Cost Growth and Quality Benchmarks, and Primary Care Target

Triggered by unsustainable growth in healthcare costs in Connecticut, Governor Lamont signed Executive Order #5 in January, 2020, charging the Office of Health Strategy (OHS) to benchmark total healthcare expenditures growth in the state. OHS, in consultation with a technical team and advisory committees, will create a per annum rate-of-growth for health care spending. Once calculated, Connecticut will be the 5^th state to have a statewide cost growth benchmark.

Overall, Executive Order #5 requires OHS to complete the following initiatives:

Develop annual health care cost growth benchmarks by December 2020 for Calendar Years (CY) 2021-2025.

1. Set targets for increased primary care spending as a percentage of total health care expenditure to reach 10% by 2025.
2. Develop healthcare quality benchmarks across all public and private payers beginning in 2022, including clinical quality, over/under utilization, and patient safety measures.
3. Monitor and report annually on health care spending growth across public and private payers.
4. Monitor accountable care organizations and the adoption of alternative payment models.

OHS will carry out these initiatives with the support of a Technical Team as the key deliberating body and a Stakeholder Advisory Board. The Stakeholder Advisory Board will provide input to the Technical Team on developing the benchmarks and primary care targets.  OHS’s Quality Council will develop the quality benchmarks with DSS support. Other bodies, such as the OHS Consumer Advisory Council, Health Care Cabinet, Practice Transformation Task Force, MAPOC, and other stakeholders will be consulted and then feed into Stakeholder Advisory Board activities.

The Technical Team

The Technical Team includes experts who will directly engage with OHS, facilitated by consulting experts at Bailit Health, on the creation of the annual healthcare cost growth and quality benchmarks, and primary care spending targets. The team will receive input from the Stakeholder Advisory Board, also facilitated by Bailit Health, on most initiatives.

The Technical Team’s charge is to meet the following objectives per Executive Order #5:

1. Recommend annual cost growth benchmarks across all payers and populations for CYs 2021-2025 by maximizing work from Connecticut and other states, including best-in-class efforts and existing cost growth benchmarks, and then adapt approaches for CT.
2. Recommend primary care spending targets across all payers and populations as a share of total health care expenditures for CYs 2021-2025, to reach a target of 10% by 2025.
3. Prioritize health equity in recommendations.

The Stakeholder Advisory Board

The Stakeholder Advisory Board (SAB) members represent a cross section of the healthcare landscape, consumers, providers, employers, and health plan carriers, who will provide input and feedback to the Technical Team. The SAB’s mission is to advise OHS, the Technical Team (CGBTT), and consulting experts on the creation of the annual healthcare cost growth and quality benchmarks, and primary care spending targets.

The SAB will obtain additional input and feedback from other entities for the development of:

1. Annual cost growth benchmark across all payers and populations for CYs 2021-2025, ensuring the cost growth benchmark does not result in unintended consequences or exacerbate existing health inequities.
2. Primary care spending targets across all payers and populations as a share of total health care expenditures for CYs 2021-2025 to reach the target of 10% by 2025.
3. A strategy to use the state’s All Payer Claims Database (APCD) to analyze cost, and cost trends and growth drivers.
4. Annual quality benchmarks effective for CY22, and analysis of the impact of cost growth benchmarks and primary care targets on quality and equity.