The HCQCC met today to discuss the long-awaited Roadmap to Cost Containment (Roadmap). Prior to this part of the meeting, they had a few sub-committee updates. The anticipated sub-committee restructuring has been completed and there are now fewer committees with a sharper focus for each (check out our earlier post here). Jack Evjy, MD from the MMS presented a brief report on the Advisory Committee’s discussion about the Roadmap and promised a more detailed report at the next QCC meeting.
The Council also voted to amend their Data Intake Collection regulations. The changes allow for an administrative process for data collection and also establish a fee schedule for those who wish to use the QCC’s data. These regulations will the subject of a hearing in November, details to follow.
Last on the agenda was the discussion of the Roadmap. Secretary Bigby set the stage by reminding the Council of their previous goals around cost and quality and other state initiatives in this area. Beth Waldman and Michael Bailit, from Bailit Consulting, presented the Roadmap recommendations to the Council members. (see the slides here)
The recommendations are: adopt comprehensive payment reform, adopt and use health information technology, implement evidence-based coverage informed by comparative effectiveness information, develop health resource planning, support system redesign, implement health plan design innovation to promote use of high-value care, enact malpractice reform and peer review protections, implement administrative simplification, engage consumers, encourage healthy behaviors, and further promote transparency. (Check out the details on the proposals below the fold.)
Check out our blog here for more information on payment reform and the Special Commission’s recommendations. The discussion revolved around the specific recommendations of the Special Commission. Many questions remained unanswered as they were not addressed by the Special Commission, but rather left to the implementing oversight entity. Of special concern to the Council was the structure of the ACO- an undecided matter thus far. Based on the discussion, the final Roadmap may contain some further recommendations about the ACO structure and requirements for that structure.
Implement evidence-based coverage informed by comparative effectiveness information: The QCC would recommend creation of an entity (state or regional) to look at existing clinical research and synthesis of this research and make recommendations about services to insurers, employers, providers and consumers. The entity will focus initially on areas where there is overuse. The discussion around this topic also highlighted the need to look at areas where there is underuse as well. The potential for cost containment with this strategy is high based on the existing research and programs. The entity will also need to make sure there is an exception and appeal process for those individuals for whom the recommendation is clinically inappropriate.
Implement health plan design innovation to promote use of high-value care: increase employer offering and employee take-up of products that provide incentives for use of high value services and providers with the goal of improving health outcomes and reducing premiums costs. Of note, this strategy is not about cost-shifting from employers to consumers, but about getting better value within the system. The RAND Report modeled savings in a range of $1.1 billion increase over 10 years to a $1.2 billion savings over 10 years.
The QCC did not get to the rest of the strategies at this meeting and postponed the remainder of the discussion to the next meeting.
They did briefly discuss their role once this Roadmap is complete. The recommendation is that they should develop a scorecard of the Commonwealth’s progress in containing health care costs to be released annually. The QCC will look at the transition from a high-level to make sure things are working properly.
The next meeting will be October 21st at 1pm at One Ashburton Place on the 21st Floor.
Georgia J. Maheras, Esq.
Private Market Policy Manager