Module 2: Communications for Sustained Stakeholder Engagement 

Effective communication is a cornerstone of successful stakeholder engagement. The cost growth target is a systemic approach to a complex problem, and explaining its benefits and progress to secure and sustain stakeholder support requires clear and ongoing communications. 

Likewise, earning and maintaining stakeholder buy-in amid inevitable changes in state administrations, the economy, and other circumstances demands consistent communication and education. This section describes key communication activities that states need to undertake to gain and maintain stakeholder momentum to implement cost growth targets.

Identify The Audience

States need to engage stakeholders regularly to educate them, increase buy-in, and garner support in establishing and implementing the cost growth target program. Key stakeholders include members of the state’s health care industry such as its payers and hospitals; those who represent groups directly harmed by rising costs, including employers, organized labor, and consumer advocates; and policymakers, including regulators and legislators who can support the program and effect policy change. Engaging local media and funders may also be important. Table1 outlines the stakeholder engagement opportunities at various points of program implementation.

Table 1. Stakeholder Engagement Opportunities

Develop Clear Messages

As state leaders seek to educate industry, policymakers, and the larger community about cost growth targets — whether introducing the concept, setting a target or measuring progress against it — they must clearly communicate how targets are an important first step toward making health care affordable. The following are key messages that states could use to make the case that rising health care costs harm families, employers, and governments and clearly delineate how targets help solve the problem:

The Problem 

• No one should have to choose between going to the doctor and putting food on the table for their family. Unreasonably high health care costs are eating into household budgets, leading many individuals and families to skip needed care and/or forgo other household necessities. They have also driven more than 40% of Americans into medical debt. 
• Rising health care costs stretch the budgets of the state government and employers in the state. As states spend more and more on health care, fewer dollars are left for other policy priorities like education and housing. Likewise, high health care costs lead employers to lay off workers and limit pay increases. 
• High health care costs affect many individuals and families. High deductibles, premiums, and out-of-pocket costs comprise a growing percentage of total household income, particularly for those with job-based health insurance.

The Solution 

• Cost growth targets provide a starting point for improving health care affordability. Health care costs are rising faster than wages, state revenue, and the economy. This has made health care unaffordable. Cost growth targets serve as spending goals that states set to constrain health care spending so that it does not grow faster than increases in wages and/or the state economy. 
• Cost growth targets bring transparency to health care spending. In tracking and reporting how payers and providers are performing against the cost growth targets, states open up the “black box” of health care costs. This allows everyone to compare spending between different health care insurers and providers. By further analyzing the spending data states are also able to pinpoint drivers of cost growth and devise specific strategies to contain costs. 
• Cost growth targets can lead to actions that improve affordability. Setting a cost growth target is just the first step. With the information generated by cost growth target programs, policymakers can make data-informed decisions about how to make health care more affordable, for example, by controlling pharmaceutical prices or standardizing hospital prices. 
• Cost growth targets create accountability. Cost growth target programs hold insurers and providers accountable to a common goal through annual reporting, and in some states, performance improvement plans and financial penalties.

These messages can be further customized to emphasize the cost growth target’s value proposition to each audience group. For example, when speaking to legislators, it may help to talk about the importance and relevance of health care affordability and the cost growth target to key state priorities like attracting or maintaining local businesses.

Identify Messengers

States should consider building a coalition of supporters who can engage public officials and develop talking points that they can use to discuss issues publicly or privately. For example, in California, the legislation establishing the Office of Health Care Affordability (OHCA) was supported by efforts from a diverse coalition of consumers, employers, and organized labor. In every meeting of the OHCA board, representatives from various unions provided public comment on the detrimental impact of high health care costs on the lives of working people. As a result, when the OHCA board published the cost growth target for California, public comments in support far outnumbered industry opposition.

Build Communications into Staffing

To prioritize communications, a dedicated member of the target program team should work regularly with communications staff, if available, to ensure the state conveys the value and progress of the program in a consistent and understandable way. In the absence of dedicated communications staff, the state lead should assign staff communications responsibilities, such as working with appropriate department staff on a website or web page and creating fact sheets or Q&A documents based on examples provided in the resources section below.

Refute Industry Concerns

Health systems and hospitals are likely to bring up concerns about cost growth targets to explain spending that exceeded the target. Common concerns include the validity of the cost growth target methodology, their own fixed operating costs, and the argument that higher commercial prices are needed to cover gaps left by low Medicare and Medicaid payment rates. State officials should be prepared to respond to these arguments by preparing talking points and tough Q&As and participating in practice sessions led by communications staff.

Build Will for Action Through Ongoing Communication

As the initiative matures, stakeholder engagement should move toward actions the state and its partnering stakeholders can take to mitigate cost growth. Because meaningful action to address drivers of cost growth is the most challenging part of a target program, the communications strategy should repeatedly and effectively elevate the key cost drivers and policy actions that the cost growth mitigation strategy will address in the future. The cost-driver messaging should be done early, long before the development of any cost mitigation strategy.

Approaches to ongoing communication should include: 

• Dedicated website: States should maintain a website that describes the program and how it can address the issue of affordability. The site should include board or advisory committee meeting materials and recordings and other documents related to program implementation. There should be a designated staff member responsible for this function. 
• Newsletters, blog posts, videos, and social media posts: States can leverage these tools to share information about program developments and bring attention to health care affordability and the need to address cost growth. 
• Public hearings: Some states have created public hearings on target performance and mitigation strategies. In Massachusetts, the Health Policy Commission (HPC) holds an annual hearing where payers and providers testify under oath and answer questions from members of the HPC’s governing board and state officials. Members of the public are invited to share stories on their challenges with the cost of health care in the state. 
• Invitation-only forums, private meetings of associations, and webinars: States should present about the target and related analyses on affordability and cost growth in the state at forums or meetings held for other purposes, such as legislative briefings, state interagency meetings, and meetings of the state’s hospital association, medical association, and consumer advocacy associations. 
• Legislator briefings: Through repeated strategic messaging about what is driving health care cost growth, states can set the stage for future policy action. For example, Connecticut was able to pass legislation to codify its target program by gaining support via extensive outreach. The Connecticut Office of Health Strategy (OHS) held regular meetings and briefings with legislators on issues around affordability and how the target program was working to address them. The OHS also developed relationships with stakeholders most closely aligned with the target program’s goals, including members of the business community, and worked with them to garner support. To assist with these efforts, the Peterson-Milbank Program on Sustainable Health Care Costs has developed two fact sheets – one that addresses health care cost trends and their impact on households, employers and states, and another that explains and provides and overview of complementary policies to slow cost growth. 
• Media coverage and op-eds: Media outreach is an effective way to reach a broader audience, and states should cultivate relationships with local reporters who cover health care affordability. States should also consider opportunities, such as program milestones reached or current events tied to health care affordability, to draft op-eds in collaboration with target program stakeholders.

At each opportunity, states should lean on their messages to highlight the problem of health care affordability and describe what it means for families, employers, and the state. 

Resources

State officials are encouraged to contact the Peterson-Milbank Program for Sustainable Health Care Costs for information and guidance on how to communicate the value of and progress within a state’s cost growth target initiative, as well as respond to industry concerns.

Additional resources include:

Information on Health Care Affordability

• Consumer Healthcare Experience State Survey (CHESS). Altarum’s Health Care Value Hub includes results from the Consumer Healthcare Experience State Survey (CHESS), which surveys residents on a wide range of health system issues, including confidence using the health system, financial burden and views on fixes that might be needed, and offers state-specific data briefs.
• Diagnosis Debt.This KFF Health News series shows that medical debt is now the defining feature of the US health system, illustrating the problem with data and personal stories.
• The National Alliance o Health Care Purchasers Hospital Fair Priceis a resource that offers employers guidance on how to leverage storytelling and data to advocate for lower prices, and is useful for providing insights into collaborating with employers.
• Opinion Poll: Rising Healthcare Costs Continue to Hurt Small Business Bottom Lines.This 2024 poll finds small businesses are struggling to keep up with rising healthcare costs and a majority support policy solutions, including facility fee bans, hospital price caps, and enhanced health care market oversight.
• Our Health Care System Has Lost Its Way.This Families USA report highlights the problem of unaffordable and low-quality care in the United States.
• Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer.The Commonwealth Fund Affordability Survey finds many Americans, regardless of where their insurance comes from, have inadequate coverage that has led to delayed or foregone care, significant medical debt, and worsening health problems.
• The monthly Peterson-Milbank Program for Sustainable Health Care Costs Newsletter features the latest research and analysis relevant to health care cost transparency and accountability.
• The Peterson-KFF Health System Tracker provides clear, up-to-date information on US health care cost trends, drivers, and issues — and shows how the US is performing relative to other countries.

Examples of Communications Content

Explainers: such as accessible infographics, leave-behind fact sheets, FAQs, or videos that share topline findings from target performance or cost driver reports, ideally using a combination of graphics and text.

• A State-led Approach to Health Care Affordability(video)
• California Office of Health Care Affordability FactSheet
• HPC Short: Out-of-Pocket Spending for Birth Care
• HPC Health Care Cost Growth Benchmark Frequently Asked Questions
• New Jersey Health Care Affordability, Responsibility, and Transparency (HART) Program Blueprint(fact sheet)
• Spending and Use of Emergency Department Services in Rhode Island(data story)
• Washington State Health Care Transparency Board FAQ

Press releases announcing new developments, such as establishment of an implementation committee, setting of target values, releases of target or cost driver reports, and announcements of the deployment of enforcement mechanisms.

• Connecticut’s First-Ever Healthcare Cost Growth Benchmark Report Confirms the Need for Reforms To Make Healthcare More Affordable
• HPC Finds Mass General Brigham Cost Trends and Expansions Threaten State Health Care Affordability Efforts
• Oregon Passes Bipartisan Legislation to Slow Rising Cost of Health Care and Increase Transparency for Consumers
• Statewide Health Care Spending Target Approval is Key Step Towards Improving Health Care Affordability for Californians

Reports featuring baseline data, performance against the target, or analysis of cost drivers.

• Massachusetts Annual Health Care Cost Trends Reports
• Oregon Health Care Cost Growth Target Data and Reports
• Rhode Island Annual Report on Health Care Spending and Quality, 2024
• Washington’s Baseline Benchmark Report, 2017-2019

Op-eds from a state official or committee member making the case for targets to help raise the program’s profile.

• What States Can Do to Get Rising Health-Care Costs Under Control (Washington and Connecticut)

Examples of Dissemination Approaches

Websites ideally include a home page with overview text and sections for meeting materials, information for data submitters, and reports and explainers.

• California Office of Health Care Affordability Slow Spending Growth
• Connecticut Office of Health Strategy Healthcare Benchmark Initiative
• Delaware Health Care Spending and Quality Benchmarks
• New Jersey Health Care Cost Growth Benchmark Program
• Oregon Health Authority’s Sustainable Health Care Cost Growth Target
• Rhode Island Health Spending Accountability and TransparencyProgram
• Washington Health Care Cost Transparency Board

Social media includes YouTube, LinkedIn, and other social media accounts for posting videos of events or key findings from explainers and reports.

• Massachusetts Health Policy Commission on X (formerlyTwitter)

Email updates and newsletters that keep audiences informed and reminded of how cost growth target programs are helping move the needle on affordability.

• Rhode Island newsletters

Events include in-person or virtual briefings/forums targeting specific audiences, such as legislators, employers, or public advocates, or a public hearing that aims to draw media attention and involve a range of stakeholders. Videos and slides can be posted.

• Rhode Island’s 2024 Health Care Cost Trends Public Forum: presentation and chartbook
• Connecticut Office of Health Strategy Virtual Forum on the Health Care Cost Growth Benchmark
• Connecticut Healthcare Affordability: How I tImpacts Your Company and Employees Symposium
• New Jersey Informational Webinar for Hospital and Provider Stakeholders