BOSTON (SHNS) – Massachusetts health care costs fell in 2020 for the first time since the implementation of a landmark cost control law a decade ago, but the decline was a one-off caused by the COVID-19 pandemic. An alarming trend likely to be an outlier and unlikely to reverse, state analysts concluded in a new report.

The latest annual health care cost trend report from the Commission on Health Policy, released Tuesday, shows the panel’s recent work on the rising trend in health care costs and the growing burden it places on Bay State families, despite being the top line. It reflects many of the caveats that have come. For the first time since the bureau’s founding in 2012, the health spending environment index has tilted downward.

From 2019 to 2020, statewide total per capita health spending fell 2.4%, marking the seventh consecutive year of slowing annual growth. The last two of those have beaten his 3.1% benchmark, which represents a target to keep cost increases within a manageable range.

But officials said they did not see the change as meaningful progress toward containing prices in an industry that is a pillar of Massachusetts’ economy and puts economic pressure on many families and employers. made it

HPC members said Tuesday that to keep the cost curve down, lawmakers will tighten the panel’s regulatory powers, impose additional scrutiny and restrictions on health industry heavyweights, and reduce health insurance premiums and cost burdens residents face. He said there was a need to reduce the burden of It has proven difficult for Democrats to achieve in Congress.

“When I think about the last decade, I strongly feel that the Commonwealth is a lot better because of HPC, but as you said, things are changing for us,” HPC Chair Deborah Devaux told the panel. told reporters after her first meeting on “New factors are emerging that are driving higher costs. Some of the factors that have been around for a long time are still there. So I think it’s time to look at new approaches.”

HPC analysts wrote in a report that spending growth, which has dominated in recent years, is “likely to continue” on an upward trajectory into 2021 and beyond.

At a committee meeting on Tuesday, HPC executive director David Seltz said the long-term upward trend in costs was due to “persistent challenges and market failures that have not been adequately addressed over the past decade.” I thought it was. Excessive variability in drug prices and costs between different providers.

“Policy makers believe urgent action is needed to strengthen and evolve our approach, otherwise increasing inaccessibility and health insecurity for Massachusetts residents and businesses. There will continue to be a healthcare system where equality continues to expand,” Seltz said.

Familiar recommendations return in new context

The commission’s latest annual report accompanies new comprehensive data on trends that both providers and patients have been warning about over the past two years. Some hospitals and other health workers had previously issued warnings about the financial burden caused by the pandemic.

The 2012 legislation that created HPC established a benchmark for measuring annual healthcare cost growth. Those annual numbers beat the 3.6% benchmark in 2014 and 2015, fell short of it for his next two years, and beat his new 3.1% benchmark in 2018 and 2019. In 2023, the benchmark will return to 3.6% again.

State governments will not face formal consequences if healthcare cost increases exceed target levels, but HPC can mandate individual providers and payers to implement cost-cutting measures.

HPC members unanimously endorsed the report’s set of recommendations. Its latest edition highlights three areas of action that regulatory experts believe the incoming administration and Congress should address as her top priorities for 2023. Above-average spending growth, excessive provider and drug prices, and rising insurance premiums and costs.

The regulator also asked lawmakers to overhaul the performance improvement planning (PIP) process, which can mandate providers to make changes designed to keep costs down. HPC said policymakers should expand the list of indicators used to refer health care providers to her PIP review. “Financial penalties” as a deterrent to excessive spending.

Only once has the committee exercised full performance improvement planning authority. In January, he ordered General Brigham to address spending above his level more than any other provider in Massachusetts from 2014 to 2019.

HPC members on Tuesday approved a PIP for the hospital system aimed at cutting annual spending by $127 million.

Total health care spending per capita also declined nationally in 2020, albeit a smaller decrease of 0.3% compared to Massachusetts’ 2.4% decrease.

The reasons behind the 2020 shift underscore the panel’s warnings: The overall decline in per capita spending is not due to price reductions, but to health care costs in the early months of the COVID-19 emergency. In fact, the average price of commercial insurance has risen 2.7%, the highest rate since at least 2016, according to HPC analysts.

Changes have been uneven across different types of healthcare spending, partly reflecting the different impacts of the pandemic. The steepest decline was seen in provider offices, where spending fell 17.4% from 2019 to 2020, according to HPC.

Commercial insurance costs fell more in outpatient services and emergency departments than in hospital inpatient services, but despite declines in other departments, total spending on pharmacies increased by more than 8%.

‘Warning Signals’ About Struggling Families

The outlook for spending cuts is very high, but the regulator said it would not lead to “proportionate cost savings” for Bay Stater, which has commercial insurance. Her average monthly contribution to these policyholders fell from $59 to $49 in 2020, while family health insurance premiums were borne by employers and employees in the same year. He added about $500, HPC said.

This situation created a particular challenge for middle-income earners, who are typically ineligible for MassHealth or for large subsidies through the Health Connector.

According to the authors, for a family of four with an annual household income of $83,000 to $139,000 (three to five times the federal poverty level), employer and employee health insurance payments and out-of-pocket costs combined: It accounts for 22% of total rewards. This is her fifth-highest share of household compensation for medical costs in the United States.

The prospects are even worse when you consider the notoriously high costs inherent in Massachusetts.

“Combined with local costs for housing, childcare, and other expenses, if you were a typical Massachusetts family of four, lived in the Worcester metropolitan area, and had income in this range, all your income It’s absorbed into childcare, meals, transportation, medical care and other necessities that don’t have money left over for emergencies, temporary expenses, or other discretionary expenses like vacations,” HPC wrote. “Such a family in the Boston area would be at a deficit of more than $1,500 each month.”

David Auerbach, Senior Director of Research and Cost Trends at HPC, said in particular that the findings were “a warning signal to us that, wow, affordability is a serious problem, and healthcare is a big factor in that.” It was helpful,” he said.

One pandemic-era success story highlighted in the report is telemedicine. The Baker administration and lawmakers agreed during the crisis to formalize access to services delivered by phone or video conferencing, and HPC said the use of telemedicine would “further exacerbate the income-related gap in healthcare access.” It was found that there is a high possibility of preventing

Mental health services, in particular, have found a new home on remote platforms. Fewer than 1% of psychotherapy visits were made via telemedicine in 2019. Between April and December 2020, nearly 87% of such visits were via telemedicine, according to HPC.

Governor Charlie Baker signed into law a bill to expand access to mental health care services in August, but the House and Senate couldn’t agree on the approach, stalling two other major health care bills.

Last year, the House of Representatives approved a bill that updated the regulatory hurdles large healthcare providers such as MGB face as they try to expand into markets served by smaller, financially vulnerable community hospitals. did. never appeared in the Senate for a vote.

A top priority for Chairman Ron Mariano, the measure updates the “determine need” process to allow HPC to examine not only the costs and impact of mergers and acquisitions, but also the market impact of hospital expansion. make it

Meanwhile, the House has restricted out-of-pocket insulin spending to $25 a month, requires drug companies to notify states before any significant price increases or new drug launches, and has approved a Senate-approved plan targeting drug companies and pharmacies. Didn’t bring up the bill. Administrators who benefit from both the HPC Annual Cost Trends Hearing and review by the Center for Health Information Analysis.

Department of Health and Human Services Secretary Marilou Sudders said some of the committee’s recommendations were included in the health care bill Baker introduced in March. Both chapters put the bill to a vote before the formal session ended on August 1.

Sudders hopes there will be an “opportunity” to address these issues early next year, when a new governor takes office and Congress begins its next two-year term.

“This is an unrealized opportunity,” she said.