Sanchez: A few common themes emerged

Health panel finds higher payments justified for high-quality providers

IN MAY OF 2016, I was named co-chair of the Special Commission on Provider Price Variation, a 23-member group consisting of legislators, insurers, providers, employers, and other stakeholders. The commission spent the last six months tackling complex issues in health care, including the payer-provider contracting relationship, the impact of health care market forces, how transparency can be implemented meaningfully, and a potential role for the state in reviewing provider rates. The conversation was engaging and informative, but at times challenging.

Given the complexity of the issues at hand and the short time frame, we created a process to allow all members to engage in a respectful dialogue and tackle the breadth of this issue. I did not want to revisit old reports and analyses and rehash old debates. Instead, I wanted to foster objective, focused discussions and hopefully find some points of agreement. Although the commission’s mandate was specific in some areas, there was ambiguity in the language. Therefore, the commission’s work was informed by broader health care concerns, such as continued increases in costs and how to support community providers. The Legislature succeeded in reforming health care in Massachusetts from Chapter 58 to now. The question this commission needed to answer is: What does the market look like in the future?

Considering the size of the commission, as well as the time frame, we created three subcommittees to allow commission members to continue conversations between meetings and draft initial recommendations in their respective topic areas to bring back to the full commission. In addition, to facilitate thoughtful and in-depth conversations, the commission invited nationally-recognized industry experts to each meeting, where they presented on their areas of expertise. Once the commission drafted its recommendations, a final panel of experts was assembled to further challenge and explore our thinking. To engage members of the public and stakeholders not represented on the commission, we held a public listening session. These issues impact all residents of the Commonwealth so we wanted to provide an opportunity for people to address the commission.

Meet the Author

Jeffrey Sanchez

State Representative, Massachusetts House
From the beginning, in my role as chair of the commission, my goal was for all stakeholders to come together, discuss action-oriented ideas that address the challenges in our health care market, and see if commission members could reach consensus. It was not easy work, but over the course of nine meetings, all of which were open to the public, and almost a dozen subcommittee meetings, a few common themes emerged. Commission members agreed that higher payments are justified for high-quality providers and providers that care for sicker or high-cost patients. The commission also agreed that patients receiving emergency services or those cared for without their knowledge by an out-of-network provider should not be subject to a surprise bill. Members emphasized the fact that small businesses face unique hurdles when they purchase health insurance and may need additional resources. There was also recognition that it is essential to design innovative insurance products that appeal to consumers and employers. There was broad agreement that patients need more accessible, actionable, and understandable information, both when they choose their plans and when they access care. Finally, commission members agreed that all stakeholders must work to ensure the sustainability of providers across the Commonwealth. The commission also recognized that any proposed actions should not increase total healthcare spending in the Commonwealth or increase the financial burden on patients and employers.

The work of the Commission and its final recommendations are encompassed in a report that will be released Wednesday, March 15. While this report signifies the end of this special commission, it is merely the beginning of a conversation. The recommendations present a menu of options to address rising healthcare costs and price variation, which the Legislature may consider. There is a lot of uncertainty at the federal level as we wait and see how Congress and the Trump administration are going to act regarding the future of health care. Massachusetts is a leader in health care innovation and policy reform. There is a lot to do in the coming months and all stakeholders must work together to address these complex matters. I look forward to continuing the conversation.

Jeffrey Sanchez is a state representative from Boston and the cochair of the Legislature’s Committee on Health Care Financing.