Today’s
Health
Care Cabinet meeting was as fascinating as
last
month’s. We heard again from the consultants working with the Cabinet to
develop a plan to reform CT’s health care system. This time they focused on
reforms
in Rhode Island and Massachusetts. Rhode Island is also facing hospital
consolidation, but with more geographic overlap than CT, so they may not face
the anti-competitive concerns we do. Rhode Island focused their reforms on
increasing primary care spending (not just rates), PCMH expansion (as has been
very successful for CT’s Medicaid program), support for HIT, alternative
payment models, and hospital reform, most specifically a cap on cost increases.
Unfortunately the reforms haven’t yet resulted in controlling costs. RI is also
behind in building consumer protections for their reforms; something CT cannot
afford to put off given our history and culture. The key to Rhode Island’s
success is a visionary leader who was very transparent, inclusive policymaking,
aggressive and respectful stakeholder engagement, and a commitment to
evidence-based standards. Massachusetts also has a long history of diverse
reforms; some worked and some didn’t. Massachusetts is wisely focusing price
transparency on markets rather than consumers. While getting price information
to consumers is important, to expect that alone to reduce costs is not
realistic. Their latest iteration is movement toward global payments (similar
to capitation), which are gaining momentum. It seems global payments have saved
money, increasing primary care use, but overall annual health cost increases
exceeded the benchmark in2013 o 2014 (the latest year). One of Massachusetts’s
most effective tools is the ability to regulate the market, especially blocking
provider market consolidation that could drive up prices. Next month we will
hear about Maryland and Oregon.
We also
heard from a panel of CT hospital representatives
responding to last month’s presentation on hospital spending
-- the impact of consolidation on prices and
the lack of correlation between government and commercial plan prices. The
hospitals mainly complained about the state’s Medicaid cuts, suggesting that
they are driving up prices for commercial plans. However research does not
support the cost shifting theory. It was pointed out that Medicaid is working
better now than anytime in recent memory, and that in times when the state was
very generous with hospitals’ Medicaid payments, there is no evidence that
commercial prices were reduced.
