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Massachusetts Health Care Reform – Full Speed Ahead; Health Policy Commission 2015 Cost Trends Report

The Massachusetts Health Policy Commission (HPC) has issued its 2015 Cost Trends Report, based on the HPC’s annual health care cost growth hearings. The report contained 13 key recommendations across a wide range of health care policy issues, all aimed at fostering initiatives to create an integrated strategy for tackling the benchmark-breaking rise in 2014 aggregate costs of 4.8%, which blew through the state’s benchmark of 3.6%.  Created by Chapter 224 of the Acts of 2012, as part of a comprehensive legislative approach, the HPC has a broad portfolio of responsibilities, including reviewing material changes in corporate and clinical affiliations, registering provider organizations, certifying (non-CMS) ACOs and patient-centered medical homes, and promoting alternative payment methods (APMs) and innovations in health care delivery.

The HPC’s proposals include increasing use of APMs, including bringing PPO enrollees under them and addressing perceived underlying provider price differentials; identifying what the state can do to tackle drug costs, while recognizing that federal action would be required for a successful strategy; addressing perceived problems with out-of-network billing; seeking to establish site of service equivalency; promoting greater integration of behavioral health and long-term care into payment and system reform initiatives; insurance product design; standardizing quality measures; and fostering more relevant price and quality transparency through recommendations for actions to be taken by its sister agency, the Center for Health Information and Analysis (CHIA), also created by Chapter 224.

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About this Author

M. Daria Niewenhous, Health Care Tech Attorney, Mintz Levin, HIPAA Lawyer
Member

Daria's practice ranges from transactional matters to general counsel services. She has extensive experience with the merger and acquisition of hospitals, long-term care facilities, clinics, assisted living facilities, home health and hospice programs, group practices, and other provider entities. She guides clients through the regulatory aspects of capital projects and other strategic initiatives. Active in health care reform matters, Daria is currently working with clients on ACO formation, clinical integration and affiliation, and similar arrangements. In addition, Daria provides...

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