On Monday and Tuesday this week, the Massachusetts Health Policy Commission (HPC) held its 5th annual Health Care Cost Trends hearing. Government officials, health care providers, insurers, and advocates came together to provide testimony and answer questions from the HPC commissioners on strategies to contain health care costs.
Below are some of the major themes from the hearing, a number of which were also reflected in Health Care For All’s testimony to the HPC. You can read our full testimony here.
Massachusetts is below the state benchmark for spending growth, but there is more work to be done:
Massachusetts successfully remained under the state benchmark for health care spending growth in 2016. As of 2014, Massachusetts health care spending growth was the fourth lowest in the nation. In 2015 and 2016, Massachusetts remained below the US average in health care spending growth.
However, major problems remain in our health care spending. In 2014, Massachusetts still spent the second most in the country on health care per person, exceeded only by Alaska. It is estimated that about 26% of an average Massachusetts family’s wages go towards health care costs. Families with a greater number of health issues tend to pay even more, and often have a difficult time affording care.
Commissioners emphasized that, while lowering growth rates to below the benchmark has been a success, much more work is needed to lower costs. Commissioners also made it clear that cost cutting measures shouldn’t impact access to care for Massachusetts residents.
Unnecessary Hospital Use and Readmissions:
One cost containment method identified repeatedly at the hearing was reducing unnecessary hospital use, particularly hospital readmissions. A readmission is when a patient returns to a hospital within 30 days of being discharged from a previous hospital stay. Data presented at the hearing showed that Massachusetts readmission rates grew between 2015 and 2016.
While decreasing readmissions would help to decrease overall spending, several panelists at the hearing pointed out the challenges of preventing readmissions. Particularly for patients with chronic conditions, readmissions may be a result of the illness and do not necessarily indicate errors on the part of the hospital. The question was also raised if reducing readmissions is the best strategy to support vulnerable populations. Some panelists cautioned against any strategies that would financially penalize patients who make multiple hospital visits within a short time period, as this could end up preventing these patients from accessing needed care.
Those suffering from addiction and those with behavioral health conditions were identified as groups more likely to have a readmission. Because of this, improving treatment for addiction and behavioral health was identified as one way to help lower readmission rates. One panelist commented that, when a patient is in the hospital for an overdose, they can be provided detox services, “but where do they go after?” Without adequate resources invested in treatment and recovery programs, people suffering from addiction may repeatedly return to the hospital. Commissioners also identified improved care coordination and engaging patients more actively in their care as a way to decrease unnecessary readmissions.
Social Determinants of Health:
Both commissioners and panelists identified social determinants of health as a key contributing factor to high health care costs. Several commissioners noted that there has not yet been enough done to invest in programs that focus on these social determinants.
The importance of ensuring that communities have access to necessities such as nutritious food, transportation, housing and infrastructure was repeatedly stressed during the hearing. These resources allow communities to maintain better health overall and to access health care services when needed. One community health center CEO mentioned that a lack of transportation and infrastructure are major issues for patients, and that the health center provides transportation services to some patients to ensure they are able to access care. While a number of panelists and commissioners agreed that providers and payers should be doing more to invest in addressing unmet social needs, they also expressed concerns about how to do this without adding more money to the system.
One specific program mentioned during the hearing was the Prevention and Wellness Trust Fund. This fund promotes healthy behaviors, which helps to prevent illness and hospitalizations and improve health outcomes. The fund’s authorization expired this summer, and it has not been reauthorized in the current state budget. Health Care For All believes that allowing funding to lapse for this program is a shortsighted approach to containing cost, as the program will reduces overall cost in the long term by creating a healthier population which has less need for costly medical care.
Keeping Care in the Community: