Frustration surfaces at Health Policy Commission

THERE WAS A LONG, awkward silence Wednesday when a power-packed panel of CEOs from the state’s largest health care organizations was asked by a member of the Health Policy Commission for any promising trend they saw among a bevy of grim-looking health care statistics.

Finally, Sandra Fenwick, the CEO of Boston Children’s Hospital, spoke up. “I just think we need to keep at it,” she said.

Kevin Tabb, the president and CEO of Beth Israel Lahey Health, said the lengthy list of negative metrics provide a roadmap of sorts that he and his colleagues need to work on. “I would suggest that everybody sitting at the table is as frustrated as you are,” he said.

There was also silence when David Cutler, a member of the commission and an economics professor at Harvard University, pressed Tabb; Fenwick; and Anne Klibanski, the president and CEO of Partners HealthCare, on whether their cost per patient will decline over the next five years. The executives weren’t willing to make that promise, pointing out that many of the drivers of health care spending (pharmaceuticals, new technology, and labor costs) are largely out of their control.

All in all it was a sobering panel discussion wrapping up two days of cost-trend hearings by the Health Policy Commission, which is charged with reining in the cost of health care in Massachusetts. The commission has had success in reducing the growth in health care spending, but many commission members seemed frustrated and talked of the need to approach the challenge more radically.

Commission member Chris Kryder pointed out that the current growth benchmark of 3.1 percent represents an annual wealth transfer of $1.8 billion from employers and consumers to health care providers. Commissioner Donald Berwick said it may be time to develop a new benchmark, or more than one.

Commissioner Ron Mastrogiovanni summed up the two days of hearings this way: “This is a very complex industry and that complexity leads to increased revenue and higher gross margins.”

Cutler acknowledged a point made by Tabb that he and his fellow commissioners are asking some of the same questions year after year. “Probably the biggest difference between asking the questions in the past and asking them now is that the level of frustration in our voices is probably higher now than it was in the past,” he said. “That’s reflecting the fact that all the data we see on consumers and on individuals and on patients shows the frustration. They can’t afford medical care and they can’t get access to it.”

Berwick said he had recently met with the head of the national health service in London and the vice president of Taiwan, and both officials were focused on the overall cost and quality of the health care system in their nations.

“They’re thinking about the well-being of the system. You’re not, not in terms of results,” Berwick told the CEOs. “I’m not criticizing you as human beings. But we have no solutions in this room until the leaders of the heath system agree to free up resources that can then be used for other purposes.”

Berwick stressed that the state is confronting a systemic problem. “Who can criticize Children’s Hospital or Partners?” he asked. “You’re all doing wonderful stuff, but you’ve got to do it differently.”

The CEOs all pointed to steps they are taking at their institutions to streamline care and reduce costs. Klibanski, recounting a recent visit she made with a staffer to a patient’s home where a simple photograph sent to a doctor triggered a diagnosis and course of treatment, talked up the potential of telemedicine. “Where we deliver care is a very important part of our strategy going forward,” she said.

Steven Strongwater, the president and CEO of Atrius Health, sees promise in the company’s Medically Home Program, which he said has the potential to shift 15 to 30 percent of routine hospitalizations to patient homes. So far, he said, hundreds of patients have participated and he hopes that number will grow into the thousands. “We really believe it can disrupt care,” he said.

Tabb and Klibanski said a key reason why they are expanding either through partnerships or acquisitions elsewhere around the state is to better deliver care where it is most appropriate. Both of the executives said their flagship hospitals are turning away patients. “Patients are turned away all the time,” Klibanski said. “High alert is a daily event.”

There also seemed to be praise for health care legislation filed last week by Gov. Charlie Baker, who is seeking to place greater emphasis on primary care and behavioral health care.

Cutler seemed encouraged by some of the changes taking place in the health care system, but he was nervous about the pace of change. “Care is clearly changing,” he said. “My sense is it is changing faster in other countries than it is here.”