Latest news with #HealthPolicyCommission
Boston Globe
25-07-2025
- Health
- Boston Globe
Healey naming chief hospital lobbyist to regulatory agency overseeing state health care costs, prompting outcry
Related : The Healey administration defended the selection of Walsh, saying he fulfills a statutory requirement for a member of the HPC's board to come from a hospital background. Walsh served in the Mass. House for more than a decade earlier in his career. Advertisement Walsh intends to recuse himself from matters involving MHA members that go before the commission and to wall himself off at his day job from matters that go to the HPC for approval, according to the governor's office, which also said he filed a Section 23(b)(3) disclosure form and intends to consult both the State Ethics Commission and the HPC's general counsel. 'Massachusetts is home to the best hospitals in the world. They are at the heart of our health care system. It's essential for someone to bring the perspective and expertise of our hospital system as a commissioner to the HPC,' Healey spokesperson Karissa Hand said. 'Steve Walsh is uniquely qualified to bring that expertise to the work of the HPC — with his deep understanding of the current challenges facing hospitals, his work with 70 community hospitals across the state, and his experience as a legislator and policymaker.' Advertisement Beacon Hill has been abuzz in recent days with speculation about the impending move, and multiple figures with an interest in the health care sector had reached out to Healey's office before Friday to voice their concerns. In a statement, Walsh noted that he helped to create the Health Policy Commission more than a decade ago when he served as a state representative. 'Massachusetts patients and providers are facing profound challenges that will likely intensify, but they are also part of a state that believes in collaborative problem solving, innovative public policy, and bold action to support the people at the heart of care delivery,' Walsh said. 'That is exactly the type of progress the Health Policy Commission makes possible, and I look forward to helping shape a stronger healthcare system along with my fellow commissioners.' A hospital oversight law Healey signed in 2024 reshaped membership of the board at the HPC, a watchdog agency responsible for reviewing hospital expansions and mergers, reining in health care-related spending, and tracking key industry trends. The law newly calls on the governor to appoint one member with 'expertise in representing hospitals or hospital health systems.' Walsh has led the industry group representing hospitals since 2017, and before that, he spent six terms in the House. He played a key role in creation of the HPC through a landmark 2012 cost-containment law. Several people interviewed by the News Service said despite Walsh's extensive knowledge and experience, they think his job lobbying on behalf of virtually all hospitals across the state should render him ineligible for the oversight post. Advertisement 'As a registered lobbyist for the industry, Steve Walsh's appointment is a blatant conflict of interest and problematic to the employer community,' said Eileen McAnneny, president of the Employer Coalition on Health. 'I hope [the governor] rethinks the decision in light of these concerns.' Some had been in touch with the governor's office during the week, after hearing the appointment was possible, to register their opposition. Greater Boston Interfaith Organization President Phil Hillman and Rev. Burns Stanfield, the group's prior president, wrote a letter to Healey on Wednesday arguing that existing conflict of interest law 'makes it impermissible for Steve Walsh to serve as a[n] HPC Board member while he remains the MHA President.' 'We think he's very thoughtful and with great skills, and could even imagine him on the commission someday, but right now, with the position he has, that's a conflict of interest. We want the integrity of that provision respected,' Stanfield said in an interview. 'It's not about Steve personally. It's just about protecting that wall, that concern around conflict of interest.' Healey also named five other people to the HPC board, including reappointing Chair Deborah Devaux and 1199 SEIU Massachusetts Division senior policy analyst Jamie Willmuth. She newly picked former Codman Square Health Center CEO Sandra Cotterell, Biogen senior vice president Christopher Leibman and Point32Health Chief Financial Officer Umesh Kurpad.
Boston Globe
17-04-2025
- Health
- Boston Globe
Rising drug prices are hammering patients, employers, and insurers. Is there any end in sight?
As an affordability crisis grows in pricey New England, the rising cost of prescription drugs is squeezing patients, health plans, and employers. President Related : Advertisement Costs could rise further, however, if the Trump administration follows through on the president's Efforts to contain drug spending have run up against the 'Demand for these drugs is quite dramatic,' said Rena Conti, associate professor at Boston University's Questrom School of Business. 'And I don't anticipate demand is going to fall in the near term.' Advertisement While health insurance covers the largest share of drug prices, Americans' out-of-pocket prescription drug spending averages $177 a year, according to Georgetown University's Health Policy Institute in Washington, D.C. It's much higher — about $456 annually — for those over 65, who also pay for a higher share of their drugs out of pocket. The growing cost burden has caught the attention of state lawmakers, who passed a bill in the waning days of last year's legislative session that would Related : Senator Cindy Friedman, the Senate chair of the Joint Committee on Health Care Financing, described the action as a 'first step.' Her panel is preparing legislation this year that would seek to contain the costs of a broader range of prescription medicines identified by the state Health Policy Commission, potentially including GLP-1s. 'There's a lot more that can be done,' said Friedman, a Democrat from Arlington. 'We can start looking at upper payment limits for the most essential drugs,' setting an effective ceiling on what Massachusetts health plans will pay. Massachusetts got a wake-up call last month when the state Center for Health Information and Analysis reported that Advertisement Overwhelmed by demand for GLP-1 drugs such as Ozempic, Mounjaro, Wegovy, Zepbound, and Saxenda, used to treat diabetes and obesity, the state's two largest While there is variation, the average monthly retail price of the new class of obesity medications is about $1,200 without insurance. And the price of branded drugs overall has risen dramatically over the past five years. State officials have long complained the process of setting drug prices is opaque, involving a chain of actors that includes insurers, drug makers, pharmacies, and middlemen called pharmacy benefit managers, operating through transactions largely invisible to regulators. Related : The bill passed in the Massachusetts Legislature last year aims to lift the curtain on drug pricing, creating a dedicated office within the state 'We want to have expert, objective information about where the money's going in this system, where are the opportunities [for savings], and where are the challenges,' said David Seltz, executive director of the Health Policy Commission, which is staffing up the Office of Pharmaceutical Policy and Analysis authorized under the new Massachusetts law. It remains to be seen whether greater transparency or the selective price caps approved so far will moderate prices more broadly. Prices for prescription medicines in the United States, where most biopharma companies are based, are higher than in any other advanced country. Advertisement The federal government has had mixed success in restraining drug costs. Congress abandoned its longstanding hands-off posture toward drug pricing in 2022, when it empowered the agency that runs Medicare, the largest US health insurer, to negotiate prices with drug makers. So far, negotiations have covered only 10 of the most expensive medicines — drugs such as Farxiga for chronic kidney disease and Eliquis for preventing strokes and blood clots — and the lower negotiated prices aren't set to take effect until next January. Related : Medicare will include some of the most popular weight-loss drugs, including Trump's executive order aims to expand Medicare drug price negotiations and streamline approval for lower-priced generic drugs and biosimilars. But it would also Carolyn McGrath's diabetes medication sat on her kitchen table. Suzanne Kreiter/Globe Staff Meanwhile, drug makers continue raising their prices. The Industry officials said the bigger driver of rising prescription drug spending is greater use of medicines such as the GLP-1s by patients whose weight loss could actually save money overall. Such weight loss, they said, results in improved health and less spending for other serious conditions such as strokes or heart attacks. Advertisement Stami Turk, director of state public affairs for the Pharmaceutical Research and Manufacturers of America, a trade group, said reports like that of the Center for Health Information and Analysis in Massachusetts don't tell the whole story when they cite increased drug costs. She said state officials also need to focus on the value of medicines. 'They need to look at how prescription drugs are being used,' Turk said. 'With the use of GLP-1s, you could save the health system tens of billions of dollars a year' by preventing other diseases. Related : State officials, for their part, said they're looking for new ways to assess the value of drugs and wring savings out of the system. Officials at both Mass Health, the state's Medicaid program, and the Group Insurance Commission, the health plan for state employees, have been actively negotiating rebates from drug makers to keep premiums down. Despite rebates, selective price caps, and other steps, Seltz at the Health Policy Commission sees 'increased pricing on existing drugs and high launch prices on new drugs' continuing to push up health spending in Massachusetts. He cited data from a state report showing the average price of a branded drug has increased 69 percent since 2019. 'When I look at the last couple of years,' he said, 'I see an upward trajectory.' Patients are grateful for treatments that weren't available to past generations, helping to prolong their lives. As they live longer, however, the cost of drugs becomes more of a burden. Advertisement 'It keeps me alive,' McGrath, the community college professor, said of her insulin. 'But the drug companies are profiting from my condition. And there's nothing I can do about it.' Robert Weisman can be reached at
Boston Globe
12-03-2025
- Health
- Boston Globe
Spending on Massachusetts health care has grown more than twice as fast as state hoped, new report shows
Advertisement Lauren Peters, CHIA's executive director, expressed alarm about the soaring spending. With the 8.6 percent increase, health care spending in Massachusetts totaled $11,153 per resident. 'For 2023, we are seeing unsustainable cost growth trends persist, putting increasing pressure on residents, employers, and the system as a whole, emphasizing the urgent need for bold and systemic solutions,' Peters said in a statement. Peters is expected to discuss the analysis on Thursday at a meeting of the state Health Policy Commission and the Legislature's Joint Committee on Health Care Financing. The report covers a variety of health care expenditures, including prescription drugs, outpatient and inpatient treatment at hospitals, and physician visits. Prescription drugs, along with new MassHealth supplemental payments, spurred the growth in spending, according to the report. Total spending on medicines increased by $1 billion, while MassHealth — the Medicaid program in Massachusetts — made $1.5 billion in new incentive payments to hospitals that met certain standards for quality and equity. Spending on prescription drugs represented the largest share of overall health care expenditures and increased by 11.6 percent over 2022, to $15.2 billion, the report stated. The next-largest category was outpatient care at hospitals, which totaled $14 billion, an increase of 8.3 percent over the previous year. Pricey blockbuster weight-loss drugs such as Wegovy and Zepbound are believed to have contributed to increased spending on prescription medicines. The impact will likely prove bigger when CHIA does its report for 2024, given that Advertisement While the affordability of health care overall was a pervasive issue in Massachusetts, with 41.3 percent of residents struggling to pay for treatment, the burden was greater for Hispanic residents (58.2 percent had difficulty affording it) and for non-Hispanic Black residents (48.7 percent had trouble affording it), said the report. David Seltz, executive director of the Health Policy Commission, said health care costs are 'continuing to grow at an alarming pace.' 'Again this year, pharmacy spending was a major driver of cost growth, increasing by $1 billion from the previous year,' he said in a statement. The chief executive of the Massachusetts Biotechnology Council, which represents more than 1,700 drug and life science companies in the state, challenged the suggestion that rising drug prices were largely to blame for increased health care spending. Ozempic injection pens moved along a conveyor at the Novo Nordisk A/S production facilities in Hillerod, Denmark, in 2023. Carsten Snejbjerg/Bloomberg 'MassBio is currently reviewing the latest cost trends report from CHIA, and we question whether the available data fully captures all factors contributing to the indicated rise in pharmacy spend,' Kendalle Burlin O'Connell, chief executive and president of MassBio, said in a statement. She said her trade group wants 'a more complete picture of the underlying causes of increased costs.' For his part, Steve Walsh, president and chief executive of the Massachusetts Health & Hospital Association, said the report underscores that the benchmark of 3.6 percent for growth in annual spending is unrealistic. For several years, his group has argued that it should be raised. 'Massachusetts deserves a modernized approach to the benchmark that embraces the real-time needs of today's patients and healthcare providers — one that can account for inflation, labor costs, and the state's actual gross state product,' he said in a statement. Advertisement One expert on health care policy said Massachusetts actually spent far more in 2023 than CHIA calculated. Alan Sager, a professor of health law, policy, and management at the Boston University School of Public Health, said the actual total would be 45 percent higher if CHIA included expenses that the federal government does when calculating how much each state spends. CHIA doesn't include, among other things, worksite health care, workers' compensation health spending, vocational rehab, school health, dental insurance, out-of-pocket spending for treatments not covered by insurers, and spending by several federal agencies, including the Department of Defense. If those expenditures were included, he said, health care spending in Massachusetts would have totaled $113.5 billion in 2023, or about $16,200 per person. 'We spend so much on health care,' said Sager, who sits on a council that guides CHIA's research. 'It's enough to provide the care that works for everyone who needs it. We probably waste up to half the money we spend.' Jonathan Saltzman can be reached at
Boston Globe
28-02-2025
- Business
- Boston Globe
‘An arms race for more cancer beds': Dana-Farber's proposed hospital could increase health care spending, state report finds
Without adequate consumer protections, the new hospital 'may exacerbate ongoing affordability challenges in Massachusetts,' said David Seltz, executive director of the Health Policy Commission. Advertisement Much of the report projected where patients would receive future cancer care, and how the price of services at different hospitals varied. For example, shifting inpatient cancer care to Dana-Farber's new hospital from the Brigham or even Beth Israel could result in less health care spending from commercial insurers, as Dana-Farber's prices are lower than those other facilities. If Beth Israel fills its vacated beds with patients who had been going to higher-priced facilities, that too would result in lower spending by commercial insurers. But outpatient cancer care at Dana-Farber is more expensive than the average outpatient facility, so if Dana-Farber treats more patients who don't have to stay overnight, that could increase annual outpatient spending by private health insurers. Between cost savings from inpatient care and increased spending on outpatient care, insurers could spend between $10.7 million to $17 million more annually on cancer care. 'For patients seeking cancer care in Massachusetts, this would be a significant realignment for cancer care among major health care providers,' Seltz said in a statement. The report also dug into spending increases that could result at other health care institutions beyond Dana-Farber and Beth Israel, showing the ripple effects of market changes. In addition to increased spending by private insurers at Dana-Farber, commercial spending could increase at Brigham and Women's, as the Brigham backfills beds vacated by patients who go to Dana-Farber. Those shifts could increase commercial spending by $4.2 million to $15.9 million, the report found. Advertisement Medicare spending could also rise, both on the inpatient and outpatient side, the report said. Though Dana-Farber currently has lower inpatient Medicare rates compared to many other Boston hospitals, Dana-Farber has a somewhat unique reimbursement methodology, which includes an assessment of a hospital's costs. The hospital's reimbursements from Medicare may subsequently increase with the expense of running a new hospital. Moving outpatient Medicare patients to Dana-Farber could increase spending in excess of $10 million. The new Health Policy Commission report recommends that Dana-Farber pledge additional commitments, and that the state potentially monitor the health systems to address concerns, including around future price increases at Dana-Farber. The preliminary report will be a factor considered in an upcoming Public Health Council vote on the project scheduled for March, a key state approval. The findings come amid an ongoing debate between Dana-Farber and Mass General Brigham, which have been battling before state regulators over the size, necessity, and impacts of the Dana-Farber project. That debate began in 2023, when Dana-Farber announced its intentions to end its longterm affiliation with Brigham and Women's and switch to Beth Israel. As part of the deal, Dana-Farber said it would construct a new 300-bed inpatient hospital on the campus of Beth Israel Deaconess Medical Center, jointly staffed with Beth Israel and largely overseen by Dana-Farber. Dana-Farber has long held that the proposal would reduce health care spending. A required cost analysis conducted by a third-party vendor, done at Dana-Farber's expense, found that the project would not increase health care spending beyond the state's annual 3.6 percent benchmark. Advertisement Mass General Brigham has pushed back against the need for more cancer beds, and suggested the project could increase health care spending. In its own analysis, MGB suggested only 30 percent of patients currently cared for at the Brigham might move to Dana-Farber. That would compel Dana-Farber to fill those beds with patients drawn from community hospitals, leading to higher health care spending. In a joint statement, Dana-Farber, Beth Israel Deaconess Medical Center and Beth Israel's physician group, Harvard Medical Faculty Physicians, called the new state report 'thoughtful and robust.' 'Together, Dana-Farber Cancer Institute, Beth Israel Deaconess Medical Center and Harvard Medical Faculty Physicians have embarked on a journey to reimagine cancer care in our region, expand access to life-changing treatment and harness the power of scientific discovery,' the group said. An MGB spokesperson did not immediately comment on the report Thursday. Dana-Farber and Beth Israel have touted the deal as being a necessity for the region, one that will increase access to high-quality care and respond to future projected higher rates of cancer amid an aging population. Competitor Mass General Brigham has argued the proposed beds are not necessary and touted its own quality. The Health Policy Commission's report said it was too early to evaluate Dana-Farber and Beth Israel's preliminary plans to improve quality. As for the need for new beds, the report said that modeling based on demographic trends likely overstates future need for inpatient oncology care, while other factors like medical advancements may decrease future inpatient need. Advertisement 'Our assessment is that we can't say with certainty that the expansion proposed by Dana-Farber is either necessary or that it is sufficient to ensure future access to inpatient care,' said Sasha Hayes-Rusnov, associate director for market oversight and monitoring at the Massachusetts Health Policy Commission, at a Thursday presentation. Commissioner Dr. Alecia McGregor pointed out the dire need for maternity and behavioral health beds throughout the state, and worried the drive to build more cancer beds was based on business motivations rather than patient need. 'This appears like an arms race for more cancer beds, by some of the biggest players in the healthcare system,' she said. 'It pains me to think that hospital systems might be competing for these relatively generously reimbursed services at the expense of other needed services.' Jessica Bartlett can be reached at
Yahoo
27-02-2025
- Health
- Yahoo
Report: Problem of long ER wait times worsening in Massachusetts
BOSTON (SHNS) – The share of patients in Massachusetts experiencing long waits in hospital emergency departments grew between 2020 and the first half of 2024, especially for those experiencing behavioral health issues, according to new state research. Nearly 39 percent of behavioral health-related emergency department visits lasted more than 12 hours before discharge or admission to a higher level of care between January 2024 and May 2024, up from 31.3 percent in all of 2020, researchers at the Health Policy Commission said Thursday. Overall, the share of total trips that involved emergency department stays of 12 hours or longer has grown by half, from 6.6 percent in 2020 to 9.9 percent in the first five months of 2024, researchers said. Researchers plan to present data at an HPC Board meeting Thursday before publishing a full report, which will also include policy recommendations to rein in the still-potent crisis. Providers and reform advocates have warned that lengthy boarding in emergency departments delays essential care for Bay Staters in need and burdens health care staff. 'HPC research has found that the percent of patients boarding in the ED has grown across visit types, but especially for [behavioral health]-related visits,' HPC Executive Director David Seltz said in a statement. 'This growing trend of behavioral health ED boarding is not only harmful for these patients and their families, but also impacts hospital staff, non-[behavioral health] patients, and emergency medical services across the Commonwealth.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
