Chairman Jeffrey Sánchez delivers remarks to the Health Policy Commission at start of 2016 Cost Trends Hearing, addressing disparities, behavioral health, and price variation.
BOSTON—Representative Jeffrey Sánchez (D-Jamaica Plain), House Chair of the Joint Committee on Health Care Financing, addressed the Health Policy Commission this morning on the first day of the Annual Cost Trends Hearing. Chairman Sánchez of the 15th Suffolk District, spoke at the request of Speaker of the House Robert A. DeLeo. Below are his full remarks.
Thank you to Dr. Stuart Altman, members of the Health Policy Commission, and Director David Seltz for all the hard work that you and your staff have invested in organizing this third annual Cost Trends Hearing. It is my pleasure to address you today at the request of the Speaker of House of Representatives Robert DeLeo. I appreciate the value and trust that the Speaker has given me to address all of you today. Last year, Speaker DeLeo spoke about continuing to expand access to health care, ensuring our health care system is transparent and agile to respond to issues like the opioid epidemic, the importance of coordinated and collaborative care, and frankly, the importance that all of us don’t get lost in the alphabet soup of health care jargon.
The reason we are here is to understand where we are with our health care system, so that each citizen of the Commonwealth doesn’t have to make a choice that may compromise their family’s economic stability and wellbeing in every sense. Should Mr. Alvarez once again have to go to the emergency room for treating his chronic diabetes, COPD, or whatever other chronic condition he may have, because he feels it’s the only way knows to deal with it? Since it may take weeks to get an appointment with a primary care provider or specialist, and when he does, he knows he may be subject to the language line or a translator that doesn’t have a clue about where he comes from, where he lives, and isn’t able to gain his trust or faith within a ten minute harried appointment. All the regression analysis and discussion about all-inclusive, stratified, risk adjusted, capitated payment arrangement means nothing if we can’t figure out, in this Commonwealth of plenty, how we can help the most vulnerable among us to care for themselves. Because they want to, despite what we will hear in the next 2 days.
As reported by CHIA, Total Health Care Expenditures in Massachusetts grew 4.1% from 2014 to 2015. While this number exceeded the benchmark of 3.6%, it is slower than national projections for healthcare growth at 4.6%. However, there are still some areas of concern. Cost sharing among commercial members continues to increase faster than inflation and wage growth, pharmacy spending continues to grow at a substantial rate, accounting for 1/3 of the overall growth in total health care expenditures, and adoption of alternative payment methods in the commercial market was lower in 2015 compared to 2014.
The passing of Chapter 224 was a milestone in health care reform and, four years later, we have a number of accomplishments to be proud of. Massachusetts has better data on the health care market than any other state in the country. We have certification standards for both patient centered medical homes and accountable care organizations, and a process to ensure carriers are in compliance with state and federal mental health parity laws. The HPC is fully engaged on the issue of growth and integration, and we are having an open dialogue through these valuable hearings as a component of our transparency initiatives.
Moving forward, let’s be thoughtful about what we, as policy makers, need to understand from stakeholders, residents, small business owners, and the industry in order to make health reform work for everyone.
Not only do we need to make health care more affordable, but most importantly, we need to ensure that people are able to effectively access the system to get the care they want and need. What are the right strategies to effectively engage people so they know how to sign up for health insurance, choose the right policy for themselves and their families, and understand that quality services exist in their community?
We know that 97% of residents have insurance, but those who remain uninsured are overwhelmingly people of color. The complexion of Massachusetts is changing quickly. In 2000, people of color were 11% of the population and now make up almost 20%. In the past 5 years, we have seen a greater increase of minority populations compared to the rest of the nation. In 2015, the Massachusetts Health Insurance Survey found that only about 82% of Hispanics reported having health insurance for the full year, compared to 92% of whites and African-Americans. 57% of Hispanics who had an emergency department visit stated that it was for a non-emergent condition, compared to about 34% of African-Americans and whites. And 25% of African-Americans and 28% of Hispanics reported being unable to get a health care appointment when needed, compared to 19% of whites.
We need to engage minorities, low-income residents, and other vulnerable populations to make sure health reform is working for them. The Attorney General’s most recent report found that more health care dollars are spent on higher-income communities than on lower-income communities —even though low-income communities tend to have greater health needs. Does this mean that there is implied judgement that investment matters more in wealthy communities rather than increasing access to the poor?
We rely on an industry of translators and language lines to help define healthcare between patient and provider in some communities. Leadership in Health Care does not reflect the breadth and experience of communities from the Board Room to the Executive Suite and most importantly from bench to bedside. I’m tired of the term culturally competent care. It is only with truly relevant care, can patients be empowered.
One area where we have made progress is access to treatment for mental health and substance use disorders. This session the Legislature, along with Governor Baker, agreed to a comprehensive law to prevent and treat opioid addiction, and have increased the number of recovery beds. And since fiscal year 2012, we have increased funding for substance use disorder services by more than 65%, including 150 new recovery beds this year. We’ve also seen the implementation of Chapter 258, a law requiring insurers to cover 14 days of substance abuse treatment without prior authorization.
While we’ve made some progress in addressing the opioid epidemic, we still face great challenges in behavioral health. Over the past year and half, I have toured over 40 health care facilities across the state. I have seen the struggles of behavioral health patients boarding in emergency departments because there is nowhere for them to go. In one visit I learned of a young man who was in the emergency department for 70 days because of his age, his history of substance use, and his mental health struggles. Everyone agrees that health care and behavioral health delivery is deeply siloed. For healthcare professionals to successfully manage a patient’s care, treatment of physical health cannot remain separate from behavioral health.
At the same time, we are witnessing an unprecedented era of innovation in medicine, and Massachusetts is leading the pack as the hub of R&D and scientific discovery. We are now seeing new treatments and devices that are dramatically changing the narrative of disease. There is no denying that these inventive therapies and technologies impact our ability to restrain spending growth and adhere to the benchmark. The controversy surrounding drug prices, both for new products and older generic drugs, has sparked debate in our hearing rooms about options to balance cost and value, without restricting patient access to care or stifling the innovation ecosystem that is integral to Massachusetts. I’m sure this will continue this session as well.
A few months ago, Chapter 115 of the Acts of 2016 created a special commission to study provider price variation. In my role as co-chair, I hope to foster an objective, fact based conversation among commission members in order to continue the work all of you have put in throughout the year to untangle that Gordian knot of price variation. A major question before us is what do we agree is justified and is there consensus on if we should do anything if unjustified variation exists. We have a very tight timeline to accomplish this work with a report due on March 15th of next year.
In conclusion, the question before all of us, including those in attendance and testifying at this hearing, is – what do we want healthcare to look like in the future or are we satisfied with the trajectory we have embarked upon. Can it weather the uncharted waters of the national and local landscape? Remember, this is the tenth anniversary of Chapter 58. We’ve done so much. Now where do we go?
We are grateful to the Health Policy Commission, the Center for Health Information and Analysis, Governor Baker and his Administration. Speaker DeLeo, and the members of the House of Representatives, and myself look forward to being a part of these conversations and finding solutions with you.