First Health Care Costs Hearing Reveals More Questions Than Answers | CT news junkie

OHS Executive Director Deidre Gifford Credit: Mike Savino’s photo

State officials have tried to get a better look at what’s driving health care costs soaring, but a Wednesday hearing raised largely more questions than answers.

The Office of Health Strategy held its first-ever hearing to review some of the findings from its March report that found costs in the commercial health care market rose 18.8%. This is well above the 3.4% goal the state has set and ranked as the highest increase among the few states that have health care benchmarks.

We’ve been trying to cut health care costs in the state of Connecticut for decades, but we still haven’t been able to do it, said Sen. Heather Somers, R-Groton, a ranking member of the Legislative Committee on Public Health.

The purpose of Wednesday’s hearing was to review the data and come up with policy recommendations for lawmakers and Gov. Ned Lamont’s administration.

However, officials at Yale-New Haven Health and Hartford HealthCare, the state’s two largest health care networks, have dismissed some of the report’s findings.

The report identified the two networks as key drivers of cost increases in 2021 related to hospital care. Officials said the methodology behind those findings was flawed.

We use these terms and often didn’t understand the problem, said Jim Cardon, chief clinical integration officer at Hartford HealthCare.

He said a major flaw is that many people delayed seeking medical care in 2020, meaning they needed higher levels the following year.

At the same time, efforts to steer patients towards more cost-effective outpatient options mean that those patients with more severe needs would skew the data. Gayle Kosyla, chief financial officer of Yale-New Haven Health, agrees, saying the March benchmark report is misrepresenting what’s happening with the cost of health care.

OHS Executive Director Deidre Gifford acknowledged that the state is still figuring out how to assess costs, and that includes properly weighing the data.

He said his office will work with analysts to create a standard market basket before its next report is due in March.

However, Families USA Frederick Isasi rejected some hospital positions. He said health care costs have risen 50% over the past five years in Connecticut, far outpacing wage growth.

Do you see the idea that if you can’t afford treatment, then it’s not affordable? he asked health officials.

He also questioned the two systems about the role consolidation played, noting that hospitals across the country are buying up doctors’ offices. Networks often refer patients to their hospitals for routine services, including imaging and billing for large facilities.

Cardon said Hartford HealthCare built ambulatory surgery centers to reduce the need for outpatient care.

The panel also questioned Bristol Myers Squibb, maker of the blood thinner Eliquis, on what is driving the rise in prescription drugs.

OHS has identified Eliquis and the immunosuppressant Humira as two key drivers of healthcare costs. Abbvie, producer of Humira, declined OHS’s request to attend the hearing.

Bristol Myers Squibb senior vice president Chris Mancil said his company is not to blame.

Contrary to popular belief, drugmakers aren’t the driver of America’s rising health care costs, he said, instead blaming drug industry middlemen.

He said the public often focuses on the list price or the amount customers pay but ignores the rebates and rebates manufacturers offer from their net price. He said Bristol Myers Squibb offered $115 million in rebates and rebates for Eliquis.

But he declined to offer the net price for Eliquis or any other drug when panelists asked, citing confidentiality agreements.

This drew frustration from the panel.

I think it’s fair for the state of Connecticut to articulate a rough figure of, you know, what the actual net price is at the pharmacy, said Anna Kaltenboeck, principal and drug reimbursement practice manager with research and health advisors ATI Advisory.

Mancil said he would like to work with state officials to better understand the difference between net and list prices, but also said Bristol Myers Squibb wanted to protect its confidentiality agreements.

Regulators in recent years have tried to address the issue of pharmaceutical and other benefit managers by negotiating lower prices with manufacturers, but pocketing the difference instead of passing the savings on to customers.

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