Market Oversight and Monitoring
Strengthening market functioning and health system transparency.
The HPC’s market oversight and monitoring activities are designed to strengthen market functioning and health system transparency, with the goal of encouraging a more value-based health care market.
Changes by health care providers, including consolidations and alignments of provider organizations, have been shown to impact the performance of our health care system in delivering high-quality, affordable, and accessible care. The HPC monitors and reports on the current structure of health care providers in the Commonwealth, as well as on the potential impacts of proposed changes.
A primary responsibility of the Massachusetts Health Policy Commission (HPC) is to oversee the functioning of the health care market in Massachusetts. This includes:
- Tracking and analyzing the number, type, and frequency of material changes to the governance or operations of health care providers (Material Change Notices, or MCNs);
- Evaluating the impact of significant health care provider changes on the competitive market and on the state’s ability to meet the health care cost growth benchmark through Cost and Market Impact Reviews, or CMIRs as well as through comments on filings with other state agencies, such as Determination of Need (DoN) applications filed with the Department of Public Health;
- Evaluating the performance of individual health care providers and payers which threaten the health care cost growth benchmark and overseeing Performance Improvement Plans (PIPs) to improve the cost performance of such entities;
- Overseeing a program that provides transparency on the composition and function of provider organizations in Massachusetts, the Registration of Provider Organizations Program (RPO);
- Assessing the value of certain high-cost pharmaceutical products and determining whether a manufacturer’s pricing of such products is excessive or unreasonable; and
- Conducting research and analysis to catalyze improvements in the performance of the health care market, such as by evaluating policy approaches to address market dysfunction like unwarranted variation in provider prices, analyzing the impact of market structure on cost trends, recommending approaches to mitigate market dysfunction that could result from care delivery reforms, evaluating different approaches to and identifying best practices in incenting provider performance, and assessing the role of provider supply and health system financing in driving health disparities.
The HPC’s programs in this area include:
Material Change Notices and Cost and Market Impact Reviews
Tracking and evaluating the impact of significant health care provider changes through review of material change notices (MCNs) and cost and market impact reviews (CMIRs).
Registration of Provider Organizations
Developing and implementing a Registration of Provider Organizations (RPO) program to provide transparency on the composition and function of provider organizations in the health care system.
Drug Pricing Review
Conducting reviews of high-cost drugs referred by MassHealth, the Massachusetts Medicaid Program, and assessing if the pricing is unreasonable or excessive in relation to the value.