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Performance of the Massachusetts Health Care System

Annual Report March 2022

Performance of the Massachusetts Health Care System

Annual Report March 2022

CENTER FOR HEALTH INFORMATION AND ANALYSIS

Table of Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Total Health Care Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Components of Total Health Care Expenditures, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Per Capita Total Health Care Expenditure Trends, 2013-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Private Commercial Insurance by Product Type, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Medicare Programs, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 MassHealth by Program Type, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Net Cost of Private Health Insurance by Market Sector, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Other Public Programs, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Total Health Care Expenditures by Service Category, 2019-2020: Gross of Prescription Drug Rebates . . . . . . . . . . . . . . . . .24 Total Health Care Expenditures by Service Category, 2019-2020: Net of Prescription Drug Rebates . . . . . . . . . . . . . . . . . .25 Change in Total Health Care Expenditures by Service Category, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Commercial Spending by Service Category, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 MassHealth Spending by Service Category, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Medicare Spending by Service Category, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Understanding the Methodology: 2022 Annual Report Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 Estimated Impact of Rebates on Pharmacy Spending and Growth, 2018-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Range of Payer-Reported Commercial Rebates as a Percentage of Gross Pharmacy Expenditures, 2018-2020 . . . . . . . . . . . .32 Total Health Care Expenditures Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Private and Public Insurance Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Enrollment in Private and Public Markets, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

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Annual Report on the Performance of the Massachusetts Health Care System | March 2022

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Table of Contents (continued)

Enrollment Trends: Private Commercial Market by Payer, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Enrollment Trends: MassHealth by Delivery System, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 MassHealth New Enrollments and Disenrollments, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Enrollment Trends: Medicare, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Provider and Health System Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total Acute Care Hospital Inpatient Discharges, October 2018 to September 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Acute Care Hospital Inpatient Discharges Related to COVID-19 by Payer Type, March 2020 to September 2021 . . . . . . . . . . . 43 Acute Care Hospital Inpatient Discharges Related to COVID-19 by Discharge Setting, March 2020 to September 2021 . . . . . . . .44 Emergency Department Treat-and-Release Visits, October 2018 to September 2021 . . . . . . . . . . . . . . . . . . . . . . . . . 45 Median Acute Hospital Change in Outpatient Visits from Prior Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 HFY 2016-2020 Total and Operating Margin Trends by Hospital Cohort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Hospital Operating Revenue and Expense Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 HFY 2020 Median Total Margin by Hospital Cohort, with and without COVID-19 Relief Funds . . . . . . . . . . . . . . . . . . . . .49 HFY 2016-2020 Hospital Health System Median Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Nursing Facility Utilization, by Payer Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Nursing Facility Occupancy Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Total Facilities, Total Beds, and Median Occupancy by County, 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Nursing Facility Median Total Margin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 Nursing Facility Total Revenue and Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 Provider and Health System Trends Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

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Annual Report on the Performance of the Massachusetts Health Care System | March 2022

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Table of Contents (continued)

Quality of Care in the Commonwealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Statewide Scores on Selected Clinical Quality Measures, 2018 and 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Patient-Reported Experience During Acute Hospital Admission, July-December 2020 . . . . . . . . . . . . . . . . . . . . . . . . .61 Primary Care Patient-Reported Experiences for Adults, 2018 & 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Primary Care Patient-Reported Experiences for Pediatrics, 2018 & 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 MassHealth Member Primary Care Patient-Reported Experiences for Adults, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . 64 MassHealth Member Primary Care Patient-Reported Experiences for Pediatrics, 2019 . . . . . . . . . . . . . . . . . . . . . . . . .65 Trends in Statewide All-Payer Adult Acute Hospital Readmission Rate, Discharges, and Readmissions, SFY 2011-2020 . . . . . . . 66 Rates of Maternity-Related Procedures Relative to Performance Targets, by Hospital, 2020 . . . . . . . . . . . . . . . . . . . . . .67 Hospital Adherence to the Leapfrog Standard for Safe Practices and Hand Hygiene, 2020 . . . . . . . . . . . . . . . . . . . . . . 68 Quality of Care in the Commonwealth Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Total Medical Expenses & Alternative Payment Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Change in Commercial HSA TME by Payer, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Change in Commercial Unadjusted TME by Payer, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Change in MassHealth MCO and ACO-A HSA TME by Payer, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Change in MassHealth MCO and ACO-A Unadjusted TME by Payer, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Change in Managing Physician Group Commercial HSA TME, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Change in Managing Physician Group Commercial Unadjusted TME, 2019-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Adoption of Alternative Payment Methods by Insurance Category, 2018-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 APM Adoption Trends by Commercial Payers, 2018-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Commercial Adoption of Alternative Payment Methods by Managing Physician Group, 2020 . . . . . . . . . . . . . . . . . . . . . 82 APM Adoption Trends by MassHealth MCOs and ACO-As, 2018-2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Total Medical Expenses & Alternative Payment Methods Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

CHIA center for health information and analysis

Annual Report on the Performance of the Massachusetts Health Care System | March 2022

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