"A community hospital is a better place to start and create the incentive to go there rather than not have any disincentive to go to an AMC first," David Segal, president and CEO of Neighborhood Health Plan, said during a hearing on the report Wednesday.
Segal was explaining the rationale behind one of Neighborhood's programs, which offers lower co-pays for treatment at community hospitals. The health plan had a similar approach to pain management, waiving out-of-pocket costs for chiropractic visits and other alternatives to opioid use.
Neighborhood has another program that sends multidisciplinary teams into underserved communities to get people into the system and ideally prevent emergency department visits. It also has improved care coordination in its community health centers, which has led to a 3% reduction in inpatient admissions and an 8% drop in per-member, per-month costs, Segal said.
Baystate Health has been trying to get more patients into care models that have full upside and downside risk, said Dr. Mark Keroack, president and CEO of the integrated not-for-profit health system.
The challenge is that "individual actors in the healthcare system are incented on a fee-for-service basis," which ultimately creates perverse incentives, he said.
Also, part of it is a branding issue, Keroack said. Baystate is trying to convey that the quality of care doesn't differ between one of its community hospitals and one of its specialty institutions, he said.
Scaling and improving Wellforce's home care and telehealth services has helped stem unnecessary admissions and funnel patients to the appropriate settings, said Normand Deschene, CEO of the health system.
"But a lack of integration of behavioral health into acute care systems remains to be one of our greatest challenges," he said.
There is a lack of collaboration between payers and providers that limits data sharing and transparency, said Michael Carson, president and CEO of Harvard Pilgrim Healthcare.
The provider mix also skews toward specialty hospitals, said Liora Stone, owner and president of Precision Engineering, a small manufacturing business based in Uxbridge.
"We need to have more availability of options in central Massachusetts," she said.
Total healthcare expenditures reached $6.1 billion in 2017, a 1.6% increase over the prior year, below the state's target of 3.6%. While the rate of healthcare cost growth exceeded the 3.6% benchmark from 2012 through 2015, inflation has dipped below the benchmark over the past two years, dropping steadily from around 5% in 2015.
Total hospital spending has increased by 11.7% since 2013, well below the 19.4% national average. But inpatient hospital admissions have remained flat since 2014 and continue to exceed the U.S. average, suggesting that prices have been relatively held in check.
Economists and policy experts are concerned that dynamic may change if regulators approve the regional mega-merger between Beth Israel Deaconess and Lahey Health.
Premiums paid by Massachusetts employers have been increasing since 2016, according to data compiled by the Center for Health Information and Analysis.
Small Massachusetts employers paid an average of $8,000 annually per worker in 2017, the second highest in the country and more than $1,500 higher than the national average. Large employers paid nearly $7,000, the 10th highest in the U.S.
Nearly a third of total income for lower-income, commercially insured Massachusetts residents is consumed by health care costs, leading to higher rates of outstanding medical debt.
"There's not enough collaboration between payers and providers to understand the missed opportunities in the system," Carson said.
