The Massachusetts Health Policy Commission Takes a Very Different Approach to the 2020 Cost Trends Hearing
By Niko Lehman-White and Rosemarie Day
The Massachusetts Health Policy Commission (HPC)’s Annual Cost Trends Hearing usually adheres to a consistent template. The focus of the hearing is the annual healthcare spending growth in Massachusetts, possibly the most important charge of this state agency, which it is tasked with keeping under 3.1%.
This year, the HPC tossed out their old playbook. Conducted virtually, for the first time, the hearing lasted only half a day instead of two days and it didn’t even mention the cost growth number. We’re not sure if this was because cost containment has fallen on the HPC’s priority list during the pandemic or because they figured it would be poor form to talk about cost containment during a time when so many are at increased health risk. Yet the pivot to talking about equity was both timely and made for an excellent and informative session. Here are what we saw as the top four takeaways.
1. The HPC is refocusing on health equity issues
The keynote address, delivered by Harvard professor David Williams, set the tone for the entire hearing. Williams took us through mountains of evidence about how racial disparities in health outcomes can persist through all levels of income and education, and cross international borders. Part of this is because segregation by neighborhood causes a self-perpetuating cycle, in which America’s historical housing discrimination practices like redlining (when banks don’t allow mortgages in certain areas) made it difficult for minorities to accumulate wealth and hindered upward mobility for generations. But racism harms health in a more direct way, too. The stress of racism causes physiological changes and susceptibilities to illnesses like atrial fibrillation, breast cancer, diabetes and many more which amount to what some call “accelerated aging”. You don’t have to go to Harvard to hear him speak, a recording of his keynote is available here.
2. Maslow’s hierarchy of needs comes to the forefront
Maslow’s hierarchy of needs came up multiple times during the hearing. For anyone not familiar with this model, it conveys the concept that people need to have their physiological and safety needs addressed before they can start working on things that make them most happy, like self-esteem and self-actualization. But for too many in Massachusetts, even basic physiological needs are not met. Homelessness in particular was noted by panelists as a significant challenge, and their discussion of the importance of community resources and social determinants dovetailed with William’s discussion of place-based solutions. Some of the ways to address these issues, included launching mobile vaccination units when kids don’t come to their checkups, participating in Medicaid ACOs, ensuring diverse voices have a seat at the table, examining clinical data to determine where gaps exist, and building up public health infrastructure and collaborating with public health teams.
3. The tumult in Massachusetts' healthcare industry will last at least well into 2021
Andrew Dreyfus, CEO of Blue Cross Blue Shield (BCBS) of Massachusetts, gave a rundown of healthcare utilization trends. Utilization dropped over the summer and is now back to previous levels. But in the coming year, utilization may end up above normal as hospitals treat COVID and non-COVID alike. To make up for their lean summers, Dreyfus reported that many providers are asking for fee increases, although providers with capitated contracts have been shielded from the drop in fee-for-service-based revenues and have been more protected financially. This winter, COVID cases are expected to rise again, causing further tumult, to operations as well as finances.
4. Telemedicine is like a plane being built during flight right now
Telemedicine also came up repeatedly, with providers and payers alike still struggling to figure out how to best use it in the new world. This medium has been critical during the pandemic, but not all potential users have computers or internet, and software is not always multilingual or easy to use, further threatening to deepen health disparities and posing significant challenges to anyone trying to implement a system. Virtual care doesn’t only benefit patients, however, providers reported that their staff often want to see their own risks reduced and telemedicine is a good way to reduce their exposure. Insurers are also facing questions about how to reimburse for telehealth care – they are currently paying for it at in-person levels during COVID but remain unsure of whether to continue this policy after the pandemic ends.