement (CHCICI) Committee Chair then turned it over to Iyah Romm to provide an update on the status of the CHART Phase 2 framework (slides 18-36). The Phase 2 framework is laid out in detail in the HPC presentation. Notable moments in the discussion was the suggestion from Commissioner Allen that the framework consider the role of non-directly health related organizations such as schools, head start programs, and social service providers to broadly encompass the social determinants of health. Romm also proposed to the Commission an HPC community hospital study to develop an action-oriented report on the future of community hospitals in Massachusetts (slides 33-34). Next steps for the CHART Phase 2 framework are to finalize the request for proposal (RFP) and requisite application materials to be released in early June 2014 (slide 36). The Commission voted unanimously to authorize the Executive Director to issue a Request for Proposals for Phase 2 of the CHART Investment Program. Commissioner David Cutler highlighted his wish to see “bold” proposals as a part of this process while Commissioner Jean Yang reiterated the need that they be achievable.

Cutler, Chair of the Cost Trends and Market Performance (CTMP) Committee, then introduced Karen Tseng, Policy Director for Market Performance, to give an update on Material Change Notices (MCN) received (slides 40-41). Tseng then turned to the cost and market impact review (CMIR) final report on Lahey Health System’s proposed acquisition of Winchester Hospital (slides 42-48). The HPC released a preliminary report on the proposed acquisition on April 16th and received a written response from Lahey and Winchester on May 1st which responded to concerns about increased market leverage and the potential for increasing facility fees if the deal goes through (slides 46-47). Based on its analysis, findings in the final report, and conversations with the parties following the issuance of the preliminary report, the HPC declined to refer the Final Report to the Massachusetts Attorney General’s Office. The Commission then voted unanimously to issue the Final Report.

The next full Health Policy Commission is scheduled for July 2nd.

  - Kelly Elder