The pace of state-based regulation and oversight of healthcare providers is accelerating — and it could be an indication that patience is growing thin with federal, payer and provider efforts to improve healthcare value.
Across the nation, we’re seeing a growing number of states adopt healthcare affordability boards. It’s a trend that started to pick up pace in 2021, with states like Delaware, Rhode Island, Connecticut and, most recently, Indiana putting statutory, administrative and funding support in place for healthcare cost control efforts. Several other states are implementing healthcare cost growth target strategies to limit increases in healthcare spending. The most progressive states also tie benchmarks related to quality of care and patient satisfaction to their efforts.
In September, CMS added momentum (and funding) by offering a framework for states to use in containing healthcare cost growth, advancing health equity and driving accountable care and healthcare transformation. The AHEAD model — States Advancing All-Payer Health Equity Approaches and Development — brings new money and a new approach to transforming healthcare financing.
These are signs not just of state budgetary pressures, but also of the desire to protect consumers from rising healthcare costs. They also reflect heavier scrutiny regarding the return states receive for their healthcare investments — namely, the impact on the health of the state’s most vulnerable — and, I believe, at least some impatience with the progress being made.
Can experimentation among states around healthcare cost containment lead to answers that can be scaled? And are global hospital budgets a solution — or are they a Trojan horse?
It’s an interesting topic to ponder. On the one hand, all of us can agree that high costs of care deter people from seeking care — often, the people who need it most. It’s one reason why HFMA continues to be laser-focused on cost effectiveness and value, convening key stakeholders in developing a system for delivering needed care in a way that is accessible and affordable.
On the other hand, results from many statewide efforts have been less than positive, so skepticism is warranted. If we are to advance these efforts, therefore, it’s important for HFMA to engage with these state boards, CMS and other stakeholders, bringing real-world knowledge and data to the discussion.
It’s possible these state-based efforts hold promise and offer an alternative to current value-based payment models. It’s time to take the lead on this new front in healthcare transformation — as an Association and at the local level, wherever our potential to make a difference is highest.