Health Care Quality & Cost Council Web Site Delays
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There was a story in the Boston Business Journal last week about the delays incurred by the MA Health Care Quality and Cost Council in trying to put up a web site that would show — for the first time — what the private sector actually pays providers for health care services in Massachusetts.
The story says, and I quote, “The system insurers use to pay hospitals is extraordinarily complex.” True — but as a member of the Council, as the CEO of one of the insurers, and as the head of an insurance company that submits similar data in NH and ME — both of which have operations in place — I would offer a more complex answer. This delay is mostly of our own collective making. Pinning it on the plans is easy, but it’s inaccurate. And I say that as someone who likes and respects both the Boston Business Journal and its reporter, and the members and staff of the Council.
Here are my Top Five Reasons Why This Web Site Is So Hard To Get Off The Ground…
1) The Council has been of two minds about posting cost data on its web site from the beginning — some members believing it was a critical part of the Council’s mission, and some believing it’s an unimportant side-show. As a result, it simply didn’t get the focus it deserved until the Council had been around for almost a year.
2) The Council could have asked for limited amounts of claims data when it first began seeking it from health insurers, thereby building a fully developed data set over time, rather than trying to gather it all at once. Instead, the Council asked for all claims data — with a fairly long historical tail — straight out of the gate, which led to interpretive and organizational indigestion.
3) The Council is pretty small for the tasks it has been assigned, including this one. Sometimes, it’s hard to get a lot done quickly when you’re trying to hire your first few employees. Most states that do this work have much larger staffs and operating budgets.
4) There are many people who would prefer to see this site never get off the ground, and as participants in the system, there are dozens of ways to delay and roadblock development and implementation.
5) Payment policies in MA are complex — but the plans, providers and employers all own a piece of this one. Our provider contracts are more complicated in MA than they are in ME or NH because the provider community here seeks more customization than the provider community in NH or ME. The employer community also relies on a broader set of plan designs in MA than we see in ME or NH.
The tragedy of the delay is the lost opportunity — now going on four years — to engage in a data driven discussion about what’s driving up health care costs. Without it, it’s all anecdotes and misrepresentations. For example, there was a story in the paper the other day about the financial trouble Cape Cod Hospital is having that said the following…”The biggest problems for these hospitals are flat reimbursements from insurers and payers and rising costs,” said Marc Bard, partner at the Bard Group, a Needham firm that provides management consulting to hospitals. “Everybody’s getting the same amount but paying more.”
I don’t know if Mr. Bard was accurately quoted or not — but I can promise you that no hospital we deal with in Massachusetts has been getting flat payments from us for the past few years. I also don’t pretend to know what the other carriers in MA are up to, but I’d be astonished if their experience was any different than ours. I do know that the American Hospital Association says private carriers are now paying, on average, about 40% more for hospital care than Medicare or Medicaid, and if we went away, over half the hospitals in the country would be looking at bankruptcy.
Put simply, this delay is a shame and problem. We all own it. And until we get serious about public reporting on health care cost and quality, we will continue to rely on misinformation, personal anecdotes, rumor and mythology. This, unfortunately, will not be enough to discuss, address or solve the problem.
So the one tiny piece of the healthcare reform law that was supposed to address the cost side of the equation is being bogged down. Why am I not surprised? The politicians are much more concerned about handing out free healthcare to anyone they can locate to make even more people dependent on government… creating a loyal constituency that gets money, housing and healthcare all from the government and all for free. This all folds in to your discussion on younger people leaving the region and the problems this trend will create. The cost of living tends to be high in a state when you tax the workers back to the Stone Age to cover all of these free government hand outs. Living in a one party state can be extremely frustrating.
I agree with most of your points Charlie. But I believe that putting this initiaitve into the hands of yet another council was the big mistake from my perspective. The state had already developed a website that contained quality information and could have improved upon that site quickly added the price data. You can be sure price information would have been up by now! Sure, it wasn’t perfect and it may not have been as “spiffy” as the proposed new site but it was up and running and people were using the information. Unfortunately it has not been updated since 2006. The council in fact slowed down a process that was already in motion! Maybe the end product will be better and better received by those being reported on because of the process involved. I sure hope so because otherwise this delay was completly avoidable!
I don’t see why committee members can’t make this happen in a reasonable timeframe if they wanted to and thought it was important. As an outsider, I conclude that they believe (1) markets can’t be trusted anyway so we shouldn’t bother putting this price information into the public domain and (2) the public isn’t smart enough to use it intelligently and to act in their own best interests. PCP’s, for their part, are unlikely to incorporate the information into their referral decisions. Bottom line: why bother? It sounds like classic liberal (and wrong) thinking to me. Since Massachusetts healthcare and halth insurance is already dominated by non-profit hospitals and non-profit insurers there is no blame to assign to supposedly greedy for profit insurers and for profit hospitals. Yet, healthcare costs in MA are among the highest in the country. What a mess!
Amy - You raise an interesting issue. Legislatures hesitate to give this kind of responsibility to specific administrations and prefer to give it to groups of interested parties. As a result, both the Health Care Quality and Cost Council and the Connector Authority have Boards that oversee their activities. This “groupthink” inevitably slows down their progress or waters down their focus. The flip side, of course, is more input and deliberation. Pick your preference. And I hope the end product is out soon.
Sean - I hope it’s not as gloomy as your comments suggest - although your worries about holding onto the so-called “younger generation” are right on, and I worry about that, too.
The delays are frustrating Charlie. Similar delays have been seen with the Connnector. There are still no small group (non-taxpayer subsidized) plans being offered there, and reportedly there won’t be until sometime next year (3 years into the law). So while more assessments, red tape and costs are being thrown at employers by state government, the hallmarks of the “reform” on the cost side have not been implemented. Transparency and affordable aggregated small group plans through the Connector were going to make the mandates affordable. Yet unfortunately cost continues to be the last political and public policy goal–well behind access & quality. Thus the payers–employers, consumers and taxpayers–continue to take a back seat to the receivers of our money.
Are the other health plans in the state as willing as HCHP to post their cost data? Will public access to this information reveal anything about the profitability of one health plan versus another or for that matter about one hospital group versus another? Shouldn’t this information be accompanied by outcome data so that transparancy for both the cost and value of a service can be derived? And finally should the Council have the authority to compel production of this data for the good of the public?