By: Julie Myers, Esq.
In August 2012, Governor Patrick signed into law the third wave of health care reform in the Commonwealth, Chapter 224 of the Acts of 2012: “An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation” (“Chapter 224”). A major provision of Chapter 224 was the creation of the Health Policy Commission (“HPC”), an independent state agency charged with setting and enforcing the health care cost growth benchmark, certifying new payment methods and care delivery models and improving access to affordable and quality healthcare.
Over the last thirteen months, the HPC has made significant strides in its implementation of Chapter 224. In addition to holding almost 40 public commission, committee or advisory council meetings, the HPC has published a report on consumer-driven health plans, issued guidance on the prohibition of mandatory nurse overtime, initiated the first cost trend analysis using the All Payer Claims Database, and developed a community hospital grant program. This past October, the HPC held its first annual health care cost trends hearing, a two day event focused on the public examination of health care costs, and in December 2013 the HPC issued its first cost and market impact review report.
Lois Johnson has served as General Counsel to the HPC since its inception. Through the efforts of Ms. Johnson and the team of talented people comprising the HPC, Chapter 224 will continue its successful rollout and help the Commonwealth meet its cost containment and quality improvement goals, as well as position Massachusetts as a national leader in innovative health care policy. Ms. Johnson was able to take time and discuss her career as well as her achievements working on behalf of the Commonwealth during this dynamic time in health law and policy.
Lois, could you give a brief description of your career path? Did you intend to focus on healthcare when you decided to go into the legal profession?
Sure. I can say that I definitely did not begin my legal career with a particular goal to get into health policy. After law school, I went to work for a big firm where I practiced labor and employment law. Then, I took a bit of a detour and got a fellowship at the Georgetown Women’s Law and Public Policy Program where I worked at the Women’s Legal Defense Fund and focused on issues affecting women workers. It was the era of Clinton health reform, and so one of the projects I worked on was analyzing the effect of various proposals and legislative drafts on women workers. From there, I practiced labor and employment law for a number of years representing individual and organized employees including those working at health care facilities such as hospitals or nursing homes. After that, I went to work at the Massachusetts State House as Counsel for the Senate Ways and Means Committee where our committee was charged with writing the state budget and reviewing major pieces of policy legislation. You can’t work on the state budget without dealing with health care issues because it represents such a significant portion of our state spending.
What were the major issues in health care when you were working on the state budget?
While working on the state budget, I focused on long term care, in particular the direct-care workforce, the people who are caring for our loved ones and provide daily living services and support to persons with disabilities and chronic care needs in facilities and in the community. I also worked to develop career ladders and programs to both improve the quality of the care and the status of those workers. During my time at the Senate Ways and Means Committee I developed an understanding of and interest in state government. After my time at the State House, I was thrilled to then work for Attorney General Martha Coakley in the Health Care Division at the Office of the Attorney General (“AGO”). It was there that I developed most of my knowledge of the current state of health care policy in Massachusetts and really began to learn about health care financing and the industry itself from both providers and insurers.
You were on the forefront of the AGO’s cost containment efforts, correct?
Working at the AGO was an incredible opportunity to develop my knowledge and be a part of health policy development in Massachusetts. One of the things I am most proud of was being a part of the AGO’s cost trends work and contributing to the series of legislative efforts since Chapter 58 of the Acts of 2006 focusing on health care cost containment.
Let’s talk more about your work at the AGO and your transition to working under Chapter 224 at the HPC?
So, for example, following Chapter 305 of the Acts of 2008 (“Chapter 305”), in which the Attorney General was authorized to perform cost trends examinations and obtain information from payers and providers, I worked on that effort for the first three reports. It was very exciting and a great opportunity to be part of a team of excellent attorneys. I also worked on the legislative effort for Chapter 288 of the Acts of 2010 (“Chapter 288”) and then Chapter 224. At the HPC, I am able to put those efforts into action.
Can you discuss the evolution of these particular statutes?
Chapter 305 was the beginning of a series of statutes to improve transparency in our State’s health care system. It inaugurated the annual cost trends hearings and gave the Attorney General authority to conduct and participate in those hearings and perform cost trends examinations. It really initiated a watershed of transparency. Through that first cost trends report, we identified the key metrics of health care costs and measures of efficiency — relative prices and total medical expenses — which were later codified in Chapter 288 and are now publicly reported routinely to our sister agency Centers for Health and Information Analysis. Thereafter, Chapter 224 builds from Chapter 288 with a more comprehensive look at the framework for promoting value in health care as well as greater transparency to contain costs and improve quality overall.
The broad construct of Chapter 224 is to set a state-wide bench mark for health care cost growth. To monitor this benchmark, Chapter 224 created the HPC as an independent agency to monitor performance under that benchmark through public hearings and dialogue between providers, insurers, consumers and government. Chapter 224 also sets up a number of ways in which we can try to meet that benchmark and evaluate performance, for example, encouraging alternative payment methods and alternative delivery system models like ACOs and patient centered medical homes, programs to invest in community hospitals and cost and market impact reviews.
How does it feel to work for such a young agency on new legislation? Is it exciting, daunting?
It’s incredibly exciting and challenging. At the beginning there were four of us, and now we have over 25 employees. It’s fun, but it comes with its challenges. There are specific responsibilities and expectations; my role involves compliance, procurement, developing policies for employees and making sure that we are operating consistent with applicable laws. Then there’s the policy and regulatory development and trying to fulfill our statutory responsibilities under Chapter 224. I’m learning something new and challenging myself every day.
Could you speak more about who exactly comprise the HPC? Are there other attorneys, data analyst folks, policy people, etc.?
Right now, our Legal Division is three attorneys. But we also have individuals using their legal expertise and other skills across the organization. Across the HPC we have policy directors that are charged with different responsibilities. There is a Market Performance team, a Care Delivery and Quality Improvement team, a System Performance and Strategic Investment team, a Cost Trends team, and a Data and Analysis team. We also have the Office of Patient Protection, as well as Operations/Administration and Finance. The thing that’s unique about the HPC is our governance structure. Our staff reports to the Executive Director, who is hired by an 11-member unpaid board composed of public and private sector experts appointed by the State Auditor, the Attorney General and the Governor.
What are you looking forward to working on in your capacity at the HPC?
I think that Chapter 224 is a tremendous opportunity. It is an experiment, which is really what I find exciting about health policy work in Massachusetts. I’m looking forward to what we can accomplish with enhanced transparency and the rigor of our data analysis and examination in any number of ways — our annual cost trends hearings, our cost trend report as well the cost and market impact reports.
Is there anything you would like to add regarding your career, your experience at the HPC or your perspective on health law and policy today in the Commonwealth?
I feel like I have had some tremendous opportunities to work in this laboratory of Massachusetts and am thrilled to be able to continue to do that.
Julie Myers, Esq. is a legal analyst and mediator in the Health Care Division of the Massachusetts Office of the Attorney General where she currently focuses on the Office’s mental health parity initiatives and mediating consumer complaints. Julie is a recent graduate of Northeastern University School of Law and Tufts University School of Medicine earning her JD and Masters in Public Health.