Baker’s health care bill would implement cost control

Oct. 19--Gov. Charlie Baker filed a new health care bill to establish price controls Friday, a move representatives of the pharmaceutical industry described as "dangerous."

"We are deeply disappointed that Governor Baker is attempting, once again, to implement dangerous price controls that would have a devastating impact on patients," said Tiffany Haverly, spokeswoman for the Pharmaceutical Research and Manufacturers of America.

The legislation includes reforms in five major areas: behavioral health and primary care; managing health care cost-drivers; improving access to high-quality, coordinated care; community hospitals and health centers; and promoting insurance market reforms.

In addition to the bill, Baker signed an executive order forming a commission to study the individual and small group insurance market, often referred to as the "merged market," to examine the underlying trends that are contributing to growing costs for individuals and small- and mid-size employers.

The administration also approved $15 million to be deposited into the Health Safety Net Trust Fund to support care provided to uninsured and underinsured patients by acute care hospitals and community health centers.

"We need to prepare our health care system for the future, focus our efforts on achieving the best outcomes for patients and bring down costs," Baker said Friday. "The current health care system is not incentivized to take proactive steps to address the challenges associated with supporting an aging population, individuals with a chronic illness, or those in need of behavioral health services."

The legislation prioritizes investments in behavioral and primary care and establishes a spending target. Providers and insurers, including MassHealth, will be required to increase spending on behavioral health and primary care by 30 percent over three years within the construct of the state's health care benchmark.

Spending in 2019 will serve as the baseline, and providers and insurers will be measured on their performance beginning in 2023. The legislation does not suggest a standard pathway for providers and insurers to achieve the target.

Providers and insurers will be required to report their progress on an annual basis through the Center for Health Information Analysis and the Health Policy Commission. If the target is not achieved, providers and insurers will be referred by CHIA to the HPC and may be subject to a performance improvement plan which may require them to identify strategies and opportunities to increase investments in primary care and behavioral health.

"The biopharmaceutical industry is committed to working with legislators to ensure patients have access to medications, that the industry has the ability to continue their efforts to develop new treatments and cures, and to lower health care costs in a commonsense way," Haverly said. "While conversations about affordability are important, arbitrarily capping prices will never be the answer."

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