2022 Virtual Convening of Peterson-Milbank State Cost Growth Target Programs

Overview

This two-part virtual meeting on state cost growth target programs convened states participating in the Peterson-Milbank Program for Sustainable Health Care Costs to reflect on Phase I of the program and discuss Phase II, which will shift the emphasis from establishing cost growth target programs to reporting and policy action. The virtual meeting included group discussions facilitated by Peterson Center on Healthcare and Milbank Memorial Fund staff, as well as presentations from Bailit Health, the technical assistance provider, and Burness, a strategic communications firm.

Introduction

Milbank Memorial Fund Program Officer Rachel Block began the meeting by highlighting the accomplishments of participating states during the first phase of the program. All six states:

• established a governance or advisory structure
• set multi-year cost growth targets
• analyzed, and published information about health care cost growth drivers
• conducted public meetings, and
• considered policy options for accountability and cost mitigation strategies

In addition to these accomplishments, California, Connecticut, and Delaware passed legislation related to cost growth targets. Block then highlighted next steps and detailed the direct technical assistance that will help states shift the emphasis from establishing programs to reporting and supporting interventions to reduce cost growth during Phase II of the program.

Phase I Learning Experiences

Michael Bailit, president of Bailit Health, facilitated a discussion with state staff about their experiences establishing cost growth target programs. Participants discussed accomplishments, lessons learned from other participating states, and goals and aspirations for 2023. Many states talked about the importance of involving hospitals in the early stages of setting cost growth targets. Bailit also discussed new initiatives in California, the most recent state to join the Peterson-Milbank program. With California implementing cost growth targets, 1 in 5 Americans lives in a state with a cost growth target program.

The Role of Governing and Advisory Boards

Next, Christopher Koller, president of the Milbank Memorial Fund, reflected on his role as health commissioner in Rhode Island and his experience working with an advisory council. He then facilitated a panel discussion about the role of governance and oversight with staff from Rhode Island, Massachusetts, and Oregon, three states that have established governance structures. Themes from the discussion included the context-specific nature of governance, tradeoffs between different stakeholders within governance structures, the role of governance in ensuring quality data and credibility, and the leadership role of governance bodies during periods of political transition.

Effectively Using Analysis to Drive Action

During this session, Keanan Lane of the Peterson Center on Healthcare led a discussion about using data analysis to support cost driver mitigation efforts. Representatives from Oregon, Nevada, and Rhode Island discussed cost driver analysis strategy and trends, and how to present complicated analysis to non-data experts. Discussion questions focused on the role of analytics in stakeholder engagement and policymaking; when to engage stakeholders in the analytics process; and how states can leverage analysis for decision-making and consensus. Lane pointed to additional resources to help translate analytics into action, citing the strategic communication support available through the Peterson-Milbank Program, the Cost Growth Target playbook, Bailit Health’s Analytics to Action presentation, and A Data Use Strategy for State Action to Address Health Care Cost Growth.

Talking About Affordability

Milbank Memorial Fund Communications Director Christine Haran started the session with an overview of the communications materials that Milbank will provide during the second phase of the program. Participants from Connecticut, Washington, and Oregon shared examples of effective communication strategies during their efforts to implement a cost growth target program. Strategies included:

• involving legislators in the communications process
• frequent communication via platforms like Twitter or listservs
• using simple and relatable data to illustrate complicated themes
• engaging consumers in the legislative process through grassroots efforts

Burness consultants Maya Brod and Jemma Weymouth presented on how to use storytelling to effectively communicate health care cost data to consumers, industry, and decision makers. The consultants discussed telling stories responsibly by not deepening existing stereotypes, telling the average story rather than the exceptional story, and avoiding “superhero” or bootstrap stories that minimize the systemic nature of the problem. This session included a skills-building exercise and previewed future communications support from Burness.

State Strategies for Controlling Health Care Costs: Implementation Guides

In the final session, Anne Hwang, senior consultant at Bailit Health, reviewed a framework for addressing health care cost growth and selecting state policy strategies, and the tactical implementation support that Bailit Health can provide to participating states during Phase II. Hwang also discussed Bailit-authored implementation guides published by the Commonwealth Fund covering key cost growth strategies, including:

• limiting the rate of growth in provider prices
• capping high provider prices
• adopting multipayer value-based payment models
• adopting multipayer hospital global budgets
• using rate review to make health insurance more affordable