States-Only Preconference: Paying the Price: How Can States Catalyze Real Cost Containment

Wednesday, Aug. 15, 2018
8 a.m. to 4 p.m.

Breakfast and lunch will be served during preconference sessions.

This preconference, for state officials only, drills deeply into the health care cost conundrum and explores strategies states can implement to stem the trajectory of rising costs.

A recent JAMA article reminds us, “It’s the prices stupid,” but what’s a state to do? States pay ever-increasing health care costs, including higher insurance premiums with more cost shifting and less choice for consumers. The number of uninsured is rising, there is less money for other social benefits such as investments in social determinants of health, and states face serious budget challenges. The trade-offs are significant — one person’s cost savings is another person’s salary (health care continues to be a powerful jobs engine), and savings for one payer can shift costs to others.

This session provides a safe space to tackle these vexing problems. With the help of expert faculty, we examine the current state of a health care marketplace driven by consolidation, innovation, and competing demands, including the need to balance costs against Wall Street expectations. What does the emergence of new partners like Walmart and Berkshire-Hathaway portend? What is our vision to address costs across sectors and payers? What strategies will get us there?

Are the current tools in state toolboxes, such as insurance regulation, state certificate-of-need laws, payment reform, rate regulation, licensure, public purchasing, and anti-competitive actions by state attorneys general, up to the task? Can states develop new, innovative tools to catalyze a multi-partner movement for real change? Instead of simply shifting costs, how can states take on the longstanding challenge of unaffordable prices?

This preconference is for state  officials including legislators and staff, executive branch officials, and attorneys general staff. The following experts, and others to be announced, will address each topic:

  • Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation
  • Erin Fuse Brown, associate professor of law at Georgia State University
  • Jamie King, University of California Hastings College of Law professor and executive editor of The Source on Healthcare Price & Competition
  • Ana Gupte, PhD, managing director and senior research analyst of health care services for Leerink Partners LLC

This preconference is supported, in part, by Kaiser Permanente

This preconference is open to state officials only.


In this facilitated discussion, state leaders will focus on multi-payer system approaches to address increasing spending on health care. Because there is a later state–only session on Rx pricing, we steer clear of more narrow Rx strategies and draw a bright distinction between affordability and health care costs.

We can subsidize health care to make it more affordable for more people — but that requires investing more money, not containing rising costs. This day-long session will examine evidence to unravel what’s behind the health care spending trajectory, identify strategies that are working to address it, and develop practical cost containment solutions that states can implement.

Welcome and Setting the Context: 8-9 a.m.

Trish Riley, NASHP Executive Director

Larry Levitt, Senior Vice President for Health Reform and Senior Advisor to the President of the Kaiser Family Foundation

  1. Cost drivers – what is the evidence?
  2. Emerging market forces – new entrants, consolidation, and new technologies
  3. Role of employers and insurance
  4. Trade-offs
    1. Jobs vs. cost containment
    2. Lower costs or shifting costs
    3. Consumer affordability may not mean lower costs
    4. Access/choice vs. lower costs

State kick-off discussion leader: Greg Moody, Director, Governor’s Office of Health Transformation, Ohio

Transparency and Data: 9-9:45 a.m.

Jaime King, JD, PhD, Associate Dean and Professor, UC Hastings School of Law, and Executive Editor, The Source on Healthcare Price and Competition

  1. What are the opportunities and limits of health care price transparency?
  2. All-payer claims databases (APCDs) vs. other data sources. Should more states expand them? Is there enough consistency in what they show? How can they be more effective? Are there better options to secure needed data?

State kick-off discussion leader: Karynlee Harrington, Executive Director, Maine Health Data Organization, and others to be announced

Break: 9:45-10 a.m.

Consolidation and Market Trends 10-11:45 a.m.

Erin Fuse Brown, JD, MPH, Associate Professor of Law, Center for Law and Health Policy, Georgia State University School of Law

  1. Effectiveness of anti-trust regulations
  2. Adequacy of certificates of need/Certificates of public advantage
  3. State licensing powers: can they be tools to address costs??

State kick-off discussion leader: Melanie Fontes Rainer, California Special Assistant to the Attorney General, and Nora Mann, Massachusetts Director of Determination of Need, Department of Public Health

Working Lunch: 11:45 a.m.-12:15 p.m.

Consolidation and Market Trends continued: 12:15-1:45 p.m.

  1. Do payment and delivery reforms lower cost growth? Does cost benchmarking help?
  2. Lessons from Medicaid: Is Medicaid buy-in a viable cost containment strategy? What have we learned from Delivery System Reform Incentive Payment (DSRIP)?
  3. Public purchasing – Can harnessing a state’s buying power lower cost growth?

State kick-off discussion leaders: MaryAnne Lindeblad, Washington Medicaid Director and Renee Walk, Strategic Policy Advisor, WI Dept. of Employee Trust Funds

Pricing Strategies: 1:45-3:15 p.m.

Larry Levitt, Kaiser Family Foundation Senior Vice President for Health Reform and Senior Advisor to the President

  1. Reference pricing
  2. Global budgets
  3. Rate-setting strategies
  4. Balance billing
  5. Insurance rate review

State kick-off discussion leader: Donna Kinzer, Executive Director, Maryland Health Services Cost Review Commission, and Dan Villa, Montana Budget Director

Next Steps 3:15-3:45 p.m.