OP-ED | Healthcare Cost Growth Benchmark's Foundation Must Be Fixed

In 2020, Gov. Ned Lamont, via Executive Order, created a healthcare cost growth benchmark. At the time, it was imagined as an opportunity for state government, through the Office of Health Strategy (OHS), to come together with healthcare providers, health insurance companies, pharmaceutical manufacturers and distributors, patient representatives, health policy experts, and other stakeholders to slow the rate of healthcare spending in Connecticut. The benchmark was later codified in state statute by the legislature in 2022.

Under the concept, annual cost growth benchmarks are set, and then we test whether healthcare spending either grew more or less than the annual benchmark. Simple enough. The real benefit of the benchmarking process is less about whether we meet the annual benchmark or not, but rather whether we have the information needed to understand why we are or are not hitting our target, and then to make adjustments accordingly. Today, this is where the benchmarking process is falling short.

At the core of making the process work is the ability to share and analyze data so that policy and care delivery changes essential to the success of the benchmark can be implemented. Transparent, replicable, and reliable data and analytics are essential. Achieving a comprehensive data process is foundational to the success of achieving the shared goal of slowing healthcare spending growth.

Unfortunately, that is not the case in today's benchmarking process. Despite attempts to work collaboratively with OHS to improve the data process, Connecticut has not been able to achieve a process in which anyone should have confidence.

Instead, the proposed legislation this year (originally in HB 5054) is a more punitive, go-it-alone approach. The legislation includes penalizing providers for not attaining the benchmark and requiring performance improvement plans; intentionally excluding hospital caregivers and their expertise from participating in the newly created commission to oversee the benchmark; and when it comes to access to healthcare services, substituting the judgment of care providers with that of state bureaucracy through unproven cost and market impact reviews. And if the legislature approves, all of this would be implemented by OHS through administrative fiat, outside of the normal regulatory process.

It's the wrong approach. Instead, we should spend our time focused on fixing the foundation of the benchmark, its data process. We should build a data process where healthcare providers have access to the raw data and methodologies used to test compliance with the benchmark. We should build a process where data anomalies are identified and corrected. We should take a comprehensive look at changing demographics, service mix, acuity, and care patterns to inform how to achieve benchmark targets. Getting these right are fundamental to the success of the benchmarking process.

We oppose any changes that diverge from the collaboration that is the essence of the benchmarking process and do nothing to fix the data process that is currently harming Connecticut's chances of success. As we have been since the benchmark's inception in 2020, we continue to be willing partners, looking for every opportunity to improve care for patients, increase access, and slow healthcare spending in Connecticut.

Paul Kidwell serves as the Senior Vice President, Policy at the Connecticut Hospital Association.

EDITOR'S NOTE: This opinion was not specifically sponsored, per se, but it was supplied to CTNewsJunkie by the Connecticut Hospital Association, which is currently advocating through an advertising campaign on this website.