by Martha Bebinger for WBUR
September 18, 2019
At a Boston synagogue Tuesday night, hundreds of people gathered to press health care executives on their efforts to control health care costs.
A year into a new Massachusetts law aiming to rein in costs, it's still unclear whether the state will be successful. But the Greater Boston Interfaith Organization, or GBIO, a self-appointed health care cost watchdog group, met Tuesday at what amounted to something of a "people's hearing" and pledged to hold leaders accountable.
The topic: health care spending. The place: a basement meeting room at Temple Israel in Boston.
On one side of the stage, a high-powered cast of four hospital executives representing $10 billion in health care spending. On the other side, four health insurance CEOs who handle 85 percent of private health insurance in Massachusetts.
Because this is the Greater Boston Interfaith Organization the event began with a prayer.
"May our hearts be firm in our efforts to lift up the fallen and our hands be strong as we remove weighty stumbling blocks to afford quality health care," Temple Israel Rabbi Matthew Soffer said before handing off to the GBIO president, the Rev. Burns Stanfield.
"You put them together and there’s a lot of money in this stack," Stanfield said, waving a thick pile of medical bills and insurance statements from his wife’s recent illness.
The temptation with something as complicated as health care costs, Stanfield says, is to hope someone else will deal with the problem. But regular folks can’t afford to do that, he says, because health care costs are taking a bigger and bigger chunk out of family, town, state and federal budgets.
"Why are we here?" Stanfield asked. "Because we have a distinct calling to do something about this issue that matters."
Spending More Efficiently
"First of all, it's very difficult to follow a rabbi, a reverend and patient, but I’ll attempt to do that," said Beth Israel Deaconess Medical Center CEO Kevin Tabb, the first up to answer the question of the evening: What is his hospital doing to make sure health care costs don’t rise any faster than inflation?
Tabb, like most of the hospital and insurance executives, talked about how his hospital is already a good deal if you compare prices. There was also a lot of talk about how better coordination of care and attention to quality will reduce spending. Tabb issued a challenge to the audience: Help friends and family members curb the impulse to try every last thing possible at the end of life.
"It would be invaluable if all of you, if faith communities, would take a leadership role in statewide discussions about how we can ensure that we are doing better in end-of-life care," Tabb said. "That includes but isn't limited to helping us ensure that we are spending our money as wisely as possible."
Boston Medical Center CEO Kate Walsh says her hospital has cut costs by 10 percent over the past three years. At Steward Health Care, CEO Ralph de la Torre says his 11 hospitals are already paid less by insurers than most hospitals in the state.
At events like this one, where people are comparing Massachusetts hospital prices, the heat is typically on Children’s Hospital and Partners HealthCare, where routine tests can cost two, three or even four times more than at some other hospitals.
Partners CEO Gary Gottlieb was also at the hearing and said Partners is proving it can cut spending.
"If we look at 2012, our health adjusted total medical expense actually went down by 0.7 percent and we beat the AQC [the Blue Cross global budget, alternative quality contract] 2012 trend for the rest of the marketplace," Gottlieb said. "We expect absolutely 2013 to be below statewide benchmark. We will continue to focus on costs."
The benchmark is the goal the state has set to make sure health care spending doesn’t rise any faster than the other things you spend money on. Now, that’s still not true when it comes to health care premiums for many of us, even though a recent state report said insurers' revenue is up, especially at Tufts Health Plan. So the question to Tufts CEO Jim Roosevelt was, what is he doing about this? His answer was that Tufts is finding ways to spend money more efficiently.
"And that is what this is about, keeping medical costs down while we increase quality," he said. "That’s what matters to members, that’s what matters to patients and that is the goal."
What families and employers want is lower premiums, not charts that show spending is coming down. But you have to give Roosevelt, three other insurance executives and all the hospital leaders credit for agreeing to explain themselves at a public hearing.
"There is no other state in the country where a massive consumer advocacy group like you would be holding an event to grill health care executives where health care executives would actually show up," Jay Gonzalez said to laughter and applause. He's the vice president of CeltiCare, a for-profit insurance plan that offers some of the cheapest coverage in the state while limiting where you can go for care. "But it says something about our health care community."
Insurers say they are worried about hospital spending, worried that all the mergers and affiliations you hear about will create monopolies that demand higher, not lower, prices.
It's true there are a lot of moving pieces in this great experiment to rein in health care spending in Massachusetts, so who’s supposed to referee? There are a few people with the authority to at least question what’s happening with health care costs.
"We act as a watchdog and a spotlight because we need to trust what many on this stage have said, but we also need to verify," said David Seltz, director of the state’s relatively new Health Policy Commission, which holds its own cost hearings in two weeks.
There was a bit of laughter at the Reagan reference, but it may be telling. The open question is: Will hospitals, insurers and consumers bring health care spending down on their own or will state government have to go back to setting rates? At least in Massachusetts, the major players are talking and listening to each other as they wrestle with these questions.