INSIDE THE ISSUE

> Health Care Cost Growth Benchmark
> Profits Gained During Pandemic
> Eliminating Co-Pays?
> You Can Assist Ukraine
> National Patient Safety Week
> A New Behavioral Health Hospital
> The Benefits of Telehealth
> $1.5 Trillion Omnibus Bill

MONDAY REPORT

Measuring Healthcare Spending During Volatile Times

The state’s healthcare cost growth benchmark over the years has been an innovative way for Massachusetts regulators to assess, and control, healthcare expenditures in the state. But as the Health Policy Commission (HPC) and the legislature’s Joint Committee on Health Care Financing meet this Wednesday to discuss modifying the benchmark for Fiscal Year 2023, MHA is cautioning that taking a business-as-usual approach that ignores the real-world experience of providers still struggling from the pandemic could have long-term adverse consequences for the entire healthcare system.

In its testimony on Wednesday, MHA – representing the hospitals and physician practices that have first-hand experience with healthcare economics – will urge the government regulators to not unfairly penalize providers when comparing their performance during the pandemic against the HPC’s Health Care Cost Growth Benchmark. The HPC regulators must also recognize current economic conditions and new investments affecting future healthcare spending, MHA says.

The Center for Health Information and Analysis’ recent annual report shows total healthcare expenditures (THCE) declining by 2.4% between 2019 and 2020, which MHA says in its testimony underscores “the anomalous nature of the pandemic years in terms of healthcare cost and utilization. Given this unusually low baseline in 2020, THCE growth rates in the next two pandemic years (2020-2021 and 2021-2022) are likely to be/appear abnormally high. Given these aberrant and unprecedented changes affecting healthcare utilization and spending, it is evident the Health Care Cost Growth Benchmark already in effect for FY2021 and FY2022 is out of alignment with financial realities of healthcare providers.”

MHA has been attempting over the past year to call attention to how the well-intentioned actions of HPC commissioners sometimes do not reflect the real-world experiences of clinicians and administrators running hospitals and physician practices.

Ever since Governor Baker declared a state of emergency in March 2020 due to the pandemic, healthcare providers have faced unprecedented cost pressures that were necessary to remain safe and accessible, including expenses related to emergency preparedness, personal protective equipment, temporary staffing, capacity planning and implementation, healthcare supply chain disruptions and shortages, delayed/canceled elective procedures, COVID-19 therapeutics, testing, vaccine administration, and challenging clinical care delivery dynamics. Now, the healthcare sector, like all parts of the economy, is facing inflationary pressures and massive workforce costs due to the “great resignation,” provider burnout, spiraling travel nurse costs, and a multitude of other factors. Significant future investments in the MassHealth program are also expected, aimed at reducing health disparities, improving clinical quality outcomes, and providing greater support for safety net providers.

“The volatility affecting patient care expenses and healthcare provider financing was never contemplated in the cost benchmark process defined in 2012, which effectively relies on a steady state of economic and cost growth,” MHA will say on Wednesday. “The application of a rate that was determined a decade ago to this new financial reality would be grossly unfair and inaccurate.”

The Pandemic Was Good for Health Insurance Company Profits

It’s a well-documented fact that healthcare providers struggled financially during the pandemic – cancelling almost all non-COVID care while hemorrhaging cash to buy scarce personal protective equipment, reconfigure building space, pay overtime, and more. Health insurance companies, on the other hand, benefitted as they continued to collect premiums, but did not have to pay as many claims as people stopped seeking care.

The Centers for Health Information & Analysis is scheduled to release a report today that shows the net cost of private health insurance increased 31% statewide from 2019 to 2020. For fully insured commercial health plans, non-medical expenses and surpluses – that is the portion of a member’s premium dollar that is not spent on that member’s medical expenses – grew 35.4% from 2019 to 2020. While most of the these changes covered administrative expenses, taxes, fees, and broker commissions, the insurance companies reported average gains of $19 per member per month (PMPM) from fully insured lines of business in 2020, up from $4 PMPM in 2019. That’s a 375% increase in insurer gains from 2019 to 2020.

According to CHIA, fully insured health insurance premiums grew 2.6% in 2020. This followed a 2.3% premium increase in 2019 and substantially higher increases in 2017 and 2018.

Previous CHIA reports have shown that the percentage of health insurance plans with deductibles over $1,000 continue to rise steadily. (The cost of collecting those deductibles and the resultant bad debt falls on providers, not insurers.)

The State Wants to Rein in Co-Pays, Cost-Sharing

The Massachusetts Health Connector is contemplating eliminating co-pays and medication cost sharing for ConnectorCare enrollees with diabetes, asthma, coronary artery disease, and hypertension – conditions that disproportionately affect communities of color.

ConnectorCare is available to qualifying residents whose income is at or below 300% of the federal poverty level.

As the State House News Service reported, the Connector’s Chief of Policy and Strategy Audrey Morse Gasteier said eliminating cost-sharing for ConnectorCare members’ sick visits to primary care providers would “ease access to the care setting where many of these chronic conditions are managed.”

It appears as though the Connector will incorporate the cost-sharing change into their health plan “seal of approval” process that sets the rules for plans to be offered on the Connector’s health insurance exchange. The Connector issues a Request for Responses each March to solicit qualified health plan from health insurance carriers for consideration for the upcoming plan year. At last week’s meeting, Connector officials also said they want all insurance carriers that offer plans through the Connector to also participate in the ConnectorCare program starting in 2024.

Ukraine Ministry of Health Seeks Supplies

The Ministry of Health of Ukraine has issued an urgent plea for a variety of medical supplies, and MHA is helping to coordinate the delivery of the supplies to Ukraine to help victims of war.

The most urgent need is for: 1) Combat Application Tourniquets (CAT) and Stretch Wrap and Tuck Tourniquets (SWAT); 2) “Israeli” bandages (AKA emergency bandages that staunch blood flow from traumatic hemorrhage); and 3) analgesics.

This list from the Ministry of Health details specific asks. To assist in the relief package, please contact MHA’s Senior Vice President Valerie Fleishman (vfleishman@mhalink.org).

National Patient Safety Awareness Week

National Patient Safety Awareness Week began yesterday. While the calendar notation presents a good time to reflect on patient safety, the fact is, quite frankly, that patient safety is the day-by-day, minute-by-minute focus of all hospitals and healthcare entities. From board members to assistive personnel, from surgeons to housecleaners, anyone working in a Massachusetts hospital or patient-serving entity is trained in assessing all aspects of patient interactions to ensure individuals are kept safe.

Now, more than ever, greater attention is being placed on keeping patients safe by ensuring that healthcare workers themselves are safe. The COVID-19 pandemic’s emotional, physical, and psychological toll has resulted in the need for renewed organizational interventions to assist staff. These resilience-centered supports also benefit organizations: helping staff protect their personal health and well-being leads to improved safety, collective morale, quality, and better outcomes.

MHA has had a long and ongoing focus on employee wellness. The association’s Workforce Wellbeing Workgroup (WWW) was created to provide consultation on system-wide wellbeing initiatives MHA leads, and to share wellbeing-related challenges and best practices from within MHA member organizations. The workgroup meets monthly and is comprised of more than 25 members from a range of interests and roles, including representatives with clinical, operational, human resources, and wellbeing expertise. The entities represented include hospitals, nursing associations, and other leading healthcare organizations with an interest and/or expertise in employee wellbeing.

The WWW is now seeking additional members to advance the work it has undertaken over the years to support employees. If you would like to participate or learn more about the Workforce Wellbeing Workgroup, please contact MHA’s Vice President of Clinical Affairs Patricia Noga, R.N., PhD at pnoga@mhalink.org.

Baystate-Kindred Break Ground on New Psych Hospital

The $72 million project is estimated to take 16 months to complete with an expected opening in August 2023. Kindred Behavioral Health, a wholly owned business of LifePoint Health, will manage day-to-day operations of the hospital, while Baystate Health psychiatrists and advanced practitioners will provide care under the medical leadership of Baystate Health’s Chair of Psychiatry Barry Sarvet, M.D.

Share Your Thoughts on the Benefits of Telehealth

MHA, in collaboration with the tMED Coalition, has been a strong advocate for state and federal investments in telehealth and for providing equitable access to it. Currently, building on American Rescue Plan Act funding that Massachusetts received, MHA is engaged in advocacy efforts to expand patient navigators (community health workers, social workers, and others), who facilitate greater access to telehealth services for disenfranchised patient populations.

To help its advocacy efforts on telehealth, MHA is asking its membership who may be weighing in on a new Request for Information (RFI) from the White House to share their responses. The White House Office of Science and Technology Policy’s RFI is entitled Strengthening Community Health Through Technology and seeks to explore the utility of telehealth as a health equity intervention. MHA believes the RFI is a good opportunity to highlight policies, practices, and funding models that might be expanded upon or replicated in Massachusetts to further support access to telehealth services. Please share your responses with MHA’s Director of Health Equity Akriti Bhambi at abhambi@mhalink.org. The deadline for responding to the RFI has been extended to March 31, 2022.

Omnibus Bill Passes Congress

The U.S. House and Senate have passed a $1.5 trillion omnibus spending bill and sent it to President Biden, who was expected to sign it this past weekend after Monday Report’s deadline.

The spending bill keeps the government open through September and provides $14 billion to Ukraine. It also contains a number of healthcare provisions, but not any added funding for the Provider Relief Fund that healthcare interests had hoped for.

The bill extends telehealth flexibilities to 151 days after the end of the public health emergency, creates an eligibility exception for the 340B drug discount program due to COVID-19, and devotes funding to address maternal mortality, rural maternal health, and federal opioid epidemic and mental health programs, among other healthcare expenditures. The entire Massachusetts Congressional delegation voted for the bill.

John LoDico, Editor