Commissioning Change: How Four States Use Advisory Boards to Contain Health Spending

Glenn Melnick, Blue Cross of California Chair in Health Care Finance and professor of public policy at the University of Southern California
Susan Maerki, Independent Health Consultant


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Rapidly growing health care expenditures have long challenged state policymakers in California. From 2003 through 2018, total health care-related spending for a family with employer-sponsored insurance cumulatively increased by 142%, while median household income in California grew 43%. Over the last 10 years, state budget expenditures on health and human services grew by 96%, while spending on all other non-health programs increased by 59%.

Controlling the growth of health care spending is central to any state effort to achieve universal coverage and to bring relief to consumers struggling with premiums and out-of-pocket costs. As California pursues these goals, it can learn from several states that have established state commissions to measure, monitor, and set targets to control health care cost increases.

This paper looks at four states — Maryland, Massachusetts, Oregon, and Rhode Island — that each have well-developed regulatory bodies or independent authorities aimed at controlling growth in health spending. No single blueprint exists for these state health care spending commissions. Each state has taken its own path, however, a closer look at these models offers valuable lessons for California and other states looking to emulate their successes and plan for the inevitable trade-offs.

About the Authors

Glenn Melnick, PhD, is Blue Cross of California Chair in Healthcare Finance and professor of public policy at the University of Southern California. Susan Maerki, MHSA, MAE, is an independent health consultant and former director and health policy specialist at PwC.