By Tiffany Williams –
BOSTON — Governor Maura Healey on Monday unveiled a series of recommendations aimed at lowering health care costs across Massachusetts, announcing new steps to reduce expenses for patients, families, employers and providers while directing MassHealth to increase its investment in primary care.
The recommendations, developed by the Governor’s Health Care Affordability Working Group over the past six months, target some of the largest drivers of health care spending, including prescription drug prices, out-of-network charges, workforce shortages, administrative costs, barriers to primary care and preventable hospitalizations. The administration said it will begin implementing several of the recommendations in the coming weeks and months.
Strengthening Primary Care
Governor Healey announced that she has signed an Executive Order directing MassHealth to increase its investments in primary care to 12 percent of total medical spending by the end of 2028.
The administration also voiced strong support for the Legislature’s efforts to advance primary care reform legislation aimed at expanding access, improving care coordination and strengthening the primary care workforce.
Working Group Releases 12 Recommendations
Governor Healey convened the Health Care Affordability Working Group in January to identify practical strategies to reduce health care costs while maintaining the Commonwealth’s standard of care.
The group was co-chaired by former Health and Human Services Secretary Kate Walsh and Citizens Massachusetts President Lisa Murray and included representatives from government, hospitals, insurers, employers, labor organizations, patient advocacy groups and academia.
After six months of work, the group issued 12 recommendations organized around five priority areas designed to improve affordability while maintaining access to care.
Reducing Costs for Patients and Businesses
Among the recommendations is a proposal to reduce out-of-network costs that can leave patients with unexpectedly higher medical bills.
Governor Healey is directing the Division of Insurance to establish default out-of-network payment rates. The administration said the agency will conduct listening sessions before developing new regulations.
The recommendations also call for evaluating new strategies to stabilize the health insurance market by strengthening competition and helping reduce premium costs for individuals and small businesses.
Expanding Access to Care
The working group also recommended expanding innovative health care models that allow certain hospital-level services to be delivered safely at home or in community settings.
Additional recommendations focus on improving transitions of care for patients leaving hospitals, reducing unnecessary delays in hospital discharges and identifying low-value tests and procedures that increase costs without improving patient outcomes.
The Health Policy Commission will oversee a clinical expert committee that will identify low-value services and develop accountability measures and payment incentives designed to reduce unnecessary care.
Addressing Workforce Challenges
The recommendations include investments aimed at expanding the health care workforce by increasing nursing faculty recruitment and retention, supporting nursing education and growing the pipeline of primary care providers, behavioral health professionals, long-term care staff and community health workers.
The Healey-Driscoll Administration said it is evaluating additional approaches, including scholarships and loan forgiveness programs, to encourage more nurses to become and remain nursing faculty.
Lowering Prescription Drug Costs
The report identifies prescription drug prices as one of the fastest-growing health care expenses.
Under the recommendations, the Executive Office of Health and Human Services, the Massachusetts Health Connector, the Group Insurance Commission and the Health Policy Commission will work together to develop a coordinated purchasing strategy intended to leverage the state’s buying power to reduce prescription drug costs and improve access to medications.
Using Technology to Improve Care
The working group also recommended improving health information sharing among hospitals, physicians and insurers to reduce paperwork and improve coordination of care.
It further supports responsible use of artificial intelligence in health care while recommending clear standards governing how AI is used in claims review, coding and coverage decisions to ensure transparency, accountability and patient protections.
Administration Plans Additional Action
The Healey-Driscoll Administration said the working group will continue collaborating through the end of the year as additional recommendations are finalized.
Monday’s announcement builds on previous actions by the administration aimed at improving health care affordability, including capping certain co-pays and deductibles, eliminating prior authorization requirements for several routine and essential medical services, investing state funding to help residents maintain health insurance coverage and moving to prohibit medical debt from being reported to credit agencies.