The first meeting of the new Steering Committee to guide the Office of Health Strategy’s (OHS) plan to cap healthcare cost growth was uncharacteristically quiet. The meeting started with public comment from the Universal Healthcare Foundation of CT that the committee membership is “not balanced”, includes mainly members with “deep vested business interests”, and lacks subject matter experts and members who are affected by high healthcare prices. The new committee is taking over for the now-retired Technical Team and is meant to bring the industries to the table to collaborate on lowering costs. Asking industries to voluntarily lower profits hasn’t worked in multiple past Connecticut healthcare reform attempts going back decades. The meeting ended early as few offered comments or responded to prompts from OHS.
We did learn some new information from the consultants about further analysis of APCD data. Between 2015 and 2018, on average ED costs grew by 7.5% annually, more than any other sector. Increased spending was driven by higher prices, especially ED services, rather than utilization, which fell for most sectors. ED use was down across all income levels. ED use was very high in six zip codes that are majority Black and Hispanic/Latino. Income is more tightly correlated with ED use than race. Residents of communities of color were less likely to have had a primary care visit. Surprisingly, ED visits were higher among patients with a primary care visit than those without (76% vs. 55%). As a possible explanation, 70% of ED visits were for patients with at least one chronic condition, who may be more likely to access primary care. Residents of low-income communities were twice as likely to have a chronic condition and also twice as likely to have more than one chronic condition. Almost half of ED visits (46%) during those years were non-urgent or avoidable. Avoidable ED visits were far more common in communities of color and low-income communities.
The presentation repeated prior analysis finding that hospital prices, not utilization, were the main driver of rising health costs. Costs at hospitals with the biggest growth in prices, mostly large health systems, grew fastest overall. Unaffiliated hospitals had slower growth in both prices and overall costs. It was pointed out that this analysis only covers commercial plans, not Medicare or Medicaid, and does not include drug costs.