BOSTON — On Wednesday, November 12, 2025, the Massachusetts Health Policy Commission (HPC) hosted its 13th annual Health Care Cost Trends Hearing, titled Working Together to Safeguard the Commonwealth’s Commitment to Health Care, Affordability, Access, and Equity. Materials from the hearing, including a recording of the full event, are available on the HPC's website. 

Amid federal policy changes that have created uncertainties about the health care landscape, the 2025 Health Care Cost Trends Hearing convened industry stakeholders, clinicians, business leaders, and community members to reflect on recent policy actions and discuss areas for further collaborative action to advance the Commonwealth’s health care goals and values. 

This year’s hearing offered a critical opportunity for panelists to speak to and further discuss the pressing issues challenging the stability and sustainability of the Commonwealth’s health care system. These issues included the barriers to health care affordability, ongoing workforce constraints, financial volatility, high and rising prescription drug costs, and threats to health care access and coverage, as well as the industry’s efforts to address them.

Opening Remarks 

Attorney General Andrea Joy Campbell acknowledged that the rising cost of health care in Massachusetts is forcing residents to make hard decisions about what health plans to enroll in and what care to receive. She opened by reminding listeners that increasing premium costs for Massachusetts residents – which the Commonwealth is currently experiencing during the 2025 open enrollment period – will cause many to downgrade to less robust coverage or forgo other necessary household expenses. She asserted that “business as usual is not working… and patients as a result are suffering,” and asked that the audience keep “the patient impact of our health care affordability crisis at the forefront of your minds” throughout the hearing.

Attorney General Campbell expressed concern that millions of Americans who purchase health insurance through the Affordable Care Act Marketplace will lose access to advanced premium tax credits, compounding the health care affordability crisis even further. She outlined the actions her office is taking to combat other federal policy changes that threaten Massachusetts residents’ – particularly immigrant communities – access to health care. This includes lawsuits against the federal government in response to the Trump Administration’s efforts to limit eligibility to certain health safety net programs based on immigration status and to share health information with immigration enforcement agencies.

The Attorney General additionally outlined action her office has taken to protect access to public health, reproductive health care, gender-affirming care, diversity and accessibility initiatives, and medical research in Massachusetts, stating, “we will fight back in every way we can.” She highlighted that federal restrictions on health care access and coverage only threaten to increase existing disparities even further and called on stakeholders across the Commonwealth to collaborate to ensure that Massachusetts continues to be a model to other states for health care coverage and access.

Attorney General Campbell closed her remarks by sharing her gratitude for living in Massachusetts and her hope that other states will look to the Commonwealth in how to respond to federal policy changes, “We are a small state, but we punch above our weight.”

Attorney General Campbell’s remarks start at the 35:52-minute mark in the Cost Trends Hearing recording.

Panels and Presentations

The hearing included five panels – comprised of health care leaders, clinicians, and stakeholders whose work spans the Massachusetts health care system, moderated by HPC commissioners – and two research presentations.

Panel 1 – A Call to Action: Community, Clinician, and Employer Voices on Current Health Care Challenges

Moderated by HPC Commissioner Sandra Cotterell

Purpose:  The first panel of the day provided a platform for “community voices,” including clinicians, community advocates, and employers, to deliver perspectives on the everyday impact that growing health care costs, access challenges, and persistent inequities in care and outcomes have on Massachusetts residents. This panel helped frame the issues that were further discussed throughout the hearing.

This panel began with brief testimonials of participants’ experiences and reflections, highlighting the need for policy action to address ongoing challenges facing employers, health care providers, and patients. The panelists focused on ways in which providers and patients are confronting the challenges of delivering and accessing affordable, high-quality, equitable health care. 

Participants:

• Neil Abramson, Business Owner, ECi Consignment Stores, Leominster, Massachusetts
• Julie Fraher, RN, Quality Improvement, Edward M. Kennedy Community Health Center
• Katherine Gergen Barnett, MD, Vice Chair of Primary Care Innovation and Transformation, Boston Medical Center Department of Family Medicine
• Liliana Patino, Senior Director of Community Impact and Development, Eliot Community Human Services
• Ellana Stinson, MD, Emergency Medical Physician; President, New England Medical Association

Notable Comments: Panelists focused their testimony on the impact of rising costs on patients, providers, and employers and how these increasing barriers to care are causing ripple effects throughout the health care system. 

Neil Abramson spoke from the perspective of a local employer, and shared his own experiences and those of his employees who are dealing with rising health care costs, stating that employers are being asked to pay more for health care and getting less in return. He added that every additional fee – even the cost of parking at a hospital – represents another barrier to care.

Julie Fraher, RN, discussed the challenges providers face in the sustainability of innovative care delivery models and shared her experience working on a remote patient monitoring program funded through a grant from the HPC. She discussed the impacts on access to innovative care and affordability when short-term funding ends and the downstream impacts on the workforce that relies on grant funding for employment.

Liliana Patino shared that community agencies are increasingly stretched to meet not only the physical and behavioral health needs of community members, but also to fill structural gaps like food and housing insecurity. She stressed that these challenges are exacerbated by fragmentation in the health care and human services systems and increasing fear among immigrant communities to seek needed services.

Ellana Stinson, MD, discussed the system-wide impacts of barriers to primary care, including lack of access and increasing wait times. As an emergency medicine physician, she shared her experience treating patients who otherwise could have been treated by a primary care provider and discussed how care for these patients could have been less complex and costly if they had access to primary care when they initially needed it. She believes that gaps in the Massachusetts health care system are growing to concerning extents.

Katherine Gergen Barnett, MD, also discussed the importance of primary care and the perverse incentives created by fee-for-service payment models that undervalue relationship-based services, like primary care. She emphasized the role that increased rates of uninsurance due to recent federal policy changes will have in further challenging Massachusetts’ primary care system and called for increased investment in primary care, particularly through team-based care models.

Key Themes: 

• Massachusetts is already seeing the consequences of the growing cost of care, and it is likely that this growth will continue. Increasingly expensive and inaccessible care not only impacts the most vulnerable patients – though marginalized populations bear the brunt of the costs and the consequences – but it also affects the business community and can have significant economic repercussions.
• Primary care is incredibly important for patient outcomes and the cost of care. With access to primary care, patients may be less likely to seek higher-cost care at emergency departments and will receive more continuous support, which can improve outcomes and reduce cost in the long term.
• The health care workforce – particularly primary care, frontline, and community-based behavioral health providers – is struggling under growing demand from patients, increasing administrative burden, unrealistic productivity standards, and moral injury. Without more support for these workers, increasing numbers will burn out and leave the workforce, and fewer new providers will enter to take their place, creating a shortage of essential providers. 

The first panel begins at the 1:07:27-minute mark in the Cost Trends Hearing recording.

Research Presentation: State and Federal Policy Landscape: Impacts on Health Care in Massachusetts

Audrey Shelto, President and CEO, Blue Cross Blue Shield of Massachusetts Foundation

Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation delivered a research presentation focused on the anticipated impacts on the affordability and accessibility of health care in Massachusetts under the recent federal policy changes included in H.R. 1, the One Big Beautiful Bill Act (OB3). The presentation began with a primer of the MassHealth program, including an overview of the populations covered and the program’s expenditures and federal revenues, and information about the Massachusetts Health Connector. The presentation also included an overview of the key Medicaid and marketplace provisions within OB3, focusing on three significant areas of health care policy changes: Medicaid eligibility; Medicaid financing; and Marketplace eligibility.

As a result of federal policy changes overall, estimates project that approximately300,000 Massachusetts residents will lose MassHealth or Health Connector coverage over the next decade (200,000 residents losing MassHealth coverage and 100,000 residents losing Connector coverage). Collectively, studies project that Massachusetts will lose $3.5 billion annually after OB3 is fully implemented, and providers will face increasing uncompensated care costs and reduced revenues from MassHealth as residents lose their coverage.

Medicaid Eligibility 

Effective January 1. 2027, there will be significant changes to Medicaid eligibility. Notably, these eligibility changes will make it more difficult for individuals in Massachusetts to stay enrolled in MassHealth due to work requirements and more frequent redeterminations. 

Specifically, federal Medicaid policy will now require states to implement work reporting or community engagement requirements as a condition of eligibility for certain adults – primarily individuals who are under 65 years old, do not have dependent children, and are not enrolled in or applying for Medicaid on the basis of disability or pregnancy. In addition, the Medicaid redetermination requirements now require states to redetermine Medicaid eligibility every six months, instead of every 12 months. 

These federal changes eliminate Medicaid and CHIP eligibility for many lawfully present immigrants effective October 1, 2026. As a result of this change, Massachusetts estimates that approximately 2,500 people will lose access to MassHealth. 

Medicaid Financing

Policy changes included in OB3 will also impact Medicaid financing through restrictions on provider taxes and State Directed Payments. 

Provider taxes are assessments on health care providers that states use to finance Medicaid. Almost all Medicaid programs rely on provider taxes to generate their respective shares of Medicaid funding, generating approximately $2.3 billion per year for the Medicaid program. The new law placed an immediate moratorium on new or increased provider taxes. Effective October 1, 2027, new restrictions on provider taxes will require states with a current provider tax above 3.5 percent to reduce the tax beginning in fiscal year 2028.  

State Directed Payments (SDPs) are rates that Medicaid programs require managed care organizations to pay providers for certain services and are typically aimed at advancing certain health policy initiatives in their respective states. Effective January 1, 2028, SDPs will be limited to 100 percent of Medicare rates, which is likely to reduce the amount that managed care organizations are paying to providers. The SDP restrictions will also require any state with SDPs above current Medicare rates to reduce these payments. 

Marketplace Eligibility

Impacts on Lawfully Present Immigrants: Massachusetts estimates that over 60,000 lawfully present immigrants will lose coverage through the Health Connector due to changes in eligibility for subsidized health insurance purchased through the Affordable Care Act Marketplace. 

• Effective January 1, 2026, lawfully present immigrants in Massachusetts with incomes under 100 percent of the federal poverty level, who do not qualify for MassHealth due to immigration status, will be ineligible for subsidized coverage through the Health Connector.
• Effective January 1, 2027, lawfully present immigrants within income above 100 percent of the federal poverty level will no longer be eligible for subsidized coverage. 

Pending Impacts on Enhanced Premium Tax Credits: In 2021, Congress established Enhanced Premium Tax Credits (EPTCs), which expanded both subsidies for those already eligible and income limits for eligibility. The impacts of the expiration of EPTCs are wide reaching – many individuals in Massachusetts will face significant premium increases, and others will face elimination of subsidized coverage through the Health Connector. EPTCs are set to expire on January 1, 2026, if not extended by Congress.
The research presentation on the State and Federal Policy Landscape begins at the 1:53:59-minute mark in the Cost Trends Hearing recording and the presentation slidesare available on the HPC’s website.

Panel 2 – Leading the Way: State Strategies to Promote Affordability, Access, and Equity

Moderated by HPC Board Vice Chair Martin Cohen

Purpose:  The second panel was comprised of Massachusetts health care leaders. The discussion built off of the themes highlighted during Panel 1, A Call to Action: Community and Clinician Voices on Threats to Access, Affordability and Equity, and the research presentation examining the impact of federal policy changes. 

Panelists focused on threats to health care access, affordability, and equity and the necessary efforts to work together as state agencies and health care stakeholders to mitigate negative impacts. Each panelist shared their own perspectives on the impact and timing of federal policy changes on access, coverage, and equity for their respective constituencies.

Participants:

• Michael Curry, President and CEO, Massachusetts League of Community Health Centers; Co-Founder, Health Equity Compact
• Michael Lauf, President and CEO, Cape Cod Healthcare; Board Chair, Massachusetts Health and Hospital Association
• Michael Levine, Undersecretary for MassHealth, Executive Office of Health and Human Services
• Audrey Morse Gasteier, Executive Director, Massachusetts Health Connector
• Amy Rosenthal, Executive Director, Health Care For All  

Notable Comments: Michael Levine outlined the specific steps that MassHealth is taking to mitigate the impact of the federal changes as Medicaid eligibility changes, particularly around the work requirements and six-month redetermination requirements. He noted MassHealth’s need to determine the individuals who do not have to comply with the work requirements and the number of people who automatically comply with work requirements; the need to engage in communities and with individuals to help them understand the steps that must be taken to maintain coverage; and the need to determine the individuals who are not compliant with the new work requirements or qualifying activities, and connect those people to job opportunities or volunteer opportunities so they can remain covered by MassHealth. 

Michael Curry acknowledged the impact of federal policy changes on community health centers (CHCs) and the significant impact on patients’ access to health care and coverage, health equity, and the workforce. He emphasized CHCs’ reliance on federal programs and federal grants, which are utilized to sustain the health centers, the workforce, and their ability to provide accessible and equitable care to the current population of patients served by CHCs. He vocalized deep concern about the anticipated loss of coverage for Massachusetts residents, the patient population being served at CHCs across the Commonwealth, and the anticipated influx of uninsured patients seeking care at CHCs. 

Audrey Morse Gasteier discussed the fear and concern that people are facing given the anticipated impacts to coverage. She added that “people are in duress” over the contemplation of loss of coverage, and that the Connector’s call center has been experiencing an exceptionally high call volume with members concerned by premium increases and an increase in individuals threatening self-harm. She emphasized the Connector’s duty to keep individuals informed of these federal policy changes and clearly communicate eligibility changes, help them navigate their ongoing concerns regarding loss of coverage, and support individuals’ questions of where they will be able to access care if they lose coverage.  

Michael Lauf emphasized the need for further investment in the health care workforce to better mitigate ongoing workforce challenges across the health care industry and investment in primary care. He noted that the creation of new workforce pipelines, technological advancement, administrative simplification, and reliance on more innovative care models would better address affordability and access issues in the Commonwealth.

Amy Rosenthal noted the impact of ongoing immigration issues and access to health care. She said that people are avoiding care because of fears of immigration problems, and that Health Care for All is working to figure out how to create safe spaces for people to access care, ask questions, and better understand their options for obtaining health insurance. 

Key Themes:

• Amid federal policy changes, MassHealth and the Massachusetts Health Connector expect substantial impacts on patient coverage and are working to clearly communicate eligibility changes and requirements to members, actively engage within communities, and provide support to individuals as they navigate potential loss of coverage and access to care.
• The need for collaboration and partnership across health plans, providers, nonprofit organizations and government to align their efforts to mitigate coverage impacts, improve health care affordability and accessibility, and address ongoing and worsening health care workforce issues.
• The widespread impact of federal immigration policies on various communities across the state and the impact on people accessing health care out of fear for themselves and loved ones.

The second panel begins at the 2:36:11-minute mark in the Cost Trends Hearing recording.

Panel 3 – Innovation Insights: Transforming Care through Hospital at Home Programs

Moderated by HPC Commissioner Steven Walsh

Purpose: This panel was composed of leaders from two innovative Massachusetts hospital at home programs who highlighted the promise of this model of care delivery in the Commonwealth. The panelists discussed the benefits of hospital at home programs, including on patient outcomes and experience, as well as the program limitations.

The panel provided the HPC’s Board of Commissioners and policymakers with the opportunity to reflect on how these and similar programs could be implemented as part of a multi-pronged intervention to address hospital capacity constraints, workforce challenges, geographic mismatches of supply and demand, health disparities, and rising health care costs.

Related: HPC Shorts Episode 8: Hospital at Home in Massachusetts

Participants:

• Danny Metzger-Traber, Vice President, Strategic Business Operations, Mass General Brigham Healthcare at Home
• Constantinos (Taki) Michaelidis, MD, Medical Director, UMass Memorial Health Hospital at Home Program  

Notable Comments: Danny Metzger-Traber noted that hospital system costs are about the same for hospital at home programs and brick-and-mortar hospitals, but highlighted the benefit for patient care and capacity including the ability to reduce hospital readmission rates and keep patients in their home, which are savings to the system. He also mentioned that programs expect to become more efficient as they grow and innovate, and while they need that “runway,” the current outcomes signal that the Commonwealth should continue to invest in these programs. 

Taki Michaelidis, MD, highlighted the support that hospital at home programs in Massachusetts receive from state health agencies and also discussed how federal uncertainty is impacting the ability of these programs to invest and meet community needs. He noted that from an access and equity perspective, this is a program that they want to continue to grow to support patients, as some of their best outcomes are among disadvantaged communities. Dr. Michaelidis stated “being in the home is by definition pro-equity” as providers are able to identify food security concerns, signs of mild cognitive impairment, and problems with medication affordability. 

Key Themes:

• Hospital at home programs provide innovative solutions to increase hospital capacity, improve access and health equity, and meet community needs.
• Hospital at home programs have demonstrated improved patient health and satisfaction outcomes, and patients who participate in these programs are more likely to request hospital at home in future encounters in the hospital or emergency department.
• Panelists discussed that reduced readmissions and post-acute care for hospital at home programs are the primary driver of health care savings, and that utilization for post-acute care and skilled nursing facilities have decreased for hospital at home patients.
• The current federal environment poses challenges to maintain and expand hospital at home programs, and long-term reauthorization is necessary for hospitals to have the confidence to invest in programs.
• Lessons learned from hospital at home programs can help improve inpatient care, and as patient experience and education improves, participation in these programs will grow. 

The third panel begins at the 4:17:22-minute mark in the Cost Trends Hearing recording.

Research Presentation: Health Care Trends in Massachusetts and the Imperative to Advance Affordability

David Seltz, Executive Director, Health Policy Commission

HPC Executive Director David Seltz shared recent findings on the current drivers of health care cost growth and the implications of health care becoming increasingly unaffordable for residents of the Commonwealth. 

The HPC found that total annual health care expenditures per Massachusetts resident grew 8.6 percent from 2022 to 2023, from $10,264 to $11,153.  This significantly exceeded the health care cost growth benchmark of 3.6% set by the HPC, and was one of the highest recorded increases since measurement against the benchmark began in 2012. 

Massachusetts also now has the highest average family premiums for employer-based coverage in the U.S. In 2023, this averaged $26,355, and in 2024, this rose to $28,151. Including out-of-pocket spending, the average cost of health care coverage for a Massachusetts family exceeded $32,000 in 2024. These high health care costs create challenges for businesses and residents, and contribute to a cost of living that is increasingly unaffordable for middle-class families across Massachusetts. 

This presentation begins at the 4:46:33-minute mark in the Cost Trends Hearing recording. The presentation slidesare available on the HPC’s website.

Panel 4 – Navigating Pharmaceutical Market Trends: Balancing Innovation and Sustainability

Moderated by HPC Commissioner Christopher Leibman

Purpose: This panel focused on the evolving dynamics in the pharmaceutical market, drug development and innovation, spending trends, and how different organizations from across the health care ecosystem are working to improve health care affordability, access, and equity. This year marked the first Health Care Cost Trends Hearing following the passage of Chapter 343, which increased state oversight and transparency of the pharmaceutical industry.

Panelists were asked to reflect on the potential of new medications and therapies to treat rare and/or chronic diseases, the impact on patient outcomes and the health care system, and the role of insurers, purchasers, and pharmacy benefit managers (PBMs) in facilitating access to such medications. Panelists were asked to offer strategies and solutions which can shape a sustainable and affordable system that incentivizes innovation which delivers value and ensures equitable patient access to needed medications and therapies. 

Participants:

• Sarah Emond, President and CEO, Institute for Clinical and Economic Review
• Patrick Gilligan, President and CEO, Point32Health
• Marissa Schlaifer, Vice President, Policy, Optum
• Tracy Sims, Executive Director of Corporate Affairs, Eli Lilly and Company
• Matthew Veno, Executive Director, Group Insurance Commission

Notable Comments: Sarah Emond posited that previous efforts to address prescription drug pricing have not centered affordable access for patients, which has been brought into focus with the innovation of GLP-1s and the coverage challenges amid high pharmaceutical spending. She described this as “an affordability crisis” that is unsustainable, and highlighted the need for more transparency and leadership in the drug supply chain, particularly for the role of PBMs, she stated, “we’re in this situation because of choices we have made, it’s time to start making different ones.” 

Patrick Gilligan emphasized that now is the time to focus on affordability as providers, health plans, and others in the health care system are suffering economically and have concerns about MassHealth coverage. He added that everything points to the need to focus on health care costs. He stated that Massachusetts is “failing on affordability” and should innovate to identify cost-savings and that plans are having to make difficult decisions in this environment, such as not providing coverage for GLP-1s.  

Marissa Schlaifer said that PBMs would prioritize affordability for patients and health plans and cited data about significant increases in drug prices in recent years. She acknowledged that many of these high-cost medications provide new clinical tools to treat patients, especially those with unmet need, “but they come at a cost that may not be affordable for our clients.” 

Tracy Sims underscored that there is “a lot of benefit to proactivity” when identifying the next medical innovation. He discussed the potential positive impacts of cell and gene therapies for patients and shared that his organization would be open to participating in conversations around medical innovations in the pipeline. He also discussed the economic impacts of “sub-optimally” treating obesity in Massachusetts, such as direct impacts to the state budget “due to increased costs borne by related diseases from Medicaid,” and highlighted the importance of treating obesity with all clinical tools available to support patient needs, including GLP-1 medications. 

Matthew Veno highlighted that if GLP-1 pricing was sustainable, everyone would be celebrating the innovation and value for members. He shared that the GIC would continue to try to provide coverage for members despite these challenges, but understood why others may make a different decisions because “pricing of these drugs puts us at a breaking point.” He noted the ongoing considerations to eliminate coverage in the short-term, despite the effectiveness of these medications in treating a disease with high prevalence and large downstream costs. He added that he hopes that the GLP-1 coverage decisions highlight issues in the traditional market and he underscored the need to address these ongoing concerns, including sustainability and predictability. 

Key Themes:

• The current model is unsustainable, and payers are often forced to make difficult decisions about coverage for high-cost drugs like GLP-1s.
• While panelists recognized the value of GLP-1 drugs, they also discussed that it’s not realistic to expect payers to continue to cover GLP-1s due to prices and high utilization, which will continue to be a problem as more innovative products come down the pipeline (e.g., cell and gene therapy).
• GLP-1 coverage losses will widen health equity gaps, and while lower prices through direct-to-consumer programs can help, GLP-1s will still remain out of reach for many patients in need.
• Payers have grown to rely on rebate dollars as a source of revenue to lower premiums or fund other programs. As the difference between gross and net price has grown, and with limited data on net pricing across the market inhibiting comprehensive cost impact understanding, it may be time to reevaluate the role of rebates.
• Transparency is a critical component to improving affordability for patients, particularly to understand what is happening in the drug supply chain and drug pricing.  

The fourth panel begins at the 4:56:43-minute mark in the Cost Trends Hearing recording.

Panel 5 – Moving Forward Together: How CEOs are Maintaining a Focus on Affordability in a Time of Uncertainty

Moderated by HPC Board Chair Deborah Devaux

Purpose: The final panel of the hearing brought together health care system leaders and the head of the premier independent watchdog of state and local finances to discuss how organizations are strategically responding in the current uncertain environment. 

The panelists discussed their organizations’ efforts to maintain Massachusetts values in health policy efforts, even in the context of restrained revenues. The panel also provided an opportunity for leaders to reflect on how industry and government can work together to stabilize the system and address known challenges, such as workforce constraints, financial pressures, and mounting affordability and access challenges for employers and patients.

Participants:

• Doug Howgate, President, Massachusetts Taxpayers Foundation
• Sarah Iselin, President and CEO, Blue Cross Blue Shield of Massachusetts
• Zandra Kelley, MD, President and CEO, Greater Lawrence Family Health Center
• Manny Lopes, President and CEO, Fallon Health
• Kevin Tabb, MD, President and CEO, Beth Israel Lahey Health

Notable Comments: Doug Howgate emphasized that while the impacts of federal action will be significant, there is both the ability and urgent need for stakeholders across the Commonwealth to work together to maximize federal support and reduce coverage loss. 

Sarah Iselin underscored that we cannot expect employers and consumers to make up the difference of the loss in federal funding, and that the reality of less funding will make for increasingly challenging negotiations between payers and providers. She noted that Blue Cross Blue Shield of Massachusetts is committed both to reducing their administrative costs and working to maintain under-benchmark average price increases. Iselin identified the most urgent priorities for the Commonwealth as strengthening and enforcing the health care cost growth benchmark, rethinking how we pay for care, focusing more on health planning, and addressing administrative complexity by building data infrastructure to allow for better data flow across the health care system.

Zandra Kelley, MD, said that we need to protect and keep community health centers open, both as a critical health care access point for residents, and as community health centers have demonstrated their ability to decrease the overall cost of health care, particularly in their delivery of primary care. 

Manny Lopes urged stakeholders to further consider utilization, saying, “We can get caught up about the cost of care, but we can't forget about care management and utilization management. Because as much as we're paying, we're still not getting the outcomes we expect. We should really focus on the other variable of utilization, making sure people get the care they need when they need it. Particularly in underserved communities.

Kevin Tabb, MD, noted that to address both high costs and the threat of federal funding losses there need to be tough conversations about what services will continue to be provided and how to reduce the duplication of services throughout the state. Dr. Tabb said, “I think that there may be some members of the panel or of the HPC who would say, let's just pay hospitals less. And that's a conversation we should have. But if we're going to have that conversation, then let's be honest about what the result is. Which is that, even in the face of more efficiency, even in the face of new technologies, even in the face of new payment models, there will be less provision of services. And if that's the case, let's get serious about that and talk together about how we do that in a rational fashion.”

Key Themes:

• Panelists agreed that this is an exceedingly difficult time for the Massachusetts health care system and unanimously agreed that there is a health care affordability crisis. Panelists noted their continuing efforts to reduce spending, including utilizing unit price negotiations, investing in primary and community care, and innovative programs.
• Looking to the future, panelists called for a more rational health care system and a “benchmark with teeth” that holds entities to account for above-target spending increases. Panelists called for a convening of leaders to outline a path forward. One of the suggested actions to address this was health planning -- to reduce the duplication of services, increase affordability, and create a more rational health care system.
• Panelists emphasized the importance of administrative simplification and noted that the role of state government could be to further data sharing via a centralized clearinghouse. Providers also discussed the emerging role of AI, including for ambient listening to reduce charting time for physicians.
• Given changes at the federal level, stakeholders agreed that some level of sacrifice will be required for the state and residents of the Commonwealth to stay afloat in terms of “taking money out of the system.” 

The fifth panel begins at the 6:06:43-minute mark in the Cost Trends Hearing recording.

Reflections and Discussion

The HPC Board of Commissioners shared reflections and key takeaways from the panel discussions and the consistent themes brought up throughout the hearing. 

Key Themes:

• There is a shared responsibility and commitment across Massachusetts to mitigate the impending harms from recent federal policy changes.
• Challenges throughout the Commonwealth’s primary care system have significant downstream impacts on clinicians, patient health, and affordability.
• Massachusetts is experiencing an affordability crisis beyond the health care system alone.
• Bold, patient-centric action is needed to move the health system in the right direction and address the persistent health equity challenges discussed throughout the hearing.

The Commissioners’ reflections and discussion begin at the 7:25:29-minute mark in the Cost Trends Hearing recording. 

Testimony

In advance of the hearing, 50 entities (25 provider organizations, nine health plans, seven pharmaceutical manufacturers, four pharmacy benefit managers (PBMs), three significant equity investors, one real estate investment trust (REIT), and one management services organization (MSO)) – were required to submit pre-filed written testimony, responding to questions from the HPC and the Office of the Attorney General. The full text responses from all 50 organizations, in addition to a summary of themes is available on the HPC’s website. 

The HPC also accepted oral and written testimony from members of the public. During the hearing, oral testimony was provided by Lindsey Tucker, Managing Director, Health Equity Compact and Dr. Wayne Altman, President, Family Practice Group, and Founder, Massachusetts Primary Care Alliance for Patients. Written testimony was provided by Dr. Katherine Gergen Barnet; Eileen McAnneny, President of the Employer Coalition on Health; Richard T. Moore; and Lora Pellegrini, President and CEO of the Massachusetts Association of Health Plans.

The oral public testimony can be found at the 7:48:11-minute mark in the Cost Trends Hearing recording. The written public testimony is available on the HPC’s website.