Cost Growth and Quality Benchmarks, and Primary Care Target
Triggered by unsustainable growth in healthcare costs in Connecticut, Governor Lamont signed Executive Order #5 in January, 2020, charging the Office of Health Strategy (OHS) to benchmark total healthcare expenditures growth in the state. OHS, in consultation with a technical team and advisory committees, will create a per annum rate-of-growth for health care spending. Once calculated, Connecticut will be the 5th state to have a statewide cost growth benchmark.
Overall, Executive Order #5 requires OHS to complete the following initiatives:
Develop annual health care cost growth benchmarks by December 2020 for Calendar Years (CY) 2021-2025.
- Set targets for increased primary care spending as a percentage of total health care expenditure to reach 10% by 2025.
- Develop healthcare quality benchmarks across all public and private payers beginning in 2022, including clinical quality, over/under utilization, and patient safety measures.
- Monitor and report annually on health care spending growth across public and private payers.
- Monitor accountable care organizations and the adoption of alternative payment models.
At this juncture in the implementation of the benchmark, OHS created the Healthcare Benchmark Initiative Steering Committee (HBISC) with senior stakeholders, subject matter experts, state agency executives, and consumer advocates who will advise on all aspects of the Healthcare Benchmark Initiative, including:
- Healthcare cost growth benchmarks and cost growth mitigation strategies to ensure equitable access to affordable healthcare;
- Quality benchmarks and quality measure alignment to ensure equitable, high-quality healthcare and improved population health;
- Advanced primary care that is patient-driven, team-based, equitable and effective and without unnecessary burdens for clinicians; and
- Use of the All-Payer Claims Database (APCD) and other data sources to inform recommendations for legislative and executive branch proposals that will reduce the rate of spending growth, improve healthcare and patient outcomes, and support and sustain better primary care, all in an equitable manner.
The Stakeholder Advisory Board will continue to provide input to HBISC on the healthcare benchmark initiatives outlined above. The Technical Team has been sunset, and its members invited to participate in the HBISC, or on the Stakeholder Advisory Board. Both the Stakeholder and Technical Team advisory boards have fulfilled their mission with due diligence and vital input over the past year.
The reasoning for the formation of the HBISC is twofold:
- OHS is transitioning from having a panel of technical experts advise on policy direction to engaging high-level representatives of entities impacted by the healthcare benchmark initiative and other subject matter experts. This is a crucial shift as OHS moves into the implementation phase, in order to make sure OHS has the buy-in and direct input from the entities these new policies will affect.
- By retaining the Stakeholder Advisory Board, OHS will continue to benefit from the engagement and guidance of group of stakeholders that has served OHS well during first year of benchmark implementation. OHS expects that the Stakeholder Advisory Board will meet on a less frequent basis, such as quarterly.
OHS’s Quality Council will develop the quality benchmarks with DSS support. Other bodies, such as the OHS Consumer Advisory Council, Health Care Cabinet, Practice Transformation Task Force, MAPOC, and other stakeholders will be consulted and then feed into Stakeholder Advisory Board activities.
The Technical Team includes experts who will directly engage with OHS, facilitated by consulting experts at Bailit Health, on the creation of the annual healthcare cost growth and quality benchmarks, and primary care spending targets. The team will receive input from the Stakeholder Advisory Board, also facilitated by Bailit Health, on most initiatives.
The Technical Team’s charge is to meet the following objectives per Executive Order #5:
- Recommend annual cost growth benchmarks across all payers and populations for CYs 2021-2025 by maximizing work from Connecticut and other states, including best-in-class efforts and existing cost growth benchmarks, and then adapt approaches for CT.
- Recommend primary care spending targets across all payers and populations as a share of total health care expenditures for CYs 2021-2025, to reach a target of 10% by 2025.
- Prioritize health equity in recommendations.
The Stakeholder Advisory Board (SAB) members represent a cross section of the healthcare landscape, consumers, providers, employers, and health plan carriers, who will provide input and feedback to the Technical Team. The SAB’s mission is to advise OHS, the Technical Team (CGBTT), and consulting experts on the creation of the annual healthcare cost growth and quality benchmarks, and primary care spending targets.
The SAB will obtain additional input and feedback from other entities for the development of:
- Annual cost growth benchmark across all payers and populations for CYs 2021-2025, ensuring the cost growth benchmark does not result in unintended consequences or exacerbate existing health inequities.
- Primary care spending targets across all payers and populations as a share of total health care expenditures for CYs 2021-2025 to reach the target of 10% by 2025.
- A strategy to use the state’s All Payer Claims Database (APCD) to analyze cost, and cost trends and growth drivers.
- Annual quality benchmarks effective for CY22, and analysis of the impact of cost growth benchmarks and primary care targets on quality and equity.