Module 2: Public-Private Stakeholder Engagement

Effective stakeholder engagement and communications are critical to the cost growth target’s success. The factors driving health care cost growth are complex, and the impact of the target on affordability will occur over the long term, so explaining the benefits and progress of the target program requires clear and ongoing communications.

Likewise, earning and maintaining stakeholder buy-in amid inevitable changes in state administrations, the economy, and other circumstances demands consistent engagement. This section describes key communication activities that states need to undertake to gain and maintain momentum to implement cost growth targets.

Socialize the Concept of Health Care Cost Growth Targets

Well before obtaining any authority to establish the program, state leaders need to introduce members of the health care community to the concept of cost growth targets and reasons to implement one. In doing so, states need to make the case that rising health care costs harm governments, employers, and families and clearly delineate how targets can help address this issue. The following are key talking points that states could use to define the problem and make the case for a cost growth target:

• No person should have to choose between going to the doctor and putting food on the table for their family. Health care costs are eating into household budgets, leading many individuals and families to skip needed care and/or forgo other household necessities.
• High health care costs affect everyone. High deductibles, premiums, and out-of-pocket costs comprise a growing percentage of total household income, including for those with job-based health insurance.
• Rising health care costs stretch the budgets of the state government and state employers. As states spend more and more on health care, fewer dollars are left for other policy priorities like education and housing. Likewise, employers, especially small businesses, are burdened by health care costs, making it hard to stay competitive.
• COVID-19 expenses and high inflation reinforce the need to understand health care cost growth. The COVID-19 pandemic and high inflation have stressed state, employer, and household budgets, underscoring the need to understand statewide health care costs and address the drivers of unsustainable increases.
• Cost growth targets pave the way to identifying effective ways to reduce health care costs. Developing the capacity to track and benchmark spending across payers at the state level will promote a new understanding of health care costs. Analysis of spending data will pinpoint drivers of cost growth and enable states to devise specific strategies to contain costs.
• Target programs can measure and improve care for people of color and other marginalized groups. States can measure and address health inequities as part of their implementation process by prioritizing cost driver analyses that focus on variation in utilization and costs by population, and by ensuring that the governing and/or advisory bodies that develop related policy recommendations are representative of the state’s demographics.

Identify Goals for Stakeholder Engagement

States need to engage stakeholders regularly to educate them, increase buy-in, and garner support. States must conduct outreach with each key stakeholder group: state legislators, employers, health providers, payers, journalists, consumer advocates, and the public. Engagement of organized labor and local funders may also be important. Three goals for stakeholder engagement are:

• Ensure opportunities for feedback and guidance from affected stakeholders. This exchange will primarily occur through engagement with groups most directly impacted by the initiative, such as payers and provider organizations. A state’s program lead and dedicated staff should cultivate relationships with influencers in these groups to hear and respond to input and concerns.
• Foster necessary support to effect change. Outreach will likely include all stakeholders, but may especially emphasize contact with legislators, employers, organized labor, local funders, and consumer advocates who have a vested interest in affordable health care and can serve as major allies in advancing strategies to slow health care cost growth.
• Maintain clear communications on the value and role of target programs. Health care costs affect all state residents. Outreach should ensure a clear understanding of the target program’s goal of lowering health care costs for all constituencies.

Throughout the initiative, states should aim to build a culture of accountability in which all stakeholders are committed to transparency in health care costs and holding down cost growth. However, as states move further along in their implementation, the program priorities, and consequently the specific goals for stakeholder communication, will evolve. In the early stages, most of the communication should focus on obtaining buy-in and describing how targets can help advance affordability. As the initiative matures, stakeholder engagement should move toward actions the state and its partnering stakeholders can take to mitigate cost growth. States should also routinely assess any changes in the environment or new opportunities that may require a shift in focus and revision of goals for stakeholder engagement.

Develop a Strategic Communications Plan

To prioritize communications in the implementation process, a dedicated member of the target program team should work regularly with communications staff, if available, to ensure the state conveys the value and progress of the program in a consistent and understandable way. In the absence of dedicated communications staff, the state lead should assign staff communications responsibilities, such as working with appropriate department staff on a website or web page and creating fact sheets or Q&A documents based on examples provided in the resources section below.

States should develop a communications plan as a roadmap for informing and engaging stakeholders. The communications plan should detail:

• Communications goals that are derived from the program goals. If a state is pursuing a target program to promote health care affordability, for example, a communications goal might include sharing data demonstrating that health care costs are currently rising at an unsustainable rate, making health care less affordable for individuals, employers, and the state. Another goal might be promoting an understanding of the steps involved in the target-setting and implementation process to generate buy-in for the approach among stakeholders.
• Target audiences who need to know about the program, such as state officials, legislators, and members of stakeholder groups directly involved in the cost growth work; the broader group of stakeholders, such as insurers, health providers, employers, and patient advocates; and the public at large.
• Key messages that emphasize the capacity to address core health care cost challenges. These should include broad, overarching messages on the importance and relevance of the target to key state priorities, but should also be customized to emphasize the target’s value proposition to each audience group.

• Tactics that state staff will employ to share key messages, including conducting outreach to media to share announcements or new reports, engaging with stakeholders, and hosting informational events. Staff should develop content that covers topics in varying levels of detail — from accessible fact sheets to detailed reports or data dashboards. Staff should also make the content available via a range of platforms and approaches, such as a dedicated website, social media channels, and/or an annual public hearing.
• A timeline of releases and events, which states should update every six months based on key events such as report releases and public meetings.

Conduct Repeated Outreach Using Strategic Messaging

Continued stakeholder engagement is necessary to maintain momentum and sustain the program. In addition to obtaining stakeholder input on the policy development, states should conduct regular outreach that includes strategic messaging about what is driving health care cost growth. Opportunities to communicate about the program include:

• Creation of the new governing structure and/or governing board and committees
• Identification of the target value
• Publication of annual performance reports as well as cost driver analyses
• Similar activities in other states, or the release of national publications that underscore the need to address affordability and/or support the target program’s approach
• Consumer health care affordability survey results
• Accountability actions, such as issuance of a performance improvement plan or penalty

Approaches to ongoing communication should include:

• Dedicated website: States should maintain a website that describes the program and how it can address the issue of affordability. The site should include board or advisory committee meeting materials and recordings and other documents related to program implementation.
• Public meetings of state boards and committees: At a minimum, states need to report performance annually to the program’s governing body, which will review the state’s performance and associated analyses and explain the findings via public meetings. Streaming public meetings, as well as posting and distributing recordings and summaries of meetings, will improve program visibility.
• Public hearings: Some states have created public hearings on target performance and mitigation strategies. In Massachusetts, the Health Policy Commission (HPC) holds a two-day annual forum where payers and providers testify under oath and answer questions from members of the HPC’s governing board and state officials. Members of the public are invited to share stories on their challenges with the cost of health care in the state.
• Invitation-only forums and private meetings of associations: The state should present about the target and related analyses on affordability and cost growth in the state at forums or meetings held for other purposes, such as legislative briefings, state interagency meetings, and meetings of the state’s hospital association, medical association, and consumer advocacy associations.
• Media mentions and op-eds: Media outreach is an effective way to reach a broader audience, and the state should cultivate relationships with local reporters who cover health care affordability. The state should also consider opportunities, such as program milestones reached or current events tied to health care affordability, to draft op-eds in collaboration with target program stakeholders.
• Newsletters, blog posts, videos, and social media posts: The state can leverage these tools to share information about program developments and bring attention to health care affordability and the need to address cost growth.

At each opportunity, states should highlight the problem of health care affordability and describe what it means for families, employers, and the state. States should also consider building a coalition of supporters who can engage public officials, and develop talking points that can be used to discuss issues publicly or privately.

In addition, because meaningful action to address drivers of cost growth is the most challenging part of a target program, the communications strategy should repeatedly and effectively elevate the key cost drivers that the cost growth mitigation strategy will address in the future. This cost-driver messaging should be done early, long before the development of the cost mitigation strategy.

Through repeated strategic messaging about what is driving health care cost growth, states can set the stage for future policy action. For example, Connecticut was able to pass legislation to codify its target program by gaining support via extensive outreach. The Connecticut Office of Health Strategy (OHS) held regular meetings and briefings with legislators on issues around affordability and how the target program was working to address them. The OHS also developed relationships with stakeholders most closely aligned with the target program’s goals, including members of the business community, and worked with them to garner support.

Resources

Communications Toolkit

The Peterson-Milbank Program for Sustainable Health Care Costs communications toolkit helps state policymakers develop a local communications plan to share the value of and progress within a state’s cost growth target initiative.

Information on Health Care Costs’ Impacts on Individuals and Families

• Altarum’s Consumer Healthcare Experience State Survey (CHESS) Briefs provides consumers’ views on a wide range of health system concerns (e.g., confidence using the health system) in several states.
• Families USA’s report Bleeding Americans Dry highlights big hospital corporations’ role in making health care unaffordable.
• Families USA’s report Our Health Care System Has Lost Its Way highlights the problem of unaffordable and low-quality care in the United States.
• The monthly Peterson-Milbank Program for Sustainable Health Care Costs Newsletter features the latest research and analysis relevant to health care cost transparency and accountability.
• The Manatt State Cost Containment Update, a digital publication produced with support from the Robert Wood Johnson Foundation and in collaboration with the Peterson-Milbank Program for Sustainable Health Care Costs, features news on data-driven state activity on cost containment. The resourced page also includes related publication and webinar recordings.
• The Peterson-KFF Health System Tracker provides clear, up-to-date information on US health care cost trends, drivers, and issues — and shows how the US is performing relative to other countries.

Examples of Communications Content

• Press releases announcing new developments, such as establishment of an implementation committee, setting of target value, releases of target or cost driver reports, and announcements of the deployment of enforcement mechanisms.
  • Oregon Passes Bipartisan Legislation to Slow Rising Cost of Health Care and Increase Transparency for Consumers
  • HPC Finds Mass General Brigham Cost Trends and Expansions Threaten State Health Care Affordability Efforts
• Explainers such as accessible infographics, fact sheets, FAQs, or videos that explain the program or share topline findings from target performance or cost driver reports, ideally using a combination of graphics and text.
  • Key Components of Nevada’s Health Care Cost Growth Benchmark
  • New Jersey Health Care Affordability, Responsibility, and Transparency (HART) Program Blueprint
  • Washington State Health Care Transparency Board FAQ
  • HPC Short: Out-of-Pocket Spending for Birth Care
• Reports featuring baseline data, performance against the target, or analysis of cost drivers.
  • Health Care Cost Trends: State and Market-Level Cost Growth in Oregon, 2013–2019
• Blogs or op-eds from a state official or committee member making the case for targets to help raise the program’s profile.
  • How Connecticut Is Moving to Control Health Care Costs

Examples of Dissemination Approaches

• Websites ideally include a home page with overview text and sections for meeting materials, information for data submitters, and reports and explainers.
  • Oregon Health Authority’s Sustainable Health Care Cost Growth Target
• Social media includes YouTube, LinkedIn, and other social media accounts for posting videos of events or key findings from explainers and reports.
  • Massachusetts Health Policy Commission on Twitter
• Events include in-person or virtual briefings/forums targeting specific audiences, such as legislators, employers, or public advocates, or a public hearing that aims to draw media attention and involve a range of stakeholders. Videos and slides can be posted.
• Rhode Island Health Care Cost Trends Project 2020 Cost Growth Target Performance
• Connecticut Office of Health Strategy Virtual Forum on the Health Care Cost Growth Benchmark
• New Jersey Informational Webinar for Hospital and Provider Stakeholders