Manatt Spotlights

 

In this issue, Manatt examines how benchmarking programs can elevate the importance of primary care and behavioral health care investments and allow for the measurement of spending on these critical preventive services. A PDF of our update is also available here.

Leveraging State Benchmarking Programs to Drive Investments in Primary Care

The takeaway. State cost growth benchmarking programs support market transparency and accountability, and may be used to assess and redirect health care spending to higher-value, preventive services, such as primary and behavioral health care, through priority service targets.

What it is. States are increasingly seeking to both constrain health care cost growth as well as influence where health care dollars are being invested, with the goal of redirecting spending to high-value services and activities that support long-term population health, such as primary care.

While the U.S. far exceeds peer countries in health care spending—at $4.1 trillion or $12,530 per person in 2020¹—it continues to lag in terms of care access, administrative efficiency, equity and health care outcomes: There is a disconnect between how much the U.S. is investing in health and how much it is getting in return.² Studies indicate that the disconnect may be attributable, in part, to where health care dollars are being invested. Studies of other Organization for Economic Cooperation and Development (OECD) countries indicate that stronger primary care systems, for example, are correlated with better population health outcomes, such as lower overall mortality rates, lower rates of premature death and lower hospitalizations for ambulatory care sensitive conditions,³ and higher infant birth weight, life expectancy and overall satisfaction with the health care system.⁴ Even within the U.S., communities with greater primary care availability have reported better patient outcomes as well as decreased utilization of more costly health service categories, such as inpatient hospitalizations and emergency department visits.⁵

States like Rhode Island and Delaware have long recognized the value of investments in primary care and successfully directed attention and spending through existing insurance regulatory authorities. Other states, such as Connecticut and Massachusetts, are testing how they may leverage their benchmarking programs as a mechanism for advancing broader primary care investment agendas.

In 2010, Rhode Island implemented Affordability Standards,⁶ which established annual price inflation caps and required regulated commercial insurers to spend at least 10.7% of their total health care spending on primary care services under the health insurance commissioner’s rate review authority.⁷ Insurer primary care spending subsequently increased from 5.7% in 2008 to 9.1% in 2012 and achieved the state-set target of 10.7% in 2014⁸ before reaching 12.3% of total medical spending in 2018 (see Figure 1).⁹ A 2019 study found that the Affordability Standards increased aggregate primary care spending and saw reductions in total spending growth, with no impacts on health care quality.¹⁰

Figure 1. Primary Care Spending in Rhode Island, Total and as a Percentage of Total Medical Spending, 2008–2019

In 2020, Delaware’s Department of Insurance Office of Value Based Health Care Delivery (OVBHCD)¹¹ proposed similar affordability standards, which the state is seeking to codify through its proposed Regulation 1322 Requirements for Mandatory Minimum Payment Innovations in Health Insurance.^{12, 13} The standards would, among other actions, set a target for commercial health insurers to increase investments in primary care¹⁴ by 1.5% annually, targeting an increase in primary care spending from 7% of total cost of care in rate filing year 2022 (plan year 2023) to 11.5% by rate filing year 2025 (plan year 2026).^{15, 16, 17}

States may also advance primary care investment agendas through their existing benchmarking programs and processes.

The Challenge of Defining “Primary Care Services” to Support Spending Measurement

In 2018, the New England States Consortium Systems Organization (NESCSO) developed a standardized methodology for calculating all-payer primary care spending across six New England states—Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont—using each state’s respective all-payer claims database (APCD) data.¹⁸ NESCSO developed and tested the following definitions for primary care in its analysis:

• “Defined PCPs, Selected Services,” which includes selected claims payments for general practice, family medicine, pediatrics, internal medicine, nurse practitioner and physician assistant and excludes OB/GYN services.
• “Defined PCPs, All Services,” which includes all claims payments for the provider services listed in Definition 1 and continues to exclude OB/GYN services. This definition did not restrict service codes.

NESCSO found that the all-state average of primary care spending as a proportion of total medical spending ranged from 5.5% to 8.2%, depending on the definition used to capture primary care providers, services and spending. Primary care spending as a proportion of total spending was highest for the Medicaid population (8.0%–10.4% by state), followed by commercial (6.1%–9.3%), Medicare Advantage (5.5%–8.4%) and Medicare fee-for-service (3.4%–5.4%). See Figure 2 below for more detail. These findings align with other recent state studies that have examined total primary care spending.¹⁹

Figure 2. Primary Care Percentage of Total Medical Payments by Payer Type, 2018, NESCSO Study

What it means. Health care cost growth benchmarking programs can provide states with a mechanism to similarly advance cost containment and “priority service” objectives, allowing stakeholders to measure and monitor primary care spending against total system spend and use this information to influence investments in preventive services.

State cost growth benchmarking programs are data-driven, transparency-focused cost-containment initiatives that measure resident health care spending growth in relation to established targets; payers and providers that exceed targets may be subject to public inquiry or penalty. States collect benchmarking data directly from public and private payers operating in their states, monitoring health care spending across all lines of business. Payers may be asked to segment spending data by service category (which may be expanded to include primary care services and other priority services), key populations or product types, attribute spending to providers who may influence patient service utilization, or supplement “core” reporting with contextual information.²⁰ States are then able to analyze payer data to understand broad market health care spending trends, and to better target policy and program actions to address cost drivers—or, for “priority service” areas like primary care, advance agendas that displace lower-value spending with spending on services that promote long-term population health outcomes (see Figure 3 below).

Figure 3. Illustrative Example of Increased Investments in Primary Care and Impacts on Overall Health Care Cost Growth Over Time

Connecticut. In 2020, Connecticut’s Governor Lamont issued Executive Order No. 5, which, in addition to establishing the statewide cost growth benchmark, also charged the Office of Health Strategy (OHS) with developing and recommending a primary care spending target for the state beginning in 2021 in order to reach a primary care spending target of 10% (as a percentage of total health care expenditures, or THCE) by 2025. OHS’ preliminary analysis of primary care spending in the state by market found that the state’s average primary care spending in 2019 was 5.3%, with the highest percentage of primary care spend within Medicaid (7.8%), followed by the commercial market (5.0%) and Medicare (4.2%) (see Figure 4). In December 2021, OHS adopted primary care spending targets of 5.3% for 2022, 6.9% for 2023, 8.5% for 2024 and 10% by 2025. OHS will collect primary care spending data from payers within their cost growth benchmark data submissions in late 2022.

Figure 4. Primary Care Spending as a Percentage of Total Spending in Connecticut, 2018 and 2019 ²¹

Massachusetts. In March 2022, Massachusetts’ Governor Baker similarly filed “An Act Investing in the Future of Our Health” for the creation of a statewide aggregate primary care and behavioral health care spending target and set a goal of increasing spending on these services by 30% over three years while maintaining the state’s health care cost growth benchmark.^{22, 23} Payer and provider progress toward meeting spending targets will be assessed by the state’s Center for Health Information (CHIA) and Health Policy Commission (HPC) through its regular cost growth benchmark reporting process. Entities that fail to achieve the established primary care spending target may be required to complete a performance improvement plan (PIP) wherein they identify strategies to increase investments in primary care and behavioral health. The Baker-Polito Administration estimates this action will generate nearly $1.4 billion in systemwide investments for primary care and behavioral health services over the next three years.²⁴

Other states pursuing benchmarking programs are also considering setting primary care and behavioral health priority service targets as part of their programs.²⁵ California’s AB-1130, proposes establishing an Office of Health Care Affordability, a statewide cost growth benchmark, and priority service benchmarks for primary care and behavioral health investments.²⁶

What happens next. As state cost growth benchmarking programs continue to proliferate and mature, more states will explore ways to leverage their data collection and reporting to advance local priorities, including increasing investments in preventive services like primary care and behavioral health.

To return to the Manatt State Cost Containment Update Home Page, please click here.

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_{¹ “NHE Fact Sheet,” Centers for Medicare & Medicaid Services. Available here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet}

_{² “Mirror, Mirror 2021: Reflecting Poorly—Health Care in the U.S. Compared to Other High-Income Countries,” The Commonwealth Fund. August 4, 2021. Available here: https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly}

_{³ M. Niti, T. Ng. “Avoidable hospitalisation rates in Singapore, 1991–1998: assessing trends and inequities of quality in primary care,” Journal of Epidemiology and Community Health. January 2003. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732279/}

_{⁴ J. Macinko, B. Starfield, L. Shi. “The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD) Countries, 1970–1998,” Health Services Research. June 2003. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360919/}

_{⁵ C. Chang., T. A. Stukel, A. B. Flood, D. C. Goodman. “Primary Care Physician Workforce and Medicare Beneficiaries’ Health Outcomes,” JAMA. May 25, 2012. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108147/}

_{⁶ 230-RICR-20-30-4.10 – Affordable Health Insurance – Affordability Standards. Current, effective June 2020. Available here: https://ohic.ri.gov/sites/g/files/xkgbur736/files/2022-03/230-ricr-20-30-4-final-sos.pdf}

_{⁷ Equal to the Medicare price index plus one percentage point for both inpatient and outpatient services.}

_{⁸ “Investing in Primary Care: A STATE-LEVEL ANALYSIS,” Patient-Centered Primary Care Collaborative, Robert Graham Center and Milbank Memorial Fund. July 2019. Available here: https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/Investing-Primary-Care-State-Level-PCMH-Report.pdf}

_{⁹ http://www.ohic.ri.gov/documents/2020/June/Primary%20Care%20Expenditure%20Data%20Update%20June%202020.pdf}

_{¹⁰ A. Baum et al. “Health Care Spending Slowed After Rhode Island Applied Affordability Standards To Commercial Insurers,” Health Affairs. February 2019. Available here: https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05164}

_{¹¹ Established via Senate Bill 116, 150th General Assembly (2019–2020). Available here: https://legis.delaware.gov/BillDetail/47520}

_{¹² Office of Value Based Health Care Delivery (OVBHCD), Delaware Department of Insurance. Available here: https://insurance.delaware.gov/divisions/consumerhp/ovbhcd/}

_{¹³ “1322 Requirements for Mandatory Minimum Payment Innovations in Health Insurance, Proposed Rule, Public Notice.” Department of Insurance, Office of the Commissioner. Available here: https://regulations.delaware.gov/register/january2022/proposed/25%20DE%20Reg%20684%2001-01-22.htm}

_{¹⁴ Beginning in rate filing year 2022 (for plan year 2023).}

_{¹⁵ “An Integrated Approach to Improve Access, Quality and Value,” OVBHCD, Delaware Department of Insurance. December 18, 2020. Available here: https://insurance.delaware.gov/wp-content/uploads/sites/15/2020/12/Delaware-Health-Care-Affordability-Standards-Report-12182020.pdf}

_{¹⁶ “Delaware Sets Primary Care Investment Target,” Primary Care Collaborative. January 28, 2021. Available here: https://www.pcpcc.org/fr/node/209659}

_{¹⁷ Delaware’s Affordability Standards also incorporated price caps for aggregate unit price growth for inpatient and outpatient hospital services through 2025 to contain health care cost growth.}

_{¹⁸ “The New England States’ All-Payer Report on Primary Care Payments,” New England States Consortium Systems Organization (NESCSO). December 22, 2020. Available here: https://nescso.org/wp-content/uploads/2021/02/NESCSO-New-England-States-All-Payer-Report-on-Primary-Care-Payments-2020-12-22.pdf}

_{¹⁹ “Investing in Primary Care, A State-Level Analysis,” Patient-Centered Primary Care Collaborative (PCPCC). July 2019. Available here: https://www.pcpcc.org/sites/default/files/resources/pcmh_evidence_report_2019.pdf}

_{²⁰ J. Ario, K. McAvey, A. Zhan. “State Benchmarking Models: Promising Practices to Understand and Address Health Care Cost Growth,” Manatt Health. June 2021. Available here: https://www.manatt.com/insights/white-papers/2021/state-benchmarking-models-promising-practices-to-u}

_{²¹ “Leveraging State Benchmarking Models to Address Health Care Cost Growth,” Manatt Health webinar, April 2022. Available here: https://www.manatt.com/insights/webinars/leveraging-state-benchmarking-models-to-address-he}

_{²² S. 2774, “An Act Investing in the Future of Our Health.” Filed March 17, 2022. Available here: https://malegislature.gov/Bills/192/S2774}

_{²³Calendar year (CY) 2019 will serve as the baseline year CY 2024 spending will be measured against.}

_{²⁴ “Baker-Polito Administration Files Health Care Legislation Aimed at Expanding Access to Care,” Press Release, Office of Governor Baker and Lt. Governor Polito. March 15, 2022. Available here: https://www.mass.gov/news/baker-polito-administration-files-health-care-legislation-aimed-at-expanding-access-to-care}

_{²⁵ “Groundbreaking Study Links Higher Primary Care Spending to Better Care Quality in California,” California Health Care Foundation. April 19, 2022. Available here: https://www.chcf.org/press-release/groundbreaking-study-links-higher-primary-care-spending-to-better-care-quality-in-california/}

_{²⁶ AB-1130, California Health Care Quality and Affordability Act (2021–2022 Regular Session). Introduced February 18, 2021. Available here: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1130}

To return to the Manatt State Cost Containment Update Home Page, please click here.

 

In each edition, Manatt will feature a “deep dive” topic that shares new cross-cutting benchmarking program developments as states seek to evolve and advance their cost growth benchmarking programs to meet new regulatory and landscape needs. In this issue, Manatt examines opportunities for states to leverage All Payer Claims Databases (APCDs) and other key data assets to supplement state benchmarking programs. A PDF of our update is also available here.

Leveraging APCDs and Other Data Assets

The takeaway.  State benchmarking programs may leverage other data resources - including All Payer Claims Databases (APCDs), private claims databases, and federal and state survey data - to provide policy-makers, regulators, consumer advocates, and researchers with important context for findings (e.g., who bears burden of cost growth) and allow results to be as actionable as possible (e.g., specific providers or drugs contributing to cost growth). 

What it is. State cost growth benchmarking programs are data-driven, transparency-focused cost-containment initiatives that measure resident health care spending growth in relation to established targets; payers and providers that exceed targets may be subject to public inquiry or penalty.  States collect benchmarking data directly from public and private payers operating in their states, monitoring health care spending across all lines of business.  Payers may be asked to segment spending data by service category, key populations or product types, attribute spending to providers who may influence patient service utilization, or supplement “core” reporting with contextual information such as premium cost growth, Alternative Payment Methodology (APM) adoption rates, and member cost-sharing growth to help states better understand cost drives across payers and populations.  Payer submissions, typically delivered in a set of summative tables with aggregate data (i.e., not person-level information), are sourced from a combination of their administrative (claims/encounter) data and financial data (non-claims-based payments), to present a complete, timely, and verifiable accounting of health care spend.  Payers may be required to have an accountable person at their organization (e.g., CEO, chief actuary) certify that the data presented is valid to the best of their knowledge.

States may also use All Payer Claims Databases (APCD) to better understand health care market cost trends.  APCDs are large-scale databases that collect health care claims and encounter data from public and private payers across most lines-of-business, with the notable exceptions of the private self-insured (unless voluntarily reported) and Medicare fee-for-service (unless manually integrated by the state from CMS files).¹ Claims/encounter data can be a rich source of information, including person-level detail on patient diagnosis, the service delivered, the provider delivering the service, and the amount paid for delivery, by both the payer and patient. APCDs also collect other administrative information from payers to supplement and contextualize claims data, including enrollee demographic characteristics (e.g., age, zip code), and characteristics of enrollees’ coverage types and details (e.g., network characteristics, plan premiums). APCDs can provide health services researcher with large sample sizes, person-, provider-, and service-level detail, and the ability to following patient populations/panels over time (i.e., longitudinal information), making them valuable and powerful – if at times unwieldy – data assets.²

Unfortunately, APCD data cannot replace payer benchmarking data reporting, a common myth in health data circles, for reasons including that APCD data:

• Does not include non-claims payment information, which is of increasing importance as more payers and providers are paid under APMs;
• Does not include the vast majority of ERISA-preempted self-insured claims data (self-insured lives typically comprise over 60% of the employer-sponsored insurance market);
• Is not as timely as benchmarking data files, with calendar year benchmarking data received as soon as five months after year-end with payer-provided incurred but not reported (IBNR) estimates; and
• Does not have payer verification of results – or the methods used to derive them.

However, benchmarking and APCD data analyses can be paired to great effect:  with benchmarking data uniquely capable of identifying cross-market concerns, while APCD data can be used to add context and detail to findings, making them that much more actionable for policy-makers, regulators, advocates, and researchers. 

Figure 1. Benchmarking Data vs. APCD Data

What it means. While benchmarking data can provide important insights into aggregate, year-over-year cost growth trends by state, payer, provider (often), service category, and population group, states can derive additional insights by pairing benchmarking data and findings with analyses of other data assets, such as APCDs.⁶ Six of the eight states that have a benchmarking program, or have one actively in development, also have an APCD - including Washington, Oregon, Massachusetts, Delaware, Connecticut and Rhode Island – though analytic coordination across the two data assets varies considerably.⁷ 

Figure 2. Current State of APCD Implementation as of February 2022

Massachusetts has used its APCD, as well as other data assets it stewards, such as the Massachusetts Health Insurance Survey (MHIS), to support the state’s broader cost trends evaluations and hearings. For example, in 2021, the Massachusetts Health Policy Commission (HPC) used state benchmarking data to identify hospital outpatient spending as the fastest-growing service category for the commercial market, followed by spending on physician services and other professional services (Figure 3).^{8, 9}

The HPC then leveraged other available data to better understand the equity implications of cost growth:  pairing service category trends with information on who bears the costs.

Using commercial claims data from the Massachusetts APCD, the HPC found that individuals in the highest-income quintile had a higher proportion of their overall health care spending concentrated in hospital outpatient and professional services, whereas individuals in the lowest-income quintile had a higher proportion of their spending concentrated on prescription drugs, inpatient services, and emergency department (ED) services (Figure 4). These findings – made possibly only by linking benchmarking data with other available data resources - highlighted an important disparity in individuals’ access and utilization of health care services by income for policymakers and regulators consideration.

Figure 3. Percentage annual growth in spending per commercial enrollee, 2016-2019.¹⁰ 

Figure 4. Percent of health care spending by category and income for commercially insured adults by lowest- and highest-income quintile, 2018. ¹¹

State APCD Use Cases

APCDs have been used to support numerous use cases across the 18 states that presently host them.  They may be used by policy-makers, regulators, consumer advocates, researchers, and other stakeholders to:  better understand health care spending and utilization by payer, provider, and population group; answer specific policy and research questions (e.g., potential impact of Medicaid expansion); support public health monitoring, population health assessments, and cross-payer quality measurement initiatives; increase health system and cost transparency; and guide purchasers in decision-making.¹²

Massachusetts’ HPC uses the state’s APCD to expand upon benchmarking-related topics and issues, including to:¹³

• Analyze out-of-pocket costs for commercial insured populations,¹⁴ including copayments, co-insurance, and deductibles for both medical and prescription spending among the commercially insured using APCD data. The HPC found that from 2015-2017, average annual OOP spending for the commercially insured grew about 20%, from $601 to $721. Within that average annual OOP spend, APCD data provided additional clarity on who faced the cost of increasingly high OOP spending by examining the distribution of the annual OOP spend: while half of all members spent $345 or less OOP annually, individuals at or above the 90th percentile of OOP spending in all three years spent nearly ten times more, or nearly $3,499 on average, in comparison.
• Analyzing telehealth visits among commercially insured residents in 2015-2017,¹⁵ which examined telehealth visits using commercial claims data from the Massachusetts APCD. This analysis found that the rate of telehealth utilization among commercially-insured patients in Massachusetts almost doubled between 2015 and 2017, from 2.0 visits per 1,000 members in 2015 to 4.0 visits per 1,000 members in 2017 – even prior to the pandemic -  a finding that mirrors trends observed in a similar national commercially-insured population.  The investigation only added context to future benchmarking discussions around patient access, service utilization, and cost.

While having an APCD allows for more robust analyses of heath care trends, states may also use private claims data assets – such as data from the Health Care Cost Institute (HCCI) or FAIR Health - to better understand their health care spending trends.

State-level survey data has been widely used by states to understand health care cost growth and consumer affordability, including Massachusetts, Oregon, and Connecticut. For example, Connecticut paired American Community Survey (ACS) data with APCD data to create the Connecticut Healthcare Affordability Index (CHAI), a tool for policymakers and consumers to better understand the growing burden of rising health care costs for Connecticut families. The CHAI used data from the Connecticut APCD to calculate out-of-pocket costs for families with employer-sponsored and individual marketplace insurance by town, county, age group, gender, and health risk score.¹⁶

States may also use the Medical Expenditure Panel Survey (MEPS) Insurance Component (IC), which fields questionnaires to private and public sector employers to collect data on the number and types of private health insurance plans offered, benefits associated with these plans, annual premiums, annual contributions by employers and employees, eligibility requirements, and employer characteristics.¹⁷ For many states that do not have health insurance premium reporting as part of their benchmarking data collection process, the MEPS-IC provides similar premium cost growth data – though with a lag of at least two years – that provides insight into how employees and employers are directly confronting cost growth in local markets.

What happens next. As benchmarking programs continue to proliferate and mature, additional opportunities will emerge to examine how states are pairing their data with other assets to reinforce findings and other, novel use cases.

To return to the Manatt State Cost Containment Update Home Page, please click here.

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_{¹ APCD Council, FAQs. Available here: https://www.apcdcouncil.org/frequently-asked-questions}

_{² “Overview of All-Payer Claims Databases,” Agency for Healthcare Research and Quality. Available here: https://www.ahrq.gov/data/apcd/index.html}

_{³ “Annual Report on the Performance of the Massachusetts Health Care System (October 2019),” Massachusetts Center for Health Information and Analysis (CHIA). October 2019. Available here: https://www.chiamass.gov/assets/2019-annual-report/2019-Annual-Report.zip}   

_{⁴ Interactive Dashboard, Top 20 Drugs in 2015: Total Expenditures. Commercial Prescription Drug Use & Spending, 2015-2017, Massachusetts Center for Health Information and Analysis (CHIA). February 2020. Available here: https://www.chiamass.gov/prescription-drugs/#prescription-dashboard}

_{⁵ CHIA data set used does not reflect the impact of prescription drug rebates. Also does not include spending for drugs or administration of drugs covered under a medical benefit.}

_{⁶ Other informative data assets that states have used include hospital discharge data, payer expenditure reports, provider financial reports, and surveys of employers and households.}

_{⁷ Nevada is planning for APCD development, pending the release of federal funds to support establishment.}

_{⁸ “2021 Annual Health Care Cost Trends Report,” Massachusetts Health Policy Commission (HPC). September 2021. Available here: https://www.mass.gov/doc/2021-health-care-cost-trends-report/download}

_{⁹ Other informative data assets that states have used include hospital discharge data, payer expenditure reports, provider financial reports, and surveys of employers and households.}

_{¹⁰ Data source: Payer reported TME data to CHIA and other public sources; HPC analysis of data from Center
for Health Information and Analysis Annual Report, March 2021.}

_{¹¹ Data source: HPC analysis of Massachusetts APCD, 2018.}

_{¹² D. McCarthy, “STATE ALL-PAYER CLAIMS DATABASES: Tools for Improving Health Care Value. Part 2: The Uses and Benefits of State APCDs,” The Commonwealth Fund. December 2020. Available here: https://www.commonwealthfund.org/sites/default/files/2020-12/McCarthy_State_APCDs_Part2_v2.pdf}

_{¹³ Health Policy Commission (HPC) DataPoints Series. Available here: https://www.mass.gov/service-details/health-policy-commission-hpc-datapoints-series}

_{¹⁴ “DataPoints Issue 19: Persistently High Out-of-Pocket Costs Make Health Care Increasingly Unaffordable and Perpetuate Inequalities in Massachusetts,” Massachusetts Health Policy Commission (HPC). Jan. 13, 2021. Available here: https://www.mass.gov/info-details/hpc-datapoints-issue-19-persistently-high-out-of-pocket-costs-make-health-care.}

_{¹⁵ “DataPoints Issue 16: The Doctor Will (Virtually) See You Now,” Massachusetts Health Policy Commission. March 12, 2020. Available here: https://www.mass.gov/info-details/hpc-datapoints-issue-16-the-doctor-will-virtually-see-you-now}

_{¹⁶ L. Manzer and D. M. Pearce, “Connecticut Healthcare Affordability Index,” prepared for the Connecticut Office of Health Strategy and Connecticut Office of the State Comptroller. December 2020. Available here: https://portal.ct.gov/-/media/OHS/CT-Healthcare-Affordability-Index/CHAI/CT-Healthcare-Affordability-Index.pdf}

_{¹⁷ The Medical Expenditure Panel Survey, Insurance/Employer Component. Agency for Healthcare Research and Quality. Accessed December 22, 2021. Available here: https://meps.ahrq.gov/survey_comp/Insurance.jsp}

To return to the Manatt State Cost Containment Update Home Page, please click here.

 

In each edition, Manatt will feature “deep dive” topics that share new cross-cutting benchmarking program developments as states seek to evolve and advance their cost growth benchmarking programs to meet new regulatory and landscape needs. In this issue, Manatt examines recent program changes in the following areas:

• Accountability: As payers and providers exceed set health care cost growth targets, there is a growing interest in how to hold outliers accountable. Massachusetts and Oregon are pursuing varying approaches to advancing accountability.
• Consumer Affordability: Beyond addressing aggregate spending, states are focusing on how consumers bear the burden of rising health care costs. Massachusetts and Connecticut are leveraging important tools to better understand how rising health care costs impact consumers.

A PDF version of our October Spotlight is available here.

To return to the Manatt State Cost Containment Update Home Page, please click here.