Predictions for the 2024 HPC Cost Trends Hearing
It’s the IMG health care team’s favorite time of year – though we are not talking about the holiday season. On November 14, the Massachusetts Health Policy Commission will host its annual Cost Trends Hearing. This event convenes providers, payors, patient advocates, labor leaders, and policymakers to discuss the challenges and opportunities for creating a more affordable and equitable health care system in the Commonwealth. Here are some key themes our team will be listening for as we tune into the “Super Bowl of Massachusetts Health Care” this week.
Home health and post-acute care
Home health and post-acute care spending is another key area of concern for health care leaders. These services are essential for patients transitioning out of hospital settings but are facing rapidly increasing costs and extreme staffing shortages.
Spending in this sector has grown in recent years as home health agencies face reimbursement disparities and high temporary labor costs to meet demand. When post-acute care settings and home health providers have capacity constraints, hospitalized individuals face extreme discharge delays. This places additional financial pressure on the health care ecosystem because hospitals are responsible for covering the costs associated with these delays.
We anticipate leaders to emphasize the need for greater oversight, quality benchmarks, and transparency around post-acute care to ensure more effective and affordable care. We also expect them to offer recommendations on how to better align post-acute care issues with broader healthcare cost containment goals, while improving the quality and accessibility of care.
Lindsay Antaya
Senior Account Executive
Investing in and improving access to primary care
Massachusetts has a shortage of primary care physicians. With around one-third of Massachusetts residents expressing dissatisfaction with their ability to schedule a primary care appointment and a projected shortage of 725 primary care doctors by 2030, leaders at the hearing will likely discuss strategies for addressing this shortage and emphasize the need for increased investment in the primary care workforce.
We hope to see panelists address issues like physician burnout, administrative burdens, and an aging provider population. They’ll likely advocate for higher compensation for primary care physicians, expanded training programs, and greater use of nurse practitioners and physician assistants to help meet the demand for primary care services.
Emily Costello
Assistant Account Executive
Moving forward after Steward’s departure
Steward Health Care will be at the top of the docket, as the health system’s bankruptcy continues to leaverippling effects on our state’s health care system. Following years of financial mismanagement and intentional divestiture, Steward’s unraveling significantly impacted patients’ access to care, with the closures of Carney Hospital and Nashoba Valley Medical Center exacerbating existing capacity pressures across the state.
Since before the pandemic, our state has been burdened by capacity, throughput, workforce, and financial challenges, and Steward represents what can happen when these crises reach a tipping point. When it comes to ‘what’s next,’ we expect both the providers that took over Steward hospitals and other leaders to discuss how industry stakeholders can work together to ease pervasive challenges and protect access to care.
Lauren Durniak
Account Executive
The rising cost of care and extraordinary pressures
This has been the looming topic during the last few Cost Trends Hearings. According to the latest HPC Cost Trends Report, family health insurance premiums in Massachusetts are second highest in the country. This has implications for health inequities that our state is working to close. Nearly half of survey respondents cited by HPC whose income is below $50,000 indicated they delay care due to affordability challenges – which leads to worsened health outcomes and disproportionately affects communities of color.
Hospitals, community health centers, physician practices, and health systems face enormous pressures as they care for these patients. Emergency departments and hospitals are overcrowded, including with patients waiting to be discharged to the next level of care. Providers across the care continuum are still contending with workforce shortages that contribute to these constraints. They must also grapple with Medicare and Medicaid reimbursements that do not cover their expenses – leaving them to rely on higher commercial rates. We’ll be listening for proposed solutions to these issues throughout Thursday’s hearing.
Jackson Murphy
Vice President
Medicaid Rates
Reimbursement rates are top of mind for Massachusetts’ health care leaders, especially as hospitals experience persistent financial challenges and patients face rising costs.
According to the Cost Trends Report, our state’s Medicaid program (MassHealth) saw a significant uptick in enrollment from 2019-2022. This was largely due to the suspension of Medicaid eligibility redeterminations during the pandemic, which helped more Americans maintain access to their insurance. Even with this increased enrollment, the average annual spending for patients with full MassHealth coverage decreased .1 percent year over year. For commercially insured patients, annual spending increased 5.5 percent on average per year during that same period, despite a decrease in enrollment.
Safety net hospitals consistently raise alarm bells about reimbursement disparities, arguing that the cost of providing services outweighs what MassHealth pays for them. We predict leaders to call for increased MassHealth reimbursement rates, while looking to private payors to collaborate on ways the entire health system can boost affordability for patients.
Jess Petro
Senior Account Manager