iIn this episode, Foley Partner Larry Vernaglia sits down with Steve Walsh, President & Chief Executive Officer of the Massachusetts Health & Hospital Association (MHA) to talk about the health care sector—drawing from what both of them have seen nationally and locally over the past twenty months—to discuss the current and future trends of healthcare finance and policy, surprise billing, response to the COVID pandemic and recent vaccination mandate, as well as the labor shortage crisis throughout the entire health care sector.
Larry Vernaglia is a partner and health care lawyer with Foley & Lardner LLP where he is the Department Chair for the firm’s Industry Teams Department, responsible for overall strategy and leadership across all industry teams. Prior to that, he served for eight years as chair of the firm’s Health Care Industry Team. Lawrence represents hospitals, health systems and academic medical centers, and a variety of other health care providers. Lawrence's practice involves regulatory and transactional matters, including Medicare/Medicaid reimbursement compliance advice and appeals; mergers, acquisitions and financings; state regulatory issues including licensing, change of ownership, and CoN/DoN; survey/certification appeals; fraud & abuse/Stark law analyses; managed care contracting; and general corporate and business planning in health care. He serves as Outside Policy Counsel for the Massachusetts Health & Hospital Association.
Steve Walsh joined the Massachusetts Health & Hospital Association (MHA) as president and CEO in November 2017. A member of the American College of Health Care Executives (ACHE), Walsh previously served as the Executive Director of the Massachusetts Council of Community Hospitals (MCCH), an organization he led since 2014. During his tenure, Walsh worked with executives from Massachusetts health care institutions to promote and drive innovative change in health care delivery, policy and regulation. Prior to MCCH, Walsh served six terms in the Massachusetts House of Representatives and was appointed Chair of the House Committee on Health Care Financing in 2011. He oversaw the drafting and passage of the Commonwealth’s 2012 landmark health care payment reform law, Chapter 224. This legislation incentivized utilization of alternative payment methodologies and investment in community health, while encouraging patient empowerment and primary care. He was also a conferee of Chapter 288 of the Acts of 2010, the Commonwealth's small business health care legislation.
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Larry Vernaglia
This is Larry Vernaglia, I am a health care partner in the Boston Office of Foley and Lardner, and it's a great pleasure to be sitting here with my friend, Steve Walsh, who is the president and CEO of the Massachusetts Health and Hospital Association (MHA). Hi, Steve.
Steve Walsh
Hey, Larry. Thanks so much for having me.
Larry Vernaglia
Glad to have you. We've had a number of guests on our podcast series who've talked about sometimes narrow topics, particular business issues, and regulatory challenges. What we wanted to do with this is maybe pull out a few thousand feet, and talk about the hospital industry, and what we've been through over the last year or two, and then what we might be seeing in the future. That's the goal for our conversation today, but before we do, I note that you've now been here at MHA since around 2017.You came with considerable experience in health care and government. Tell us a little about how you got here.
Steve Walsh
I spent 12 years in the legislature here in Massachusetts, and finished there as the Chair of Health Care Finance, and having left there completing the task of authoring the Health Side Chapter 224, which was our Cost Containment Law, and from there moved to the Massachusetts Council of Community Hospitals, where I represented 23 community providers, and then four years ago this coming November 1st, so just a couple of days away from an anniversary, came to MHA. We merged with MCCH, and I have been having a great experience here since then.
Larry Vernaglia
Before you got here, the Association changed its name from the Mass. Hospital Association to Mass. Health and Hospital Association. A shift in the mission too?
Steve Walsh
Well, I don't know if it's a shift, I think it's more of an evolution to where health care is, right? I think something we're going to get into is it's not all about the hospitals anymore. Health care is taking place outside of the four walls of the hospital, and really a whole different future I think for the way we provide services. I think MHA had decided that it was time to represent the whole health care industry, and all the other things that were happening, so adding in that other “H,” I think, was an excellent move by my predecessor, and certainly changes kind of the way we think about delivering services to our patients.
Larry Vernaglia
Before we get into looking at the future, let's talk about the recent past. We're now sitting here in Burlington, 20 months into the pandemic, and in addition to all the prior issues that hospitals in the industry have faced, we've dealt with a disease that's upset the entire industry and the economy. What are the big takeaways that the hospital industry has learned from this?
Steve Walsh
Well, I think we're still learning. I mean, it has been a long 20 months. I think our health care providers locally and nationally are still really very much in the thick of it, but I think the one thing that we learned probably more than anything else is that at the end of the day, when competition melts away and gives way to collaboration, you can do amazing things on behalf of your patients, on behalf of your communities. I remember early on hearing first from my colleague in Washington State, and then discussions with those in New York, and then next New Jersey, and then into Massachusetts, and the remarkable way about the way the COVID wave moved is that it was hitting various parts of the country at different times, and we were all able to learn from each other.
And then at the micro level here, you had 72 CEOs coming together every day, sharing their experiences, and trying to figure out together how to serve the needs of the state, and no longer were we this individual hospital, that individual provider, right? We were the Commonwealth's hospital, sharing resources, sharing best practices, sharing beds, sharing staff, equipment, load balancing by region. It was a remarkable effort of cooperation and collaboration by some of the best minds in health care here and across the country that got us through this. And although there was a lot of heartache, and a lot of loss, a lot of tragedy, it could have been much worse. And I think our health care community is just beginning to come out of this as we still face some unique pressures that are left over from the real challenges of last year.
Larry Vernaglia
In the early days of the pandemic, our clients were able to rely on some of the learning they received in the wake of the marathon bombing, and some of the collaboration that had to take place there. Did you see those lessons play out as the pandemic did?
Steve Walsh
I think we did. I think there was a lot of learning on the fly. I think people are really relying on their own individual experiences, but none of us were around 100 years ago. We didn't have that to fall back on. We learned a little bit about history—Boston had a unique history here. Those leaders of our hospital community were able to come together and draw from that experience. Pretty remarkable on that horrible day on Marathon Monday.
Not one individual that made it to a hospital lost their life, and they really did come together in an emergent situation to provide incredible care for those that needed it most, and they did that once again, but even our board chair now, he was an army medic. He had experience setting up a field hospital. I mean, that was the birth of the D.C. Youth Center in Worcester, and understanding how to best utilize a convention hall to treat large amounts of people at one time. And so all of those unique experiences that our leaders bring to their jobs every day were on full display in the effort.
Larry Vernaglia
Let's talk about the collaboration issue, which you raised, because I think that that's one that as I think about what's happened during the pandemic, the lessons learned are going to be one of the most fascinating things out of this, and I'm interested that you put that on the table first. Are there elements of that collaboration that you think should survive after we put the pandemic to rest, if we ever do?
Steve Walsh
Yeah, I think it has to survive. I think the job of a hospital CEO—and I'm not one, and I don't want to be in some of their shoes—and the challenges they face on a day to day basis, but it's a pretty lonely job. And you think about the past year, the past 20 months, our hospital CEOs got closest to each other, and to their communities in many ways, when they were most isolated, and didn't have the ability to get together in person. I mean, really kind of remarkable how when you look back you say, "Well, geez, all of this happened over a conference call on Zoom."
The chair at the time, we became incredibly close to a woman in Iowa who was our phone operator for our 7:00 AM meetings. We knew her at the end of the nine months, we had a teary eye as we said goodbye to her for the last time, and so it really is the collaboration. You hope that as the Hatfields and the McCoys emerge again in the spirit of market competition, they remember some of the things they really appreciated, enjoyed, and loved about working so closely together with this common enemy. I think that that's really the key to the future of health care, because we have so much more in common than we have differences.
Larry Vernaglia
Are there any other lessons that you think that the pandemic has taught us that we want to carry forward into the 2025, 2030?
Steve Walsh
Well into today, tomorrow, and the next day, the lesson around health equity, and the poor job that we had done, and I think that was an important lesson, not one that anyone is proud of, but one that is certainly our CEOs are taking incredibly seriously. I'm very proud of the work that our community is doing now, and to the leadership of a couple of our key CEOs—Dr. Betancourt, Dr. Churchwell—to look at our boards, to look at our communities, to look at our patients, make sure that our workforce, and our boards of directors, our trustees, are reflective of the patients, the communities they serve, and make sure that we're delivering the best possible care, regardless of what zip code you live in.
It shouldn't have taken a pandemic. It shouldn't have taken the murder of George Floyd. It shouldn't have taken a lot of things for us to get here, but we're here, and that's a good thing, and so there is no tomorrow when it comes with working on issues of health equity and racial injustice. It's a today problem and an everyday problem, and I think our CEOs have embraced that, and I would look at that as the flip side of something that we would really peel back the onion on we weren't so proud of, and we realized we had to improve upon.
Larry Vernaglia
That's a great point. Let's think about some other trends that you're seeing in the industry right now, and particularly, we're only a little bit into the Biden administration. Maybe from your perch, you can give us a sense of sort of what are the significant federal trends that the industry should be looking out for, maybe on reimbursement or even enforcement issues?
Steve Walsh
Well, I think the big issue that was pre-president Biden, and continues today, is the issue around surprise billing, right? The No Surprise Act. I think there is no disagreement among anybody that patients have to be in the middle. They have to be taken out of the middle of a surprise bill. You can't go for services and then get a bill in the mail for some thousands, or tens of thousands, of dollars for something that you weren't aware of, wasn't fully explained, that you didn't sign off on, because of some disagreement between a provider and a payer, and under the leadership of our own Congressman, Rich Neal, we thought there was a great compromise struck by the Committee on Ways and Means and passed through Congress on surprise billing, and it followed a bit of a New York model, where it's an arbitration model.
You put your best and final number on the table, and you get as close to the middle as possible, and there's no default payment that may seem to benefit one side or the other side. And that's what gets you the closest to the 50/50 or 51/49, and that's still important. And as of January 1st in this country, there will be no more surprise bills to patients. That's a good day. It's an important step. I think we're nervous about the way this is now moving through the rulemaking process, and whether it has the intent that we think that the Committee on Ways and Means had when they passed the bill. So that's something we're watching incredibly closely. I think the other big issue is our hospitals didn't spare any expense. And in the middle of COVID, it's really hard to talk about finances. Right?
Larry Vernaglia
Right.
Steve Walsh
I mean, hospitals in Massachusetts, and I know my colleagues around the country, they voluntarily made the decision to curtail elective services, right? They basically shut down their business. Right?
Larry Vernaglia
Right.
Steve Walsh
Voluntarily, because they at least here, we have 14,555 hospital beds. We had to decant those patients to be able to meet the demands of those that would be coming into resurge. So if you didn't have COVID in your community, you had no business. You just had bills. If you did, you were trying to figure out how to make a go of it, and to try to survive financially, and that's something we didn't talk about as we were talking about the loss of life. So the federal government and our delegation have been incredibly helpful. The CARES Act funding has been a literal lifesaver to stabilize the hospital community, but here, and I know, again, around the country, but here alone, we're still about $1.8 billion off when we account for all federal and state funding.
So that continues to be a huge challenge, and again, not just for the health care industry, perfectly recognize that there's other industries that are hurting. I just happen to represent this one, and this happens to be the one that had to stand up during COVID to meet the demands of our communities, and for that, we really think that there will be and should be additional funding over time to stabilize the most important assets to any community, their hospital. Right? From a job perspective, a philanthropic perspective, and a quality of life perspective, your local hospital is the most important piece of the fabric of that community, and we need to make sure that they're whole.
Larry Vernaglia
So that was clearly the financial impact during the pandemic, which we're not out of yet, and I know the cost structure for the industry continues to go through the ceiling. Everything is more expensive from labor to supplies, and band-aids, and everything else. So as you're looking for the next 12 or 24 months from a hospital's perspective, what are those key threats that they should be looking out for?
Steve Walsh
We continue to pay attention I would say to four key things, kind of from a clinical and policy perspective at hospitals, and I think this is the exact same list of four around the country, and the first is staffing. Now, this is not different than any other industry. Okay? If you turn on CNN, just this morning, you will hear about a toy shortage, which apparently is getting a little bit better. They're producing toys again. A shortage of truck drivers, Christmas trees, toilet paper, and when people don't show up to work at the factory, we make less widgets, and we put less widgets out.
When they don't show up to work at a hospital, somebody waits in an emergency department, and that's somebody's mother, somebody's father, somebody's son, somebody's daughter. Incredibly challenging industry from the perspective of you have to be able to prioritize the care of those that come to you for help. When you don't have the workforce to do that, it really becomes a challenge to your entire mission, and staffing issues throughout the country right now is a huge problem. There's just one hospital in Massachusetts, one system, has 1,800 vacancies as we sit here today, and so that is our number one threat to our ability to be able to meet the demands of our patient population.
So if you still have some COVID patients in the hospital, and you have a workforce challenge, you have this little bit of a perfect storm where everything else that's coming in through the emergency department, through deferred care, through elective surgeries that didn't happen over the last 20 months, everybody is a little sicker, the acute is a little higher, and our hospitals are full. So even though you think COVID is over, we're onto this new normal, and again, we get it. People desperately want COVID to be behind us, right?
We lost two years of our life. We get it, but it's not that way for the health care community. So they're still having these capacity challenges where you might be one catastrophic event away from that hospital turning over, and not be able to meet the demands. Last week in Massachusetts, no ICU beds, serious concern. We're partnering with other states, and so the third is still some COVID, and some long stay COVID patients, and then the last is this epidemic around behavioral health.
And again, that is something that came out through the pandemic and has been worse since we have been now doing a new tool for our members to assess borders every week, and there's 653 borders. 653 people in our emergency departments just in Massachusetts alone last week waiting for a bed or behave health services. It's not good care, not good care for those patients. It's not good for the staff at the hospital. It's not good for the health care system, and so we need to fix that. So the Governor Baker administration has done a tremendous job of making this a priority. The legislature is doing that through some Harper funding, but the behave health crisis is real, it's throughout the entire country, and it's something that we have to put the same type of attention, energy, and vigilance in that we did to fighting COVID a year ago.
Larry Vernaglia
Let's go back to your number one threat right now, which you saw as a relation to staffing, and you mentioned one hospital having 1,800 vacancies. I'm seeing it in my own practice, and when we look at the labor market nationally, but here in Massachusetts in particular, one thing that stands out is our nursing strike at St. Vincent's in Worcester, which approaching the eight month mark now, which is probably the longest strike—certainly the longest strike in Massachusetts history—in the nation. What do we make of that? Where is that going to end up?
Steve Walsh
We need resolution, right? St. Vincent's is a great hospital, it's a safe hospital, it's a high quality facility, great leadership, and they have made every effort to end that strike, and there's 100 beds offline that Central Massachusetts desperately needs. There's a lot of talented nurses that are outside the hospital. They should be within the hospital, and so when you couple that with the challenges around capacity, around staffing, it's a huge problem. Our CEOs have been doing things to address the challenge of labor, they understand. They understand that this is different, that our caregivers have given everything they have over the past 20 months. They are tired, right?
So there's a whole new effort to really understand clinician burnout differently than ever before. We have a CEO who talks about seeing an nurse outside of the hospital after a shift, taking off the scrubs, off the shoes, off the hat, putting it in a trash bag, and changing into new clothes to get in the car. And that CEO said, "That nurse didn't do that before COVID."
Larry Vernaglia
Right.
Steve Walsh
This is different. We get it, but at the same time, we still need to meet the demands of patients, and to do that, we need to better understand our workforce. We're doing that through worker flexibility, through the reduction of burnout, through benefits like childcare, flexible scheduling, trying to add additional incentives in, recruiting new people to the workforce. There's a whole lot of things that our teams are doing around caring for our caregivers, but having nurses outside the walls of the hospital that need to be inside, it obviously isn't helping anybody, and it also is further exasperated by this temporary nursing issue.
Larry Vernaglia
Sure.
Steve Walsh
Now, I talked about Washington State calling, and then New York, New Jersey, Massachusetts, and when COVID first hit, it hit various states at different times. That's what allowed us to be able to meet the demands. That's what allowed us to learn from each other. Right now, the problem is the workforce shortage is in all 50 states at the same time. So if we're not willing to pay the 2X, 3X, or 4X that temporary nursing agencies are charging to be able to meet the demands of our patients, there's 49 other states that are going to, and so it has now driven up the cost of labor. So you've got this labor shortage, right? Coupled with a long strike, coupled with temporary nursing becoming so expensive, coupled with the fiscal challenges we talked about. This is the threat. This is the new threat that's keeping our CEOs up at night.
Larry Vernaglia
But that money is not flowing into the pockets of nurses. A lot of that money is staying with those agencies.
Steve Walsh
There's certainly that, right? I mean it is not a direct pass through, absolutely, but again, this is one of these interesting pieces that certainly your firm understands as well as anyone, being so invested in this. The challenge we have with temporary nurse agencies, and I think the Attorney General here, the Department of Public Health tried to regulate what those nurse agencies could do.
Larry Vernaglia
Right.
Steve Walsh
But if you push too hard on that balloon, they're going to go someplace else.And then you're left with the loss of those workers that would've otherwise been here, so the leverage is really right now in the hands of the companies, and it needs a federal response. We need a federal program, so that everybody has a level playing fields, as it relates to temporary labor.
Larry Vernaglia
One of the most stark exacerbations of the staffing shortage has been the reaction to mandatory vaccinations of the workforce. And every morning, your Modern Healthcare report will tell you how many people are out at each hospital as a result of refusing to take the vaccine. What's the perspective here in Massachusetts, and maybe as compared to what you're seeing in other states and jurisdictions?
Steve Walsh
Well, I think we've done a really good job in Massachusetts. I think there's been a lot of education, a lot of discussion, a lot of prodding, and pushing, and pulling, and assisting, but I think this is an area that Governor Baker has led on, and we're what? Top five in the nation, and vaccines were done well. And that comes right through our health care community. We were a leader in the flu vaccine. I think our health care community understands and appreciates this. In every single business there's going to be some folks that for whatever reason make a decision that they don't want to take a vaccine, or they just want to be contrarian to whatever the rules of the day might be.
I think as you get closer to the deadlines, we get closer and closer to 99% in most of these facilities, and it is a concern. I think there's a really difficult dilemma that our leaders have faced about doing the right thing for the patients and the vaccine. Right? We have a responsibility to protect our patients, protect our workers, protect the families that are coming in to visit those patients in the hospital in their time of greatest need. We have to have an expectation that our workers will take the vaccine and be healthy. I mean, science has proved this is the right thing to do, versus the fact that their number one keep me up at night problem is staffing, right?
Larry Vernaglia
Steve, I know that the board here at MHA took some bold actions around vaccinations, and the way they individually wanted to think about it. What was their perspective?
Steve Walsh
Yeah. So they thought this was so important to health and safety, their workforce and their communities, that I'm very proud of the work that they did. They made a commitment for each of them to independently implement a mandatory vaccination policy.
Larry Vernaglia
And how quickly were they able to do that? Probably some haven't implemented it yet.
Steve Walsh
Yeah. So all but a couple have announced, and the dates vary, and they're working through that now, but we have more than half of the hospitals that have already hit their target dates for mandatory vaccination and are doing really, really well with their workforce.
Larry Vernaglia
That's Awesome. Steve, let's now start looking into the future for the hospital of the health system industry, and you mentioned when you were talking about the things we learned during the pandemic that maybe the hospital isn't four walls and a bunch of beds. I'm putting words in your mouth, but if you're thinking about the role of the hospital being something broader than it was historically, where do you see it going?
Steve Walsh
Yeah. I mean, it's just something we think about a lot, right? And I might still have 31 bosses that think it's four walls in a hospital, just to be clear. No. Listen, you get in any room with really smart health care people, and they're trying to figure out what the future looks like, and where it's going, and it's outside of the walls, and if you look at the capacity challenges, right now, we're actually through public service announcements telling people don't go to the emergency room if it's not an emergency. Right?
Larry Vernaglia
Right.
Steve Walsh
Seek care from your primary care provider, an urgent care setting, or in another setting, so we're coming full circle. I mean, we're going back to house calls again. I mean, the old thing is right. The doctor used to say, "Take two aspirin and call me in the morning," because most things are gone by the morning. I think we are now back to this type of an environment where you're going to see more and more things happen in the home. Now, how do you do that? You got to be smart about it. Well, we stood up with telemedicine, because we had to during the pandemic in Massachusetts, and other places have done a good job of this as well. It took about four minutes. Right?
Larry Vernaglia
Right.
Steve Walsh
And we've been arguing it, debating it for the last 14 years. So where there's a will you can get there, and now Massachusetts is doing a really good job utilizing telemedicine. Well, what's the next? We have a law that passed a couple years ago. We've never used it as well as we could around mobile integrated health care. So you call 911, the ambulance shows up at your house, they don't have to move you. Let's triage that situation there in the home. Let's call a doctor. Let's figure out where's the best place for you.
I don't know if it's the hospital. It might be, and if it is, you know where you're going? The hospital, but maybe it's a community setting. Maybe it's an outpatient service. Maybe it's triaged, and it's set up an appointment in your primary care. And so I think we're moving in a direction where we have to think of about the entire health care landscape differently. Now, the other thing to do, and to come around a little bit to our financial discussion from before, is when you think about it differently, how do you pay for it differently? And we have a very complicated system for the way we pay for health care. And I think that's going to be almost as big a challenge as delivering the care is how to be reimbursed for the care.
Larry Vernaglia
When you were talking about your government experience, when you were in the state legislature, you mentioned your role in drafting Chapter 224, our state cost containment bill, and our friends in other states look at Massachusetts as we originally started with Romney Care, which became the backbone for the ACA, and we became really good at giving away health insurance. And we still are looking at how do we start to manage costs. Is this one of the techniques for it?
Steve Walsh
I think it will be. I mean, there's a number of tools that folks are looking at. Certainly I think that prior to COVID, there really was a promise of an accountable care organization that would meet the demands of the patient differently. And if you look at a patient that has co-morbidities, and you manage them through some type of a global payment, you do two things. The provider does well when they manage the patient to be well, and our community is healthier. So it really makes a ton of sense in terms of taking a holistic approach towards the patient, and using a risk based model to say, "We can do better when you do better."
But it's hard to get from A to B on that. I mean, we've been trying a long time, and you're still in this situation where the historic contracts with insurers are kind of baked in, and that's what the chassis is built upon. And we have to think about this much differently. I think Massachusetts has done a good, not great job of controlling cost relative to the rest of the country. It doesn't mean we have hit our benchmark every year, but we've been close.
And I think now you'll see the Health Policy Commission and others here look to what's the evolution of Chapter 224, and kind of what are the next steps, but those next steps have to include how do we best care for our patients in different care settings, through a different model, that allows our hospitals to continue to survive and thrive, but make sure that the cases there are the ones that need to be there most?
Larry Vernaglia
What do you wish we had done in terms of cost containment that we couldn't because of the realities of politics? If you had the magic wand, what would you use it to do?
Steve Walsh
Something that still vexes me is this administrative simplification piece. I mean, you think about it, I never have understood why I can get my credit card statement in the mail once a month. It has lines for everything that I purchased, it has what I paid, and it has what my balance is, and it's almost never wrong, but if I go to my doctor for a service, there's fourteen pieces of mail that comes. There's an explanation of benefits, and this is what I paid at the thing, and this is what I paid for the copay, and this is what they billed for, and this is what the insurance company contracted for, this is the difference, and this could be a balanced bill, if we did balanced bill, this is what's going to be written off. Why is that? Why? And I guess to that is, if my doctor tells me I need a service, don't I need the service?
Larry Vernaglia
Right.
Steve Walsh
Why is there someone at a back office of an insurance company somewhere making a decision about whether or not I need that service? My doctor just said I need that service. So why am I now jumping through a series of hoops in order to get it? So those are just little things that I think inconvenience the public, that make them really frustrated when they come to any of our providers for service, and they don't understand what something costs, what the cost to them is going to be, and whether or not when their doctor tells me they need something, whether it be a medication, or a procedure, they're able to get it without limitation.
And I think those are things we all should be working on. There's no fault in that, right? I mean, that's all of us coming together. And again, that collaborative fashion that we started our conversation about to say this is about patients. It isn't about me. It isn't about you. It's about patients, and what is oftentimes an emotional time when they are sick, or a loved one is sick in need of services. We should be doing everything we can to make it as simple, as seamless, and as efficient as possible for them.
So in everything we do, we should be saying, "Let's look at this through the eyes of the patient, and if it makes sense, let's do it. If it doesn't make sense, let's try something different." And I think with our backs to the wall in COVID, I think the leaders of health care that I've had the privilege of working with, that's the way they approach their daily life. What does it mean to our patients? And when that happens, our system runs better than any other one in the world.
Larry Vernaglia
As we close out our time together, I want to follow up on one item you were discussing relating to cost containment, and that's relating to the Health Policy Commission and some of the bureaucracy we built up in Massachusetts. As I travel around the country, the questions hospital leaders ask me are about that process, and what did we learn in terms of what we're doing right, and what as they roll out cost containment programs in other states should they consider doing differently? Do you have any advice for your colleagues in other jurisdictions about how their process should unfold?
Steve Walsh
Yeah, I think the biggest mistake that we made in Massachusetts relative to that were two kind of quasi groups that take a look at health care for us, and other states have asked me about this as well, as well as our leader of the Health Policy Commission, David Seltz, who does such a tremendous job. We have Center for Health Information and Analysis, kind of that's about the arithmetic. What'd you spend? Do we meet the benchmark? Do we not meet the benchmark? And then the Health Policy Commission, which kind of looks at the policies around that money, and makes decisions relative to how to best control the framework.
And the staff at the Health Policy Commission is really incredible, talented, dedicated professionals, who believe in the mission to provide affordable, accessible care to the patients, to the Commonwealth. I think we structured the board incorrectly. I think that looking back on it, we created a board that was in some ways an all-volunteer board, that were trying to protect against conflicts, so they could have no connection to any of the health care entities. And I don't mean providers or hospitals, it could be payers or anybody else. There's some really talented people in Massachusetts that work in insurance companies, that work in health centers, that work in pharma, that work in hospitals, that are stakeholders, but they have the ability, the talent, the professionalism to be able to separate what they're doing during the day versus what's best for the industry as a whole.
And I think other states, if they were going to go down this same path, you have to professionalize that board in a way that makes it clear that this is the group of people that are running health care for the Commonwealth, and we're going to go and get the best we possibly can with the best experience, regardless of what their affiliations might be. And that doesn't mean there's not some really talented people on that board. It doesn't mean that they're not fully committed, and haven't done a good job with the tools that they have, but when you look at just in contrast to the Gaming Commission of Massachusetts, right?
Larry Vernaglia
Right.
Steve Walsh
We have three casinos. The Gaming Commission, full-time, full-time job, professional board that runs it. And I think that if the Health Policy commission is going to continue to operate in the manner they are, and in some ways maybe in the future have even more ability to help control the health care market, we should look at that model, so that those commissioners, whether they be these ones or new ones in the future, have a full time presence in operating and running this industry, because that's what I think it deserves, demands that we need to do in order to be successful.
Larry Vernaglia
Thank you, Steve, for your time today. We all appreciate your making yourself available and offering some remarks that are relevant, not just to our hospitals here in Massachusetts, but nationally. We appreciate your efforts, and look forward to seeing more exciting activity out of Massachusetts, and as we make it through the pandemic together.
Steve Walsh
Thanks, Larry. Thanks. It was a really enjoyable conversation. Always happy to kick around some of the challenging issues of the day, and appreciate all that you're doing both in the Commonwealth and around the country for our health care providers.
