[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6281109,"mediaKeyId","2608176-a7674bc61d8bcf8372dfd5b2f4f6e712","parentId",2608176,"title","HPC outlines legal process and oversight for setting Massachusetts health cost benchmark; performance plans remain available tool","audioSeconds",191,"startMs",1608000,"endMs",1799000,"viewUrl","/Search/View?dp=1&key=2608176-a7674bc61d8bcf8372dfd5b2f4f6e712&start=1608&end=1799","thumbnailUrl","https://assets.pipeline.soar.com/2608176-a7674bc61d8bcf8372dfd5b2f4f6e712/thumbnail_1608000.jpg","articleUrl","/articles/6281109/Massachusetts/HPC-outlines-legal-process-and-oversight-for-setting-Massachusetts-health-cost-benchmark-performance-plans-remain-available-tool","mediaUrl","https://secure.pipeline.soar.com/6281109-f5a44926a2de1b5fdf8d7823475ef452/orig.mp4?Expires=1771164495&Signature=iG732SZi8Bu5N6jYzAKNuPNzsEuroDMCjtv1yQp5PPXK3AlTXVP5uqB75-R8SxfxfNM8r6sAIVmhU80w3qvFqeffZcvq9GQEAFzTnkmaP90Q-K5wirF1sbAP9nTsgRBlfpksDVyYHrR9O-AAeBChnDe7H1E6Wwh23A9m5~9swDJ20IVAnKyEF-HUDOc0dBC3RE4AZ4qIJ5kNYN9JDWvUR-07voFcf7KWL-mDujNN~WQEx~rxfZUTRJSiOHxfW9OLAuhReaZBWUgK5-OngZWBjhkHz13Iqg0Zl3n02Hx~MBUzDbe4lM7NnyltOP4hccGjUkxxnv~5oHeTPzj7R7XfmA__&Key-Pair-Id=KUT5TJCACFTXG","author","Massachusetts Legislature","date","2025-03-13T00:00:00Z","article","Health Policy Commission executive director David Seltz told the commission and the joint legislative committee that the benchmark is set under state law and the HPC has discretion — within statutory limits — to modify it each year after a public hearing and consultation with the Joint Committee on Health Care Financing.

Seltz reviewed the law’s phased approach: in the statute’s first five years the benchmark was a fixed PGSP‑based rate of 3.6%, then the law tied the benchmark to potential gross state product minus 0.5 percentage points for the next five years while permitting limited modification. After the 10‑year mark, the statute preserves the benchmark’s tie to long‑term economic growth but gives the HPC broader discretion to raise or lower the benchmark if warranted.

“Now after year 10, we are in a new phase as prescribed by the law where, again, the default rate for the benchmark to be set every year is still tied to that long term economic growth rate, but it does allow broad discretion to the HPC board to either raise or lower the benchmark if it feels that it is warranted to do so,” Seltz said.

Seltz described the multi‑step accountability and referral process that can follow a benchmark decision: CHIA compiles health plan and provider spending and refers confidentially to the HPC a list of providers and payers whose growth exceeds the benchmark; the HPC conducts a comprehensive review (pricing, payer mix, populations served and any external factors) and then may vote in public to require a performance improvement plan (PIP) if it determines such a plan is warranted. Seltz noted the commission has required a single PIP in its history — for Mass General Brigham — which the commission said yielded an estimated $170 million in near‑term savings through care management and other measures.

Seltz emphasized the board would not vote on the benchmark at the hearing and that the HPC’s board vote to establish the 2026 benchmark was scheduled for a later meeting (announced at the hearing as April 17). He also noted that if the board decides to modify the benchmark upward or downward, additional legislative oversight by the Joint Committee on Health Care Financing would be required under the statute.

Seltz and other HPC staff explained that CHIA’s annual report is a central input but “not the sole piece of information” used to consider a modification; the commission also examines price trends, patient acuity, capacity and affordability measures, and the economic outlook. Staff said they review the most recent data available to determine whether a modification would be appropriate and to identify which providers or payers might need closer review.

During discussion commissioners and legislators asked about changes proposed in the legislature — including multiyear benchmarks — and staff cited other states' approaches (California, Oregon, Rhode Island, Connecticut) that set targets or sector‑specific goals. Staff said sector‑specific benchmarks are one policy option to address price variation among hospitals and allow targeted expectations for high‑value areas such as primary care.

Seltz also acknowledged that the referral list the commission receives from CHIA is currently confidential and said the commission was considering whether more of that process should be public; he recommended greater public disclosure in future refinements of the process.

No formal board action on the benchmark occurred at the hearing; the HPC board will meet later to vote and any board modification would trigger statutory legislative review and potential follow‑up actions such as referrals for performance improvement plans.","mediaType","Video","parentTitle","Joint Committee on Health Care Financing - 3-13-2025","oneSentenceSummary","The Health Policy Commission explained the statutory framework for setting the annual health care cost growth benchmark and the commission’s process for reviewing providers and payers whose spending exceeds the benchmark.","taxTitle","2025 Legislature MA, Massachusetts","taxId",77682,"location","Massachusetts","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6281113,"CHIA: Massachusetts health spending rose 8.6% in 2023 as pharmacy and hospital outpatient costs accelerate",947,2346000,3293000,"/Search/View?dp=1&key=2608176-a7674bc61d8bcf8372dfd5b2f4f6e712&start=2346&end=3293","https://assets.pipeline.soar.com/2608176-a7674bc61d8bcf8372dfd5b2f4f6e712/thumbnail_2346000.jpg","/articles/6281113/Massachusetts/CHIA-Massachusetts-health-spending-rose-86-in-2023-as-pharmacy-and-hospital-outpatient-costs-accelerate","https://secure.pipeline.soar.com/6281113-d417d56adf42bb94bf869f3f9a9073aa/orig.mp4?Expires=1771164495&Signature=hjR3-v2l~g2HiknkCmECg8FRczdxEWQaD1Eoi6bZj1muBkeYfA5Eq2O-cRItC7NqmpOdNPN1vOk95r5ZaLkz5I-2xLraaHzsoPSJc4d4nuXHxxpZzhPyKbYX380OJqdA1tHXzdO8oeoE9iBcAB0dB-0A9vTLNZ0jJfv4fSsWkM0ZyWCjyvGwJhIRaDlzZS-mCLZC4pAgHV~1DTJiG7fbnef~Ouhzs9BOTGKyUIIC~koI2axlLWa6Hob9NleVSZg-2gtbwFHEZTYfixnZUjSSMQ--tr8gZEZVOLzIN40YLnI1pe-FuoqtOBsTRGKZUIoyxd1zn3yzSWlpPM1SPB~okg__&Key-Pair-Id=KUT5TJCACFTXG","The Center for Health Information and Analysis reported that total health care expenditures in Massachusetts rose to $78.1 billion in 2023, a per‑person average of $11,153 and an 8.6% growth rate — more than double the 3.6% health care cost growth benchmark.

CHIA executive director Lauren Peters and Health Policy Commission staff presented the agency’s annual report at the Health Policy Commission (HPC) hearing, citing pharmacy spending, hospital outpatient services and non‑claims (supplemental) payments as the largest drivers of the increase. “In 2023, total health care expenditures increased to $78,100,000,000 equating to $11,153 per Massachusetts resident. This put the per capita growth rate at 8.6%,” Peters said during the presentation.

CHIA’s breakdown showed commercial spending rose 7.2% with a 1.5% decline in membership (an 8.9% PMPM increase), Medicare spending rose 7.1% and MassHealth grew 14.8% in 2023 (4.4% enrollment growth), driven in part by roughly $1.5 billion in new supplemental payments to hospitals for performance‑based incentives and base‑rate increases. CHIA noted those supplemental payments were largely financed by a mix of an updated hospital assessment and federal matching funds; excluding them reduced MassHealth growth materially.

Pharmacy spending grew 10% in 2023 (net of rebates) and accounted for more than $11 billion of statewide spending. CHIA highlighted two pharmacy trends: very high prices for branded drugs and rapidly rising utilization for newer medicines. Brand prices rose sharply (the average commercial gross price per branded prescription rose about 69% since 2019) while generic prices remained flat. CHIA singled out GLP‑1 drugs (Ozempic, Wegovy, Mounjaro and similar agents) — used for diabetes and weight‑loss — whose utilization rose fivefold since 2020 and which accounted for roughly 5.5% of commercial drug spending in 2023 after rebates. CHIA staff estimated the GLP‑1 class added about three percentage points to commercial drug spending growth in 2023 and about 0.6 percentage points to overall commercial spending growth.

Hospital outpatient department (HOPD) services were another major cost driver. CHIA and HPC staff said HOPD spending is large and heterogeneous: it includes emergency department and ambulatory surgery services, infusion and oncology care and services that can also be delivered in physician offices. HPC Senior Director David Auerbach explained that site‑of‑care shifts — for example, hip and knee replacements moving from inpatient to outpatient settings — can lower per‑case costs, but overall HOPD spending rose because of price increases, higher utilization of expensive infusion and oncology drugs, and a greater share of care performed by hospital‑licensed outpatient facilities rather than physician offices or ambulatory surgery centers.

CHIA and HPC also highlighted utilization and capacity issues: inpatient discharges remain below pre‑pandemic levels while average length of stay has increased (about 5.5 days as of June 2024), and emergency department length of stay also remains more than 10% above pre‑pandemic levels. Hospital margins improved in fiscal year 2023 but trended down again in quarterly data through June 2024, with only 43% of hospitals reporting positive operating margins as of June 2024.

Speakers tied the spending trends to household affordability. CHIA’s household insurance survey found more than 40% of Massachusetts residents reported at least one health care affordability problem in 2023 and more than one in four reported an unmet need due to cost. HPC staff modeled the implication for a representative household and showed health care spending (premiums plus out‑of‑pocket) at an average family’s level exceeded growth in typical household income — a dynamic that leaves many families with substantially less disposable income if spending continues at recent rates.

CHIA and HPC staff listed several policy levers under discussion: greater transparency on pharmaceutical pricing and pharmacy benefit manager activity (now required by recent law), targeted policies to reduce unwarranted hospital outpatient price variation or site‑neutral payments for services that can safely be provided outside hospital settings, targeted investment in primary care, and reforms to authorize more public accountability where spending growth is excessive.

CHIA emphasized the report offers a fact base for the HPC’s annual benchmark decision but is not the only input: the HPC also reviews pricing, patient acuity, capacity and affordability measures before any modification to the benchmark.

The HPC will not set the 2026 benchmark at the hearing; staff said the HPC board will vote at a later meeting (announced for April 17) after digesting testimony and data.","The Center for Health Information and Analysis reported statewide total health care expenditures grew 8.6% in 2023, more than double the 3.6% benchmark, driven by pharmacy price growth, hospital outpatient care and MassHealth supplemental payments, raising affordability concerns across the Commonwealth.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6281104,"Employers and insurers press to lower benchmark; advocates urge keeping 3.6% and investing in primary care",1109,8959000,10068000,"/Search/View?dp=1&key=2608176-a7674bc61d8bcf8372dfd5b2f4f6e712&start=8959&end=10068","https://assets.pipeline.soar.com/2608176-a7674bc61d8bcf8372dfd5b2f4f6e712/thumbnail_8959000.jpg","/articles/6281104/Massachusetts/Employers-and-insurers-press-to-lower-benchmark-advocates-urge-keeping-36-and-investing-in-primary-care","https://secure.pipeline.soar.com/6281104-0c0c3e561c38481db5e09968029b18d9/orig.mp4?Expires=1771164495&Signature=iZyC-SSmjIHsjXeQ4Wp6sNWGPgW9d5kvSqk1RPtxIgZFbQkaHRZTv4L4ak2F3olGKca3Fpx2qtfRwPEnofq0iCbZNCet2jnEtsVTeEmzj9ueg28mhUEGWI2sp65FPPLvmL5qXr4Mf3weognp~lHapucbMSSCnaIKX6EGbXCM-NimNTWUpHT9neHC9vAK5gqxop8Y5FIoxyEpRlK~BD~qqehI8axv5q0E5xxMoOv5E0Td2nEUTAkWjy9Ll3e9TFBOHIzXzXN38VUhBJlFG100Ey4bsQ6-g-yyx4c5pB09Hk~Fm6n9poqMgMJfFuYTZUoIIFQeB-Qqaefty0kWrVf72g__&Key-Pair-Id=KUT5TJCACFTXG","Three stakeholder groups told the Health Policy Commission hearing they want different policy responses to the CHIA data: business representatives and health plans urged a lower benchmark and stronger accountability tools; consumer advocates urged keeping the benchmark at 3.6% and directing investments to primary care and access.

Eileen McEnany, president of the Employer Coalition on Health, told the hearing: “If we want to reduce the cost of health care, we must first reduce the cost benchmark and impose different penalties for non‑compliance.” McEnany said employers face double‑digit increases in premiums and cited employer surveys and recent rate actions; she argued a lower benchmark would “signal that we are finally serious about getting healthcare cost under control” and would force stakeholders to find savings without prescribing how to achieve them.

The Massachusetts Association of Health Plans (MAHP) testified similarly. MAHP President and CEO Laura Pellegrini said health plans are experiencing losses driven by rising pharmacy and hospital outpatient costs and asked lawmakers for tools and accountability across providers and the pharmaceutical sector. “Without cost constraints on providers and the pharmaceutical industry, health plans cannot make health care more affordable for your constituents,” she told the committee, and she urged a moratorium on new benefit mandates that would increase premiums.

Advocates framed the choice differently. Alex Sheff of Health Care for All said CHIA’s report and household survey data show costs are already forcing families to skip care and take on medical debt; she said her group recommends keeping the benchmark at 3.6% “to keep the benchmark current at its 3.6% level moving forward” and using the HPC’s tools to rein in price variation while investing in primary care and workforce. Sheff highlighted health equity disparities in affordability and access, noting Black and Hispanic residents reported higher incidence of unmet need.

Several advocacy and policy witnesses asked for targeted actions: stronger controls on prescription drug prices and PBM oversight (the new session law requires PBM licensure and creates a pharmacy policy office at HPC), sector‑specific targets (for example, increasing the share of spending on primary care), improved prior‑authorization processes and more data transparency on provider price variation. Health Care for All emphasized that primary care accounts for a shrinking share of spending and that building capacity (including residency slots) and paying primary care differently are necessary to improve access and reduce downstream high‑cost care.

The hearing made clear the political tension: employer and insurer representatives said stronger limits and accountability are necessary and pressed for a lower benchmark, while consumer advocates warned that lowering the benchmark could be counterproductive without concrete tools to lower prices and protect access. The HPC and lawmakers signaled interest in several policy levers already enacted in recent legislation — including PBM licensure and pharmacy reporting — while acknowledging additional steps may be required if spending stays above the benchmark.","Employer groups and health plans urged the Health Policy Commission to tighten the health care cost growth benchmark and give payers enforcement tools, while consumer advocates and callers to the HPC recommended maintaining the 3.6% benchmark and investing in primary care and access measures.","actionData","errors"]

Article not found

HPC outlines legal process and oversight for setting Massachusetts health cost benchmark; performance plans remain available tool

CHIA: Massachusetts health spending rose 8.6% in 2023 as pharmacy and hospital outpatient costs accelerate

Employers and insurers press to lower benchmark; advocates urge keeping 3.6% and investing in primary care