Devaux says Health Policy Commission needs more power

New chair says ‘powers need to be changed and strengthened’

FOR SOME TIME, the Health Policy Commission has been urging lawmakers to increase the powers of the agency so it can better rein in rising hospital costs.

Deborah Devaux, the new chair of the agency, is voicing the same message but with a bit more urgency. In an interview on CommonWealth’s Health or Consequences podcast with John McDonough of the T.F. Chan School of Public Health at Harvard University and Paul Hattis of the Lown Institute, Devaux said it’s time for action.

“I believe the powers need to be changed and strengthened,” she said. “We need to consider new approaches because the challenges and issues have changed over the last 10 years, and accelerated in the last three years.”

A top concern is that half of all patients report deferring medical care because of the high cost, she said.

Devaux said her priority is to strengthen accountability for the state’s cost growth benchmark, the commission’s target for health care spending growth. The benchmark appeared to work well for many years, but has been sputtering of late. 

The consensus on the commission is that the cost growth benchmark needs more muscle behind it. Devaux said the commission needs the power to dole out financial penalties for organizations that repeatedly exceed the benchmark. 

“We hope we never have to apply those penalties, but they serve as an important factor in the focus on cost,” she said. 

Devaux said the state needs to gather data on the drugs contributing the most to cost growth and the ability to set target pricing for those drugs. And she said health insurers need more regulatory attention, suggesting the commission should set targets and standards for premiums and cost sharing.

Devaux also said the commission needs more control over the issuance of performance improvement plans. Performance improvement plans are currently the commission’s primary enforcement mechanism for holding health care payers and providers accountable for spending in excess of the health cost benchmark. 

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Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

For the first time in its 10 years in existence, the commission in January ordered Mass General Brigham to develop a performance improvement plan. It took nine months for the commission and the state’s largest hospital system to come to agreement on a plan to rein in costs by roughly $128 million a year. 

“We have really appreciated the responsiveness and commitment of MGB through the performance improvement plan,” Devaux said. “I was very respectful of how MGB came to the table.” 

But Devaux suggested the process may need some tweaks. She said the commission should have more authority in setting spending targets and identifying the strategies used to reach those targets. She also said the commission needs the power to hand out financial penalties for persistent noncompliance with the cost growth benchmark.