Hartford Business Journal

28 HARTFORDBUSINESS.COM | MARCH 20, 2023 FOCUS: HEALTH CARE Hospital expenses last fiscal year were $3.5 billion higher than pre-pandemic levels, according to the Connecticut Hospital Association (CHA), primarily due to supply, drug, and labor cost increases. Lamont's proposals attempt to pull several cost-control levers, Gifford said, by eliminating hospital facility fees charged at free-standing offices and clinics, and capping out-of-net- work costs for inpatient and outpa- tient hospital services to 100% of the Medicare rate for the same service in the same geographic area. The proposals also outlaw certain hospital contracting practices that Gifford said limit competition and have become more prevalent amid industry consolidation. That includes anti-steering clauses — which prohibit insurers from using incentives to steer patients to higher-value providers — and all-or- nothing clauses that require health plans to accept all providers in a healthcare system, or none at all. The proposals would also ban health systems from inserting anti-tiering clauses into commercial contracts. Insurers for years have been pushing tiered networks that essen- tially rank hospitals and doctors by cost and quality metrics and incen- tivize consumers to visit providers offering the best bang for their buck. Providers, in the past, have raised concerns about how those networks are determined. Lamont also wants Connecticut to join a multistate bulk purchasing consortium to negotiate prescription drug discounts, and create more transparency around prescrip- tion drugs experiencing major price spikes. "Our goal is to work with the healthcare community and stake- holders to address the high costs of health care and, yes, to make sure we have access and equity in our healthcare system," Gifford said. Insurers vs. hospitals There's split opinion on Lamont's proposals. Providers — including hospitals and physicians — oppose some of the measures, arguing they would create potentially billions of dollars in commercial revenue losses at a time when health systems are already facing financial headwinds. Conversely, health insurers and some consumer advocates are onboard, forming a rare alliance in favor of Lamont's proposals. They argue that prohibiting anti- steering and anti-tiering clauses would make it easier to align financial incentives with care cost and quality metrics — essentially awarding the best care at the lowest cost. "As Connecticut's market becomes more and more concentrated under just a few umbrella health systems, appropriate safeguards are warranted to assure no one party is unduly advantaged over another," the Connecticut Association of Health Plans wrote in testimony supporting Lamont's bills. Some Democrats — including Sen. Saud Anwar (D-South Windsor), a practicing physician and co-chair of the Public Health Committee — raised concerns about Lamont's proposals during a recent public hearing and questioned who they would benefit, noting consumers need to be the beneficia- ries of reduced costs. "If this bill is just going to make the insurance industry richer, I'm not going to be able to even look at this very seriously myself," Anwar said, according to the CT Mirror. Paul Kidwell, senior vice presi- dent for policy at the Connecticut Hospital Association, argues Lamont's proposals would favor health insurers over hospitals in commercial contract negotiations. Of particular concern is the cap on out-of-network payments for hospital services, he said. That would cause hospitals to lose billions in commercial revenue, even as the government continues to underpay caregivers for services provided to Medicare and Medicaid patients. In its recent financial report, the CHA said Connecticut hospitals in fiscal 2022 lost a combined $2.1 billion from the government-funded Medicare and Medicaid programs. Government underpayment, he said, shifts costs to employers and individuals with commercial insur- ance, resulting in rising premiums and out-of-pocket costs for those patients. Medicaid, which is funded by both the federal and state government, needs to increase its payment rates for hospital care to address those concerns, Kidwell said. Banning contracting practices like all-or-nothing clauses can also negatively impact patients by limiting or restricting access to certain care locations within a health system, Kidwell said. "What the proposal really does is shift the leverage to the health insurance companies," said Kidwell, whose association in testimony has pointed out that the four national health insurers operating in Connecticut made between $4.1 billion and $20.1 billion in profits last year. Despite those disagreements, Kidwell said CHA does have areas of agreement with the Lamont administration, including on greater investment in workforce develop- ment to help fill nursing and other healthcare position shortages. cbre.com www.cbre.com/hartford Suites from ±625-3,600 SF 100 Allyn Street | Hartford, CT New Ownership!! Under new Ownership, 100 Allyn Street is an excellent choice for tenants seeking boutique, urban office space with a convenient CBD location. Current space opportunities include a 625 SF suite on the second floor and a 3,600 SF suite on the third floor, ideal for small to medium-sized tenants. Storage space is also available. 100 Allyn Street is located directly across from the XL Center Coliseum, with parking available in the immediately adjacent lot on Allyn Street. Retail amenities include Agave Cantina Bar & Grill and Aladdin's Pizzeria. Come see what this unique building has to offer!

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