Team Insights: Health Policy Commission Cost Trends Hearing 

By The IMG Health Care Team 

This week, the Massachusetts Health Policy Commission will hold what’s known as the “Super Bowl” of health care. Over the past decade, this event, the annual Cost Trends Hearing, has become a staple for all stakeholders in the Massachusetts health care landscape. Throughout the day on November 8th, heavy hitters in the industry will testify about a variety of topics including workforce issues, pharmaceuticals, behavioral health, and more. Members of Issues Management Group’s health care team have identified and analyzed several topics up for discussion at this year’s hearing, breaking down how potential outcomes could impact communities across the Commonwealth.   

Spending benchmark 

This year, there will be a particular focus on affordability and equity. When it comes to affordability, it will be interesting to watch how participants reference the health care benchmark. In 2012, Massachusetts became the first state in the nation to establish a health care spending benchmark. Some might argue it is the HPC’s signature tool to influence health care in Massachusetts. Every year since established, the benchmark for health care spending growth – and the measure against which the state is held accountable – has held at 3.6 or 3.1%. 

In 2023, there is some debate as to whether that measure still holds. The need for a benchmark is not the question at hand. The question at hand is whether the 2012 benchmark is appropriate, given the realities of the 2023 health care landscape. Most experts would agree that health care inflation is trending closer to 7, 8, 9, or even 10%. At the end of last year’s cost trend hearing, a panel comprised of some of the state’s largest providers and payers took this issue head on. There appeared to be consensus on the panel that holding expenses to 3.1% given workforce pressures, capacity constraints, and the regular inflationary pressures affecting us all was not realistic

That was a year ago, and things have not gotten meaningfully easier in health care. All the pressures that existed last year still linger. Let’s see how the benchmark is viewed this year. It will be interesting to see if there is a yearning for the status quo, or an acknowledgement that changing economics, workforce shortages, and evolving patient demands call for a modified approach to moderate spending. 

Rich Copp, Executive Vice President 

Workforce issues 

The Commonwealth’s health care workforce has faced significant headwinds, including turnover and staffing shortages, burnout, increased administrative burden, and instances of workplace violence. While many organizations have made great strides toward rebuilding their workforces as they navigate the changing stages of the pandemic, new approaches are necessary to continue that momentum and achieve further stabilization. Provider organizations can build on the Healey-Driscoll Administration’s investments in providers and nursing education by making changes that increase flexibility, encourage professional development, and improve diversity, equity, and inclusion.

We anticipate that organizations at this year’s hearing will discuss EMR optimization as a strategy to innovate care delivery and streamline administrative processes. The continued shift toward virtual care often means that providers spend more time sifting through patient messages and other virtual documentation than seeing patients in their office. By improving these processes, organizations can reduce providers’ nonclinical workload and create more flexibility.  

We also expect the rising prominence of nonclinical employees, such as Community Health Workers and patient liaisons, to be a major point of investment for organizations trying to navigate the changing needs of patients and offset the increasing emotional and operational burdens felt by providers. The services offered by these nonclinical staff members are essential to meeting individuals’ medical and social needs and add significant value to provider organizations through their community connections and lived experiences.  

Jess Petro, Account Manager

Behavioral health care access 

Recent reports on the state of behavioral health care in Massachusetts paint a stark picture of a region lacking the mental and behavioral health resources necessary to support patients’ growing needs. While access to primary care has long been prioritized in terms of high quality, low cost, and equitable access, affordable and accessible behavioral health services have been found to lower overall health care spending and ultimately improve quality of life.

Increasing access and lowering cost of behavioral health services across the state is particularly salient in the wake of a June Department of Public Health (DPH) report detailing a 2.5% increase in opioid-related overdose deaths from 2021 to 2022. Moreover, the DPH data notes that for Black Massachusetts residents, that rate rose by about 42%. These findings indicate a need for focused efforts to close gaps in behavioral health care, specifically around improving access to treatment for opioid use disorder.  

Discussions of behavioral health care and access to life-saving treatment will likely emerge as a focus of this year’s Health Policy Commission Cost Trends Hearing. We can expect to hear testimony pointing to these needs across the Commonwealth and calling for greater investment in community-based organizations at the local level. 

Jules Slater, Account Executive

Pharmaceutical spending 

Pharmaceutical spending will also likely be discussed in different forums throughout the Hearing. According to the HPC, retail drug spending is one of the fastest areas of spending growth in the Commonwealth and is a major contributor to rising healthcare costs for patients.  

We expect that the HPC will specifically focus on increasing regulation and transparency around pharmaceutical prices. Currently, pharmaceutical manufacturers and pharmacy benefit managers are not explicitly covered by the HPC’s oversight responsibilities, nor is the Center for Health Information and Analysis (CHIA) authorized to collect data on them. 

Both the HPC and panelists will likely share the sentiment that rising drug prices will have drastic effects on affordability, patient outcomes, and the financial stability of the healthcare system at large. In turn, we will be listening for recommendations from the HPC on how drug prices can be more closely monitored and how pharma executives can work with leaders across the continuum of care to lower costs

Lindsay Antaya, Account Executive 


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