As they began to sketch out Wednesday how they will go about conducting a legislatively-required study of the pandemic’s effects on Massachusetts’ health care system, officials at the Health Policy Commission acknowledged that understanding the true impacts will take all of this year and likely more.
The health care law that Gov. Charlie Baker signed on Jan. 1 touched upon telehealth, coronavirus testing and treatment coverage, out-of-network billing, and more, but it also charged the Health Policy Commission to work with the Center for Health Information and Analysis to analyze and report on the accessibility, quality, and cost of health care services, the short-term financial position of health care organizations, and how the pandemic’s impacts might affect long-term health care policy considerations.
The idea, HPC Executive Director David Seltz said, is “to begin to examine and understand the impact of COVID-19 on the health care system and not just to understand past impacts, but as I mentioned before, really to help inform the future of health care in Massachusetts, the structure of health care, the goals that we want to set for ourselves, the lessons learned from the last 11 months and how that may inform how we can build, as the act says, a more resilient health care system that puts patients first.”
The HPC Advisory Council met Wednesday afternoon to hold an initial discussion on how it intends to go about conducting the study and what other factors ought to be considered.
Seltz presented an outline, which he said represents “how we’re preliminarily thinking about weaving together some different of these component pieces into a broader narrative.” It calls for sections in a final report on spending trends, financial impacts and projections for long-term financial impacts, indicators of closures or consolidation, trends in utilization of various health care sectors, an analysis of health care disparities, a look into the impacts on health-related social needs, an assessment of impacts to the health care workforce, and more.
An interim report is due from the group on April 1 – just five weeks from now – and a more complete report is due to the Legislature on Jan. 1, 2022.
“This is a very, as I said before, ambitious and comprehensive mandate for the Health Policy Commission and the timelines that the Legislature included are as well quite ambitious,” Seltz said. “So there is some expectation that we’ll be able to have new data and analysis on some of these topics in the short term. Those impacts will largely be focused on what we know about what happened in calendar year 2020. But recognizing the fact that this pandemic is still very much ongoing, we don’t think it’s appropriate at this time to be making conclusionary statements about what the total impact of COVID has been.”
He added, “So while we absolutely expect we’ll have some new data and information about calendar year 2020 this spring, we really see this as probably a research and examination project that will be broad in scope and will last throughout the calendar year and likely beyond.”
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans and an Advisory Council member, said she thinks it is still too early to be able to assess health plan finances.
“We’re not going to really know the full impact for many, many months,” she said. “So I think the study is a bit premature, but obviously the Legislature has requested it and so you can give them a snapshot in time but I think there is much more to play out from this.”
Massachusetts Health and Hospital Association CEO Steve Walsh agreed with Pellegrini and added that it may be difficult for the HPC to conduct meaningful outreach to stakeholders at hospitals before the interim report is due because “we’re still very much in a state of emergency.”
“I know we all want it to be behind us,” Walsh said. “It just isn’t yet.”
Other HPC Advisory Council members chimed in Wednesday to suggest specific areas where the report could drill down in great detail. A handful of members noted the importance of looking at how the pandemic has affected behavioral health services and usage, and Kaitlin McColgan of the Massachusetts League of Community Health Centers said the report should give a lot of attention to the communities and patient populations that have seen some of the most severe impacts of the pandemic.
“I just don’t think we can really emphasize that enough. I think throughout the pandemic our members have felt, and probably so many people in different communities, that we’re really living in two different universes during COVID,” she said. McColgan added, “I think that prism of the parallel universes of those communities that have been hard hit versus just the general experience. As Massachusetts overall, we all feel like we’ve lived through this but it is such a concentrated impact in certain communities.”
Massachusetts Public Health Association Executive Director Carlene Pavlos said there needs to be a deeper look at the role of local public health boards and how they fit into the larger picture.
“It’s not the same as the health care system, but I think we’ve seen in this pandemic that the fractured and inefficient way in which local public health is organized in this state and the historic lack of investment in local public health in this state has not served us well during the pandemic,” she said.
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