New law feature allows Mass. to keep healthcare company costs in check

The Massachusetts Health Policy Commission, the group that oversees the state's healthcare market, will notify providers and insurers being flagged for excessive cost growth, according to a Boston Business Journal report.

Here are four things to know about the initiative.

1. The initiative is a new feature of the 2012 Massachusetts health cost containment law. The new portion of the law essentially allows the commission to require performance improvement plans for entities "whose excessive cost growth is deemed to threaten the state's overall benchmark of keeping growth in total medical expenses below that of gross state product," according to the report, which cites information from commission officials.

2. To identify the providers and insurers with excessive cost growth, the commission will use data from the Center for Health Information and Analysis. CHIA has provided the commission with a list of entities with excessive cost growth, including less than 20 providers and about five insurers, for two years running, said Kate Scarborough Mills, the commission's policy director for market performance, according to the report. She said data from 2012-13 is final. However, information from 2013-14 is preliminary.

3. Specifics on how the data will be used has yet to be determined. However, the commission is able to ask for performance improvement plans in certain instances, according to the report.

4. To do this, the commission would have to confirm concerns about the entity's cost growth and determine if a performance improvement plan would likely be successful, Ms. Scarborough Mills said, according to the report.

4. Commission Executive Director David Seltz told the Boston Business Journal the commission has the authority to determine whether to require a plan and said entities that don't make a good faith effort to comply could face a $500,000 fine.


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