In June 2019, Pioneer Institute, with support from Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans, contracted with noted pollster David Paleologos, head of DAPA Research at Suffolk University’s Research Bureau, to conduct a valid and reliable survey of Massachusetts consumers with employer sponsored health insurance. The goals of the survey were to determine consumers’ awareness, attitudes, views, usage, and knowledge of healthcare prices. This white paper presents analysis of the results.
About Barbara Anthony
Barbara Anthony is Pioneer Institute’s Senior Fellow in Healthcare. She is also currently a Senior Fellow at the Harvard Kennedy School’s Center for Business and Government where she is leading study groups and researching and writing about Massachusetts healthcare cost containment efforts. She served as Massachusetts Undersecretary of the Office of Consumer Affairs and Business Regulation from 2009 to 2015 where she oversaw five state agencies: Banking, Insurance, Professional Licensure, Telecommunications and Cable, and the Division of Standards. Anthony, with a background in law and economics, is a well-known consumer advocate and a highly respected public interest lawyer and policy maker. Among her accomplishments, Anthony oversaw implementation of the state’s Data Security Law and regulations, kept health insurance rate increases under control, helped implement the state’s 2012 Health Care Cost Containment Law, oversaw efforts to reform the mortgage foreclosure process, initiated a financial literacy project, Project Credit Smarts, in several Massachusetts colleges, and spearheaded a campaign to empower Massachusetts healthcare consumers through price and quality transparency.
Previously, Anthony was Executive Director of Health Law Advocates, the Boston-based non-profit law firm dedicated to health care access; Regional Director of the Northeast Regional Office of the Federal Trade Commission; Chief of the Public Protection Bureau of the Massachusetts Attorney General’s Office; and Vice President and Chief Compliance Officer for BayBanks, Inc. Anthony began her legal career as a Trial Attorney in the Antitrust Division of the U.S. Department of Justice in Washington, D.C. Anthony’s expertise focuses on privacy and data security, financial services, Internet fraud, and health care.
She is a graduate of Suffolk University Law School, where she currently serves as an Adjunct Professor of Law. She holds a graduate degree in economics and a bachelor of science in business administration from Northeastern University. She serves on the boards of the Cambridge Health Alliance Foundation, Cambridge Community Cable Television, the state Treasurer’s Financial Literacy Trust Fund Board and the Advisory Board of the Rappaport Center for Law and Public Policy at Boston College Law School.
She regularly appears as a media commentator on consumer protection and business regulation issues.
This report reveals that consumers in just one Massachusetts county could have saved nearly $22 million in a single year and $116.6 million adjusted for inflation over four years if they switched from using the most expensive providers for 16 shoppable healthcare services to those whose prices were closer to average.
Recently, Governor Baker signed legislation, H. 4672, that would create a Covid-19 task force, appointed by the legislature, to study and make recommendations to the general court that address health disparities among certain populations based on certain characteristics, including age, and which also asks the future task force to recommend other impacted populations for further study. Pioneer has prepared a public letter to that future task force that contains a list of specific recommendations regarding Covid-19 and the state’s nursing homes.
This op-ed originally appeared in WGBH News. In much of the country, a substantial number of Covid-19 deaths have occurred in nursing homes. Too many states were caught unaware that crowding, poor infection control, insufficient isolation facilities, and lack of proper training and equipment for nursing home workers would create petri dishes for Covid’s destruction. As of now, this lack of preparation accounts for 24,000, or over one-third, of Covid-related deaths nationally. We saw what was happening in Italy, where frontline doctors were forced to make age-based life and death decisions because so many elderly people were sick and ventilators were in short supply. We saw the first signs of the virus on our own shores in Washington state nursing […]
At a time when the coronavirus pandemic has caused massive shifts in state policies on telehealth and scope of practice in healthcare, a new Pioneer Institute study underscores that most of the 50 states continue to suffer from weak laws regarding price transparency. The study identified states that have laws that require carriers, providers or both to provide personalized cost information to consumers before obtaining healthcare services.
This new study contends that the Massachusetts Department of Public Health’s (DPH’s) Crises Standards of Care (CSC) issued earlier this month bear the earmarks of a state bureaucratic effort. The guidelines need to be rethought under a process that includes a thorough vetting by Massachusetts citizens.
This op-ed by Barbara Anthony appeared in WGBH News on March 26, 2020. Recently I overheard a dad in a local playground complain that his kids couldn’t play tag with other kids anymore. He asked, “what will they prohibit next?” His complaint got me thinking. I thought back to my mom telling me about food and materials rationing during World War II. She went on about her mother standing in line with a ration book to get lard (what’s that?) and something that tasted like coffee, cheese, and something that looked like meat. Your ration card was your destiny. Then at night, her family had to draw the shades or shut off all the lights. They lived in Revere near […]
While we are now practicing physical distancing, we may not be giving a lot of thought to our supers or building managers and what we as residents should do to help keep them safe. Here aree some tips from Pioneer’s Senior Fellow in Healthcare, Barbara Anthony.
New study finds there is little correlation between a patient’s out-of-pocket cost and either the amount insurers pay or the overall price of a procedure at 14 representative Massachusetts hospitals.
This study finds some significant improvements in the online cost estimator tools created by Massachusetts’ three largest health insurers, but there is much still to be done for the carriers to maximize the opportunity price transparency represents.
As a little girl I have a dim memory of my mother taking me to a medical “dispensary” in what was then not-very-trendy East Boston. I remember it being really convenient; it was just down the street from where we lived, had short wait times, and a nominal cost, if any at all. This was during a time when physicians made home visits. I guess my mother couldn’t reach our family doctor, so off to the dispensary we went. Medical dispensaries—we might call them “clinics” —were quite common in Boston beginning in the early 1800s. (That is not when I went!) Most were operated as charities for people who could not afford private physicians or were not sick enough for […]
State leaders need to work together to tackle Medicaid challenge MASSACHUSETTS HAS A unique culture when it comes to health care. Over the last quarter century, we have seen the business, provider, payer, consumer, and academic sectors come together to advance reforms aimed at expanding coverage and containing the cost of care. Whether it was repeal of hospital rate-setting and passing insurance reforms in the 1990s, or the 2006 the passage of Romneycare, or major cost control legislation enacted in 2010 and 2012, stakeholders across the board have had a seat at the table. Consensus may not be the right goal in all cases, but given the way it has careened from one extreme to the other on health care in […]
This policy brief applauds the decision by the Commonwealth of Massachusetts’s Health Policy Commission to allow the benchmark for increases in the overall rate of healthcare spending to decrease this year, but urges state policy makers to remain focused on the larger culture changes that will be needed to rein in healthcare costs.
Regardless of what takes place at a national level, Massachusetts has its own set of challenges to continue pursuing the state’s commitment to universal coverage at affordable prices. This report offers a ten-point program that the state should vigorously focus on in the days ahead.
Eighteen months after an initial survey of prices at hospitals in Massachusetts, Pioneer Institute conducted a follow-up survey of all but one of the hospitals from the first survey to see if there had been any change in the performance of these institutions since their last assessment. Initial survey calls were conducted between September 20th and November 2nd, 2016.
Commission Misses Great Opportunity to Advance Healthcare Price Transparency While most of the country is focused on national health care issues playing out in Washington, Massachusetts is in the midst of an extremely important debate with lasting effects on what Commonwealth residents pay for healthcare prices, about which few citizens are even aware. Last year, as part of a hastily crafted law replacing a ballot initiative to institute limited provider rate-setting pushed by 1199 SEIU, the state legislature established a special commission to study the Bay State’s stubbornly high healthcare prices. The Provider Price Variation Commission (PPVC), populated by a who’s who of local healthcare bigwigs, very diligently attempted what was asked of them: not only identifying the reasons for […]
The Governor filed a number of healthcare market reform proposals along with his fiscal 2018 budget. One of his proposals aimed at reining in healthcare costs would impose limits, or capitate, the prices that insurance companies are allowed to pay providers (physicians and hospitals); it appears that the capitated prices serve as an indirect way of putting price caps on provider prices. Hmm, sounds complicated. Let us try to explain. Background The best place to start is with a description of the problem the Governor is trying to fix. Massachusetts has an insatiable appetite for healthcare services. According to the Health Policy Commission (HPC), the Bay State’s total spending on healthcare increased by 4.1 percent in 2015 to $57.4 billion; […]
In January, the Baker Administration introduced a number of healthcare market reform proposals in its fiscal 2018 budget. The public face of these proposals is found in a slide presentation on the website of the Executive Office of Health and Human Services (EOHHS). There have also been news stories written about the proposals and certain stakeholder groups have been briefed. Beyond the EOHHS document, however, there is not much transparency or explanation about any of these proposals. Two of them are especially important as each has potentially far-reaching impacts: a new annual $2,000 penalty per employee on businesses who do not attain 80 percent enrollment in their employer-sponsored health plans and a proposal to limit what insurance companies may pay […]
Governor Baker’s recent healthcare proposals include provisions aimed at improving transparency in healthcare pricing. These policies imply that it is necessary to release more information in order to realize cost savings through healthcare price transparency measures, but current state laws already require the disclosure of price information upon request. Enforcing existing laws and creating incentives for carriers and providers to promote consumer friendly price transparency are necessary complements to the Governor’s proposals. The Governor’s proposal (found in a slide presentation on the EOHHS website) has two major components. The Center for Health Information and Analysis (CHIA) is to: “Collect data from the health plans to develop a market-level report.” Create a list of healthcare pricing data across all providers for […]
As the Legislative Special Commission on Provider Price Variation wraps up its work (their potential report/recommendations are due in mid-March), PioneerHealth took this opportunity to provide our expertise and vision for moving towards a sustainable and transparent healthcare system. We envision a host of policy recommendations, enhanced enforcement of existing laws, and a statewide education campaign to help consumers learn to make value-conscious decisions. Following these steps will put the Commonwealth on a path towards healthcare cost containment.
There are rumblings among some in the hospital community voicing displeasure with the Group Insurance Commission’s (GIC) new plan to cap payments to providers at 160% the Medicare rate. The GIC says this move will help save the agency $50-100 million annually and meet the state’s cost growth benchmark. Over the years, the GIC has been a leader in healthcare cost containment, from tiered provider plans to a recently launched cash incentive program called Vitals SmartShopper designed to incentivize high-value healthcare decisions. In yet another innovative program from the state agency responsible for 436,000 state workers and their family members, the GIC has voted to limit payments to providers, some of the most prestigious of which have attacked the plan […]
Testimony emphasized the need to focus more on what would help consumers make better decisions about spending on healthcare.
This paper is the fourth in a series on price transparency in the healthcare industry, and the first Pioneer report to focus on the retail price of prescription medications. Researchers called 44 retail drug stores across the state asking for the price of a 30-day supply of each drug in a common dosage. In each case the callers said they were self-pay and pressed the drug store for information about discounts.
This policy brief is the third in a series of reports on healthcare price transparency prepared by Pioneer Institute. Researchers surveyed six major metropolitan areas and spoke with 54 acute care hospitals across those regions: Des Moines, IA, Raleigh-Durham, NC, Orlando, FL, Dallas-Ft. Worth, TX, New York, NY and Los Angeles, CA asking for the price of an MRI of the left knee without contrast. In addition, they explored the existence of federal and state laws that might apply in the states where the hospitals surveyed are located. They also examined the websites of the 54 hospitals for price information. The results of this survey are described in this policy brief.
Notwithstanding a Massachusetts law requiring the clear, prompt disclosure of price estimates to patients upon request, recent studies by Pioneer of a sample of hospitals, specialist physicians and dentists throughout the state showed that it is still not easy to obtain this information, often requiring some persistence and longer than the two days allowed by law (“Survey: Price Information Difficult to Obtain by Massachusetts Hospitals,” June 24, 2015; “State Healthcare Price Transparency Law Still Not a Reality,” August 12, 2015). The 2012 Massachusetts law requires healthcare providers to give consumers procedure prices within two business days of request (Chapter 224 of the Acts of 2012, “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency […]
Pioneer surveyed 96 specialists from across Massachusetts, split almost evenly among dentists, dermatologists, ophthalmologists and gastroenterologists. With the exception of dentists and some ophthalmologists, many medical specialists make it very difficult for Massachusetts consumers to reap the benefits of a state law that requires medical price transparency. This survey highlighted some shortcomings in the current law and the need for additional guidance and coordination from government agencies and professional associations. Download Report:
Pioneer Institute surveyed 22 out of approximately 66 Massachusetts acute care hospitals and 10 free-standing clinics seeking prices for one common procedure – an MRI of the left knee without contrast. While Pioneer was ultimately able to get the information from all 10 clinics and 21 of the 22 hospitals, the process was time consuming, confusing and replete with long rounds of telephone tag.