The State of Play: Cost Growth Benchmarking Programs (as of February 1, 2022)
Detailed State Updates as of February 1, 2022
| State |
Update |
Detail |
| CA |
Legislative |
California’s 2022-2023 proposed state budget proposes to allocate $30 million for a new Office of Health Care Affordability. The legislature is expected to re-introduce benchmarking legislation (AB 1130) this year. |
| CT |
Benchmarking Program |
In November 2021, Connecticut appointed Sumit Sajnani to serve as Health Information Technology Officer within the Office of Health Strategy (OHS). OHS presented pre-benchmark cost growth trend data for 2018-2019 at its January 24th meeting. All OHS Health Benchmark Initiative (HBI) Meeting Materials are available here. |
| DE |
Legislative |
In October 2021, Delaware Governor John Carney signed Senate Bill No. 120 into law, requiring insurers to spend a defined percentage of their total health care spend on primary care and preventive health services, such as annual check-ups and management of chronic care. In 2022, carriers will be required to spend at least 7 percent of their total cost of medical care on primary care, followed by 8.5 percent in 2023; 10 percent in 2024; and 11.5 percent in 2025. |
| IN |
Other Activity |
In January 2022, Indiana state leaders have distributed letters to health care industry leaders in the state giving them until April 1 to propose and implement specific measures to bring Indiana hospital prices down to “at least the national average” by 2025. If the industry is unable to provide a viable plan for doing so by April 1st, the legislature promises to pursue legislation to statutorily reduce prices through to-be-determined methods. |
| MA |
Benchmarking Program |
During the Massachusetts HPC January 2022 Board Meeting, the HPC Board announced it has voted to require a Performance Improvement Plan (PIP) from Mass General Brigham (MGB), finding that the systems’ spending performance “raises significant concerns” and has likely already impacted the state’s ability to meet the health care cost growth benchmark. Within 45 days of receiving the PIP notice, MGB will be required to file either: a PIP proposal; a request for a waiver; or, a request for an extension. MGH will be subject to ongoing monitoring by the HPC during the 18-month implementation process, and if needed, a fine of up to $500,000 may be assessed as a last resort. |
| ME |
Other Activity |
In July 2021, Maine established a new Office of Affordable Health Care with the passage of LD 120. Duties of the new Office include:
- Analyzing health care cost growth trends and correlation to the quality of health care;
- Monitoring the adoption of alternative payment methods in this State and other states that foster innovative health care delivery and payment models to reduce health care cost growth and improve the quality of health care;
- Developing proposals for consideration by the legislative oversight committee on potential methods to improve consumer experience with the health care system, including the provision of a consumer advocacy function on health care matters not addressed by the Health Insurance Consumer Assistance Program.
Maine is seeking an Executive Director for the new Office. |
| NJ |
Legislative |
In December 2021, Governor Phil Murphy signed an Executive Order officially launching the New Jersey Health Care Cost Growth Benchmark Program. The program launch is bolstered by a stakeholder compact organized by the Murphy Administration consisting of advocacy groups, hospitals and health care providers, insurers, a union, employers and other stakeholders across New Jersey. The compact reflects a shared goal for stakeholders and the State to work toward constraining the growth of health care costs over time.
The state’s benchmark targets are built from a 75%/25% blend of forecasted median income and potential gross state product (PGSP). The benchmark target will be implemented for 2023-2027, starting at 3.5% and gradually declining to 2.8% in 2027, following an initial “transition” year for reporting in 2022, in which providers and payers would begin reporting data to the state without accountability measures in place. More information on the state’s benchmarking program is available here. |
| NV |
Legislative |
In December 2021, Governor Sisolak issued an Executive Order establishing a benchmark for health care cost growth beginning in 2022. The cost growth targets are generated from a blend of median wage and gross state product each year, resulting the following targets:
- 3.19% for 2022
- 2.98% for 2023
- 2.78% for 2024
- 2.58% for 2025
- 2.37% for 2026
The Patient Protection Commission will work with the Division of Insurance, the State Based Health Exchange and the Department of Health and Human Services to monitor progress to ensure that payors and providers are meeting these goals. |
| OR |
Benchmarking Program |
The Oregon Health Authority (OHA) is transitioning governance of the Cost Growth Target program to the Advisory Committee beginning in 2022, which will oversee ongoing program implementation processes established by the previous Implementation Committee. The Advisory Committee will include industry representatives; non-industry representatives; ex-officio members; and subject matter experts in health care financing, administration, economics, and equity.
In early 2022, OHA intends to publish state and market level trends data from CY 2018 and 2019 using payer-submitted benchmarking data, once data validation is complete. This will be the first public report released by OHA using data collected by the state’s Cost Growth Target program.
More information on the state’s Cost Growth Target Program activities and working program timeline is available here. |
| RI |
Benchmarking Program |
In November 2021, Rhode Island became the sixth state to join the Peterson-Milbank Program for Sustainable Health Care Costs. In an interview with Milbank Memorial Fund, Rhode Island Insurance Commissioner Patrick Tigue discusses Rhode Island’s progress on cost containment and next steps for the program. |
| UT |
Other Activity |
In November 2021, Utah Governor Cox announced the formation of the Utah Sustainable Health Collaborative, which will be focused on reducing health care costs and improving health outcomes for Utahns. In a December 2021 interview, Rich Saunders, chief innovation officer and senior advisor to Gov. Spencer Cox, discusses the purpose, partners, and future plans for the Utah Sustainable Health Collaborative. |
| VT |
Other Activity |
Vermont’s Joint Task Force on Affordable, Accessible Health Care is examining a number of policy considerations to improve consumer affordability of health care, including a cost growth benchmark as an option for future legislative action |
| WA |
Benchmarking Program |
As of mid-November 2021, the Washington Health Care Cost Transparency Board was actively discussing:
- Risk adjustment for determining benchmark performance at the carrier and provider levels (raised Massachusetts and Rhode Island’s experiences with rising risk scores)
- Patient attribution to clinicians and organizing clinicians into large provider entities
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